HB26-1096 • 2026

Colorado Medicaid Access to Primary Care Services

The bill prohibits the department of health care policy and financing (department) from denying a medicaid member (member) the ability to purchase primary care services or enter into a direct primary

Healthcare

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Rep. L. Feret, Rep. D. Johnson, Sen. C. Kipp, Sen. J. Rich, Rep. B. Bradley, Rep. L. Garcia Sander, Rep. R. Gonzalez, Rep. R. Keltie, Rep. R. Weinberg, Rep. T. Winter
Last action: 2026-04-02
Official status: Senate Committee on Health & Human Services Postpone Indefinitely
Effective date: Not listed

Plain English Breakdown

The bill text indicates a requirement for reporting data on provider enrollment status changes between August 12, 2026, and November 1, 2028.

Colorado Medicaid Access to Direct Primary Care Services

This bill stops the state health department from blocking Medicaid members who want to pay directly for primary care services, while requiring them to sign a form stating they cannot use their Medicaid benefits to get reimbursed for those specific payments.

What This Bill Does

Prohibits the Department of Health Care Policy and Financing from denying Medicaid members the ability to purchase direct primary care services or enter into agreements with providers.
Requires members who buy these services directly to sign a document acknowledging that the provider does not accept Medicaid payments for those specific visits.
States that members cannot submit claims to get reimbursed by Medicaid for any primary care services they paid for through a direct agreement.
Mandates that providers offering this service must enroll in the Colorado Medical Assistance Program specifically as an ordering, prescribing, and referring provider so their orders are accepted.
Requires providers to report data on how many members they served between August 12, 2026, and November 1, 2028.

Who It Names or Affects

Medicaid members in Colorado who wish to pay directly for primary care services.
Direct primary health-care providers who want to offer services to Medicaid patients through a direct payment model.
The Department of Health Care Policy and Financing, which must allow these arrangements.

Terms To Know

Direct Primary Care Agreement: A contract where a patient pays a provider directly for services over time instead of using insurance billing for each visit.
Ordering, Prescribing, and Referring Provider: A doctor or practitioner enrolled in Medicaid who can order tests or write prescriptions but does not bill the program for their own direct services to that patient.

Limits and Unknowns

The Department of Health Care Policy and Financing must seek federal authorization before it can fully implement these changes.
Members retain the right to see other primary care providers who are enrolled in Medicaid for covered services, but this bill does not change how those standard visits work.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

L.001

HOU Health & Human Services

Passed [*]

Plain English: This amendment requires direct primary care providers to report how many Medicaid members they served and their enrollment status by November 15, 2028.

Direct primary care providers must tell the state department how many Medicaid members they treated between August 12, 2026, and November 1, 2028.
Providers must also report if they were enrolled in Colorado's medical assistance program during that time or if they left the program to start offering direct primary care services.
The state department must include these numbers in its annual 'SMART ACT' presentation by January 1, 2029.

This amendment only adds reporting requirements and does not explain how the data will be used to change laws or funding.
The text defines specific dates for reporting but does not describe penalties if providers fail to submit their information on time.

L.003

SEN Health & Human Services

Passed [*]

Plain English: This amendment removes specific sections of the bill that were intended to stop Medicaid members from being denied access to primary care services.

Deletes lines 10 through 27 on page 5 of the original bill text.
Deletes lines 1 through 12 on page 6 of the original bill text.

The amendment only lists which parts to delete and does not provide new language, so it is unclear what rules will replace them or if the entire section was meant to be removed.
Without seeing the full content of the deleted lines, we cannot explain exactly how this change affects Medicaid members' ability to buy primary care services.

L.004

SEN Health & Human Services

Passed [*]

Plain English: This amendment requires Medicaid members who pay directly for primary care to sign a detailed agreement explaining their rights, payment rules, and how the provider will handle referrals.

Members must sign a document acknowledging they can still see regular Medicaid doctors even if they buy direct care services.
The signed paper states that neither the member nor the doctor can ask for Medicaid money to pay for these specific direct care visits.
Providers must explain in bold, easy-to-read text how young members under 21 are protected and how referrals work for other medical needs.
Members get a right to cancel their agreement with 30 days' notice without paying extra fees or losing prepaid money.

