Second Regular Session
Seventy-third General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 22-0487.01 Jane Ritter x4342
HOUSE BILL 22-1289
House Committees Senate Committees
Public & Behavioral Health & Human Services
A BILL FOR AN ACT
C
ONCERNING IMPROVING ACCESS TO HEALTH BENEFITS FOR101
ECONOMICALLY INSECURE COLORADO FAMILIES BY ENHANCING102
PUBLIC HEALTH PROGRAMS .103
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov
.)
The bill makes the following changes to health insurance coverage
for low-income pregnant people and children in low-income families:
! Provides full health insurance coverage for Colorado
pregnant people who would be eligible for medicaid and
the children's basic health plan (CHIP) if not for their
HOUSE SPONSORSHIP
Gonzales-Gutierrez and McCluskie,
SENATE SPONSORSHIP
Moreno,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing statute.
Dashes through the words indicate deletions from existing statute. immigration status and continues that coverage for 12
months postpartum at the CHIP federal matching rate;
! Provides comprehensive health insurance coverage to all
Colorado children who would be eligible for medicaid and
CHIP if not for their immigration status;
! Requires the state department of health care policy and
financing to create an outreach and enrollment strategy for
enrolling eligible groups into new coverage options;
! Makes comprehensive lactation supports and supplies,
including breast pumps, a covered benefit for perinatal
people on medicaid and CHIP;
! Draws down federal funds to improve perinatal and
postpartum support and requires that priorities for the funds
be determined through a stakeholder process;
! Permanently authorizes an existing survey of birthing
parents, run by the state department of public health and
environment and increases the ability of the survey to
collect and report on the experiences of birthing people of
color in Colorado;
! Creates a special enrollment period for health insurance
coverage due to pregnancy so that an eligible person can
sign up for insurance as soon as the person becomes
pregnant; and
! Improves the quality of health insurance coverage available
through the health insurance affordability enterprise.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. Legislative declaration. (1) The general assembly2
finds and declares that:3
(a) Health insurance coverage is an important social determinant4
of health because it provides both access to the health-care system and5
financial security. Access to quality prenatal care is one of the most6
important determinants of birth outcomes and a primary strategy to reduce7
infant and maternal mortality.8
(b) The stress and challenges of pregnancy and parenting with9
limited financial resources are contributing factors to a high rate of10
depression. One in four low-income pregnant or postpartum individuals11
HB22-1289-2- experience depression in a given year.1
(c) Insurance coverage improves health status and mental health,2
while decreasing infant, child, and adult mortality rates. Medicaid and the3
children's health insurance program (CHIP) are key supports for pregnant4
people and new parents, as well as their children in the critical early years5
of life.6
(d) Research shows that medicaid coverage for children and7
pregnant people is associated with improved health and well-being.8
Children born to medicaid-covered or otherwise insured parents are more9
likely to be born at a healthier birth weight and are at lower risk of infant10
mortality than babies born to people who are uninsured. Medicaid and11
other insurance coverage of pregnant people is also associated with a12
greater likelihood of children finishing high school and college and13
having higher incomes as adults.14
(e) When parents have health insurance, their children are more15
likely to be insured;16
(f) In Colorado, Hispanic and Latina individuals of reproductive17
age are three times more likely to be uninsured compared to their18
non-Hispanic peers. Research indicates that chronic stress associated with19
being a racial or ethnic minority in the United States is largely responsible20
for higher preterm birth rates and constitutes an independent risk factor21
for preterm delivery.22
(g) Approximately twenty-four percent of all pregnancy-related23
deaths occur between forty-three to three hundred sixty-five days after a24
pregnancy ends. There is growing evidence that providing insurance25
coverage for at least one year of postpartum care can reduce preventable26
maternal deaths, particularly among Black persons and immigrant27
HB22-1289
