Colorado 2025 Regular Session

Colorado Senate Bill SB228 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		First Regular Session
2	2		Seventy-fifth General Assembly
3	3		STATE OF COLORADO
4		-	~~REVISED~~
	4	+	ENGROSSED
5	5		This Version Includes All Amendments Adopted
6		-	on Second Reading in the ~~Second House~~
	6	+	on Second Reading in the House of Introduction
7	7		LLS NO. 25-0975.01 Rebecca Bayetti x4348
8	8		SENATE BILL 25-228
9	9		Senate Committees House Committees
10		-	Appropriations ~~Appropriations~~
	10	+	Appropriations
11	11		A BILL FOR AN ACT
12	12		C
13	13		ONCERNING THE CREATION OF A CASH FUND WITHIN THE COLORADO101
14	14		HEALTHCARE AFFORDABILITY AND SUSTAINABILITY ENTERPRISE102
15	15		FOR PREMIUMS PAID BY INDIVIDUALS TO BUY IN TO THE STATE103
16	16		MEDICAL ASSISTANCE PROGRAMS FOR LOW -INCOME104
17	17		INDIVIDUALS WITH DISABILITIES , AND, IN CONNECTION105
18	18		THEREWITH, MAKING AND REDUCING APPROPRIATIONS .106
19	19		Bill Summary
20	20		(Note: This summary applies to this bill as introduced and does
21	21		not reflect any amendments that may be subsequently adopted. If this bill
22	22		passes third reading in the house of introduction, a bill summary that
23	23		applies to the reengrossed version of this bill will be available at
24	24		http://leg.colorado.gov/
25	25		.)
26	26		Joint Budget Committee. Under current law, there are 2 programs
27		-	HOUSE
28		-	Amended 2nd Reading
29		-	April 9, 2025
30		-	SENATE
31		-	3rd Reading Unamended
32		-	April 3, 2025
33	27		SENATE
34	28		2nd Reading Unamended
35	29		April 2, 2025
36	30		SENATE SPONSORSHIP
37		-	Amabile and Bridges, Kirkmeyer~~, Cutter, Exum, Michaelson Jenet, Mullica~~
	31	+	Amabile and Bridges, Kirkmeyer
38	32		HOUSE SPONSORSHIP
39	33		Bird and Sirota, Taggart
40	34		Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
41	35		Capital letters or bold & italic numbers indicate new material to be added to existing law.
42	36		Dashes through the words or numbers indicate deletions from existing law. available to low-income individuals to buy in to the state medical
43	37		assistance program: One for adults with disabilities and one for children
44	38		with disabilities (medicaid buy-in programs). Individuals who participate
45	39		in either program pay a premium based on their family income. The
46	40		premiums are credited to the medicaid buy-in cash fund. The premiums
47	41		credited to the medicaid buy-in cash fund are used to offset the costs of
48	42		providing the medicaid buy-in programs. The costs of providing the
49	43		medicaid buy-in programs are also offset by the money in the healthcare
50	44		affordability and sustainability fee cash fund in the Colorado healthcare
51	45		affordability and sustainability enterprise (CHASE) within the department
52	46		of health care policy and financing (HCPF).
53	47		The bill repeals the existing medicaid buy-in cash fund and creates
54	48		the healthcare affordability and sustainability medicaid buy-in cash fund
55	49		(buy-in cash fund) within CHASE and directs that individuals who
56	50		participate in the existing medicaid buy-in programs pay their premiums
57	51		into the buy-in cash fund. The bill creates a medicaid buy-in enterprise
58	52		support board within CHASE to support the existing enterprise with the
59	53		implementation of the medicaid buy-in program, including consulting
60	54		with HCPF and the state medical services board on the amount of the
61	55		premiums for and other components of the medicaid buy-in programs.
62	56		Because CHASE is an enterprise for purposes of the Taxpayer's Bill of
63	57		Rights, its revenue does not count against the state fiscal year spending
64	58		limit.
