Transcript Highlights:

• </c><00:09:08.080><c> fraud</c> our unit, which is the Medicaid fraud our unit, which is the Medicaid
• They help the state Medicaid program administer the Medicaid program itself.
• They help the state Medicaid program administer the Medicaid program itself.
• </c> &gt;&gt; from for Medicaid? &gt;&gt; from for Medicaid?
• &gt;&gt; Medicaid,<01:24:52.800><c> right,</c> &gt;&gt; Medicaid, right, &gt;&gt; Medicaid, right, &gt

Summary: The committee chair opened by explaining that the committee has expanded from a traditional audit-follow-up role into an oversight role focused on whether audit recommendations are implemented and whether controls are in place to detect fraud. He said the committee was concerned about fraud uncovered in social service programs in other states and wanted to understand New Hampshire’s safeguards, especially around major contracts and program performance. Charles Buchanan, director of the New Hampshire Medicaid Fraud Control Unit, and investigator Tim Brackett described the unit’s structure and mission. Buchanan said the unit, housed in the Attorney General’s Criminal Justice Bureau, investigates and prosecutes fraud by health care providers serving Medicaid beneficiaries, as well as abuse, neglect, and financial exploitation of residents in health care facilities. He outlined common Medicaid fraud schemes such as billing for services not rendered, upcoding, using unqualified staff, drug substitution, kickbacks, supplemental charges, and inflated customary charges. He also described resident abuse/neglect and drug diversion in hospitals, nursing homes, and assisted living settings. Brackett said his role is financial investigator/auditor and noted the unit is grant-funded and must include a prosecutor, investigator, and auditor. The witnesses then explained how cases reach the unit and how they are handled. Most referrals come from the state Department of Health and Human Services’ program integrity unit and from managed care organizations’ special investigations units, which look for fraud, waste, and abuse and refer credible allegations. Other sources include qui tam whistleblower actions, the national Medicaid Fraud Control Units association, citizen complaints, provider referrals, adult protective services law-enforcement referrals, local law enforcement, and federal agencies. Once a referral is received, the unit can accept or deny it; accepted matters may be investigated criminally or civilly, while nonviable matters can be referred back to HHS or other agencies for administrative action, including repayment demands and reimbursement offsets. No votes or formal committee actions were taken in the portion provided.

Transcript Highlights:

• If it's Medicaid, Medicaid will pay for the<00:09:04.000><c> fees.
• </c> qualified for Medicaid. qualified for Medicaid.
• </c> Medicaid, a quarter of the Medicaid Medicaid, a quarter of the Medicaid population<00:38:05.680>
• </c> Department for Medicaid Services. Department for Medicaid Services.
• , Medicaid, Medicaid, &gt;&gt; right?

Summary: The Medicaid Oversight Advisory Board met for its third meeting and approved the July 30 minutes. The chair outlined a full agenda covering the state-based marketplace versus the federally facilitated marketplace, connectors and navigators, presumptive eligibility, eligibility/enrollment/redetermination, and a rural health transformation update. Commissioner Lisa Lee and Assistant Director David Barry presented first on Kentucky’s state-based exchange, Connect, explaining that it is an integrated eligibility and enrollment system for Medicaid, CHIP, SNAP, TANF, child care, and qualified health plans. They reviewed Kentucky’s move from a state-based exchange to healthcare.gov in 2017 and back to a state-based marketplace in 2021, and said the system helps route applicants to the correct program and allows families to move more easily between Medicaid and exchange coverage as circumstances change. The presenters said the exchange is funded by carrier assessments on qualified health plans rather than general fund dollars, with costs allocated across programs based on use. They said Kentucky’s exchange fees are lower than the federal platform’s and that the state-based system provides local assistance through DCBS offices, connectors, and licensed agents in every county. Members asked about startup and operating costs, fee-setting, and whether any general fund dollars are used; the department said it would follow up with the CFO on fee details and said it was not aware of general fund support for exchange operations. Members also raised concerns about Medicaid eligibility verification and improper enrollment, while the department emphasized that the state system uses different questions than healthcare.gov and is designed to identify the correct coverage based on monthly Medicaid income and annual tax-credit income. The board also discussed enrollment trends, including a COVID-era spike during the public health emergency when disenrollments were largely paused, and current qualified health plan enrollment of more than 97,000 people on Connect. Commissioner Lee explained presumptive eligibility as temporary Medicaid coverage, noting it applies to pregnant women and hospital-based cases, with hospitals able to grant it and certain providers able to grant it to pregnant women. She said full eligibility is still determined within 30 days and that presumptive eligibility ends when full Medicaid eligibility is determined or at the end of the following month. The meeting then shifted to connectors, with representatives from Community Action Kentucky and the Kentucky Primary Care Association describing their statewide outreach network, local offices, and role helping residents apply for Medicaid, renew coverage, report changes, and navigate benefits; they said connectors do not determine eligibility but assist with applications, recertifications, and outreach events across the Commonwealth.

