This section presents an overview of the state’s geography and demographics, data on the social determinants of health affecting the MCH population, an overview of the infrastructure that supports the delivery of Title V MCH services, and statutes and regulations related to the MCH population. For additional background data, see the most current MCH Snapshot.

 

Geography

Colorado is located in the Rocky Mountain region of the United States and has the highest mean elevation of any state. The Continental Divide runs from north to south through west central Colorado and bisects the state into the eastern plains and western slopes. The state is further divided into five regions: the Front Range, the Western Slope, the Eastern Plains, the Central Mountains, and the San Luis Valley. Eighty-four percent of the state’s population lives either along the Front Range, which includes the metropolitan areas of Denver, Boulder, Fort Collins, Greeley, Colorado Springs, and Pueblo, or in the Western Slope city of Grand Junction (Colorado Department of Local Affairs, 2023). In total, there are 64 counties in the state with 17 designated as urban, 24 rural, and 23 frontier counties. Frontier counties have a population density of six or fewer persons per square mile  (Rural Health Information Hub, 2023). In Colorado’s 47 rural and frontier counties, residents’ health may be impacted by more limited local provider options, lack of specialty healthcare, the difficulty of travel to health care due to long distances and weather conditions, limited public transit options, a scarcity of resources and services, and fewer economic opportunities.

There are two sovereign Indian nations in Colorado, the Southern Ute Indian Tribe and the Ute Mountain Ute Tribe. Both tribes have reservations located in the southwest corner of the state. Both tribes have their own governance separate from state and local governments (Colorado Commission of Indian Affairs, 2024). The Colorado State Demography Office reports that among those who identify as American Indian/Alaska Native alone living in Colorado, there are 36,678 people who identify as non-Hispanic and 61,063 people who identify as Hispanic (Colorado Department of Local Affairs, 2022).

Tourism

Tourism is a major driver of Colorado’s economy, which generates earnings, employment, and taxes across the state. Several counties across the state contain attractive travel destinations and cite tourism as their primary economic driver. Of Colorado’s eight designated travel regions, the Rockies Playground, The Great West, and Mountains and Mesas regions had the top three highest proportions when comparing travel earnings in relation to total earnings (Colorado Tourism Office, 2023). For a list of counties within each region, see page 23 of the reference cited for this section.

 

Population and Demographics

Colorado ranks 21st among states in population size (United States Census Bureau, 2023). The total state population in 2022 was 5,890,612. In terms of Colorado’s MCH population, 21 percent of the state’s population is females ages 15-44 and 32 percent are children and youth ages 0-25 (Colorado Department of Local Affairs, 2023). Of the overall population of children and youth, approximately 383,000 are identified as having special health care needs (Health Resources and Services Administration, 2022). The two major racial and ethnic groups in Colorado are white non-Hispanic and persons of any race who are of Hispanic origin or ethnicity. Estimates from the Colorado State Demography Office (2022) show that 22.5 percent of Coloradans identify their ethnicity as Hispanic. Categories by race include white alone (66.5%), Black/African-American alone (4.1%), Asian alone (3.6%), Native Hawaiian/Other Pacific Islander alone (0.2%), American Indian and Alaska Native alone (0.6%), and people who report two or more races (2.6%) (Colorado Department of Local Affairs, 2022).

Approximately 16 percent of Colorado residents ages five years and older speak a language other than English at home; 68 percent of those speaking another language in the home speak Spanish (United States Census Bureau, 2022). Two and a half percent of households in Colorado are estimated to be linguistically isolated, i.e., all members 14 years and older have at least some difficulty with English (United States Census Bureau, 2022).

Although Colorado is a mid-sized state, it has had one of the fastest growth rates of all states and migration continues to be an important factor in the state's population growth. Between 2020 and 2025, Colorado's population is expected to grow from 5,784,584 to 6,014,467. While natural increase (births minus deaths) will contribute 88,727 persons, net migration will contribute 141,160 to the total increase of 229,882 (Colorado Department of Local Affairs, 2024).

Employment

Employment, income, housing, food security, and transportation are all closely linked to health and wellness and should be considered in understanding the overall health status of the MCH population in Colorado. As of April 2024, Colorado’s unemployment rate was 3.7 percent (United States Bureau of Labor Statistics, 2024). This was lower than the national unemployment rate for the same time period, 3.9 percent (United States Bureau of Labor Statistics, 2024). Colorado’s unemployment ranking was 32nd in the nation (United States Bureau of Labor Statistics, 2024).