The amendment does not explain the specific costs members must pay out of pocket, only that these payments are private and separate from Medicaid.
It is unclear how this rule applies if a member already has an existing agreement before this law takes effect.

L.005

SEN Health & Human Services

Passed [*]

Plain English: This amendment requires doctors who have direct payment agreements with Medicaid patients to work together with the patient's main insurance plan for care planning and referrals.

Direct primary care providers must tell the managed care entity if a patient has serious health issues that need services beyond their private agreement.
Providers must answer requests from the managed care entity quickly when information is needed to help coordinate the patient's overall care.
If a patient needs medical services not covered by their direct agreement, the provider must refer them to doctors enrolled in Colorado Medicaid.
Direct primary care providers cannot take actions that would stop patients from getting other health benefits they are entitled to under Medicaid.

The amendment does not define exactly what counts as a 'reasonable time' for responding to requests or notifications.
It is unclear how the state will enforce these cooperation rules if a provider fails to follow them.

L.006

SEN Health & Human Services

Passed [*]

Plain English: This amendment requires direct primary care providers to share specific health information with a Medicaid member's managed care organization and report when they start or end their agreement with the patient.

Direct primary care providers must share relevant health records, such as diagnoses and medication lists, with the member's managed care entity for tasks like care coordination and identifying gaps in treatment.
Providers are required to inform the managed care entity within five days after a new direct primary care agreement is established with a Medicaid member.
Providers must also notify the managed care entity within five days if they terminate their direct primary care agreement with a member.

The amendment states that information sharing must follow state and federal privacy laws, but it does not list specific penalties for failing to share data or meet notification deadlines.
The text defines what types of health records can be shared, but it relies on the managed care entity requesting this information when 'reasonably necessary'.

L.007

SEN Health & Human Services

Passed [*]

Plain English: This amendment stops direct primary care providers from actively marketing their services to Medicaid members through methods like cold calls, door-to-door visits, or offering referral fees.

Direct primary care providers cannot knowingly market or advertise their services if it looks like they are trying to influence a member to buy them.
Providers and their staff are banned from contacting members directly via phone, text, email, mail, or door-to-door visits to discuss benefits.
It is illegal for these providers to pay third parties finder's fees in exchange for referring Medicaid members to them.
The amendment prohibits misrepresenting Colorado medical assistance rules and distributing marketing materials directly to members.

The text does not define exactly what counts as 'reasonably be interpreted' or provide specific examples of unfair trade practices beyond the listed items.
This summary only covers the new restrictions added by this amendment and does not explain other parts of the original bill.

L.008

SEN Health & Human Services

Passed [*]

Plain English: This amendment makes it illegal for businesses to block Medicaid members from buying direct primary care services, gives the Attorney General sole power to enforce this rule, and clarifies that these agreements are not health insurance.

It defines blocking a Medicaid member's access to direct primary care as an unfair or deceptive trade practice under state law.
It grants the Colorado Attorney General exclusive authority to enforce these new rules instead of allowing other agencies to do so.
It explicitly states that individuals cannot file private lawsuits against providers for violating this section.

The amendment text does not explain what specific actions are prohibited in the referenced subsection (4) or how direct primary care agreements currently work, as those details were likely defined earlier in the bill.
Because the full context of Section 6-23-106 is missing from this excerpt, it is unclear exactly which business behaviors trigger these new penalties.

L.011

SEN Health & Human Services

Passed [*]

Plain English: This amendment sets a maximum price limit for Medicaid members who choose to pay directly for primary care services.

The cost charged to a Medicaid member cannot be more than $80 or the same amount charged to someone without Medicaid, whichever is lower.
Direct primary care providers are not allowed to collect any payment from a member until specific requirements in the bill have been met.

The amendment does not explain what the 'requirements described in subsection (4)' are because that text was not included.
It is unclear if this price limit applies to every single visit or only to a specific type of service agreement since those details were not provided.

