Transcript Highlights:

• And sadly, long-term care fits within that same sense.
• It’s called long-term care support and services.
• as you go to long-term care services.
• Of individuals in long-term care, 56% have dementia.
• or needs long-term care, where do they go?

Keywords: 994, senate, all

Summary: The committee met with a quorum present and heard a presentation from Marty Wright, CEO of the West Virginia Healthcare Association, on the state’s long-term care system. He described the continuum from home care to assisted living to skilled nursing facilities, emphasizing that these settings increasingly serve short-term rehab-to-home patients as well as older adults needing round-the-clock care. He also outlined the number of facilities in West Virginia, the predominance of Medicaid as the payer for long-term nursing home care, the private-pay nature of assisted living, and the role of OFAC/CMS in regulation. A major focus of the presentation was workforce shortages and turnover, especially for CNAs, LPNs, and RNs, along with declining interest in nursing careers and the impact of regulatory burden and burnout. Wright said the system is also struggling to serve younger patients with substance use disorder, mental illness, or other behavioral needs, who are often not well suited for traditional nursing home placement but have limited alternatives. Senators raised concerns about where such patients are being housed, the long-term effects of opioid and behavioral health issues, and the gap between school-age special needs populations and adult care needs. Wright said Medicaid can cover long-term nursing home care for those who meet financial and medical eligibility requirements, but affordability and spend-down requirements remain major barriers. He also warned that Medicare Advantage can create confusion and shorter covered stays for rehab patients, and he urged early planning around long-term care insurance and estate planning. No votes were taken on the presentation, and the committee adjourned after questions and discussion.

Transcript Highlights:

• They intensify, especially as people transition into systems of elder care and long-term care facilities
• . ...into systems of elder care and long-term care facilities.
• Aging trans people, especially... ...entering long-term care systems.
• Today, as they age, they are once again entering systems, particularly long-term care, where their risk
• care systems, investing in mandated training, and... ...long-term care systems, investing in mandated

Summary: The Select Committee on Older LGBTQ Californians held an inaugural hearing focused on the health care and support landscape for older LGBTQ Californians, including people aging with HIV and transgender, gender non-conforming, and intersex seniors. Opening remarks emphasized the long history of discrimination faced by older LGBTQ adults, the growth of the aging LGBTQ population, and the need to translate existing state commitments into concrete services. Senators highlighted concerns about nursing home vulnerability, the aging of people living with HIV, and the impact of federal actions and Medicaid cuts on California’s safety net. The first panel featured Justice in Aging, CalHHS, the Department of Aging, and the Aging and HIV Institute. Testimony described widespread inequities, including discrimination, social isolation, economic insecurity, and gaps in culturally competent care. State officials outlined the Master Plan for Aging, the first statewide survey of LGBTQIA older adults, gender-affirming care protections in Medi-Cal, and efforts to improve coordination across departments. Advocates argued the state has been too slow to respond to federal threats and that services are often hard to find or fragmented. Committee members pressed the departments on how survey findings are being turned into action, how rural and underserved communities are being reached, and whether more formal stakeholder coordination or “no wrong door” access systems are needed. The second panel focused on seniors living with HIV. A long-term survivor gave emotional testimony about the “survivorship penalty,” loss of benefits, housing insecurity, and the need for legal and navigation support, housing assistance, and protection from outdated disability standards. The Department of Aging reported on implementation of SB 258, which added HIV status to the definition of greatest social need for area agencies on aging; it said 20 of 33 area plans now identify HIV as a target population and many include specific strategies, such as LGBTQIA mental health connections programs. The Office of AIDS described Project Cornerstone, Ryan White, ADAP, HOPWA, the Medi-Cal waiver, and PrEP-AP, noting these programs serve thousands of older clients and rely on whole-person case management. Case management testimony underscored persistent needs for medication subsidies, transportation, food, and housing. Committee members questioned how ADAP rebate funds might be used, how SB 258 is enforced across local agencies, and how to reduce administrative barriers and auto-connect eligible people to benefits. The final panel began with the Department of Social Services outlining protections for TGI seniors in licensed care facilities, including SB 219’s nondiscrimination requirements and related provider notices and resident rights materials. The hearing remained focused on identifying service gaps, improving coordination across aging, health, and social service systems, and ensuring state programs better reflect the lived experience of older LGBTQ Californians.