Transcript Highlights:

• </c> Medicaid right now. Medicaid right now.
• You know, we have Medicaid data.
• If you look at the<00:24:55.720><c> Medicaid</c><00:24:56.280><c> chips</c> the Medicaid chips the Medicaid
• Again, Medicaid data is little tricky. Again, Medicaid data is so<00:29:10.040><c> complex.
• Medicaid? Medicaid?

Summary: The subcommittee held its first meeting to discuss creating a Healthcare Transparency Dashboard focused largely on Kentucky Medicaid. Members introduced themselves and described their interest in using data transparency to improve policy, access to care, and program efficiency. The co-chairs said the dashboard should begin with a basic framework and expand over time, with a mission centered on collaboratively designing and maintaining a secure, data-driven dashboard housed with the Legislative Research Commission. Discussion focused on what should be measured and how data should be organized. Members agreed the dashboard should segment Medicaid populations rather than aggregate them, with separate attention to aged and disabled enrollees, expansion adults, and children. Suggested measures included emergency department utilization and follow-up, cancer screenings, child and adolescent well visits, adult well visits, postpartum care, newborn screenings and follow-ups, hospitalization and readmission rates, pharmacy, behavioral health, and claims data. Several members emphasized the need to include demographic and geographic information, while noting some items such as education may not be readily available in Medicaid data and that HIPAA and access issues will affect how detailed the public-facing dashboard can be. Members also discussed existing data sources and warned against duplicating work already being done by the cabinet, the Office of Data Analytics, CMS scorecards, and university Medicaid directed payment reporting. The group was encouraged to review the Medicaid and CHIP scorecard, which includes quality, administrative, and program characteristic measures, as a possible model. No formal votes were taken, but the subcommittee agreed to continue refining the mission statement, identify priority metrics, and consider benchmarking, outcomes, data-sharing, and technical platform issues before the next meeting.

Transcript Highlights:

• </c> Medicaid Services. Medicaid Services.
• </c><00:03:08.840><c> 1.4</c> here just Medicaid at a glance. 1.4 here just Medicaid at a glance. 1.4
• So, the Medicaid we have the Medicaid Oversight Advisory we have the Medicaid Oversight Advisory Board
• </c> Medicaid program that would be exempt. Medicaid program that would be exempt.
• </c> state are either on Medicaid or KCHIP. state are either on Medicaid or KCHIP.

Summary: The Budget Review Subcommittee for Health and Family Services met for its first meeting, established quorum, and heard a presentation from Department for Medicaid Services Commissioner Lisa Lee and CFO Steve Becktold. The department reviewed its compliance with House Bill 695, which requires legislative approval before certain Medicaid eligibility, service, benefit, or waiver changes, along with fiscal impact reporting to the Legislative Research Commission. They described current waivers, including home and community-based waivers, managed care and transportation waivers, and the 1115 re-entry waiver, and said the community engagement waiver is in public comment and on track for submission to CMS. They also said required reports and other HB 695 tasks, including a pharmacy rebate fund, budget analyses, expenditure reports, and a behavioral health scorecard, are underway or completed as required. The CFO outlined Medicaid’s budget, saying the department has two appropriation units and projecting near-full use of state funds while leaving some federal funds unspent because of matching-rate differences. They reported roughly 211 filled positions and 11 vacancies. Members asked about the vacancy makeup, the behavioral health scorecard, and whether a provider involved in quality metrics could have a conflict if used in the scorecard process; the department said it would follow up. Members also asked about the community engagement waiver and its interaction with federal policy, and the department said CMS guidance is still pending and that it will proceed under HB 695. A substantial portion of the discussion focused on federal Medicaid policy changes under a reconciliation bill, including possible limits on provider taxes, directed payments, cost-sharing, and community engagement requirements. Department officials said the final federal impact is still uncertain because the Senate bill is not finalized, but they have modeled several scenarios and warned that any reduction in federal support or benefits would be harmful, especially for hospitals and rural hospitals. They estimated Medicaid benefits are funded about 80% federal and 20% state overall, with expansion populations closer to 90% federal funding, and said administrative costs would also rise if federal requirements change. Members also asked about work requirements and eligibility. The department said the community engagement waiver would mainly affect the expansion population, which they estimated at about 450,000 people out of roughly 1.5 million total Medicaid enrollees, and that many groups are exempt, including children, the aged, blind, disabled, and people in substance use disorder treatment. Officials said they can provide data on how many enrollees are working or work-ready and explained that their eligibility system is designed to prevent duplication by automatically placing people in the correct category and correcting errors quickly. They also noted a federal proposal to require expansion eligibility reviews every six months, compared with current annual renewals.

