Transcript Highlights:

• I am a registered nurse appointed by Governor Newsom to serve on the board in a direct care provider
• Telehealth is also providing direct patient care.
• care.
• Before they actually go in and can provide the direct care.
• That is for everybody, whether it's U.S., California, or international. 500 hours in direct patient care

Summary: The joint Assembly and Senate Business and Professions sunset oversight hearing focused first on the Board of Registered Nursing (BRN), with opening remarks emphasizing legislative oversight, consumer protection, workforce access, and the need to evaluate whether licensing boards are efficient and effective. BRN leaders reported progress since the last review, including faster licensing timelines, streamlined enforcement, improved consumer satisfaction, expanded nursing program enrollment, and new statewide data collection on faculty. Committee members then questioned the board about nurse practitioner scope and supervision, international licensure, English proficiency, online nursing education and clinical placements, military and veteran pathways, workforce shortages, diversity in nursing, the LVN-to-RN 30-unit option, and the role of the board’s RN executive officer. The board explained California’s tiered APRN system, the NCLEX and national certification requirements, the 500-hour direct patient care clinical requirement, and its use of nursing education consultants and board-approved programs to oversee schools and placements. Members also discussed retention problems, especially for new graduates, and the board said shortages are often driven by burnout, lack of support, and employers’ reduced use of new-grad training programs. Public comment largely centered on proposed BRN sunset issues affecting advanced practice nursing, education oversight, and workforce development. Nurse practitioner, nurse midwife, and nurse anesthesiology groups generally supported the BRN sunset report but asked for clearer implementation of AB 890, support for APRN-to-RN delegation authority, streamlined renewals for nurse midwives, and protection of the current population-focus model. The California Medical Association raised concerns about out-of-state nurse practitioners practicing independently without California transition-to-practice requirements, specialty delegation, ratios, and data collection. Higher education representatives from UC, CSU, private nonprofit colleges, and nursing associations urged the board to reduce duplicative documentation, modernize clinical placement rules, improve parity between in-state and out-of-state programs, and address bottlenecks in securing clinical sites. An online nursing school argued that California should create a pathway for distance-learning programs so students can complete clinicals in-state rather than traveling out of state. Several speakers also highlighted the need to expand access for rural and underserved communities, support diverse and nontraditional students, and preserve affordable pathways into nursing.

Transcript Highlights:

• director of the board of respiratory director of the board of respiratory care. care. care.
• </c><00:18:42.960><c> Yeah,</c> care of. Yeah, care of.
• </c> care specialist. care specialist.
• </c> the timeliness of care. the timeliness of care.
• </c> not direct supervision. not direct supervision.

Keywords: 958, all

Summary: The committee first handled several referred administrative regulations, including a package from the Board of Respiratory Care described as a substantive housekeeping update to its regulations and incorporated materials. There were no questions from members, and the committee also heard from the Kentucky Board of Medical Licensure, which was present in case questions arose but did not require action. Members then took up an amendment to the state health plan for facilities and services, specifically 900 KAR 5:02. Wesley Duke explained that a previously proposed criteria related to mega-voltage requirements, originally suggested by the Kentucky Hospital Association, was now being removed because the association no longer considered it necessary. The committee moved to accept the agency amendment, with a motion and second, and approved it without opposition. The committee next considered Senate Joint Resolution 23, a “food is medicine” resolution sponsored by Senator Shelley Funke Frommeyer. Supporters from the Kentucky Department of Agriculture and the Kentucky Hospital Association described the initiative as a voluntary, statewide effort already adopted by 52 hospitals, aimed at improving patient health while supporting Kentucky farmers and local food systems. Members discussed access to healthy food, grocery-store availability, school nutrition, and the need to reduce barriers to local procurement; the resolution was adopted unanimously after a roll call vote, with one senator briefly explaining a late vote due to weather. Finally, the committee began hearing Senate Bill 12, which would allow mid-level practitioners to serve as the leader of a Level IV trauma center under physician direction. The sponsor and witnesses from Appalachian Regional Healthcare argued the change would help address rural trauma-care shortages, align with national standards, and improve access without changing scope of practice or other trauma-center requirements. Several members raised questions and comments about rural access, liability, costs, and the broader health impacts, but no vote on the bill was taken in the portion of the meeting provided.

Transcript Highlights:

• dollar add-on increases, state-directed payments for hospital care, behavioral health throughputs for
• And for private hospitals, we are proposing to increase managed care directed payments and fee-for-service
• We are proposing to increase managed care directed payments and fee-for-service supplemental payments
• care and outpatient care.
• care needs.

