Colorado § 25.5-4-104 - State medical assistance program - single state agency.

§ 25.5-4-104. State medical assistance program - single state agency.

(1) The state department, by rules, shall establish a program of medical assistance to provide necessary medical care for the categorically needy. The state department is designated as the single state agency to administer the medical assistance program in accordance with Title XIX of the federal "Social Security Act" and this article 4 and articles 5 and 6 of this title 25.5. The program is not required to furnish to members under sixty-five years of age the benefits that are provided to members sixty-five years of age and over under Title XVIII of the federal "Social Security Act", but the medical assistance program must otherwise be uniform to the extent required by Title XIX of the federal "Social Security Act".

(2) The state department may review any decision of a county department and may consider any application upon which a decision has not been made by the county department within a reasonable time to determine the propriety of the action or failure to take timely action on an application for medical assistance. The state department shall conduct any additional investigation the state department deems necessary. After giving the county department an opportunity to rebut the state department's findings or conclusions that the action or delay in taking action was a violation of or contrary to state department rules, the state department shall make a decision whether to grant medical benefits and the amount of medical benefits pursuant to this article 4 and articles 5 and 6 of this title 25.5 and the rules of the state department. Applicants or members affected by the state department's decisions, upon request, must be given reasonable notice and opportunity for a fair hearing by the state department.

Source: L. 2006: Entire article added with relocations, p. 1819, § 7, effective July 1. L. 2024: Entire section amended, (SB 24-176), ch. 152, p. 622, § 19, effective August 7.

Editor's note: This section is similar to former § 26-4-104 as it existed prior to 2006.

ANNOTATION

Annotator's note. Since § 25.5-4-104 is similar to § 26-4-104 as it existed prior to the 2006 amendments relocating article 4 of title 26 to title 25.5, relevant cases construing that provision have been included in the annotations to this section.

Program for "medically needy" not required. The superimposition of a program for the medically needy could create much administrative difficulty and uncertainty and encourage excessive medical expenses and resultant waste. Fullington v. Shea, 320 F. Supp. 500 (D. Colo. 1970), aff'd mem., 404 U.S. 963 (1971).

Since the federal laws relative to the "medically indigent" are optional, the failure of Colorado to extend medicaid to the "medically indigent" while at the same time extending it to the "categorical" recipients does not constitute an invalid discrimination violative of the equal protection clause of the fourteenth amendment to the constitution of the United States. Fullington v. Shea, 320 F. Supp. 500 (D. Colo. 1970), aff'd mem., 404 U.S. 963 (1971).

Applied in Dodge v. State Dept. of Soc. Servs., 657 P.2d 969 (Colo. App. 1982).