Income and poverty

Colorado has an income advantage. The median household income in Colorado is the 8th highest among all 50 states at $89,302, higher than the national median of $74,755 (United States Census Bureau, 2022). However, the median household income fluctuates significantly among Colorado’s counties. Douglas County, located just south of Denver along the Front Range, has the highest median household income at $139,010. Costilla County, located in southern Colorado, has the lowest at $34,578 (United States Census Bureau, 2024).

The level at which Colorado families can be economically self-sufficient generally requires an income above 240 percent of federal poverty level, sometimes higher depending on geographic location (Kucklick, Manzer, & Mast, 2022). One in four (26.4%) Coloradoans live with incomes below 200 percent of the federal poverty level (Brennan & Contomo, 2020). Among children younger than 18 years of age, one-third (28%) live in families with incomes below 200 percent of the federal poverty level (Kids Count Data Center, 2022) ($62,400 for a family of four) (Federal Register, 2024).

Housing

Having safe, stable and affordable housing contributes to optimal health by allowing money to be directed to healthy food, recreation, and health care. Among occupied housing units in Colorado, 33.6 percent are rented. In renter-occupied units, more than half (53.2%) pay 30 percent or more of the household income to rent. The median rent in Colorado is $1,646. The median home value for owner-occupied units in Colorado is $531,100 (2022) compared to $373,300 in 2018. This is a 42 percent increase in five years. (United States Census Bureau, 2022).

“The cost of living is super high. Luckily, we were able to secure a house through the affordable housing program. Families need more affordable options for housing.” - Health eMoms participant (Colorado Department of Public Health and Environment, 2020)

Some communities are not able to find safe and affordable housing, which means they are more likely to live in poor quality homes. Poor housing conditions and environmental toxins can be detrimental to health, especially during early childhood (Bay area Health Inequities Initiative & The Federal Reserve Bank of San Francisco, 2018). Severe housing problems are indicative of housing quality. Sixteen percent of households in Colorado experience at least one of four severe housing problems (incomplete kitchen facilities, incomplete plumbing facilities, more than one person per room, and cost burden greater than 50%) (United States Department of Housing and Urban Development, 2016-2020). As of January 2023, there were an estimated 14,439 people in Colorado experiencing homelessness; 3,641 of these were persons in households with at least one adult and one child (United States Department of Housing and Urban Development, 2023).

Nutrition Security

Having access to nutritious food influences healthy eating. People who live in neighborhoods where grocery stores are not being built have limited access to fresh, healthy food such as fruits and vegetables. Among women who recently had a baby, 6.4 percent ate less than they felt they should because of lack of money for food (Colorado Department of Public Health and Environment, 2022). Among Colorado families with children ages 0-17 years, 3.3 percent sometimes or often could not afford enough to eat. (Health Resources and Services Administration, 2022). Among low-income Coloradans, 5 percent do not live close to a grocery store (United States Department of Agriculture, 2020). The Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are programs that have been demonstrated to positively impact food security and nutrition outcomes. Almost eight in ten (78%) Coloradans who are eligible for SNAP have access to SNAP benefits (United States Department of Agriculture, 2022). This is the same as the national average of 78 percent for SNAP enrollment (United States Department of Agriculture, 2022). As of November 2022, the total number of WIC infant and child participants compared to the total number of WIC-eligible Medicaid infant and child participants averaged 43 percent (Colorado Department of Public Health and Environment, 2022).

“SNAP has been a tremendous help to us. Some months we worry about not being able to buy diapers, but we have made it by so far.”- Health eMoms participant (Colorado Department of Public Health and Environment, 2020)

Transportation

Transportation is necessary to travel to work and school, access healthy food and medical care, and foster community connections. When transportation systems don't provide access to all communities, some groups have a harder time accessing resources. Direct transportation and by-products can also impact health. Most Coloradans commute to work in a single occupancy vehicle (64.7%) or work from home (21.1%). Less than one in ten use public transport (1.6%), walk to work (2.5%), bike to work (1.0%). Two and a half percent of working Coloradans do not have a vehicle (United States Census Bureau, 2022).