L.013

SEN Health & Human Services

Passed [*]

Plain English: This amendment adds a rule requiring patients to sign an agreement with their direct primary care provider before receiving any services so they understand the costs.

Requires members and providers to create a written agreement before health-care services begin.

L.015

SEN Health & Human Services

Lost

Plain English: This amendment simplifies the bill by removing rules about prepaid fees and requiring members to sign or initial next to each item on a form.

Removes language that mentions 'prepaid' amounts when discussing termination of services.
Deletes two lines from page 2 that contained additional details about these payments.
Updates the signing requirement so people must either sign or initial next to every item on a document.

The amendment text only shows specific word changes and does not explain what was in the deleted lines, making it unclear exactly which payment rules were removed.
Because this amendment lost its vote, these changes did not become part of the final bill.

L.016

SEN Health & Human Services

Lost

Plain English: This amendment requires direct primary care providers to work with Medicaid managed care plans for patient safety and coordination if the patient agrees.

Direct primary care doctors must share information about serious health conditions with a member's Medicaid plan when needed for other services.
Doctors must answer requests from Medicaid plans quickly to help plan or coordinate care that is not covered by their direct agreement.
Providers are required to refer patients to enrolled Medicaid providers if the patient needs services outside of what the direct primary care doctor offers.
Direct primary care doctors must give members contact information for their assigned Medicaid managed care entity.

This amendment was lost in committee and did not become part of the final bill, so these rules would not take effect under this proposal.
The text does not specify exact time limits for what counts as a 'reasonable' or 'timely' response to requests.

L.017

SEN Health & Human Services

Lost

Plain English: This amendment adds a list of rules that direct primary care providers must follow to prevent unfair marketing and deceptive practices when dealing with Medicaid members.

Direct primary care providers cannot pay anyone for referring patients to them.
Providers are not allowed to lie about or confuse people regarding Colorado medical assistance program rules.
Providers can only send marketing materials directly to a member if the member asked for that information first.
It is forbidden for these providers to use unfair or deceptive tricks in their advertising.

This amendment was voted down and did not pass, so it does not change any laws right now.
The text defines what providers cannot do but does not explain the specific punishments for breaking these rules.

L.018

SEN Health & Human Services

Lost

Plain English: This amendment makes breaking the bill's rules a deceptive trade practice that only the Attorney General can enforce, while clarifying that direct primary care agreements are not health insurance.

It defines violating specific parts of this law as an unfair or deceptive business practice under state code section 6-1-105.
It gives the Colorado Attorney General exclusive power to enforce these rules, meaning no other agency can do so.
It states that individuals cannot file private lawsuits against businesses for breaking these specific rules.
It clarifies that this law does not turn direct primary care agreements into health insurance or expand what Medicaid covers.

The amendment text refers to subsection (4) and section 6-23-106, but the specific rules in those sections are not included here.
This amendment was marked as 'Lost' during committee review, so it did not become part of the final bill.

L.019

SEN Health & Human Services

Passed [*]

Plain English: This amendment changes the law to allow Colorado's Attorney General to enforce specific rules about direct primary care, even though other parts of this article usually cannot be enforced by them.

It updates section 6-23-105 in state law regarding who can enforce these rules.

The amendment text does not explain what the specific rules in section 6-23-106 are, only that they become enforceable.
It is unclear exactly how this enforcement power will be used without reading the full details of section 6-23-106.

Bill History

2026-04-02 Senate
Senate Committee on Health & Human Services Postpone Indefinitely
2026-02-25 Senate
Introduced In Senate - Assigned to Health & Human Services
2026-02-23 House
House Third Reading Passed - No Amendments
2026-02-20 House
House Second Reading Special Order - Passed with Amendments - Committee
2026-02-17 House
House Committee on Health & Human Services Refer Amended to House Committee of the Whole
2026-02-03 House
Introduced In House - Assigned to Health & Human Services