65	59		The bill also makes conforming amendments.
66	60		Be it enacted by the General Assembly of the State of Colorado:1
67	61		SECTION 1. In Colorado Revised Statutes, 25.5-4-402.4, amend2
68	62		(2) introductory portion, (2)(f), (2)(g), (3)(a), (3)(d)(I), and (3)(d)(III);3
69	63		and add (3)(c)(III), (5.1), and (7)(g) as follows:4
70	64		25.5-4-402.4. Hospitals - healthcare affordability and5
71	65		sustainability fee - Colorado healthcare affordability and6
72	66		sustainability enterprise - federal waiver - fund created - reports -7
73	67		rules - legislative declaration - repeal. (2) Legislative declaration. The8
74	68		general assembly hereby
75	69		finds and declares that:9
76	70		(f) Consistent with the determination of the Colorado supreme10
77	71		court in Nicholl v. E-470 Public Highway Authority, 896 P.2d 859 (Colo.11
78	72		228-2- 1995), that the power to impose taxes is inconsistent with enterprise status1
79	73		under section 20 of article X of the state constitution, it is the conclusion2
80	74		of the general assembly that the healthcare affordability and sustainability3
81	75		fee
82	76		AND THE MEDICAID BUY-IN PREMIUMS charged and collected by the4
83	77		Colorado healthcare affordability and sustainability enterprise is a fee
84	78		ARE5
85	79		FEES, not a tax TAXES, because the fee is FEES ARE imposed for the6
86	80		specific purposes of allowing the enterprise to defray the costs of7
87	81		providing the business services specified in subsections (2)(d)(I), and8
88	82		(2)(d)(II),
89	83		AND (2)(c) of this section to hospitals AND INDIVIDUALS that9
90	84		pay the fee
91	85		FEES and is ARE collected at rates that are reasonably10
92	86		calculated based on the benefits received by those hospitals
93	87		AND11
94	88		INDIVIDUALS; and12
95	89		(g) So long as the Colorado healthcare affordability and13
96	90		sustainability enterprise qualifies as an enterprise for purposes of section14
97	91		20 of article X of the state constitution, the revenues from the healthcare
98	92		15
99	93		affordability and sustainability fee FEES charged and collected by the16
100	94		enterprise are not state fiscal year spending, as defined in section17
101	95		24-77-102 (17), or state revenues, as defined in section 24-77-103.618
102	96		(6)(c), and do not count against either the state fiscal year spending limit19
103	97		imposed by section 20 of article X of the state constitution or the excess20
104	98		state revenues cap, as defined in section 24-77-103.6 (6)(b)(I).21
105	99		(3) Colorado healthcare affordability and sustainability22
106	100		enterprise. (a) The Colorado healthcare affordability and sustainability23
107	101		enterprise, referred to in this section as the "enterprise", is created. The24
108	102		enterprise is and operates as a government-owned business within the25
109	103		state department for the purpose of: 26
110	104		(I) Charging and collecting: 27
111	105		228
112	106		-3- (A) The healthcare affordability and sustainability fee; AND 1
113	107		(B) M
114	108		EDICAID BUY-IN PREMIUMS;2
115	109		(II) Leveraging healthcare affordability and sustainability fee3
116	110		revenue to obtain federal matching money; and 4
