2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 6 - COLORADO MEDICAL ASSISTANCE ACT - LONG-TERM CARE (§§ 25.5-6-101 — 25.5-6-2001) › Part 14 - MEDICAID BUY-IN (§§ 25.5-6-1401 — 25.5-6-1406) › Section 25.5-6-1404 - Medicaid buy-in program - eligibility - premiums - medicaid buy-in fund - report - rules - repeal

(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. 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.
(b)
The rules setting the premiums and the sliding-fee scale shall be based on an actuarial study of the disabled population in this state. The state department may solicit and accept federal grants to cover the costs of the actuarial study. Moneys received through any grants and any premiums shall be credited to the medicaid buy-in cash fund, which fund is hereby created in the state treasury. Moneys in the fund shall be appropriated by the general assembly and expended by the state department for the purpose of conducting implementation activities as determined by the state department, including conducting the actuarial study. Premiums shall be credited to the fund for the purpose of offsetting program costs.
(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)
(a)
To ensure that the state department maintains access to state and federal funding provided by the federal "Families First Coronavirus Response Act", Pub.L. 116-127, and the federal "Consolidated Appropriations Act, 2023", subsections (1)(a), (1)(b), and (3)(a) of this section establishing coverage group requirements and requiring payment of premiums in order to maintain eligibility for the medicaid buy-in program are suspended until the last day of the twelfth month following the end of the declared federal public health emergency as a result of the coronavirus disease 2019, known as "COVID-19".
(b)
The state board may adopt rules to implement this subsection (6) to ensure that the state department can resume routine operations that follow guidance issued by the federal centers for medicare and medicaid services, including terminations of eligibility, the processing of eligibility renewals, and the transition between medical assistance and children's basic health plan eligibility categories.
(c)
This subsection (6) is repealed, effective September 1, 2025.
Amended by 2024 Ch. 77,§ 4, eff. 4/18/2024.
Amended by 2023 Ch. 118,§ 4, eff. 4/27/2023.
Amended by 2022 Ch. 421, § 105, eff. 8/10/2022.
Amended by 2020 Ch. 237, § 3, eff. 7/6/2020.
L. 2008: Entire part added, p. 2199, § 1, effective July 1.
2022 Ch. 421, was passed without a safety clause. See Colo. Const. art. V, § 1(3).