Current through Register Vol. 47, No. 5, March 10, 2024
A.
Overview of Requirements
In order to qualify to receive discounted health care
services under available CICP funds, an Applicant shall satisfy the following
requirements:
1. Execute an affidavit
regarding citizenship status;
a. Beginning on
July 1, 2022, applicants are no longer required to execute an affidavit
regarding citizenship status.
2. Be lawfully present in the United States;
a. Beginning on July 1, 2022, applicants are
no longer required to be lawfully present in the United States.
3. Be a resident of
Colorado;
4. Meet all CICP
eligibility requirements as defined by state law and procedures; and
5. Furnish a social security number (SSN) or
evidence that an application for a SSN has been submitted, or meet one of the
following exceptions:
a. individual is an
unborn child;
b. individual is
homeless and unable to provide a SSN;
c. individual is ineligible for a SSN:
d. individual may only be issued a
SSN for a valid non-work reason in accordance with
20 C.F.R. sec.
422.104;
e. individual refuses to obtain a SSN because
of well-established religious objections.
B. Applicants
1. Any adult age 18 and older may apply to
receive discounted health care services on behalf of themselves and members of
the Applicant's family household.
2. If an Applicant is deceased, the personal
representative of the estate or a family member may complete the application on
behalf of the Applicant. The family member completing the application will not
be responsible for any copayments incurred on behalf of the deceased
member.
3. The application to
receive discounted health care services under available CICP funding shall
include the names of all members of the Applicant's family household. All
non-spouse or civil union partner, non-student adults ages 18-64 must have
financial support demonstrated or attested to in order to be included in
household size. All minors and those 65 or older do not need documentation of
financial support to be counted in household size. Income from spouses or civil
union partners and all non-student adults must be included in the
application.
4. A minor shall not
be rated separately from his or her parents or guardians unless he or she is
emancipated or there exists a special circumstance. A minor is an individual
under the age of 18.
C.
Signing the Application
The Applicant or an authorized representative of the
Applicant must sign the application to receive discounted health care services
submitted to the Qualified Health Care Provider within 90 calendar days of the
date of health care services. If an Applicant is unable to sign the application
or has died, a spouse, civil union partner, relative, or guardian may sign the
application. Until it is signed, the application is not complete, the Applicant
cannot receive discounted health care services under the CICP, and the
Applicant has no appeal rights. All information needed by the provider to
process the application must be submitted before the application is
signed.
D. Affidavit
1. Each first-time Applicant, or Applicant
seeking to reapply, 18 years of age or older shall execute an affidavit
stating:
a. That he or she is a United States
citizen, or
b. That he or she is a
legal permanent resident or is otherwise lawfully present in the United States
pursuant to 1 CCR 204-30; Rule 5.
2. For an Applicant who has
executed an affidavit stating that he or she is lawfully present in the United
States but is not a United States citizen, the provider shall verify lawful
presence through the Federal Systematic Alien Verification for Entitlements
(SAVE) Program operated by the United States Department of Homeland Security or
a successor program designated by the United States Department of Homeland
Security within three business days of receipt of the lawful presence
documentation. A SAVE verification is not needed for Applicants who provide an
ID issued by a REAL ID Act compliant state that bears the REAL ID Act
indicator.
3. Effective July 1,
2022, Applicants are no longer required to execute an affidavit of lawful
presence.
E.
Establishing Lawful Presence
1. Each
first-time Applicant, or Applicant seeking to reapply, eighteen years of age or
older shall be considered lawfully present in the country if they produce a
document or waiver in accordance with
1 CCR
204-30; Rule 5 (effective September 17, 2020), which
is hereby incorporated by reference. This incorporation of
1 CCR
204-30; Rule 5 excludes later amendments to, or
editions of, the referenced material. Pursuant to Section
24-4-103 (12.5), C.R.S., the
Department maintains copies of this incorporated text in its entirety,
available for public inspection during regular business hours at: Colorado
Department of Health Care Policy and Financing, 1570 Grant Street, Denver,
Colorado 80203. Certified copies of incorporated materials are provided at cost
upon request.
2. Submission of
Documentation
Lawful presence documentation may be accepted from the
Applicant, the Applicant's spouse, civil union partner, parent, guardian, or
authorized representative in person, by mail, by email, or facsimile.
3. Expired or absent documentation
for non-U.S. citizens
a. If an Applicant is
unable to present any documentation evidencing his or her immigration status,
refer the Applicant to the local Department of Homeland Security office to
obtain documentation of status.
b.
In unusual circumstances involving Applicants who are hospitalized or medically
disabled or who can otherwise show good cause for their inability to present
documentation and for whom securing such documentation would constitute undue
hardship, if the Applicant can provide an alien registration number, the
provider may file U.S.C.I.S. Form G-845 and Supplement, along with the alien
registration and a copy of any expired Department of Homeland Security
document, with the local Department of Homeland Security office to verify
status.
c. If an Applicant does not
present documentation proving their lawful presence but instead presents a
receipt indicating that he or she has applied to the Department of Homeland
Security for a replacement document, file U.S.C.I.S. Form G-845 and Supplement
with a copy of the receipt with the local Department of Homeland Security
office to verify status.
4. Effective July 1, 2022, Applicants are no
longer required to provide proof of lawful presence.
F. Residence in Colorado
An Applicant must be a resident of Colorado. A Colorado
resident is a person who currently lives in Colorado and intends to remain in
the state.
Migrant workers and all dependent family members must meet
all of the following criteria to comply with residency requirements:
1. Maintains a temporary home in Colorado for
employment reasons;
2. Meet the
lawful presence criteria, as defined in paragraph E of this Section;
and
3. Employed in
Colorado.
G. Applicants
Not Eligible
1. The following individuals are
not eligible to receive discounted services under the CICP:
a. Individuals for whom lawful presence
cannot be verified.
I. Effective July 1,
2022, lawful presence is no longer a requirement for CICP, and these
individuals are no longer ineligible for discounted services.
b. Individuals who are being held
or confined involuntarily under governmental control in State or federal
prisons, jails, detention facilities or other penal facilities. This includes
those individuals residing in detention centers awaiting trial, at a wilderness
camp, residing in half-way houses who do not have freedom of movement and
association, and those persons in the custody of a law enforcement agency
temporarily released for the sole purpose of receiving health care.
c. College students whose residence is from
outside Colorado or the United States that are in Colorado for the purpose of
higher education. These students are not Colorado residents and cannot receive
services under the CICP.
d.
Visitors from other states or countries temporarily visiting Colorado and have
primary residences outside of Colorado.
e. Persons who qualify for Medicaid. However,
Applicants whose only Medicaid benefits are the following shall not be excluded
from consideration for CICP eligibility:
I.
QMB benefits described at Section 8.100.6.L of these regulations;
II. SLMB benefits described at Section
8.1006.M, or
III. The QI1 benefits
described at Section 8.100.6.N.
f. Individuals who are eligible for the
Children's Basic Health Plan.
H. Health Insurance Information
The Applicant shall submit all necessary information related
to health insurance, including a copy of the insurance policy or insurance
card, the address where the medical claim forms must be submitted, policy
number, and any other information determined necessary.
I. Subsequent Insurance Payments
If a Client receives discounted health care services under
the CICP, and their insurance subsequently pays for services, or if the Client
is awarded a settlement, the insurance company or patient shall reimburse the
Qualified Health Care Provider for discounted health care services rendered to
the Client.
