Transcript Highlights:

• We're defining direct primary care services as those services that a primary care provider is licensed
• It's an option that already exists for other health care providers under the Idaho Direct Primary Care
• Representative Healy continued: "...on line 18 says direct primary care services means those services
• And when I say, define direct primary care, it says a health care model where patients pay physicians
• So it says means services online 18 says direct primary care services means those services that are primary

Summary: The committee first heard House Bill 754, which would add physical therapists to Idaho’s direct primary care statute so they can enter direct payment agreements with patients without those arrangements being treated as insurance contracts. The sponsor and supporters said the bill would improve access, especially for patients who need frequent therapy or live in underserved areas, and emphasized that it would not expand physical therapists’ scope of practice. One member objected that the bill’s wording could blur the definition of primary care and create scope confusion. After testimony from a physical therapy association representative and a small business health care provider, the committee voted to send the bill to the floor with a do-pass recommendation, with several members recording no votes. The committee then took up House Bill 724, which would add and clarify safety-related rights for children in foster care, including safe placement, access to medical and forensic exams after abuse disclosures, basic necessities, and consideration of safety in visitation and placement decisions. The sponsor said the bill is a narrow child-safety measure that does not alter parental rights or removal standards, while foster parents, a psychologist, former foster youth, and others testified in support with accounts of abuse, unsafe placements, and inadequate oversight. Some members raised concerns about enumerating rights in statute and about broad language that could have unintended future consequences; a substitute motion to send the bill to amending order failed on a roll call vote, and the original motion to send the bill to the floor with a do-pass recommendation passed. Finally, the committee heard House Bill 759, a budget-related measure to reduce Medicaid residential habilitation funding and require a new audit/rate study of home and community-based services. The sponsor said the reduction reflects a governor’s budget recommendation and that the audit would help determine appropriate rates and spending. Providers and family members of people with disabilities testified that the bill was too vague, that prior rate studies were not fully followed, and that any reductions could harm staffing and services; they asked for clearer standards, collaboration, and assurance that rate-study results would actually be used. A motion to hold the bill until a later date was offered, but the sponsor opposed delaying the budget item and the committee continued discussion toward a floor recommendation.

Transcript Highlights:

• on strategies to strengthen recruitment and retention of direct care workers.
• of payment rates for direct care workers.
• care to folks who are self-directed.
• care services, home health, rehabilitation services, case management, and private duty nursing services
• I took a few notes, one of which is I believe Sydney, you were talking about direct care work?”

Keywords: 995, all

Summary: The Massachusetts Commission on the Status of Persons with Disabilities’ Long-Term Services and Supports and Health Equity Subcommittee met to hear a presentation from the Lurie Institute for Disability Policy at Brandeis University. Monica Mitra introduced the institute’s work on disability health equity and long-term services and supports, and staff described several research centers focused on community living policy, disability and pregnancy, and parents with disabilities. The presentation emphasized participatory research, accessible dissemination, and the connection between health equity and access to home- and community-based services. Joe Caldwell discussed the Community Living Policy Center’s work on Medicaid HCBS, the direct care workforce crisis, housing, and policy advocacy, including efforts related to the Money Follows the Person program and the Medicaid access rule’s interested parties advisory group. Sid Pickern highlighted a workforce study interviewing direct care workers, a forthcoming policy brief on the access rule, and housing research including Massachusetts’ Alternative Housing Voucher Program. Teresa Nguyen described the Community Living Equity Center’s focus on disparities in community living for people of color, especially a study on self-direction and community living outcomes, and asked for help recruiting participants. Lauren Bixby demonstrated the community living data dashboard, which compares adults who need LTSS with those receiving Medicaid LTSS using ACS and TMSIS data. She explained that the dashboard can be filtered by state and demographics, but noted major race and ethnicity data gaps for Massachusetts and other states. Commissioners praised the dashboard and the institute’s work, asked questions about data sources and the 1115 waiver, and discussed possible connections to the Health Equity Compact. No votes were taken; the meeting ended with an invitation for follow-up, including a forthcoming direct care workforce brief and the institute’s October 28 lecture.

Transcript Highlights:

• We're defining direct primary care services means those services that a primary care provider is licensed
• She said the bill’s definition of direct primary care services includes services that primary care providers
• fee directly for comprehensive primary care services.
• And when I say, define direct primary care, it says a health care model where patients pay physicians
• So I just want to draw attention to the definition of direct primary care services, and with all the

Committee: House Health and Welfare

Keywords: 989, all

Transcript Highlights:

• However, direct support workers provide highly specialized care.
• Home and community-based services cost roughly half as much as nursing home care.
• Our direct support professionals, again, are the backbone of our services.
• Direct service workers provide daily assistance that makes this possible by supporting personal care,
• Direct service workers provide daily assistance that make this possible by supporting personal care,

Committee: House Appropriations

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

Transcript Highlights:

• So a system of care is a proven model for a connected network of comprehensive services and supports
• I don't know the answer to the first question about how many of the seven agencies provide direct services
• Agencies provide direct services, but I can help follow up and connect with our partners to find out
• In terms of that direct service and who's actually providing that direct service, it is either in our
• have provided direct services to students over the past several years.

