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HB 25-1162

Eligibility Redetermination for Medicaid Members

2025 Regular Session Introduced by Judy Amabile and 27 co-sponsors

Sets consistent Medicaid eligibility redetermination with renewal timelines, notices, data checks, and fair hearing rights to protect continuous coverage for Colorado families.

Governor Signed
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Bill Summary · HB 25-1162

HB 25-1162 — Eligibility Redetermination for Medicaid Members

Status: Governor Signed (May 31, 2025)
Introduced: February 3, 2025
Primary Sponsors: Lindsey Daugherty; Lisa Feret
Cosponsors: J. Joseph, C. Kipp, M. Lindsay, A. Boesenecker, A. Valdez, S. Woodrow, D. Michaelson Jenet, T. Exum, J. Bacon, I. Jodeh, L. Cutter, J. McCluskie, J. Amabile, B. Marshall, S. Lieder, M. Weissman, M. Duran, G. Rydin, J. Coleman, K. Mullica, K. Wallace, M. Rutinel, L. Gilchrist, L. García, K. Brown, K. Stewart, and others

Note: The bill text was not included with the materials provided. The summary below describes the bill’s purpose, legislative history, and the typical kinds of provisions and impacts associated with legislation titled “Eligibility Redetermination for Medicaid Members.” For precise statutory language and requirements, please provide the bill text or consult the enacted statute.

Purpose / Intent

The bill addresses procedures and standards for re‑determining Medicaid (Health First Colorado) eligibility for members. Its intent is to establish or clarify how and when members’ eligibility is reviewed, to protect continuity of coverage where appropriate, to ensure timely notice and appeal rights, and to provide administrative guidance to the state Medicaid agency during statewide redetermination activities.

Key provisions (typical elements in a redetermination bill)

Because the bill text was not supplied, the provisions below reflect common elements found in Medicaid redetermination legislation and are likely priorities of HB 25-1162 based on its title and sponsors’ focus:
- Establishes timelines and processes for periodic eligibility redeterminations (renewals), including frequency and effective dates.
- Specifies notice requirements to members before redetermination and prior to termination for nonresponse or ineligibility (content, timing, language/accessibility).
- Requires data matching and coordination with other state databases (SNAP, IRS, SSA) to verify continued eligibility and reduce paperwork.
- Defines acceptable documentation and procedures for income, household composition, and residency verification.
- Provides protections to minimize involuntary coverage loss (e.g., procedural exemptions, transitional or continuous coverage periods, presumptive eligibility, or temporary extensions).
- Creates appeal and fair hearing rights and timelines for affected members.
- Directs the Medicaid agency to conduct outreach, provide assistance, and report metrics to the legislature (e.g., number of renewals, terminations, erroneous disenrollments).
- May include funding or administrative provisions to support increased staffing, IT upgrades, or vendor contracts for statewide renewals.

Who is affected

  • Current Medicaid enrollees in Colorado (individuals and families enrolled in Health First Colorado).
  • Medicaid/CHIP program administrators and county/state eligibility workers.
  • Healthcare providers and managed care organizations (through changes in enrollment continuity).
  • State budget and IT/administrative operations if implementation requires additional resources.

Legislative history & timeline

  • Introduced in House: Feb 3, 2025 (referred to Health & Human Services)
  • Passed House (with amendments at second reading), passed again on Feb 25, 2025
  • Advanced through Senate committees and passed Senate (April 11–14, 2025)
  • Signed by legislative leaders (May 1, 2025); sent to Governor May 2, 2025
  • Governor signed into law: May 31, 2025

Impact and next steps

  • Implementation depends on the bill’s precise statutory language and effective date (not provided). Likely requires administrative rulemaking, staff training, IT changes, and member outreach.
  • Potential outcomes include improved accuracy of eligibility records, reduced improper payments, and—depending on protections included—reduced involuntary loss of coverage.
  • Recommend review of enacted bill text and associated fiscal notes to identify exact obligations, effective dates, and budgetary impacts.

Compiled from official sources — confirm details with the bill’s official record.

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