117	111		(III) Utilizing and deploying: 5
118	112		(A) The healthcare affordability and sustainability fee revenue and6
119	113		federal matching money to provide the business services specified in7
120	114		subsections (2)(d)(I) and (2)(d)(II) of this section to hospitals that pay the8
121	115		healthcare affordability and sustainability fee;
122	116		AND9
123	117		(B) T
124	118		HE MEDICAID BUY-IN PREMIUM REVENUE TO PROVIDE THE10
125	119		MEDICAID BUY-IN PROGRAMS CREATED PURSUANT TO PART 14 OF ARTICLE11
126	120		6
127	121		OF THIS TITLE 25.5 AND SECTION 25.5-5-206, WHICH ARE SERVICES AND12
128	122		BENEFITS SPECIFIED IN SUBSECTION (2)(c) OF THIS SECTION.13
129	123		(c) (III) T
130	124		HE REPEAL OF THE MEDICAID BUY-IN CASH FUND, AS IT14
131	125		EXISTED IN SECTION 25.5-6-1404 (3)(b) BEFORE ITS REPEAL, EFFECTIVE15
132	126		M
133	127		AY 1, 2025, BY THIS SENATE BILL 25-228, ENACTED IN 2025, AND THE16
134	128		ENTERPRISE'S ABILITY TO CHARGE AND COLLECT THE MEDICAID BUY -IN17
135	129		PREMIUMS AND PROVIDE PREMIUM -FUNDED BUSINESS SERVICES TO18
136	130		INDIVIDUALS AND HOSPITALS THAT REPLACE AND SUPPLEMENT SERVICES19
137	131		PREVIOUSLY FUNDED BOTH BY THE MEDICAID BUY -IN PREMIUMS AND THE20
138	132		HEALTHCARE AFFORDABILITY AND SUSTAINABILITY FEE DO NOT21
139	133		CONSTITUTE CREATION OF A NEW ENTERPRISE OR THE QUALIFICATION OF22
140	134		AN EXISTING GOVERNMENT -OWNED BUSINESS AS AN ENTERPRISE FOR23
141	135		PURPOSES OF SECTION 20 OF ARTICLE X OF THE STATE CONSTITUTION,24
142	136		SECTION 24-77-103.6 (6)(b)(II), OR SECTION 24-77-108, AND, THEREFORE,25
143	137		DO NOT REQUIRE OR AUTHORIZE ADJUSTMENT OF THE STATE FISCAL YEAR26
144	138		SPENDING LIMIT CALCULATED PURSUANT TO SECTION 20 OF ARTICLE X OF27
145	139		228
146	140		-4- THE STATE CONSTITUTION OR THE EXCESS STATE REVENUES CAP , AS1
147	141		DEFINED IN SECTION 24-77-103.6 (6)(b)(I), AND DO NOT REQUIRE VOTER2
148	142		APPROVAL.3
149	143		(d) The enterprise's primary powers and duties are:4
150	144		(I) To charge and collect:5
151	145		(A) The healthcare affordability and sustainability fee as specified6
152	146		in subsection (4) of this section;
153	147		AND7
154	148		(B) T
155	149		HE MEDICAID BUY-IN PREMIUMS DESCRIBED IN SUBSECTION8
156	150		(5.1)
157	151		OF THIS SECTION AND SECTIONS 25.5-5-206 AND 25.5-6-1404;9
158	152		(III) To expend:10
159	153		(A) Healthcare affordability and sustainability fee revenue,11
160	154		matching federal money, and any other money from the healthcare12
161	155		affordability and sustainability fee cash fund as specified in subsections13
162	156		(4) and (5) of this section;
163	157		AND14
164	158		(B) M
165	159		EDICAID BUY-IN PREMIUM REVENUE FROM THE BUY -IN FUND15
166	160		AS SPECIFIED IN SUBSECTION (5.1) OF THIS SECTION;16
167	161		(5.1) Healthcare affordability and sustainability medicaid17
168	162		buy-in cash fund. (a) T
169	163		HE HEALTHCARE AFFORDABILITY AND18
170	164		SUSTAINABILITY MEDICAID BUY -IN CASH FUND, REFERRED TO IN THIS19
171	165		SECTION AS THE "BUY-IN FUND", IS CREATED IN THE STATE TREASURY. THE20
172	166		BUY-IN FUND CONSISTS OF THE PREMIUMS CREDITED TO THE BUY -IN FUND21
173	167		PURSUANT TO SECTIONS 25.5-5-206 AND 25.5-6-1404 AND ANY OTHER22
