Colorado § 25.5-5-101 - Mandatory provisions - eligible groups - rules.

§ 25.5-5-101. Mandatory provisions - eligible groups - rules.

(1) In order to participate in the medicaid program, the federal government requires the state to provide medical assistance to certain eligible groups. Pursuant to federal law and except as provided in subsection (2) of this section, any person who is eligible for medical assistance under the mandated groups specified in this section must receive both the mandatory services that are specified in sections 25.5-5-102 and 25.5-5-103 and the optional services that are specified in sections 25.5-5-202 and 25.5-5-203. Subject to the availability of federal financial participation, the following are the individuals or groups that are mandated under federal law to receive benefits under this article 5 and articles 4 and 6 of this title 25.5:

(a) Repealed.

(b) Parents and caretaker relatives living with a dependent child who meet the eligibility criteria pursuant to section 1902 (a)(10)(A) of the federal "Social Security Act", including those who subsequently would have become ineligible under such eligibility criteria because of increased earnings or increased hours of employment whose eligibility is specified for a period of time by the federal government;

(c) Pregnant women whose family income does not exceed one hundred thirty-three percent of the federal poverty line, adjusted for family size, who meet the requirements pursuant to section 1902 (a)(10)(A) of the federal "Social Security Act". Once initial eligibility has been established, the pregnant woman is continuously eligible throughout the pregnancy and for the sixty days following the pregnancy, even if the woman's eligibility would otherwise terminate during such period due to an increase in income.

(d) A newborn child born of a woman who is categorically needy. Such child is deemed medicaid-eligible on the date of birth and remains eligible for one year.

(e) Children for whom adoption assistance or foster care maintenance payments are made under Title IV-E of the federal "Social Security Act", as amended, including foster care children, pursuant to section 1902 (a)(10)(A)(i)(IX) of the federal "Social Security Act", who are under twenty-six years of age, who were in foster care under the responsibility of the state or a tribe, and who were enrolled in medicaid under the state medicaid plan when they turned eighteen years of age;

(f) Individuals receiving supplemental security income;

(g) Individuals receiving mandatory state supplement, including but not limited to individuals receiving old age pensions;

(h) Institutionalized individuals who were eligible for medical assistance in December 1973;

(i) Individuals who would be eligible except for the increase in old-age, survivors, and disability insurance under Pub.L. 92-336;

(j) Individuals who become ineligible for cash assistance as a result of old-age, survivors, and disability insurance cost-of-living increases after April 1977;

(k) Disabled widows or widowers fifty through sixty years of age who have become ineligible for federal supplemental security income or state supplementation as a result of becoming eligible for federal social security survivor's benefits, in accordance with the social security act, 42 U.S.C. sec. 1383c;

(l) Individuals with income and resources at a level which qualifies them as medicare-eligible under section 301 of Title III of the federal "Medicare Catastrophic Coverage Act";

(m) Children under the age of nineteen who meet the eligibility criteria pursuant to section 1902 (a)(10)(A) of the federal "Social Security Act".

(n) A qualified noncitizen who entered the United States before August 22, 1996, shall receive benefits under this article 5 and articles 4 and 6 of this title 25.5;

(o) A qualified noncitizen who entered the United States on or after August 22,1996, is not eligible for benefits under this article 5 or article 4 or 6 of this title 25.5 for five years after the date of entry in the United States; except that the state department may provide benefits under this article 5 and articles 4 and 6 of this title 25.5 to a pregnant person who is a qualified alien noncitizen and a child under nineteen years old who is a qualified noncitizen, so long as the pregnant person or child meets eligibility criteria other than citizenship. Coverage of individuals in this group is subject to the receipt of federal financial participation, unless state funds are specifically appropriated for coverage of groups for whom federal financial participation is unavailable.

(2) and (3) Repealed.

(4) An asset test shall not be applied as a condition of eligibility for individuals or families described in paragraphs (b), (c), (d), and (e) of subsection (1) of this section.

(5) The county departments responsible for administering benefits programs under the department of health care policy and financing and the department of human services shall identify and review all current county guidance materials, including forms, training materials, websites, and any other materials that reference a prohibition on sponsorship as a condition of eligibility for benefits and shall remove all such references from verbal and digital communications and from all physical materials currently provided to applicants or beneficiaries.

(6) Repealed.

Source: L. 2006: Entire article added with relocations, p. 1854, § 7, effective July 1. L. 2009: (2)(b) amended, (HB 09-1353), ch. 360, p. 1869, § 1, effective July 1, 2010. L. 2010: (4)(c) added, (HB 10-1043), ch. 92, p. 312, § 1, effective April 15; (1)(m) amended, (HB 10-1422), ch. 419, p. 2110, § 143, effective August 11. L. 2011: (3) amended, (HB 11-1303), ch. 264, p. 1168, § 67, effective August 10. L. 2014: (1)(a) repealed and (1)(b), (1)(c), (1)(d), (1)(e), (1)(m), and (4) amended, (SB 14-067), ch. 12, p. 111, § 3, effective February 27. L. 2022: IP(1) amended, (SB 22-052), ch. 43, p. 216, § 2, effective March 24; (3) amended, (HB 22-1289), ch. 399, p. 2842, § 15, effective June 7. L. 2023: (6) added, (SB 23-182), ch. 118, p. 429, § 1, effective April 27; (3) repealed and (5) added, (HB 23-1117), ch. 65, p. 232, § 3, effective August 7. L. 2024: IP(6)(a), (6)(b), and (6)(c) amended, (HB 24-1400), ch. 77, p. 261, § 1, effective April 18. L. 2026: (1)(n) and (1)(o) added and (2) repealed, (HB 26-1235), ch. 361, p. 2172, § 7, effective August 12.

Editor's note: (1) This section is similar to former § 26-4-201 as it existed prior to 2006.

(2) Prior to the amendment to subsection (4) in 2014, subsection (4)(b)(II) provided for the repeal of subsection (4)(b), effective July 1, 2007. (See L. 2006, p. 1854.)

(3) Subsection (6)(c) provided for the repeal of subsection (6), effective January 1, 2025. (See L. 2024, p. 261.)

Cross references: (1) For provisions of the federal "Medicare Catastrophic Coverage Act of 1988" referenced in this section, see section 301 of Pub.L. 100-360, codified at 42 U.S.C. sec. 1396a et seq.

(2) For the legislative declaration in HB 22-1289, see section 1 of chapter 399, Session Laws of Colorado 2022. For the legislative declaration in HB 23-1117, see section 1 of chapter 65, Session Laws of Colorado 2023.