2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › CHILDREN'S BASIC HEALTH PLAN (§§ 25.5-8-101 — 25.5-11-101) › Article 8 - CHILDREN'S BASIC HEALTH PLAN (§§ 25.5-8-101 — 25.5-8-113) › Section 25.5-8-103 - [Effective 8/7/2024] Definitions - rules

As used in this article 8, unless the context otherwise requires:
(1)
"Child" means a person who is less than nineteen years of age.
(2)
"Children's basic health plan" or "plan" means the subsidized health insurance product designed by the department of health care policy and financing and provided to enrollees, as defined in this section.
(3)
"Department" means the department of health care policy and financing created in section
25.5-1-104
.
(4)
"Eligible person" means:
(a)
(I)
A person who is less than nineteen years of age, who is a citizen or meets the immigration status requirements set forth in section
25.5-8-109 (6)
or
25.5-8-109 (7)
, whose family income does not exceed two hundred sixty percent of the federal poverty line, adjusted for family size, and who is not eligible for medical assistance pursuant to articles
4
,
5
, and
6
of this title 25.5.
(II)
Notwithstanding the provisions of subsection (4)(a)(I) of this section, if the money in the healthcare affordability and sustainability fee cash fund established pursuant to section
25.5-4-402.4 (5)
, together with the corresponding federal matching funds, is insufficient to fully fund all of the purposes described in section
25.5-4-402.4 (5)(b)
, after receiving recommendations from the Colorado healthcare affordability and sustainability enterprise established pursuant to section
25.5-4-402.4 (3)
, for persons less than nineteen years of age, the state board may by rule adopted pursuant to the provisions of section
25.5-4-402.4 (6)(b)(III)
reduce the percentage of the federal poverty line to below two hundred sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.
(III)
Repealed.
(b)
(I)
A pregnant person who is a citizen or meets the immigration status requirements set forth in section
25.5-8-109 (6)
or
25.5-8-109 (7)
, whose family income does not exceed two hundred sixty percent of the federal poverty line, adjusted for family size, and who is not eligible for medical assistance pursuant to articles
4
,
5
, and
6
of this title 25.5.
(II)
Notwithstanding the provisions of subsection (4)(b)(I) of this section, if the money in the healthcare affordability and sustainability fee cash fund established pursuant to section
25.5-4-402.4 (5)
, together with the corresponding federal matching funds, is insufficient to fully fund all of the purposes described in section
25.5-4-402.4 (5)(b)
, after receiving recommendations from the Colorado healthcare affordability and sustainability enterprise established pursuant to section
25.5-4-402.4 (3)
, for pregnant women, the state board by rule adopted pursuant to the provisions of section
25.5-4-402.4 (6)(b)(III)
may reduce the percentage of the federal poverty line to below two hundred sixty percent, but the percentage shall not be reduced to below two hundred thirteen percent.
(III)
Repealed.
(5)
"Enrollee" means any eligible person that has enrolled in the plan.
(6)
"Essential community provider" means a health-care provider that:
(a)
Has historically served medically needy or medically indigent patients and demonstrates a commitment to serve low-income and medically indigent populations who make up a significant portion of its patient population, or in the case of a sole community provider, serves the medically indigent patients within its medical capability; and
(b)
Waives charges or charges for services on a sliding scale based on income and does not restrict access or services because of a member's financial limitations.
(7)
"Health-care program" means any health-care program in the state that is supported with state general fund or federal dollars.
(8)
"Master settlement agreement" means the master settlement agreement, the smokeless tobacco master settlement agreement, and the consent decree approved and entered by the court in the case denominated
State of Colorado, ex rel. Gale A. Norton, Attorney General v. R.J. Reynolds Tobacco Co.; American Tobacco Co., Inc.; Brown &Williamson Tobacco Corp.; Liggett & Myers, Inc.; Lorillard Tobacco Co., Inc.; Philip Morris, Inc.; United States Tobacco Co.; B.A.T. Industries, P.L.C.; The Council For Tobacco Research--U.S.A., Inc.; and Tobacco Institute, Inc.
, Case No. 97 CV 3432, in the district court for the city and county of Denver.
(9)
"Medical services board" means the medical services board created in section
25.5-1-301
.
(10)
"Subsidized enrollee" means an eligible person who receives a subsidy from the department to purchase coverage under the plan or a comparable health insurance.
(11)
"Subsidy" means the amount paid by the department to assist an eligible person in purchasing coverage under the plan or a comparable health insurance product available to the eligible person through another coverage entity.
(12)
"Trust" means the children's basic health plan trust created in section
25.5-8-105
.
Amended by 2024 Ch. 152,§ 97, eff. 8/7/2024.
Amended by 2022 Ch. 399, § 20, eff. 6/7/2022.
Amended by 2022 Ch. 43, § 4, eff. 3/24/2022.
Amended by 2017 Ch. 267, § 22, eff. 7/1/2017.
L. 2006: Entire article added with relocations, p. 1975, § 7, effective July 1. L. 2007: (4) amended, p. 149, § 10, effective March 22. L. 2008: (4)(a) amended, p. 2019, § 1, effective 3/1/2009; (4)(b) amended, p. 2019, § 2, effective 10/1/2009. L. 2009: (4)(a) and (4)(b) amended, (SB 09-211), ch. 2, pp. 3, 4, §§ 1, 2, 3, effective February 26; (4) amended, (HB 09 -1293), ch. 152, p. 650, § 8, effective July 1; (4)(b) amended, (SB 09 -292), ch. 369, p. 1985, § 130, effective August 5. L. 2010: (4)(a)(I), (4)(a)(II), (4)(a)(III)(A), (4)(a)(III)(B), (4)(b)(I), (4)(b)(II), (4)(b)(III)(A), and (4)(b)(III)(B) amended, (HB 10 -1422), ch. 419, p. 2114, § 150, effective August 11. L. 2017: IP, (4)(a)(II), and (4)(b)(II) amended, (SB 17-267), ch. 267, p. 1466, § 22, effective July 1.
(1) This section is similar to former § 26-19-103 as it existed prior to 2006.
(2) Subsection (4)(a)(III)(C) and (4)(b)(III)(C) provided for the repeal of subsection (4)(a)(III) and (4)(b)(III), respectively, effective the July 1 following the revisor of statutes' receipt of the notice required pursuant to subsection (4)(a)(III)(B) and (4)(b)(III)(B). (See L. 2010, p. 2114.) The revisor of statutes received said notice dated February 17, 2017.
(3) Section 34 of chapter 267 (SB 17-267), Session Laws of Colorado 2017, provides that the section of the act changing this section does not take effect if the centers for medicare and medicaid services determine that the amendments do not comply with federal law. For more information, see SB 17-267. ( L. 2017, p. 1478.) The executive director of the department of health care policy and financing did not notify the revisor of statutes by June 1, 2017, of such determination; therefore, the amendments to this section took effect July 1, 2017.
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For the legislative declaration in SB 17-267, see section 1 of chapter 267, Session Laws of Colorado 2017.