174	168		MONEY THAT THE GENERAL ASSEMBLY MAY APPROPRIATE OR TRANSFER23
175	169		TO THE BUY-IN FUND. MONEY IN THE BUY-IN FUND SHALL NOT BE24
176	170		TRANSFERRED TO ANY OTHER FUND AND SHALL NOT BE USED FOR ANY25
177	171		PURPOSE OTHER THAN THE PURPOSES SPECIFIED IN THIS SUBSECTION (5.1).26
178	172		(b) T
179	173		HE STATE TREASURER SHALL CREDIT ALL INTEREST AND27
180	174		228
181	175		-5- INCOME DERIVED FROM THE DEPOSIT AND INVESTMENT OF MONEY IN THE1
182	176		BUY-IN FUND TO THE BUY-IN FUND.2
183	177		(c) S
184	178		UBJECT TO ANNUAL APPROPRIATION BY THE GENERAL3
185	179		ASSEMBLY, THE ENTERPRISE MAY EXPEND MONEY FROM THE BUY -IN FUND4
186	180		FOR THE PURPOSE OF PROVIDING THE MEDICAID BUY -IN PROGRAMS5
187	181		CREATED PURSUANT TO PART 14 OF ARTICLE 6 OF THIS TITLE 25.5 AND6
188	182		SECTION 25.5-5-206.7
189	183		(7) Colorado healthcare affordability and sustainability8
190	184		enterprise board. (g) (I) T
191	185		HE MEDICAID BUY-IN ENTERPRISE SUPPORT9
192	186		BOARD IS CREATED WITHIN THE ENTERPRISE FOR THE PURPOSE OF10
193	187		SUPPORTING THE ENTERPRISE BOARD WITH THE IMPLEMENTATION OF THE11
194	188		MEDICAID BUY-IN PROGRAMS. THE MEDICAID BUY-IN ENTERPRISE SUPPORT12
195	189		BOARD CONSISTS OF FIVE MEMBERS APPOINTED BY THE GOVERNOR , WITH13
196	190		THE ADVICE AND CONSENT OF THE SENATE , AS FOLLOWS:14
197	191		(A) O
198	192		NE MEMBER WHO IS A REPRESENTATIVE OF PERSONS WITH15
199	193		DISABILITIES, WHO IS LIVING WITH A DISABILITY;16
200	194		(B) T
201	195		WO MEMBERS WHO ARE REPRESENTATIVES OF A DISABILITY17
202	196		RIGHTS ORGANIZATION OR A DISABLED PERSONS CONSUMER ADVOCACY18
203	197		ORGANIZATION;19
204	198		(C) O
205	199		NE EMPLOYEE OF THE STATE DEPARTMENT ; AND20
206	200		(D) O
207		-	NE EMPLOYEE OF THE DEPARTMENT
208		-	OF LABOR AND21
209		-	EMPLOYMENT CREATED IN SECTION 24-1-121.22
	201	+	NE EMPLOYEE OF THE DEPARTMENT OF HUMAN SERVICES21
	202	+	CREATED IN SECTION 24-1-120.22
210	203		(II) (A) M
211	204		EMBERS OF THE MEDICAID BUY-IN ENTERPRISE SUPPORT23
212	205		BOARD SERVE AT THE PLEASURE OF THE GOVERNOR . ALL TERMS ARE FOR24
213	206		FOUR YEARS. A MEMBER WHO IS APPOINTED TO FILL A VACANCY SHALL25
214	207		SERVE THE REMAINDER OF THE UNEXPIRED TERM OF THE FORMER MEMBER .26
215	208		(B) T
216	209		HE GOVERNOR SHALL MAKE THE INITIAL APPOINTMENTS TO27
217	210		228
218	211		-6- THE MEDICAID BUY -IN ENTERPRISE SUPPORT BOARD AS SOON AS1
219	212		PRACTICAL FOLLOWING MAY 1, 2025.2
220	213		(III) T
221	214		HE MEDICAID BUY-IN ENTERPRISE SUPPORT BOARD SHALL3
222	215		ELECT A CHAIR AND A VICE-CHAIR FROM AMONG ITS MEMBERS .4
223	216		(IV) O
224	217		N BEHALF OF THE ENTERPRISE , THE MEDICAID BUY-IN5
225	218		ENTERPRISE SUPPORT BOARD SHALL CONSULT WITH THE STATE6
226	219		DEPARTMENT AND THE STATE BOARD ON THE AMOUNT OF THE PREMIUMS7
227	220		FOR AND OTHER COMPONENTS OF THE MEDICAID BUY -IN PROGRAMS8
228	221		CREATED PURSUANT TO PART 14 OF ARTICLE 6 OF THIS TITLE 25.5 AND9
229	222		SECTION 25.5-5-206.10
230	223		(V) M
231	224		EMBERS OF THE MEDICAID BUY -IN ENTERPRISE SUPPORT11
232	225		BOARD SERVE WITHOUT COMPENSATION BUT MUST BE REIMBURSED FROM12
233	226		MONEY IN THE BUY-IN FUND FOR ACTUAL AND NECESSARY EXPENSES13