Summary: The subcommittee heard an overview of the Department of Health Care Services’ proposed budget, including a $229.1 billion total-funds budget and projected Medi-Cal enrollment decline as redeterminations continue. Members focused heavily on the fiscal and programmatic effects of prior budget solutions and federal changes, especially the elimination of General Fund-supported Prop. 56 dental supplemental payments beginning July 1, 2026, the hospice utilization-management change, and the impact of reduced caseloads alongside rising health care costs. DHCS said it is still completing required access and rate-reduction analyses for the dental cuts and has been engaging stakeholders, but could not yet quantify the real-world effect on utilization or provider participation. The committee also reviewed the November 2025 Medi-Cal local assistance estimate, which shows higher General Fund spending despite lower enrollment, driven by managed care rate growth, Medicare cost growth, state-only claiming, and federal policy changes. The hearing then turned to provider taxes and federal H.R. 1 constraints, with extensive discussion of the MCO tax, the hospital quality assurance fee, and other health care-related taxes. DHCS explained that H.R. 1 phases down allowable tax levels and tightens “generally redistributive” rules, making the current MCO tax structure and the proposed higher hospital fee levels difficult or impossible to renew as originally designed. Staff and the LAO described the tradeoff between preserving Medi-Cal funding and avoiding higher costs on private providers and consumers. Members asked about options for preserving revenue, including possible amendments to Prop. 35 or returning to voters, and were told the department is still evaluating approaches while federal guidance remains in flux. The committee also reviewed hospital payment increases already implemented through state-directed payments, with DHCS noting that H.R. 1 will force those payments down to Medicare levels over time. Several budget change proposals were discussed and left open, including requests tied to the managed care final rule, managed care operations, hospital value strategy, long-term care payment transparency, and interoperability requirements. The committee also heard about a one-year trailer bill extension for skilled nursing facility financing, including continuation of the SNF workforce standards program, the SNF quality assurance fee, and annual rate growth, while the department develops a longer-term financing redesign for 2027-28. Members expressed skepticism about repeated rate reform efforts and questioned whether a one-year extension of the eliminated workforce quality incentive program should be restored during the transition. Finally, Covered California presented its budget and enrollment update, reporting that the expiration of the federal enhanced premium tax credit is expected to reduce affordability significantly, with average premiums roughly doubling for many enrollees and as many as 400,000 Californians potentially losing marketplace coverage over time. The exchange said California’s $190 million subsidy program is helping lower-income enrollees, but not enough to offset the federal loss, and it is also implementing a new gender-affirming care benefit and awaiting federal action on benchmark plan changes.

Transcript Highlights:

• Senate Bill 6206 relates to incentivizing child care providers to care for children of first responders
• So this would be a different agency dealing with child care subsidies or child care.
• So this would be a different agency dealing with child care subsidies or child care.
• Work is a lack of child care.
• The cost of child care is already high, but the extended hours and short-notice care make it overwhelming

Summary: The committee heard Senate Bill 6192, which would expand structured literacy and numeracy requirements, add a third-grade math intervention process similar to the existing reading “gate,” create annual STAR teacher bonuses for selected math and ELA teachers, and require updated teacher endorsement standards. The sponsor, Sen. Braun, said the bill is meant to refocus districts on core academics and use research-based instruction while still allowing local flexibility, especially in math. OSPI said it supports the bill’s goals but raised concerns about the teacher award structure and access to student-level data. ESD representatives also flagged implementation issues with the award program. Testimony was split: some parents, students, and reading advocates opposed the bill as too prescriptive or too reliant on phonics and standardized testing, while others supported stronger academic intervention and accountability. No vote was taken. The committee then heard Senate Bill 6206, a pilot program to incentivize child care providers to serve children of first responders through grants administered by the Department of Commerce, with local matching funds and a report on recruitment and retention outcomes. Sen. Dhingra said the bill addresses a major barrier for police, firefighters, EMTs, and crisis workers, especially women leaving the field because of child care challenges. Testimony from law enforcement officers, union representatives, and a national law enforcement child care foundation strongly supported the bill, describing unpredictable schedules, last-minute overtime, and the need for nontraditional and sick-child care. Senator Wilson asked about existing non-standard-hours child care bonuses and whether the proposal should instead be housed at DCYF; staff explained the current subsidy program and that this bill would create a separate Commerce pilot. No vote was taken. Finally, the committee heard Senate Bill 5346 on student mobile device use in public schools. The bill would add mobile devices to digital citizenship instruction, direct OSPI to compile research and best practices, and require reports on school policies limiting phone use during instructional hours, with final recommendations due in 2028. Sen. Leas argued that phones are distracting, harm learning and mental health, and should be restricted in schools while still teaching responsible use. Testimony was largely supportive from students, parents, educators, and researchers who described improved engagement, fewer disruptions, and better school climate under phone restrictions; several urged a stronger bell-to-bell statewide policy. Opponents raised concerns about emergency communication, student safety, and local control. The hearing on the bill was closed without a vote.

