Transcript Highlights:

• care management.
• of care.
• of care.
• of care.
• of care.

Summary: The Assembly Budget Subcommittee on Health held a May Revision hearing covering several health-related budget proposals and broader concerns about the state’s budget structure. The Chair opened by praising some May Revision changes, such as added health IT funding, county administration support tied to Medi-Cal changes, a delay in Medi-Cal cuts for some lawfully present immigrants, and additional support for Covered California subsidies, while criticizing proposed increases in Medi-Cal premiums, changes to senior eligibility, the lack of a Medi-Cal dental solution, and other reductions affecting counties, mobile crisis units, workforce incentives, and physician shortages. The Legislative Analyst’s Office said the state’s budget condition remains weak despite progress on the structural deficit, and the Department of Finance said the May Revision uses a mix of reductions, reforms, revenue proposals, and fund shifts to cut out-year deficits. The committee first heard Department of State Hospitals proposals, including adjustments to county bed billing authority, contract exemption language for online clinical/pharmacy subscriptions, reversion of unspent funds, a revised Metro Central Utility Plant replacement project, electronic health record implementation, and workforce development funded partly through Behavioral Health Services Act resources. DSH also described savings and realignments in incompetent-to-stand-trial and conditional release programs, including extending the independent placement panel program and shifting funds to support additional bed capacity and a mental health rehab center. Members asked about the use of BHSA funds for workforce programs, and the department said the proposal would replace General Fund support with BHSA reimbursements. The Emergency Medical Services Authority proposed funding for statewide behavioral health crisis response guidance and for enterprise system development, and the Department of Managed Health Care proposed modernization of its complaint system and claims-settlement data system to improve oversight and comply with AB 3275. The largest discussion centered on the administration’s BHSA spending plan under Proposition 1, including state-directed prevention, workforce, and other uses, plus General Fund offsets for existing programs. The LAO questioned whether some proposed offsets fit Proposition 1’s non-supplant and eligible-use requirements, while the administration argued the uses were consistent with the measure and that the state-directed share can be adjusted annually. The Commission for Behavioral Health’s proposals drew the most public and member concern. The administration proposed cutting the commission’s Innovation Partnership Fund from $20 million to $10 million and reducing the Community Advocacy Program by $6.7 million, while redirecting BHSA dollars to other state purposes and direct services. Commissioners, advocates, and several members argued the cuts would weaken community voice, reduce support for underserved populations, and disrupt grants already in process; they also objected to using BHSA funds to backfill General Fund commitments. Public commenters, including youth, disability, behavioral health, LGBTQ, tribal, veteran, immigrant, and community-based organization representatives, overwhelmingly opposed the cuts and urged preservation of prevention, advocacy, mobile crisis, and innovation funding. No votes or final actions were taken during the hearing.

Transcript Highlights:

• Thank you. things they they don't care this doesn't things they they don't care this doesn't care<00:
• <01:09:46.319><c> payment</c> directed payment directed payment programs<01:09:49.159><c> directed</c
• system, preserve access to care, and do just like 40 other states are doing now with their own directed
• As was mentioned earlier, our managed care Medicaid directed payment program proposes to have hospitals
• As was mentioned earlier, our managed care Medicaid directed payment program proposes to have hospitals

Keywords: 1183, house

Transcript Highlights:

• , physical health care, but behavioral health care.
• Managed care organizations are the Health Care Authority contracts with managed care organizations to
• help us with delivering behavioral health care. ...health care authority contracts with managed care
• continuum of care.
• Really, it's not anything direct.

Bills: HB1634

Keywords: mental health, behavioral support, education, school districts, student assistance, 904, all

Transcript Highlights:

• Um, personal care homes are of care.
• for</c><00:09:42.640><c> the</c> personal care homes that cared for the personal care homes that cared
• </c> care for.
• As owners of 16 personal care care for.
• to the managed care organizations and is actually paid out through a directed payment.