234	227		INCURRED IN THE PERFORMANCE OF THEIR DUTIES PURSUANT TO THIS14
235	228		SECTION.15
236	229		SECTION 2. In Colorado Revised Statutes, 25.5-5-206, add (3)16
237	230		as follows:17
238	231		25.5-5-206. Medicaid buy-in program - disabled children -18
239	232		disabled adults - federal authorization - rules. (3) A
240	233		NY PREMIUMS OR19
241	234		COST-SHARING CHARGES PAID FOR THE MEDICAID BUY -IN PROGRAMS20
242	235		ESTABLISHED PURSUANT TO THIS SECTION ARE CREDITED TO THE21
243	236		HEALTHCARE AFFORDABILITY AND SUSTAINABILITY MEDICAID BUY -IN22
244	237		CASH FUND CREATED IN SECTION 25.5-4-402.4 (5.1).23
245	238		SECTION 3. In Colorado Revised Statutes, 25.5-6-1404, amend24
246	239		(3)(a) and (3)(b) as follows:25
247	240		25.5-6-1404. Medicaid buy-in program - eligibility - premiums26
248	241		- medicaid buy-in fund - report - rules - repeal. (3) Premiums. (a) An27
249	242		228
250	243		-7- individual who is eligible for and receives medicaid under subsection (1)1
251	244		of this section shall pay a premium pursuant to a payment schedule2
252	245		established by the state department
253	246		IN CONSULTATION WITH THE3
254	247		C
255	248		OLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY4
256	249		ENTERPRISE CREATED IN SECTION 25.5-4-402.4 (3)(a). The amount of the5
257	250		premium shall be determined from a sliding-fee scale adopted by rule of6
258	251		the state board that is based on a percentage of the individual's income7
259	252		adjusted for family size and on any impairment-related work expenses;8
260	253		except that, consistent with federal law, if the amount of the individual's9
261	254		adjusted gross income exceeds seventy-five thousand dollars, the10
262	255		individual shall be responsible for paying one hundred percent of the11
263	256		premium. The rules shall specify the amount of unearned income the state12
264	257		department shall disregard in calculating the individual's income.13
265	258		P
266	259		REMIUMS ARE CREDITED TO THE HEALTHCARE AFFORDABILITY AND14
267	260		SUSTAINABILITY MEDICAID BUY -IN CASH FUND CREATED IN SECTION15
268	261		25.5-4-402.4
269	262		(5.1) FOR THE PURPOSE OF OFFSETTING PROGRAM COSTS .16
270	263		(b) (I) The rules setting the premiums and the sliding-fee scale17
271	264		shall
272	265		MUST be based on an actuarial study of the disabled population in18
273	266		this state. The state department may solicit and accept federal grants to19
274	267		cover the costs of the actuarial study. Moneys MONEY received through20
275	268		any grants and any premiums shall be IS credited to the medicaid buy-in21
276	269		cash fund, which fund is hereby created in the state treasury. Moneys22
277	270		M
278	271		ONEY in the fund shall be
279	272		IS appropriated by the general assembly and23
280	273		expended by the state department for the purpose of conducting24
281	274		implementation activities as determined by the state department,25
282	275		including conducting the actuarial study. Premiums shall be credited to26
283	276		the fund for the purpose of offsetting program costs.27
284	277		228
285	278		-8- (II) ON JUNE 30, 2025, THE STATE TREASURER SHALL TRANSFER1