Transcript Highlights:

• We do a lot of direct service work in our community support line and our care coordination program.
• And care coordination program provides, like, the enhanced care coordination for families and children
• We do a lot of direct service work in our community support line in our care coordination program.
• We are immersed in our DPH care coordination, enhanced care coordination.
• DPH care coordination, enhanced care coordination.

Keywords: 995, all

Summary: The Permanent Commission on the Status of Persons with Disabilities equity subcommittee met, approved the prior minutes, and heard a presentation from the Massachusetts Department of Public Health’s Cater Center (Care Coordination Assistance, Training, Education, and Resources for Kids). Presenters Toria Haffey and Patty Loza explained that Cater provides training and technical assistance to MassHealth’s Cares for Kids providers serving children with medical complexity, with a focus on enhanced care coordination, family partnership, racial/cultural/linguistic equity, community resources, education systems, shared plans of care, and transition support. They described five e-learning modules, flexible one-on-one and group technical assistance, case review support, and informal virtual “cafes” for providers. They also noted the program has been operating for about two to three years and currently works with five hospital-based providers, including Boston Children’s, BMC, Tufts, NeighborHealth, and Baystate. Committee members asked about the number of families served, the relationship to MassHealth, and whether the model could be expanded beyond Boston-area providers. The presenters said Cater does not track enrollment numbers because that is handled by providers and MassHealth, and they agreed there is room to broaden reach and improve data collection. Members suggested connecting Cater with regional disability and case management networks, the Health Equity Compact, ACOs, and DDS-related contacts. Questions also focused on funding stability amid federal Medicaid cuts and workforce shortages in family engagement roles; Cater said the work remains a priority for MassHealth, though funding is a concern, and acknowledged staffing gaps, especially for family partners with lived experience. After the presentation, the committee discussed a NIH strategic plan for disability health research that had been circulated for future review. Because members had not yet read it, they agreed to place it on the agenda for the next meeting. The meeting then adjourned with no further business.

Transcript Highlights:

• and our health care system as a whole, from the managed care organization tax to hospital fees to state-directed
• , including transportation, lodging, meals, abortion care doulas, and child care and elder care.
• She said the primary driver is direct care workforce, including private duty nursing, nurse providers
• And then the directed payments are ways that the state can direct payments through the managed care system
• care.

Summary: The Assembly Budget Subcommittee on Health began with a hearing on the impacts of H.R. 1 on California health programs, focusing first on reproductive health state investments. HCAI outlined five state-funded reproductive health programs created after Dobbs, including uncompensated care, practical support, capital and clinical infrastructure, and workforce programs. Essential Access Health and Planned Parenthood testified that these funds have served hundreds of thousands of patients, but warned that the uncompensated care program is fully awarded and needs renewal, and that Title X and Medicaid-related federal uncertainty continues to threaten access. Members questioned who the uncompensated care program serves, why Medi-Cal covers a large share of abortions, and whether Planned Parenthood could expand prenatal services; public commenters urged continued support for reproductive health access. The committee then took up long-term care services and supports, starting with the HCBA and Assisted Living Waiver programs. DHCS reported large wait lists for both programs and said enrollment is limited by workforce and provider capacity, while LAO noted that increasing slots alone may not increase access without additional programmatic changes. Members pressed the department on whether more slots should be added given the lower cost of home- and community-based care compared with skilled nursing facilities, and public testimony argued that the wait lists should be reduced and that staffing concerns do not fully explain unused capacity. The committee also heard testimony on congregate living health facilities, where providers and a patient family described the homes as critical, lower-cost alternatives to nursing facilities for younger, medically complex people. Witnesses requested short-term bridge funding, while DHCS said it is proposing to transition CLFs into a managed care benefit by January 1, 2028, which would remove caps and expand access statewide. The final long-term care topic was PACE. DHCS explained that it has paused new PACE applications and service expansions for at least two years to reassess oversight capacity and develop a statewide strategic growth framework, while existing programs continue operating. CalPACE supported the pause as a planning measure but asked for four additional state nurse positions to reduce delays in level-of-care determinations and speed enrollment for frail older adults. Members shared personal stories about how PACE has helped family members and asked how the state will meet growing demand; DHCS said stakeholder engagement will begin later in the year and that some existing applications already in process will continue. Public commenters broadly supported PACE, HCBA, and CLF funding requests. The hearing then moved to the Department of Health Care Services’ 2026-27 Medi-Cal budget and related trailer bills. DHCS said Medi-Cal spending has grown due to coverage expansions, higher acuity, rising utilization, and especially pharmacy costs, and it described proposals to extend the current skilled nursing facility financing framework for one year while the state develops a new value-based payment strategy. LAO said most recent Medi-Cal spending growth has been driven more by higher per-enrollee costs than by caseload growth, with pharmacy spending growing especially quickly, and recommended better and more timely data to analyze the drivers. Members expressed concern about the rapid rise in Medi-Cal spending and asked for more detail on the largest cost increases.