Keywords: 958, all

Summary: The Health and Family Services committee heard an informational presentation on Kentucky personal care homes from representatives of the Kentucky Association of Healthcare Facilities, Management Systems of Kentucky, and Elder Care Partners. Witnesses described personal care homes as a lower-cost, 24/7 residential option for adults, often with serious mental illness, who do not meet nursing home criteria but need structured supervision, medication assistance, meals, and daily support. They said the homes are regulated by the Cabinet for Health and Family Services, are not Medicaid-funded, and are supported largely through state supplementation payments and residents’ SSI income. The presenters argued that the current reimbursement rate of about $50.70 per day is no longer sufficient to cover staffing, food, insurance, utilities, maintenance, and other costs, and said the sector has shrunk significantly over time. They cited figures showing a decline from 64 to 34 homes serving the seriously mentally ill since 2002, with 30 closures over 23 years, and said the loss of beds contributes to homelessness, hospital overcrowding, and longer psychiatric stays. They also gave examples of residents who had spent many months in hospitals before being successfully placed in personal care homes, which they said can prevent more costly institutional care. Committee members asked about staffing credentials, fraud controls, referral processes, and how reimbursement works in other states. The presenters said Kentucky does not require licensed or certified staff in these facilities, though some homes use certified medication technicians or an LPN, and they described a county case-manager-based assessment process used to set individualized rates in other states such as Minnesota. Members expressed support for the work but emphasized the need for documentation of savings and budget offsets. The presenters said they are seeking an incremental reimbursement increase over two years, roughly 25% to 50% in the first year and another 50% after that, and urged the committee to support the homes to prevent further closures.

Transcript Highlights:

• However, direct support workers provide highly specialized care.
• for them: those direct support professionals. safe staffing levels, and quality care.
• We opted to go self-directed because we saw their quality of care was decreasing.
• Direct service workers provide daily assistance that makes this possible by supporting personal care,
• Direct service workers provide daily assistance that make this possible by supporting personal care,

Summary: The committee heard public testimony on several budget requests tied to health and human services. Louisiana Children’s Advocacy Centers asked for continued support and a supplemental appropriation of $1.173 million for infrastructure and standardization, explaining that the money would expand use of the Guardify digital evidence system, improve chain of custody, and reduce reliance on DVDs. Baton Rouge and statewide CAC leaders said prior funding helped eliminate a therapy wait list and speed services for abused children. Members asked detailed questions about the digital system, MDT coordination, and how the request related to SB 237, which would strengthen multidisciplinary review of child abuse cases. The Alzheimer’s Association sought $824,000 to sustain the dementia care specialist program, saying it helps families navigate services, keep loved ones at home longer, and reduce Medicaid costs. AARP and the Live at Home Coalition also testified for 750 additional Community Choice waiver slots at a state cost of $3.3 million, arguing that home- and community-based care is cheaper than nursing homes and that the current wait list is more than 11,000 people. Legislators discussed the size of the need, the state’s long-term care spending mix, and whether more support should go to family caregivers and community-based options. Testimony also focused on disability support services, substance use treatment, and developmental disability provider rates. A parent and direct support worker described the Children’s Choice waiver’s 20-hour cap and low pay, saying it makes it hard to retain caregivers and meet the needs of medically fragile children. Odyssey House and O’Brien House asked for higher Medicaid reimbursement rates under ASAM 4, warned that removal of room-and-board payments and weak Medicaid eligibility pathways are reducing access, and called for more oversight of sober living homes; members questioned outcomes data, length of stay, and links to homelessness. Finally, the Arc of Louisiana said the LDH rate study confirmed underfunding and supported a $53.6 million increase in state general funds, with local ARC leaders describing the services they provide and the need for higher direct support professional wages.

Transcript Highlights:

• So roles found within nursing, behavioral health, direct care, and primary care are the priority focus
• And I'm going to begin with direct care and the home and community-based services grant program.
• I want to talk a little bit about another direct care effort that we are embarking on, focused on certified
• And you don't want to see direct care staff and people with disability suffering.
• It's a lot of direct care people, right? Entry-level and frontline managers.