Transcript Highlights:

• So the state of New Jersey, we do have a Medicaid benefit that allows Medicaid clients to have received
• And in this capacity I serve as the Medicaid director for the Florida Medicaid program.
• , Medicaid Services.
• Florida, Florida, Medicaid.
• The vast majority of for Medicaid enrollees are enrolled in the statewide Medicaid managed CARE program

Transcript Highlights:

• I'm the Medicaid and behavioral health medical director.
• on Medicaid work.
• I see your logos change to say Apple Health Medicaid.
• And there were significant changes. platform for SNAP and Medicaid.
• We did launch the Apple Health Medicaid benefit.

Committee: Senate Health & Long-Term Care

Summary: The committee opened with an extensive update on the expected effects of federal HR1 on Washington’s health care system, especially Medicaid and the individual market. Governor’s office and Health Care Authority staff said the bill is likely to cause immediate coverage losses in the exchange beginning in January, followed by larger Medicaid impacts over the next several years. They highlighted likely premium increases, administrative burdens from more frequent eligibility checks and work requirements, reduced retroactive coverage, limits on state-directed payments and provider taxes, and possible effects on rural hospitals and safety-net providers. They also noted separate CMS rules already being implemented in Washington on prior authorization, managed care access, home- and community-based services, and eligibility/enrollment, and explained how those rules interact with HR1’s new requirements and timelines. Members asked about Planned Parenthood funding, work requirements, rural health grants, provider impacts, and how the state will use existing systems and a forthcoming timeline to prepare for implementation. The committee then received an update on the International Medical Graduate Work Group and Washington’s efforts to create pathways for internationally trained physicians. Presenters described the state’s clinical experience license, the clinical evaluation tool used to assess readiness, a grant program for career guidance and clinical training, and a 2025 law adding a hardship waiver process. National presenters from World Education Services and the Federation of State Medical Boards said many states have adopted similar pathways because of physician shortages, but approaches vary widely. They recommended clear guardrails, employment offers before application, ECFMG certification, supervised provisional practice, data collection, and protections against exploitation. Committee members asked about portability across states, retention of IMGs, and whether Washington should pursue additional options such as dedicated residency slots, preceptorships, or practice-ready assessment models. The final topic was an update on the Apple Health doula benefit and the statewide doula hub and referral system. Senator T’wina Nobles praised the state’s work, noting Washington’s high Medicaid reimbursement rate for doulas and the importance of building infrastructure to support equitable maternal care. Health Care Authority staff said the benefit launched on January 1, 2025, and covers prenatal intake, labor and delivery, postpartum visits, and telehealth-supported services. They reported 336 state-certified doulas, 134 enrolled with Apple Health, 287 clients served, and 641 claims paid so far, while also acknowledging barriers such as provider enrollment, claims submission, client matching, and language access. Doulas for All described the hub as part of a broader effort to expand access, support community-based birth workers, and reduce maternal and infant mortality disparities, especially for Black and Indigenous families.

Transcript Highlights:

• in this bill is to address what is the situation that we find ourselves in this year by offering a reform
• It's long overdue to look at reform in this formula.
• It's long overdue to look at reform in this formula.
• Like I said, we've made some reforms to try to not find ourselves in the situation again.
• We've also made some reforms.

