Colorado Medical Bill Rights & Programs: One of the Strongest Patient Protection States in the US

SB23-093: Increase Consumer Protections for Medical Transactions

Enacted in May 2023, this law provides some of the strongest medical debt collection protections in the country:

• Interest capped at 3% per year on all medical debt (reduced from the previous 8% cap)
• Right to an itemized statement. Upon your written request, any debt collector must cease collection until they provide a full itemized statement of the medical debt
• Right to dispute. You must be given the opportunity to dispute the validity of the medical debt before collection resumes
• No collection during appeals. Collection activity is prohibited while an insurance claim or billing appeal is pending
• Written payment plan required. Any payment plan must be documented in writing between you and the collector
• Proof of debt required for default judgments. Before any default judgment, the plaintiff must file evidence with the court establishing the amount and validity of the debt

Colorado Hospital Discounted Care Program

Under HB21-1198 (effective September 1, 2022), Colorado limits what hospitals can charge low-income patients. This is one of the most protective hospital billing laws in the country:

• Eligibility: Patients with income at or below 250% FPL (~$37,650/year for a single person in 2026)
• Rate cap: Charges are limited to the greater of 100% of the Medicare rate or 100% of the Medicaid base rate (set annually by the Department of Health Care Policy and Financing)
• Mandatory screening: Hospitals must screen all uninsured patients for Health First Colorado (Medicaid), CHP+, Medicare, Emergency Medicaid, and discounted care before billing
• Payment plan cap: Monthly payments cannot exceed 4% of the patient's monthly household income
• Covered services: All medically necessary care in general acute hospitals, critical access hospitals, and free-standing emergency departments

Hospital Obligations:

• Must post financial assistance, charity care, and payment plan policies conspicuously on the website
• Must make information available in patient waiting areas and in languages appropriate to the community
• Must provide financial assistance information to each patient before discharge when possible
• Non-compliant hospitals face corrective action plans and fines up to $5,000 for knowing or willful violations

What Collectors Cannot Do:

• Cannot garnish more than 20% of disposable earnings (the federal maximum is 25%, so Colorado gives you more protection). The lesser of 20% of disposable earnings or the amount exceeding 40 times the state minimum wage applies.
• Cannot garnish wages at all if under 400% FPL for medical debt. If your family income does not exceed 400% of the Federal Poverty Level (~$60,240/year for a single person), your earnings are fully exempt from garnishment for medical debt judgments.
• Cannot take your home equity up to $250,000. Colorado's homestead exemption automatically protects up to $250,000 of equity in your home ($350,000 if you are 60 or older, or have a disability). No filing required.
• Cannot charge more than 3% annual interest on any medical debt, whether held by the original provider or a collection agency.
• Cannot pursue collection without providing an itemized statement if you request one in writing. Collection must stop until the statement is provided and you have had the chance to dispute.

Colorado Out-of-Network Billing Protections (HB19-1174, effective January 1, 2020):

Colorado enacted surprise billing protections effective January 1, 2020, a full two years before the federal No Surprises Act took effect. The state law provides robust protections:

• You pay only in-network cost-sharing for emergency services, non-emergency services from out-of-network providers at in-network facilities, and private ground ambulance services.
• No balance billing: The out-of-network provider cannot bill you for the difference between their charge and the insurance payment. The provider and insurer settle the payment dispute directly, keeping you out of the middle.
• Disclosure required: Facilities must tell you if you are at an out-of-network location or if out-of-network providers may be involved in your care, when known.
• Ground ambulance coverage: Unlike many states, Colorado's law extends to private ground ambulance services, with state-regulated health plans reimbursing at 325% of the Medicare rate.

Health First Colorado (Expanded Medicaid):

• • Adults (19-64): Up to 138% FPL (~$21,597/year for a single person in 2026)
• • Children (CHP+): Up to 260% FPL for children in families above Medicaid limits
• • Pregnant women: Higher income limits apply
• • No asset test for MAGI-based Medicaid
• • Apply any time at Colorado PEAK or through Connect for Health Colorado

Colorado Resources for Medical Bill Help: