Transcript Highlights:

• For more than a decade, I've been serving rural Arizonans as a physician, as an ER doc, as an EMS medical

Bills: HB2014, HB2156, HB2180, HB2554, HCR2047, HR2002

Keywords: air emissions, fuel blends, environmental quality, feasibility study, Arizona Department of Agriculture, livestock, compensation, funding, ranching, agriculture, appropriation, University of Arizona, education, state budget, biennial budget, state funding, appropriations, budget procedures, fiscal years, Judea

Summary: The committee first took up HCR 2047 and the identical HCR 2002, both sponsored by the chair. The resolutions recognize the historical, biblical, and legal legitimacy of Judea and Samaria, encourage those terms in official state communications, and reject the term West Bank as a modern political construct. Staff and several proponents, including representatives of an Israel-Arizona business coalition, a rabbi, and a StandWithUs representative, argued the language is historically accurate and important for truth, legal clarity, and Arizona’s relationship with Israel. No one testified against either measure. HCR 2047 passed 10-6 with 2 not voting, and HCR 2002 passed 11-6 with 1 not voting, both with due pass recommendations. The committee then considered HB 2554, which would move Arizona to a biennial state budget process and biennial capital planning. The sponsor argued the change would make government smaller, more disciplined, and less prone to long budget fights and spending growth. JLBC staff provided historical context, explaining Arizona’s past use of annual, bifurcated, and biennial budgeting and noting that second-year budgets are often adjusted for revenue and caseload changes. Members raised concerns about legislative leverage, executive flexibility, and whether the state already effectively budgets on a multi-year basis. Testimony was mixed: one supporter said the change could improve budget clarity, while others voted present or no, citing uncertainty and the need for more study. HB 2554 received a due pass recommendation on a 9-7 vote with 2 present. Next, HB 2014 was amended and passed. The bill directs ADEQ and the Department of Agriculture to study gasoline blend emissions and feasibility for seasonal fuel use in certain areas, with appropriations for the studies. The sponsor said Arizona’s fuel supply is vulnerable because of federal EPA rules and reliance on out-of-state refineries, especially California. Some members supported the study as a way to address possible fuel shortages, while others said prior stakeholder work had shown little could be done and questioned the cost. After adopting the Livingston amendment, the committee gave HB 2014 a due pass recommendation on a 12-2 vote with 4 present. The committee also advanced HB 2180, which funds the University of Arizona’s AZ Reach program, after adopting an amendment reducing the appropriation from $2.5 million to $500,000. The sponsor and a rural physician testified that AZ Reach helps small hospitals coordinate patient transfers, freeing clinicians to focus on care and improving access for rural communities. A program director explained that AZ Reach handles the administrative logistics of transfers for sending hospitals. Some members supported the program but noted concerns about the amount and ongoing budget negotiations, while others said the receiving hospitals needed to be part of the discussion. The bill passed with a due pass recommendation. Finally, HB 2156, as amended, appropriates $250,000 for the livestock compensation fund to help ranchers with wolf depredation losses and conflict-avoidance measures. A Game and Fish representative said the current federal grant funding is insufficient and unstable, while members debated the use of general funds and the program’s priorities. The bill received a due pass recommendation on a 10-7 vote with 1 not voting.

Transcript Highlights:

• Maintenance and repairs with a cost of $5,000 or more are funded through the DOC and taken from the per

Transcript Highlights:

• after year after year about how we don't have enough providers in Kentucky, about how we're losing docs

Keywords: 26RS SB 38 Testimony 00:28 26RS SB 38 Roll Call Vote 06:54 26RS SCR 9 Testimony 11:06 26RS SCR 9 Roll Call Vote 32:00 Adjournment 32:49, 958, all

