Second Regular Session Seventy-third General Assembly STATE OF COLORADO ENGROSSED This Version Includes All Amendments Adopted on Second Reading in the House of Introduction LLS NO. 22-0487.01 Jane Ritter x4342 HOUSE BILL 22-1289 House Committees Senate Committees Public & Behavioral Health & Human Services Appropriations A BILL FOR AN ACT C ONCERNING IMPROVING ACCESS TO HEALTH BENEFITS FOR101 ECONOMICALLY INSECURE COLORADO FAMILIES BY ENHANCING102 PUBLIC HEALTH PROGRAMS, AND, IN CONNECTION THEREWITH,103 MAKING AN APPROPRIATION .104 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 HOUSE Amended 2nd Reading April 20, 2022 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. pregnant people who would be eligible for medicaid and the children's basic health plan (CHIP) if not for their 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 1289-2- depression. One in four low-income pregnant or postpartum individuals1 experience depression in a given year.2 (c) Insurance coverage improves health status and mental health,3 while decreasing infant, child, and adult mortality rates. Medicaid and the4 children's health insurance program (CHIP) are key supports for pregnant5 people and new parents, as well as their children in the critical early years6 of life.7 (d) Research shows that medicaid coverage for children and8 pregnant people is associated with improved health and well-being.9 Children born to medicaid-covered or otherwise insured parents are more10 likely to be born at a healthier birth weight and are at lower risk of infant11 mortality than babies born to people who are uninsured. Medicaid and12 other insurance coverage of pregnant people is also associated with a13 greater likelihood of children finishing high school and college and14 having higher incomes as adults.15 (e) When parents have health insurance, their children are more16 likely to be insured;17 (f) In Colorado, Hispanic and Latina individuals of reproductive18 age are three times more likely to be uninsured compared to their19 non-Hispanic peers. Research indicates that chronic stress associated with20 being a racial or ethnic minority in the United States is largely responsible21 for higher preterm birth rates and constitutes an independent risk factor22 for preterm delivery.23 (g) Approximately twenty-four percent of all pregnancy-related24 deaths occur between forty-three to three hundred sixty-five days after a25 pregnancy ends. There is growing evidence that providing insurance26 coverage for at least one year of postpartum care can reduce preventable27 1289 -3- maternal deaths, particularly among Black persons and immigrant1 populations. Expanding access to prenatal and postpartum care will2 decrease racial disparities in maternal and infant mortality.3 (h) Prenatal care is cost effective. Studies have found that4 providing prenatal care for low-income persons avoids costly infant5 complications and infant death.6 (2) The general assembly further finds that:7 (a) All Colorado children deserve access to preventive and8 life-saving health care. In Colorado, fourteen percent of uninsured9 children are ineligible for medicaid or the children's basic health plan10 because of their immigration status. Health insurance coverage is linked11 to improved access to health-care services and increased use of preventive12 services.13 (b) Without expansion of health-care coverage, immigrant parents14 with children who are ineligible for coverage are more likely to put off15 seeking critical treatment until it is an emergency. Educational success,16 physical health, emotional support, and family strength are inseparable.17 (c) The COVID-19 pandemic has disproportionately harmed18 immigrant communities across the state, exposing the dual impacts of19 racism and xenophobia on access to health care. Ineligibility for20 health-care coverage has led many immigrants to forgo COVID-19 testing21 and treatment, despite both being free.22 (d) As Colorado seeks to address these inequities to build a more23 inclusive state, it is essential to expand coverage to the communities that24 have been most impacted and vulnerable before, during, and well after the25 COVID-19 health crisis; and26 (e) Expanding health-care coverage to all children, pregnant and27 1289 -4- postpartum persons, regardless of immigration status, is fundamental to1 ensuring health equity in Colorado, allowing all parents and children to2 thrive.3 SECTION 2. In Colorado Revised Statutes, 10-16-1206, amend4 (1)(e) and (1)(f); and add (1)(g) as follows:5 10-16-1206. Health insurance affordability cash fund -6 creation. (1) There is hereby created in the state treasury the health7 insurance affordability cash fund. The fund consists of:8 (e) Money that may be allocated to the fund pursuant to section9 10-16-1308; and10 (f) All interest and income derived from the deposit and11 investment of money in the fund; AND12 (g) THE FEDERAL SHARE OF THE MEDICAL ASSISTANCE PAYMENTS13 RECEIVED PURSUANT TO SECTION 25.5-4-503 (2).14 SECTION 3. In Colorado Revised Statutes, 10-16-105.7, add15 (3)(a)(II)(H) as follows:16 10-16-105.7. Health benefit plan open enrollment periods -17 special enrollment periods - rules. (3) (a) (II) A triggering event occurs18 when:19 (H) B EGINNING JANUARY 1, 2024, AN INDIVIDUAL WHO DOES NOT20 HAVE EXISTING CREDITABLE COVERAGE RECEIVES CERTIFICATION FROM A21 HEALTH-CARE PROVIDER ACTING WITHIN THE PROVIDER 'S SCOPE OF22 PRACTICE THAT THE INDIVIDUAL IS PREGNANT . COVERAGE IS DEEMED23 EFFECTIVE AS OF THE FIRST