Transcript Highlights:

• Today the Medicaid Program serves approximately 1.4 million Medicaid members throughout the state.
• </c> National Association of Medicaid National Association of Medicaid directors<00:02:45.400><c> Steve
• </c><00:03:05.159><c> Program</c> in general today the Medicaid Program in general today the Medicaid
• </c><00:03:27.560><c> in</c> therefore are enrolled in Medicaid in therefore are enrolled in Medicaid
• However, 90% of the Medicaid membership is served by Medicaid managed care organizations, or MCOs.

Summary: The Budget Review Subcommittee on Health and Family Services held its first meeting and received an overview from the Department for Medicaid Services on Medicaid’s behavioral health and substance use disorder services. Commissioner Lisa Lee and CFO Steve Beal said Kentucky Medicaid serves about 1.4 million members, including over half of Kentucky children, with 485,000 expansion members, more than 69,000 enrolled providers, and total fiscal year 2024 expenditures of $18.5 billion. They said Kentucky covers a broad range of behavioral health services, and behavioral health provider enrollment has grown from a little over 4,500 in 2019 to nearly 8,000 in 2024. They also described how Medicaid spending and utilization are tracked through claims and encounter data, with most members served through managed care organizations. Members focused on sharp increases in certain behavioral health billing codes, especially peer-to-peer services, and asked about reimbursement, utilization review, and whether the growth reflected increased need or expanded coverage. DMS said the rise was partly tied to combining facility and nonfacility behavioral health fee schedules in 2023, choosing the higher reimbursement rate to avoid cuts, and that the department has seen an uptick in peer-to-peer services. In response to concerns about overutilization, DMS said it mailed a letter to behavioral health providers, is considering limits and prior authorizations for some services, and plans to create a standardized monthly behavioral health report to monitor trends consistently and identify when controls may be needed. Lawmakers also asked whether the provider network is sufficient and whether access is adequate, especially for children. DMS said provider enrollment has expanded because behavioral health services were added to Medicaid in 2014 and because demand increased after COVID, but acknowledged studies showing children have less access than adults and said that would be an area of focus. The department said managed care organizations are required to ensure access to needed services and that current trends indicate access is available, though one member disagreed and said workforce shortages remain a major concern. Another member asked about non-emergency medical transportation spending, and DMS explained that it is handled through a capitated arrangement administered by the Transportation Cabinet rather than directly by the managed care organizations.

Transcript Highlights:

• Matt Friedman, on behalf of the Utility Reform Network.
• Chair, members of the committee, Matt Friedman, on behalf of the Utility Reform Network.
• Chair, members of the committee, Matt Friedman, on behalf of the utility reform.
• Chair, members of the committee, Matt Friedman, on behalf of the Utility Reform Network.
• Adrian Tinnon with TURN, the Utility Reform Network, and we are here in proud sponsorship of SB 1098.

Committee: Senate Energy, Utilities and Communications

Transcript Highlights:

• This bill gives us a vehicle to reform the current regulatory framework around public defense to fit
• post-consumer recycled content requirements is also a covered product under the 2025 right recycling reform
• I would also note that it's out of line with the Recycling Reform Act definition, which we passed last
• reductions to the bloat in our government that doesn't affect people like this, that doesn't affect Medicaid
• reductions to the bloat in our government that doesn't affect people like this, that doesn't affect Medicaid