Transcript Highlights:

• They intensify, especially as people transition into systems of elder care and long-term care facilities
• care systems.
• Aging trans people, especially... ...entering long-term care systems.
• Today, as they age, they are once again entering systems, particularly long-term care, where their risk
• care systems, investing in mandated training, etc. ...long-term care systems, investing in mandated

Summary: The Select Committee on Older LGBT Californians held an inaugural hearing focused on the health care and support needs of older LGBTQ Californians, including older adults living with HIV and transgender, gender non-conforming, and intersex seniors. Committee members and state officials discussed the California Master Plan for Aging, the first statewide survey of LGBTQIA older adults, and the need to address discrimination, social isolation, housing insecurity, economic instability, and gaps in culturally competent care. Several speakers emphasized that older LGBTQ adults often lack traditional family caregiving supports and may face vulnerability in nursing homes or other institutional settings. Testimony from advocates and people with lived experience highlighted the impact of federal actions, including H.R. 1, on Medi-Cal, housing, and benefits, and called for stronger state action, outreach, and navigation services. Justice in Aging urged more investment in home- and community-based services and warned that Medicaid cuts could increase institutionalization. The Department of Aging described its survey findings and said it had convened a lived-experience advisory board, updated data tools, and incorporated HIV as a factor in local aging plans under SB 258, though members pressed for clearer implementation and accountability. CalHHS described coordination across departments, Medi-Cal coverage of gender-affirming care, PACE, and other services, while the Department of Public Health outlined Ryan White, ADAP, HOPWA, Medi-Cal waiver, and PrEP-AP programs serving older adults with HIV. The hearing also featured extensive testimony from people aging with HIV, who described fragmented systems, benefits cliffs, housing costs, and the need for legal and case-management support. One witness urged funding for HIV-specific housing and navigation services, while another described how case management and safety-net programs help clients manage medication, food, transportation, and housing needs. In the final panel, the Department of Social Services reviewed protections for TGI seniors in licensed care facilities, including SB 219, nondiscrimination notices, resident rights postings, required staff training, and complaint investigations. No formal votes were taken; the chair repeatedly asked departments to follow up on implementation gaps, data visibility, and possible budget or policy responses.

Transcript Highlights:

• They intensify, especially as people transition into systems of elder care and long-term care facilities
• of elder care and long-term care facilities.
• Aging trans people, especially... ...entering long-term care systems.
• Today, as they age, they are once again entering systems, particularly long-term care, where their risk
• care systems, investing in mandated training, and... ...long-term care systems, investing in mandated

Keywords: 987, senate, all

Transcript Highlights:

• Moving on to talking about our safe and affirming long-term care facilities.
• They intensify, especially as people transition into systems of elder care and long-term care facilities
• care systems.
• Today, as they age, they are once again entering systems, particularly long-term care, where their risk
• Long-term care systems, investing in mandated training, expanding access to affirming health care across