Air Quality

Many forms of transportation lead to air pollution thus impacting air quality, especially in low-income neighborhoods. Latinos experience the highest air pollution exposure (index of 52), while Native Americans experience the lowest air pollution exposure (index of 37) (The National Equity Atlas, 2020). A recent report ranks three of Colorado’s metropolitan areas in the top 25 for poor air quality based on ozone, Denver-Aurora is ranked 6th, Fort Collins is ranked 15th, and Colorado Springs is ranked 20th. Poor air quality can be a greater burden on older and younger populations, those with chronic conditions (asthma or other chronic lung disease, cardiovascular disease or diabetes), and those with low socioeconomic status (American Lung Association, 2024).

Climate Change

A changing climate results in warmer temperatures, drier air, and changing weather patterns. These changes increase the risk for fire, drought, and heat, which impact health and have been seen in Colorado. The Colorado Health Institute built a Health and Climate Index based on 24 variables related to health and climate. Counties in western Colorado are the state’s most vulnerable region (prone to wildfire, flooding, drought, and extreme heat). Counties in southeast and eastern Colorado are the state’s least vulnerable region (Colorado Health Institute, 2022).

Education

Education is critical to the health and well-being of the MCH population. Higher levels of education can lead to employment with strong incomes resulting in the ability to live in healthy neighborhoods. Overall, Colorado has a highly educated population. More than half (54.2%) of Coloradans age 25 and older have an associate's degree or higher, and Colorado is ranked 3rd among all states in the percentage of the population with a college degree (United States Census Bureau, 2022).

Yet inequities in educational opportunities exist among different racial and ethnic groups. Many of these opportunities are affected by systemic inequities like community disinvestment and school poverty. Three in five (64.1%) Asians have an associate’s degree or higher (United States Census Bureau, 2022), as do 60.9 percent of white, non-Hispanics (United States Census Bureau, 2022). Two in five (40.7%) Black/African Americans (United States Census Bureau, 2022) and one in three (29.8%) Hispanics have an associates degree or higher (United States Census Bureau, 2022).

While the prevalence of college graduates in Colorado is high among Asian and white non-Hispanics, the percentage of high school students who graduate overall is relatively low as 39 states have higher rates of high school graduation (National Center for Education Statistics, 2024). Inequities in graduation rates mimic the disparities in college graduation attainment among adult Coloradans, with Native Hawaiians or Other Pacific Islanders having the lowest high school graduation rate and Asians having the highest (Colorado Department of Education, 2024).

Social Connectedness and Civic Engagement

Participation in civic life or religious organizations has been shown to positively impact individual longevity and well-being. In Colorado, two in three (66.6%) high school students participate in extracurricular activities. One in four (28.2%) high school students participated in organized community services as a non-paid volunteer during the past 30 days (Healthy Kids Colorado Survey, 2023). Among parents with young children, 54.2 percent report having a somewhat strong or very strong sense of belonging to their local community (Colorado Department of Public Health and Environment, 2019).

 

“Emotional support typically stemmed from friends that were also mom’s [sic] - nice chatting with people you trust/respect who have been through a lot of the same things that come with being a mama! I am a member of a MOPS group at (a church) and they have been very helpful for me. There are about 50 other moms in my group and they are amazing and we all support each other.”- Health eMoms participant (Colorado Department of Public Health and Environment, 2020)

Social and Emotional support

Social support can help improve quality of life and decrease emotional distress, while limited social support can negatively impact well-being. Overall, 5.4 percent of Colorado family households are headed by a single adult and may lack needed support systems (Colorado Department of Public Health and Environment, 2019). The majority of Colorado parents (77.9%) report that they have someone to turn to for day-to-day emotional support with parenting or raising children. Hispanic parents are less likely to report having emotional support compared to white, non-Hispanic parents (70.2% vs. 84.7%, respectively) (Health Resources and Services Administration, 2022). Three-quarters (75.4%) of high school students have an adult to go to for help with a serious problem (Healthy Kids Colorado Survey, 2023), which has been demonstrated in research as a critical protective factor in avoidance of risky behaviors.

“The care and emotional support I received and still receive has helped me survive this year.” - Health eMoms participant (Colorado Department of Public Health and Environment, 2020)

Racism

Racism and discrimination are two other social determinants of health that negatively impact health. Among high school students who were bullied in the past year, one in three (30.3%) were bullied because of their actual or perceived race or ethnic background, and one in four (24.9%) because of their actual or perceived sexual orientation (Healthy Kids Colorado Survey, 2023). Among parents with young children, 19 percent reported experiencing discrimination or harassment because of their race, ethnicity, or culture since their baby was born. Of those parents who reported experiencing this discrimination or harassment, 83.3 percent experienced it in daily life, 12.7 percent at work or school, 18.7 in a doctor’s office or other health care setting, and 4.7 percent when interacting with law enforcement (Colorado Department of Public Health and Environment, 2019).