Committee: Joint Joint Committee on Ways and Means

Summary: The joint budget hearing opened the FY27 budget process with remarks from the Senate and House Ways and Means chairs, who described the fiscal outlook as challenging because of slow revenue growth, rising health care and other costs, and uncertainty from federal policy changes. Governor Healey and Secretary of Administration and Finance Matthew Gorzkowicz then presented House 2, a $62.8 billion budget that they said grows by about 1% and does not raise taxes or fees. They emphasized affordability, fiscal discipline, protection of core services, and continued investment in education, transportation, housing, child care, health care, and public safety. The administration also discussed a separate bill to delay and phase in certain federal tax-code changes from the so-called OB3 law, especially research and experimental expense provisions, to reduce immediate budget impacts and preserve competitiveness. A major portion of the hearing focused on education and municipal aid. The administration said House 2 provides about $7.6 billion for Chapter 70 aid, fully funds the final year of the Student Opportunity Act, increases special education circuit breaker funding, and raises rural school aid. Senators and representatives from both parties raised concerns that Chapter 70 and other aid formulas are not equitable for small, rural, and low-wealth communities and are not keeping pace with inflation, and several called for broader review of the formula and related funding streams. The governor and secretary said they are open to further discussion, pointed to additional support through rural aid, special education, transportation reimbursements, and minimum aid, and said total Student Opportunity Act investment would reach about $2.1 billion over the life of the law. Transportation, housing, and fair share spending were also central topics. The administration said fair share revenues are being used holistically, with education-heavy spending in the operating budget and transportation-heavy spending in the supplemental budget, and estimated the overall split to date at roughly 57% education and 43% transportation. They highlighted MBTA stabilization, regional transit authority support, microtransit, fare-free regional transit, and bridge and commuter rail investments, while noting the MBTA remains a major fiscal concern. On housing, the governor stressed production, permitting reform, ADUs, down-payment assistance, and support for public housing authorities, while lawmakers pressed for more funding for local housing authorities and for ways to address out-migration, energy costs, and affordability. The governor also said the administration will not withhold fire safety grants from communities over MBTA Communities Act noncompliance and will handle such issues case by case. No votes were taken at the hearing; it was an informational presentation and question-and-answer session.

Transcript Highlights:

• Without reform, our housing crisis will continue to worsen because of the detrimental impacts of such
• Without reform, our housing crisis will continue to worsen because of the detrimental impacts of such
• Horton Hawaii, I'm here to strongly support HB 420 HD1, which seeks to reform the contractor repair act
• Supply the reforms ensure that legitimate<00:43:05.160><c> defects</c><00:43:05.920><c> are</c><00:43
• I'm sorry, I just wanted to state that I supported DHS's amendment regarding Medicaid protection.

Committee: House Consumer Protection & Commerce

Summary: The Consumer Protection and Commerce Committee met on February 12 and heard several bills. HB 97, relating to travel insurance, drew only brief testimony: the Insurance Division stood on written testimony, one industry witness supported the bill and requested a minor amendment, and no one else testified or asked questions. HB 226, relating to window tinting, received support from the Department of Transportation, while the Honolulu Police Department offered comments on the proposed amendments, asking for clearer language on what it means to roll windows down, when the requirement applies, how it handles bad weather, and what sanctions would apply for noncompliance. No further testimony was offered on that measure. The committee also heard HB 1179, relating to rural emergency hospitals. The Department of Human Services stood on written testimony, and Maui Health Systems strongly supported the bill, saying it would help critical access hospitals better serve kūpuna and provide long-term care beds. There were no questions or additional testimony. HB 420, relating to remedies and the contractor repair act, generated extensive and sharply divided testimony. Opponents, including attorneys representing homeowners and AARP Hawaii, argued the bill was anti-consumer, would weaken homeowners’ ability to recover for construction defects, and would shift costs and risk to consumers. Supporters, including builders, realtors, the Chamber of Commerce, and D.R. Horton Hawaii, said the bill would create a more balanced and efficient process, reduce unnecessary litigation, and help builders address legitimate defects more quickly. Testimony on HB 420 focused heavily on whether the contractor repair process and class actions help or hinder repairs. Opponents said the bill would delay or limit homeowner recovery, especially for life and safety defects, while supporters said current class-action litigation can prevent direct communication with homeowners and slow repairs. Committee members asked questions about when communication with homeowners stops and whether repairs could be made before a class is certified. No votes or final committee actions were taken during the portion of the meeting provided.

