Transcript Highlights:

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

Committee: Senate Senate Veterans' Affairs

Transcript Highlights:

• </c> self-direct this service and not self-direct this service and not self-direct<00:40:34.079><c> the
• self-direct any of their services right self-direct any of their services right now<00:56:37.880><c>
• can</c> self-direct their services they can self-direct their services they can self-direct<00:56:59.799
• So, there are changes... if if they self-direct their services if if they self-direct their services
• c> as</c> self-directing those nursing Services as self-directing those nursing Services as well<01:05

Committee: House Human Services Finance and Policy

Keywords: 1183, house

Transcript Highlights:

• CARE Oregon has employed CARE Oregon to be the administrator of their behavioral health benefit.
• So essentially, we paid the CCOs to administer both dental services and this directed payment provider
• They also are responsible for making sure services are provided and access to care is there.
• immediate care centers.
• Older people tend to use more care. Older people tend to need more expensive care.

Keywords: 907, all

Summary: The committee held an informational hearing focused first on Oregon Medicaid coordinated care organization (CCO) finances and rate setting. Oregon Health Authority staff explained how 2025 CCO financial results will inform 2027 capitation rates, including reserve requirements, subcapitation arrangements, and major cost drivers such as behavioral health, pharmacy, rural hospital costs, and dental directed payments. They said the Legislature’s added 2025 funding materially improved CCO margins and that, without it, the program would have been negative overall. Members asked about retained earnings, subcapitation, behavioral health utilization, ABA therapy, and whether outcomes are being evaluated; OHA said rate setting is actuarial and that CCOs, OHA, and other partners all play roles in monitoring efficacy and access. OHA also reviewed House Bill 4039 changes intended to increase transparency and give CCOs earlier access to rate information and reconciliation exhibits. CCO representatives then testified that the system is under significant financial pressure and that behavioral health state-directed payments, benefit changes, and federal uncertainty from H.R. 1 are reducing flexibility. CareOregon said it has lost more than $500 million over the last couple of years and is now making provider terminations and other network changes to align spending with available funding, while emphasizing that CCOs must make hard decisions about which services and providers can be sustained. Eastern Oregon CCO said rural and frontier factors, cost-based hospitals, air ambulance needs, and statewide efficiency adjustments are not fully reflected in rates, and that dental funding is especially strained. Trillium similarly warned that state-directed payments and benefit expansion pressures are constraining the global budget model and that H.R. 1 could worsen acuity and volatility. Members pressed the witnesses on who is responsible for evaluating treatment effectiveness, especially for ABA and psychotherapy, and on how utilization limits and reimbursement changes are being used to control costs. The committee then shifted to an overview of the Affordable Care Act and Oregon’s commercial insurance market. Department of Consumer and Business Services staff explained actuarial value, metal tiers, premium tax credits, medical loss ratio rules, and the main drivers of premium rates: cost trend, utilization trend, and administrative costs. They said mandates have likely added only a limited amount to premiums over the past decade, though the exact effect is difficult to isolate, and they gave examples of how high-cost, low-volume services versus broad, high-utilization services can affect rates differently. Staff also noted that Providence Health Plan and PacificSource Health Plans are withdrawing from the individual market, though consumers should still have at least three insurer options in every county and may have four in many counties. The division said it is in the middle of reviewing proposed 2027 rates and will continue its public rate review process, including hearings and written comment.

Transcript Highlights:

• while limiting their direct provision of child welfare services to no more than 35% of all contracted
• Additionally, if a lead agency exceeds the 40% threshold of direct service provision, the department
• focus on developing, administering, and overseeing the system of care, while direct service providers
• Reporting templates were refined to improve the transparency and documentation of the direct service
• Griffith, earlier you mentioned that on the direct services 35% waiver, that that was a challenge.

Summary: The Human Services Subcommittee held its first meeting of the term and heard introductory remarks from the chair, vice chair, ranking member, and members, who broadly described their interest in child welfare, mental health, aging services, homelessness, and agency accountability. The chair then outlined the subcommittee’s jurisdiction, including child welfare, mental health and substance abuse safety net services, domestic violence, developmental disabilities, elder services, and child support, and introduced the Department of Children and Families (DCF) as the first agency panel for the term. DCF presented an implementation update on HB 7089, a 2024 law aimed at increasing accountability and transparency for community-based care (CBC) lead agencies that deliver most child welfare services under contract. The department said the bill was prompted by forensic examinations that found problems such as noncompetitive procurement, related-party transactions, excessive executive compensation, and weak financial oversight. DCF described new contract requirements and monitoring tools covering board governance and annual training, conflict-of-interest disclosures, financial penalties for noncompliance, fidelity bond requirements, limits on direct service provision by lead agencies, related-party procurement rules, procurement thresholds, real-property approvals, compensation caps, expanded public reporting, and a new Future of Child Protection and Funding Work Group. DCF reported that some lead agencies had completed required board training, others were still on schedule, and two agencies exceeding the direct-service threshold had been referred to the Auditor General. Members asked DCF about the reasons for the bill, the impact on children, the work group’s regional representation, aging-out youth, the Embrace Families transition, board training requirements, and whether enforcement actions had been taken. DCF said the bill was intended to protect funds for children and families and improve oversight, and clarified that the Central Florida lead agency contract was awarded through competitive procurement rather than an absorption. DCF also said the board training was designed to be meaningful but not overly burdensome, with timing left partly to lead agencies as they implement the new requirements. The committee then heard from two CBC leaders, who generally supported the accountability goals of HB 7089 and said their agencies had already addressed most of the new governance and disclosure requirements. They reported that board training had been completed or was being scheduled, but both agencies said the fidelity bond requirement has been difficult or impossible to obtain in the market as written, though they were able to secure the separate performance bond. The CBC witnesses also warned that recruiting providers is increasingly difficult, especially for higher-acuity children and group-home placements, due to limited provider supply, regulatory burden, insurance costs, and rising risk. They said these pressures are contributing to budget deficits in some areas and urged lawmakers to consider the funding model, insurance and indemnification issues, and the risk of overregulation reducing provider participation.

Transcript Highlights:

• I state directed payments are a mechanism and the managed care rule that really governs states ability
• to direct a managed care plan to pay a provider a certain amount.
• The the managed care side for state direct payments. Yeah, that it's not called the upper panel in.
• and other long-term care services.
• You know, so was that was submitted through Fee for service initiative in some to mask care plan.

Transcript Highlights:

• We're also going to look at reproductive health care, long-term care services and supports... ...as well
• services, including abortion care.
• , and long-term care services at a PACE center.
• Primary, acute, and long-term care services at a PACE center.
• , maternal care, and non-specialty mental health services.

Keywords: 988, house, all

Transcript Highlights:

• /personal care homemaker services.
• any home care services.
• post-acute care services in the Commonwealth.
• But our pay does not appropriately reflect the importance of our direct care services.
• substance use treatment, disability services, home health care, and other social services.

Committee: Joint Joint Committee on Health Care Financing

Keywords: 995, all

Summary: The Joint Committee on Health Care Financing held a public hearing focused largely on senior long-term care issues, family caregiving, post-acute care access, and direct care workforce pay. Testimony strongly supported bills to raise the personal needs allowance for nursing home and rest home residents (including H. 1411, S. 482, and related bills), with speakers from Mass Senior Action, Dignity Alliance, nursing home residents, providers, and former state officials arguing that the current $72.80 monthly allowance has been unchanged since 2008 and is inadequate for basic items like clothing, toiletries, haircuts, and transportation. Witnesses also backed bills to increase MassHealth asset and income limits for seniors and to stop counting life insurance as cash, describing the current rules as outdated and harmful to low-income elders. The committee also heard testimony on bills allowing family members, including spouses and guardians, to be paid caregivers (H. 1394/S. 886), with supporters saying this would help families keep loved ones at home and reduce reliance on costly institutional care. Another set of bills (H. 1412/S. 903) drew support from a physician who said clearer MassHealth communication and improved post-acute care determination processes would help reduce delays and backlogs for patients awaiting skilled nursing, rehabilitation, or other post-acute placement. Several speakers emphasized that better home- and community-based care can prevent hospital readmissions and support independence. A major portion of the hearing focused on S. 877, which would establish an enhanced care worker minimum wage of $25 per hour, indexed to inflation, for certain home care and human services workers. Union representatives and direct care workers from SEIU Local 509, 1199 SEIU, and the AFL-CIO described severe staffing shortages, burnout, low wages, and high turnover across home care, mental health, disability services, and crisis response. They argued that higher pay is necessary to recruit and retain workers and to stabilize services for vulnerable residents. Committee members asked about costs, comparisons with other states, and whether non-wage incentives could help, but witnesses repeatedly said wages were the central issue. The hearing concluded after all registered testimony was heard, with the committee noting it would continue accepting written testimony and then adjourning.