Health insurance

Passing legislation in 2011, Colorado was an early adopter in the creation of a state-run health insurance exchange, Connect for Health Colorado. Colorado is now among just 18 states/DC that are running their own exchanges and enrollment platforms for 2024 coverage. Here is a summary of milestones and current events related to Colorado’s health insurance marketplace:

 

• Colorado has implemented a permanent 2.5 month open enrollment period; enrollment runs from November 1 to January 15 each year, expanding the federal platform’s annual enrollment period of November 1 to December 15 (Connect for Health Colorado, 2024);
• Connect for Health Colorado is among the most robust exchanges in the country, with six carriers offering plans in 2024 (Connect for Health Colorado, 2024).
• In the individual/family market, there were 149 on-exchange plans available in Colorado for 2024, down from 166 in 2020 (however, plan availability varies considerably from one area to another) (Connect for Health Colorado, 2024).
• A total of 237,107 people enrolled in 2023 plans during open enrollment (Connect for Health Colorado, 2024).
• Colorado implemented a reinsurance program starting in 2020. It pays a larger portion of claims in areas where premiums are highest, in an effort to make coverage more affordable in those areas.
• Colorado’s Easy Enrollment Program (referred to as a Tax Time Enrollment) debuted in 2022. The program lets Colorado residents indicate on their state tax returns that they would like Connect for Health Colorado to determine, based on the information on their tax return, whether they might be eligible for free or subsidized health coverage. If so, the exchange contacts the person to help them enroll in coverage — Medicaid, CHP+, or a subsidized private plan in the individual market. It also allows for enrollment outside of the open enrollment period.

 

Since 2015, Colorado’s insured rate has remained consistent. In 2023, about 95.4 percent of Coloradans have health insurance coverage (Colorado Health Institute, 2023). However, this consistency masks some instability in the health insurance market. According to the most recent Colorado Health Access Survey (2023), 11.3 percent of Coloradans experienced a change in insurer. In Colorado, 54.8 percent of residents had private insurance, 30.1 percent are enrolled in Medicaid or Child Health Plan Plus (CHP+), and 10.5 percent are enrolled in Medicare. The uninsured rate dropped by more than 60 percent from 14.3 percent in 2013 to 4.6 percent in 2023. Of the 4.6 percent who are uninsured in Colorado, 21.1 percent were insured for part of the year. The uninsured rate was highest among Coloradans ages 19-64 years at 6.4 percent. Only 2.4 percent of children ages 0-18 years are uninsured. The uninsured rate among White non-Hispanics is 3.3 percent. By contrast, 8.9 percent of Hispanics in Colorado are uninsured (Colorado Health Institute, 2023).

 

Several programs are available to reach low-income families and those without health insurance. Pregnant women and children living in households at or below 260 percent of the federal poverty level are eligible for health insurance coverage either through Child Health Plan Plus (CHP+) or Medicaid. As of April 2024, 433,520 children are enrolled in Medicaid and 80,968 children are enrolled in CHP+ (Colorado Department of Health Care Policy & Financing, 2024). In 2023, 36.3 percent of live births in Colorado were paid for by Medicaid (Colorado Department of Public Health and Environment, 2023).

 

The COVID-induced economic downturn caused hundreds of thousands of Coloradans to lose their jobs and with them, their employer sponsored health benefits. Colorado’s Medicaid rosters grew by 45% and was one of the top states for membership growth during the public health emergency. While Colorado processed Medicaid and CHP+ member renewals throughout the pandemic, members did not lose coverage if they were no longer eligible because of the federal continuous coverage requirement. With the end of the public health emergency, Medicaid reviewed all enrollees in Medicaid to determine if they still qualified and engaged in an extensive awareness campaign to educate members about the need to reapply for Medicaid. Colorado Medicaid began notifying the members in March 2023 who had renewals due in May 2023, while the last group of renewals were due in April 2024. Medicaid and CHP+ enrollment overall has returned to prepandemic enrollment levels.

Colorado Medicaid programs impacting MCH populations include Programs for Children, Programs for Pregnant People,  and Programs for Parents and Caretakers. The Affordable Care Act expanded Medicaid eligibility for all adults (including parents and adults without dependent children) with incomes below 133% of the federal poverty level (FPL).