Bills: HB1634

Committee: House Education

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

Transcript Highlights:

• Caring for a... receives the home and community-based services waiver.
• Caring for a receives the home and community-based services waiver.
• However, direct support workers provide highly specialized care.
• service hours to better... ...increase direct support worker wages and expand waiver service hours to
• Direct service workers provide daily assistance that makes this possible by supporting personal care,

Committee: House Appropriations

Keywords: 965, house, all

Transcript Highlights:

• </c><00:04:23.919><c> Care</c> clinicians and expertise Direct Care clinicians and expertise Direct Care
• Direct Care and treatment agency Mr stor Direct Care and treatment agency Mr stor Camp<00:34:46.280><
• c> has</c> important Direct Care and treatment has important Direct Care and treatment has about<00:39
• Direct Care and treatment the fact that Direct Care and treatment does<00:40:44.800><c> highly</c><00
• The executive board will run Direct Care and Treatment, can fire and hire a CEO to run Direct Care and

Committee: Senate Human Services

Keywords: 1187, senate, all

Transcript Highlights:

• So roles found within nursing, behavioral health, direct care, and primary care are the priority focus
• And I'm going to begin with direct care and the home and community-based services grant program.
• There were 82 grantees, 60 were direct service providers, and the population served... ...were direct
• What are some of the initiatives particular to direct service professionals and direct support services
• What are some of the initiatives particular to direct service professionals and direct support services

Keywords: 995, all

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

Transcript Highlights:

• of, or reallocating the funds to, direct services.
• This would go to the Department of Health Care Services.
• care coordination services would still be a part of the fee-for-service model?
• care coordination services would still be a part of the fee-for-service model?
• limit coordinated care services.

Keywords: 988, house, all

Transcript Highlights:

• But most importantly, is addressing the needs of low-wage workers in long-term care: the direct care
• That includes housekeeping, daily personal care, intermittent nursing services.
• So we see a high, high turnover rate with our direct care workers.
• the supply of direct-care workers.
• care compensation, and it's over 90% in the consumer-directed system.

Committee: Joint Joint Legislative Executive Committee on Planning for Aging and Disability Issues

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

Transcript Highlights:

• service professional, from the union representing the largest number of direct support professionals
• under state-contracted services. the direct support professional workforce shortage in the supported
• service professional from the union representing the largest number of direct support professionals
• Direct support professionals under state-contracted services.
• Even when directed to use the two-and-a-half rate increase last year on direct care workers, workers

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

Transcript Highlights:

• </c><00:05:19.199><c> services</c><00:05:19.680><c> and</c> long-term care services and long-term care
• direct care and treatment<00:14:40.399><c> and</c><00:14:40.720><c> direct</c><00:14:41.040><c> care
• </c><00:15:52.160><c> care</c><00:15:52.399><c> and</c> by direct care and by direct care and treatment
• c> um</c><00:45:11.280><c> and</c> to direct care and treatment um and to direct care and treatment um
• The amendment to the clone of the direct care and treatment policy article that the Human Services Committee

Keywords: 1187, senate, all

Transcript Highlights:

• I'm here today because our home care ...for home health care and home services.
• The direct care workforce is incredibly fragmented; turnover rates for the direct care workforce are
• Home care services are a vital and growing part of the health care delivery system.
• services and home care services.
• services for individuals who are nursing home eligible and 50,000. care and in-home services for individuals

Committee: Joint Joint Committee on Health Care Financing

Keywords: 995, all

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

Transcript Highlights:

• So a system of care is a proven model for a connected network of comprehensive services and supports
• I don't know the answer to the first question about how many of the seven agencies provide direct services
• Agencies provide direct services, but I can help follow up and connect with our partners to find out
• In terms of that direct service and who's actually providing that direct service, it is either in our
• have provided direct services to students over the past several years.

Summary: The House Education Committee held a work session on the Children and Youth Behavioral Health Work Group and its school-based behavioral health and suicide prevention subgroup, followed by a public hearing on House Bill 1634, as amended in a proposed second substitute. Work group leaders Lisa Callan and Tisha Kirschbaum described the group’s statewide, cross-agency structure, its Washington Thriving strategic plan, and the goal of moving toward a more integrated “system of care” for children and youth. They emphasized that behavioral health, physical health, and education are interconnected, that families and schools often face a fragmented system, and that Washington’s youth flourishing outcomes show a need for stronger supports. Committee members raised concerns about regional disparities, rural access, language and cultural responsiveness, and the burden on schools and educators, while the presenters stressed that schools should be supported to identify needs and connect students to outside clinical services rather than carry the full burden themselves. Representative My-Linh Thai and Christian Stark then outlined the school-based subgroup’s work and recommendations. They said the subgroup meets monthly, includes students, parents, educators, providers, and agencies, and has focused on prevention, early identification, early intervention, and crisis response in schools. For the 2026 session, the subgroup recommended maintaining current investments in school behavioral health programs, strengthening statewide guidance on school behavioral health, and creating a coordinated technical assistance and training network for schools. They explained that the proposed substitute for HB 1634 would direct OSPI and the educational service districts to work with behavioral health agencies and community partners to conduct a needs assessment, map resources, and build a statewide framework for technical assistance and training, with public posting required by August 1, 2027. Testimony in support came from school staff, OSPI, behavioral health professionals, students, parents, and advocacy groups, who described high student anxiety, suicide risk, staffing shortages, and the need for coordinated, accessible supports. One witness from a psychiatric watchdog group opposed the bill, arguing it could increase labeling and drugging rather than holistic care. No vote was taken in the transcript provided.