Transcript Highlights:

• But with care as we can. All right, we have mostly Department of Health Care Services.
• Managed care base rate increases, uniform dollar add-on increases, state-directed payments for hospital
• And for private hospitals, we are proposing to increase managed care directed payments and fee-for-service
• care and outpatient care.
• I'm here on behalf of Aviana Health Care as well as Maxim Health Care.

Keywords: 987, senate, all

Transcript Highlights:

• We do not provide within the agency any direct care services to clients.
• We do know there are a very, very small number of individuals in our consumer-directed care plus program
• where we're recruiting a few consumer-directed care plus consultants in maybe one or two pockets of
• care consultants.
• Do we have a system in place, you know, whether it's home health care, long-term care, respite, until

Summary: The Health Care Budget Subcommittee took up two bills and then continued oversight discussions with APD and AHCA. CS/HB 27, the Social Work Licensure Interstate Compact, was presented as a way to let Florida social workers practice in other compact states and vice versa; AARP, the Florida Chamber, and NASW Florida supported it, and the bill passed favorably. HB 1127, a child welfare bill, would create a treatment foster care pilot for children with high behavioral needs, improve DCF data collection on commercially sexually exploited children, and expand recruitment for protective investigators and case managers; the bill also passed favorably after brief supportive testimony. The committee then questioned APD at length about the iBudget waiver waitlist, enrollment pace, spending projections, and provider capacity. APD said it had sent more than 1,100 interest letters in categories 3, 4, and 5, enrolled 1,124 people so far this year, and expects to spend about 96.4% of its waiver appropriation, leaving roughly $82 million unspent. Members pressed APD on why prior discussions suggested more reserve was needed, how long the SANS process takes, whether category 6 could be expanded, and whether the agency has enough waiver support coordinators and direct support providers. APD said it has about 1,061 waiver support coordinators statewide, adequate capacity for current enrollees, but would need further analysis if the legislature directed a much larger enrollment increase. Members also asked about outreach, annual maintenance of the waitlist, portability for military families, and whether communication efforts should be privatized. Finally, AHCA walked the committee through the 2023 Achieved Savings Rebate (ASR) report for Aetna and explained how the report is used for financial monitoring, rebate calculations, and transparency. AHCA said the ASR is separate from the medical loss ratio (MLR) calculation, though both are reviewed, and that Florida uses the ASR mechanism rather than an MLR remittance requirement to recover funds from plans. Members asked about related-party disclosures, CVS/Caremark relationships, expanded benefits, encounter data, network adequacy penalties, denials and appeals reporting, interest earned on capitation payments, and whether rate increases were reaching providers. AHCA and the outside auditors said they review the plans’ reported data, reconcile it to underlying records, and can assess liquidated damages for network adequacy violations; several members requested follow-up data on rebates, interest, provider capacity, and related-party reporting.

Transcript Highlights:

• CMS managed care plan provides health care services for children under 21 years of age with special health
• care needs.
• The training is based on the care and needs of the individual children and the child's plan of care,
• I also had a home health care agency contact me that was questioning if the parental care would have
• They have strict oversight when they do home health care.

Summary: The Health Facilities Subcommittee met to receive implementation updates from the Agency for Health Care Administration on three bills passed in prior sessions. First, Deputy Secretary Brian Meyer reported on the transfer of the Children’s Medical Services managed care plan from the Department of Health to AHCA under HB 1085. He said the move was administrative only, with no change to enrollment, providers, services, or clinical eligibility functions, and that it was intended to create efficiencies by aligning procurement and shifting staff resources between agencies. Members then questioned AHCA about reports of reductions in private duty nursing and therapy services for medically fragile children, including concerns about appeals, provider credentialing, and whether families were losing services or being transitioned appropriately. AHCA said it was reviewing denials, monitoring the plan, and using contractual remedies while focusing on maintaining access for members. The committee also reviewed implementation of a bill creating permanent Medicaid eligibility for individuals with permanent disabilities. AHCA staff explained that the agency had submitted a federal 1115 waiver request after public comment and stakeholder meetings, but CMS had indicated it did not anticipate approving the requested authority. Members pressed AHCA on why the waiver was submitted later than the bill’s directive date and on whether the delay was avoidable. AHCA said the waiver was complex and required review, drafting, and public input, and noted that DCF already has a specialized unit to help with redeterminations while the agencies work on operational changes. The committee discussed the practical impact on families who struggle with annual eligibility renewals and the need for clearer communication and faster follow-up from the agency. Finally, AHCA presented on the home health aide program for medically fragile children and related Medicaid eligibility changes. The agency described the 2023 law that created a family caregiver provider type and the 2025 changes that increased the hourly rate, expanded hours, reduced training requirements, and removed caregiver earnings from Medicaid eligibility calculations, subject to federal approval. AHCA said it had completed state public comment, submitted the waiver amendment to CMS, and was awaiting federal action. Members raised concerns that some families may have enrolled or begun work before the eligibility fix was in place and may have lost benefits, especially in Broward County. AHCA said it would work with affected families and plans, review outreach through DCF and the health plans, and continue rulemaking, system updates, and provider training. The meeting ended with the chair noting that the committee had received the updates and adjourned without objection.