MONTH IN WHICH THE INDIVIDUAL RECEIVES24 CERTIFICATION OF THE PREGNANCY , UNLESS THE INDIVIDUAL ELECTS TO25 HAVE COVERAGE EFFECTIVE ON THE FIRST DAY OF THE MONTH FOLLOWING26 THE DATE THAT THE INDIVIDUAL MAKES A PLAN SELECTION . ANY PERSON27 1289 -5- OR ENTITY ENROLLING AN INDIVIDUAL IN COVERAGE PURSUANT TO THIS1 SPECIAL ENROLLMENT PERIOD SHALL PROVIDE A NOTICE , DEVELOPED BY2 THE DEPARTMENT THROUGH A STAKEHOLDER PROCESS , TO THE3 INDIVIDUAL REGARDING THE INDIVIDUAL 'S OPTION TO BEGIN COVERAGE4 EITHER PROSPECTIVELY OR RETROACTIVELY AND THE FINANCIAL AND TAX5 IMPLICATIONS OF THOSE OPTIONS. THE NOTICE MUST BE IN, AT A MINIMUM,6 E NGLISH AND SPANISH.7 SECTION 4. In Colorado Revised Statutes, 10-16-1207, repeal8 (4)(c)(IV)(A); and add (4)(c.5) as follows:9 10-16-1207. Health insurance affordability board - creation -10 membership - powers and duties - subject to open meetings and11 public records laws - commissioner rules. (4) The board is authorized12 to:13 (c) Recommend, for approval and establishment by the14 commissioner by rule:15 (IV) The parameters for implementing the subsidies for16 state-subsidized individual health coverage plans authorized by this part17 12, including:18 (A) The coverage required under state-subsidized individual19 health coverage plans, which coverage must maximize affordability for20 qualified individuals and must include coverage for the lowest income21 group, as determined by the board, that has no premium and provides22 benefits actuarially equivalent to ninety percent of the full actuarial value23 of the benefits provided under the plan; and24 (c.5) F URTHER RECOMMEND , FOR APPROVAL AND ESTABLISHMENT25 BY THE COMMISSIONER BY RULE , ADDITIONAL PARAMETERS FOR26 IMPLEMENTING THE SUBSIDIES FOR STATE-SUBSIDIZED INDIVIDUAL HEALTH27 1289 -6- COVERAGE PLANS AUTHORIZED BY THIS PART 12, INCLUDING THAT THE1 COVERAGE REQUIRED PURSUANT TO STATE -SUBSIDIZED INDIVIDUAL2 HEALTH COVERAGE PLANS MUST :3 (I) M AXIMIZE AFFORDABILITY FOR QUALIFIED INDIVIDUALS ;4 (II) C OVER BENEFITS EQUIVALENT TO THOSE IN A QUALIFIED5 HEALTH PLAN; AND6 (III) F OR A PERSON WHO, AT THE TIME THE PERSON APPLIES FOR7 STATE-SUBSIDIZED COVERAGE, MEETS THE INCOME REQUIREMENTS TO8 QUALIFY FOR EMERGENCY MEDICAL ASSISTANCE PURSUANT TO SECTION9 25.5-5-103 AND WHO IS A QUALIFIED INDIVIDUAL WHO MEETS THE10 ELIGIBILITY CRITERIA ESTABLISHED IN RULE PURSUANT TO SUBSECTION11 (4)(c)(IV) OF THIS SECTION, INCLUDE COVERAGE THAT:12 (A) H AS NO PREMIUM;13 (B) H AS AN ACTUARIAL VALUE OF NOT LESS THAN NINETY -FOUR14 PERCENT; AND15 (C) T O THE EXTENT POSSIBLE WITH AVAILABLE F UNDING ,16 INCLUDES COST SHARING THAT IS FURTHER REDUCED FROM SUBSECTION17 (4)(c.5)(III)(B) OF THIS SECTION SUCH THAT THE PLAN HAS CONSUMER18 COST SHARING RESPONSIBILITIES FOR EMERGENCY SERVICES EQUIVALENT19 TO COST SHARING RESPONSIBILITIES FOR EMERGENCY MEDICAL20 ASSISTANCE PURSUANT TO SECTION 25.5-5-103.21 SECTION 5. In Colorado Revised Statutes, 24-75-109, add22 (1)(a.7) and (1)(a.8) as follows:23 24-75-109. Controller may allow expenditures in excess of24 appropriations - limitations - appropriations for subsequent fiscal25 year restricted - repeal. (1) For the purpose of closing the state's books,26 and subject to the provisions of this section, the controller may, on or27 1289 -7- after May 1 of any fiscal year and before the forty-fifth day after the close1 thereof, upon approval of the governor, allow any department, institution,2 or agency of the state, including any institution of higher education, to3 make an expenditure in excess of the amount authorized by an item of4 appropriation for such fiscal year if:5 (a.7) THE OVEREXPENDITURE IS BY THE DEPARTMENT OF HEALTH6 CARE POLICY AND FINANCING FOR THE STATE MEDICAL ASSISTANCE7 PROGRAM, ESTABLISHED PURSUANT TO SECTION 25.5-2-104; OR8 (a.8) THE OVEREXPENDITURE IS BY THE DEPARTMENT OF HEALTH9 CARE POLICY AND FINANCING FOR THE STATE CHILDREN'S BASIC HEALTH10 PLAN, ESTABLISHED PURSUANT TO SECTION 25.5-2-105; OR11 SECTION 6. In Colorado Revised Statutes, 25-1.5-101, add12 (1)(cc) as follows:13 25-1.5-101. Powers and duties of department - laboratory cash14 fund - report - dispensation of payments under contracts with15 grantees - definitions - repeal. (1) The department has, in addition to all16 other powers and duties imposed upon it by law, the powers and duties17 provided in this section as follows:18 (cc) T O CARRY OUT THE HEALTH SURVEY FOR BIRTHING PARENTS19 AND REPORTING REQUIREMENTS SET FORTH IN PART 7 OF THIS ARTICLE 1.5.20 SECTION 7. In Colorado Revised Statutes, add part 7 to article21 1.5 of title 25 as follows:22 PART 723 HEALTH SURVEY FOR BIRTHING PARENTS24 25-1.5-701. Health survey for birthing parents. (1) B EGINNING25 J ULY 1, 2022, THE DEPARTMENT SHALL BEGIN DEVELOPING A26 METHODOLOGY AND BUILDING A HEALTH SURVEY FOR BIRTHING PARENTS ,27 1289 -8- REFERRED TO IN THIS SECTION AS THE "SURVEY", TO GIVE PEOPLE WHO1 HAVE GIVEN BIRTH THE OPPORTUNITY TO SHARE OPINIONS AND2 EXPERIENCES DURING THE FIRST FEW YEARS OF THEIR BABIES ' LIVES. THE3 PURPOSE OF THE SURVEY IS TO INFORM COLORADO POLICIES AND4 PROGRAMS DESIGNED TO ADVANCE HEALTH EQUITY . AS PART OF THE5 SURVEY, THE DEPARTMENT SHALL:6 (a) I NVITE A STATEWIDE COHORT OF PEOPLE WHO HAVE RECENTLY7 GIVEN BIRTH TO JOIN THE SURVEY;8 (b) A NNUALLY AND UP UNTIL A SURVEY PARTICIPANT 'S CHILD'S9 THIRD BIRTHDAY, PROVIDE TO EACH PARTICIPANT AT LEAST TWO BRIEF10 ONLINE QUESTIONNAIRES ON A VARIETY OF HEALTH AND SOCIAL TOPICS ,11 INCLUDING:12 (I) H OW THE PARTICIPANT FEELS PHYSICALLY AND EMOTIONALLY13 AFTER