Transcript Highlights:

• It's a continuum of care and continuum of service. services that, you know, as noted in Senator Blumenthal's
• The focus of the cuts to date have been of administrative personnel and not direct care providers.
• services as health care would require?
• The commitment is to ensure that direct care is provided and not compromised by these cuts.
• It creates new formalized avenues into clinical care, and it supplements that care with wraparound services

Committee: Senate Senate Veterans' Affairs

Keywords: veterans, mental health, suicide prevention, Staff Sergeant Parker Gordon Fox Grant Program, HOPE Act, BRAVE Act, Every State Counts for Vets Mental Health Act, advocacy, legislation, mental health resources

Summary: The committee meeting focused primarily on the critical issues surrounding veterans' mental health and suicide prevention. Discussions centered on the reauthorization of essential programs aimed at providing non-clinical support services to veterans, particularly the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. Senators emphasized the urgent need for adequate mental health resources as the suicide rate among veterans remains alarmingly high. Key testimonies were provided by various advocates and officials, illustrating both successful implementations of these programs and areas needing improvement.

Transcript Highlights:

• And then the final piece, uh, with all the effective date changes, uh, deals with direct care and treatment
• It's Representative Nors' bill exempting assisted living providers from direct care staff compensation
• <00:03:26.319><c> Care</c><00:03:26.680><c> staff</c><00:03:27.120><c> compensation</c> Direct Care staff
• All of these sections update statutes to account for the new Direct Care and Treatment agency.
• These sections add Direct Care and Treatment and the Direct Care and Treatment executive board, or chief

Keywords: 1183, house

Transcript Highlights:

• So this is to help a small rural health care facility provide senior services.
• </c> Care Facility provide Senior Services Care Facility provide Senior Services Northshore<00:14:42.720
• We also often have the clinic, home care, hospice, EMS, and so many other services.
• </c> service payment rates for inpatient care service payment rates for inpatient care um<01:29:39.239
• Managed Care Services Medicaid Managed Care organizations<01:30:51.400><c> and</c><01:30:51.840><c>

Committee: House Health Finance and Policy

Keywords: 1183, house

Transcript Highlights:

• is expanded, and it allows jails to bill the Department of Direct Care and Treatment for the cost.
• There are significant waiting lists for priority admissions to direct care and treatment.
• The current average wait times to access beds at direct care and treatment for forensic services and
• care services and reviewing all of the state statutes.
• In 2018, we had a direct care workforce shortage of approximately 10,000 people.

Committee: House Human Services Finance and Policy

Transcript Highlights:

• their own attendant and direct their own care with assistance from a financial services agency.
• It concerned client-directed services.
• These services can range from attendant care and habilitation services, residential options, therapies
• We were directed in Senate Bill 7 from the 83rd session to do a pilot for IDD services and managed care
• care staff taking people out in the community or direct care staff specializing more on activities,

Committee: House Human Services

Keywords: 1184, house, all

Transcript Highlights:

• We have a 49-bed hospital, long-term care facility, clinics, and other services.
• be</c> using these Services Home Care would be using these Services Home Care would be right<00:30:12.799
• </c> populations simply need more health care populations simply need more health care services<01:07
• </c><01:09:37.839><c> Care</c> in collaboration with our Direct Care in collaboration with our Direct
• labor</c><01:20:12.840><c> and</c> services like Emergency Care labor and services like Emergency Care

Committee: House Health Finance and Policy

Keywords: 1183, house

Transcript Highlights:

• That's just a direct payment from our Medicaid program to those providers for those services for individuals
• Is, you know, we pay whatever it is, whether it's fee-for-service or managed care, and then we get money
• services at 100% of Medicaid for expansion states, but they grandfathered current-directed payments
• A direct service example. Is again like physical therapy.
• That's about $33.5 million on administrative costs and $62.5 million in direct services.