Transcript Highlights:

• ><c> Not</c><00:07:24.720><c> Millionaires</c> the Protect Medicaid Not Millionaires the Protect Medicaid
• It is not fair or just that Medicaid.
• </c> Medicare cuts, medicaid cuts come down. Medicare cuts, medicaid cuts come down.
• </c> about cutting $880 billion of Medicaids. about cutting $880 billion of Medicaids.
• </c> on Medicaid are also going to get cut. on Medicaid are also going to get cut.

Transcript Highlights:

• These are the faces of Medicaid.
• </c><00:46:37.839><c> which</c><00:46:37.960><c> is</c> Medicaid the loss of Medicaid which is Medicaid
• ... no, no, Medicaid...
• ... no, no, Medicaid...
• It's not just Medicaid.

Committee: House Taxes

Transcript Highlights:

• Okay. the federal changes to the Medicaid the federal changes to the Medicaid program.
• </c> Medicaid state directed payment program. Medicaid state directed payment program.
• </c> necessary changes to Medicaid. necessary changes to Medicaid.
• Medicaid. Medicaid.
• , a few years later, Medicaid.

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:

• and Israeli also serve as the Medicaid director for the state's Medicaid program.
• But really this is a large bell that focuses on much more than just Medicaid.
• But there are a number of Medicaid sections that do impact Medicaid programs across the country, both
• Met from from the water being enrolled in the Medicaid program.
• How will AHCA measure Bibi's Medicaid provisions?

Transcript Highlights:

• </c><00:03:05.159><c> traditional</c><00:03:05.599><c> Medicaid</c> you can see our traditional Medicaid
• Medicaid members.
• Medicaid.
• It's not just that that's happening in one area of Medicaid; there are numerous areas within Medicaid
• the a Medicaid important that Medicaid the a Medicaid agency<00:25:38.440><c> itself</c><00:25:39.279

Summary: The subcommittee met to review the Department for Medicaid Services’ program integrity work. Commissioner Lisa Lee and Program Integrity Director Jennifer Dudinsky outlined Kentucky Medicaid’s structure, funding, enrollment, and spending, including FMAP rates, the size of the Medicaid and KCHIP populations, the number of providers, and 2024 expenditures. They also described the managed care and fee-for-service populations, noting that managed care serves most members while fee-for-service is concentrated in long-term care and waiver populations. Most of the discussion focused on fraud, waste, abuse prevention, and provider oversight. The department described its provider enrollment and certification checks, revalidation requirements, site reviews, fingerprinting for some high-risk providers, and termination grounds such as false application information, Medicare actions, unreported ownership changes, and abandonment of a provider number. Members asked about nonprofit ownership reporting, MCO fraud oversight, and how the department tracks unusual CPT code utilization, especially in behavioral health. The department said it uses data analytics, audits, policy review, and collaboration with behavioral health staff to monitor those trends. Dudinsky explained the division’s four branches: provider licensing and certification, audits and compliance, recovery, and third-party liability/estate recovery. She described prepayment and postpayment audits, referrals of credible fraud allegations to the Attorney General, monthly meetings with the AG’s office, and coordination with the Office of Inspector General, CMS, HHS OIG, MCOs, and other partners. She also explained payment suspensions, stand-downs during law enforcement investigations, and recovery efforts for overpayments, provider/member fraud, and third-party liability. The department said its recovery and avoidance efforts produced more than $251 million in savings so far in 2025. No votes or formal actions beyond approving the minutes were taken.

Transcript Highlights:

• And then Medicaid covers a bunch of services that are sort of unique to Medicaid.
• Apply for Medicaid.
• But for those that are just Medicaid and just Medicaid expansion, we're going to enable Cover Virginia
• to Medicaid.
• to Medicaid.

Committee: House Health and Human Services

Transcript Highlights:

• </c> to the Medicaid program. to the Medicaid program.
• </c> the Medicaid budget. the Medicaid budget.
• </c> expenditures in the Medicaid program. expenditures in the Medicaid program.
• The long-term care Medicaid PDM rate is Medicaid services.
• </c> Medicaid program. Medicaid program.

