(1) Repealed.
(2) If approved by the joint budget committee and subject to available appropriations, the state department shall submit to the federal centers for medicare and medicaid services an amendment to the state medical assistance plan, and shall request any necessary waivers from the secretary of the federal department of health and human services, to permit the state department to expand medical assistance eligibility as provided in this part 14 for the purpose of implementing a medicaid buy-in program for people with disabilities who are in the basic coverage group or the medical improvement group. In addition, the state department shall apply to the secretary of the federal department of health and human services for a medicaid infrastructure grant, if available, to develop and implement the federal Ticket to Work and Work Incentives Improvement Act of 1999, Pub.L. 106-170.
(3) If the state medical assistance plan amendment and all necessary waivers are approved, the state department shall implement the medicaid buy-in program provided in this part 14 not later than three months after receiving full federal approval, whichever is later.
(4) The state department shall seek federal authorization to implement a medicaid buy-in program for adults who are eligible to receive home- and community-based services pursuant to the supported living services waiver; the developmental disabilities waiver or its successor, part 4 of this article 6; the persons with brain injury waiver, part 7 of this article 6; and the complementary and integrative health program, part 13 of this article 6. The state department shall prepare and submit any requests necessary for federal approval not later than January 1, 2023, and shall implement the medicaid buy-in program pursuant to this subsection (4) not later than three months after receiving federal approval.
(5) (a) Except as provided in subsection (5)(b) of this section:
(I) The state department shall seek federal authorization through an amendment to the state medical assistance plan to implement the federal Balanced Budget Act of 1997, Pub.L. 105-33, 111, as amended, which provides individuals an opportunity to buy into medicaid consistent with the federal Social Security Act, 42 U.S.C. sec. 1396a (a)(10)(A)(ii)(XIII), as amended, to permit the state department to provide medical assistance eligibility to individuals in the work incentives eligibility group, age sixty-five and older, after they are no longer eligible under the federal Ticket to Work and Work Incentives Improvement Act of 1999, Pub.L. 106-170.
(II) In addition to submitting an amendment to the state medical assistance plan pursuant to subsection (5)(a)(I) of this section, the state department shall submit a state plan amendment pursuant to section 1902(r)(2) of the federal Social Security Act to use less restrictive income and resource methodologies to match the income, household, and asset levels of the medicaid buy-in program for implementation no later than July 1, 2022.
(b) The state department shall not prepare and submit the amendments to the state medical assistance plan pursuant to this subsection (5) if there are insufficient revenues from the healthcare affordability and sustainability hospital provider fee cash fund, created in section 25.5-4-402.4, for the administrative expenses associated with preparing and submitting the state plan amendments. If there are insufficient revenues from the healthcare affordability and sustainability hospital provider fee cash fund, the state department may accept and expend gifts, grants, or donations for this purpose.
Source: L. 2008: Entire part added, p. 2198, � 1, effective July 1. L. 2009: (2) amended, (HB 09-1293), ch. 152, p. 649, � 7, effective July 1. L. 2016: (4) added, (HB 16-1321), ch. 344, p. 1398, � 1, effective June 10; (1) repealed and (2) amended, (HB 16-1081), ch. 22, p. 52, � 7, effective August 10. L. 2020: (5) added, (SB 20-033), ch. 237, p. 1150, � 2, effective July 6. L. 2021: (4) amended, (SB 21-039), ch. 380, p. 2549, � 7, effective July 1. L. 2025: (5)(b) amended, (SB 25-270), ch. 151, p. 605, � 15, effective May 1; (4) amended, (SB 25-226), ch. 219, p. 1008, � 6, effective August 6.
25.5-6-1404. Medicaid buy-in program - eligibility - premiums - medicaid buy-in fund - report - rules. (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 in consultation with the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3)(a). 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. Premiums are credited to the healthcare affordability and sustainability medicaid buy-in cash fund created in section 25.5-4-402.4 (5.1) for the purpose of offsetting program costs.
(b) Repealed.
(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) Repealed.
Source: L. 2008: Entire part added, p. 2199, � 1, effective July 1. L. 2020: (1)(a) amended and (4) repealed, (SB 20-033), ch. 237, p. 1151, � 3, effective July 6. L. 2022: (3)(a) amended, (SB 22-212), ch. 421, p. 2990, � 105, effective August 10. L. 2023: (6) added, (SB 23-182), ch. 118, p. 431, � 4, effective April 27. L. 2024: (6)(c) amended, (HB 24-1400), ch. 77, p. 263, � 4, effective April 18. L. 2025: (3)(a) and (3)(b) amended, (SB 25-228), ch. 150, p. 574, � 3, effective May 1.
Editor's note: (1) For the amendments to subsection (3)(b) in SB 25-228 in effect from May 1, 2025, to July 1, 2025, see chapter 150, Session Laws of Colorado 2025. (L. 2025, p. 574.)
(2) Subsection (3)(b)(III) provided for the repeal of subsection (3)(b), effective July 1, 2025. (See L. 2025, p. 574.)
(3) Subsection (6)(c) provided for the repeal of subsection (6), effective September 1, 2025. (See L. 2024, p. 263.)