-3- populations. Expanding access to prenatal and postpartum care will1
decrease racial disparities in maternal and infant mortality.2
(h) Prenatal care is cost effective. Studies have found that3
providing prenatal care for low-income persons avoids costly infant4
complications and infant death.5
(2) The general assembly further finds that:6
(a) All Colorado children deserve access to preventive and7
life-saving health care. In Colorado, fourteen percent of uninsured8
children are ineligible for medicaid or the children's basic health plan9
because of their immigration status. Health insurance coverage is linked10
to improved access to health-care services and increased use of preventive11
services.12
(b) Without expansion of health-care coverage, immigrant parents13
with children who are ineligible for coverage are more likely to put off14
seeking critical treatment until it is an emergency. Educational success,15
physical health, emotional support, and family strength are inseparable.16
(c) The COVID-19 pandemic has disproportionately harmed17
immigrant communities across the state, exposing the dual impacts of18
racism and xenophobia on access to health care. Ineligibility for19
health-care coverage has led many immigrants to forgo COVID-19 testing20
and treatment, despite both being free.21
(d) As Colorado seeks to address these inequities to build a more22
inclusive state, it is essential to expand coverage to the communities that23
have been most impacted and vulnerable before, during, and well after the24
COVID-19 health crisis; and25
(e) Expanding health-care coverage to all children, pregnant and26
postpartum persons, regardless of immigration status, is fundamental to27
HB22-1289
-4- ensuring health equity in Colorado, allowing all parents and children to1
thrive.2
SECTION 2. In Colorado Revised Statutes, 10-16-105.7, add3
(3)(a)(II)(H) as follows:4
10-16-105.7. Health benefit plan open enrollment periods -5
special enrollment periods - rules. (3) (a) (II) A triggering event occurs6
when:7
(H) B
EGINNING JANUARY 1, 2024, AN INDIVIDUAL RECEIVES8
CERTIFICATION FROM A HEALTH -CARE PROVIDER ACTING WITHIN THE9
PROVIDER'S SCOPE OF PRACTICE THAT THE INDIVIDUAL IS PREGNANT .10
C
OVERAGE IS DEEMED EFFECTIVE AS OF THE FIRST MONTH IN WHICH THE11
INDIVIDUAL RECEIVES CERTIFICATION OF THE PREGNANCY , UNLESS THE12
INDIVIDUAL ELECTS TO HAVE COVERAGE EFFECTIVE ON THE FIRST DAY OF13
THE MONTH FOLLOWING THE DATE THAT THE INDIVIDUAL MAKES A PLAN14
SELECTION. ANY PERSON OR ENTITY ENROLLING AN INDIVIDUAL IN15
COVERAGE PURSUANT TO THIS SPECIAL ENROLLMENT PERIOD SHALL16
PROVIDE A NOTICE, DEVELOPED BY THE DEPARTMENT THROUGH A17
STAKEHOLDER PROCESS , TO THE INDIVIDUAL REGARDING THE18
INDIVIDUAL'S OPTION TO BEGIN COVERAGE EITHER PROSPECTIVELY OR19
RETROACTIVELY AND THE FINANCIAL AND TAX IMPLICATIONS OF THOSE20
OPTIONS. THE NOTICE MUST BE IN, AT A MINIMUM, ENGLISH AND SPANISH.21
SECTION 3. In Colorado Revised Statutes, 10-16-1207, repeal22
(4)(c)(IV)(A); and add (4)(c.5) as follows:23
10-16-1207. Health insurance affordability board - creation -24
membership - powers and duties - subject to open meetings and25
public records laws - commissioner rules. (4) The board is authorized26
to:27
HB22-1289
-5- (c) Recommend, for approval and establishment by the1
commissioner by rule:2
(IV) The parameters for implementing the subsidies for3
state-subsidized individual health coverage plans authorized by this part4
12, including:5
(A) The coverage required under state-subsidized individual6
health coverage plans, which coverage must maximize affordability for7
qualified individuals and must include coverage for the lowest income8
group, as determined by the board, that has no premium and provides9
benefits actuarially equivalent to ninety percent of the full actuarial value10
of the benefits provided under the plan; and11
(c.5) F
URTHER RECOMMEND , FOR APPROVAL AND ESTABLISHMENT12
BY THE COMMISSIONER BY RULE , ADDITIONAL PARAMETERS FOR13
IMPLEMENTING THE SUBSIDIES FOR STATE-SUBSIDIZED INDIVIDUAL HEALTH14
COVERAGE PLANS AUTHORIZED BY THIS PART 12, INCLUDING THAT THE15
COVERAGE REQUIRED PURSUANT TO STATE -SUBSIDIZED INDIVIDUAL16
HEALTH COVERAGE PLANS MUST :17
(I) M
AXIMIZE AFFORDABILITY FOR QUALIFIED INDIVIDUALS ;18
(II) C
OVER BENEFITS EQUIVALENT TO THOSE IN A QUALIFIED19
HEALTH PLAN; AND20
(III) F
OR A PERSON WHO, AT THE TIME THE PERSON APPLIES FOR21
STATE-SUBSIDIZED COVERAGE, MEETS THE INCOME REQUIREMENTS TO22
QUALIFY FOR EMERGENCY MEDICAL ASSISTANCE PURSUANT TO SECTION23
25.5-5-103,
INCLUDE COVERAGE THAT:24
(A) H
AS NO PREMIUM;25
(B) H
AS AN ACTUARIAL VALUE OF NOT LESS THAN NINETY -FOUR26