Committee: House Federal Funding Stabilization Subcommittee

Transcript Highlights:

• He gets self-directed services. I work three jobs. My husband's disabled.
• For the past two years, her care has been provided through Missouri's self-directed services program.
• fragile individual through Missouri's self-directed services program.
• What care will these people have if they lose their self-directed care staff?
• Weakening self-directed services completely undermines that progress.

Committee: House Budget

Keywords: 959, house, all

Transcript Highlights:

• Direction and Support Services budget entity would grant the authority to distribute funds associated
• Trust Fund within the Medicaid services to individuals and the long-term care budget entities would
• 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
• This program provides fee-for-service supplemental payments and directed payments for physicians and

Keywords: 999, senate, all

Transcript Highlights:

• Direction and Support Services budget entity would grant the authority to distribute funds associated
• such as ambulance services, advanced life support, and specialty care transport provided by fire rescue
• 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

Summary: The Legislative Budget Commission met to consider 21 budget amendments, beginning with the Department of Education’s request for $14.751 million in federal grant authority for the Preschool Development Grant. Members asked whether any funds would support VPK or provider payments; the department said the money is for birth-to-kindergarten early learning work, including IT modernization, workforce credentialing, training, and streamlining director certification. The amendment was adopted without objection. The commission then approved amendments for the Department of Veterans Affairs to shift $2.2 million within its trust fund to cover higher nursing home occupancy and reduce staffing agency use, and for the Department of Health to realign about $9.1 million for disability determinations amid a backlog of roughly 140,000 cases. The Agency for Health Care Administration presented multiple Medicaid-related amendments, 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 KidCare, hospitals, physicians, cancer hospitals, nursing IME, and public hospital payments. Members questioned network adequacy, rural access, and the KidCare surplus and expansion; the KidCare realignment drew debate, with some members objecting because the 2023 eligibility expansion has not been implemented, but the amendment passed on a roll call vote. Other amendments adopted included FDLE’s $16.3 million for counter-UAS detection and mitigation equipment, DJJ’s $1.6 million for Florida Scholars Academy and a Social Services Block Grant realignment, and emergency management pass-throughs for FIFA World Cup security and counter-drone funding to the Miami host committee. The Department of Commerce received $148.4 million for disaster recovery under the CDBG-DR program, with questions about the split between housing, infrastructure, and administrative costs. The Department of State also received $408,377 for arts and culture grant authority. Most amendments were adopted without objection, and the commission adjourned after completing the agenda.

Transcript Highlights:

• services within the 3% state-directed cap.
• services within the 3% state-directed cap.
• And direct services alone does not fill this gap because many people can't benefit from services that
• And direct services alone does not fill this gap because many people can't benefit from services that
• services, foster care, and adoptions.

Keywords: 987, senate, all

Transcript Highlights:

• Community-based services save taxpayer dollars. Cutting the... Care.
• For the past two years, her care has been provided through Missouri's self-directed services program.
• if they lose their self-directed care staff?
• And, of course, we have gone over the Our self-directed care staff.
• Weakening self-directed services completely undermines that progress.

Committee: House Budget

Summary: The committee first heard the State Auditor’s fiscal year 2027 budget request. Auditor Scott Fitzpatrick described rebuilding the office after staffing had fallen to a historic low, explaining that the office has grown from 92.5 to 119 FTE but still needs several years to reach full staffing, especially at the manager level. He said most of the budget is payroll, noted the office’s use of lapsing general revenue while staffing is rebuilt, and outlined requests including core operating funds, a small sports betting audit NDI, and a $290,000 increase to the CPA stipend to address recruitment and retention problems. Members also discussed the auditor’s authority to audit state agencies and subrecipients, the office’s role in performance audits, and the meaning of “E” appropriations and the auditor’s recent general revenue conditions report. The committee then moved to public testimony on House Bill 10, focusing on Department of Health and Senior Services and Department of Mental Health issues. One witness from the American Heart Association supported continued funding for cardiac emergency response planning in schools, citing AEDs, CPR training, and about 480 schools served. Another witness from the Alzheimer’s Association urged rejection of a proposed $1 million reduction to the Missouri caregiver program, arguing it supports families caring for people with dementia and helps avoid more expensive institutional care. Most of the testimony concerned proposed cuts to developmental disability services, especially day habilitation and self-directed supports (SDS). Providers, family members, and workers said the proposed reductions would force service cuts, reduce wages, and threaten community-based care that keeps people at home and out of more costly facilities. They argued the cuts would shift costs to emergency, residential, or institutional settings and asked the committee to preserve current funding levels. Several members asked questions about provider rates, the share of services delivered by private providers, and the cost difference between SDS and institutional care. The hearing ended with the chair apologizing for earlier tension, explaining the schedule, and recessing the committee to return later because of House floor obligations.