 

Since 2014, with Medicaid expansion, children and youth with special health care needs in Colorado have had the ability to be part of the Medicaid Buy-In Program for Children with Disabilities. This program allows qualifying families of children with a disability to “buy-into” Colorado Medicaid for that child. Family income must be below 300% of the Federal Poverty Level. Eligible families receive Medicaid benefits by paying a monthly premium on a sliding scale based on their adjusted income.

 

Colorado’s Medicaid program also offers waivers for children and youth who meet certain criteria. Of the Medicaid members who qualify for Long Term Services and Supports based on functional needs, 10% are children and youth with special health care needs. This table provides an overview of the children’s waiver programs and this table shows adult waiver programs. There are currently no waitlists for any of Colorado Medicaid’s children’s waivers and all but one of the adult waivers, as a result of legislation passed in 2014. 
 

Medicaid also offers the Prenatal Plus program, which is a special program for at-risk pregnant people during their pregnancy through 60 days postpartum. Services include case management, behavioral health services, and nutrition counseling. These services are meant to lower risk for negative maternal and infant health outcomes due to social determinants of health and other non-medical parts of a member's life that could affect their pregnancy. There are currently ten Prenatal Plus providers across the state as of June 2023.

 

There is also a program for pregnant people struggling with substance use disorder, called Special Connections. Special Connections helps pregnant people and their families have healthier pregnancies and healthier babies by providing case management, counseling, and health education during pregnancy and up to one year after delivery. There are currently seven Special Connections programs in the state of Colorado.

 

Home visiting services are also available to Medicaid members during their first pregnancy through their child’s second birthday through the Nurse Home Visitor Program. The evidence-based home visiting model supported through this program is Nurse-Family Partnership. In 2022, 313 families enrolled in Medicaid accessed Nurse Home Visitor Program services.
 

The state’s Medicaid program implements the Accountable Care Collaborative (ACC), which includes seven Regional Accountable Entities (RAEs) across the state that are responsible for coordinating physical and behavioral health care for members. The RAEs develop, contract, and manage a network of primary care physical health providers and behavioral health providers to ensure member access to appropriate care.

 

Health care services for low-income and uninsured persons in Colorado include 20 Community Health Centers that operate 243 clinic sites in 48 counties and provide care to patients living in 63 of the state’s 64 counties. Colorado Community Health Centers provide care to over 832,000 people (one in seven Coloradans). Eight-eight percent of patients at community health centers have family incomes at or below 200% of the federal poverty level (Colorado Community Health Network, 2023). Children’s Hospital Colorado and the University of Colorado School of Medicine form the largest pediatric specialty care network in Colorado, serving over 283,000 children and youth annually, with roughly 50% enrolled in Medicaid or CHP+. Children and youth from every county in the state receive care either onsite at the main campus in metro Denver, and/or through approximately 40 Network of Care and Special Outreach locations, as well as through telehealth (more than 1000 telehealth visits per week).

 

Health Information Exchange

Colorado, like many states, has more than one regional health information exchange. The first health information exchange in Colorado was Quality Health Network (QHN), which is based out of Grand Junction and has served the Western Slope since 2004. Starting in 2010, Contexture (previously CORHIO) began offering health information exchange services to providers in communities along the Front Range, Eastern Plains and some of the mountain towns.

The Colorado Community Managed Care Network works closely with both health information exchanges as a health center controlled network comprised of 20 community health centers with over 190 clinic sites (including school based clinics, pharmacies, and mobile units). The organization was founded as a non-profit in 1994 to respond proactively to the advent of mandatory Medicaid managed care, and has evolved with Colorado’s changing health care landscape. Areas of focus now include managed and accountable care, health information technology, and clinical quality improvement programming.

 

Located within the Governor’s Office, Colorado’s Office of eHealth Innovation works closely with all three health information entities and is responsible for defining, maintaining, and evolving Colorado's Health IT strategy concerning care coordination, data access, healthcare integration, payment reform and care delivery.

 

State Health Agency Roles and Responsibilities

Colorado’s Title V Maternal Child Health (MCH) program is administered by the Colorado Department of Public Health and Environment (CDPHE). CDPHE is one of 22 cabinet-level entities whose Executive Director is appointed by the Governor. Jill Hunsaker Ryan is the Department’s Executive Director. CDPHE serves Coloradans by providing public health and environmental protection services that promote healthy people in healthy places. Public health professionals use evidence-based practices in the public health and environmental fields to create the conditions in which residents can be healthy. In addition to maintaining and enhancing core programs, CDPHE continues to identify and respond to emerging issues affecting Colorado's public and environmental health.