PERCENT; AND27
HB22-1289
-6- (C) TO THE EXTENT POSSIBLE WITH AVAILABLE F UNDING ,1
INCLUDES COST SHARING THAT IS FURTHER REDUCED FROM SUBSECTION2
(4)(c.5)(III)(B)
OF THIS SECTION SUCH THAT THE PLAN HAS CONSUMER3
COST SHARING RESPONSIBILITIES FOR EMERGENCY SERVICES EQUIVALENT4
TO COST SHARING RESPONSIBILITIES FOR EMERGENCY MEDICAL5
ASSISTANCE PURSUANT TO SECTION 25.5-5-103.6
SECTION 4. In Colorado Revised Statutes, 25-1.5-101, add7
(1)(cc) as follows:8
25-1.5-101. Powers and duties of department - laboratory cash9
fund - report - dispensation of payments under contracts with10
grantees - definitions - repeal. (1) The department has, in addition to all11
other powers and duties imposed upon it by law, the powers and duties12
provided in this section as follows:13
(cc) T
O CARRY OUT THE HEALTH SURVEY FOR BIRTHING PARENTS14
AND REPORTING REQUIREMENTS SET FORTH IN PART 7 OF THIS ARTICLE 1.5.15
SECTION 5. In Colorado Revised Statutes, add part 7 to article16
1.5 of title 25 as follows:17
PART 718
HEALTH SURVEY FOR BIRTHING PARENTS19
25-1.5-701. Health survey for birthing parents. (1) B
EGINNING20
J
ULY 1, 2022, THE DEPARTMENT SHALL BEGIN DEVELOPING A21
METHODOLOGY AND BUILDING A HEALTH SURVEY FOR BIRTHING PARENTS ,22
REFERRED TO IN THIS SECTION AS THE "SURVEY", TO GIVE PEOPLE WHO23
HAVE GIVEN BIRTH THE OPPORTUNITY TO SHARE OPINIONS AND24
EXPERIENCES DURING THE FIRST FEW YEARS OF THEIR BABIES ' LIVES. THE25
PURPOSE OF THE SURVEY IS TO INFORM COLORADO POLICIES AND26
PROGRAMS DESIGNED TO ADVANCE HEALTH EQUITY . AS PART OF THE27
HB22-1289
-7- SURVEY, THE DEPARTMENT SHALL:1
(a) I
NVITE A STATEWIDE COHORT OF PEOPLE WHO HAVE RECENTLY2
GIVEN BIRTH TO JOIN THE SURVEY;3
(b) A
NNUALLY AND UP UNTIL A SURVEY PARTICIPANT 'S CHILD'S4
THIRD BIRTHDAY, PROVIDE TO EACH PARTICIPANT AT LEAST TWO BRIEF5
ONLINE QUESTIONNAIRES ON A VARIETY OF HEALTH AND SOCIAL TOPICS ,6
INCLUDING:7
(I) H
OW THE PARTICIPANT FEELS PHYSICALLY AND EMOTIONALLY8
AFTER HAVING GIVEN BIRTH;9
(II) T
HE PARTICIPANT'S MENTAL HEALTH AND SUBSTANCE USE10
BEFORE, DURING, AND AFTER PREGNANCY;11
(III) T
HE PARTICIPANT'S OPINIONS ON CHILDHOOD VACCINATIONS12
AND OTHER IMPORTANT HEALTH DECISIONS ;13
(IV) T
HE PARTICIPANT'S ABILITY TO TAKE LEAVE FROM WORK ;14
(V) T
HE PARTICIPANT'S ABILITY TO FEED THE PARTICIPANT'S BABY15
IN THE PARTICIPANT'S PREFERRED WAY;16
(VI) T
HE PARTICIPANT'S EXPERIENCES WITH DOCTORS AND OTHER17
HEALTH-CARE WORKERS DURING AND AFTER PRE GNANCY , INCLUDING ANY18
EXPERIENCES OF DISCRIMINATION; AND19
(VII) T
HE PARTICIPANT'S FAMILY'S ACCESS TO HEALTH CARE AND20
HEALTH SERVICES, INCLUDING BEHAVIORAL HEALTH SERVICES AND ORAL21
HEALTH SERVICES, AND OTHER RESOURCES NECESSARY FOR THE FAMILY22
TO BE HAPPY AND HEALTHY.23
(2) T
HE SURVEY MUST BE DESIGNED TO OVERSAMPLE MEMBERS OF24
GROUPS THAT COMPRISE A SMALL PERCENTAGE OF THE POPULATION AND25
THAT DISPROPORTIONATELY EXPERIENCE HEALTH INEQUITIES , INCLUDING26
A
FRICAN AMERICANS AND NATIVE AMERICANS, SO THAT DATA ABOUT27
HB22-1289
-8- THE EXPERIENCES OF THESE POPULATIONS CAN BE MADE PUBLIC .1
P
ARTICIPANT DATA ABOUT RACE, ETHNICITY, SEXUAL ORIENTATION, AND2
GENDER IDENTITY MUST BE COLLECTED AND REPORTED IN A M ANNER THAT3
PROTECTS PERSONALLY IDENTIFYING INFORMATION .4
SECTION 6. In Colorado Revised Statutes, 25.5-2-103, amend5
(1)(b) as follows:6
25.5-2-103. Reproductive health-care program - report - rules7
- definitions. (1) As used in this section, unless the context otherwise8
requires:9
(b) "Eligible individual" means an individual with reproductive10
capacity, regardless of gender, citizenship, or immigration status,
who11
would be eligible to enroll in the medical assistance program, except that12
the individual is not a citizen of the United States and is not considered13
an eligible noncitizen pursuant to 8 U.S.C. secs. 1611 and 1612 and14
section 25.5-5-101 (2)(b) AS DESCRIBED IN SECTION 25.5-4-103 (13) BUT15
IS NOT ELIGIBLE DUE SOLELY TO THE INDIVIDUAL'S IMMIGRATION STATUS,16
AND WHO IS NOT ELIGIBLE FOR STATE MEDICAL ASSISTANCE , AS DESCRIBED17
IN SECTION 25.5-2-104.18
SECTION 7. In Colorado Revised Statutes, add 25.5-2-104 and19
25.5-2-105 as follows:20
25.5-2-104. State-funded health and medical care.21
(1) B
EGINNING JANUARY 1, 2024, THERE IS CREATED THE STATE MEDICAL22
ASSISTANCE PROGRAM REFERRED TO IN THIS SECTION AS "STATE MEDICAL23
ASSISTANCE". STATE MEDICAL ASSISTANCE INCLUDES ALL BENEFITS AND24
SERVICES AT THE SAME COST TO THE BENEFICIARY AS ARE OFFERED25
PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM DEFINED IN SECTION26
25.5-4-103
(13), SUCH THAT, TO THE MAXIMUM EXTENT POSSIBLE ,27
HB22-1289
