Transcript Highlights:

• Is the PED broken down into different classes of acuity, and if so, do y'all? Track that.
• But I'm not quite sure our funding reflects the difference in the acuities.
• And so, this tries to visualize the size of the pass-through.
• So we'll move on to the School for the Blind and Visually Impaired.
• Next, we have the special provisions for the Texas School for the Blind and Visually Impaired.

Bills: SB1, SB 1

Keywords: appropriations, budget, state funding, education, healthcare, infrastructure, campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards, 1185, senate, all

Transcript Highlights:

• We're essentially serving people with higher acuity.
• Um the other people with higher acuity.
• This chart visualizes one of the drivers of increased expenditures in the healthcare access fund.
• > the<00:48:23.680> drivers<00:48:23.920> of chart visualizes one of the drivers
• of chart visualizes one of the drivers of increased<00:48:24.800> expenditures<00:48:25.359><

Keywords: 1187, senate, all

Transcript Highlights:

• If you um flip to the second page of your presentation, Presentation, you'll see a visual depiction of
• Moving on to the overview slide, you'll see a couple of visuals of what the anticipated bedroom, living
• I<00:29:52.080> don't<00:29:52.360> have<00:29:52.960> a<00:29:53.000> visual
• <00:29:54.120> The I don't have a visual of that today.
• Medicaid patients or higher acuity Medicaid patients or higher acuity patients,<01:45:46.400>

Keywords: 1189, house, all

Summary: Division Three of the Finance Committee met in work session on April 20, 2026, to consider Senate Bills 481, 603, and 663, with the discussion focused primarily on SB 481, relative to the sale of the Sununu Youth Services Center property. The chair explained that the bill was advisory only and that the committee’s recommendations would go to full Finance on April 27. For SB 481, members reviewed conflicting provisions in the prior budget law about whether sale proceeds should go to the general fund or the Youth Development Center Claims and Administration Settlement Fund, and the bill was described as a compromise that would direct proceeds to the general fund before June 30, 2027, and to the settlement fund after that date. It was noted that the settlement fund had originally received about $20 million and had roughly $10 million remaining. The committee also received an extensive update from DCYF Director Marie Noonan on the new Youth Development Center in Hampstead. She reported that construction remained on schedule, with major structural and interior work complete, substantial completion expected in late summer or early fall 2026, and occupancy anticipated in early 2027. The presentation highlighted the facility’s design features, including single-occupancy bedrooms, sensory rooms, an education wing, medical and clinical suites, visitation space, a gym, and multiple outdoor courtyards, all intended to support a trauma-informed setting. Members asked about the facility’s funding, square footage, fencing, and scanner; staff said the building is about 34,000 square feet, funded entirely with federal ARPA state recovery funds to date, and that the scanner is on site but not yet operational pending policy and staff training. Committee members also raised concerns about the facility’s design and security. In response, DCYF said some concrete walls are required for structural and safety reasons, but they are being painted to maintain a brighter environment, and that the fencing will be about 15 feet high with privacy netting because the campus is shared with Hampstead. Officials said the new facility is legislatively limited to a maximum of 12 youth, while the current center can house 12 to 18, and emphasized that courts ultimately determine placements. No votes or final actions were taken during the work session.

Transcript Highlights:

• for the center from McCracken: $45 million for a female detention center and $35 million for a high acuity
• million<00:40:15.840> for<00:40:15.960> a<00:40:16.000> high<00:40:16.200> acuity
• center and $35 million for a high acuity center and $35 million for a high acuity mental<00:40:17.360
• achiever, a member of the Order of the Arrow, a member of Alpha Phi Omega Fraternity, and a former visual

Keywords: 958, all

Transcript Highlights:

• Now watching her acuity level go up and her monthly cost going up was irritating, but I think justified
• Now watching her acuity level go up and her monthly cost going up was irritating, but I think justified
• We don't like to hear of like a single $1,800 increase on cost, but acuity level demands it in a sudden
• Um, this one there's a lot of But acuity level demands it in a sudden health change.
• She has physical disabilities, visual impairment. She's also type 1 diabetic.