Transcript Highlights:

• And so there's just and our directed plan of correction with the Office of Long-Term Care.
• You can't find a direct care provider that you trust to have in your home.
• So they came in and, in there, what they call a directed plan of care that they gave Warren.
• They're directed by long-term care, and there are federal surveyors. Okay.
• And I'm just... ...directed by long-term care and there are federal surveyors. Okay.

Keywords: 1204, all

Transcript Highlights:

• </c> long-term care. long-term care.
• </c> Minnesota Care. Minnesota Care.
• Leading Care. Leading Care.
• </c> care. Thank you. care. Thank you.
• </c> primary care services. primary care services.

Keywords: 1187, senate, all

Transcript Highlights:

• , education, and child care.
• I am a mom, and I care for 12 children at my child care. As you can see, I wear a lot of hats.
• Thursday direction.
• For direct care registered nurses, the time period is after being employed on a fully compensated basis
• Abortion care is essential health care, and creating a sustainable revenue source to invest in this care

Summary: The Ways and Means Committee met on February 6, 2026, and first voted to suspend the five-day notice rule for all bills on the agenda. Senators Braun and Gildon objected, arguing the bill needed more public review and that the fiscal note had only just been released, but a roll call vote passed 15-9 and the committee proceeded to Senate Bill 6346. Staff briefed SB 6346 as a proposal to create a 9.9% income tax on Washington taxable income above a $1 million per-household standard deduction, with a $50,000 charitable deduction, apportionment rules for nonresidents and certain professions, quarterly estimated payments, and credits for capital gains tax and certain business taxes. Staff said the tax would begin in 2029 and eventually raise about $3.5 billion annually from roughly 30,000 taxpayers. The bill also would expand the Working Families Tax Credit, create a sales tax exemption for grooming and hygiene products, increase the small business B&O tax credit and filing threshold, and end the B&O surcharge on high-grossing businesses one year early. Members questioned the bill’s constitutionality, its exemption from referendum, treatment of student athletes, natural-resource industries, and whether real estate gains would be captured. Public testimony was sharply divided. Supporters, including labor groups, educators, health care advocates, counties, child care workers, and some business owners and high-income individuals, said the bill would make the tax code more progressive and provide stable funding for health care, education, child care, public defense, and other services, while expanding the Working Families Tax Credit. Opponents, including many small business, construction, housing, and taxpayer advocates, argued the measure would function as a tax on pass-through businesses and retained earnings, harm housing production and investment, encourage wealthy residents and businesses to leave the state, and violate the state constitution or the will of voters. No final action on SB 6346 was taken during the hearing.

Transcript Highlights:

• </c> harm to the inmate the healthc care harm to the inmate the healthc care provider<00:08:25.599><c
• </c><00:13:35.680><c> can</c> access to medically necessary care can access to medically necessary care
• We've directed them to separate violent and nonviolent, and as it stands right now, they're directed
• We've directed them to separate violent and nonviolent, and as it stands right now, they're directed
• We've directed them to separate violent and nonviolent, and as it stands right now, they're directed

Keywords: Meeting Start: 00:00:00 Roll Call: 00:00:04 SB 02: 00:01:37 Discussion in Opposition to SB 02: 00:09:49 SB 84: 00:22:19 SB 111: 00:30:35, 958, all