Keywords: 995, all

Summary: The subcommittee met to approve the April and May minutes, welcome a new member, and hear an update from Gina Frey of EOHHS on statewide health and human services workforce development efforts. Frey described cross-secretariat initiatives under the Workforce Skills Cabinet, including MA Repay loan repayment awards, expanded community college and tuition supports, ESOL/work-readiness programming for immigrants, and efforts to build career pathways and reduce attrition in nursing, behavioral health, direct care, and primary care. She also reviewed a $46 million ARPA-funded home and community-based services grant program that supported 82 grantees, led to hiring 8,752 new staff, over 1,000 interns, 2,000 new certifications, and a drop in vacancy rates from 22% to 12%. Members raised concerns about the impact of immigration policy changes on the direct care workforce, including losses of trained workers in provider agencies, and asked whether any exemption or other relief efforts were underway. Frey said EOHHS is tracking the issue closely but did not identify a specific exemption effort. The discussion also touched on Medicaid and related program changes, with Frey noting the administration is focused on understanding potential impacts to eligibility and work requirements. Rep. Howard asked about initiatives for direct support professionals and wraparound supports, and Frey said those efforts are often led by individual agencies such as MassAbility and DDS, with EOHHS coordinating across them. The latter part of the meeting shifted to planning FY26 subcommittee goals and possible events. Members discussed using the Health Policy Commission’s Behavioral Health Workforce Center and possibly asking for a study comparing compensation in DDS and related direct care roles against health care and education jobs. They also discussed a possible cross-state public event on immigration’s impact on the workforce, especially for people with disabilities and direct support services, and agreed to continue refining goals and event ideas by email and at the next meeting. Frey provided a website link and contact information for Amy Doyle at the Health Policy Commission to facilitate future presentations.

Transcript Highlights:

• However, direct support workers provide highly specialized care.
• for them, those direct support professionals. safe staffing levels, and quality care.
• And developmental disabilities, but number two is to those who are caring for them, those direct support
• We opted to go self-directed because we saw their quality of care was decreasing.
• Direct service workers provide daily assistance that makes this possible by supporting personal care,

Keywords: 965, house, all

Transcript Highlights:

• But most importantly, is addressing the needs of low-wage workers in long-term care: the direct care
• So we see a high, high turnover rate with our direct care workers.
• And when we talk about market, we're not just talking about other direct support, home care, etc.
• the supply of direct-care workers.
• care compensation, and it's over 90% in the consumer-directed system.

Summary: The committee met for what was described as its final meeting, with members and staff reflecting on the work of the Joint Legislative Executive Committee on Aging and Long-Term Care and noting that future work would likely shift to standing health and wellness committees. The meeting began with introductions and then moved into updates on major initiatives that originated from the committee, including Washington Cares, the Dementia Action Collaborative, and Medicaid long-term care programs. Presenters emphasized that these efforts were developed through long-term legislative-executive collaboration and were intended to help Washington prepare for the state’s aging population. On Washington Cares, DSHS described the program’s development from a 2014 research effort to its 2019 enactment, premium collection beginning in 2023, portability improvements in 2024, and 2025 changes including a grandfathered opt-out fix and a framework for supplemental private long-term care insurance. The agency said benefits are expected to go fully live next summer, with a pilot of up to 400 applicants planned for next January. On dementia policy, the Dementia Action Collaborative reported on the state dementia plan, Project ECHO training for providers, and pilot dementia-capable community programs at area agencies on aging, citing preliminary results that about 85% of family caregivers said services helped people remain at home. DSHS also reviewed Medicaid Transformation Project initiatives, including Medicaid Alternative Care, Tailored Supports for Older Adults, presumptive eligibility, and health-related social needs benefits such as rental assistance, nutrition support, and home modifications. The committee then heard an emerging issues panel from ombuds and disability advocates. Patricia Hunter of the long-term care ombuds program raised concerns about staffing shortages, resident rights, surveillance technology, private equity ownership of facilities, and illegal discharges or evictions. Betty Sweeterman of the Developmental Disabilities Ombuds discussed people stuck in hospitals without medical need, gaps in behavioral health services for people with developmental disabilities, and the need for better workforce training. Todd Carlyle of Disability Rights Washington urged expansion and bundling of community supports such as PACT, GOSH, and peer bridgers to reduce repeated institutionalization and support discharge from inpatient psychiatric settings. Provider and labor panels followed, with nursing home, assisted living, supported living, and union representatives all emphasizing workforce shortages, low wages, Medicaid rate inadequacy, case management bottlenecks, behavioral health complexity, and the need for more flexible care models and stronger accountability for rate increases. No formal votes were taken; the meeting ended with public comment on manufactured housing and closing remarks thanking staff and participants for the committee’s work.