 

CDPHE pursues its mission through broad-based health and environmental protection programs and activities. These include chronic disease prevention; control of infectious diseases; family planning; injury and suicide prevention; general promotion of health and wellness; provision of health statistics and vital records; health facilities licensure and certification; laboratory and radiation services; emergency preparedness; air and water quality protection; hazardous waste and solid waste management; pollution prevention; and consumer protection. The statutory authority for CDPHE is found predominantly in Title 25 of the Colorado Revised Statutes.

 

Colorado’s most recent Public Health Improvement Plan was released in June 2022 and is currently being updated. CDPHE’s new strategic plan was released in July 2023. The Prevention Services Division’s current strategic plan was developed in 2022. The external-facing priorities reflected in the strategic plan directly align with the MCH framework:

• Priority 1: Increase access to safe, healthy and connected communities
• Priority 2: Expand meaningful community inclusion and improve racial equity
• Priority 3: Increase social and emotional wellbeing
• Priority 4: Increase equitable economic opportunities and access

 

The MCH program, administered by the Children, Youth and Families Branch, collaborates with and leverages programs across the Prevention Services Division and other CDPHE programs/work units to address the needs of MCH populations. Colorado MCH includes state strategies and works with 56 local public health agencies serving 64 counties to improve the health of Coloradans using population-based and infrastructure-building strategies. In Colorado, the 4,789 local governments across the state including counties, municipalities, special districts and public school districts have local control. Colorado has a decentralized public health system in which each of its 64 counties are required to either operate a local public health agency or participate in a district public health agency. The MCH program is state supported and county administered with an emphasis on state and local partnerships to align efforts. This allows for centralized coordination, support, and technical assistance, and a flexible responsiveness to the unique needs and strengths of local communities.

 

The Colorado MCH Framework is grounded in the program’s strategic anchors–racial equity, community inclusion, and moving upstream–which serve as a foundation to impact seven priorities and three health impact areas. The use of evidence based practices, dedication to quality and process improvement, commitment to core public health services, and the leveraging of stories to better understand invaluable context behind quantitative data and impacts of emerging issues are just a few of the key qualities influenced by the specific interests of CDPHE, the Prevention Services Division, and the Children, Youth and Families Branch.

 

Statutes and Regulations

The second regular session of the 74th General Assembly commenced on January 10th, and ended in the early evening hours on May 8th, 2024, right at the 120-day cap (as directed by the Colorado Constitution).

 

Included below are descriptions of bills passed during the 2024 session that are aligned with Colorado MCH strategies. Click here for a full list of state statutes relevant to MCH efforts.

 

Reducing Racial Inequities

 

Racial Equity Study: SB24-053 acknowledges the negative, intergenerational impact of slavery, racial discrimination and systemic racism on Black Coloradans. This bill establishes the Black Coloradan Racial Equity Commission within the Legislative Department to conduct a study to determine the extent to which Black Coloradans have experienced, and continue to experience racial discrimination as a result of systemic policies. This study will make recommendations related to any potential historical and ongoing effects of slavery and subsequent systemic racism on Black Coloradans, quantify the economic impact on Black Coloradans, and more. The results and recommendations created by this study will be presented to the named legislative committees in three years.

 

Protect Tribal Lands from Unauthorized Annexation: SB24-193 was introduced with the intent to respect the sovereignty of  federally recognized Tribes with lands within the exterior boundaries of the state, reduce the jurisdictional complexities that arise when municipalities annex Tribal land, and ensure cooperation and collaboration by municipalities with Tribal governments. This bill therefore, prohibits a municipality from annexing Tribal lands that are within the boundaries of a reservation or federally recognized Tribe unless the Tribal government issues a resolution or ordinance that approves this annexation.

 

Federal Indian Boarding School Research Program: HB24-1444 recognizes the intergenerational impact of federal Native American boarding schools had on Native American communities. This bill reestablishes the “Federal Indian Boarding School Research Program” in History Colorado to research and make recommendations to promote understanding of the deaths and cultural suppression that occurred at federal Native American boarding schools in Colorado. In consultation with Tribal governments, History Colorado is required to facilitate research on the events, deaths, and other harms that occurred at these facilities. This program continues through December 2027. 

