First Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 25-0975.01 Rebecca Bayetti x4348
SENATE BILL 25-228
Senate Committees House Committees
Appropriations
A BILL FOR AN ACT
C
ONCERNING THE CREATION OF A CASH FUND WITHIN THE COLORADO101
HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE102
FOR PREMIUMS PAID BY INDIVIDUALS TO BUY IN TO THE STATE103
MEDICAL ASSISTANCE PROGRAMS FOR LOW -INCOME104
INDIVIDUALS WITH DISABILITIES , AND, IN CONNECTION105
THEREWITH, MAKING AND REDUCING APPROPRIATIONS .106
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/
.)
Joint Budget Committee. Under current law, there are 2 programs
SENATE SPONSORSHIP
Amabile and Bridges, Kirkmeyer
HOUSE SPONSORSHIP
Bird and Sirota, Taggart
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. available to low-income individuals to buy in to the state medical
assistance program: One for adults with disabilities and one for children
with disabilities (medicaid buy-in programs). Individuals who participate
in either program pay a premium based on their family income. The
premiums are credited to the medicaid buy-in cash fund. The premiums
credited to the medicaid buy-in cash fund are used to offset the costs of
providing the medicaid buy-in programs. The costs of providing the
medicaid buy-in programs are also offset by the money in the healthcare
affordability and sustainability fee cash fund in the Colorado healthcare
affordability and sustainability enterprise (CHASE) within the department
of health care policy and financing (HCPF).
The bill repeals the existing medicaid buy-in cash fund and creates
the healthcare affordability and sustainability medicaid buy-in cash fund
(buy-in cash fund) within CHASE and directs that individuals who
participate in the existing medicaid buy-in programs pay their premiums
into the buy-in cash fund. The bill creates a medicaid buy-in enterprise
support board within CHASE to support the existing enterprise with the
implementation of the medicaid buy-in program, including consulting
with HCPF and the state medical services board on the amount of the
premiums for and other components of the medicaid buy-in programs.
Because CHASE is an enterprise for purposes of the Taxpayer's Bill of
Rights, its revenue does not count against the state fiscal year spending
limit.
The bill also makes conforming amendments.
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
(2) introductory portion, (2)(f), (2)(g), (3)(a), (3)(d)(I), and (3)(d)(III);3
and add (3)(c)(III), (5.1), and (7)(g) as follows:4
25.5-4-402.4. Hospitals - healthcare affordability and5
sustainability fee - Colorado healthcare affordability and6
sustainability enterprise - federal waiver - fund created - reports -7
rules - legislative declaration - repeal. (2) Legislative declaration. The8
general assembly hereby
finds and declares that:9
(f) Consistent with the determination of the Colorado supreme10
court in Nicholl v. E-470 Public Highway Authority, 896 P.2d 859 (Colo.11
SB25-228-2- 1995), that the power to impose taxes is inconsistent with enterprise status1
under section 20 of article X of the state constitution, it is the conclusion2
of the general assembly that the healthcare affordability and sustainability3
fee
AND THE MEDICAID BUY-IN PREMIUMS charged and collected by the4
Colorado healthcare affordability and sustainability enterprise is a fee
ARE5
FEES, not a tax TAXES, because the fee is FEES ARE imposed for the6
specific purposes of allowing the enterprise to defray the costs of7
providing the business services specified in subsections (2)(d)(I), and8
(2)(d)(II),
AND (2)(c) of this section to hospitals AND INDIVIDUALS that9
pay the fee
FEES and is ARE collected at rates that are reasonably10
calculated based on the benefits received by those hospitals
AND11
INDIVIDUALS; and12
(g) So long as the Colorado healthcare affordability and13
sustainability enterprise qualifies as an enterprise for purposes of section14