Transcript Highlights:

• For these families, child care is a basic need.
• direct care workers and an administrative rate that covers overhead and other costs, supported living's
• Even when directed to use the two-and-a-half rate increase last year on direct care workers, workers
• This industry exists solely because of direct support professionals, caregivers who provide daily care
• And bottom line is, we have to take care of our families; we have to take care of our children.

Summary: The House Early Learning and Human Services Committee held public hearings on two bills. HB 1873 would expand Working Connections Child Care eligibility to full-time graduate and professional students with household income at or below 85% of state median income, with copays waived to the extent allowed by federal law. The prime sponsor and student testifiers argued that child care costs and limited stipends force student parents to choose between education and family responsibilities, while some members raised questions about program cost, uptake, and return on investment. The committee also heard HB 2600, which would require DSHS to update the Supported Living Cost Report template and convene a work group to develop Medicaid rate recommendations aimed at improving compensation for direct support professionals. Supporters, including SEIU-affiliated workers, said the bill would increase transparency and help ensure state funding reaches frontline caregivers, citing low wages and high turnover. Opponents from provider organizations argued the current cost report is already detailed, that the bill would add administrative burden, and that recent rate increases have already been passed through to wages and benefits. In executive session, the committee considered three Senate bills. It adopted a striking technical amendment and voted 9-1 to report out SSB 5911, which protects funds for youth in extended foster care and raises the threshold for protected accounts. It then voted 10-0 to report out SSB 5957, expanding the Homeless Youth Advisory Committee to include more people with lived experience and representatives of disproportionately homeless populations. Finally, it voted 7-3 to report out SSB 6184, which updates Office of Homeless Youth programs and language, including expanding eligibility for emerging adults up to age 21. The meeting ended with an interim planning discussion focused on future work on critical incidents, juvenile justice, developmental disabilities data, homelessness, child care, and facility tours.

Transcript Highlights:

• So the bill, state directed payments, what they are is in states that use Medicaid managed care delivery
• The state can direct payments through the Medicaid managed care organizations to a particular class of
• care.
• care.
• </c> care, but it may be the follow-up care. care, but it may be the follow-up care.

Keywords: 00:00:22 - Call to Order and Roll Call 00:03:00 – Approval of June 25, 2025 Minutes 00:03:22 - Update on Federal Changes to the Medicaid Program 01:03:44 - State Directed Payments, Provider Taxes, and the Rural Health Transformation Fund: How Medicaid Changes Could Impact Kentucky Hospitals 01:29:42 – Public Comments 01:45:25 – Announcements 01:46:19 - Adjournment, 958, all

Summary: The Medicaid Oversight and Advisory Board met on July 30, 2025, approved the June 25 minutes, and received a presentation from Katherine Castanza of the National Conference of State Legislatures on Medicaid provisions in H.R. 1. The presentation outlined more than 20 Medicaid-related provisions, emphasizing that the largest federal savings come from work/community engagement requirements, changes to provider taxes, limits on state-directed payments, more frequent eligibility redeterminations for expansion populations, and related eligibility/enrollment changes. She said the fiscal effects are backloaded, with most reductions occurring in the later years of the 10-year window, and noted potential significant impacts on hospital payments and state financing. She also described new funding opportunities, including a $50 billion rural health transformation fund and a new home and community-based services waiver with associated grants. A substantial portion of the discussion focused on Kentucky’s pending community engagement 1115 waiver and how it would interact with the new federal requirements. Board members asked whether the waiver had been approved, what the cabinet’s contingency plan would be if CMS does not approve it, and what the timeline is for compliance. Cabinet representatives said the waiver has not yet been approved by CMS, remains under public comment, and that the state will wait for CMS guidance before moving forward; if needed, the state would amend the waiver or submit a new one. They said the work requirement must be in place by January 1, 2027, with a possible extension to 2028. Castanza also explained that expansion adults with incomes between 100% and 138% of the federal poverty level would face new cost-sharing requirements beginning October 1, 2028, and that eligibility redeterminations would move from annual to every six months starting January 1, 2027. She then walked through provider tax changes, including a moratorium on new provider taxes beginning October 1, 2026, and a phased reduction in the hold-harmless threshold for existing taxes beginning January 1, 2028, with exemptions for nursing facilities and ICF/IID providers. Board members questioned the timing and likely impact on Kentucky, and Castanza responded that the effect would depend on each tax’s current rate and would phase in over time.

