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 4 - COLORADO MEDICAL ASSISTANCE ACT - GENERAL MEDICAL ASSISTANCE (§§ 25.5-4-101 — 25.5-4-506) › Part 2 - ADMINISTRATION (§§ 25.5-4-201 — 25.5-4-216) › Section 25.5-4-210 - [Effective 8/7/2024] Purchase of health insurance for members

(1)
(a)
The state department shall purchase group health insurance for a medical assistance Member who is eligible to enroll for coverage if enrollment of the member in the group plan would be cost-effective. In addition, the state department may purchase individual health insurance for a medical assistance Member who is eligible to enroll in a health insurance plan if enrollment of the member would be cost-effective to this state. A determination of cost-effectiveness must be in accordance with federal guidelines established by the secretary of the federal department of health and human services.
(b)
Notwithstanding any provision of subsection (1)(a) of this section to the contrary, the state department, in purchasing health insurance for medical assistance members who are eligible to enroll for private coverage, shall not purchase health insurance for more than two thousand individuals.
(2)
Enrollment in a group health insurance plan is required of members for whom enrollment has been determined to be cost-effective as a condition of obtaining or retaining medical assistance. A parent is required to enroll a dependent child Member, but medical assistance for the child is not discontinued if a parent fails to enroll the child.
(3)
The state department shall pay any premium, deductible, coinsurance, or other cost-sharing obligation required under the group plan for services covered under the state medical assistance plan. In addition, the state department shall pay any premium, deductible, coinsurance, or other cost-sharing obligation required under an individual plan purchased by the state department for a medical assistance Member pursuant to subsection (1) of this section. Payment of the services are treated as payment for medical assistance. Coverage provided by the purchased health insurance plan is considered third-party liability for the purposes of section
25.5-4-209
.
(4)
Services not available to a Member under the purchased plan are provided to the member if the services would otherwise be provided as medical assistance services pursuant to this article 4 or article 5 or 6 of this title 25.5. Nothing in this section requires services provided under a group health insurance plan for medical assistance to be made available to members not enrolled in the plan. Enrollment in a group health insurance plan pursuant to this section does not affect the eligibility of a Member who otherwise qualifies for medical assistance pursuant to this article 4 or article 5 or 6 of this title 25.5.
Amended by 2024 Ch. 152,§ 26, eff. 8/7/2024.
L. 2006: Entire article added with relocations, p. 1828, § 7, effective July 1. L. 2010: (1) amended, (SB 10 -167), ch. 296, p. 1378, § 6, effective May 26.
This section is similar to former § 26-4-518.5 as it existed prior to 2006.
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 10-167, see section 1 of chapter 296, Session Laws of Colorado 2010.