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 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 2 - OPTIONAL PROVISIONS (§§ 25.5-5-201 — 25.5-5-208) › Section 25.5-5-204 - [Effective 1/1/2026] Presumptive eligibility - pregnant person - children - long-term care - state plan

(1)
For purposes of this section, "presumptive eligibility" means the self-declaration of income, assets, and status in order to promptly receive medical assistance services prior to the verification of income, assets, and status.
(2)
(a)
A pregnant person is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if the person declares all pertinent information relating to the criteria of income, assets, and, only if necessary to administer reimbursement for services, status.
(b)
(2.5)
A child less than nineteen years of age is presumptively eligible for the medical assistance program and shall receive services specified by federal law only if a parent or legal guardian of the child declares all pertinent information relating to the criteria of income, assets, and, only if necessary to administer reimbursement for services, status of the child's family.
(2.7)
(a)
The state department is authorized to seek federal authorization to allow a person who is in need of long-term services and supports, as defined in section 25.5-6-1702(10), to be presumptively eligible for the medical assistance program pursuant to this article 5 and articles
4
and
6
of this title 25.5.
(b)
If the state department receives federal authorization pursuant to subsection (2.7)(a) of this section and sufficient spending authority, a person in need of long-term services and supports shall be presumptively eligible for the medical assistance program if the person or the person's legal representative declares all pertinent information relating to the criteria of income, assets, immigration status, and any other Information that may be Required pursuant to the Federal Authorization. If required due to limitations of federal authorization or spending authority, the state department may implement this subsection (2.7)(b) as a pilot program rather than statewide.
(c)
The state department shall make any necessary changes to the state plan waivers for home- and community-based service programs and any other federal authorization that are authorized pursuant to this article 5 and articles 4 and 6 of this title 25.5 to comply with this subsection (2.7).
(d)
If it is determined that a Member was not eligible for medical benefits after the Member had been determined to be eligible based upon presumptive eligibility, the state department shall not pursue recovery from a county department for the cost of medical services provided to the Member, and the county department shall not be responsible for any federal error rate sanctions resulting from such determination.
(3)
The state department shall make any necessary changes to the state plan to comply with this section.
Amended by 2024 Ch. 323,§ 1, eff. 1/1/2026.
Amended by 2024 Ch. 152,§ 45, eff. 8/7/2024.
Amended by 2022 Ch. 399, § 18, eff. 6/7/2022.
Amended by 2021 Ch. 83, § 26, eff. 7/1/2024.
L. 2006: Entire article added with relocations, p. 1864, § 7, effective July 1. L. 2007: (2.5) added, p. 1493, § 4, effective 1/1/2008. L. 2009: (2.7) added, (HB 09-1103), ch. 694, p. 694, § 1, effective April 22. L. 2021: (2.7)(a) and (2.7)(b) amended, (HB 21 -1187), ch. 332, p. 332, § 26, effective 7/1/2024.
This section is similar to former § 26-4-304 as it existed prior to 2006.
2024 Ch. 323, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2021 Ch. 83, 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 contained in the 2007 act enacting subsection (2.5), see section 1 of chapter 347, Session Laws of Colorado 2007.