-9- ELIGIBLE INDIVIDUALS MUST NOT BE ABLE TO TELL THAT THE PERSON IS1
ENROLLED IN A DIFFERENT PROGRAM FROM MEDICAL ASSISTANCE2
PURSUANT TO SECTION 25.5-4-103 (13).3
(2) A
CHILD WHO IS LESS THAN NINETEEN YEARS OF AGE IS4
ELIGIBLE TO RECEIVE STATE MEDICAL ASSISTANCE IF THE CHILD WOULD BE5
ELIGIBLE FOR MEDICAL ASSISTANCE AS DEFINED IN SECTION 25.5-4-1036
(13)
BUT IS NOT ELIGIBLE DUE SOLELY TO THE CHILD 'S IMMIGRATION7
STATUS.8
(3) A
CHILD WHO IS LESS THAN NIN ETEEN YEARS OF AGE IS9
PRESUMPTIVELY ELIGIBLE FOR STATE MEDICAL ASSISTANCE AND WILL10
RECEIVE SERVICES SPECIFIED BY STATE LAW ONLY IF A PARENT OR LEGAL11
GUARDIAN OF THE CHILD DECLARES ALL PERTINENT INFORMATION12
RELATING TO THE CRITERIA OF INCOME AND ASSETS OF THE CHILD 'S13
FAMILY.14
(4) S
TATE MEDICAL ASSISTANCE MUST BE FUNDED BY STATE15
FUNDS ONLY, EXCEPT TO THE EXTENT FEDERAL FUNDS ARE MADE16
AVAILABLE THROUGH EXPRESS WRITTEN AUTHORIZATION THROUGH A17
FEDERAL WAIVER, STATE PLAN AMENDMENT , OR OTHERWISE, BY THE18
CENTERS FOR MEDICARE AND MEDICAID SERVICES .19
(5) T
HE STATE DEPARTMENT SHALL SEEK ANY NECESSARY20
FEDERAL APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL21
PARTICIPATION IN IMPLEMENTING THIS SECTION .22
(6) T
O THE MAXIMUM EXTENT ALLOWABLE UNDER FEDERAL LAW ,23
THE STATE DEPARTMENT SHALL , USING APPROPRIATE FUNDING, USE THE24
SAME INFRASTRUCTURE AND PROVIDER NETWORK TO DELIVER STATE25
MEDICAL ASSISTANCE AS IT DOES TO DELIVER MEDICAL ASSISTANCE AS26
DEFINED IN SECTION 25.5-4-103 (13).27
HB22-1289
-10- (7) THIS SECTION CONSTITUTES STATE AUTHORITY WITHIN THE1
MEANING OF 8 U.S.C. SEC. 1621 (d), AS THAT LAW EXISTED ON JANUARY2
1,
2022.3
(8) B
EGINNING JANUARY 1, 2024, AND CONTINUING EVERY YEAR4
THEREAFTER, THE STATE DEPARTMENT, IN ITS PRESENTATION TO THE JOINT5
BUDGET COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS6
PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE7
SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF8
REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES , AT THE HEARING9
HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE10
M
EASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT11
(SMART)
GOVERNMENT ACT", SHALL REPORT ON THE COST SAVINGS AND12
HEALTH BENEFITS ASSOCIATED WITH STATE MEDICAL ASSISTANCE .13
25.5-2-105. State children's basic health plan. (1) B
EGINNING14
J
ANUARY 1, 2024, THERE IS CREATED THE STATE CHILDREN 'S BASIC15
HEALTH PLAN. THE STATE CHILDREN'S BASIC HEALTH PLAN INCLUDES ALL16
BENEFITS AND SERVICES, AT THE SAME COST TO THE BENEFICIARY, AS ARE17
OFFERED PURSUANT TO THE CHILDREN 'S BASIC HEALTH PLAN IN SECTION18
25.5-8-107,
SUCH THAT, TO THE MAXIMUM EXTENT POSSIBLE , ELIGIBLE19
INDIVIDUALS MUST NOT BE ABLE TO TELL THAT THEY ARE ENROLLED IN A20
DIFFERENT PROGRAM FROM THE PLAN DESCRIBED IN SECTION 25.5-8-107.21
(2) A
CHILD WHO IS LESS THAN NINETEEN YEARS OF AGE IS22
ELIGIBLE TO RECEIVE THE STATE CHILDREN'S BASIC HEALTH PLAN IF THE23
CHILD WOULD BE ELIGIBLE FOR THE CHILDREN 'S BASIC HEALTH PLAN AS24
DESCRIBED IN 25.5-8-107, BUT IS NOT ELIGIBLE DUE SOLELY TO THE25
CHILD'S IMMIGRATION STATUS.26
(3) A
CHILD WHO LESS THAN NI NETEEN YEARS OF AGE IS27
HB22-1289
-11- PRESUMPTIVELY ELIGIBLE FOR THE STATE CHILDREN 'S BASIC HEALTH PLAN1
AND WILL RECEIVE SERVICES SPECIFIED BY STATE LAW ONLY IF A PARENT2
OR LEGAL GUARDIAN OF THE CHILD DECLARES ALL PERTINENT3
INFORMATION RELATING TO THE CRITERIA OF INCOME AND ASSETS OF THE4
CHILD'S FAMILY.5
(4) T
HE STATE CHILDREN'S BASIC HEALTH PLAN MUST BE FUNDED6
BY STATE FUNDS ONLY, EXCEPT TO THE EXTENT FEDERAL FUNDS ARE7
MADE AVAILABLE THROUGH EXPRESS WRITTEN AUTHORIZATION THR OUGH8
A FEDERAL WAIVER, STATE PLAN AMENDMENT , OR OTHERWISE, BY THE9
CENTERS FOR MEDICARE AND MEDICAID SERVICES .10
(5) T
HE STATE DEPARTMENT SHALL SEEK ANY NECESSARY11
FEDERAL APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL12
PARTICIPATION IN IMPLEMENTING THIS SECTION .13
(6) T
O THE MAXIMUM EXTENT ALLOWABLE UNDER FEDERAL LAW ,14
THE STATE DEPARTMENT SHALL , USING APPROPRIATE FUNDING, USE THE15
SAME INFRASTRUCTURE AND PROVIDER NETWORK TO DELIVER THE STATE 'S16
CHILDREN'S BASIC HEALTH PLAN AS IT DOES TO DELIVER THE CHILDREN 'S17
BASIC HEALTH PLAN DESCRIBED IN SECTION 25.5-8-107.18
(7) T
HIS SECTION CONSTITUTES STATE AUTHORITY WITHIN THE19
MEANING OF 8 U.S.C. SEC. 1621 (d), AS THAT LAW EXISTED ON JANUARY20
1,
2022.21
(8) B
EGINNING JANUARY 1, 2024, AND CONTINUING EVERY YEAR22
THEREAFTER, THE STATE DEPARTMENT SHALL , IN ITS PRESENTATION TO23
THE JOINT BUDGET COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS24
PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE25
SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF26
REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES , AT THE HEARING27
HB22-1289
-12- HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE1
M
EASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT2
(SMART)
GOVERNMENT ACT", THE STATE DEPARTMENT SHALL REPORT3
ON THE COST SAVINGS AND HEALTH BENEFITS ASSOCIATED WITH STATE 'S4
BASIC HEALTH PLAN.5
SECTION 8. In Colorado Revised Statutes, 25.5-4-103, amend6
(10) as follows:7
25.5-4-103. Definitions. As used in this article 4 and articles 58
and 6 of this title 25.5, unless the context otherwise requires:9
(10) "Legal immigrant"
"LAWFULLY RESIDING" means an10
individual who is not a citizen or national of the United States and who11
was lawfully admitted to the United States by the immigration and12
naturalization service, or any successor agency, as an actual or13
prospective permanent resident or whose extended physical presence in14
the United States is known to and allowed by the immigration and15
naturalization service, or any successor agency.16
SECTION 9. In Colorado Revised Statutes, 25.5-4-301, amend17
(13) as follows:18
25.5-4-301. Recoveries - overpayments - penalties - interest -19
adjustments - liens - review or audit procedures. (13) To the extent20
allowable under federal law, the state department shall recover from a21
legal immigrant's THE sponsor OF A LAWFULLY RESIDING INDIVIDUAL all22
medical assistance paid on behalf of a THE sponsored legal immigrant23
LAWFULLY RESIDING INDIVIDUAL who is enrolled in the medical assistance24
program.25
SECTION 10. In Colorado Revised Statutes, amend 25.5-4-50326
as follows:27
HB22-1289
-13- 25.5-4-503. Waiver applications - authorization. (1) The state1
department is authorized to apply for health insurance flexibility and2
accountability waivers that will enable the state to add more flexibility to3
Colorado's medicaid program and that will result in a cost-effective4
method of providing health-care services to Coloradans.5
(2) T
HE STATE DEPARTMENT SHALL PURSUE AND , IF APPROVED,6
IMPLEMENT A DEMONSTRATION WAIVER THAT AUTHORIZES THE STATE TO7
USE FEDERAL MEDICAL ASSISTANCE PAYMENTS AUTHORIZED PURSUANT TO8
SECTION 1903(v) OF THE FEDERAL "SOCIAL SECURITY ACT", AS AMENDED,9
TO ENHANCE THE STATE'S SUBSIDIZATION OF HEALTH INSURANCE FOR10
LOW-INCOME COLORADANS, AND, IF NEEDED TO MAXIMIZE FEDERAL11
FINANCIAL PARTICIPATION, FOR COLORADANS RECEIVING STATE MEDICAL12
ASSISTANCE PURSUANT TO SECTION 25.5-2-104.13
SECTION 11. In Colorado Revised Statutes, 25.5-5-101, amend14
(3) as follows:15
25.5-5-101. Mandatory provisions - eligible groups.16
(3) Notwithstanding any other provision of this article and articles 4 and17
6 of this title
TITLE 25.5, as a condition of eligibility for medical18
assistance under this article ARTICLE 5 and articles 4 and 6 of this title19
TITLE 25.5, a legal immigrant PERSON WHO IS LAWFULLY RESIDING IN THE20
STATE shall agree to refrain from executing an affidavit of support for the21
purpose of sponsoring an alien on or after July 1, 1997, under rules22
promulgated by the immigration and naturalization service, or any23
successor agency, during the pendency of such legal immigrant's THE24
LAWFULLY RESIDING PERSON'S receipt of medical assistance. Nothing in25
this subsection (3) shall be construed to affect a legal immigrant's26
AFFECTS A LAWFULLY RESIDING PERSON'S eligibility for medical assistance27
HB22-1289
-14- under this article PURSUANT TO THIS ARTICLE 5 and articles 4 and 6 of this1
title TITLE 25.5 based upon such legal immigrant's THE LAWFULLY2
RESIDING PERSON'S responsibilities under an affidavit of support entered3
into before July 1, 1997.4
SECTION 12. In Colorado Revised Statutes, 25.5-5-201, amend5
(3), (4) and (4.5)(a); and add (6) as follows:6
25.5-5-201. Optional provisions - optional groups. (3) A legal7
immigrant LAWFULLY RESIDING PERSON who is receiving medicaid8
nursing facility care or home- and community-based services on July 1,9
1997, shall MUST continue to receive such services as long as he or she10
THE PERSON meets the eligibility requirements other than citizen status.11
State general funds may be used to reimburse such care in the event that12
federal financial participation is not available.13
(4) A pregnant legal immigrant shall be PERSON WHO IS LAWFULLY14
RESIDING IS eligible to receive prenatal and medical services for labor and15
delivery as long as she MEDICAL ASSISTANCE AS LONG AS THE INDIVIDUAL16
meets eligibility requirements other than
THOSE RELATED TO citizen OR17
IMMIGRATION status. State general funds may be used to reimburse such18