20 of article X of the state constitution, the revenues from the healthcare
15
affordability and sustainability fee FEES charged and collected by the16
enterprise are not state fiscal year spending, as defined in section17
24-77-102 (17), or state revenues, as defined in section 24-77-103.618
(6)(c), and do not count against either the state fiscal year spending limit19
imposed by section 20 of article X of the state constitution or the excess20
state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).21
(3) Colorado healthcare affordability and sustainability22
enterprise. (a) The Colorado healthcare affordability and sustainability23
enterprise, referred to in this section as the "enterprise", is created. The24
enterprise is and operates as a government-owned business within the25
state department for the purpose of: 26
(I) Charging and collecting: 27
SB25-228
-3- (A) The healthcare affordability and sustainability fee; AND 1
(B) M
EDICAID BUY-IN PREMIUMS;2
(II) Leveraging healthcare affordability and sustainability fee3
revenue to obtain federal matching money; and 4
(III) Utilizing and deploying: 5
(A) The healthcare affordability and sustainability fee revenue and6
federal matching money to provide the business services specified in7
subsections (2)(d)(I) and (2)(d)(II) of this section to hospitals that pay the8
healthcare affordability and sustainability fee;
AND9
(B) T
HE MEDICAID BUY-IN PREMIUM REVENUE TO PROVIDE THE10
MEDICAID BUY-IN PROGRAMS CREATED PURSUANT TO PART 14 OF ARTICLE11
6
OF THIS TITLE 25.5 AND SECTION 25.5-5-206, WHICH ARE SERVICES AND12
BENEFITS SPECIFIED IN SUBSECTION (2)(c) OF THIS SECTION.13
(c) (III) T
HE REPEAL OF THE MEDICAID BUY-IN CASH FUND, AS IT14
EXISTED IN SECTION 25.5-6-1404 (3)(b) BEFORE ITS REPEAL, EFFECTIVE15
M
AY 1, 2025, BY THIS SENATE BILL 25-228, ENACTED IN 2025, AND THE16
ENTERPRISE'S ABILITY TO CHARGE AND COLLECT THE MEDICAID BUY -IN17
PREMIUMS AND PROVIDE PREMIUM -FUNDED BUSINESS SERVICES TO18
INDIVIDUALS AND HOSPITALS THAT REPLACE AND SUPPLEMENT SERVICES19
PREVIOUSLY FUNDED BOTH BY THE MEDICAID BUY -IN PREMIUMS AND THE20
HEALTHCARE AFFORDABILITY AND SUSTAINABILITY FEE DO NOT21
CONSTITUTE CREATION OF A NEW ENTERPRISE OR THE QUALIFICATION OF22
AN EXISTING GOVERNMENT -OWNED BUSINESS AS AN ENTERPRISE FOR23
PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION,24
SECTION 24-77-103.6 (6)(b)(II), OR SECTION 24-77-108, AND, THEREFORE,25
DO NOT REQUIRE OR AUTHORIZE ADJUSTMENT OF THE STATE FISCAL YEAR26
SPENDING LIMIT CALCULATED PURSUANT TO SECTION 20 OF ARTICLE X OF27
SB25-228
-4- THE STATE CONSTITUTION OR THE EXCESS STATE REVENUES CAP , AS1
DEFINED IN SECTION 24-77-103.6 (6)(b)(I), AND DO NOT REQUIRE VOTER2
APPROVAL.3
(d) The enterprise's primary powers and duties are:4
(I) To charge and collect:5
(A) The healthcare affordability and sustainability fee as specified6
in subsection (4) of this section;
AND7
(B) T
HE MEDICAID BUY-IN PREMIUMS DESCRIBED IN SUBSECTION8
(5.1)
OF THIS SECTION AND SECTIONS 25.5-5-206 AND 25.5-6-1404;9
(III) To expend:10
(A) Healthcare affordability and sustainability fee revenue,11
matching federal money, and any other money from the healthcare12
affordability and sustainability fee cash fund as specified in subsections13
(4) and (5) of this section;
AND14
(B) M
EDICAID BUY-IN PREMIUM REVENUE FROM THE BUY -IN FUND15
AS SPECIFIED IN SUBSECTION (5.1) OF THIS SECTION;16
(5.1) Healthcare affordability and sustainability medicaid17
buy-in cash fund. (a) T
HE HEALTHCARE AFFORDABILITY AND18
SUSTAINABILITY MEDICAID BUY -IN CASH FUND, REFERRED TO IN THIS19
SECTION AS THE "BUY-IN FUND", IS CREATED IN THE STATE TREASURY. THE20
BUY-IN FUND CONSISTS OF THE PREMIUMS CREDITED TO THE BUY -IN FUND21
PURSUANT TO SECTIONS 25.5-5-206 AND 25.5-6-1404 AND ANY OTHER22
MONEY THAT THE GENERAL ASSEMBLY MAY APPROPRIATE OR TRANSFER23
TO THE BUY-IN FUND. MONEY IN THE BUY-IN FUND SHALL NOT BE24