 

Increase Prosocial Connection

 

Behavioral Health First Aid Training: SB24-007 creates the Behavioral Health First Aid Training Program in the Office of Suicide Prevention in CDPHE. Participants of the training will be prepared to teach certification courses to youth and adults in their organizations and communities, with the intent to recognize warning signs of suicide and suicidal despair. The office must adopt rules for the program, and contract with a third party entity to administer and offer the training program at no cost to eligible organizations, which may include public schools, nonprofit organizations, and first responder agencies.

 

Student Weight Based Bullying Prevention: HB24-1285 recognizes the impact weight based bullying has on youth, specifically those from Black, Indigenous, and other communities of color, as well as LGBTQIA+ youth. This bill makes statutory changes to current law, which does not formally recognize weight based bullying.

 

Non-Legal Name Changes: HB24-1039 recognizes the impact using a student’s chosen name has on the well being and overall health outcomes of students. The bill requires public and charter schools to address a student by the student’s chosen name during school functions. This bill also states intentionally using a name other than a student’s chosen name is discriminatory and allows students to file a report with the school district. The school district must implement a policy on how a school will honor a request for using a student’s chosen name.

 

Create Safe and Connected Built Environments

 

Housing in Transit-Oriented Communities: HB24-1313 recognizes the issue of Colorado’s housing supply not keeping pace with the population growth in the state. The 2020 Census set the Colorado shortage at 225,000 units. This bill identifies local governments that must create, report, and implement a housing opportunity to increase housing inventory. The Department of Local Affairs (DOLA) in collaboration with multiple state agencies and offices, must provide broad technical assistance to affected local governments, and administer a grant program to assist with planning, compliance and various infrastructure projects for the purpose of increasing regulated affordable housing, transit centers, and neighborhood centers.

 

Sustainable Affordable Housing Assistance: SB24-174 requires the Department of Local Affairs (DOLA) develop methodologies and conduct various housing needs assessments and action plans, and provide grants and technical assistance to assist local governments to conduct housing needs assessments and action plans. This bill includes requires DOLA to develop methodologies for conducting statewide, regional, and local housing needs assessments, and methodologies to identify areas at an elevated risk of displacement; publish an affordability strategies directory, a long-term affordability strategies directory, and a “displacement risk mitigation strategies” director to guide local governments in adopting policies that encourage the development of housing types; and, in consultation with Colorado Parks and Wildlife, the Outdoor Recreation Industry Office, and the Colorado Tourism Office, to publish a natural land and agricultural report that includes opportunities for local governments and Metropolitan Planning Organizations to connect areas like open space, wildlife habitat, and other priority landscapes.

 

Improve Access to Supports

 

School Food Programs: HB24-1390 aims to alleviate the funding gap the ‘Healthy School Meals for All’ (approved by Colorado voters in 2022) program encountered during implementation. Analysts anticipate a $24 million shortfall this year, and a $50 million shortfall next year, due to the funding mechanism supporting this program (increasing income taxes for individuals earning $300,000 or more) not providing sufficient funds/revenue to support this program. This bill requires the Colorado Department of Education to explore ways to maximize federal funding, allows the department to delay the implementation of certain elements of the program, and establishes an advisory group to identify long term solutions to balance program revenues and expenditures.

 

Free Menstrual Products for Students: HB24-1164 requires Local Education Providers provide free menstrual hygiene products to students in all applicable bathrooms by June 2028, using a phased in approach (i.e., 25% of bathrooms by 2025, 50% of bathrooms by 2026, 75% of bathrooms by 2027). This bill also expands the Menstrual Hygiene Grant Program in the Colorado Department of Education to be available to rural and small rural school districts.

 

Welcome, Reception, and Integration Grant Program: HB24-1280 establishes the new statewide “Welcome, Reception, and Integration” grant program in the Colorado Department of Labor and Employment to award grants to community-based organizations that provide culturally and linguistically appropriate navigation of state services to migrants within one year of arrival in the United States. This grant program will support organizations specializing in migrant services such as: providing housing information/education and referrals to housing, distributing emergency and transitional supplies including food and clothing, providing case management, providing transportation, bus passes, and orientation to the bus and transportation system, legal services and more.

 

Maternal Health Midwives: HB24-1262 recognizes the impact and unintended consequences facility closures and other disruptions in care have on maternal health outcomes in the state. This bill requires the Colorado Civil Rights Division within DORA to collect reports of mistreatments in the context of maternity care in ways that allow data to be accessible (confidential information can be de-identified and reports can be generated for the public) and expands the information that can be provided by individuals. This bill also requires CDPHE to contract with an external entity to study closures and report on the availability of perinatal health care providers and others.

