{"data":{"id":"us-co/c.r.s.-25.5-2-104","jurisdiction":"us-co","citation":"C.R.S. § 25.5-2-104","heading":"State-funded health and medical care - rules.","body":"(1) (a) There is created the state medical assistance program, referred to in this section as \"state medical assistance\". Subject to the limitations detailed in subsection (1)(b) of this section, state medical assistance includes all benefits and services at the same cost to the beneficiary as benefits and services offered pursuant to the medical assistance program, defined in section 25.5-4-103 (13), such that, to the maximum extent possible, an eligible individual is not able to tell that they are enrolled in a different program from medical assistance, as defined in section 25.5-4-103 (13).\n\n(b) Pregnant women who are not eligible for the medical assistance program solely due to their immigration status and children under nineteen years old whose family household income does not exceed two hundred sixty percent of the federal poverty line, adjusted for family size, and who do not meet the immigration requirements for eligibility are subject to the following limitations on benefits:\n\n(I) Beginning July 1, 2026, they are subject to an annual cap on dental services in the amount of one thousand one hundred dollars;\n\n(II) Beginning January 1, 2027, they must be offered behavioral health services on a fee-for-service basis only;\n\n(III) Beginning January 1, 2027, they are not eligible for services offered through the accountable care collaborative pursuant to section 25.5-5-419; and\n\n(IV) Beginning January 1, 2027, they shall not receive managed care services pursuant to part 4 of article 5 of this title 25.5.\n\n(c) Beginning January 1, 2027, children under nineteen years old whose family household income does not exceed two hundred sixty percent of the federal poverty line, adjusted for family size, and who are not eligible for the medical assistance program due to their immigration status, shall not receive, pursuant to the state medical assistance program created in this section, long-term services and supports described in section 25.5-5-102 (1)(e); section 25.5-5-202 (1)(c), (1)(n), and (1)(p); home health services described in section 25.5-5-102 (1)(f) for members who require ongoing home health services following sixty days of acute home health services; and services described in part 19 of article 6 of this title 25.5 unless they already receive these services on or before December 31, 2026.\n\n(2) A child who is less than nineteen years of age is eligible to receive state medical assistance if the child would be eligible for medical assistance as defined in section 25.5-4-103 (13) but is not eligible due solely to the child's immigration status.\n\n(3) A child who is less than nineteen years of age is presumptively eligible for state medical assistance and will receive services specified by state law only if a parent or legal guardian of the child declares all pertinent information relating to the criteria of income and assets of the child's family.\n\n(3.5) (a) For the 2026-27 state fiscal year, enrollment in state medical assistance of children under nineteen years old whose family household income does not exceed two hundred sixty percent of the federal poverty line, adjusted for family size, and who are not eligible for the medical assistance program due to their immigration status, is subject to an enrollment cap of twenty-five thousand if one of the following conditions is met:\n\n(I) Enrollment of the children described in this subsection (3.5)(a) in state medical assistance exceeds twenty-five thousand children; or\n\n(II) Expenditures for a fiscal quarter of the 2026-27 state fiscal year exceed one quarter of the appropriation for state medical assistance plus five percent to account for cost fluctuations due to seasonality.\n\n(b) If a condition detailed in subsection (3.5)(a) of this section is met, the state department must cap the enrollment of the children described in subsection (3.5)(a) of this section at twenty-five thousand children beginning on the first day of the month following sixty days after the state department determines that a condition detailed in subsection (3.5)(a) of this section is met.\n\n(c) The state department shall adopt rules necessary to implement the enrollment cap detailed in this subsection (3.5).\n\n(d) On or before November 1, 2026, the state department shall submit a report to the joint budget committee detailing what is driving enrollment and utilization of state medical assistance by children who are under nineteen years old whose family household income does not exceed two hundred sixty percent of the federal poverty line, adjusted for family size, and who are not eligible for the medical assistance program due to their immigration status. The report must include strategies for reducing costs associated with enrolling these children in state medical assistance.\n\n(4) State medical assistance must be funded by state funds only, except to the extent federal funds are made available through express written authorization through a federal waiver, state plan amendment, or otherwise, by the federal centers for medicare and medicaid services.\n\n(5) The state department shall seek any necessary federal approvals to maximize any available federal financial participation in implementing this section.\n\n(6) To the maximum extent allowable under federal law, the state department shall, using appropriate funding, use the same infrastructure and provider network to deliver state medical assistance as it does to deliver medical assistance as defined in section 25.5-4-103 (13).\n\n(7) This section constitutes state authority within the meaning of 8 U.S.C. sec. 1621 (d), as that law existed on January 1, 2022.\n\n(8) (a) During its 2024 presentation to the joint budget committee of the general assembly and in its presentation to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of the \"State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act\", the state department shall report on its plans and progress in implementing state medical assistance.\n\n(b) Beginning January 1, 2026, and continuing every January thereafter, the state department, in its presentation to the joint budget committee of the general assembly and in its presentation to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of the \"State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act\", shall report on the cost savings and health improvements associated with state medical assistance.","path":["Title 25.5 - HEALTH CARE POLICY AND FINANCING","Article 2 - State-funded Health and Medical Care"],"source_url":"https://olls.info/crs/crs2026-title-25.5.htm","current_through":"Colorado Revised Statutes 2026","vintage":"","retrieved_at":"2026-09-14T18:37:45Z","sha256":"8e5d9f0a010c61fc46f68d2932b6203e74bc9071f99fefab35559115a57230fe","source_id":"us-co","stale":false,"prev":"us-co/c.r.s.-25.5-2-103","next":"us-co/c.r.s.-25.5-2-105"},"notice":"GroundRules: Original legal text. Not legal advice."}