Summary: The committee first considered Senate Bill 38, sponsored by Sen. Richardson, which would require Medicaid to reimburse pharmacists for services already within their legal scope of practice. Richardson and Taylor Williams of the Kentucky Pharmacists Association argued the bill would improve access to care, especially in rural areas, reduce emergency room use, and lower Medicaid costs by using pharmacists as lower-cost providers. Members asked whether the bill’s language simply aligned Medicaid with an earlier commercial parity law, and Richardson confirmed that it did. He also cited prior study work, research articles, and examples such as strep/flu testing and medication therapy management as covered services. The bill passed unanimously, and several members commented in support, including concerns about pharmacy access and the need for pharmacists to remain available to patients. The committee then took up a concurrent resolution sponsored by Sen. Meredith calling for a feasibility study of a proposed new Medicaid delivery model. Meredith argued that Kentucky’s Medicaid spending is growing unsustainably and that current managed care arrangements are not improving outcomes enough. He proposed an accountable community health care organization, described as a locally owned, not-for-profit public-private partnership combining elements of accountable care models, with the goal of reducing bureaucracy, improving outcomes, and lowering costs. He said the study would examine a five-year program and ultimately test the model in five regions, with initial focus on the Lincoln Trail, Green River, and Barren River area development districts. Members asked about the study timeline, vendor costs, rural versus urban impacts, and provider recruitment; Meredith said the resolution would be studied by November and that no fiscal note had been prepared. The resolution passed unanimously.

Transcript Highlights:

• Just two quick questions: How many docs or people are going to be impacted by this?

Keywords: 996, all

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• I know that my mom was an Indian Health Service nurse in Crown Point, and they had a lot of docs who

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• friend, a veteran, who was given a bunch of narcotics when he discharged from the Air Force, the VA docs

Bills: SB5, SB11, SB12, SB9, SB42, SB15, SB5, SB11, SB12, SCR1

Keywords: hemp regulation, consumable products, cannabinoids, occupational licenses, criminal offenses, SB 11, Texas attorney general, election crimes, election law enforcement, criminal prosecution, Election Code, Government Code Chapter 402, local prosecutors, county attorney, district attorney, grand jury, probable cause reports, state election offenses, voter fraud, election integrity

Transcript Highlights:

• But every penny that we spend on overhead that's not being audited, and you know as much as I do, Doc

Transcript Highlights:

• Doc Roberts, Chula Vista Firefighters Local 2180, in strong support.

Summary: The committee heard several bills focused on public employment, retirement, and recognition of cultural and public service issues. AB 569 would allow local governments and unions to negotiate supplemental pension contributions for certain employees; AB 989 would make California Native American Day an official paid state holiday; AB 268 would recognize Diwali as an official state holiday; AJR 3 would urge protection of Social Security, Medicare, and Medi-Cal from federal cuts; AB 1067 would require misconduct investigations to continue even if an employee retires during the process; AB 1510 made technical and conforming changes to state employee pay and benefits laws and to Santa Clara Valley Transportation Authority labor law; and AB 1233 would create a statewide database of classified school employee employment history and serious misconduct records. The committee also took up AB 1383, which would lower the retirement age for certain first responders and restore some bargaining rights over retirement benefits, drawing extensive testimony for and against. Supporters of the holiday bills emphasized long-overdue recognition of Native American and South Asian communities and the importance of honoring California’s diversity. Supporters of AJR 3 described the reliance of seniors, people with disabilities, and families on federal and state health and retirement programs, warning that cuts would cause serious harm. AB 1067 was presented as a way to prevent employees from retiring to avoid accountability, while AB 1233 was framed as a student-safety measure to help schools identify applicants with prior egregious misconduct. Opposition to AB 1233 focused on due process and the breadth of the misconduct records, and opposition to AB 1383 argued it would reverse PEPRA reforms, raise pension costs, and strain local budgets, while supporters said firefighters and other first responders face unique health and safety risks and deserve earlier retirement. Most bills were reported out of committee on unanimous or near-unanimous votes and placed on hold for add-ons or referral to Appropriations or another committee. AB 912 was taken up on the consent calendar and held; AB 569, AB 989, AB 268, AJR 3, AB 1067, and AB 1510 all advanced with do-pass recommendations and were placed on hold. AB 1233 was moved to the Committee on Education. AB 1383 drew the most extensive debate, with many witnesses in support and opposition, and committee members largely expressing support for first responders while also noting concerns about cost and pension policy.