Summary: The committee first considered Senate Bill 2, sponsored by Senator Mike Wilson, which would prohibit incarcerated people from receiving cross-sex hormones or gender-affirming surgeries, while allowing a tapering period if stopping an existing treatment would cause physical harm. Wilson said the bill was needed to prevent the Department of Corrections from providing such care by memo or policy rather than statute, and he argued the care was elective and not medically necessary. Senators Thomas, Neal, Nemes, Styers, and others questioned whether any gender-affirming surgeries had actually occurred in Kentucky, whether the hormone treatments were physician-prescribed, and whether the bill would override medical judgment; Wilson said the department reported no surgeries, that 67 incarcerated people were receiving cross-sex hormone therapy, and that he would only support treatment if it fit the bill’s narrow medical-harm exception. Public testimony on SB 2 was strongly opposed. Chris Hartman of the Fairness Campaign said the bill would deny medically necessary care, violate the Eighth Amendment, and target a very small and vulnerable incarcerated population. Dr. Jack Skilles testified that gender-affirming care is medically necessary and supported by major medical organizations, warning that denying it could worsen mental health and lead to suicidality. Hannah Callahan, a transgender woman, described being denied hormone therapy while incarcerated and said the interruption caused severe physical and mental harm, including suicidal thoughts. Emma Curtis, Lexington’s Fourth District councilwoman, also urged a no vote, framing the issue as a matter of compassion and religious duty. The committee then voted on SB 2. Senator Neal explained his no vote by saying he was not medically trained and deferred to doctors; Senator Nemes said he wanted clarification that the bill would not stop ongoing treatment; and Senator Styers argued the bill was a poor priority and noted there was no fiscal note and that only 67 people were affected. Senator Wheeler moved the bill, Senator Reed seconded, and the committee reported Senate Bill 2 favorably. Afterward, the committee began hearing Senate Bill 84, sponsored by Senator Steve Rawlings, which would limit judicial deference to state agency interpretations and require courts, not agencies, to interpret ambiguous laws, citing the U.S. Supreme Court’s 2024 Loper Bright decision overturning Chevron deference.

Transcript Highlights:

• I am a registered nurse appointed by Governor Newsom to serve on the board in a direct care provider
• Telehealth is also providing direct patient care, so a part of that can be counted toward those 500 hours
• care.
• Before they actually go in and can provide the direct care.
• That is for everybody, whether it's U.S., California, or international: 500 hours in direct patient care

Keywords: 987, senate, all

Transcript Highlights:

• I am a registered nurse appointed by Governor Newsom to serve on the board in a direct care provider
• Telehealth is also providing direct patient care.
• care.
• Before they actually go in and can provide the direct care.
• That is for everybody, whether it's U.S., California, or international. 500 hours in direct patient care

Summary: The joint Assembly and Senate Business and Professions sunset oversight hearing focused first on the Board of Registered Nursing (BRN), with chairs emphasizing oversight, consumer protection, workforce access, and the need to evaluate whether licensing boards are functioning efficiently. BRN leadership reported major process improvements since the last sunset review, including faster license processing, streamlined enforcement, improved consumer satisfaction, and growth in nursing education enrollment. Members questioned the board extensively about nurse practitioner scope and supervision, international licensure, online nursing programs and clinical placements, military pathways, the 30-unit LVN-to-RN option, workforce shortages, diversity in nursing, and retention of new graduates. The board explained California’s tiered APRN system, the NCLEX and national certification requirements, clinical hour standards, and its role in approving programs and assigning nursing education consultants. Public testimony on the BRN was mixed: nurse practitioner, nurse midwife, and nurse anesthetist groups largely supported the sunset report and especially the proposed APRN-to-RN delegation language, while physician and hospital stakeholders raised concerns about out-of-state NP practice, specialty delegation, ratios, and the need for regulatory parity and clearer standards. Higher education representatives urged reduced duplication in documentation, more flexible clinical placement rules, and better coordination to address bottlenecks in placements and faculty hiring. The committee did not take a vote during the excerpted BRN discussion. The hearing then moved to the Physical Therapy Board of California, where the board’s president began an overview of the board’s mission, structure, vacancies, and public-protection role under the Physical Therapy Practice Act. The transcript excerpt ends before substantive questioning, testimony, or any action on the physical therapy item is shown.

Transcript Highlights:

• who provide direct care.
• agency workers who provide direct care.
• And compliance for home care agency workers who provide direct care.
• It ensures that Medicaid home care funds are used exactly as you intend to compensate direct care workers
• It ensures that Medicaid home care funds are used exactly as you intend to compensate direct care workers