HAVING GIVEN BIRTH;14 (II) T HE PARTICIPANT'S MENTAL HEALTH AND SUBSTANCE USE15 BEFORE, DURING, AND AFTER PREGNANCY;16 (III) T HE PARTICIPANT'S OPINIONS ON CHILDHOOD VACCINATIONS17 AND OTHER IMPORTANT HEALTH DECISIONS ;18 (IV) T HE PARTICIPANT'S ABILITY TO TAKE LEAVE FROM WORK ;19 (V) T HE PARTICIPANT'S ABILITY TO FEED THE PARTICIPANT'S BABY20 IN THE PARTICIPANT'S PREFERRED WAY;21 (VI) T HE PARTICIPANT'S EXPERIENCES WITH DOCTORS AND OTHER22 HEALTH-CARE WORKERS DURING AND AFTER PREGNANCY , INCLUDING ANY23 EXPERIENCES OF DISCRIMINATION; AND24 (VII) T HE PARTICIPANT'S FAMILY'S ACCESS TO HEALTH CARE AND25 HEALTH SERVICES, INCLUDING BEHAVIORAL HEALTH SERVICES AND ORAL26 HEALTH SERVICES, AND OTHER RESOURCES NECESSARY FOR THE FAMILY27 1289 -9- TO BE HAPPY AND HEALTHY.1 (2) T HE SURVEY MUST BE DESIGNED TO OVERSAMPLE MEMBERS OF2 GROUPS THAT COMPRISE A SMALL PERCENTAGE OF THE POPULATION AND3 THAT DISPROPORTIONATELY EXPERIENCE HEALTH INEQUITIES , INCLUDING4 A FRICAN AMERICANS AND NATIVE AMERICANS, SO THAT DATA ABOUT5 THE EXPERIENCES OF THESE POPULATIONS CAN BE MADE PUBLIC .6 P ARTICIPANT DATA ABOUT RACE, ETHNICITY, SEXUAL ORIENTATION, AND7 GENDER IDENTITY MUST BE COLLECTED AND REPORTED IN A M ANNER THAT8 PROTECTS PERSONALLY IDENTIFYING INFORMATION .9 SECTION 8. In Colorado Revised Statutes, 25.5-2-103, amend10 (1)(b) as follows:11 25.5-2-103. Reproductive health-care program - report - rules12 - definitions. (1) As used in this section, unless the context otherwise13 requires:14 (b) "Eligible individual" means an individual with reproductive15 capacity, regardless of gender, citizenship, or immigration status, who16 would be eligible to enroll in the medical assistance program, except that17 the individual is not a citizen of the United States and is not considered18 an eligible noncitizen pursuant to 8 U.S.C. secs. 1611 and 1612 and19 section 25.5-5-101 (2)(b) AS DESCRIBED IN SECTION 25.5-4-103 (13) BUT20 IS NOT ELIGIBLE DUE SOLELY TO THE INDIVIDUAL'S IMMIGRATION STATUS,21 AND WHO IS NOT ELIGIBLE FOR, OR DECLINES TO ENROLL IN, STATE22 MEDICAL ASSISTANCE, AS DESCRIBED IN SECTION 25.5-2-104.23 SECTION 9. In Colorado Revised Statutes, add 25.5-2-104 and24 25.5-2-105 as follows:25 25.5-2-104. State-funded health and medical care.26 (1) B EGINNING NO LATER THAN JANUARY 1, 2025, THERE IS CREATED THE27 1289 -10- STATE MEDICAL ASSISTANCE PROGRAM REFERRED TO IN THIS SECTION AS1 " STATE MEDICAL ASSISTANCE". STATE MEDICAL ASSISTANCE INCLUDES2 ALL BENEFITS AND SERVICES AT THE SAME COST TO THE BENEFICIARY AS3 ARE OFFERED PURSUANT TO THE MEDICAL ASSISTANCE PROGRAM DEFINED4 IN SECTION 25.5-4-103 (13), SUCH THAT, TO THE MAXIMUM EXTENT5 POSSIBLE, ELIGIBLE INDIVIDUALS MUST NOT BE ABLE TO TELL THAT THE6 PERSON IS ENROLLED IN A DIFFERENT PROGRAM FROM MEDICAL7 ASSISTANCE PURSUANT TO SECTION 25.5-4-103 (13).8 (2) A CHILD WHO IS LESS THAN NIN ETEEN YEARS OF AGE IS9 ELIGIBLE TO RECEIVE STATE MEDICAL ASSISTANCE IF THE CHILD WOULD BE10 ELIGIBLE FOR MEDICAL ASSISTANCE AS DEFINED IN SECTION 25.5-4-10311 (13) BUT IS NOT ELIGIBLE DUE SOLELY TO THE CHILD 'S IMMIGRATION12 STATUS.13 (3) A CHILD WHO IS LESS THAN NINETEEN YEARS OF AGE IS14 PRESUMPTIVELY ELIGIBLE FOR STATE MEDICAL ASSISTANCE AND WILL15 RECEIVE SERVICES SPECIFIED BY STATE LAW ONLY IF A PARENT OR LEGAL16 GUARDIAN OF THE CHILD DECLARES ALL PERTINENT INFORMATION17 RELATING TO THE CRITERIA OF INCOME AND ASSETS OF THE CHILD 'S18 FAMILY.19 (4) S TATE MEDICAL ASSISTANCE MUST BE FUNDED BY STATE20 FUNDS ONLY, EXCEPT TO THE EXTENT FEDERAL FUNDS ARE MADE21 AVAILABLE THROUGH EXPRESS WRITTEN AUTHORIZATION THROUGH A22 FEDERAL WAIVER, STATE PLAN AMENDMENT , OR OTHERWISE, BY THE23 CENTERS FOR MEDICARE AND MEDICAID SERVICES .24 (5) T HE STATE DEPARTMENT SHALL SEEK ANY NECESSARY25 FEDERAL APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL26 PARTICIPATION IN IMPLEMENTING THIS SECTION .27 1289 -11- (6) TO THE MAXIMUM EXTENT ALLOWABLE UNDER FEDERAL LAW ,1 THE STATE DEPARTMENT SHALL , USING APPROPRIATE FUNDING, USE THE2 SAME INFRASTRUCTURE AND PROVIDER NETWORK TO DELIVER STATE3 MEDICAL ASSISTANCE AS IT DOES TO DELIVER MEDICAL ASSISTANCE AS4 DEFINED IN SECTION 25.5-4-103 (13).5 (7) T HIS SECTION CONSTITUTES STATE AUTHORITY WITHIN THE6 MEANING OF 8 U.S.C. SEC. 1621 (d), AS THAT LAW EXISTED ON JANUARY7 1, 2022.8 (8) (a) DURING ITS 2024 PRESENTATION TO THE JOINT BUDGET9 COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS PRESENTATION TO THE10 HEALTH AND HUMAN SERVICES COMMITTEE OF THE SENATE AND THE11 HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF REPRESENTATIVES ,12 OR ANY SUCCESSOR COMMITTEES, AT THE HEARING HELD PURSUANT TO13 SECTION 2-7-203 (2)(a) OF THE "STATE MEASUREMENT FOR14 ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT (SMART)15 GOVERNMENT ACT", THE STATE DEPARTMENT SHALL REPORT ON ITS16 PLANS AND PROGRESS IN IMPLEMENTING STATE MEDICAL ASSISTANCE .17 (b) BEGINNING JANUARY 1, 2026, AND CONTINUING EVERY18 JANUARY THEREAFTER, THE STATE DEPARTMENT, IN ITS PRESENTATION TO19 THE JOINT BUDGET COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS20 PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE21 SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF22 REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES, AT THE HEARING23 HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE24 MEASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT25 (SMART) GOVERNMENT ACT", SHALL REPORT ON THE COST SAVINGS AND26 HEALTH IMPROVEMENTS ASSOCIATED WITH STATE MEDICAL ASSISTANCE.27 1289 -12- 25.5-2-105. State children's