Transcript Highlights:

• It clarifies that a person on supervision with DOC or the Department of Juvenile Justice must report

Summary: The Committee on Fiscal Policy met and considered a wide range of bills, including early learning and special needs funding (SB 1102), Israel bond investment authority (SB 1674), Parkinson’s disease research at USF (SB 1800), mental health and substance use disorder reforms (SB 1620), veterans nursing home beds (SB 788), securities regulation updates (SB 988), labor pool regulation (SB 1672), Alzheimer’s awareness (SB 398), educator preparation (SB 1590), student mental health reporting (SB 1310), specialty license plates (SB 824), financial institutions and IOTA-related issues (SB 1612), transportation facility designations (SB 1408), utility worker protections (SB 1386), DNA testing grants (SB 1072), the Council on the Social Status of Black Men and Boys (SB 364), housing support for former foster youth and homeless students (SB 584), sex offender registration changes (SB 1654), migrant vessel disposal (SB 830), commuter rail indemnification (SB 916), juvenile justice revisions (SB 1344), aggravating factors in capital cases (SB 984), and a criminal offender substance abuse pilot program (SB 1140). Most bills were explained by sponsors, often with supportive testimony from affected agencies, advocacy groups, or industry representatives, and several were amended before final action. The committee adopted amendments on many measures, including clarifications and effective-date changes for SB 1102; technical changes to SB 1620 implementing mental health commission recommendations; a delete-all amendment for SB 1620; an amendment to SB 988; a consumer-disclosure amendment on SB 1612; and multiple amendments to SB 1408, SB 364, SB 584, SB 1654, and SB 1344. SB 1672 on the Labor Pool Act drew extensive public testimony in opposition from worker advocates, who argued repeal would weaken protections for temp workers and formerly incarcerated workers, and the bill was temporarily postponed to a later meeting without a vote. Several bills received notable testimony in support, including SB 584, where former foster youth described housing instability and the importance of campus housing and federal voucher coordination; SB 1386, which was backed by utility and industry groups seeking stronger penalties for assaults on utility workers; and SB 984, which drew opposition from the Florida Conference of Catholic Bishops over expansion of death penalty aggravators. The committee also heard support and opposition on SB 1612 regarding IOTA interest rates and legal aid funding, with bankers and civil legal aid representatives disputing the proper rate structure and whether the bill conflicted with Florida Bar rules. At the end of the meeting, the committee reported all voted-on bills favorably, including SB 1102, SB 1674, SB 1800, SB 1620, SB 788, SB 988, SB 398, SB 1590, SB 1310, SB 824, SB 1612, SB 1408, SB 1386, SB 1072, SB 364, SB 584, SB 1654, SB 830, SB 916, SB 1344, SB 984, and SB 1140. Members also requested to be recorded on various bills, and the committee adjourned after noting one remaining meeting would be lengthy.

Transcript Highlights:

• down in San Antonio and say I'd like to come back and train, they would just laugh at me and say, "Doc

Bills: SB1406, SB1681, SB2480, SB2721

Keywords: body donation, medical science, forensic science, willed body program, informed consent, boarding home, boarding home facility, adult care home, group home, assisted living, county reporting, municipal reporting, annual report, reasonable accommodation, fair housing, disability accommodation, local ordinance, permit requirement, Texas Health and Human Services Commission, HHSC

Transcript Highlights:

• Do you do work up there, Doc? You don't do your orthopedics? Okay. Thank you. I have 1087 also.

Bills: SB913, SB1086, SB1087, SB1143, SB1534, SB1553, SB1718, SB1754, SB2004, SB2322, SB2448

Keywords: hotel occupancy tax, municipal revenue, tax code, local government funding, Texas legislation, county taxation, economic development, hotel industry, local government, counties, taxation, tourism, workforce development, youth programs, employment, education, technical training, health physics, higher education, nuclear energy