 

Housing and Nutrition Services for Medicaid Members: HB24-1322 requires the Department of Health Care Policy and Financing (HCPF) to study the feasibility of covering specified housing and nutrition services and report to the General Assembly by November 2024. The study must address several issues, including costs and funding mechanisms, and how the services will integrate with existing state housing and nutrition services. If HCPF determines that providing these services is budget neutral to the General Fund due to offsetting reductions in medical services and other expenditures, the department must seek federal authorization to cover the services by July 2025.

 

Increase Social and Emotional Well-being 

 

Birth Equity: HB24-1459 prohibits correctional facilities from using restraints on pregnant and postpartum incarcerated individuals during labor and delivery. This bill also requires correctional facilities to develop administrative policies including a system for human milk storage, to ensure a newborn can receive the human milk the parent has pumped for the newborn’s nourishment.              

 

Improving Perinatal Health Outcomes: SB24-175 creates and amends multiple programs concerning perinatal health programs. This bill requires large employer health benefit plans to cover doula services to the same extent and same provider qualification requirements as required by Medicaid. CDPHE is also required to contract with the state Perinatal Quality Collaborative (PQC) in order to provide funds for quality improvement initiatives to selected hospitals, track statewide implementation of Maternal Mortality Review Committee recommendations, address gaps and disparities in maternal care. The department is also required to establish a grant program to provide funds to eligible hospitals to participate in QI initiatives. This bill requires the Department of Health Care Policy and Financing to cover over-the-counter- choline supplements for Medicaid members.

 

School Psychologist Licensure Interstate Compact: HB24-1096 recognizes the importance of improving the availability of school psychological services to the public. The bill is intended to establish a pathway to allow school psychologists to obtain equivalent licenses to provide school psychological services in any member state. Therefore, this bill enacts the School Psychologists Licensure Interstate Compact, which allows licensed school psychologists in a member state to more easily obtain a license from another member state.

 

Promote Positive Child and Youth Development

 

Bill of Rights for Foster Youth: HB24-1017 recognizes the disproportionate adverse health outcomes youth in foster care experience, and the need for the state to improve the health outcomes and experiences of youth in foster care. This bill creates a non-exhaustive list of statutory rights youth in foster care are entitled to, including, but not limited to: freedom from discrimination or harassment on the basis of race and ethnicity, religion, gender identity, gender expression, disability, familial status, etc., freedom from threats, punishment or retaliation for making complaints about a violation of the rights and protections established in this statute, access to federal and state services, appropriate guidance, support and supervision in a safe, healthy, and comfortable environment where youth are treated with respect and dignity, access to education and basic essentials, ability to participate in legal proceedings, and more.

 

Best Practices to Prevent Discrimination in Schools: SB24-162 modifies an existing initiative created by a previous bill (SB23-296), which required the Colorado Department of Education (CDE) to develop training for school staff regarding harassment and discrimination policies to be available at no cost to public schools. This bill now requires CDE to contract with an organization to develop best practices and trainings for notifying students and parents about school policies and procedures, processing reports, and implementing trauma-informed responses.

 

Increase Access to School Based Health Care: SB24-034 expands the definition of eligible School Based Health Centers to include evidence based/informed school-linked models to deliver primary care services through various modalities such as: telehealth, mobile units, and others.

 

Increase Economic Mobility

 

Prohibit Residential Occupancy Limits: HB24-1007 prohibits local governments from enacting occupancy limits in properties. The bill also lists exceptions, should the local government demonstrate health and safety standards would be violated by not enforcing an occupancy limit, and others.

 

Family Affordability Tax Credit: HB24-1311 creates a family affordability income tax credit for Coloradans with children for tax years 2024 through 2033. The credit is available to single filers with a federal adjusted gross income (AGI) up to $75,000 or joint filers with AGI up to $85,000. The bill authorizes and encourages the Department of Revenue to develop a way to distribute the credits in 12 monthly payments, rather than once annually, but does not require distributions on this schedule.

 

Operation of Home Based Businesses: SB24-134 prohibits a homeowner association (HOA) from restricting the operation of a home-based business in a HOA unit. All businesses operated out of a home, however, are required to adhere to noise, nuisance, or other applicable rules.

 

Overview of the State Reference List