286	279		THE BALANCE OF THE MEDICAID BUY -IN CASH FUND TO THE HEALTHCARE2
287	280		AFFORDABILITY AND SUSTAINABILITY MEDICAID BUY -IN CASH FUND3
288	281		CREATED IN SECTION 25.5-4-402.4 (5.1).4
289	282		(III) T
290	283		HIS SUBSECTION (3)(b) IS REPEALED, EFFECTIVE JULY 1,5
291	284		2025.6
292	285		SECTION 4. In Colorado Revised Statutes, 25.5-6-1405, amend7
293	286		(1) as follows:8
294	287		25.5-6-1405. Rule-making authority. (1) The state board shall9
295	288		promulgate rules necessary to implement and administer the medicaid10
296	289		buy-in program created in this part 14, including,
297	290		IN CONSULTATION WITH11
298	291		THE COLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY12
299	292		ENTERPRISE CREATED IN SECTION 25.5-4-402.4 (3)(a), the establishment13
300	293		of appropriate premium and cost-sharing charges on a sliding-fee scale14
301	294		based on income. The premiums and cost-sharing charges shall be based15
302	295		upon an actuarial study of the disabled population in this state. 16
303	296		SECTION 5. Appropriation - adjustments to 2025 long bill.17
304	297		(1) To implement this act, appropriations made in the annual general18
305	298		appropriation act for the 2025-26 state fiscal year to the department of19
306	299		health care policy and financing are adjusted as follows:20
307	300		(a) The cash funds appropriation from the Medicaid buy-in cash21
308	301		fund created in section 25.5-6-1404 (3)(b), C.R.S., for medical and22
309	302		long-term care services for Medicaid-eligible individuals is decreased by23
310	303		$6,660,761.24
311	304		(b) The cash funds appropriation from the healthcare affordability25
312	305		and sustainability Medicaid buy-in cash fund created in section26
313	306		25.5-4-402.4 (5.1)(a), C.R.S., for medical and long-term care services for27
314	307		228
315	308		-9- Medicaid-eligible individuals is increased by $6,660,761.1
316	309		(2) To implement this act, appropriations made in the annual2
317	310		general appropriation act for the 2024-25 state fiscal year to the3
318	311		department of health care policy and financing, as amended by Senate Bill4
319	312		25-206, enacted in 2025, are adjusted as follows:5
320	313		(a) The cash funds appropriation from the Medicaid buy-in cash6
321	314		fund created in section 25.5-6-1404 (3)(b), C.R.S., for medical and7
322	315		long-term care services for Medicaid-eligible individuals is decreased by8
323	316		$1,110,126.9
324	317		(b) The cash funds appropriation from the healthcare affordability10
325	318		and sustainability Medicaid buy-in cash fund created in section11
326	319		25.5-4-402.4 (5.1)(a), C.R.S., for medical and long-term care services for12
327	320		Medicaid-eligible individuals is increased by $1,110,126.13
328	321		SECTION 6. Effective date. This act takes effect May 1, 2025.14
329	322		SECTION 7. Safety clause. The general assembly finds,15
330	323		determines, and declares that this act is necessary for the immediate16
331	324		preservation of the public peace, health, or safety or for appropriations for17
332	325		the support and maintenance of the departments of the state and state18
333	326		institutions.19
334	327		228
335	328		-10-