Bills: HF2216, HF1978, HF2354, HF1963, HF1994, HF1995, HF1894

Keywords: assisted living, nursing home, long-term care, guardian, conservator, resident rights, arbitration, mandatory arbitration, consumer protection, fee increase, rate increase, price hike, private pay, public funds, Medicaid, waiver services, elderly, seniors, older adults, disability rights

Transcript Highlights:

• Provide alternatives to a court reporter to include audio recording or audio-visual recording.
• issue came to our attention, particularly to address the placement crisis with children who have high acuity
• issue came to our attention, particularly to address the placement crisis with children who have high acuity

Keywords: 0:16 – CALL TO ORDER 0:20 – ROLL CALL 0:56 – ELECTION OF CO-CHAIRS 1:54 – APPROVAL OF MINUTES 2:10 – OFFICE OF THE ATTORNEY GENERAL 3:28 – PERSONNEL BOARD 4:30 – EDUCATION AND LABOR CABINET, BOARD OF EDUCATION, DEPARTMENT OF EDUCATION 5:18 – PUBLIC PROTECTION CABINET, OFFICE OF CLAIMS & APPEALS 12:03 – PUBLIC PROTECTION CABINET, DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 12:54 – CABINET FOR HEALTH AND FAMILY SERVICES, DEPARTMENT FOR MEDICAID SERVICES 14:54 – CABINET FOR HEALTH AND FAMILY SERVICES, DEPARTMENT FOR COMMUNITY-BASED SERVICES 31:44 – NEXT MEETING ANNOUNCEMENT/ADJOURNMENT, 958, all

Summary: The Administrative Regulation Review Subcommittee met to reorganize its leadership for the new term, renewing Representative Derek Lewis as House co-chair and Senator Steven West as Senate co-chair. The committee then approved the minutes and moved through a series of agency regulations, generally adopting staff-suggested amendments without objection. Among the regulations reviewed were an Attorney General rule changing how a commission reviews and distributes funds and how grant reporting is handled; Personnel Board changes abolishing and renaming certain job classifications and adjusting probationary periods; an Education and Labor Cabinet rule removing references to local board of education members; several Public Protection Cabinet rules covering Board of Claims and Crime Victims’ Compensation procedures; an Alcoholic Beverage Control rule on direct-to-consumer shipping forms; and a Medicaid Services emergency regulation establishing the Kentucky Trauma Hospital Rate Improvement Program for rural hospitals serving many Medicaid patients. The committee also heard that the Board of Claims and Crime Victims’ Compensation regulations included both staff and, in one case, an agency amendment, which were approved. The most extended discussion came on the Department for Community Based Services’ regulation increasing per diem rates for private child-placing therapeutic foster care levels 2 and 3. Committee members questioned the estimated $10 million biennial cost, the source of the funding, and why the cabinet had not yet filed regulations implementing Senate Bill 151 on kinship care. DCBS staff said the rate increase was discretionary and intended to address placement crises for children with high needs, while acknowledging they could not personally explain the budget decisions. A kinship caregiver testified in support of the rate increase but urged the cabinet to also implement SB 151 and expand support for kinship families. The committee expressed frustration over the lack of SB 151 implementation but stated the rate increase itself was appropriate and allowed the regulation to proceed.

Transcript Highlights:

• It would be a separate facility, but it houses both and will care for individuals who have high-acuity
• We are applying for waivers to increase our capacity to serve youth with high-acuity needs.
• Also working with visually impaired preschoolers, which is VIPS.
• 00:31:46.200> Kuckians<00:31:47.200> blind<00:31:47.600> or<00:31:47.840> visually
• prepare Kuckians blind or visually prepare Kuckians blind or visually impaired<00:31:48.960>