Official Summary Text

The bill prohibits the department of health care policy and financing (department) from denying a medicaid member (member) the ability to purchase primary care services or enter into a direct primary care agreement. A member who purchases direct primary care services from a direct primary health-care provider or enters into a direct primary care agreement must sign a document acknowledging that the direct primary health-care provider is enrolled in the Colorado medical assistance program only as an ordering, prescribing, and referring provider; that the direct primary health-care provider does not accept medicaid payments for the services rendered; that the member cannot submit a claim for medicaid reimbursement for the services rendered by the direct primary health-care provider; and that the member retains the right to receive primary care services from a primary care provider who is enrolled in the Colorado medical assistance program.
(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Current Bill Text

Read the full stored bill text

Second Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
REENGROSSED
This Version Includes All Amendments
Adopted in the House of Introduction
LLS NO. 26-0044.01 Chelsea Princell x4335 HOUSE BILL 26-1096
House Committees Senate Committees
Health & Human Services
A BILL FOR AN ACT
CONCERNING ACCESS TO DIRECT PRIMARY CARE SERVICES FOR101
COLORADO MEDICAID MEMBERS.102
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://www.leg.state.co.us/billsummaries.)
The bill prohibits the department of health care policy and
financing (department) from denying a medicaid member (member) the
ability to purchase primary care services or enter into a direct primary
care agreement. A member who purchases direct primary care services
from a direct primary health-care provider or enters into a direct primary
care agreement must sign a document acknowledging that the direct
HOUSE
3rd Reading Unamended
February 23, 2026
HOUSE
Amended 2nd Reading
February 20, 2026
HOUSE SPONSORSHIP
Johnson and Feret, Bradley, Garcia Sander, Gonzalez R., Keltie, Weinberg, Winter T.
SENATE SPONSORSHIP
Rich,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law.
primary health-care provider is enrolled in the Colorado medical
assistance program only as an ordering, prescribing, and referring
provider; that the direct primary health-care provider does not accept
medicaid payments for the services rendered; that the member cannot
submit a claim for medicaid reimbursement for the services rendered by
the direct primary health-care provider; and that the member retains the
right to receive primary care services from a primary care provider who
is enrolled in the Colorado medical assistance program.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. Legislative declaration. (1) The general assembly2
finds that:3
(a) The public policy of the state of Colorado promotes access to4
medical care for all Colorado citizens by encouraging innovative,5
cost-saving arrangements;6
(b) Direct primary health-care providers use a model of7
health-care delivery based on a periodic fee for a specified period of time,8
rather than a fee-for-service arrangement financed through health9
insurance;10
(c) Direct primary care services represent an option that can11
improve access to affordable primary care services, increasing the health12
and well-being of patients;13
(d) Although direct primary care services are not reimbursable by14
medicaid, a medicaid member who utilizes a direct primary health-care15
provider is still able to use their medicaid benefits for services not16