Summary: The Appropriations Committee held a public hearing on several bills. Senate Bill 5109 would raise the mortgage lending fraud prosecution surcharge on recorded deeds of trust from $1 to $5 and remove the 2027 sunset on the surcharge and account. Committee staff said the change would generate additional revenue for county auditors and the Department of Financial Institutions to contract with prosecutors; King County and the Washington Association of Prosecuting Attorneys testified in strong support, saying the current funding has eroded and the bill would better sustain mortgage fraud prosecutions. A question was raised about whether other budget funding could serve a similar purpose, but supporters said the dedicated surcharge/account structure was the best fit. No vote was taken. The committee also heard Engrossed Substitute Senate Bill 5500, which would require DCYF’s biennial child care report to include a current cost-of-quality study in addition to the market rate survey. Testifiers from Child Care Aware of Washington, child care providers, and the early education design team supported the bill, saying the market rate survey alone does not capture the true cost of providing quality care. Staff said the bill would have a small fiscal impact for DCYF. The committee then heard Substitute Senate Bill 5834 and Senate Bill 5835, both Department of Retirement Systems request bills: one would broaden use of pension fund interest earnings for fund-protection expenses beyond the 2025-27 biennium, and the other would raise the threshold for lump-sum payment of small monthly benefits from $50 to $250. Neither bill drew public testimony, and staff said the fiscal impacts were minimal. Later, the committee heard Engrossed Senate Bill 5872, which would create the Pre-K Promise Account for ECAP funding and allow gifts, grants, and donations to be used solely to expand the program. Supporters including rural health coalitions, the Balmer Group, and Snohomish County said the account would help expand access to early learning, especially in child care deserts; DCYF estimated staffing costs to administer the account. Substitute Senate Bill 6007 would direct WSIPP to study DCYF’s child welfare screening tools and their effects on outcomes, with a reported cost of about $234,000; there was no public testimony. Engrossed Substitute Senate Bill 6019 would clarify home care agency rate-setting and require that no more than 20% of Medicaid home care rates go to administrative costs, with DSHS saying there would be no fiscal impact. Labor and caregiver witnesses supported it as a parity and accountability measure. Finally, Senate Bill 6065 would allow school districts in binding conditions or enhanced financial oversight to use transportation vehicle funds more flexibly, including temporary loans or permanent transfers with approval; a rural education representative supported the bill, and staff said OSPI would incur only modest administrative costs. The committee took no final action and adjourned after the hearings.

Transcript Highlights:

• provision of medical care.
• And with the direct payment from Medicaid, that's based on cost of care.
• Our state-directed payments right now are a pass-through with the managed care organizations.
• </c> managed care with their uh providers. managed care with their uh providers.
• </c> with the managed care organizations. with the managed care organizations.

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board met on January 12, 2026, to approve the December 10, 2025 minutes and continue finalizing its findings and recommendations. Members reviewed findings on administrative inefficiencies, Medicaid and workforce participation under HR 1, Medicaid budget growth, rural health transformation fund development, and provider tax/state-directed payment changes. The board approved a motion to change “pilot” to “partnership” in the workforce-related recommendation, and also adopted a technical amendment clarifying overlapping HCBS services by removing reference to adult daycare waiver services and revising the language to focus on reducing duplication, simplifying provider contracting, and standardizing processes across programs. A separate technical correction was noted to change “DMS” to “DPH” in the rural health transformation finding, to be handled in the final edits. Several findings drew discussion but no final substantive vote during the meeting. On the rural health transformation fund, Dr. Berg said Kentucky had done well in federal funding and noted limits on what could be shared publicly, while Commissioner Lee said a public website had been created and recommended the department reference be changed to the Department for Public Health. Finding five prompted extended discussion about provider taxes, state-directed payment reductions under HR 1, and whether the board should address the relationship between actuarial studies, MCO payments, and actual provider reimbursement more directly. Senator Meredith and others argued for a broader, more transparent baseline review of rates across provider groups, while Commissioner Lee said CMS will require certain fee schedule comparisons to Medicare beginning July 1, 2026, and that quarterly expenditure reports already go to LRC. The board did not finish resolving finding five during the meeting and agreed to return to it after staff prepared more explicit language. Members also discussed the possibility of an all-payers claims database as a better way to understand what is being paid across payers and services. No final vote on the full findings package was taken in the portion of the meeting provided, but the board did adopt the noted amendments and continued working through the remaining language.

Transcript Highlights:

• For Tier 2, this is the cost associated, the direct cost associated with serving... ...children in care
• in care.
• And that was one of the reasons, because I think direct care to the child is very important, even with
• And that was one of the reasons, because I think direct care to the child is very important, even with
• the non-direct.