Summary: The committee held an inaugural hearing on the health care and support needs of older LGBTQ Californians, with members and witnesses emphasizing that this population has made major gains in rights and longevity but still faces discrimination, isolation, economic insecurity, and gaps in services. Opening remarks highlighted concerns about older LGBTQ people entering nursing homes and feeling forced back into the closet, as well as the growing number of Californians aging with HIV. The hearing was structured into three panels, with public testimony considered if time allowed. The first panel focused on the overall health and support landscape. Justice in Aging described survey findings showing discrimination, poor health, difficulty with errands, and economic insecurity among older LGBTQ Californians, and warned that federal Medicaid cuts and broader federal actions could worsen access to home- and community-based services and culturally competent care. CalHHS and the Department of Aging described the Master Plan for Aging, the first statewide LGBTQIA older adult survey, and efforts to support gender-affirming care, PACE, care management, and community supports. Witnesses stressed the need for better outreach, data collection, and a “no wrong door” approach so people can more easily find and access services. The chair and senators pressed the departments on how survey findings are being translated into concrete action and how state agencies are coordinating across silos. The second panel addressed health care for seniors living with HIV. A longtime survivor described severe financial and benefits consequences from a federal clawback and argued that California needs stronger legal, navigation, and housing supports, including HIV-specific housing funding. The Department of Aging reported on implementation of SB 258, saying it has educated area agencies on aging, added HIV data to planning tools, and found that 20 of 33 area agencies identified HIV as a target population, with 16 including specific strategies. The Office of AIDS outlined Project Cornerstone, Ryan White, ADAP, HOPWA, a Medi-Cal waiver, and PrEP-AP, noting these programs serve thousands of older clients and that local case managers are expected to coordinate whole-person care. Case managers and advocates said housing, food, transportation, mental health, and premium assistance remain major needs, and senators asked whether future ADAP rebate funds could support navigation, housing, and other gap-filling services. The final panel turned to transgender, gender nonconforming, and intersex seniors. The Department of Social Services described protections under SB 219, including nondiscrimination notices, resident rights postings, required records for preferred names and pronouns, and annual inspections of licensed facilities. The Department of Public Health and a TransLatin Coalition leader were introduced to discuss additional supports for TGI seniors. Across the hearing, members repeatedly returned to the themes of visibility, coordination, and implementation, asking departments to follow up on how they will better connect services, improve outreach, and ensure that existing laws and programs are actually reaching the people they are meant to serve.

Transcript Highlights:

• Medicaid Long-Term Care Program.
• network in long-term care.
• Thank you. only long-term care provider service network in long-term care.
• to stay enrolled in the long-term care program.
• From 2014 to 2022, the long-term care program was able to lower the From 2014 to 2022, the long-term

Summary: The committee held a panel discussion focused on how Florida health care organizations are working to improve access, quality, and affordability. Panelists from Florida Community Care/Independent Living Systems, Sunshine Health, AdventHealth, UF Health, and Nemours described their approaches, including Medicaid managed care, value-based contracting, community partnerships, mobile screening units, smart-room technology, telehealth, and specialized programs for maternal health, children, and complex chronic conditions. Several speakers emphasized that managed care and coordinated care can improve outcomes while reducing unnecessary utilization and costs. Members asked about the impact of Medicare’s V28 changes, mobile cancer screening, urgent care versus emergency room billing, pediatric specialty access, complaint resolution, Black maternal mortality, provider shortages, network adequacy, and the use of AI in prior authorization. Witnesses said V28 has affected providers and revenue, UF Health’s mobile screening program is expanding beyond a few cancer types, and its urgent care model bills patients at the appropriate level rather than both urgent care and ER rates. Nemours said it reduced specialty wait times through scheduling changes, telemedicine, and registry tools, while AdventHealth described postpartum coordination and maternal heart programs to reduce maternal complications and mortality. On complaints and access problems, panelists said their organizations use patient/member advocates, care managers, call centers, and escalation processes to resolve issues, and Sunshine Health specifically discussed a transportation complaint that was addressed with its vendor and the family. Sunshine Health also said it is not using AI for prior authorization, though it is exploring responsible uses elsewhere, and Florida Community Care said it is not using AI in utilization management. In closing, panelists identified workforce shortages, provider burnout, and high-cost drugs as the biggest ongoing challenges. The meeting ended with thanks to the panel and adjournment after Representative Brackett moved to rise, without objection.

Transcript Highlights:

• Long-term care has a... ...of the state's Medicaid budget for the biennium.
• Long-term care has a budget of $12.9 billion.
• So clients can access DD and long-term care.
• If they receive developmental disability or long-term care services through the ACA, which personal care
• That was 4,400 folks that are receiving long-term care.