Summary: The committee began with a public hearing on Substitute House Bill 1592, which would change how state public defense funds are distributed and, in the substitute version, keep current law on state funding responsibility while revising the allocation formula. Staff explained the bill would shift county and city distributions to a pro rata, caseload-based model, allow very low-density counties to request OPD to provide some or all public defense services, require additional data collection and reporting, and direct OPD to study caseload reductions and retention. Representative Peterson said the bill is meant to create a better structure for future state support of indigent defense without the very large cost of the original proposal. Testimony from counties, cities, OPD, defenders, and local officials was strongly supportive, emphasizing a statewide public defense crisis, rising local costs, staffing shortages, and the need for a fairer funding model. The committee then heard Substitute House Bill 1742 on environmentally sustainable urban design and Substitute House Bill 1906 on water system regulation and water rates. HB 1742 would create a center in Ecology to promote sustainable urban design, fund design competitions and grants, and establish an advisory council; the sponsor said the bill reflects a desire to support a pilot project through alternative funding, and there was no public testimony. HB 1906 would require more planning and notice for Group A water systems, add customer notice and right-of-first-refusal provisions for some ownership changes, and direct the UTC to consider external funding sources, capital planning, and rate smoothing when setting water rates. Water utility and PUD witnesses supported the goal of improving transparency and consolidation of failing small systems, while noting the substitute reduced some fiscal concerns. The committee also heard HB 2248 on Secretary of State corporate and charity filings, HB 2438 creating the SEED scholarship for early childhood education students, and HB 2515 addressing emerging large energy use facilities such as data centers. HB 2248 would redirect part of annual filing fees to the Secretary of State revolving fund, require initial reports from nonprofits and LLPs, and change trademark certificate procedures; the fiscal note showed modest revenue losses, and the division supported restoring the fee split for operational funding. HB 2438 would transfer $10 million annually from the GET account to fund scholarships and wraparound services for early childhood education degree seekers, with testimony from early learning advocates and a student describing workforce shortages and personal financial barriers. HB 2515 drew extensive testimony both for and against: supporters said it would protect ratepayers, water resources, and grid reliability by requiring tariffs, reporting, clean-energy requirements, and a fee on large energy users; opponents argued it singled out data centers, could hurt investment and jobs, and included unrelated labor and procurement provisions. After public testimony, the committee moved into executive-session briefing on several bills and amendments, including HB 1903 on statewide low-income energy assistance, HB 1909 on a court unification task force, HB 1982 on vacating certain convictions tied to treaty Indian rights, HB 2034 on LEOFF Plan 1 retirement changes, HB 2105 on employer notice of federal I-9 audits, HB 2210 on ranked-choice voting, HB 2215 on Climate Commitment Act fuel supplier obligations, and HB 2271 on post-consumer recycled content requirements. Staff summarized proposed substitutes and amendments, with several changes aimed at reducing or shifting fiscal impacts, narrowing agency duties, or striking provisions entirely.

Transcript Highlights:

• But I, and I think that the way, you know, when I was Medicaid director and oversaw Medicaid and behavioral
• But I, and I think that the way, you know, when I was Medicaid director and oversaw Medicaid and behavioral
• of the Medicaid forecast.
• The next is our Medicaid cost-based maintenance. The next is our Medicaid cost-based maintenance.
• So any individual who comes on to Medicaid, they could have So any individual who comes on to Medicaid

Committee: Senate Health and Welfare

Transcript Highlights:

• well as our Medicaid providers.
• Sherissa Fottinos on the Medicaid and behavioral health...
• on Medicaid work.
• I see your logos change to say Apple Health Medicaid.
• We did launch the Apple Health Medicaid.

Summary: The committee first received an update on the effects of HR1 and related federal Medicaid and marketplace changes from Governor’s Office and Health Care Authority staff. Presenters said the most immediate coverage losses are expected in the individual market beginning in January, with premium increases and an estimated 80,000 people potentially unable to afford coverage. They warned that larger Medicaid impacts will follow over the next year and beyond, including tighter eligibility checks, work requirements, reduced retroactive coverage, limits on state-directed payments and provider taxes, new cost-sharing, and changes affecting certain non-citizen adults. They also said the state plans to seek a waiver or extension for work requirements and will continue to analyze impacts, including on rural providers and Planned Parenthood-related services. Members asked about the effect on nursing homes, rural hospitals, and how the state can help providers and enrollees navigate the new requirements; staff said timelines and a state-specific implementation chart are being developed. The committee then heard a report on the International Medical Graduate Work Group and Washington’s efforts to create pathways for internationally trained physicians. Testimony described the clinical experience license, the clinical evaluation assessment tool, grant funding for IMG support organizations, and a new hardship waiver process enacted this year. National presenters said many states have adopted similar pathways because of physician shortages, but Washington and Tennessee are among the few states that have actually issued licenses so far. They recommended clear guardrails, an employment offer before application, ECFMG certification, supervised practice, and data collection to avoid exploitation and protect patients. Members asked about state-to-state variation, retention of IMGs, and whether Washington should pursue dedicated residency or preceptorship options; presenters said the key next step is moving successful participants from supervised experience to a durable long-term license. The final topic was implementation of Washington’s Apple Health doula benefit and the statewide doula hub and referral system. Senator T’wina Nobles highlighted the state’s $3,500 per-birth Medicaid reimbursement rate for doulas and the importance of the hub for referrals, training, and billing. Health Care Authority staff said the benefit launched January 1, 2025, and covers prenatal intake, labor and delivery, postpartum visits, and telehealth-supported services. They reported 336 state-certified doulas, 134 enrolled in Apple Health, 287 unique clients served, and 641 claims paid so far. Testimony emphasized doulas’ role in improving birth outcomes, reducing unnecessary interventions, and addressing racial disparities in maternal health, while noting that implementation is still early and ongoing.

