Act sets health coverage limits for some immigrant Coloradans

The state health program would limit some dental, behavioral health, managed care, and other services for certain pregnant people and children. The provisions cover pregnant people who are ineligible for medical assistance only because of immigration status, and children under 19 whose family income is no more than 260% of the federal poverty line and who lack eligibility because of immigration status. Dental services for the covered pregnant people and children would have an annual $1,100 limit. Behavioral health services would be offered only through fee-for-service payments. The covered people would not receive services through the accountable care collaborative or managed care. Children generally would not receive specified long-term, home health, and other listed services, unless they were already receiving them by December 31, 2026. The dental limit begins July 1, 2026. The behavioral health, accountable care, managed care, and children’s service limits begin January 1, 2027.

The state department would cap enrollment in the state medical assistance program at 25,000 covered children if a listed enrollment or spending trigger occurs. The cap covers children under 19 whose family income is no more than 260% of the federal poverty line and who are ineligible for medical assistance because of immigration status. The cap applies if enrollment exceeds 25,000 children or if quarterly spending exceeds one-quarter of the program’s appropriation plus 5% for seasonal cost changes. The department must adopt rules to carry out the cap and report enrollment and cost-reduction strategies to the Joint Budget Committee. The cap applies during state fiscal year 2026-27. If a trigger occurs, it begins on the first day of the month after 60 days have passed since the department determines that the trigger was met. The report is due by November 1, 2026.

The act provides specified state funding for program technology, benefits systems, and behavioral health fee-for-service payments, while directing several appropriation adjustments. The funding applies to the Department of Health Care Policy and Financing during state fiscal year 2026-27. The $73,917 behavioral health payment amount assumes the department receives $137,274 in federal funds. Some reductions do not apply if the related annual appropriation is too small or does not exist. The funding provision depends on the annual general appropriation act becoming law, and the health services adjustment depends on whether House Bill 26-1401 becomes law. The funding and related adjustments apply to state fiscal year 2026-27 and take effect under the conditions and effective dates stated in the act.