TRANSFERRED TO ANY OTHER FUND AND SHALL NOT BE USED FOR ANY25
PURPOSE OTHER THAN THE PURPOSES SPECIFIED IN THIS SUBSECTION (5.1).26
(b) T
HE STATE TREASURER SHALL CREDIT ALL INTEREST AND27
SB25-228
-5- INCOME DERIVED FROM THE DEPOSIT AND INVESTMENT OF MONEY IN THE1
BUY-IN FUND TO THE BUY-IN FUND.2
(c) S
UBJECT TO ANNUAL APPROPRIATION BY THE GENERAL3
ASSEMBLY, THE ENTERPRISE MAY EXPEND MONEY FROM THE BUY -IN FUND4
FOR THE PURPOSE OF PROVIDING THE MEDICAID BUY -IN PROGRAMS5
CREATED PURSUANT TO PART 14 OF ARTICLE 6 OF THIS TITLE 25.5 AND6
SECTION 25.5-5-206.7
(7) Colorado healthcare affordability and sustainability8
enterprise board. (g) (I) T
HE MEDICAID BUY-IN ENTERPRISE SUPPORT9
BOARD IS CREATED WITHIN THE ENTERPRISE FOR THE PURPOSE OF10
SUPPORTING THE ENTERPRISE BOARD WITH THE IMPLEMENTATION OF THE11
MEDICAID BUY-IN PROGRAMS. THE MEDICAID BUY-IN ENTERPRISE SUPPORT12
BOARD CONSISTS OF FIVE MEMBERS APPOINTED BY THE GOVERNOR , WITH13
THE ADVICE AND CONSENT OF THE SENATE , AS FOLLOWS:14
(A) O
NE MEMBER WHO IS A REPRESENTATIVE OF PERSONS WITH15
DISABILITIES, WHO IS LIVING WITH A DISABILITY;16
(B) T
WO MEMBERS WHO ARE REPRESENTATIVES OF A DISABILITY17
RIGHTS ORGANIZATION OR A DISABLED PERSONS CONSUMER ADVOCACY18
ORGANIZATION;19
(C) O
NE EMPLOYEE OF THE STATE DEPARTMENT ; AND20
(D) O
NE EMPLOYEE OF THE DEPARTMENT OF HUMAN SERVICES21
CREATED IN SECTION 24-1-120.22
(II) (A) M
EMBERS OF THE MEDICAID BUY-IN ENTERPRISE SUPPORT23
BOARD SERVE AT THE PLEASURE OF THE GOVERNOR . ALL TERMS ARE FOR24
FOUR YEARS. A MEMBER WHO IS APPOINTED TO FILL A VACANCY SHALL25
SERVE THE REMAINDER OF THE UNEXPIRED TERM OF THE FORMER MEMBER .26
(B) T
HE GOVERNOR SHALL MAKE THE INITIAL APPOINTMENTS TO27
SB25-228
-6- THE MEDICAID BUY -IN ENTERPRISE SUPPORT BOARD AS SOON AS1
PRACTICAL FOLLOWING MAY 1, 2025.2
(III) T
HE MEDICAID BUY-IN ENTERPRISE SUPPORT BOARD SHALL3
ELECT A CHAIR AND A VICE-CHAIR FROM AMONG ITS MEMBERS .4
(IV) O
N BEHALF OF THE ENTERPRISE , THE MEDICAID BUY-IN5
ENTERPRISE SUPPORT BOARD SHALL CONSULT WITH THE STATE6
DEPARTMENT AND THE STATE BOARD ON THE AMOUNT OF THE PREMIUMS7
FOR AND OTHER COMPONENTS OF THE MEDICAID BUY -IN PROGRAMS8
CREATED PURSUANT TO PART 14 OF ARTICLE 6 OF THIS TITLE 25.5 AND9
SECTION 25.5-5-206.10
(V) M
EMBERS OF THE MEDICAID BUY -IN ENTERPRISE SUPPORT11
BOARD SERVE WITHOUT COMPENSATION BUT MUST BE REIMBURSED FROM12
MONEY IN THE BUY-IN FUND FOR ACTUAL AND NECESSARY EXPENSES13
INCURRED IN THE PERFORMANCE OF THEIR DUTIES PURSUANT TO THIS14
SECTION.15
SECTION 2. In Colorado Revised Statutes, 25.5-5-206, add (3)16
as follows:17
25.5-5-206. Medicaid buy-in program - disabled children -18
disabled adults - federal authorization - rules. (3) A
NY PREMIUMS OR19
COST-SHARING CHARGES PAID FOR THE MEDICAID BUY -IN PROGRAMS20
ESTABLISHED PURSUANT TO THIS SECTION ARE CREDITED TO THE21
HEALTHCARE AFFORDABILITY AND SUSTAINABILITY MEDICAID BUY -IN22
CASH FUND CREATED IN SECTION 25.5-4-402.4 (5.1).23
SECTION 3. In Colorado Revised Statutes, 25.5-6-1404, amend24
(3)(a) and (3)(b) as follows:25
25.5-6-1404. Medicaid buy-in program - eligibility - premiums26
- medicaid buy-in fund - report - rules - repeal. (3) Premiums. (a) An27
SB25-228
-7- individual who is eligible for and receives medicaid under subsection (1)1
of this section shall pay a premium pursuant to a payment schedule2
established by the state department
IN CONSULTATION WITH THE3
C
OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY4
ENTERPRISE CREATED IN SECTION 25.5-4-402.4 (3)(a). The amount of the5
premium shall be determined from a sliding-fee scale adopted by rule of6
the state board that is based on a percentage of the individual's income7
adjusted for family size and on any impairment-related work expenses;8
except that, consistent with federal law, if the amount of the individual's9
adjusted gross income exceeds seventy-five thousand dollars, the10
individual shall be responsible for paying one hundred percent of the11