care in the event that federal financial participation is not available.19
(4.5) (a) Subject to the receipt of federal financial participation,20
to the maximum extent allowed under federal law, a person who was21
eligible for all pregnancy-related and postpartum services under
the22
medical assistance program for the sixty days following the pregnancy23
remains continuously eligible for all services under the medical assistance24
program for the twelve-month postpartum period.25
(6) (a) B
EGINNING JANUARY 1, 2024, A PREGNANT PERSON WHO IS26
NOT A CITIZEN AND WHO IS NOT ELIGIBLE FOR MEDICAL ASSISTANCE27
HB22-1289
-15- PURSUANT TO SUBSECTION (4) OF THIS SECTION IS ELIGIBLE TO RECEIVE1
MEDICAL ASSISTANCE PURSUANT TO THIS SUBSECTION (6)(a) IF THE2
INDIVIDUAL MEETS THE ELIGIBILITY REQUIREMENTS OTHER THAN THOSE3
RELATED TO CITIZENSHIP AND IMMIGRATION STATUS .4
(b) A
PREGNANT PERSON WHO IS ELIGIBLE FOR MEDICAL5
ASSISTANCE PURSUANT TO THIS SUBSECTION (6) REMAINS CONTINUOUSLY6
ELIGIBLE FOR ALL MEDICAL SERVICES PURSUANT TO THE MEDICAL7
ASSISTANCE PROGRAM FOR THE TWELVE -MONTH POSTPARTUM PERIOD .8
(c) T
HE STATE DEPARTMENT SHALL SEEK ANY NECESSARY9
FEDERAL APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL10
PARTICIPATION IN IMPLEMENTING THIS SUBSECTION (6). BENEFITS FOR11
SERVICES OBTAINED PURSUANT TO THIS SUBSECTION (6) MUST BE12
PROVIDED WITH ONLY STATE FUNDS IF FEDERAL FINANCIAL PARTICIPATION13
IS UNAVAILABLE FOR SUCH SERVICES.14
(d) B
EGINNING JANUARY 1, 2024, AND CONTINUING EVERY YEAR15
THEREAFTER, THE STATE DEPARTMENT, IN ITS PRESENTATION TO THE JOINT16
BUDGET COMMITTEE OF THE GENERAL ASSEMBLY , AS WELL AS IN ITS17
PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE18
SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF19
REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES , AT THE HEARING20
HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE21
M
EASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT22
(SMART)
GOVERNMENT ACT", SHALL REPORT ON THE COST SAVINGS AND23
HEALTH BENEFITS ASSOCIATED WITH THE COVERAGE EXPANSION CREATED24
PURSUANT TO THIS SUBSECTION (6).25
SECTION 13. In Colorado Revised Statutes, 25.5-5-202, add26
(1)(y) as follows:27
HB22-1289
-16- 25.5-5-202. Basic services for the categorically needy - optional1
services. (1) Subject to the provisions of subsection (2) of this section,2
the following are services for which federal financial participation is3
available and that Colorado has selected to provide as optional services4
under the medical assistance program:5
(y) F
OR ANY PERINATAL PERSON , COMPREHENSIVE LACTATION6
SUPPORT SERVICES, BREASTFEEDING SUPPLIES , MAINTENANCE, AND7
EQUIPMENT. BREASTFEEDING EQUIPMENT INCLUDES A DOUBLE ELECTRIC8
BREAST PUMP, PUMP PARTS, AND BREAST MILK STORAGE SUPPLIES.9
SECTION 14. In Colorado Revised Statutes, 25.5-5-204, amend10
(2) and (2.5) as follows:11
25.5-5-204. Presumptive eligibility - pregnant person -12
children - long-term care - state plan. (2) (a) A pregnant woman shall
13
be PERSON IS presumptively eligible for the medical assistance program14
and shall receive services specified by federal law only if the woman15
PERSON declares all pertinent information relating to the criteria of16
income, assets, and status AND, ONLY IF NECESSARY TO ADMINISTER17
REIMBURSEMENT FOR SERVICES , STATUS.18
(b) A woman shall declare her immigration status unless the19
general assembly provides funding for prenatal care services for20
undocumented residents.21
(2.5) A child under the age of eighteen years shall be LESS THAN22
NINETEEN YEARS OF AGE IS presumptively eligible for the medical23
assistance program and shall receive services specified by federal law24
only if a parent or legal guardian of the child declares all pertinent25
information relating to the criteria of income, assets, and status AND,26
ONLY IF NECESSARY TO ADMINISTER REIMBURSEMENT FOR SERVICES ,27
HB22-1289
-17- STATUS of the child's family.1
SECTION 15. In Colorado Revised Statutes, add 25.5-6-115 as2
follows:3
25.5-6-115. Notification of federal immigration consequences.4
T
HE STATE DEPARTMENT SHALL CONSULT WITH STAKEHOLDERS ,5
INCLUDING PEOPLE WITH LIVED EXPERIENCE , IMMIGRANTS RIGHTS6
ADVOCATES, HEALTH-CARE ADVOCATES, AND IMMIGRATION LAWYERS, TO7
PROVIDE CLEAR AND ACCURATE INFORMATION AND REFERRALS8
REGARDING CURRENT PUBLIC CHARGE POLICIES .9
SECTION 16. In Colorado Revised Statutes, 25.5-8-103, amend10
(4)(a)(I) and (4)(b)(I) as follows:11
25.5-8-103. Definitions. As used in this article 8, unless the12
context otherwise requires:13
(4) "Eligible person" means:14
(a) (I) A person who is less than nineteen years of age,