Committee: Senate Ways and Means

Transcript Highlights:

• I serve as the Medicaid director for the Florida Medicaid program.
• I serve as the Medicaid director for the Florida Medicaid program.
• They needed to review Medicaid eligibility and help facilitate whether or not someone was active in Medicaid
• They needed to review Medicaid eligibility and help facilitate whether or not someone was active in Medicaid
• So they may not be actively enrolled on Medicaid, but maybe they're eligible for Medicaid.

Summary: The Health and Human Services Committee received an overview of Florida’s intellectual and developmental disabilities (IDD) managed care pilot, created by legislation in 2023 to test whether a managed care model could integrate Medicaid medical services with iBudget waiver home- and community-based services for adults in pre-enrollment categories. AHCA explained the existing system, the pilot’s scope in Regions D and I, and the rollout timeline, including federal approval, contract execution with Florida Community Care, and the October 2024 go-live. Officials reported that, as of early February, 370 individuals had been sent for onboarding and 168 more were in queue, with about $35.8 million of the appropriation remaining. APD also clarified the difference between the pre-enrollment categories and the waiver waitlist, and noted that crisis cases can be enrolled more quickly depending on eligibility and funding. Florida Community Care described the pilot as a comprehensive managed care model offering medical, long-term care, and iBudget services, plus enhanced benefits such as bed-hold days, caregiver transportation, and help with legal guardianship costs. The plan said it uses one care coordinator, a 1:18 coordinator ratio, a face-to-face assessment within five days of enrollment, and 180 days of continuity of care for existing providers. The company emphasized that it is recruiting providers by offering higher rates than some iBudget rates, lower administrative burden, and network adequacy incentives, while APD said it continues to monitor provider supply and demand and recruit across service types and regions. Members repeatedly questioned whether the pilot’s costs, provider rates, and service levels were truly comparable to the iBudget system, and AHCA and APD said it was too early to draw firm conclusions because claims data are still lagging. Committee members also raised concerns about communication, enrollment delays, provider shortages, and whether the pilot could scale statewide. APD said it has used letters, phone calls, texts, emails, and community meetings to reach eligible individuals, and that some delays stem from required assessments, Medicaid eligibility checks, and level-of-care determinations. Several members asked for more detailed comparisons of costs and provider reimbursement between the pilot and iBudget, and APD said it would provide additional data. Public testimony at the end was strongly critical of managed care, with a participant and his mother describing poor service, transportation failures, and loss of control under prior managed care arrangements, and urging the committee not to expand such a model without safeguards. No votes or formal committee action were taken before adjournment.

Transcript Highlights:

• program or to federal Medicaid funding.
• </c> potential changes to our Medicaid potential changes to our Medicaid Program<00:03:07.040><c> or<
• </c> it's around 50% for the regular Medicaid it's around 50% for the regular Medicaid and<00:41:29.520
• Right now, Medicaid the federal government funds Medicaid as mandatory spending.
• </c> low reimbursement rates I mean Medicaid low reimbursement rates I mean Medicaid right<01:13:06.880

Committee: Senate Finance

Transcript Highlights:

• This legislation here does nothing to shrink the Medicaid expansion.
• This isn't strengthening Medicaid. It's weakening its foundation.
• This isn't strengthening Medicaid. It's weakening its foundation.
• This bill does absolutely nothing to cut Medicaid.
• This bill does absolutely nothing to cut Medicaid.

Summary: The committee primarily considered House Bill 440, which would move Medicaid expansion language from the Oklahoma Constitution into state statute and send the change to voters in a special election. Supporters argued this would give the Legislature flexibility to manage the program, especially if federal Medicaid matching rates were reduced, and said it would help protect the state budget and allow future adjustments such as eligibility or work requirements. Opponents said the measure would weaken voter-approved constitutional protections, create uncertainty for more than 300,000 enrollees, rural hospitals, and providers, and could allow future cuts without another vote of the people. Members also discussed the possible fiscal impact of a federal match change from 90-10 to 60-40, with supporters saying the state could face roughly a billion-dollar annual cost and would need flexibility to avoid cuts to other services. Questions also focused on the choice of an August special election rather than the November general election, and on whether tribal governments and other stakeholders had been consulted. After debate, the committee tabled an amendment and passed House Bill 440 on a 14-2 vote. The committee then took up House Joint Resolution 1087, which would change the Avalon reimbursement program so the Legislature could manage funding levels and methodologies rather than being bound to the current structure. It passed 14-2. The committee also considered House Joint Resolution 1067, a trigger measure that would only appear on the November ballot if House Bill 440 failed in August; it would relieve the state of any obligation to fund Medicaid expansion for working adults if the federal match dropped below 90%. After adopting a committee substitute and tabling an amendment, the resolution also passed 14-2. The committee then laid over H.J.R. 1089 and adjourned.

