Second Regular Session Seventy-third General Assembly STATE OF COLORADO REREVISED This Version Includes All Amendments Adopted in the Second House LLS NO. 22-0707.01 Chelsea Princell x4335 SENATE BILL 22-052 Senate Committees House Committees Health & Human Services Public & Behavioral Health & Human Services A BILL FOR AN ACT C ONCERNING ALIGNING MEDICAL ASSISTANCE INCOME ELIGIBILITY101 REQUIREMENTS WITH FEDERAL LAW .102 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 aligns the medicaid and children's basic health plan income eligibility requirements for pregnant women and children with federal law. Current law requires money in the healthcare affordability and sustainability fee cash fund (fund) to be used to expand eligibility for medicaid by increasing the income eligibility level for children and HOUSE 3rd Reading Unamended March 9, 2022 HOUSE Amended 2nd Reading March 8, 2022 SENATE 3rd Reading Unamended February 15, 2022 SENATE Amended 2nd Reading February 14, 2022 SENATE SPONSORSHIP Jaquez Lewis and Smallwood, Buckner, Donovan, Hansen, Holbert, Kolker, Moreno, Pettersen, Priola, Rankin, Story, Woodward HOUSE SPONSORSHIP Mullica and Bradfield, Bernett, Bird, Esgar, Exum, Gray, Herod, Hooton, Jodeh, Lindsay, Lontine, McCluskie, McLachlan 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 women under the children's basic health plan to up to 250% of the federal poverty line. The bill increases the eligibility level to up to 260%. Under current law, if the money in the fund is insufficient to fully fund all the purposes of the fund, the medical services board (state board) may reduce the percentage of the federal poverty level. The bill authorizes the state board to reduce the percentage of the federal poverty level to below 260%, but not below 250%. The bill increases the medicaid income eligibility level for pregnant women from 133% of the federal poverty level to a federally approved specified percentage of the federal poverty level, adjusted for family size, as set forth in rules promulgated by the state board. The bill increases the income eligibility level under the children's basic health plan for children and pregnant woman from 250% of the federal poverty level to a federally approved specified percentage of the federal poverty level, adjusted for family size, as set forth in state board rule. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. In Colorado Revised Statutes, 25.5-4-402.4, amend2 (5)(b)(IV)(B) as follows:3 25.5-4-402.4. Hospitals - healthcare affordability and4 sustainability fee - legislative declaration - Colorado healthcare5 affordability and sustainability enterprise - federal waiver - fund6 created - rules - reports - repeal. (5) Healthcare affordability and7 sustainability fee cash fund. (b) All money in the fund is subject to8 federal matching as authorized under federal law and, subject to annual9 appropriation by the general assembly, shall be expended by the10 enterprise for the following purposes:11 (IV) Subject to available revenue from the healthcare affordability12 and sustainability fee and federal matching funds, to expand eligibility for13 public medical assistance by:14 (B) Increasing the eligibility level for children and pregnant15 women under the children's basic health plan to up to two hundred fifty 16 052-2- SIXTY percent of the federal poverty line;1 SECTION 2. In Colorado Revised Statutes, 25.5-5-101, amend2 (1) introductory portion and (1)(c) as follows:3 25.5-5-101. Mandatory provisions - eligible groups - rules.4 (1) In order to participate in the medicaid program, the federal5 government requires the state to provide medical assistance to certain6 eligible groups. Pursuant to federal law and except as provided in7 subsection (2) of this section, any person who is eligible for medical8 assistance under the mandated groups specified in this section shall MUST9 receive both the mandatory services that are specified in sections10 25.5-5-102 and 25.5-5-103 and the optional services that are specified in11 sections 25.5-5-202 and 25.5-5-203. Subject to the availability of federal12 financial participation, the following are the individuals or groups that are13 mandated under federal law to receive benefits under this article ARTICLE14 5 and articles 4 and 6 of this title TITLE 25.5:15 (c) Pregnant women whose family income does not exceed one16 hundred thirty-three percent of the federal poverty line, adjusted for17 family size, who meet the requirements pursuant to section 190218 (a)(10)(A) of the federal "Social Security Act". Once initial eligibility has19 been established, the pregnant woman is continuously eligible throughout20 the pregnancy and for the sixty days following the pregnancy, even if the21 woman's eligibility would otherwise terminate during such period due to22 an increase in income.23 SECTION 3. In Colorado Revised Statutes, 25.5-5-201, amend24 (1) introductory portion and (1)(m.5) as follows:25 25.5-5-201. Optional provisions - optional groups - rules.26 (1) The federal government allows the state to select optional groups to27 052 -3- receive medical assistance. Pursuant to federal law, any person who is1 eligible for medical assistance under the optional groups specified in this2 section shall MUST receive both the mandatory services specified in3 sections 25.5-5-102 and 25.5-5-103 and the optional services specified in4 sections 25.5-5-202 and 25.5-5-203. Subject to the availability of federal5 financial aid funds, the following are the individuals or groups that6 Colorado has selected as optional groups to receive medical assistance7 pursuant to this article ARTICLE 5 and articles 4 and 6 of this title 25.5:8 (m.5) Pregnant women, whose family income does not exceed one9 hundred eighty-five NINETY-FIVE percent of the federal poverty line,10 adjusted for family size; 11 SECTION 4. In Colorado Revised Statutes, 25.5-8-103, amend12 (4)(a)(I), (4)(a)(II), (4)(b)(I), and (4)(b)(II) as follows:13 25.5-8-103. Definitions - rules. As used in this article 8, unless14 the context otherwise requires:15 (4) "Eligible person" means:16 (a) (I) A person who is less than nineteen years of age, whose17 family income does not exceed two hundred fifty SIXTY percent of the18 federal poverty line, adjusted for family size. 19 (II) Notwithstanding the provisions of subsection (4)(a)(I) of this20 section, if the money in the healthcare affordability and sustainability fee21 cash fund established pursuant to section 25.5-4-402.4 (5), together with22 the corresponding federal matching funds, is insufficient to fully fund all23 of the purposes described in section 25.5-4-402.4 (5)(b), after receiving24 recommendations from the Colorado healthcare affordability and25 sustainability enterprise established pursuant to section 25.5-4-402.4 (3),26 for persons less than nineteen years of age, the state board may by rule27 052 -4- adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III)1 reduce the percentage of the federal poverty line to below two hundred2 fifty SIXTY percent, but the percentage shall not be reduced to below two3 hundred five THIRTEEN percent.4 (b) (I) A pregnant woman whose family income does not exceed5 two hundred fifty SIXTY percent of the federal poverty line, adjusted for6 family size, and who is not eligible for medicaid.7 (II) Notwithstanding the provisions of subsection (4)(b)(I) of this8 section, if the money in the healthcare affordability and sustainability fee9 cash fund established pursuant to section 25.5-4-402.4 (5), together with10 the corresponding federal matching funds, is insufficient to fully fund all11 of the purposes described in section 25.5-4-402.4 (5)(b), after receiving12 recommendations from the Colorado healthcare affordability and13 sustainability enterprise established pursuant to section 25.5-4-402.4 (3),14 for pregnant women, the state board by rule adopted pursuant to the15 provisions of section 25.5-4-402.4 (6)(b)(III) may reduce the percentage16 of the federal poverty line to below two hundred fifty SIXTY percent, but17 the percentage shall not be reduced to below two hundred five THIRTEEN18 percent.19 SECTION 5. 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.22 052 -5-