Summary: The Senate Economic Development Committee met to hear a series of bills and informational primers, with several resource witnesses from the Governor’s Office, the Texas Workforce Commission, and the Texas Higher Education Coordinating Board. The chair opened by noting the death of Senator King’s son and asking members to keep the family in their prayers. Most bills were laid out and left pending subject to the call of the chair after brief author presentations and public testimony. The committee heard several local hotel occupancy tax bills: SB 1553 for Kerr County, SB 1086 for Childress County, SB 1087 for Mason County, and SB 913 for Alpine. Supporters, including the Texas Hotel and Lodging Association and local officials, said the measures would allow counties or the city to use hotel tax revenue for tourism-related projects and local development. The committee also heard SB 1534, which would direct a study on health physics education and workforce needs in Texas; resource witnesses from TWC and THECB testified on the bill. All of these measures were left pending. A major portion of the hearing focused on SB 1754, which would prohibit local tax abatements for renewable energy facilities selling power at wholesale, with an exception for certain battery storage tied to dispatchable generation. The bill drew strong support from witnesses who argued counties should not subsidize wind and solar projects that can harm neighboring landowners and that renewables already receive substantial federal support. Opponents from the solar and storage industry argued the bill would remove a voluntary local economic development tool, raise power prices, and discourage investment. Senators also debated landowner impacts, grid reliability, and whether the bill was the right policy tool; the bill was left pending. The committee also heard SB 2322, a committee substitute related to the Jobs, Energy, Technology, and Innovation Act, which would exempt electric generation facilities from the program’s compelling-factor test so they can qualify for school tax limitation agreements. Supporters said the change would correct an unintended barrier for dispatchable generation, while Senator Johnson argued it would weaken the program’s purpose by subsidizing projects that would locate in Texas anyway. SB 1718 would add the NRA annual meeting to the major events reimbursement program; the NRA supported it, while gun violence prevention advocates opposed using state incentives for the organization. SB 2004 would add the Arlington Grand Prix to the major events program, and SB 2448 would create a rural workforce development grant program; both drew supportive testimony and were left pending. The committee also heard SB 1143, a substitute bill aimed at improving transparency and coordination in programs serving opportunity youth ages 14 to 24, with witnesses supporting better reporting and workforce alignment. At the end of the meeting, Senator Johnson moved that the committee stand in recess subject to the call of the chair.

Transcript Highlights:

• I, as a family doc, see them from day one till the day that they take their last...” “...breath, and

Summary: The Assembly Public Safety Committee met to consider several bills, with six measures approved on consent, including bills on background checks, female offender prison facilities, a juvenile justice hunger survey, protective orders and firearms, a youth offender camp pilot, and peace officer behavioral health training. AB 710 and AB 848 were pulled by the authors. The committee also took up AB 458, AB 394, AB 1094, AB 1092, and AB 1036, with extensive testimony on each. AB 458, by Assembly Member Stephanie, would require state agencies purchasing firearms, ammunition, or accessories to vet vendors for compliance with firearms laws and procurement standards. Supporters, including Brady and the California Police Chiefs Association, said taxpayer funds should not go to dealers with serious violations; opponents argued the bill added burdens and vague standards. The committee approved the bill as amended and sent it to Appropriations. AB 394, by Assembly Member Wilson, would expand protections for transit workers and riders by broadening enhanced battery penalties, clarifying who may seek temporary restraining orders in the transit context, and making those orders system-wide. Transit agencies, labor groups, and law enforcement supported the bill, while public defender and civil liberties groups raised concerns about vagueness, duration, and impacts on access to transit. The committee passed AB 394 to Judiciary as amended. AB 1094, by Assembly Member Baines, would raise the minimum parole eligibility term for child torture convictions involving a child under 14 in the perpetrator’s care or custody from seven years to 20 years. Prosecutors, sheriffs, and police groups supported the bill, citing the severity of the abuse and the need to protect child victims; opponents argued the parole system already screens for risk and that harsher sentences do not improve public safety. The committee approved the bill as amended to Appropriations. AB 1092, by Assembly Member Castillo, would extend concealed carry weapon license renewals from two years to four years; supporters said it would reduce costs and administrative burdens, while the chair and others opposed it as unnecessary. The committee ultimately voted the bill down. AB 1036, by Assembly Member Schultz, would expand post-conviction discovery access for people convicted of felonies with sentences of one year or more, including Brady materials and jury selection notes. Innocence organizations and defense groups supported it, while district attorneys opposed the broader discovery obligations; the committee passed it to Appropriations as amended.

Transcript Highlights:

• Thank you for your testimony, Doc.