Summary: The Ways and Means Committee held a work session to review how H.R. 1 (the One Big Beautiful Bill Act) could affect Washington’s Medicaid, long-term care, developmental disabilities, and food assistance programs, with a focus on implementation challenges, fiscal impacts, and likely coverage losses. Staff and agency officials explained Washington’s Medicaid financing structure, eligibility categories, caseload trends, and the role of the Health Care Authority and DSHS in administering Apple Health and related services. They also described how Medicaid expansion increased access to behavioral health services and how H.R. 1’s provisions are expected to affect the expansion population most directly. Health Care Authority and DSHS officials outlined several major H.R. 1 changes: new work and community engagement requirements for the Medicaid expansion population, six-month redeterminations instead of annual renewals, changes to immigrant eligibility, limits on provider taxes and state-directed payments, new cost-sharing requirements, reduced retroactive coverage, and changes affecting long-term care eligibility. They said Washington is still awaiting federal guidance on many details, but estimated that about 620,000 Apple Health expansion enrollees could be subject to work requirements, that roughly 30,000 immigrants could lose Medicaid eligibility under the new definition of qualified alien, and that some long-term care and developmental disability clients could be indirectly affected. Officials also said the state is working with other agencies to build shared verification systems and may seek a delay waiver, though they do not expect broad federal flexibility. The committee also heard that H.R. 1 immediately blocks Medicaid reimbursement for Planned Parenthood services for one year, with the state planning to backfill about $11 million to preserve access. In addition, officials warned that the law could reduce federal Medicaid revenue by billions over time and strain hospitals and emergency rooms as more people become uninsured. They noted that Washington’s rural health transformation grant application is due November 5 and could bring some funding, but not to offset coverage losses. No votes were taken; the session was informational only. The committee then heard a separate presentation on food assistance, where staff and DSHS described H.R. 1’s SNAP changes, including expanded work requirements, immigrant eligibility restrictions, higher state administrative costs, and a possible future state share of benefit costs tied to payment error rates. DSHS estimated a four-year fiscal impact of about $750 million for food assistance changes and said the state is working on system and policy changes across agencies before the new requirements take effect.

Transcript Highlights:

• ><c> it</c> our Long-Term Care Services System it our Long-Term Care Services System it certainly<00:
• He said he has long-term care insurance, but his understanding is that long-term care insurance is not
• c> uh</c> I have long-term care insurance and uh I have long-term care insurance and uh my<00:57:38.799
• c><00:57:39.960><c> care</c> my understanding is that long-term care my understanding is that long-term
• could</c><00:58:37.880><c> use</c> long-term care insurance they could use long-term care insurance they

Committee: House Human Services Finance and Policy

Keywords: 1183, house

Transcript Highlights:

• comprehensive long-term care plan since 2018.
• , but also convincing other providers who are currently in the long-term care system that they might
• started as a long-term care plan.
• the previously long-term care providers, ...providers that come into that system, maybe some of the
• And other than that, I really believe that, like in the long-term care system, a managed care approach

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

Transcript Highlights:

• foster care system.
• system do not spend dramatically long periods of time there.
• CWS CARES system later this year going...
• So in terms of the entire level of care system, which serves the vast, vast majority, more than 90%,
• So in terms of the entire level of care system, which serves the vast, vast majority, more than 90% of

Keywords: 988, house, all

Transcript Highlights:

• Child Care, per capita rates and utilization, and long-term care caseload forecasts, among other factors
• Long-term care is a continuum.
• The long-term care system only works when every level is supported, and facilities like ours are a critical
• It shifts costs to emergency systems, hospitals, and long-term care budgets at far greater expense.
• This results in increased long-term health care costs for the state.