provided by the medicaid member's direct primary health-care provider;17
and18
(e) Patients in Colorado, including those on medicaid, have the19
right to choose the providers that best fit their unique health needs and20
have the ability to access health-care providers that are closer to home,21
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when available. Access to timely and appropriate primary care is a crucial1
component of ensuring the health and well-being of our communities,2
particularly in rural and frontier areas where access to clinics, providers,3
and other resources may be limited.4
(2) Therefore, the general assembly declares that Coloradans5
enrolled in medicaid must have the option to access direct primary6
health-care providers, and direct primary health-care providers must be7
allowed to opt-in to providing services to medicaid patients.8
SECTION 2. In Colorado Revised Statutes, 6-23-101, amend the9
introductory portion; and add (2.5) as follows:10
6-23-101. Definitions.11
As used in this section ARTICLE 23, UNLESS THE CONTEXT12
OTHERWISE REQUIRES:13
(2.5) "M EMBER" HAS THE MEANING SET FORTH IN SECTION14
25.5-1-103.15
SECTION 3. In Colorado Revised Statutes, add 6-23-106 as16
follows:17
6-23-106. Direct primary care - medicaid members - federal18
authorization - report - definition - repeal.19
(1) AS USED IN THIS SECTION , UNLESS THE CONTEXT OTHERWISE20
REQUIRES, "ORDERING, PRESCRIBING, OR REFERRING PROVIDER" MEANS A21
PHYSICIAN OR AN ELIGIBLE NON-PHYSICIAN PRACTITIONER ENROLLED IN22
THE COLORADO MEDICAL ASSISTANCE PROGRAM WHO ORDERS TESTS ,23
SERVICES, OR MEDICATIONS FOR A MEMBER BUT DOES NOT BILL THE24
COLORADO MEDICAL ASSISTANCE PROGRAM FOR THE SERVICES DIRECTLY.25
(2) THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING26
SHALL NOT PROHIBIT A MEMBER FROM PURCHASING PRIMARY CARE27
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SERVICES OR ENTERING INTO A DIRECT PRIMARY CARE AGREEMENT.1
(3) A DIRECT PRIMARY HEALTH -CARE PROVIDER SHALL NOT2
SUBMIT A FEE -FOR-SERVICE CLAIM FOR PRIMARY CARE SERVICES3
RENDERED TO MEDICAID FOR REIMBURSEMENT.4
(4) A MEMBER WHO PURCHASES PRIMARY CARE SERVICES FROM A5
DIRECT PRIMARY HEALTH -CARE PROVIDER OR ENTERS INTO A DIRECT6
PRIMARY CARE AGREEMENT WITH A DIRECT PRIMARY HEALTH -CARE7
PROVIDER MUST SIGN A DOCUMENT PROVIDED BY THE DIRECT PRIMARY8
HEALTH-CARE PROVIDER ACKNOWLEDGING THE FOLLOWING:9
(a) THE DIRECT PRIMARY HEALTH-CARE PROVIDER IS ENROLLED IN10
THE COLORADO MEDICAL ASSISTANCE PROGRAM ONLY AS AN ORDERING,11
PRESCRIBING, AND REFERRING PROVIDER AND THE DIRECT PRIMARY12
HEALTH-CARE PROVIDER DOES NOT ACCEPT MEDICAID PAYMENTS FOR THE13
SERVICES RENDERED;14
(b) T HE MEMBER MAY NOT SUBMIT A CLAIM FOR MEDICAID15
REIMBURSEMENT FOR PRIMARY CARE SERVICES RENDERED BY THE DIRECT16
PRIMARY HEALTH-CARE PROVIDER PURSUANT TO THE DIRECT PURCHASE17
OF PRIMARY CARE SERVICES OR AS A RESULT OF THE DIRECT PRIMARY18
CARE AGREEMENT ENTERED INTO BETWEEN THE DIRECT PRIMARY19
HEALTH-CARE PROVIDER AND THE MEMBER; AND20
(c) THE MEMBER RETAINS THE RIGHT TO RECEIVE PRIMARY CARE21
SERVICES FROM A PRIMARY CARE PROVIDER WHO IS ENROLLED IN THE22
COLORADO MEDICAL ASSISTANCE PROGRAM.23
(5) A DIRECT PRIMARY HEALTH -CARE PROVIDER WHO PROVIDES24
PRIMARY CARE SERVICES TO A MEMBER WHO DIRECTLY PURCHASES25
PRIMARY CARE SERVICES FROM THE DIRECT PRIMARY HEALTH -CARE26
PROVIDER OR AS A RESULT OF THE DIRECT PRIMARY CARE AGREEMENT27
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ENTERED INTO BETWEEN THE DIRECT PRIMARY HEALTH -CARE PROVIDER1
AND THE MEMBER MUST ENROLL IN THE COLORADO MEDICAL ASSISTANCE2