Keywords: 958, all

Summary: The Capital Planning Advisory Board met for its first meeting of the year, confirmed a quorum, approved the prior year’s minutes, and welcomed new co-chairs and members. The board reviewed the capital planning timeline and a list of agencies that submitted plans but would not testify. Members were reminded to keep presentations brief because of a packed agenda. The Cabinet for Health and Family Services presented first, outlining priorities centered on public safety, infrastructure preservation, and preventive maintenance. Its requests included a $21 million maintenance pool, phase two funding for a new state public health laboratory, construction of an 18-bed children’s psychiatric hospital, and several projects at Western State Hospital and Western State Nursing Facility, including HVAC work, cooling tower repair or replacement, and chiller plant repiping. Additional projects covered elevator upgrades at Hazlewood and phased cottage renovations at Oakwood. Board members asked about vacant buildings, the cost per bed for the youth psychiatric facility, and the relationship between the CHFS youth facility and a separate DJJ facility; CHFS said the youth facility would serve DCBS-involved youth and be separate from the DJJ project. The Kentucky Department of Education then described its state-operated facilities, including the Kentucky School for the Deaf, the Kentucky School for the Blind, and the FFA leadership training center. Its priorities included additional funding for the FFA classroom and activity building, a rewrite of the SEEK education finance application system, renovation and repair of the FFA swimming pool, electrical upgrades, campus education enhancements, safety and security work, door and window replacements, and HVAC maintenance. Members asked about student outcomes, the size and cost of the swimming pool project, and construction cost assumptions; KDE said it tracks student outcomes through special education staff and that current estimates reflect higher post-COVID construction costs. The Education and Labor Cabinet began its presentation with 12 priority projects, including a state labor exchange system, renovation of the McDow Vocational Rehabilitation Center, and a new adult education and family literacy management information system. The cabinet said the labor exchange would connect job seekers and employers at no cost, while the McDow renovation was needed because the 30-year-old facility faces safety and code concerns. The cabinet planned to continue through the remaining priorities and answer questions at the end of its presentation.

Transcript Highlights:

• that the providers accept referrals from a certain selected group of individuals who have those high-acuity
• We're seeing increasing acuity across the board, and it's really difficult to find placements for those
• The work with the blind and visually impaired has experienced a tremendous shortage of staff.
• mobility instructor, showing someone how to use a cane, a vision rehab therapist, a teacher of the visually
• mobility instructor, showing someone how to use a cane, a vision rehab therapist, a teacher of the visually

Keywords: 995, all

Summary: The hearing was an informational and oversight session of the Joint Committee on Children, Families, and Persons with Disabilities, with chairs and members hearing agency updates from several commissioners. The Department of Public Health’s Bureau of Family Health and Nutrition described its maternal and child health work, including home visiting, early intervention, WIC, newborn hearing screening, and cross-agency efforts on prenatal substance exposure, respite care, children’s vision, and maternal health initiatives. DPH emphasized that federal grant cuts, layoffs, and the loss of data systems such as PRAMS would weaken services and planning, and members asked about Title V funding and the impact of federal uncertainty. The Massachusetts Commission on the Deaf and Hard of Hearing highlighted communication access services, interpreter and CART referrals, emergency after-hours support, family navigation, and independent living services. Commissioners and members discussed the shortage of ASL interpreters and the need to expand training pipelines, including partnerships with colleges and possible ASL programming for younger students. The Department of Developmental Services reported serving nearly 50,000 people and focused on youth and adult services, transition-age supports, autism services, self-direction, respite, and new high-acuity residential models. Members asked about respite availability, self-direction outcomes, and workforce shortages; DDS said it was expanding clinical capacity and provider rates while monitoring possible federal Medicaid, SNAP, and immigration-related impacts. The Commission for the Blind described services for about 28,000 legally blind residents, most of whom are older adults, including social rehabilitation, orientation and mobility training, children’s services, assistive technology, vocational rehabilitation, and Turning 22 supports. The commissioner discussed a UMass-based effort to build the workforce pipeline for blindness services and said the agency was watching federal restructuring but had not yet seen direct cuts. MassAbility’s leadership then warned about major federal changes affecting Social Security disability determinations, including staff restructuring, office closures, and a new overpayment repayment policy, and said the agency was preparing for possible increases in claims and uncertainty around reallotment dollars that help fund services. The Disabled Persons Protection Commission closed the hearing with an update on its abuse investigations and protective services for adults with disabilities. DPPC reported rising hotline calls and investigations, a growing caseload, its sexual assault response team, the abuser registry, and a new interagency protective services integration system funded by ARPA dollars through 2027. The agency also flagged new federal rules that could affect funding eligibility and said it may need statutory changes to comply. Members asked about funding, reporting pathways, and how complaints reach DPPC, and the commissioner said the agency uses both mandated reporting and proactive outreach to identify and respond to abuse.