basic health plan. (1) B EGINNING1 NO LATER THAN JANUARY 1, 2025, THERE IS CREATED THE STATE2 CHILDREN'S BASIC HEALTH PLAN. THE STATE CHILDREN'S BASIC HEALTH3 PLAN INCLUDES ALL BENEFITS AND SERVICES , AT THE SAME COST TO THE4 BENEFICIARY, AS ARE OFFERED PURSUANT TO THE CHILDREN 'S BASIC5 HEALTH PLAN IN SECTION 25.5-8-107, SUCH THAT, TO THE MAXIMUM6 EXTENT POSSIBLE, ELIGIBLE INDIVIDUALS MUST NOT BE ABLE TO TELL7 THAT THEY ARE ENROLLED IN A DIFFERENT PROGRAM FROM THE PLAN8 DESCRIBED IN SECTION 25.5-8-107.9 (2) A CHILD WHO IS LESS THAN NINETEEN YEARS OF AGE IS10 ELIGIBLE TO RECEIVE THE STATE CHILDREN'S BASIC HEALTH PLAN IF THE11 CHILD WOULD BE ELIGIBLE FOR THE CHILDREN 'S BASIC HEALTH PLAN AS12 DESCRIBED IN 25.5-8-107, BUT IS NOT ELIGIBLE DUE SOLELY TO THE13 CHILD'S IMMIGRATION STATUS.14 (3) A CHILD WHO LESS THAN NI NETEEN YEARS OF AGE IS15 PRESUMPTIVELY ELIGIBLE FOR THE STATE CHILDREN 'S BASIC HEALTH PLAN16 AND WILL RECEIVE SERVICES SPECIFIED BY STATE LAW ONLY IF A PARENT17 OR LEGAL GUARDIAN OF THE CHILD DECLARES ALL PERTINENT18 INFORMATION RELATING TO THE CRITERIA OF INCOME AND ASSETS OF THE19 CHILD'S FAMILY.20 (4) T HE STATE CHILDREN'S BASIC HEALTH PLAN MUST BE FUNDED21 BY STATE FUNDS ONLY, EXCEPT TO THE EXTENT FEDERAL FUNDS ARE22 MADE AVAILABLE THROUGH EXPRESS WRITTEN AUTHORIZATION THR OUGH23 A FEDERAL WAIVER, STATE PLAN AMENDMENT , OR OTHERWISE, BY THE24 CENTERS FOR MEDICARE AND MEDICAID SERVICES .25 (5) T HE STATE DEPARTMENT SHALL SEEK ANY NECESSARY26 FEDERAL APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL27 1289 -13- PARTICIPATION IN IMPLEMENTING THIS SECTION .1 (6) T O THE MAXIMUM EXTENT ALLOWABLE UNDER FEDERAL LAW ,2 THE STATE DEPARTMENT SHALL , USING APPROPRIATE FUNDING, USE THE3 SAME INFRASTRUCTURE AND PROVIDER NETWORK TO DELIVER THE STATE 'S4 CHILDREN'S BASIC HEALTH PLAN AS IT DOES TO DELIVER THE CHILDREN 'S5 BASIC HEALTH PLAN DESCRIBED IN SECTION 25.5-8-107.6 (7) T HIS SECTION CONSTITUTES STATE AUTHORITY WITHIN THE7 MEANING OF 8 U.S.C. SEC. 1621 (d), AS THAT LAW EXISTED ON JANUARY8 1, 2022.9 (8) (a) DURING ITS 2024 PRESENTATION TO THE JOINT BUDGET10 COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS PRESENTATION TO THE11 HEALTH AND HUMAN SERVICES COMMITTEE OF THE SENATE AND THE12 HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF REPRESENTATIVES,13 OR ANY SUCCESSOR COMMITTEES , AT THE HEARING HELD PURSUANT TO14 SECTION 2-7-203 (2)(a) OF THE "STATE MEASUREMENT FOR15 ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT (SMART)16 GOVERNMENT ACT", THE STATE DEPARTMENT SHALL REPORT ON ITS17 PLANS AND PROGRESS IN IMPLEMENTING THE STATE BASIC HEALTH PLAN.18 (b) BEGINNING JANUARY 1, 2026, AND CONTINUING EVERY19 JANUARY THEREAFTER, THE STATE DEPARTMENT, IN ITS PRESENTATION TO20 THE JOINT BUDGET COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS21 PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE22 SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF23 REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES , AT THE HEARING24 HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE25 MEASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT26 (SMART) GOVERNMENT ACT", SHALL REPORT ON THE COST SAVINGS AND27 1289 -14- HEALTH IMPROVEMENTS ASSOCIATED WITH THE STATE BASIC HEALTH1 PLAN.2 SECTION 10. In Colorado Revised Statutes, 25.5-4-103, amend3 (10) as follows:4 25.5-4-103. Definitions. As used in this article 4 and articles 55 and 6 of this title 25.5, unless the context otherwise requires:6 (10) "Legal immigrant" "LAWFULLY RESIDING" means an7 individual who is not a citizen or national of the United States and who8 was lawfully admitted to the United States by the immigration and9 naturalization service, or any successor agency, as an actual or10 prospective permanent resident or whose extended physical presence in11 the United States is known to and allowed by the immigration and12 naturalization service, or any successor agency.13 SECTION 11. In Colorado Revised Statutes, 25.5-4-201, amend14 (1) as follows:15 25.5-4-201. Cash system of accounting - financial16 administration of medical services premiums - medical programs17 administered by department of human services - federal18 contributions - rules. (1) The state department shall utilize the cash19 system of accounting, as enunciated by the governmental accounting20 standards board, regardless of the source of revenues involved, for all21 activities of the state department relating to the financial administration22 of any nonadministrative expenditure that qualifies for federal financial23 participation under Title XIX of the federal "Social Security Act", AND24 FOR THE ADMINISTRATION OF THE STATE-FUNDED HEALTH AND MEDICAL25 CARE PROGRAM, CREATED PURSUANT TO SECTION 25.5-2-104, AND FOR26 THE STATE CHILDREN'S BASIC HEALTH PLAN, CREATED PURSUANT TO27 1289 -15- SECTION 25.5-2-105, except for expenditures under the program for the1 medically indigent, article 3 of this title TITLE 25.5.2 SECTION 12. In Colorado Revised Statutes, 25.5-4-301, amend3 (13) as follows:4 25.5-4-301. Recoveries - overpayments - penalties - interest -5 adjustments - liens - review or audit procedures. (13) To the extent6 allowable under federal law, the state department shall recover from a7 legal immigrant's THE sponsor OF A LAWFULLY RESIDING INDIVIDUAL all8 medical assistance paid on behalf of a THE sponsored legal immigrant9 LAWFULLY RESIDING INDIVIDUAL who is enrolled in the medical assistance10 program.11 SECTION 13. In Colorado Revised Statutes, amend 25.5-4-50312 as