premium. The rules shall specify the amount of unearned income the state12
department shall disregard in calculating the individual's income.13
P
REMIUMS ARE CREDITED TO THE HEALTHCARE AFFORDABILITY AND14
SUSTAINABILITY MEDICAID BUY -IN CASH FUND CREATED IN SECTION15
25.5-4-402.4
(5.1) FOR THE PURPOSE OF OFFSETTING PROGRAM COSTS .16
(b) (I) The rules setting the premiums and the sliding-fee scale17
shall
MUST be based on an actuarial study of the disabled population in18
this state. The state department may solicit and accept federal grants to19
cover the costs of the actuarial study. Moneys MONEY received through20
any grants and any premiums shall be IS credited to the medicaid buy-in21
cash fund, which fund is hereby created in the state treasury. Moneys22
M
ONEY in the fund shall be
IS appropriated by the general assembly and23
expended by the state department for the purpose of conducting24
implementation activities as determined by the state department,25
including conducting the actuarial study. Premiums shall be credited to26
the fund for the purpose of offsetting program costs.27
SB25-228
-8- (II) ON JUNE 30, 2025, THE STATE TREASURER SHALL TRANSFER1
THE BALANCE OF THE MEDICAID BUY -IN CASH FUND TO THE HEALTHCARE2
AFFORDABILITY AND SUSTAINABILITY MEDICAID BUY -IN CASH FUND3
CREATED IN SECTION 25.5-4-402.4 (5.1).4
(III) T
HIS SUBSECTION (3)(b) IS REPEALED, EFFECTIVE JULY 1,5
2025.6
SECTION 4. In Colorado Revised Statutes, 25.5-6-1405, amend7
(1) as follows:8
25.5-6-1405. Rule-making authority. (1) The state board shall9
promulgate rules necessary to implement and administer the medicaid10
buy-in program created in this part 14, including,
IN CONSULTATION WITH11
THE COLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY12
ENTERPRISE CREATED IN SECTION 25.5-4-402.4 (3)(a), the establishment13
of appropriate premium and cost-sharing charges on a sliding-fee scale14
based on income. The premiums and cost-sharing charges shall be based15
upon an actuarial study of the disabled population in this state. 16
SECTION 5. Appropriation - adjustments to 2025 long bill.17
(1) To implement this act, appropriations made in the annual general18
appropriation act for the 2025-26 state fiscal year to the department of19
health care policy and financing are adjusted as follows:20
(a) The cash funds appropriation from the Medicaid buy-in cash21
fund created in section 25.5-6-1404 (3)(b), C.R.S., for medical and22
long-term care services for Medicaid-eligible individuals is decreased by23
$6,660,761.24
(b) The cash funds appropriation from the healthcare affordability25
and sustainability Medicaid buy-in cash fund created in section26
25.5-4-402.4 (5.1)(a), C.R.S., for medical and long-term care services for27
SB25-228
-9- Medicaid-eligible individuals is increased by $6,660,761.1
(2) To implement this act, appropriations made in the annual2
general appropriation act for the 2024-25 state fiscal year to the3
department of health care policy and financing, as amended by Senate Bill4
25-206, enacted in 2025, are adjusted as follows:5
(a) The cash funds appropriation from the Medicaid buy-in cash6
fund created in section 25.5-6-1404 (3)(b), C.R.S., for medical and7
long-term care services for Medicaid-eligible individuals is decreased by8
$1,110,126.9
(b) The cash funds appropriation from the healthcare affordability10
and sustainability Medicaid buy-in cash fund created in section11
25.5-4-402.4 (5.1)(a), C.R.S., for medical and long-term care services for12
Medicaid-eligible individuals is increased by $1,110,126.13
SECTION 6. Effective date. This act takes effect May 1, 2025.14
SECTION 7. Safety clause. The general assembly finds,15
determines, and declares that this act is necessary for the immediate16
preservation of the public peace, health, or safety or for appropriations for17
the support and maintenance of the departments of the state and state18
institutions.19
SB25-228
-10-