Transcript Highlights:

• However, it does not cover victims of invasive. visual recording, or indecent assault.
• offenses where a victim can qualify for a pseudonym to include indecency. decent assault, and invasive visual

Bills: SB251, SB608, SB487, SB535, SB761, SB955, SB957, SB958, SB988, SB990, SB1019, SB1021, SB1120

Keywords: criminal law, magistrates, Bell County, judicial authority, legal framework, evidence collection, sexual assault kits, reporting, law enforcement, transparency, confidentiality, victim protection, stalking, indecent assault, invasive visual recording, criminal justice, privacy rights, SB 535, Texas criminal procedure, rape shield

Transcript Highlights:

• We had already imposed those visual aid on. to overcome and succeed.
• young, I had to... ...difficulty in school with reading and comprehension related to my dyslexia. visual

Bills: SB568, SCR5, SB57, SB1447, SB27, SB24

Keywords: special education, funding, individualized education program, visual impairments, accessibility, support services, state education code, SCR 5, Senate Concurrent Resolution 5, Texas School for the Deaf, TSD, Robert Rives, gymnasium naming, building naming, honorary resolution, commemorative resolution, deaf education, hard of hearing, Gallaudet University, alumni hall of fame

Bills: SB568, SCR5, SB57, SB1447, SB27, SB24

Keywords: special education, funding, individualized education program, visual impairments, accessibility, support services, state education code, SCR 5, Senate Concurrent Resolution 5, Texas School for the Deaf, TSD, Robert Rives, gymnasium naming, building naming, honorary resolution, commemorative resolution, deaf education, hard of hearing, Gallaudet University, alumni hall of fame

Transcript Highlights:

• They make sure that they're pulling people out of our coordinated entry system who have the highest acuity
• Acuity, who score into needing that intervention to fill any empty units.
• This is a good visual. We're located in each of the major cities across the state.
• overhearing when, you know, the adults in the room are talking or, you know, you can't access that visual
• you're not going to replicate how to eat, you know, and that's a skill that a young child with a visual

Keywords: 908, all

Summary: The Human Services Committee met in interim session and first approved the previous meeting minutes before receiving a series of presentations on homelessness and housing stability. Jennifer Henderson of the North Dakota Housing Finance Agency updated members on the new Interagency Council on Homelessness, describing its executive-order mandate to review resources, gather input from stakeholders, identify gaps, and develop recommendations. She said the council’s first work is building a statewide program matrix of existing homeless services and funding sources, with attention to youth, tribal communities, and other vulnerable populations. Members raised concerns about youth homelessness, homeless veterans, and how the council will stay focused on a practical framework rather than getting lost in details. The committee also discussed possible connections to the rural health transformation grant and agreed to continue the topic later in the spring. Beth Olson of Presentation Partners in Housing described the organization’s housing-first model in Cass County and Clay County, including homeless prevention/diversion, housing navigation, and Cooper House, a 42-unit permanent supportive housing building in Fargo. She said the organization focuses on people with long-term and chronic homelessness, many with mental health, addiction, health, domestic violence, and Indigenous identity-related barriers, and reported strong outcomes: 85 of 86 people housed in 2025, 91% still housed after one year, and major reductions in emergency room use, ambulance rides, jail stays, detox days, and shelter use. She also explained that state funding has grown from a small share of the budget to about $1.1 million in state-connected funding for fiscal 2026, largely through contracts tied to supportive services. Members asked about vouchers, rent contributions at Cooper House, length of stay, and whether similar projects could be expanded elsewhere. Andrea Olson of the Community Action Partnership of North Dakota outlined statewide homeless and housing-related services delivered through six community action agencies in all 53 counties. She explained the Community Services Block Grant structure, said housing was identified as the top need in the most recent statewide needs assessment, and described programs including Supportive Services for Veteran Families, North Dakota Homeless Grant services, and Home ARP supportive services. She emphasized that the end of North Dakota Rent Help has increased pressure on the system, that the current $2 million annual homeless grant is far smaller than prior rent-help assistance, and that community action is using case management and financial assistance to move households toward self-sufficiency. Members asked about funding formulas, rural service delivery, and coordination with Presentation Partners to avoid duplication. YouthWorks then began a presentation on youth homelessness, describing services for ages 12 to 24, the special needs of youth and former foster youth, and the organization’s use of federal and state funds to support transitional housing, emergency shelter, maternity housing, and diversion services.