Transcript Highlights:

• All right, we have mostly Department of Health Care Services.
• All right, we have mostly Department of Health Care Services.
• For services and supports for primary care, $50 million.
• services that moved into managed care under CalAIM.
• And for private hospitals, we are proposing to increase managed care directed payments and fee-for-service

Summary: The subcommittee heard a lengthy Department of Health Care Services presentation on the governor’s Medi-Cal budget, including a $229.1 billion total-funds proposal, projected Medi-Cal enrollment declines as redeterminations continue, and several major cost drivers such as managed care growth, Medicare-related costs, pharmacy spending, and changes tied to federal policy. Members focused heavily on the elimination of Prop. 56 dental supplemental payments beginning July 1, 2026, questioning the likely impact on provider participation and utilization. DHCS said it is completing the required rate reduction/access analysis for CMS, has been holding stakeholder meetings and issuing provider bulletins, but could not yet quantify the real-world effect. The committee also discussed a $50 million savings proposal tied to new hospice utilization management authority and asked about possible effects on emergency dental care and provider participation. The hearing then moved through the November 2025 family health estimate and several county and program administration issues, including CCS, GHPP, and Every Woman Counts. DHCS said family health costs are rising despite slight caseload declines because of higher utilization and medical costs, and members raised concerns about CCS website accessibility, county administrative funding, and the transition of youth aging out of CCS. The department said most CCS beneficiaries are also on Medi-Cal, that counties have long raised funding concerns, and that it had clarified use of maintenance-and-operations dollars to address some county workload issues. Members also asked about Every Woman Counts potentially seeing higher demand as Medi-Cal changes take effect; DHCS said that is possible and that the program has multiple funding sources including General Fund. A major portion of the hearing focused on provider taxes and federal changes under H.R. 1, especially the Medi-Cal managed care organization tax and the hospital quality assurance fee. DHCS explained that H.R. 1 restricts new or increased health care-related taxes, phases down allowable tax levels over time, and tightens “generally redistributive” rules, which could sharply reduce the state’s ability to use the MCO tax for Medi-Cal financing. Members asked whether the Legislature could amend Prop. 35 or whether voters would need to act; DHCS said a three-fourths legislative amendment may be possible if it aligns with the measure’s purpose, but the department is still evaluating options. The committee also discussed hospital financing, with DHCS describing recent increases in state-directed payments and the effect of H.R. 1 in capping those payments at Medicare levels, and the LAO noting the tradeoff between preserving provider taxes and maintaining Medi-Cal funding. The subcommittee also reviewed a series of DHCS budget change proposals and trailer bill items, including managed care final-rule implementation, managed care operations, a hospital value strategy, a one-year extension of skilled nursing facility financing, long-term care payment transparency, and interoperability/prior authorization requirements. Members repeatedly questioned the use of limited-term versus permanent positions, the overlap among proposals, and the timing of new financing reforms. DHCS said the SNF extension would preserve current workforce standards, sanctions, growth limits, and the SNF quality assurance fee while the department develops a broader 2027-28 redesign. No votes were taken; items were repeatedly held open for later action. Covered California then presented on the expiration of the federal enhanced premium tax credit and the resulting affordability crisis. The agency said Californians will lose about $2.5 billion in premium assistance for 2026, average premiums could nearly double for many enrollees, and as many as 400,000 people could eventually leave marketplace coverage. Open enrollment ended with 1.9 million sign-ups, down 3% from the prior year, with especially steep declines among middle-income consumers and increased movement into bronze plans. Covered California said the state’s $190 million affordability subsidy is helping lower-income enrollees retain coverage, but cannot fully replace the lost federal assistance. Members also asked about the Health Care Affordability Reserve Fund, repayment of loans from that fund, the status of federal review of California’s essential health benefits benchmark, and implementation of the new gender-affirming care benefit under AB 144.