Summary: The committee heard a presentation from Dr. Kelly O’Dare on first responder behavioral health access, peer support, and suicide prevention. She described UCF Restores, the Second Alarm Project, and related partnerships that provide culturally competent treatment, peer training, clinician education, disaster response support, and behavioral health navigation. She cited survey and state data showing significant rates of sleep problems, anxiety, depression, substance use, and suicide among Florida first responders, and said evidence-based treatment has helped many patients recover, including a reported 76% who no longer met PTSD diagnostic criteria after treatment. Senators asked about measuring outcomes, peer support standards, and whether the state should create more consistent statewide requirements; O’Dare said peer support training must be specialized, linked to higher levels of care, and supported by sustainable funding and statewide coordination. The committee also heard from a public commenter who supported the work and emphasized the need for adequate resources and peer support infrastructure. The committee then received a Department of Children and Families presentation from Casey Penn on the proposed funding methodology for community-based care lead agencies under HB 7089. Penn explained that the new model is intended to be actuarially based, reimbursement-oriented, and more transparent than prior funding approaches, using historical expenditures, standardized reporting, and two main tiers: Tier 1 for largely fixed administrative and operational costs, and Tier 2 for direct child-serving costs based on per-child-per-month blended rates. He said the model includes a 2% risk corridor for Tier 2, hold-harmless funding in the first year, and optional Tier 3 performance incentives, with an estimated additional state appropriation need after offsets. Senators raised concerns about prevention, historical inequities, reasonableness of costs, administrative overhead, blended state and federal funds, adoption subsidies, high-acuity placements, and disaster-related disruptions. Penn said some of those issues could be addressed in future iterations as the child welfare information system is modernized, and he agreed to provide written responses to committee questions. Representatives of the Florida Coalition for Children and CBCs responded that the model is a major improvement but urged additional safeguards, including an administrative cap, clearer separation of direct and indirect costs, and better treatment of federal and pass-through funds. They argued that the system already has oversight and that deficits reflect insufficient appropriations rather than excess spending, while also noting that higher-acuity children and regional differences can drive costs. No votes were taken on either topic, and the meeting ended with committee staff introductions and adjournment.

Transcript Highlights:

• And the effects on our hospitals, health care facilities, and health care providers will be felt for
• States are permitted to direct managed care plans on what amounts to pay providers so long as they meet
• in-person care.
• of our health care providers to be able to provide that care.
• This is primary care.

Summary: The joint informational hearing focused on the impacts of H.R. 1 on California’s Medi-Cal program and on community health effects from recent immigration enforcement actions. Committee leaders said H.R. 1 would sharply reduce federal funding, increase administrative burdens, and worsen access to care, especially for Medi-Cal enrollees, immigrant families, rural communities, and reproductive health patients. The second half of the hearing examined how ICE raids and related federal actions are creating fear, reducing clinic and emergency department use, and disrupting children’s access to schools and early childhood education. Department of Health Care Services Director Michelle Bass outlined the main H.R. 1 provisions affecting Medi-Cal: work requirements, semiannual eligibility redeterminations, shorter retroactive coverage, new cost-sharing, limits on provider taxes and state-directed payments, reduced federal support for emergency and lawful immigrant coverage, and a one-year ban on Medicaid funding for prohibited abortion providers. She estimated millions could lose coverage, with tens of billions of dollars in federal funding at risk. Planned Parenthood Affiliates of California warned the defunding provision could force clinic closures, service reductions, and loss of access to family planning, STI testing, and cancer screenings. The California Hospital Association said the financing changes could cut hospital revenue by tens of billions over 10 years and threaten access, especially for rural and safety-net hospitals. The Western Center on Law and Poverty argued the law would increase churn, paperwork, and uninsured rates, disproportionately harming working adults and people experiencing homelessness. Committee members asked about implementation timelines, notification systems, administrative costs, the effect on immigrant eligibility, and whether California could delay or mitigate some provisions. Bass said the state was still assessing federal guidance, planning county and provider outreach, and exploring a possible delay for work requirements and a transition period for provider-tax changes. Members also discussed how state budget actions may need to be revisited in light of H.R. 1, and how California might preserve access through state-only funding or other policy changes. In the second panel, CHIRLA, Los Angeles County Department of Health Services, and the Children’s Partnership described the health consequences of immigration enforcement. Speakers said raids and data-sharing fears are causing anxiety, trauma, and avoidance of care, with Los Angeles County reporting declines in emergency, urgent care, and clinic visits after enforcement actions. The Children’s Partnership said school and early childhood absences are rising in some communities and that enforcement is undermining children’s emotional well-being and access to education. Members asked for more data and discussed possible state protections, telehealth, mobile care, and legal and policy responses to reduce fear and preserve access to health and education services.

Transcript Highlights:

• > and</c><00:59:03.920><c> a</c> impacts direct health care costs and a impacts direct health care costs
• It's simply the direction of the health care agent saying no to that.
• It's simply the direction of the health care agent saying no to that.
• It's simply the direction of the health care agent saying no to that.
• A health care directive is a document that any person can sign.

Keywords: 1187, senate, all