Transcript Highlights:

• While some residents require minimal assistance, many now have complex health care needs with acuity
• like an emergency, the needs of an older adult may not always be readily visible, such as hearing, visual

Summary: The Assembly Aging and Long-Term Care Committee met on April 22, established a quorum, and adopted its 2023-24 committee rules. The hearing then considered five bills focused on aging, long-term care, immigrant seniors, nutrition, and emergency preparedness. AB 450 would create a task force to study the needs of undocumented Californians age 55 and older; supporters from CHIRLA and other advocates described barriers to housing, health care, retirement, and digital access, while members raised questions about eligibility and process. The bill was approved on a due pass motion and re-referred to the Committee on Human Services. AB 508 would require residential care facilities for the elderly to disclose staffing information upon request at admission and when rates increase. The author and supporters argued that staffing levels are closely tied to quality of care and that families need transparency to make informed choices; a witness described her father’s death in an understaffed facility. Assisted living industry representatives opposed the bill as burdensome but said they were continuing discussions with the author. The committee adopted amendments and passed the bill to Appropriations. AB 1476 would allow senior congregate meal programs to continue offering to-go meals, a practice expanded during the pandemic. Supporters said the option improved access for homebound and food-insecure seniors and helped bring people into senior centers; there was no opposition, and the bill passed to Appropriations. AB 1068 would create a working group on evacuation and sheltering needs for older adults and people with disabilities in long-term care during disasters, and AB 1069 would ensure area agencies on aging and aging/disability resource programs have access to emergency shelters to provide services. Both measures drew broad support from aging, disability, and advocacy groups, with testimony citing recent fires and evacuations, and both were approved and re-referred to the Committee on Emergency Management. The committee also left rolls open for additional members to add votes before adjournment.

Transcript Highlights:

• I just wanted to make sure everybody has a visualization of the areas that I'm talking about.
• I also did throw up in here a visualization of the conceptual design of the area.
• with the state of North Dakota on creating a safety net contract with them to care for those higher acuity
• So we could also swing that additional 10 beds to support a higher acuity patient that requires significant

Keywords: 908, all

Summary: The committee first approved the December 10 minutes and then received a DEQ base budget summary and agency overview. DEQ staff explained that the agency is largely federally and special funded, with major ongoing costs in salaries, operating expenses, grants, and continuing appropriations. Director Dave Glatt and accounting director Beth Jacobson highlighted core programs, the move to a new chemistry laboratory, the new state fuel inspection program, wastewater-related funding from HB 1577, and implementation of SB 2267 for on-site wastewater rules. They also noted the agency’s spending patterns, possible federal EPA cuts, and the likelihood of some fee adjustments or program changes if federal support declines. Members asked about DEQ’s travel, field offices, future staffing, and how the agency would respond to reduced federal regulation. DEQ said most staff are based in Bismarck, with field offices in Fargo, Sawyer, and Gwinner, and that travel is driven by inspections and spill response. Glatt said the agency would continue to rely on science and law, and that any future federal retrenchment could mean more state responsibility but likely not a wholesale increase in FTEs. The committee also discussed a feedlot enforcement case in the Minot area, with DEQ explaining its role in ensuring compliance, permitting, and animal-waste management standards. The Department of Health and Human Services then presented on FTE block grant reporting, TANF balances, child care transfers, and the Rural Health Transformation Program. Donna Ockland explained that no line-item transfers had occurred yet for the new rural health work, but about 33 positions were planned and some current staff time could be reimbursed through approved cost allocation. HHS also reviewed TANF’s frozen eligibility and block grant structure, the transfer of up to 30% of TANF funds to child care, and recent program changes that increased benefits and raised the income limit. Staff said the department is using TANF more strategically to support child care and other allowable uses, while still carrying over unused funds as many states do. Finally, Pat and HHS staff gave an update on the Rural Health Transformation Program, saying the first funding opportunity was being posted and that the state is on track to obligate the federal funds within the required timeline. They described priorities such as workforce retention, preceptor development, technical assistance for critical access hospitals, community wellness projects, and ambulance upgrades. Members asked about rural versus urban eligibility, immigrant recruitment, evaluation of year-two funding, and how the program would address varied local workforce needs. The meeting then shifted to an Office of Management and Budget update on the new State Hospital project, where Lindsay Ashley reported continued construction progress, updated cost information, and selected alternates, with photos and details showing work underway in multiple building sections.