Transcript Highlights:

• </c> our fee for service and our managed care our fee for service and our managed care spends.<00:47:
• to the managed care organizations and is actually paid out through a directed payment.
• So, they have state plan services. They're not going totally without, uh, any medical care.
• So, they have state plan services. They're not going totally without, uh, any medical care.
• So, they have state plan services. They're not going totally without, uh, any medical care.

Keywords: 958, all

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

Transcript Highlights:

• except for those that are exempted under existing laws, such as primary care services or substance use
• So the bill, state directed payments, what they are is in states that use Medicaid managed care delivery
• The state can direct payments through the Medicaid managed care organizations to a particular class of
• Services estimated that changes to state directed payments could put $5.5 billion at risk, 1.1 of those
• And we all know what those services are: OB, behavioral health, emergency care.

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

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

Transcript Highlights:

• Direction and Support Services...” “...million in budget authority in the Medical Care Trust Fund within
• trust fund within the Medicaid services to individuals and the long-term care budget entities.
• These programs provide fee-for-service supplemental payments and directed payments for physicians...
• These programs provide fee-for-service supplemental payments and directed payments for physicians and
• Trust Fund and Medical Care Trust Fund within the Medicaid Services to Individuals budget entity, which

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

Transcript Highlights:

• any of the following services: emergency department services, primary care services, obstetrics, prenatal
• any of the following services: emergency department services, primary care services, obstetrics, prenatal
• any of the following services: emergency department services, primary care services, obstetrics, prenatal
• The notice must include the rationale for services, primary care services, services, primary care services
• </c> impact on access to health care services impact on access to health care services in<00:40:01.359

Keywords: 926, house, all

Transcript Highlights:

• The Medicaid program supports services that help people stay at home with personal care services, developmental
• The Medicaid program supports services that help people stay at home with personal care services, developmental
• So when you move claims, when you move services from fee-for-service into managed care, there's no longer
• Primary care case management is a common service in other states.
• So the only state-directed payments once we stand up comprehensive managed care.

Summary: The Joint Finance-Appropriations Committee held a budget hearing on the Division of Medicaid within the Department of Health and Welfare. Legislative Services analyst Alex Williamson reviewed Medicaid’s five budgeted programs, enrollment groups, staffing, historic spending growth, and the distinction between ongoing base adjustments and one-time enhancements. She explained that most Medicaid spending is in trust and benefit payments, discussed the large FY 2026 and FY 2027 budget changes, and walked through the governor’s recommendations, including hospital assessment fund alignment, claims forecast updates, MMIS procurement funding, estate recovery, program integrity support, and population forecast adjustments. Members asked extensive questions about the 4% provider rate reduction, the expansion population, federal match rates, and the effect of House Bill 345 and federal changes on Medicaid costs and eligibility. Williamson and Deputy Director Sasha O’Connell said the expansion population has declined, but costs are driven by utilization, provider rates, pharmacy, hospital, developmental disability, behavioral health, and long-term care services. They said the department is pursuing cost containment through prior authorization, redeterminations, higher cost sharing, and program integrity efforts, while noting that expansion is codified in law and any repeal or major eligibility change would require legislative action and could affect hospital assessment revenue and other offsets. The committee also discussed the MMIS replacement project, with lawmakers emphasizing milestone-based funding and risk control. O’Connell explained the estate recovery request as a replacement case management system plus contractor support to help recover Medicaid costs from estates, and said the program is federally required and revenue-generating. Several members raised concerns about backlogs, contractor costs, and whether AI or other technology could improve efficiency in program integrity and estate recovery. No votes were taken during the hearing; the discussion remained informational and focused on the governor’s budget recommendations and possible future reductions or policy changes.

Transcript Highlights:

• </c><00:22:34.240><c> Care</c><00:22:34.400><c> and</c><00:22:34.640><c> treatment</c> other Direct Care
• </c><00:23:10.080><c> Care</c><00:23:10.279><c> and</c> forensic um and uh other Direct Care and forensic
• </c><00:24:49.080><c> Care</c><00:24:49.240><c> and</c> at a cbhh or any other Direct Care and at a cbhh
• assisted living, home care, or adult day services.
• </c> to attract and retain quality direct to attract and retain quality direct care<01:37:13.679><c>

Committee: House Human Services Finance and Policy

Keywords: 1183, house