Transcript Highlights:

• </c> Medicaid. That would be a nice benefit. Medicaid. That would be a nice benefit.
• So, um, as we are considering, we also simultaneously pursue Medicaid dollars and Medicaid funds.
• So, um, as we are considering, we also simultaneously pursue Medicaid dollars and Medicaid funds.
• So, um, as we are considering, we also simultaneously pursue Medicaid dollars and Medicaid funds.
• </c> insurance, Medicare, Medicaid, whoever. insurance, Medicare, Medicaid, whoever.

Summary: The subcommittee opened its second meeting on House Bill 742, which would require catastrophic special education aid to be drawn from the education trust fund, and discussed whether to also examine differentiated aid within the adequacy formula. The chair said the committee had previously heard from HHS/Medicaid officials and now wanted to hear from local special education directors about how the aid system works in practice, including billing, training, data collection, and whether districts handle claims consistently. Members also referenced Arkansas as a possible comparison state and said they hoped to develop ideas by November to address the current funding process. Committee members focused on the current special education aid thresholds and the impact of proration. The chair described the existing formula as requiring districts to absorb costs up to 3.5 times the state average per student, with the state paying 80% from 3.5 times through 10 times and paying above that, and said FY25 appropriated about $34 million while actual claims were about $50.1 million, leaving roughly a $16 million shortfall that caused proration. Members also raised the possibility of lowering the threshold to 2.5 times and asked how that would affect the number of eligible students and costs. Another member asked about how districts decide whether services are education-related or medical-related and how Medicaid or private insurance reimbursement affects later state aid claims. District representatives from Boothby Therapy Services, Bedford, and Guilford introduced themselves and described their roles. Guilford’s director said the district tracks students with paraprofessional support, nurses, transportation, or specialized programming, uses a data system to log every service touchpoint, and tries to maximize both Medicaid and special education aid; she said a lower threshold would likely capture all students with paras or nurses and that rising staffing and service costs would increase the number of students over the cap. Bedford’s assistant director said the district uses a different system, tracks roughly 60 to 80 students a year, and pursues Medicaid and special education aid simultaneously but does not pursue private insurance if it would affect FAPE; she said reducing the threshold to 2.5 times would likely double the number of qualifying students. Members asked follow-up questions about software, data entry, and how districts decide whether to bill Medicaid or seek state catastrophic aid, and the directors explained that their systems log services by staff type and student, with some districts using the same data for both Medicaid and state reimbursement claims.

Transcript Highlights:

• </c> all of us that are Medicaid providers. all of us that are Medicaid providers.
• ><c> Medicaid,</c> more talk about Medicaid, more talk about Medicaid, &gt;&gt; okay, &gt;&gt; okay,
• Medicaid? Medicaid?
• </c> can bill Medicaid for those services. can bill Medicaid for those services.
• Medicaid state funding. The system is Medicaid state funding.