Bills: HB75, SB134, SB201, SB258, SB288, SB313, SB320, SB321, SB325, SB339, SB345, SB393, SB422, SB440, SB470, SB487, SB523

Keywords: HB75, Act 963, gaming, casino gaming, promotional play, promotional wagers, slot machine proceeds, net gaming proceeds, gross revenue, taxable revenue, gaming operators, gaming tax, Louisiana gaming, gaming revenue deduction, casino tax, gaming promotion, revenue cap, pilot program, child sexual abuse materials, sexting

Transcript Highlights:

• overcrowded ERs, longer wait times, higher premiums, our most vulnerable patients showing up with greater acuity
• making a tremendous impact on patient care in all health care settings, and even more so in high-acuity
• These metrics are imperative not only for visualizing the digital divide, which is that gap in access
• ...not only for visualizing the digital divide, which is that gap in access to digital technologies,

Keywords: 995, all

Summary: The Joint Committee on Health Care Financing held a public hearing on a large docket of bills focused on MassHealth benefits and reimbursement, health equity, behavioral health, public health, dental access, 340B drug pricing, tobacco cessation, and coverage for children. The chairs emphasized rising health care costs, provider shortages, administrative burdens, and persistent inequities by income, race, geography, and immigration status. Much of the testimony centered on H.1416/S.901, an act to advance health equity, with legislators and members of the Health Equity Compact arguing for statewide benchmarks, stronger health equity leadership, reimbursement for interpreter services, community health workers and patient navigation, Medicaid graduate medical education support, and a health equity zone trust fund. Witnesses described disparities in life expectancy, maternal mortality, access to primary care, and the impact of federal Medicaid and social service cuts, and urged the committee to report the bill favorably. The committee also heard strong support for H.1368/S.847 on rapid whole genome sequencing for critically ill MassHealth children. Testifiers from industry, academia, hospitals, and families said early sequencing can end long diagnostic odysseys, improve treatment decisions, shorten hospital stays, and save money, while also providing emotional relief and information for families. The hearing then moved to H.1407 on MassHealth rate parity for inpatient behavioral health providers, where Rep. Scanlan and the Massachusetts Association of Behavioral Health Systems said the bill would codify existing administrative parity so managed care plans cannot pay less than the MassHealth fee-for-service rate. On H.1392/S.853 to preserve and protect public health, witnesses supported higher vaccine administration fees to improve provider participation and immunization rates. The committee also heard testimony on H.770/845 to protect 340B providers in MassHealth, and on S.848 to require reporting and transparency around 340B revenues and outside administrative costs. Additional bills drew testimony on tobacco cessation coverage for MassHealth members, with advocates supporting broader access to counseling and medications through medical, behavioral health, and dental providers. On H.1409, a nursing home operator asked for more flexibility in a MassHealth staffing-related penalty tied to patient days per resident. On H.1401/S.888, supporters of the “Take 10” dental access proposal said adult MassHealth dental coverage is underused because too few dentists accept MassHealth, leading to long travel times and avoidable emergency room visits; they urged incentive payments for dentists serving new adult MassHealth patients. Finally, on H.1403/S.855, “Cover All Kids,” advocates and immigrant community members urged removal of immigration status as a barrier to full MassHealth coverage for children, while also backing a related bill to ensure 12 months of continuous coverage for children. No votes were taken during the hearing; the committee primarily received testimony and asked questions on costs, reimbursement levels, and implementation details.