Summary: The House Appropriations Committee held a public hearing on proposed substitute House Bill 2289, the House operating budget. Budget staff Mary Monroe gave a detailed overview of the proposal’s near general fund outlook, reserve levels, major revenue assumptions, and major spending and savings items. She highlighted assumed revenue from capital gains and a proposed “millionaires tax,” a transfer from the budget stabilization account, administrative reductions across agencies, and several major policy shifts, including changes affecting Working Connections Child Care, K-12 education, higher education, long-term care, behavioral health, wildfire response, and state employee compensation. Members then asked questions, including about the higher education building account/operating fee swap and its interaction with the capital budget and Climate Commitment Act funds. The committee also announced amendment deadlines for the budget process. The bulk of the meeting was public testimony, with many speakers generally supporting or opposing specific parts of the budget. Supportive testimony praised funding for wildfire prevention, public health, reproductive health, civil legal aid, the Poison Center, some higher education institutions, and certain disability and child welfare services. Many speakers urged restoration or protection of funding for K-12 education, especially transition to kindergarten, local effort assistance, bus depreciation, and Running Start; others opposed cuts to child care, early learning, public defense, long-term care, adult day and home care services, occupational/physical/speech therapy for Medicaid patients, and community and technical colleges. Several local government, health, and nonprofit representatives also asked the committee to preserve public works, homelessness, energy assistance, environmental justice, and recovery/diversion programs, while some business and public safety groups sought continued funding for organized retail crime prevention and related initiatives. No votes were taken during the hearing. The committee recessed briefly and later resumed with virtual testimony, where additional witnesses repeated concerns about education cuts, long-term care, health care access, disability services, dispute resolution, early childhood programs, and the need for ongoing or increased funding in those areas.

Transcript Highlights:

• So they are working on long-term care.
• So would they stop that long-term care work moving into? No, that is ongoing.
• The Department enhancement is unique to long-term care facilities.
• Issue nine is a budget change proposal related to the long-term care payment transparency final rule.
• We primarily serve Medi-Cal dental patients in long-term care facilities, specifically SNFs, and I want

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.

Transcript Highlights:

• What concerns us most is the long-term sustainability of this mandate.
• care system for all Californians, especially those facing the greatest barriers to care.
• We also recognize that it's not addressing the long-term need.
• We also recognize that it's not addressing the long-term need.
• our health care system.

Keywords: 988, house, all

Transcript Highlights:

• This is where our long-term care services live.
• /c><00:09:11.640><c> and</c> long-term care in their homes and long-term care in their homes and communities
• </c><00:15:03.600><c> for</c> long-term care services and supports for long-term care services and supports
• c> and</c> towards long-term care facilities um and towards long-term care facilities um and in<00:42
• c><00:42:53.440><c> is</c> long-term care system and it is long-term care system and it is important<

Committee: Senate Health and Human Services

Keywords: 1187, senate, all

Transcript Highlights:

• So they are working on long-term care.
• So would they stop that long-term care work moving into? No, that is ongoing.
• We anticipate a new phased implementation beginning in 2028. enhancement is unique to long-term care
• Issue nine is a budget change proposal related to the long-term care payment transparency final rule.
• Patients in long-term care facilities, specifically SNFs, and I want to give voice to the segment of

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

Transcript Highlights:

• They are working on long-term care, really carving skilled nursing facilities and sub-acute facilities
• So would they stop that long-term care work moving into...? No, that is ongoing.
• The Department enhancement is unique to long-term care facilities.
• Issue nine is a budget change proposal related to the long-term care payment transparency final rule.
• to give voice to the... patients in long-term care facilities, specifically SNFs, and I want to give

Keywords: 987, senate, all

Transcript Highlights:

• </c> managed care model for the long-term managed care model for the long-term services<00:30:23.440>
• </c><00:32:08.240><c> care</c> care plans managing the long-term care care plans managing the long-term
• c> we're</c><00:41:42.800><c> making</c><00:41:43.040><c> a</c> long-term care and we're making a long-term
• a program that includes long-term care.
• </c><00:52:22.480><c> Um,</c> long-term care. Um, long-term care.