Summary: The Medicaid Oversight Board met on March 9 with a quorum present and no minutes to approve. The chair reordered the agenda to hear House Bill 689 first. Representative Amy Neighbors presented HB 689, which would authorize Kentucky to seek CMS approval for a Medicaid state-directed payment program for physician and non-physician professional services delivered through qualifying hospital-affiliated groups, beginning January 1, 2026, with retroactive payments for that year. She said the bill is intended to improve access to care in rural and underserved areas, support workforce retention, and generate about $29 million annually in federal Medicaid funds without using general fund dollars. Representatives from Owensboro Health and St. Elizabeth Healthcare testified in support, describing staffing and subsidy pressures, lower Medicaid and Medicare reimbursement, and the importance of the program for maintaining access and quality in rural and safety-net settings. Committee members noted the bill had already passed the House Health Services Committee unanimously and discussed broader concerns about Kentucky’s low reimbursement rates and the need to consider other systems not covered by the proposal. The board then heard Senate Bill 2011 from Senator Donald Douglas and Cody Hunt of the Kentucky Medical Association. The bill would address a Medicaid coding issue by ensuring that coverage limits do not reduce payment to fewer than two evaluation and management service units per provider, per patient, per day. Douglas argued the current one-visit, one-issue limitation forces multiple visits, increases no-shows, and prevents providers from treating the whole patient. Hunt explained that the bill is meant to correct a longstanding regulation that limited E&M services to one per physician per recipient per date of service, which can prevent providers from coding additional medically necessary work during the same visit. He said DMS has already filed a regulatory amendment to fix the problem, but a statutory change is still needed to prevent the issue from returning. He also said the bill is not intended to change reimbursement policy, only coding rules, and that MCO payment practices vary. Members generally supported the concept. Senator Berg asked about fiscal impact and private-payer billing; Hunt said there should be no fiscal impact because the bill does not change payment policy, only coding. Representative Moore said the proposal could reduce costs and improve convenience by avoiding extra visits. Chairman Meredith said the bill illustrated problems with fee-for-service care and supported moving toward a more holistic delivery model. Dr. Schuster raised a drafting concern about the bill summary language, and Hunt responded that the regulatory amendment should address the issue generally for providers. No votes were taken on either bill during this portion of the meeting.

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> fraud Medical Aid or excuse me Medicaid fraud Medical Aid or excuse me Medicaid fraud<00:01:33.960
• </c> office's ability to investigate Medicaid office's ability to investigate Medicaid fraud<00:01:50.159
• </c> the director of Minnesota's Medicaid the director of Minnesota's Medicaid fraud<00:02:58.760><c>
• </c> million in state funds on our Medicaid million in state funds on our Medicaid fraud<00:04:07.360
• </c> agency that administers the Medicaid agency that administers the Medicaid Program<00:04:29.080><

Transcript Highlights:

• So in the state of New Jersey, we do have a Medicaid benefit that allows Medicaid clients to receive
• In this capacity, I serve as the Medicaid director for the Florida Medicaid program.
• and Medicaid Services.
• In order to enroll in Medicaid, Medicaid is an...
• What does Medicaid do? How would you incentivize hospitals to take Medicaid patients?

Committee: Senate Health Policy

Summary: The Senate Health Policy Committee met to discuss maternal and infant health, beginning with a presentation from New Jersey’s Maternal and Infant Health Innovation Authority (MiHA). Pamela Taylor described New Jersey’s statewide effort to reduce maternal mortality and racial disparities through the Nurture New Jersey campaign, a strategic plan with more than 80 recommendations, universal home visiting, Medicaid-covered doula care, hospital report cards, limits on non-medically indicated early elective C-sections, and a new maternal and infant health innovation center. Senators asked about doula certification, funding, home visiting, and how New Jersey coordinates across agencies; Taylor said the authority uses quarterly stakeholder meetings, annual summits, and a tracker for recommendations, and that community input helped shape its programs. Florida Agency for Health Care Administration Deputy Secretary Brian Meyer then outlined Florida Medicaid’s maternal coverage and managed care structure. He reviewed eligibility and services for pregnant women, labor and delivery, postpartum coverage, newborn coverage, and family planning, noting 12 months of postpartum coverage, expanded benefits in managed care plans, and new contracts launching February 1 with more maternal-health-focused benefits, quality measures, and a new quality withhold incentive structure. Senators questioned doula certification and duplication with Healthy Start, provider access and network adequacy, kick payments, quality reporting, and whether Florida should consider broader eligibility standards; Meyer said many details are still plan-driven, that quality metrics are public, and that the agency is working on maternal-health work groups and incentives. Department of Health Division Director Shea Holloway followed with an overview of Florida’s maternal and child health programs and data. She cited Florida CHARTS data showing pregnancy-related deaths, severe maternal morbidity, and infant mortality trends, and described the Title V block grant, the Maternal Mortality Review Committee, the Florida Perinatal Quality Collaborative, the electronic prenatal risk screen, Healthy Babies, BH Impact for perinatal mental health, Healthy Start, WIC, family planning, telehealth maternity care, and the Pregnancy Care Network. Senators asked about delays in mortality review reporting, preterm birth, substance use disorder in pregnancy, WIC participation, cesarean rates, and the impact of the abortion ban; Holloway said the department is continuing to monitor outcomes, expand screening and telehealth, and use data and hospital partnerships to improve care. The committee then adjourned without further business.

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:

• 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:

• 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:

• 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:

• ><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:

• </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 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?