PROGRAM AS AN ORDERING , PRESCRIBING, OR REFERRING PROVIDER TO3
ENSURE ORDERS , PRESCRIPTIONS , AND REFERRALS FOR MEMBERS ARE4
ACCEPTED AND PROCESSED APPROPRIATELY THROUGH THE COLORADO5
MEDICAL ASSISTANCE PROGRAM.6
(6) THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING7
SHALL SEEK ANY FEDERAL AUTHORIZATION NECESSARY TO IMPLEMENT8
THIS SECTION. 9
(7) (a) ON OR BEFORE NOVEMBER 15, 2028, A DIRECT PRIMARY10
HEALTH-CARE PROVIDER WHO PROVIDES PRIMARY CARE SERVICES TO A11
MEMBER SHALL SUBMIT TO THE STATE DEPARTMENT:12
(I) THE NUMBER OF MEMBERS THE DIRECT PRIMARY HEALTH-CARE13
PROVIDER HAS SERVED FROM AUGUST 12, 2026, TO NOVEMBER 1, 2028;14
AND15
(II) WHETHER THE DIRECT PRIMARY HEALTH-CARE PROVIDER WAS16
ENROLLED IN THE COLORADO MEDICAL ASSISTANCE PROGRAM AND17
DISENROLLED IN THE COLORADO MEDICAL ASSISTANCE PROGRAM18
BETWEEN AUGUST 12, 2026, AND NOVEMBER 1, 2028, AND STARTED19
PROVIDING DIRECT PRIMARY CARE SERVICES TO MEMBERS DURING THAT20
TIME.21
(b) O N OR BEFORE JANUARY 1, 2029, THE STATE DEPARTMENT22
SHALL INCLUDE AS PART OF ITS "SMART ACT" PRESENTATION REQUIRED23
BY SECTION 2-7-203 INFORMATION THAT IS READILY AVAILABLE ON:24
(I) T HE NUMBER OF MEMBERS SERVED BY DIRECT PRIMARY25
HEALTH-CARE PROVIDERS AS REPORTED BY THE DIRECT PRIMARY26
HEALTH-CARE PROVIDERS PURSUANT TO SUBSECTION (7)(a) OF THIS27
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SECTION;1
(II) T HE NUMBER OF PRIMARY CARE PROVIDERS WHO WERE2
ENROLLED IN THE COLORADO MEDICAL ASSISTANCE PROGRAM AND3
REPORTED TO THE STATE DEPARTMENT PURSUANT TO SUBSECTION (7)(a)4
THAT THEY DISENROLLED IN THE COLORADO MEDICAL ASSISTANCE5
PROGRAM BETWEEN AUGUST 12, 2026, AND NOVEMBER 1, 2028;6
(III) T HE NUMBER OF PRIMARY CARE PROVIDERS WHO WERE7
ENROLLED IN THE COLORADO MEDICAL ASSISTANCE PROGRAM BEFORE8
AUGUST 12, 2026; AND9
(IV) T HE NUMBER OF PRIMARY CARE PROVIDERS WHO WERE10
ENROLLED IN THE COLORADO MEDICAL ASSISTANCE PROGRAM AFTER11
NOVEMBER 1, 2028.12
SECTION 4. In Colorado Revised Statutes, 25.5-4-301, amend13
(1)(a)(III)(B) as follows:14
25.5-4-301. Recoveries - overpayments - penalties - interest -15
adjustments - liens - review or audit procedures - cash fund - rules -16
definitions - repeal.17
(1) (a) (III) (B) A member may enter into a written agreement18
with a third party or provider, INCLUDING A DIRECT PRIMARY CARE19
AGREEMENT, AS DEFINED IN SECTION 6-23-101, under which the member20
agrees to pay for items provided or services rendered that are outside of21
the network or plan protocols, INCLUDING DIRECT PRIMARY CARE22
RETAINER PAYMENTS MADE ON BEHALF OF THE MEMBER . The member's23
agreement to be personally liable for nonemergency, nonreimbursable24
items must be recorded on forms approved by the state board and signed25
and dated by both the member and the provider in advance of the services26
being rendered.27
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SECTION 5. Act subject to petition - effective date. This act1
takes effect at 12:01 a.m. on the day following the expiration of the2
ninety-day period after final adjournment of the general assembly (August3
12, 2026, if adjournment sine die is on May 13, 2026); except that, if a4
referendum petition is filed pursuant to section 1 (3) of article V of the5
state constitution against this act or an item, section, or part of this act6
within such period, then the act, item, section, or part will not take effect7
unless approved by the people at the general election to be held in8
November 2026 and, in such case, will take effect on the date of the9
official declaration of the vote thereon by the governor.10
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