Transcript Highlights:

• Senator Stewart, you care to vote. Senator Grillner, you care to vote.
• Senator Jett, you care to vote. Senator Ice, you care to vote.
• Senator Stewart, do you care to vote? Senator Grellner, do you care to vote?
• Senator Jett, do you care to vote? Senator Rice, do you care to vote?
• We do want to be careful.

Bills: SB65, SB248, SB330, SB378, SB844, SB1330, SB1410, SB1475, SB1476, SB1565, SB1618, SB1623, SJR39, SJR47, SB2084, SB1655, SB1679, SB2174, SB1775, SB1873, SB1204, SB1884, SB1916, SB1937, SB1447, SB1500, SB2007, SB2074, SB1944, SB2018, SB1984, SB2026, SB2045, SB2049, SB2062, SB2112, SB2118, SB2127, SB2134, SB2135, SB2139, SB2154, SB1195

Keywords: SB65, naloxone, Narcan, opioid overdose, overdose reversal, opioid antagonist, emergency opioid antagonist, substance abuse services, harm reduction, public health, overdose prevention, good samaritan, civil immunity, criminal immunity, controlled substances, addiction treatment, fentanyl, opioid crisis, school overdose response, first aid

Transcript Highlights:

• We don't care if we are charged for anything.
• Can you direct me to the language in the bill? Bill that explains the apportionment process.
• What about direct investment by Oklahoma state employees into private businesses?
• This is working closely with the health care authority to make sure that we get this right.
• So this is the health care authority language that they needed put into this bill.

Bills: SB65, SB248, SB330, SB378, SB844, SB1330, SB1410, SB1475, SB1476, SB1565, SB1618, SB1623, SJR39, SJR47, SB2084, SB1655, SB1679, SB2174, SB1775, SB1873, SB1204, SB1884, SB1916, SB1937, SB1447, SB1500, SB2007, SB2074, SB1944, SB2018, SB1984, SB2026, SB2045, SB2049, SB2062, SB2112, SB2118, SB2127, SB2134, SB2135, SB2139, SB2154, SB1195

Keywords: SB65, naloxone, Narcan, opioid overdose, overdose reversal, opioid antagonist, emergency opioid antagonist, substance abuse services, harm reduction, public health, overdose prevention, good samaritan, civil immunity, criminal immunity, controlled substances, addiction treatment, fentanyl, opioid crisis, school overdose response, first aid

Transcript Highlights:

• Some examples of these important services include primary health care, preventive health care, vision
• This creates a health care issue.
• We're talking about health care access here, community health care access to all of our Oklahomans.
• We're talking about health care access here, community health care access to all of our Oklahomans.
• I'm happy for that, but not at the price. ...at the care, not at the price of our health care systems

Bills: SB65, SB248, SB330, SB378, SB844, SB1330, SB1410, SB1475, SB1476, SB1565, SB1618, SB1623, SJR39, SJR47, SB2084, SB1655, SB1679, SB2174, SB1775, SB1873, SB1204, SB1884, SB1916, SB1937, SB1447, SB1500, SB2007, SB2074, SB1944, SB2018, SB1984, SB2026, SB2045, SB2049, SB2062, SB2112, SB2118, SB2127, SB2134, SB2135, SB2139, SB2154, SB1195

Keywords: SB65, naloxone, Narcan, opioid overdose, overdose reversal, opioid antagonist, emergency opioid antagonist, substance abuse services, harm reduction, public health, overdose prevention, good samaritan, civil immunity, criminal immunity, controlled substances, addiction treatment, fentanyl, opioid crisis, school overdose response, first aid