Transcript Highlights:

• that by you know that that cost increase what is it labor or is it the is it the severity of the acuity
• Is that based on the acuity of the well? It's based on the number of wells that you have.
• takes it out. it out and scatters it out, but there are some actual holding places like you would visualize
• And then the second one is a visual representation. of the Texas Water Fund is created by the 88th legislature

Bills: SB1, SB 1

Keywords: appropriations, budget, state funding, education, healthcare, infrastructure, campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards, 1185, senate, all

Transcript Highlights:

• In addition, cuts to reimbursement for high-acuity care or outlier payments at hospitals will impact
• The next few slides give us a little visual idea about the admissions and releases that we used to build
• This is a visualization of the graduated response system that comprises the juvenile justice system in

Summary: The committee heard testimony on the effects of H.R. 1 on Washington’s Medicaid, developmental disability, long-term care, and food assistance systems, followed by a separate discussion of juvenile rehabilitation caseloads and placement capacity. DSHS officials said HR1 could affect home equity rules, immigration-related eligibility, work requirements for some expansion-population enrollees, and provider taxes, while also creating a future opportunity for a new 1915(c) waiver. Advocates and providers warned that any state response that cuts home and community-based services would worsen already thin provider networks, increase waiting lists, push more people into hospitals or out-of-state placements, and strain families and workers. A pediatric behavioral health expert and a supported living provider said Medicaid reimbursement is already too low and further reductions would threaten outpatient, residential, and inpatient services for people with intellectual and developmental disabilities and severe behavioral needs. The committee then turned to SNAP and the state food assistance program. DSHS said HR1 would tighten work requirements and exemptions, end some immigrant eligibility for the federal program, eliminate the SNAP education program, raise state administrative costs, and eventually require Washington to share in benefit costs based on its error rate. Officials estimated large numbers of residents could lose or see reduced benefits, with significant added state costs. Anti-hunger advocates, a food bank director, and a SNAP recipient described the program as essential for low-income families, seniors, and people with disabilities, and said the changes would increase paperwork, reduce benefits, and worsen food insecurity while also harming local food economies. Testimony emphasized that food banks cannot replace SNAP and that work requirements may be difficult to meet for caregivers, people with disabilities, and those facing child care or transportation barriers. In the juvenile justice portion, the Caseload Forecast Council presented the JR forecast, which is currently mostly flat through the end of the biennium but expected to grow modestly over the longer term. Members discussed how policy choices, including the 2019 JR-25 law, have increased lengths of stay for adult-sentenced youth in JR, while diversion and other reforms have affected regular JR trends. A court researcher explained the data available to help forecast admissions and noted ongoing efforts to improve data sharing with JR, AOC, and county systems, though staffing and system-lag issues limit how quickly data can be produced. Juvenile court administrators and DCYF officials described the community-based juvenile justice continuum, rising complexity in the JR population, overcrowding at Green Hill and placement constraints at Echo Glen and Harbor Heights, and the need for more flexible community transition and mental health capacity. No votes were taken.

Transcript Highlights:

• He is visually impaired, and he relies on a feeding tube for nourishment daily.
• He is visually impaired and he relies on a feeding tube for nourishment daily.
• recurring funds from the Medical Care Trust Fund to add inpatient treatment in a hospital ICU or high-acuity