follows:13 25.5-4-503. Waiver applications - authorization. (1) The state14 department is authorized to apply for health insurance flexibility and15 accountability waivers that will enable the state to add more flexibility to16 Colorado's medicaid program and that will result in a cost-effective17 method of providing health-care services to Coloradans.18 (2) T HE STATE DEPARTMENT SHALL PURSUE AND , IF APPROVED,19 IMPLEMENT A DEMONSTRATION WAIVER THAT AUTHORIZES THE STATE TO20 USE FEDERAL MEDICAL ASSISTANCE PAYMENTS AUTHORIZED PURSUANT TO21 SECTION 1903(v) OF THE FEDERAL "SOCIAL SECURITY ACT", AS AMENDED,22 IN COORDINATION WITH THE DIVISION OF INSURANCE TO ENHANCE OR23 EXPAND A STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLAN AS24 DEFINED IN SECTION 10-16-1203 (15) AND, ONLY IF NEEDED TO MAXIMIZE25 FEDERAL FINANCIAL PARTICIPATION, FOR COLORADANS RECEIVING STATE26 MEDICAL ASSISTANCE PURSUANT TO SECTION 25.5-2-104 OR 25.5-5-20127 1289 -16- (6). TO THE EXTENT SUCH FEDERAL FUNDS ARE USED TO ENHANCE OR1 EXPAND A STATE-SUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLAN, AS2 DEFINED IN SECTION 10-16-1203 (15), THE HEALTH INSURANCE3 AFFORDABILITY ENTERPRISE CREATED PURSUANT TO SECTION 10-16-12044 MUST RECEIVE, DEPOSIT INTO THE HEALTH INSURANCE AFFORDABILITY5 CASH FUND CREATED IN SECTION 10-16-1206, AND ALLOCATE THE6 FEDERAL SHARE OF THE MEDICAL ASSISTANCE PAYMENTS PURSUANT TO7 SECTION 10-16-1205 (2), SUBJECT TO ANY CONDITIONS SET FORTH IN THE8 APPROVAL OF THE WAIVER.9 SECTION 14. In Colorado Revised Statutes, 25.5-5-101, amend10 (3) as follows:11 25.5-5-101. Mandatory provisions - eligible groups.12 (3) Notwithstanding any other provision of this article and articles 4 and13 6 of this title TITLE 25.5, as a condition of eligibility for medical14 assistance under this article ARTICLE 5 and articles 4 and 6 of this title15 TITLE 25.5, a legal immigrant PERSON WHO IS LAWFULLY RESIDING IN THE16 STATE shall agree to refrain from executing an affidavit of support for the17 purpose of sponsoring an alien on or after July 1, 1997, under rules18 promulgated by the immigration and naturalization service, or any19 successor agency, during the pendency of such legal immigrant's THE20 LAWFULLY RESIDING PERSON'S receipt of medical assistance. Nothing in21 this subsection (3) shall be construed to affect a legal immigrant's22 AFFECTS A LAWFULLY RESIDING PERSON'S eligibility for medical assistance23 under this article PURSUANT TO THIS ARTICLE 5 and articles 4 and 6 of this24 title TITLE 25.5 based upon such legal immigrant's THE LAWFULLY25 RESIDING PERSON'S responsibilities under an affidavit of support entered26 into before July 1, 1997.27 1289 -17- SECTION 15. In Colorado Revised Statutes, 25.5-5-201, amend1 (3), (4) and (4.5)(a); and add (6) as follows:2 25.5-5-201. Optional provisions - optional groups. (3) A legal3 immigrant LAWFULLY RESIDING PERSON who is receiving medicaid4 nursing facility care or home- and community-based services on July 1,5 1997, shall MUST continue to receive such services as long as he or she6 THE PERSON meets the eligibility requirements other than citizen status.7 State general funds may be used to reimburse such care in the event that8 federal financial participation is not available.9 (4) A pregnant legal immigrant shall be PERSON WHO IS LAWFULLY10 RESIDING IS eligible to receive prenatal and medical services for labor and11 delivery as long as she MEDICAL ASSISTANCE AS LONG AS THE INDIVIDUAL12 meets eligibility requirements other than THOSE RELATED TO citizen OR13 IMMIGRATION status. State general funds may be used to reimburse such14 care in the event that federal financial participation is not available.15 (4.5) (a) Subject to the receipt of federal financial participation,16 to the maximum extent allowed under federal law, a person who was17 eligible for all pregnancy-related and postpartum services under the18 medical assistance program for the sixty days following the pregnancy19 remains continuously eligible for all services under the medical assistance20 program for the twelve-month postpartum period.21 (6) (a) B EGINNING NO LATER THAN JANUARY 1, 2025, A PREGNANT22 PERSON WHO IS NOT A CITIZEN AND WHO IS NOT ELIGIBLE FOR MEDICAL23 ASSISTANCE PURSUANT TO SUBSECTION (4) OF THIS SECTION IS ELIGIBLE TO24 RECEIVE MEDICAL ASSISTANCE PURSUANT TO THIS SUBSECTION (6)(a) IF25 THE INDIVIDUAL MEETS THE ELIGIBILITY REQUIREMENTS OTHER THAN26 THOSE RELATED TO CITIZENSHIP AND IMMIGRATION STATUS .27 1289 -18- (b) A PREGNANT PERSON WHO IS ELIGIBLE FOR MEDICAL1 ASSISTANCE PURSUANT TO THIS SUBSECTION (6) REMAINS CONTINUOUSLY2 ELIGIBLE FOR ALL MEDICAL SERVICES PURSUANT TO THE MEDICAL3 ASSISTANCE PROGRAM FOR THE TWELVE -MONTH POSTPARTUM PERIOD, SO4 LONG AS ELIGIBILITY REMAINS IN EFFECT PURSUANT TO SUBSECTION5 (4.5)(a) OF THIS SECTION.6 (c) T HE STATE DEPARTMENT SHALL SEEK ANY NECESSARY7 FEDERAL APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL8 PARTICIPATION IN IMPLEMENTING THIS SUBSECTION (6). BENEFITS FOR9 SERVICES OBTAINED PURSUANT TO THIS SUBSECTION (6) MUST BE10 PROVIDED WITH ONLY STATE FUNDS IF FEDERAL FINANCIAL PARTICIPATION11 IS UNAVAILABLE FOR SUCH SERVICES.12 (d) (I) DURING ITS 2024 PRESENTATION TO THE JOINT BUDGET13 COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS PRESENTATION TO THE14 HEALTH AND HUMAN SERVICES COMMITTEE OF THE SENATE AND THE15 HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF REPRESENTATIVES ,16 OR ANY SUCCESSOR COMMITTEES , AT THE HEARING HELD PURSUANT TO17 SECTION 2-7-203 (2)(a) OF