Summary: The Senate first considered Senate Bill 1623, a measure updating the state charter for state-regulated credit unions to make them more competitive with federal credit unions. Two amendments were adopted: one changing certain board authority language from “shall” to “may,” and another restoring the title. Supporters said the bill was the product of years of negotiation with bankers and credit unions and would not affect national banks; after questions about membership expansion and census-tract service areas, the bill passed 44-0. The chamber then took up Senate Joint Resolution 39, which would send to voters a constitutional amendment lowering annual caps on assessed-value growth for homestead and agricultural property from 3% to 1%, and for other property from 5% to 3%. Proponents argued it would slow property-tax growth, help seniors and fixed-income homeowners stay in their homes, and not reduce government revenue but only slow future growth; opponents warned it would reduce local revenue growth for schools, counties, infrastructure, and bonding capacity, and would disproportionately benefit higher-value property owners. The resolution passed 38-8, and the special-election referral also passed 38-8. Senate Joint Resolution 47, which would place current voter ID requirements into the Constitution, also advanced and passed 39-8, with the special-election provision passing by the same margin. Supporters said it simply constitutionalized existing law requiring proof of identity and would preserve election security; critics said Oklahoma already has voter ID rules, the measure was unnecessary, and the language could create uncertainty for absentee voters and future changes. Debate also touched on provisional ballots, military and overseas voting, and whether the measure would make future adjustments harder. Later, Senate Bill 2084 passed 35-7 and as an emergency measure. The bill limits wrongful-termination settlements for faculty members at higher education institutions to two times annual salary, including pay and accrued benefits. Supporters said it would provide certainty for universities and regents; questions focused on tenure, free-speech claims, and how the cap would interact with existing tort limits. The Senate also passed Senate Bill 1655 unanimously to allow Oklahoma Complete Health’s Children’s Specialty Program to contact adoptive parents and offer continued voluntary services for post-adoption children, and Senate Bill 1679 was introduced as the “Preserving Oklahoma Values Act,” aimed at codifying adherence to the U.S. and Oklahoma Constitutions and rejecting foreign law, with debate beginning over its enforcement and scope.

Transcript Highlights:

• And that's because this bill, while it adjusts Minnesota care and the health care access fund and spends
• This is linked to the directed dispensing payment for pharmacies in that the directed payment is intended
• directed payment program for hospitals that participate in MA-managed care.
• This directs DHS to seek federal approval for MA to cover traditional health care practices. is a new
• So I understand giving care.

Bills: HF2435

Keywords: healthcare, dementia services, public health funding, opioid prevention, women's health, community health boards, mental health

Transcript Highlights:

• in the VA's direct care system.
• And this is as far as compared to direct care.
• This is why we believe that if you strengthen the VA direct care, you know, Direct care, then you would
• , including the choice to receive direct care at VA?
• That's their direct care, but also the community.

Transcript Highlights:

• care management.
• care.
• of care.
• of care.
• of care.

Keywords: 988, house, all

Transcript Highlights:

• direct care and treatment<00:14:40.399><c> and</c><00:14:40.720><c> direct</c><00:14:41.040><c> care
• </c><00:15:52.160><c> care</c><00:15:52.399><c> and</c> by direct care and by direct care and treatment
• c> um</c><00:45:11.280><c> and</c> to direct care and treatment um and to direct care and treatment um
• The direct care and treatment is not asking for this.
• </c> direct care and treatment policy direct care and treatment policy proposal.<01:20:43.360><c> They

Keywords: 1187, senate, all

Transcript Highlights:

• Hi, my name is Nancy Freeman, and I'm the Operations Services Chief Operating Officer for Direct Care
• Thank you for Direct Care and Treatment.
• </c><00:03:58.480><c> care</c><00:03:58.680><c> and</c> will be operated by direct care and will be operated
• Direct<00:04:11.800><c> care</c><00:04:11.959><c> and</c><00:04:12.080><c> treatment</c><00:04:12.600
• ><c> is</c> Direct care and treatment is Direct care and treatment is appreciative<00:04:13.600><c> and

Keywords: 1183, house

Transcript Highlights:

• Furthering the workforce and supporting the workforce and child care. You good?
• On behalf of the Agency for Health Care Administration, my name is Brian Meyer.
• Managed care program. So who is the vendor that's going to be doing this work?
• Direction and Support Services...” “...million in budget authority in the Medical Care Trust Fund within
• other licensed health care practitioners.