Transcript Highlights:

• So first, we added in here the Medicaid Oversight Advisory Board.
• by the federal Centers for Medicare and Medicaid Services from the requirement that changes to the Medicaid
• Services in accordance with federal law for the purpose of providing Medicaid-covered services.
• See no other business. the Medicaid oversight and advisory bill the Medicaid oversight and advisory bill
• </c><00:03:14.360><c> MC</c> that failed to comply with Medicaid MC that failed to comply with Medicaid

Summary: The Appropriations and Revenue Committee met to consider House Bill 695 and first adopted a committee substitute. The substitute made a number of Medicaid-related changes, including adding the Medicaid Oversight Advisory Board, exempting federally required Medicaid changes from needing separate General Assembly authorization, revising the treatment of University Hospitals payment programs, clarifying that the community engagement program is mandatory, moving the Medicaid pharmaceutical rebate fund to the Cabinet for Health and Family Services, and narrowing reporting requirements. It also removed provisions on Medicaid coverage for psychoeducational services and replaced them with reporting on behavioral health and substance use disorder service utilization and expenditures. The substitute further added language allowing the Medicaid program to be administered through fee-for-service, managed care, or other federally permitted delivery systems, incorporated the Medicaid Oversight and Advisory Bill, authorized a state plan amendment if needed, and made entities that failed to comply with prior Medicaid managed care reporting requirements ineligible for new MCO contracts. It also shifted responsibility for a behavioral health and substance use disorder treatment scorecard from MCOs to the Department for Medicaid Services. The sponsor noted that all language related to long-term managed care in the waiver program had been removed. After the explanation, Senator Richardson moved to adopt the substitute and Senator Nunn seconded. The committee then voted to pass the measure favorably; the transcript reflects a roll call with no nays and the bill reported out with favorable expression.

Transcript Highlights:

• First on your agenda is the Division of Medicaid.
• So that's the Idaho Medicaid Management Information System.
• The Medicaid state recovery program is the...
• Enhancement number six, Medicaid program integrity contract.
• Add $935,000 ongoing for the Medicaid Integrity Program.

Summary: The Joint Finance-Appropriations Committee met to consider several Department of Health and Welfare Medicaid items, Idaho State Police budgets, the Department of Juvenile Corrections, and the Department of Administration and Military Division. The committee first approved a FY 2026 Medicaid forecast supplemental, then approved a budget-neutral FY 2026 hospital assessment fund shift and creation of a separate hospital assessment budgeted program. For FY 2027 Medicaid, members heard extensive discussion of MMIS procurement, estate recovery, program integrity, purchasing staff, hospital assessment alignment, population forecast adjustments, and proposed reductions tied to provider rates and RESHAB. After debate among three competing motions, the committee rejected two alternatives and passed the original motion, which included the governor’s recommended Medicaid adjustments and the $22 million reduction concept, sending it with a do pass recommendation. The committee then approved Idaho State Police Brand Inspection replacement items for trucks and equipment, as well as Idaho State Police division requests for a commercial vehicle safety grant increase, a mobile live scan pilot, and replacement patrol vehicles and equipment. POST Academy replacement items were also approved. For the Department of Juvenile Corrections, members approved clinician service transfer funding from Health and Welfare, replacement items, IT hardware, and restoration of six FTPs and related funding for direct care staff and substance use disorder mentoring services. In the Department of Administration budget, the committee debated Medicaid procurement staffing and related transfers. A substitute motion to fund three FTPs failed, and the committee ultimately approved a compromise motion funding two FTPs, utilities alignment, program transfers, inflationary utilities, IT hardware, and a prior rescission adjustment. The Military Division enhancement request for indirect cost recovery for emergency management and state education assistance funding was also approved. The committee adjourned after announcing its Monday agenda, which included DEQ, public school support and financing, services for the deaf and blind, Idaho Digital Learning Academy, the State Board of Education, and the Department of Education.