(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 is 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.
Source: 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. L. 2024: Entire section amended, (SB 24-176), ch. 152, p. 627, � 26, effective August 7.
Editor's note: This section is similar to former � 26-4-518.5 as it existed prior to 2006.
Cross references: For the legislative declaration in SB 10-167, see section 1 of chapter 296, Session Laws of Colorado 2010.
25.5-4-211. Medicaid management information system - appropriation in annual general appropriation act - expenditure in next fiscal year. (1) Subject to the limitation in subsection (2) of this section, unexpended and unencumbered moneys from an appropriation in the annual general appropriation act to the state department for the medicaid management information system remain available for expenditure by the state department in the next fiscal year without further appropriation. This section applies to appropriations made by the general assembly for fiscal years beginning on and after July 1, 2013.
(2) On or before June 30, 2014, and on or before June 30 of each year thereafter, the state department shall notify the state controller of the amount of the appropriation from the annual general appropriation act for the medicaid management information system for the current fiscal year that the state department needs to remain available for expenditure in the next fiscal year. The state department may not expend more than the amount notified under the authority granted in this section.
(3) Repealed.
Source: L. 2013: Entire section added, (HB 13-1281), ch. 205, p. 851, � 1, effective May 11. L. 2017: (3) amended, (HB 17-1060), ch. 6, p. 16, � 8, effective March 1.
Editor's note: Subsection (3)(b) provided for the repeal of subsection (3), effective January 3, 2018. (See L. 2017, p. 16.)
25.5-4-212. Medicaid member correspondence improvement process - legislative declaration - definition. (1) (a) The general assembly finds and declares that:
(I) Accurate, understandable, timely, informative, and clear correspondence from the state department is critical to the life and health of medicaid members and applicants and, in some cases, is a matter of life and death for our most vulnerable populations;
(II) Unclear, confusing, and late correspondence from the state department causes an increased workload for the state, counties administering the medicaid program, and nonprofit advocacy groups assisting applicants and members; and
(III) Government should be a good steward of taxpayers' money, ensuring that it is spent in the most cost-effective manner.
(b) Therefore, the general assembly finds that improving medicaid member correspondence is critical to the health and safety of medicaid members and will reduce unnecessary confusion that requires members to call counties and the state department or file appeals.
(2) As used in this section, unless the context otherwise requires, member correspondence means any communication to provide notice of an approval, denial, termination, or change to an individual's medicaid eligibility; to provide notice of the approval, denial, reduction, suspension, or termination of a medicaid benefit; or to request additional information that is relevant to determining an individual's medicaid eligibility or benefits. Member correspondence does not include communications regarding the state department's review of trusts or review of documents or records relating to trusts.
(3) The state department shall improve medicaid member correspondence by ensuring that member correspondence revised or created after January 1, 2018:
(a) Is written using person-first, plain language;
(b) Is written in a format that includes the date of the correspondence and a member greeting;
(c) Is consistent, using the same terms throughout to the extent practicable, including commonly used program names;
(d) Is accurately translated into the second most commonly spoken language in the state if a member indicates that the language is the member's written language of preference or as required by law;
(e) Includes a statement translated into the top fifteen languages most commonly spoken by individuals in Colorado with limited English proficiency informing an applicant or member how to seek further assistance in understanding the content of the correspondence;
(f) Clearly conveys the purpose of the applicant or member correspondence, the action or actions being taken by the state department or the state department's designated entity, if any, and the specific action or actions that the applicant or member shall or may take in response to the correspondence;
(g) Includes a specific description of any necessary information or documents requested from the applicant or member;
(h) Includes contact information for applicant or member questions; and
(i) Includes a specific and plain language explanation of the basis for the denial, reduction, suspension, or termination of the benefit, if applicable.
(4) Subject to the availability of sufficient appropriations and receipt of federal financial participation, on and after July 1, 2018, the state department shall make electronically available to a member specific and detailed information concerning the member's household composition, assets, income sources, and income amounts, if relevant to a determination for which member correspondence was issued. If implemented, the state department shall notify members in the written correspondence of the option to access this information.
(5) The state department is encouraged to promote the receipt of member correspondence electronically or through mobile applications for members who choose those methods of delivery as allowed by law.
(6) As part of its ongoing process to create and improve member correspondence, the state department may engage with experts in written communication and plain language to test member correspondence against the criteria set forth in subsection (3) of this section with a geographically diverse and representative sample of medicaid members relevant to the member correspondence being revised. The state department shall also develop a process to review and consider feedback from stakeholders, including consumer advocates and counties, prior to implementing significant changes to correspondence.
(7) The state department shall ensure that applicant or member correspondence that may only affect a small number of applicants or members, but may, nonetheless, have a significant impact on the lives of those applicants or members, is appropriately prioritized for revision.
(8) As part of its annual presentation made to its legislative committee of reference pursuant to section 2-7-203, the state department shall present information concerning:
(a) The state department's process for ongoing improvement of member correspondence;
(b) Member correspondence revised pursuant to criteria set forth in subsection (3) of this section during the prior year and member correspondence improvements that are planned for the upcoming year; and
(c) A description of the results of testing of new or significantly revised member correspondence pursuant to subsection (6) of this section, including a description of the stakeholder feedback.
Source: L. 2017: Entire section added, (SB 17-121), ch. 303, p. 1651, � 1, effective August 9. L. 2024: Entire section amended, (SB 24-176), ch. 152, p. 628, � 27, effective August 7.