Colorado § 25.5-6-1404 - Medicaid buy-in program - eligibility - premiums - medicaid buy-in fund - report - rules.

§ 25.5-6-1404. Medicaid buy-in program - eligibility - premiums - medicaid buy-in fund - report - rules.

(1) Eligibility. An individual is eligible for and shall receive medicaid provided in this part 14 through a medicaid buy-in program without losing eligibility for medicaid if all of the following conditions are met:

(a) The individual meets the requirements for the basic coverage group or the individual was previously in the basic coverage group and now meets the requirements for the medical improvement group or the individual was previously in the basic coverage group and now meets the requirements for the work incentives eligibility group, if a state plan amendment for the work incentives eligibility group has been submitted and approved pursuant to section 25.5-6-1403 (5);

(b) The individual maintains premium payments calculated by the state department in accordance with subsection (3) of this section, unless the individual is exempted from premium payments under rules promulgated by the state board; and

(c) The individual meets all other requirements established by rule of the state board.

(2) There is no income or asset limitation for a participant in the medicaid buy-in program. In addition, there is no income or asset limitation for an individual who participates in the medicaid buy-in program and also receives home- and community-based services.

(3) Premiums.

(a) An individual who is eligible for and receives medicaid under subsection (1) of this section shall pay a premium pursuant to a payment schedule established by the state department in consultation with the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3)(a). The amount of the premium shall be determined from a sliding-fee scale adopted by rule of the state board that is based on a percentage of the individual's income adjusted for family size and on any impairment-related work expenses; except that, consistent with federal law, if the amount of the individual's adjusted gross income exceeds seventy-five thousand dollars, the individual shall be responsible for paying one hundred percent of the premium. The rules shall specify the amount of unearned income the state department shall disregard in calculating the individual's income. Premiums are credited to the healthcare affordability and sustainability medicaid buy-in cash fund created in section 25.5-4-402.4 (5.1) for the purpose of offsetting program costs.

(b) Repealed.

(c) Within three years after implementation of the medicaid buy-in program pursuant to this part 14, the state department shall submit a report on the effectiveness of the program to the health and human services committees of the general assembly, or any successor committees, and the joint budget committee of the general assembly.

(4) Repealed.

(5) Medicare. If federal financial participation is available, subject to available appropriations, the state department may pay medicare part A and part B premiums for individuals who are eligible for medicare and for medicaid under subsection (1) of this section.

(6) Repealed.

Source: L. 2008: Entire part added, p. 2199, § 1, effective July 1. L. 2020: (1)(a) amended and (4) repealed, (SB 20-033), ch. 237, p. 1151, § 3, effective July 6. L. 2022: (3)(a) amended, (SB 22-212), ch. 421, p. 2990, § 105, effective August 10. L. 2023: (6) added, (SB 23-182), ch. 118, p. 431, § 4, effective April 27. L. 2024: (6)(c) amended, (HB 24-1400), ch. 77, p. 263, § 4, effective April 18. L. 2025: (3)(a) and (3)(b) amended, (SB 25-228), ch. 150, p. 574, § 3, effective May 1.

Editor's note: (1) For the amendments to subsection (3)(b) in SB 25-228 in effect from May 1, 2025, to July 1, 2025, see chapter 150, Session Laws of Colorado 2025. (L. 2025, p. 574.)

(2) Subsection (3)(b)(III) provided for the repeal of subsection (3)(b), effective July 1, 2025. (See L. 2025, p. 574.)

(3) Subsection (6)(c) provided for the repeal of subsection (6), effective September 1, 2025. (See L. 2024, p. 263.)