(1) To be eligible
for a subsidy, a child must not be insured by a comparable health plan through an
employer.
(2) If one child from a family is enrolled in the plan, all children must be
enrolled, unless the other children have alternative health insurance coverage.
(3) The department may establish procedures such that children with family
incomes that exceed the percent of the federal poverty guidelines specified in
section 25.5-8-103 (4)(a) may enroll in the plan, but are not eligible for subsidies
from the department.
(4) A child whose family income does not exceed the applicable level
specified in section 25.5-8-103 (4)(a) shall be presumptively eligible for the plan.
Children who are determined to be eligible for the plan shall remain eligible for
twelve months subsequent to the last day of the month in which they were enrolled;
except that a child shall no longer be eligible for the plan and shall be disenrolled
from the plan if the department becomes aware of or is notified that any of the
following has occurred:
(a) The child has moved out of the state; or
(b) Repealed.
(c) The child has been enrolled in a commercial health insurance plan during
the twelve-month period following enrollment in the plan under this article.
(4.5) (a) (I) To the extent authorized by federal law, the department shall
require an applicant to state only the applicant's family income and shall notify the
applicant that the applicant's family income will be verified by federally approved
electronic data sources. The department shall allow an applicant to provide income
information more recent than the records of the federally approved electronic data
sources.
(II) The department shall annually verify the member's income eligibility at
reenrollment through federally approved electronic data sources. If a member
meets all eligibility requirements, a member remains enrolled in the plan. The
department shall also allow a member to provide income information more recent
than the records of federally approved electronic data sources.
(III) If the state department determines that a member was not eligible for
medical benefits solely based upon the member's income after the member had
been determined to be eligible based upon information verified through federally
approved electronic data sources, the state department shall not pursue recovery
from a county department for the cost of medical services provided to the member,
and the county department is not responsible for any federal error rate sanctions
resulting from the determination.
(IV) Notwithstanding any other provision in this paragraph (a), for
applications that contain self-employment income, the state department shall not
implement this paragraph (a) until it can verify self-employment income through
federally approved electronic data sources as authorized by rules of the state
department and federal law.
(V) The county department, state department, or other entity designated by
the state department to make the eligibility determination shall automatically
transfer to the state insurance marketplace through a system interface the
application data and verifications of a child or pregnant woman who is determined
ineligible for medical assistance benefits pursuant to this section.
(VI) The state department may seek federal authorization to not require
additional verification during a member's eligibility reenrollment process if
information about the member's income is not verified through a federally approved
electronic data source. The state department may use the information on file or the
information that was originally collected during the application process to
determine whether the member is eligible for reenrollment. Notwithstanding this
subsection (4.5)(a)(VI) to the contrary, the state department shall require additional
income verification if information about a member's income is not verified through a
federally approved electronic data source for two or more consecutive years or as
specified through federal authorization.
(VII) The state department may seek federal authorization to not require
additional verification during a member's eligibility reenrollment process if
information about the member's assets is not verified through a federally approved
electronic data source in a reasonable time, as determined by the state department.
The state department may complete the member's eligibility reenrollment process
without any additional verification of the member's assets if there has been no
change in the member's assets since the initial verification during the application
process or as specified through federal authorization.
(VIII) The state department may seek federal authorization to delay a
member's procedural termination during the reenrollment process to allow the
member to continue receiving necessary services during the reenrollment process.
The state department may apply this delay in procedural termination to a specific
population or as specified through federal authorization.
(IX) The state department may seek federal authorization to allow an
applicant's or member's eligibility for reenrollment to be based on financial findings
from the supplemental nutrition assistance program established pursuant to part 3
of article 2 of title 26, the temporary assistance for needy families program
established pursuant to part 7 of article 2 of title 26, and other means-tested
benefit programs administered through the Colorado benefits management system.
The state department may apply financial eligibility for medicaid to individuals
whose gross income program and assets for applicable means-tested benefit
programs are below applicable medicaid limits, regardless of differences in
household composition and income-counting rules between programs or as
specified through federal authorization.
(X) Subject to available appropriations and upon receiving necessary federal
authorization, the state department may implement subsections (4.5)(a)(VI),
(4.5)(a)(VII), (4.5)(a)(VIII), and (4.5)(a)(IX) of this section.
(b) Repealed.