Summary: The Commerce Committee held its first meeting, took roll, established a quorum, and heard opening remarks from the chair, vice chair, and ranking member emphasizing the committee’s broad scope and focus on Florida’s economy and daily-life issues. The committee then considered several bills, with members and staff noting the agenda included four bills and a PCS. The first measures dealt with insurance and consumer regulation. CS/HB 367 on home and service warranty associations was explained as allowing financial requirements to be met through one or more contractual liability policies and reducing certain filing requirements; an amendment adding requirements for liability insurance coverage was adopted, and the bill passed favorably. HB 655 on pet insurance and wellness programs created a regulatory framework for pet insurance and also passed favorably. HB 6015, which deleted the word “reusable” from the wine keg statute, had brief support testimony and passed favorably. The committee spent the most time on CS/HB 105, a strike-all PCS on thoroughbred permit holders and decoupling racing from gaming. The sponsor said the revised bill would decouple racing and gaming while adding protections for the thoroughbred industry, including a notice period before racing could stop, permit transferability, and changes to how breeders’ and owners’ funds are administered. Supporters argued the bill would preserve and strengthen the industry through clearer rules and more direct support, while opponents—horsemen, breeders, trainers, veterinarians, and related businesses—warned it would harm a major rural industry, threaten jobs, and favor casino interests. After extensive debate, the strike-all was adopted and the bill was reported favorably on a divided vote. Finally, HB 11 on municipal water and sewer utility rates was presented as correcting an unintended consequence in surcharge law for utilities owned by one municipality but located in another. Testimony focused on the fairness of the current surcharge structure and the impact on Miami Gardens and North Miami Beach. After debate about negotiation, parity, and local impacts, the bill passed favorably. The committee then adjourned after its first meeting.

Transcript Highlights:

• And this one, docs and nurses, you put me in a quandary today. And thank you for bringing this.

Summary: The Health Professions and Programs Subcommittee heard and advanced several health care bills. HB 909, joining the Occupational Therapy Licensure Compact, was presented with a strike-all amendment and reported favorably as amended by a 13-0 vote. HB 911, the related public records exemption protecting certain biological information, was also adopted and reported favorably as amended by a 14-0 vote. CS for HB 597, allowing schools to procure and administer glucagon for students with diabetes under trained personnel, passed unanimously 14-0 after a technical amendment. HB 519, aligning state law with federal language on controlled substances administered by paramedics, passed as amended 14-0. The committee then took up HB 919 on nursing education programs. Sponsor Rep. Overdorf argued the bill would create accountability for underperforming nursing schools by requiring remediation, tuition refunds in the lowest-performing programs, and public reporting of passage rates. Supporters said it would improve quality and protect students from debt without licensure success, while opponents from private nursing schools warned it could close programs and reduce nurse supply. After extensive debate, the bill was reported favorably 15-0. HB 1553, which would require health care providers to submit identified uterine fibroid data so the Department of Health can implement the research database previously authorized by law, passed unanimously 15-0. The final bill, HB 883, would allow psychiatric mental health nurse practitioners to practice autonomously; supporters said it would expand access to mental health care, especially in rural and underserved areas, while opponents raised concerns about quality and physician oversight. After lengthy testimony and debate, the bill was reported favorably 14-3.

Transcript Highlights:

• I talked to a doc... from the Manchester VA yesterday morning, and you know what she had to do in the

Bills: SB124, SB201, SB275, SB410, SB478, SB607, SB610, SB611, SB654, SB702, SB787, SB831, SB892

Keywords: Department of Veterans Affairs, disciplinary procedures, accountability, personnel actions, whistleblower protection, cancer, military, aircrew, veterans, health study, toxins, morbidity, mortality, service members, mental health, community care, accessibility, treatment programs, substance abuse, appointments

Summary: During the meeting, various members engaged in extensive discussions surrounding 15 proposed bills related to veterans' affairs. Notably, concerns regarding recent VA workforce changes sparked debates, particularly about potential cuts and their implications for veterans' care and benefits. Chairman Moran emphasized the need for thoughtful reforms and coordination with stakeholders, urging responsible measures to prevent negatively impacting service delivery. The meeting highlighted a significant bipartisan effort to enhance veterans' access to essential health services, particularly in light of recent challenges faced by the VA workforce. Senator Blumenthal's assertions about the urgent plight of veterans due to cuts in personnel drew strong reactions, showcasing the deep concern among committee members regarding the current state of veteran services.

Transcript Highlights:

• A doc can't have a financial interest in the company and try to steer you to their products.