WHO IS A15
CITIZEN OR MEETS THE IMMIGRATION STATUS REQUIREMENTS SET FORTH16
IN SECTION 25.5-8-109 (6) OR 25.5-8-109 (7), whose family income does17
not exceed two hundred fifty percent of the federal poverty line, adjusted18
for family size,
AND WHO IS NOT ELIGIBLE FOR MEDICAL ASSISTANCE19
PURSUANT TO ARTICLES 4, 5, AND 6 OF THIS TITLE 25.5.20
(b) (I) A pregnant woman
PERSON WHO IS A CITIZEN OR MEETS THE21
IMMIGRATION STATUS REQUIREMENTS SET FORTH IN SECTION 25.5-8-10922
(6)
OR 25.5-8-109 (7), whose family income does not exceed two hundred23
fifty percent of the federal poverty line, adjusted for family size, and who24
is not eligible for medicaid
MEDICAL ASSISTANCE PURSUANT TO ARTICLES25
4,
5, AND 6 OF THIS TITLE 25.5.26
SECTION 17. In Colorado Revised Statutes, 25.5-8-107, add27
HB22-1289
-18- (1)(a)(V) and (1)(i) as follows:1
25.5-8-107. Duties of the department - schedule of services -2
premiums - copayments - subsidies - purchase of childhood3
immunizations. (1) In addition to any other duties pursuant to this article4
8, the department has the following duties:5
(a) (V) I
N ADDITION TO THE ITEMS SPECIFIED IN SUBSECTIONS6
(1)(a)(I), (1)(a)(II),
AND (1)(a)(III) OF THIS SECTION, AND ANY7
ADDITIONAL ITEMS APPROVED BY THE MEDICAL SERVICES BOARD , THE8
MEDICAL SERVICES BOARD SHALL INCLUDE , FOR ALL PERINATAL PEOPLE,9
COMPREHENSIVE LACTATION SUPPORT SERVICES , BREASTFEEDING10
SUPPLIES, MAINTENANCE, AND EQUIPMENT. BREASTFEEDING EQUIPMENT11
INCLUDES A DOUBLE ELECTRIC BREAST PUMP , PUMP PARTS, AND BREAST12
MILK STORAGE SUPPLIES.13
(i) (I) T
HE DEPARTMENT SHALL DEVELOP AND IMPLEMENT AN14
OUTREACH STRATEGY FOR COLORADANS WHO BECOME ELIGIBLE FOR15
HEALTH COVERAGE PURSUANT TO SECTION 25.5-2-104, 25.5-2-105,16
25.5-5-201
(6), OR 25.5-8-109 (7). THE STATE DEPARTMENT SHALL WORK17
WITH STAKEHOLDERS TO DEVELOP AN OUTREACH STRATEGY THAT18
INCLUDES:19
(A) F
UNDING FOR COMMUNITY -BASED ORGANIZATIONS TO20
PARTNER WITH THE DEPARTMENT ON OUTREACH ;21
(B) A
METHOD FOR PROVIDING INFORMATION RELATED TO22
ELIGIBILITY AND ENROLLMENT THAT CAN BE PROVIDED TO NONPROFIT23
PARTNERS, SCHOOL DISTRICTS, AND CHARTER SCHOOLS FOR OUTREACH24
PURPOSES; AND25
(C) A
T A MINIMUM, PROVIDING INFORMATION RELATED TO26
ELIGIBILITY AND COVERAGE IN ENGLISH, SPANISH, AND IN EACH27
HB22-1289
-19- LANGUAGE SPOKEN BY AT LEAST TWO -AND-ONE-HALF PERCENT OF THE1
POPULATION OF ANY COUNTY WHO SPEAK ENGLISH LESS THAN VERY WELL,2
AS DEFINED BY THE UNITED STATES BUREAU OF THE CENSUS AMERICAN3
COMMUNITY SURVEY , AND WHO SPEAK THE MINORITY LANGUAGE AT4
HOME;5
(II)
APPROXIMATELY TWELVE AND TWENTY -FOUR MONTHS AFTER6
IMPLEMENTATION OF THE STRATEGY REQUIRED PURSUANT TO SUBSECTION7
(1)(i)(I)
OF THIS SECTION, THE DEPARTMENT SHALL CONVENE8
STAKEHOLDERS, INCLUDING DIRECTLY IMPACTED INDIVIDUALS , SERVICE9
PROVIDERS, AND ADVOCACY ORGANIZATIONS THAT ARE DIVERSE WITH10
REGARD TO RACE , ETHNICITY, IMMIGRATION STATUS , SEXUAL11
ORIENTATION, AND GENDER IDENTITY AND WHO ARE AFFECTED BY HIGHER12
RATES OF HEALTH DISPARITIES AND INEQUITIES. THE DEPARTMENT SHALL13
REPORT ON THE OUTREACH AND ENROLLMENT STRATEGY OUTCOMES ,14
INCLUDING ENROLLMENT OF ELIGIBLE PERSONS INTO THESE PROGRAMS15
COMPARED TO THOSE PERSONS WHO ARE ELIGIBLE FOR COVERAGE , BUT16
NOT ENROLLED.17
(III) B
EGINNING JANUARY 1, 2024, AND CONTINUING EVERY YEAR18
THEREAFTER, THE DEPARTMENT SHALL REPORT ON THE COST SAVINGS AND19
HEALTH BENEFITS ASSOCIATED WITH THE PROGRAM TO THE JOINT BUDGET20
COMMITTEE AND IN ITS PRESENTATION TO THE HEALTH AND HUMAN21
SERVICES COMMITTEE OF THE SENATE AND THE HEALTH AND INSURANCE22
COMMITTEE OF THE HOUSE OF REPRESENTATIVES , OR ANY SUCCESSOR23
COMMITTEES, PURSUANT TO SECTION 2-7-203.24
SECTION 18. In Colorado Revised Statutes, 25.5-8-109, amend25
(5.5)(a) and (6); and add (7) as follows:26
25.5-8-109. Eligibility - children - pregnant women - repeal.27
HB22-1289
-20- (5.5) (a) Subject to the receipt of federal financial participation, to the1
maximum extent allowed under federal law, a person who was eligible for2
the plan while pregnant and who remains eligible for all3
pregnancy-related and postpartum services under the plan for the sixty4
days following the pregnancy remains continuously eligible for all5
services under the plan for the twelve-month postpartum period.6
(6) (a) Notwithstanding any other provision of law, but subject to7
the availability of sufficient appropriations and the receipt of federal8
financial participation, the department may SHALL provide benefits under9
this article PURSUANT TO THIS ARTICLE 8 to a pregnant woman who is a10
qualified alien PERSON WHO IS LAWFULLY RESIDING , AS DEFINED IN11