(c) Subject to the provisions and requirements of section 25.5-4-205 (3)(e),
the department shall establish a process so that an enrollee or the parent or
guardian of an enrollee may apply for reenrollment either over the telephone or
through the internet.
(5) (a) (I) A pregnant woman whose family income does not exceed the
applicable level specified in section 25.5-8-103 (4)(b) shall be presumptively
eligible for the plan. Once determined eligible for the plan, a pregnant woman shall
be considered to be continuously eligible throughout the pregnancy and for the
sixty days following the pregnancy, even if the woman's eligibility would otherwise
terminate during such period due to an increase in income. Upon birth, a child born
to a woman eligible for the plan shall be eligible for the plan and shall be
automatically enrolled in the plan in accordance with the eligibility requirements
for children specified in subsection (4) of this section.
(II) Repealed.
(b) (I) Under the plan, prenatal and postpartum primary health-care providers
shall implement policies regarding the integration of evidence-based tobacco use
treatments into the regular health-care delivery system, including, but not limited
to:
(A) Assessment of tobacco use and exposure to second-hand smoke;
(B) Education on the dangers of tobacco use during pregnancy and
postpartum;
(C) Referrals to appropriate cessation services.
(II) Health-care providers may coordinate the implementation of such
policies with the tobacco education, prevention, and cessation programs
established in section 25-3.5-804, C.R.S.
(c) The addition of coverage under the plan for pregnant women shall only be
implemented if the department obtains a waiver from the federal department of
health and human services.
(d) Enrollment of a pregnant woman in the plan shall be limited based upon
annual appropriations made out of the trust by the general assembly as described
in section 25.5-8-105 and any grants and donations. The general assembly shall
annually establish maximum enrollment figures for pregnant women in the plan.
The department shall not exceed the enrollment caps regardless of whether the
funding comes from annual appropriations or grants and donations.
(5.5) (a) Subject to the receipt of federal financial participation, to the
maximum extent allowed under federal law, a person who was eligible for the plan
while pregnant and who remains eligible for the plan for the sixty days following
the pregnancy remains continuously eligible for all services under the plan for the
twelve-month postpartum period.
(b) The department shall seek any plan amendment necessary to implement
a twelve-month postpartum benefit pursuant to this subsection (5.5) and shall
implement the benefit only upon receipt of federal authorization and financial
participation, and no later than July 1, 2022.
(c) If permissible under federal law, an eligible individual within the
postpartum period may resume coverage under the plan upon implementation of
this section.
(6) (a) Notwithstanding any other provision of law, but subject to the receipt
of federal financial participation, the department shall provide benefits pursuant to
this article 8 to a pregnant person who is lawfully residing, as defined in section
25.5-4-103 (10), and a child less than nineteen years of age, who is lawfully residing,
so long as such pregnant person or child meets eligibility criteria other than those
related to citizenship or immigration status.
(7) (a) Beginning no later than January 1, 2025, notwithstanding any other
provision of law, the department shall provide benefits pursuant to this article 8 to
a pregnant person who is not a citizen and is not eligible pursuant to subsection (6)
of this section, so long as the pregnant person meets the eligibility criteria other
than those related to citizenship or immigration status. Eligibility pursuant to this
section extends continuously through the twelve-month postpartum period, so long
as eligibility remains in effect pursuant to subsection (5.5)(a) of this section.
(b) The department shall seek any necessary federal approvals to maximize
any available federal financial participation in implementing this subsection (7).
(c) (I) During its 2024 presentation to the joint budget committee of the
general assembly and in its presentation to the health and human services
committee of the senate and the health and insurance committee of the house of
representatives, or any successor committees, at the hearing held pursuant to
section 2-7-203 (2)(a) of the State Measurement for Accountable, Responsive, and
Transparent (SMART) Government Act, the state department shall report on its
plans and progress in implementing the coverage expansion created pursuant to
this subsection (7).
(II) Beginning January 1, 2026, and continuing every January thereafter, the
state department, in its presentation to the joint budget committee of the general
assembly and in its presentation to the health and human services committee of the
senate and the health and insurance committee of the house of representatives, or
any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of
the State Measurement for Accountable, Responsive, and Transparent (SMART)
Government Act, shall report on the cost savings and health improvements
associated with the coverage expansion created pursuant to this subsection (7).
(d) This subsection (7) constitutes state authority within the meaning of 8
U.S.C. sec. 1621 (d), as that law existed on January 1, 2022.
(8) Repealed.