Keywords: 928, house, all

Summary: The committee to study long-term managed care met to approve the prior meeting minutes, with a clarification that “OB3” referred to the “one big beautiful bill.” The minutes were then approved. Chair Jim Kofalt outlined the day’s agenda, which included testimony from the Granite State Home Health and Hospice Association, the New Hampshire Association of Counties, and later DHHS. He also noted that future meetings were expected soon and that the meetings were being livestreamed on YouTube. Granite State Home Health and Hospice Association, represented by Kellyanne Totten and Amy Moore, urged inclusive planning and a cautious, phased approach if managed care is considered. They emphasized that home care providers are not uniform, with different licensing and service models, and said any pilot should include varied provider types, rural and southern regions, and agencies of different sizes. They warned that workforce shortages, inflation, and a possible 9% CMS cut to Medicare home health payments could force agencies to reduce service areas or service types. They also said the 2023 Medicaid CFI rate increase has begun to lose its effect. In response to questions, they said the rural health transformation fund may help with planning and telehealth but likely cannot be used directly for rates or recruitment/retention. They also described the New England Home Care Nurse Residency Program, a Department of Labor grant, as a way to bring new registered nurses into home care with added training and school partnerships. The New Hampshire Association of Counties, through county nursing home administrators Craig Labore and David Ross, revisited the earlier Step Two managed care discussions from 2016-2018. They said prior consultants found the long-term services and supports system was underfunded and needed investment to stabilize providers and expand community-based care. They argued the same concerns remain today and said a managed model would jeopardize the Medicaid quality incentive payment program and, for county nursing homes, the proportionate share payment program. Their testimony was generally opposed to moving forward with managed long-term services and supports without significant additional funding and safeguards.

Transcript Highlights:

• What concerns us most is the long-term sustainability of this mandate.
• and navigate people through systems and connect them to care... ...to improve a lot of our systems and
• care system for all Californians, especially those facing the greatest barriers to care.
• We also recognize that it's not addressing the long-term need.
• our health care system.

Summary: The hearing focused on the expected health coverage losses tied to H.R. 1, the resulting pressure on California’s county indigent care systems, and what data and policy changes the Legislature may need before the next budget cycle. Chair Hart and Assemblymember Addis framed the issue as a major rollback in coverage that could leave more Californians uninsured and push more people into county safety-net programs. Members repeatedly emphasized the need for baseline, county-by-county data on eligibility, benefits, caseloads, and funding before making larger structural decisions. The Legislative Analyst’s Office explained the history of county indigent care under Welfare and Institutions Code 17000, the shift in funding through 1991 realignment, and the later redirection of funds to CalWORKs. LAO said county programs vary widely in scope and eligibility, that current realignment funding does not automatically rise with demand, and that the Legislature faces tradeoffs if it changes the funding structure. Administration witnesses from Finance and DHCS projected large Medi-Cal and Covered California enrollment losses, with DHCS estimating more than 1 million Medi-Cal members could eventually lose coverage under work requirements and redeterminations, and noting that a new federal rule could make exemptions more restrictive. Officials also said there is no single statewide real-time data system for uninsured or indigent care populations, though some hospital and utilization data exists with significant lags. County representatives from Santa Barbara, San Diego, and Tulare described how their indigent care programs are being rebuilt or strained after years of low demand. They warned that many newly uninsured residents will need only basic, emergency-oriented care under county programs, not the preventive and continuous care available through Medi-Cal, and said that without new state support counties may have to divert funds from public health or reduce other services. Several counties asked for bridge funding, technical statutory changes, and flexibility to adjust realignment methodology. The California Health Care Foundation closed by arguing that the problem is statewide and needs a statewide solution rather than a patchwork county response.

Transcript Highlights:

• As a result, people cycle repeatedly through high-cost systems without ever achieving long-term stability
• It would reduce the strain on emergency systems. It would lower our long-term cost.
• For too long, youth aging out of America's foster care system have been left behind, lacking many of
• What is the population of the foster care system?
• When I was younger, I was in the foster care system.

Committee: House Intergovernmental Affairs

Keywords: 1184, house, all

Transcript Highlights:

• who unfortunately her husband has to go into long-term care.
• of long-term care, hospital services, etc.
• of long-term care, hospital services, etc.
• long term for our dental care over time.
• long term for our dental care over time.

Keywords: 988, house, all