Summary: The subcommittee held its first meeting of the 2025-2026 term, took attendance, confirmed a quorum, and heard introductory remarks from members and staff. Chair Anderson outlined the subcommittee’s jurisdiction over access and affordability issues, including health facility regulation, insurance, Medicaid, CHIP, and state employee health coverage. The main agenda item was an update on implementation of HB 391, which created a family home health aide program for medically fragile children. Representative Tramont, the bill sponsor, explained that the law was intended to let trained family caregivers be paid through Medicaid to care for their children, reduce reliance on private duty nursing, and relieve families. He and several members expressed frustration that implementation had taken nearly two years and that families still faced barriers. Deputy Secretary Brian Meyer of AHCA and Bridget Royce of DCF said the program was implemented October 1, 2024, with billing available, but no home health agencies had yet launched the required 80-hour training program and no claims had been paid. They described the program’s requirements, including agency employment, background screening, training, a $25-per-hour Medicaid rate paid to the agency, and an annual assessment report. A major issue discussed was that income earned by family caregivers counts toward Medicaid eligibility and could cause families to lose coverage. AHCA and DCF outlined two possible fixes that would require CMS approval: disregarding the income for eligibility purposes or treating the child as a family of one. Members and public witnesses strongly urged changes to avoid forcing families to choose between income and coverage. Several providers said they had begun preparing training programs, but asked for clearer approval processes and more patient-specific training requirements. The committee then heard extensive public testimony from parents and caregivers of medically fragile children, who described the financial, emotional, and logistical strain of caring for children with severe disabilities and argued that the bill should be expanded to include Florida KidCare families and others in the coverage gap. They also raised concerns about the eight-hour-per-day limit, low pay, and the need for simpler rules and direct support. Home health providers and associations supported the concept but asked for modifications, including more targeted training and clearer implementation guidance. The meeting then shifted to a second agenda item on the Andrew John Anderson Rapid Whole Genome Sequencing Program, which was funded in the 2023 budget. Deputy Secretary Meyer said the program has been implemented since January 1, 2024, but utilization has been lower than expected, with only about 60 claims paid and many denials occurring through managed care. Public testimony from a lab, a hospital, and a pediatric rare disease expert said the program is clinically valuable and cost-saving, but managed care billing barriers, prior authorization issues, and DRG-related denials are limiting access; they urged direct billing to Medicaid and possible expansion to all newborns.

Transcript Highlights:

• To give you a visual comparison between the older medical and newer residential models, here you can
• that KDVA report to the General Assembly on the scale and impact of rising behavioral and physical acuity
• 03.599> behavioral<00:49:04.160> and<00:49:04.400> physical<00:49:04.800> acuity
• of rising behavioral and physical acuity of rising behavioral and physical acuity needs<00:49:05.599

Keywords: Call to Order and Roll Call- 00:00:00 Approve Minutes from November 13, 2025- 00:00:55 RiverLink Tolling Operations for Louisville Bridges-Quarterhill Testimony- 00:01:48 Staff Report on Veterans’ Centers- 00:26:45 Kentucky Department of Veterans Affairs Response to Staff Report- 0:58:53 Adjournment- 1:18:00, 958, all

Summary: The committee first approved the minutes from the November 13, 2025 meeting and then heard testimony from Quarter Hill, the tolling subcontractor for RiverLink on the Indiana-Kentucky bridge system. Quarter Hill described its role in back-office support and call center operations for the Lincoln, Kennedy, and Lewis and Clark bridges, and said the contract began in 2021 with go-live in September 2023. The company reported that revenue has increased since it took over, customer service response times have improved, and it has been operating at a loss because the contract was based on outdated transaction estimates and did not account for higher-than-expected volume and added support costs. Members questioned Quarter Hill about the role of consultants, the low reported collection rate, and why the company was leaving the contract. Quarter Hill said a single large consulting engineering firm had been hired to help shape the RFP and contract, but argued that consultants and overly detailed requirements can create disputes and hinder efficient service. On collection rates, the company said the reported 85% rate reflects the absence of registration holds and other enforcement tools, and that the remaining unpaid tolls are the hardest to collect. The company also said it had lost significant money on the contract and had reached a change order and termination agreement, while emphasizing that the system itself was functioning well. The committee then received a staff report on Kentucky veterans centers. Staff said quality of care is generally high and staffing has improved, but reported occupancy figures are misleading because they are based on certified beds rather than functional capacity after conversions to single-occupancy rooms and capital projects. The report said actual occupancy is closer to 85% than the commonly reported 56%, and that increasing occupancy would not necessarily increase revenue because the state’s cost of care exceeds reimbursement and private-pay revenue. Recommendations included adopting functional occupancy reporting, continuing the move to single-occupancy rooms, reviewing modernization needs at Thompson Hood, including Eastern Kentucky in planning, and referring the Radcliffe HVAC procurement and installation to the Auditor of Public Accounts and Attorney General for review.