THE "STATE MEASUREMENT FOR18 ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT (SMART)19 GOVERNMENT ACT", THE STATE DEPARTMENT SHALL REPORT ON ITS20 PLANS AND PROGRESS IN IMPLEMENTING THE COVERAGE EXPANSION21 CREATED PURSUANT TO THIS SUBSECTION (6).22 (II) BEGINNING JANUARY 1, 2026, AND CONTINUING EVERY23 JANUARY THEREAFTER, THE STATE DEPARTMENT, IN ITS PRESENTATION TO24 THE JOINT BUDGET COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS25 PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE26 SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF27 1289 -19- REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES, AT THE HEARING1 HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE2 MEASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT3 (SMART) GOVERNMENT ACT", SHALL REPORT ON THE COST SAVINGS AND4 HEALTH IMPROVEMENTS ASSOCIATED WITH THE COVERAGE EXPANSION5 CREATED PURSUANT TO THIS SUBSECTION (6).6 SECTION 16. In Colorado Revised Statutes, 25.5-5-202, add7 (1)(y) as follows:8 25.5-5-202. Basic services for the categorically needy - optional9 services. (1) Subject to the provisions of subsection (2) of this section,10 the following are services for which federal financial participation is11 available and that Colorado has selected to provide as optional services12 under the medical assistance program:13 (y) F OR ANY PERINATAL PERSON , COMPREHENSIVE LACTATION14 SUPPORT SERVICES, LACTATION SUPPLIES AND EQUIPMENT, AND15 MAINTENANCE OF MULTI-USER LOANED EQUIPMENT. AN INDIVIDUAL16 TRAINED IN ADVANCED LACTATION SUPPORT SHALL PROVIDE THE17 LACTATION SUPPORT SERVICES. LACTATION EQUIPMENT MUST INCLUDE A18 SINGLE-USER DOUBLE ELECTRIC BREAST PUMP, PUMP PARTS AND PUMP19 COLLECTION KIT, AND ACCESS TO A LOANED MULTI-USER HOSPITAL GRADE20 ELECTRIC BREAST PUMP ALONG WITH A COMPATIBLE INDIVIDUAL21 COLLECTION KIT. INDIVIDUALS MUST HAVE ACCESS TO SINGLE-USER22 LACTATION SUPPLIES AND EQUIPMENT PRIOR TO DELIVERY. ACCESS TO23 MULTI-USER LOANED BREAST PUMPS SHALL BE AUTHORIZED BY A24 HEALTH-CARE PROVIDER. ACCESS TO MULTI-USER LOANED BREAST PUMPS25 IS PRIORITIZED FOR INDIVIDUALS WITH PREMATURE, MEDICALLY FRAGILE,26 LOW BIRTH WEIGHT INFANTS, AND WITH LACTATION COMPLICATIONS .27 1289 -20- INDIVIDUALS CANNOT BE REQUIRED TO ENROLL IN SEPARATE OR1 ADDITIONAL PROGRAMS IN ORDER TO RECEIVE COVERED LACTATION2 EQUIPMENT OR LACTATION SUPPORT SERVICES .3 SECTION 17. In Colorado Revised Statutes, 25.5-5-204, amend4 (2) and (2.5) as follows:5 25.5-5-204. Presumptive eligibility - pregnant person -6 children - long-term care - state plan. (2) (a) A pregnant woman shall7 be PERSON IS presumptively eligible for the medical assistance program8 and shall receive services specified by federal law only if the woman9 PERSON declares all pertinent information relating to the criteria of10 income, assets, and status AND, ONLY IF NECESSARY TO ADMINISTER11 REIMBURSEMENT FOR SERVICES , STATUS.12 (b) A woman shall declare her immigration status unless the13 general assembly provides funding for prenatal care services for14 undocumented residents.15 (2.5) A child under the age of eighteen years shall be LESS THAN16 NINETEEN YEARS OF AGE IS presumptively eligible for the medical17 assistance program and shall receive services specified by federal law18 only if a parent or legal guardian of the child declares all pertinent19 information relating to the criteria of income, assets, and status AND,20 ONLY IF NECESSARY TO ADMINISTER REIMBURSEMENT FOR SERVICES ,21 STATUS of the child's family.22 SECTION 18. In Colorado Revised Statutes, add 25.5-6-115 as23 follows:24 25.5-6-115. Notification of federal immigration consequences.25 T HE STATE DEPARTMENT SHALL CONSULT WITH STAKEHOLDERS ,26 INCLUDING PEOPLE WITH LIVED EXPERIENCE , IMMIGRANTS RIGHTS27 1289 -21- ADVOCATES, HEALTH-CARE ADVOCATES, AND IMMIGRATION LAWYERS, TO1 PROVIDE CLEAR AND ACCURATE INFORMATION AND REFERRALS2 REGARDING CURRENT PUBLIC CHARGE POLICIES .3 SECTION 19. In Colorado Revised Statutes, 25.5-8-103, amend4 (4)(a)(I) and (4)(b)(I) as follows:5 25.5-8-103. Definitions. As used in this article 8, unless the6 context otherwise requires:7 (4) "Eligible person" means:8 (a) (I) A person who is less than nineteen years of age, WHO IS A9 CITIZEN OR MEETS THE IMMIGRATION STATUS REQUIREMENTS SET FORTH10 IN SECTION 25.5-8-109 (6) OR 25.5-8-109 (7), whose family income does11 not exceed two hundred fifty percent of the federal poverty line, adjusted12 for family size, AND WHO IS NOT ELIGIBLE FOR MEDICAL ASSISTANCE13 PURSUANT TO ARTICLES 4, 5, AND 6 OF THIS TITLE 25.5.14 (b) (I) A pregnant woman PERSON WHO IS A CITIZEN OR MEETS THE15 IMMIGRATION STATUS REQUIREMENTS SET FORTH IN SECTION 25.5-8-10916 (6) OR 25.5-8-109 (7), whose family income does not exceed two hundred17 fifty percent of the federal poverty line, adjusted for family size, and who18 is not eligible for medicaid MEDICAL ASSISTANCE PURSUANT TO ARTICLES19 4, 5, AND 6 OF THIS TITLE 25.5.20 SECTION 20. In Colorado Revised Statutes, 25.5-8-107, add21 (1)(a)(V) and (1)(i) as follows:22 25.5-8-107. Duties of the department - schedule of services -23 premiums - copayments - subsidies - purchase of childhood24 immunizations. (1) In addition to any other duties pursuant to this article25 8, the department has the following duties:26 (a) (V) I N ADDITION TO THE ITEMS SPECIFIED IN SUBSECTIONS27 1289 -22- (1)(a)(I), (1)(a)(II), AND (1)(a)(III) OF THIS SECTION, AND ANY1 ADDITIONAL ITEMS APPROVED BY THE MEDICAL SERVICES BOARD , THE2 MEDICAL SERVICES BOARD SHALL INCLUDE , FOR ALL PERINATAL PEOPLE,3 COMPREHENSIVE LACTATION SUPPORT SERVICES , LACTATION SUPPLIES4 AND EQUIPMENT, AND MAINTENANCE OF MULTI-USER LOANED EQUIPMENT.5 AN INDIVIDUAL TRAINED IN ADVANCED LACTATION SUPPORT SHALL6 PROVIDE THE LACTATION SUPPORT SERVICES. LACTATION EQUIPMENT7 MUST INCLUDE A SINGLE-USER DOUBLE ELECTRIC BREAST PUMP, PUMP8 PARTS AND PUMP COLLECTION KIT, AND ACCESS TO A LOANED MULTI-USER9 HOSPITAL GRADE ELECTRIC BREAST PUMP ALONG WITH A COMPATIBLE10 INDIVIDUAL COLLECTION KIT. INDIVIDUALS MUST HAVE ACCESS TO11 SINGLE-USER LACTATION SUPPLIES AND EQUIPMENT PRIOR TO DELIVERY.12 ACCESS TO MULTI-USER LOANED BREAST PUMPS SHALL BE AUTHORIZED BY13 A HEALTH-CARE PROVIDER. ACCESS TO MULTI-USER LOANED BREAST14 PUMPS IS PRIORITIZED FOR INDIVIDUALS WITH PREMATURE, MEDICALLY15 FRAGILE, LOW BIRTH WEIGHT INFANTS , AND WITH LACTATION16 COMPLICATIONS. INDIVIDUALS CANNOT BE REQUIRED TO ENROLL IN17 SEPARATE OR ADDITIONAL PROGRAMS IN ORDER TO RECEIVE COVERED18 LACTATION EQUIPMENT OR LACTATION SUPPORT SERVICES .19 (i) (I) T HE DEPARTMENT SHALL DEVELOP AND IMPLEMENT AN20 OUTREACH STRATEGY FOR COLORADANS WHO BECOME ELIGIBLE FOR21 HEALTH COVERAGE PURSUANT TO SECTION 25.5-2-104, 25.5-2-105,22 25.5-5-201 (6), OR 25.5-8-109 (7). THE STATE DEPARTMENT SHALL WORK23 WITH STAKEHOLDERS TO DEVELOP AN OUTREACH STRATEGY THAT24 INCLUDES:25 (A) F UNDING FOR COMMUNITY -BASED ORGANIZATIONS TO26 PARTNER WITH THE DEPARTMENT ON OUTREACH ;27 1289 -23- (B) A METHOD FOR PROVIDING INFORMATION RELATED TO1 ELIGIBILITY AND ENROLLMENT THAT CAN BE PROVIDED TO NONPROFIT2 PARTNERS, SCHOOL DISTRICTS, AND CHARTER SCHOOLS FOR OUTREACH3 PURPOSES; AND4 (C) A T A MINIMUM, PROVIDING INFORMATION RELATED TO5 ELIGIBILITY AND COVERAGE IN ENGLISH, SPANISH, AND IN EACH6 LANGUAGE SPOKEN BY AT LEAST TWO -AND-ONE-HALF PERCENT OF THE7 POPULATION OF ANY COUNTY WHO SPEAK ENGLISH LESS THAN VERY WELL,8 AS DEFINED BY THE UNITED STATES BUREAU OF THE CENSUS AMERICAN9 COMMUNITY SURVEY , AND WHO SPEAK THE MINORITY LANGUAGE AT10 HOME;11 (II) APPROXIMATELY TWELVE AND TWENTY -FOUR MONTHS AFTER12 IMPLEMENTATION OF THE STRATEGY REQUIRED PURSUANT TO SUBSECTION13 (1)(i)(I) OF THIS SECTION, THE DEPARTMENT SHALL CONVENE14 STAKEHOLDERS, INCLUDING DIRECTLY IMPACTED INDIVIDUALS , SERVICE15 PROVIDERS, AND ADVOCACY ORGANIZATIONS THAT ARE DIVERSE WITH16 REGARD TO RACE , ETHNICITY, IMMIGRATION STATUS , SEXUAL17 ORIENTATION, AND GENDER IDENTITY AND WHO ARE AFFECTED BY HIGHER18 RATES OF HEALTH DISPARITIES AND INEQUITIES. THE DEPARTMENT SHALL19 REPORT ON THE OUTREACH AND ENROLLMENT STRATEGY OUTCOMES ,20 INCLUDING ENROLLMENT OF ELIGIBLE PERSONS INTO THESE PROGRAMS21 COMPARED TO THOSE PERSONS WHO ARE ELIGIBLE FOR COVERAGE , BUT22 NOT ENROLLED.23 24 SECTION 21. 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 1289 -24- (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 NO LATER THAN JANUARY 1, 2025,17 NOTWITHSTANDING ANY OTHER PROVISION OF LAW , THE DEPARTMENT18 SHALL PROVIDE BENEFITS PURSUANT TO THIS ARTICLE 8 TO A PREGNANT19 PERSON WHO IS NOT A CITIZEN AND IS NOT ELIGIBLE PURSUANT TO20 SUBSECTION (6) OF THIS SECTION, SO LONG AS THE PREGNANT PERSON21 MEETS THE ELIGIBILITY CRITERIA OTHER THAN THOSE RELATED TO22 CITIZENSHIP OR IMMIGRATION STATUS . ELIGIBILITY PURSUANT TO THIS23 SECTION EXTENDS CONTINUOUSLY THROUGH THE TWELVE -MONTH24 POSTPARTUM PERIOD, SO LONG AS ELIGIBILITY REMAINS IN EFFECT25 PURSUANT TO SUBSECTION (5.5)(a) OF THIS SECTION.26 (b) T HE DEPARTMENT SHALL SEEK ANY NECESSARY FEDERAL27 1289 -25- APPROVALS TO MAXIMIZE ANY AVAILABLE FEDERAL FINANCIAL1 PARTICIPATION IN IMPLEMENTING THIS SUBSECTION (7).2 (c) (I) DURING ITS 2024 PRESENTATION TO THE JOINT BUDGET3 COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS PRESENTATION TO THE4 HEALTH AND HUMAN SERVICES COMMITTEE OF THE SENATE AND THE5 HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF REPRESENTATIVES ,6 OR ANY SUCCESSOR COMMITTEES, AT THE HEARING HELD PURSUANT TO7 SECTION 2-7-203 (2)(a) OF THE "STATE MEASUREMENT FOR8 ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT (SMART)9 GOVERNMENT ACT", THE STATE DEPARTMENT SHALL REPORT ON ITS10 PLANS AND PROGRESS IN IMPLEMENTING THE COVERAGE EXPANSION11 CREATED PURSUANT TO THIS SUBSECTION (7).12 (II) BEGINNING JANUARY 1, 2026, AND CONTINUING EVERY13 JANUARY THEREAFTER, THE STATE DEPARTMENT, IN ITS PRESENTATION TO14 THE JOINT BUDGET COMMITTEE OF THE GENERAL ASSEMBLY AND IN ITS15 PRESENTATION TO THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE16 SENATE AND THE HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF17 REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEES , AT THE HEARING18 HELD PURSUANT TO SECTION 2-7-203 (2)(a) OF THE "STATE19 MEASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT20 (SMART) GOVERNMENT ACT", SHALL REPORT ON THE COST SAVINGS AND21 HEALTH IMPROVEMENTS ASSOCIATED WITH THE COVERAGE EXPANSION22 CREATED PURSUANT TO THIS SUBSECTION (7).23 (d) T HIS SUBSECTION (7) CONSTITUTES STATE AUTHORITY WITHIN24 THE MEANING OF 8 U.S.C. SEC. 1621 (d), AS THAT LAW EXISTED ON25 J ANUARY 1, 2022.26 SECTION 22. In Colorado Revised Statutes, add 25.5-8-109.327 1289 -26- as follows:1 25.5-8-109.3. Health services initiatives. (1) T O THE EXTENT2 FEDERAL FINANCIAL PARTICIPATION IS AVAILABLE , THE DEPARTMENT3 SHALL DESIGN AND IMPLEMENT HEALTH SERVICE INITIATIVES PURSUANT4 TO SECTION 2105(a)(1)(D)(ii) OF THE FEDERAL "SOCIAL SECURITY ACT",5 AS AMENDED, TO PROVIDE FUNDING FOR CONTINUOUS ENROLLMENT FOR6 THE TWELVE-MONTH POSTPARTUM PERIOD FOR A PERSON WHO IS7 ENROLLED IN HEALTH-CARE COVERAGE