Bills: SB502, SB513, SB622, SB670, SB731, SB732, SB916, SB961, SB1122

Keywords: SB 502, Texas peace officers, Health and Human Services Commission, HHSC Office of Inspector General, OIG investigators, law enforcement classification, Schedule C, state employee benefits, injury benefits, peace officer status, commissioned officers, state auditor classification, Government Code, Code of Criminal Procedure, human services, health and human services, law enforcement compensation, public employee benefits, Texas state law enforcement, child welfare

Transcript Highlights:

• artificial intelligence-driven algorithm that looks at the medical record and comes back and says, you know, Doc

Bills: SB 6, SB6, SB504, SB765, SB815, SB929

Keywords: hemp, consumable hemp, hemp-derived cannabinoids, CBD, cannabidiol, CBG, cannabigerol, delta-8, delta-9, intoxicating hemp, hemp gummies, hemp vape, edibles, cannabinoid regulation, hemp licensing, retailer registration, product registration, QR code labeling, child-resistant packaging, minor access

Transcript Highlights:

• doesn't sound too bad to wait, but a rolling basis for those kinds of reviews, to be able to get the docs

Summary: The Health Care Budget Subcommittee held a panel discussion on Florida’s cancer research and funding programs, including the Casey DeSantis Cancer Research Program, the Florida Cancer Innovation Fund, the James and Esther King Biomedical Research Program, the Bankhead-Coley Research Program, and Live Like Bella. Dr. Ladapo and leaders from Moffitt, Sylvester/University of Miami, UF Health, and Mayo Clinic described how state funding has helped Florida’s four NCI-designated cancer centers expand research, recruit faculty, increase clinical trials, and build collaborations. They emphasized that the programs are intended to improve cancer care statewide, support innovation, and encourage more institutions to pursue NCI designation. The Governor’s budget recommendation was noted as including additional funding, and members asked about the cost and requirements of becoming NCI-designated and eventually comprehensive. Panelists said NCI designation requires major infrastructure, compliance, research, and training investments, with de novo development estimated at about $1 billion. They described Florida’s collaborative model as unusual nationally, with annual symposia, shared pilot funding, and joint projects across the four centers. Members also asked about rural access, home-based care, and recruitment/retention. Mayo described its “Cancer Care Beyond Walls” home-treatment model and said it could expand to rural counties within months; Moffitt and UF discussed mobile screening, satellite sites, and affiliations with local hospitals and practices. Several members raised concerns about workforce shortages, licensure delays, and the need to reach underserved areas. The discussion also covered outcomes, data reporting, and the broader economic impact of the cancer centers. Panelists cited growth in jobs, federal research funding, and clinical trial enrollment, and highlighted advances in immunotherapy, CAR-T, TIL therapy, carbon ion therapy, AI-driven screening, and the firefighter cancer initiative. They said the Florida Cancer Data System is being expanded to track recurrence and quality-of-life measures. Members also asked about philanthropy, medical tourism, and federal funding risks, including possible indirect cost reductions that could affect research budgets. The meeting ended with general support for continued investment, while some members noted an ongoing policy debate over whether future cancer research dollars should be concentrated in the four NCI centers or spread more broadly across the state.

Transcript Highlights:

• that we can address or should address with consultation, I’ve had numerous conversations with U of M docs
• that we can address or should address with consultation, I’ve had numerous conversations with U of M docs
• I’ve had numerous conversations with U of M docs on this and they don’t love this bill, by the way.

Bills: HF4493, HF3133, HF4595, HF4143, HF4142, HF3756, HF4289, HF1724, HF2291, HF4568, HF4547

Keywords: opioid use disorder, OUD, medication-assisted treatment, MAT, pharmacist prescribing, pharmacy practice, controlled substances, Schedule III, Schedule IV, Schedule V, DEA registration, Board of Pharmacy, substance use disorder, addiction treatment, buprenorphine, naltrexone, harm reduction, prescription authority, pharmacist intern, Minnesota pharmacy law

Transcript Highlights:

• effects of that. uh very much<01:26:49.280> with<01:26:49.600> what<01:26:49.920> doc
• <01:26:50.239> what<01:26:50.800> Secretary<01:26:51.360> Stack much with what doc
• what Secretary Stack much with what doc what Secretary Stack was<01:26:51.840> saying<01:26:52.000

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.