Summary: The Legislative Budget Commission considered 21 budget amendments, most of them routine authority adjustments tied to federal grants, Medicaid payment programs, and trust fund realignments. The Department of Education received $14.751 million for a Preschool Development Grant to support early learning system improvements, workforce credentialing and training, IT modernization, and related early childhood certification work. The Department of Veterans Affairs shifted $2.2 million within its trust fund to cover higher nursing home occupancy, replace contract nursing with OPS staff, and meet rising operating costs. The Department of Health moved about $9.1 million to support Disability Determinations, where roughly 140,000 cases were pending or in process, and said the change would help reduce backlog and avoid a deficit. The Agency for Health Care Administration presented multiple amendments for Medicaid-related programs, including $766 million for indirect medical education, $1.9 million for managed care network adequacy audits, $209 million for the Rural Health Transformation Program, and several large supplemental payment programs for hospitals and physicians; members asked about CMS approval delays, provider access, and how rural funds would be distributed. The commission also adopted an amendment realigning KidCare funds, placing a $32.1 million surplus into reserve, though several members objected that the state had not yet implemented the 2023 KidCare expansion and that children remained on a wait list. Another Medicaid amendment placed a $376 million surplus into reserve after updated estimating conference projections. Other agencies also received approvals. FDLE received $16.26 million to buy counter-unmanned aircraft systems equipment such as radar and RF sensors to detect and mitigate drone threats. The Department of Juvenile Justice received $1.6 million for the Florida Scholars Academy and a Social Services Block Grant realignment, with staff confirming corrective action had been taken after prior audit findings about allowable SSBG spending. The Division of Emergency Management received federal pass-through authority for FIFA World Cup security and counter-UAS funds, both controlled by the Miami host committee, and members noted the state had little direct oversight over how those local grants would be used. The Department of Commerce received $148.4 million for Community Development Block Grant Disaster Recovery work, with questions focused on the split between housing, infrastructure, and administrative costs. The Department of State received $408,377 for arts and culture federal grant obligations. All amendments were adopted, generally without objection, after brief questioning and no public testimony.

Transcript Highlights:

• It's direct care workers who are putting in the work for our family members to live independently with
• It's direct care workers who are putting in the work for our family members to live independently with
• AARP found the average cost of self-directed care in 2019 was $1,774 per month, compared to $6,175 per
• The direct care workforce is incredibly fragmented; turnover rates for the direct care workforce are
• of workers and clients. ...direct care workforce are about 50% each year.

Keywords: 995, all

Summary: The Joint Committee on Health Care Financing held a public hearing focused on two broad sets of issues: home- and community-based care, and school-based Medicaid reimbursement. In the morning session, legislators and advocates testified on bills affecting children and disabled enrollees, including proposals to clarify rate-setting for home health and home care services (H. 767/S. 870), allow family members and spouses to be paid caregivers under MassHealth (H. 1394/S. 886 and related bills), extend MassHealth coverage for applied behavior analysis and other therapies beyond age 21 for adults with autism and developmental disabilities (H. 1351/S. 871), and protect medically fragile children by improving access to continuous skilled nursing. In the later portion of the hearing, testimony shifted to a bill to improve MassHealth reimbursement for schools (S. 862), with speakers describing the school mental health crisis and the need to reinvest Medicaid funds directly into school health services. Witnesses on the home care rate-setting bill said current reimbursement methods are opaque and outdated, contributing to workforce shortages, unfilled shifts, long waitlists, and patients remaining in hospitals longer than necessary. Home care providers and trade groups argued the bill would not set rates directly but would require more transparent methodology and fuller consideration of real costs such as wages, benefits, taxes, training, and technology. On caregiver bills, many family members and provider organizations described the financial and emotional strain of caring for disabled or medically fragile relatives, especially when parents, spouses, or guardians are barred from being paid caregivers. They argued the bills would recognize existing unpaid care, help families remain at home, and reduce reliance on more expensive institutional care. Advocates for adult ABA coverage said services remain medically necessary after age 21 and that ending coverage at that age creates an inequitable “cliff” for MassHealth members compared with those with private insurance. For the PACE/community care bill, elder law attorneys and PACE advocates said current MassHealth income rules force some older adults with modestly higher incomes to spend down to $542 per month, making community living unrealistic and pushing people toward nursing homes. They supported changing the eligibility structure to a premium-based approach that would allow more people to remain in the community. On the school Medicaid bill, advocates said schools are providing effective, preventive mental health care, but reimbursement currently flows to municipalities rather than directly back to school health budgets, limiting districts’ ability to hire and retain staff. No votes were taken during the hearing; the committee heard testimony and several witnesses requested favorable reports on the bills.