PURSUANT TO SECTION 25.5-5-2018 (6) OR 25.5-8-109 (7).9 (2) T O THE EXTENT ADDITIONAL FEDERAL FINANCIAL10 PARTICIPATION IS AVAILABLE, THE DEPARTMENT SHALL ESTABLISH A11 STAKEHOLDER PROCESS IN COLLABORATION WITH DEPARTMENT STAFF TO12 DETERMINE ADDITIONAL PRIORITIES AND BUDGET ALLOCATIONS THAT13 DRAW DOWN AT LEAST FIFTY PERCENT OF THE REMAINING HEALTH14 SERVICES INITIATIVE FUNDS TO EXPAND ACCESS TO PERINATAL AND15 POSTPARTUM SUPPORTS . THE DEPARTMENT SHALL REPORT ON THE16 ESTABLISHED PRIORITIES AND BUDGET ALLOCATIONS AND THE WAYS IN17 WHICH THEY ARE INCLUSIVE OF STAKEHOLDER INPUT DURING THE18 DEPARTMENT'S 2024 PRESENTATION TO THE JOINT BUDGET COMMITTEE OF19 THE GENERAL ASSEMBLY AND IN THE DEPARTMENT 'S PRESENTATION TO20 THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE SENATE AND THE21 HEALTH AND INSURANCE COMMITTEE OF THE HOUSE OF REPRESENTATIVES ,22 OR ANY SUCCESSOR COMMITTEES , AT THE HEARING HELD PURSUANT TO23 SECTION 2-7-203 (2)(a) OF THE "STATE MEASUREMENT FOR24 ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT (SMART)25 GOVERNMENT ACT". IN CONDUCTING THE STAKEHOLDER PROCESS , THE26 DEPARTMENT SHALL:27 1289 -27- (a) ENGAGE DIRECTLY WITH IMPACTED INDIVIDUALS , SERVICE1 PROVIDERS, ADVOCACY ORGANIZATIONS , AND INDIVIDUALS WORKING IN2 OR REPRESENTING COMMUNITIES WHO ARE DIVERSE WITH REGARD TO3 RACE, ETHNICITY, IMMIGRATION STATUS , AGE, ABILITY, SEXUAL4 ORIENTATION, GENDER IDENTITY, OR GEOGRAPHIC REGION OF THE STATE5 AND WHO ARE AFFECTED BY HIGHER RATES OF HEALTH DISPARITIES AND6 INEQUITIES;7 (b) P UBLICIZE, CONDUCT, AND REPORT OUTCOMES OF8 STAKEHOLDER MEETINGS IN, AT A MINIMUM, ENGLISH AND SPANISH;9 (c) I NCLUDE OPPORTUNITIES FOR PARTICIPATION IN THE10 STAKEHOLDER PROCESS OUTSIDE OF REGULAR WORK HOURS ;11 (d) CONDUCT A MINIMUM OF FIVE STAKEHOLDER MEETINGS AND12 CONDUCT ADDITIONAL MEETINGS FOCUSED ON HEARING INPUT FROM13 INDIVIDUAL CONSTITUENCIES LISTED IN SUBSECTION (2)(a) OF THIS14 SECTION.15 (e) TAKE INTO CONSIDERATION RESEARCH AND INFORMATION16 FROM REPORTS ISSUED BY THE MATERNAL MORTALITY REVIEW17 COMMITTEE, AS REQUIRED BY SECTION 25-52-104 (6);18 (f) TAKE INTO CONSIDERATION DATA FROM THE HEALTH SURVEY19 FOR BIRTHING PARENTS TO INFORM STAKEHOLDER DECISION -MAKING; AND20 (g) CONSIDER INITIATIVES TO REDUCE DIAPER NEED , EXPAND21 ACCESS TO GROUP-BASED PRENATAL AND PEDIATRIC CARE MODELS , AND22 EXPAND HOME VISITATION PROGRAMS , INCLUDING VOLUNTARY NEWBORN23 NURSE VISITATION PROGRAMS THAT ARE UNIVERSALLY OFFERED TO ALL24 FAMILIES IN A GIVEN COMMUNITY AND PROVIDE AT LEAST ONE NURSE VISIT25 WITHIN THE FIRST THREE MONTHS OF LIFE.26 (3) (a) T HE DEPARTMENT SHALL SEEK ANY NECESSARY FEDERAL27 1289 -28- APPROVALS TO OBTAIN FEDERAL FINANCIAL PARTICIPATION IN1 IMPLEMENTING SUBSECTION (1) OF THIS SECTION.2 (b) T O THE EXTENT ALLOWABLE , THE DEPARTMENT SHALL3 MAXIMIZE FEDERAL FINANCIAL PARTICIPATION IN IMPLEMENTING THIS4 SECTION.5 SECTION 23. Appropriation. (1) For the 2022-23 state fiscal6 year, $730,573 is appropriated to the department of health care policy and7 financing. This appropriation is from the general fund. To implement this8 act, the department may use this appropriation as follows:9 (a) $258,733 for use by the executive director's office for personal10 services, which amount is based on an assumption that the office will11 require an additional 5.1 FTE;12 (b) $29,707 for use by the executive director's office for operating13 expenses;14 (c) $262,500 for general professional services and special15 projects;16 (d) $161,069 for medical and long-term care services for17 Medicaid eligible individuals, which amount is subject to the "(M)"18 notation as defined in the annual general appropriation act for the same19 fiscal year; and20 (e) $18,564 for children's basic health plan medical and dental21 costs.22 (2) For the 2022-23 state fiscal year, the general assembly23 anticipates that the department of health care policy and financing will24 receive $885,480 in federal funds. The appropriation in subsection (1) of25 this section is based on the assumption that the office will receive this26 amount of federal funds to be used as follows:27 1289 -29- (a) $181,587 for use by the executive director's office for personal1 services, which amount is subject to the "(I)" notation as defined in the2 annual general appropriation act for the same fiscal year;3 (b) $20,848 for use by the executive director's office for operating4 expenses, which amount is subject to the "(I)" notation as defined in the5 annual general appropriation act for the same fiscal year;6 (c) $487,500 for general professional services and special7 projects, which amount is subject to the "(I)" notation as defined in the8 annual general appropriation act for the same fiscal year;9 (d) $161,069 for medical and long-term care services for10 Medicaid eligible individuals; and11 (e) $34,476 for children's basic health plan medical and dental12 costs.13 (3) For the 2022-23 state fiscal year, $423,626 is appropriated to14 the department of public health and environment for use by the center for15 health and environmental information. This appropriation is from the16 general fund and is based on an assumption that the center will require an17 additional 2.5 FTE. To implement this act, the center may use this18 appropriation for health statistics and vital records for health surveys.19 SECTION 24. Safety clause. The general assembly hereby finds,20 determines, and declares that this act is necessary for the immediate21 preservation of the public peace, health, or safety.22 1289 -30-