SECTION 25.5-4-103 (10), and a child under LESS THAN nineteen years of12
age, who is a qualified alien WHO IS LAWFULLY RESIDING, so long as such13
woman PREGNANT PERSON or child meets eligibility criteria other than14
citizenship OTHER THAN THOSE RELATED TO CITIZENSHIP OR IMMIGRATION15
STATUS.16
(7) (a) B
EGINNING JANUARY 1, 2024, NOTWITHSTANDING ANY17
OTHER PROVISION OF LAW, BUT SUBJECT TO THE RECEIPT OF FEDERAL18
FINANCIAL PARTICIPATION, THE DEPARTMENT SHALL PROVIDE BENEFITS19
PURSUANT TO THIS ARTICLE 8 TO A PREGNANT PERSON WHO IS NOT A20
CITIZEN AND IS NOT ELIGIBLE PURSUANT TO SUBSECTION (6) OF THIS21
SECTION, SO LONG AS THE PREGNANT PERSON MEETS THE ELIGIBILITY22
CRITERIA OTHER THAN THOSE RELATED TO CITIZENSHIP OR IMMIGRATION23
STATUS. ELIGIBILITY PURSUANT TO THIS SECTION EXTENDS CONTINUOUSLY24
THROUGH THE TWELVE-MONTH POSTPARTUM PERIOD .25
(b) T
HE DEPARTMENT SHALL SEEK ANY NECESSARY FEDERAL26
APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL27
HB22-1289
-21- PARTICIPATION IN IMPLEMENTING THIS SUBSECTION (7).1
(c) B
EGINNING JANUARY 1, 2024, AND CONTINUING EVERY YEAR2
THEREAFTER, THE DEPARTMENT SHALL, IN ITS PRESENTATION TO THE JOINT3
BUDGET COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS4
PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE5
SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF6
REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES , AT THE HEARING7
HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE8
M
EASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT9
(SMART)
GOVERNMENT ACT", THE DEPARTMENT SHALL REPORT ON THE10
COST SAVINGS AND HEALTH BENEFITS ASSOCIATED WITH THE COVERAGE11
EXPANSION CREATED PURSUANT TO THIS SUBSECTION (7).12
(d) T
HIS SUBSECTION (7) CONSTITUTES STATE AUTHORITY WITHIN13
THE MEANING OF 8 U.S.C. SEC. 1621 (d), AS THAT LAW EXISTED ON14
J
ANUARY 1, 2022.15
SECTION 19. In Colorado Revised Statutes, add 25.5-8-109.316
as follows:17
25.5-8-109.3. Health services initiatives. (1) T
O THE EXTENT18
FEDERAL FINANCIAL PARTICIPATION IS AVAILABLE , THE DEPARTMENT19
SHALL DESIGN AND IMPLEMENT HEALTH SERVICE INITIATIVES PURSUANT20
TO SECTION 2105(a)(1)(D)(ii) OF THE FEDERAL "SOCIAL SECURITY ACT",21
AS AMENDED, TO PROVIDE FUNDING FOR CONTINUOUS ENROLLMENT FOR22
THE TWELVE-MONTH POSTPARTUM PERIOD FOR A PERSON WHO IS23
ENROLLED IN HEALTH-CARE COVERAGE PURSUANT TO SECTION 25.5-5-20124
(6)
OR 25.5-8-109 (7).25
(2) T
O THE EXTENT ADDITIONAL FEDERAL FINANCIAL26
PARTICIPATION IS AVAILABLE, THE DEPARTMENT SHALL ESTABLISH A27
HB22-1289
-22- STAKEHOLDER PROCESS IN COLLABORATION WITH DEPARTMENT STAFF TO1
DETERMINE ADDITIONAL PRIORITIES AND BUDGET ALLOCATIONS THAT2
DRAW DOWN AT LEAST FIFTY PERCENT OF THE REMAINING HEALTH3
SERVICES INITIATIVE FUNDS TO EXPAND ACCESS TO PERINATAL AND4
POSTPARTUM SUPPORTS. IN CONDUCTING THE STAKEHOLDER PROCESS , THE5
DEPARTMENT SHALL:6
(a) E
NGAGE DIRECTLY WITH IMPACTED INDIVIDUALS , SERVICE7
PROVIDERS, ADVOCACY ORGANIZATIONS , AND INDIVIDUALS WORKING IN8
OR REPRESENTING COMMUNITIES WHO ARE DIVERSE WITH REGARD TO9
RACE, ETHNICITY, IMMIGRATION STATUS , AGE, ABILITY, SEXUAL10
ORIENTATION, GENDER IDENTITY, OR GEOGRAPHIC REGION OF THE STATE11
AND WHO ARE AFFECTED BY HIGHER RATES OF HEALTH DISPARITIES AND12
INEQUITIES;13
(b) P
UBLICIZE, CONDUCT, AND REPORT OUTCOMES OF14
STAKEHOLDER MEETINGS IN, AT A MINIMUM, ENGLISH AND SPANISH;15
(c) I
NCLUDE OPPORTUNITIES FOR PARTICIPATION IN THE16
STAKEHOLDER PROCESS OUTSIDE OF REGULAR WORK HOURS ;17
(d) T
AKE INTO CONSIDERATION RESEARCH AND INFORMATION18
FROM REPORTS ISSUED BY THE MATERNAL MORTALITY REVIEW19
COMMITTEE, AS REQUIRED BY SECTION 25-52-104 (6);20
(e) T
AKE INTO CONSIDERATION DATA FROM THE HEALTH SURVEY21
FOR BIRTHING PARENTS TO INFORM STAKEHOLDER DECISION -MAKING; AND22
(f) C
ONSIDER INITIATIVES TO REDUCE DIAPER NEED , EXPAND23
ACCESS TO GROUP-BASED PRENATAL AND PEDIATRIC CARE MODELS , AND24
EXPAND HOME VISITATION PROGRAMS , INCLUDING VOLUNTARY NEWBORN25
NURSE VISITATION PROGRAMS THAT ARE UNIVERSALLY OFFERED TO ALL26
FAMILIES IN A GIVEN COMMUNITY AND PROVIDE AT LEAST ONE NURSE VISIT27
HB22-1289
-23- WITHIN THE FIRST THREE MONTHS OF LIFE.1
(3) (a) T
HE DEPARTMENT SHALL SEEK ANY NECESSARY FEDERAL2
APPROVALS TO OBTAIN FEDERAL FINANCIAL PARTICIPATION IN3
IMPLEMENTING SUBSECTION (1) OF THIS SECTION.4
(b) T
O THE EXTENT ALLOWABLE , THE DEPARTMENT SHALL5
MAXIMIZE FEDERAL FINANCIAL PARTICIPATION IN IMPLEMENTING THIS6
SECTION.7
SECTION 20. Safety clause. The general assembly hereby finds,8
determines, and declares that this act is necessary for the immediate9
preservation of the public peace, health, or safety.10
HB22-1289
-24-