Transcript Highlights:

• services.
• services.
• services.
• More IMD services.
• housing services.

Summary: The meeting focused heavily on behavioral health and substance use treatment, especially the IMD exclusion and whether North Dakota should pursue a Section 1115 waiver to allow Medicaid reimbursement for services in institutions for mental diseases for adults ages 21 to 64. Turtle Mountain representatives described major local needs, including limited access to care, high syphilis rates, and the importance of timely public health data. They also discussed the tribe’s recovery center, which opened the prior year, now operating five levels of care with 16 beds, and the desire to expand capacity, possibly through an IMD waiver or related policy changes. Committee members also raised related issues such as rural health transformation funding, telehealth, workforce retention, and the need for better coordination between tribal and state public health systems. A central issue was Turtle Mountain Public Health’s long-running effort to secure a data use agreement with the state so it can receive surveillance data and respond directly to infectious disease cases among tribal members. Speakers said the tribe had a successful COVID-era agreement that allowed faster contact tracing and case management, but that agreement ended with the pandemic. They argued that current delays in sharing data, especially for sexually transmitted infections, leave the tribe unable to respond quickly, while the state and county epidemiology workload is too distant and stretched to be effective. Committee members expressed support and said they would look into the issue, noting that other tribes have secured similar agreements. The committee also heard a detailed presentation from the National Health Law Program on the IMD exclusion. The presenter explained that federal Medicaid law generally bars payment for care in facilities with more than 16 beds, but that states can use other tools such as state plan amendments, managed care arrangements, telehealth, and community-based services. He said IMD waivers are administratively complex, time-limited, and have shown mixed results in other states, with some gains in residential treatment access but limited evidence of improved overdose outcomes or stronger community-based care. He urged the committee to consider broader continuum-of-care solutions and cautioned that waivers alone are not a cure-all. No final vote was taken on the bill draft during the portion shown, but the committee discussed the proposal to appropriate $49,000 and one FTE to HHS to pursue an IMD waiver and report back in the next interim. Members also debated the policy rationale for the 16-bed limit, the role of the state versus tribal sovereignty, and whether the bill should move through the Health Care or Human Services committee in the future.

Transcript Highlights:

• And then they're bolstering the support services in the communities that have those service gaps.
• You might call them, oh, that's a service In the communities that have those service gaps.
• Over 22,000 were open for services.
• Services should be voluntary.
• services and the help they need.

Bills: SB5979 , SB6308 , SB6319

Committee: Senate Human Services

Keywords: opioids, substance abuse, dependent children, child welfare, caregiver substance use, court orders, shelter care, judicial discretion, family law, early childhood, family services, diversion programs, court-ordered assessments

Transcript Highlights:

• the service.
• and Human Services.
• , Child Care Services.
• , they'd use HCBS services for additional services.
• So then, from a human services standpoint, a medical services standpoint, From a human services standpoint

Committee: Joint Human Services

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:

• services.
• Service contract.
• The service contract.
• Number two is Commerce Workforce Services. temporary staffing services for ASU.
• Number eight, DFA Revenue Services with Veteran Cleaning Service for janitorial services in the Ragland

Committee: All JOINT BUDGET COMMITTEE

Summary: The committee heard a series of appropriation requests and contract reviews across multiple sections. In Section B, members approved temporary appropriations for the Court of Appeals, Commerce/Aeronautics, and Insurance-related payments and refunds. Section C ARPA requests from DHS were approved to return unused federal funds. Section D infrastructure-related appropriations, including wildfire preparedness, broadband BEAD funding, forestry support, recycling, and oil and gas sample preservation, were approved after questions about broadband audit controls and performance safeguards. Section E DHS reallocations were approved, including large transfers within Medical Services from hospital medical to private and public nursing home lines, along with smaller transfers for children and family services, developmental disabilities, and youth services; members asked about the source and purpose of the medical services transfer. Sections F and G were reviewed, covering cash fund requests, federal grants, and miscellaneous grants, including community college storm repairs, corrections commissary and maintenance, 911 enhancements, maternal health, disability determinations, state police equipment, digital newspaper archiving, and CDL data improvements. In Section H, the committee reviewed pay plan appropriations and performance fund transfers tied to the new Class and Comp pay plan. Section I reviewed three methods of finance for UA Little Rock, UAMS, and the University of Arkansas system. In Section J, the committee reviewed discretionary grants, including a $1.4 million HIV services grant and nine tobacco prevention subgrants through UAPB. Members questioned the effectiveness, metrics, and addresses of some tobacco-cessation arts-based grantees, especially Arts Absolutely Inc.; after discussion, Representative Kavanaugh moved to expunge the vote on J2 and refer it back for review at a later ALC meeting, and that motion passed. J3, a Department of Energy and Environment grant for propane safety training and e-waste recycling services, was then reviewed. The committee also reviewed contracts in Section K. K-1 ratified emergency management nuclear planning work performed during a transition between agencies. K-2 construction contracts included architectural and engineering services for corrections, National Park College signage, a Razorback Road parking facility, and UAMS cyclotron installation. K-3 intergovernmental contracts covered health, education, autism waiver, stroke, newborn screening, Medicaid evidence review, and radiation testing services. K-4 out-of-state contracts included staffing, IT, tobacco prevention, audit, marketing, planetarium, recruitment, and janitorial services; Senator Irvin noted one contract appeared to belong in the out-of-state list rather than intergovernmental. K-5 in-state contracts covered staffing, cleaning, re-entry and treatment services, foster care and disability services, hearing officers, asbestos abatement, campus IT support, and janitorial work. The meeting ended after a brief personal update from Senator Irvin about tornado damage in Stone County and thanks to members for their concern, followed by adjournment.

Transcript Highlights:

• comment for human services after that.
• services.
• It's not a new service.
• assessment of need for service.
• talk. services provided to, excuse me, one-third of services provided to all seniors.

Transcript Highlights:

• ; emergency services; surgical services provided by a doctor of dental medicine or dental surgery; services
• care coordination services would still be a part of the fee-for-service model?
• The fee-for-service coordination services that you talk about that would be available under the fee-for-service
• care coordination services would still be a part of the fee-for-service model?
• The FI for service, the coordination services that you talk about that would be available under the fee-for-service

Transcript Highlights:

• and disability services policy.
• services policy aging and disability services policy Provisions<00:02:46.159><c> sections</c><00:02:
• </c><00:03:01.760><c> and</c> long-term services and long-term services and supports<00:03:03.720><c>
• It updates and clarifies state-operated services crisis services technical assistance language.
• </c><00:09:30.640><c> service</c><00:09:31.040><c> provider</c> management servicer service provider

Transcript Highlights:

• We advance service expansion and restoration, including a full return to pre-pandemic service levels
• But we can take those projects, we can then put in a service model and say, look at the service plan
• But we can take those projects, we can then put in a service model and say, look at the service plan
• key stations, and the baseline service all day, seven days a week, is half-hourly service.
• and the performance of services.

Summary: The Senate LOSSAN Rail Corridor Resiliency Subcommittee heard updates from CalSTA, Caltrans, Metrolink, and Caltrain on corridor performance, governance, funding, and long-term planning. Chair Lackey opened by saying the SB 1098 report on LOSSAN governance and performance was unfinished and overdue, and argued the corridor remains at a crossroads because ridership, on-time performance, fiscal solvency, and capital delivery are still lagging. Senator Archuleta echoed concerns about safety, maintenance, ridership recovery, and the need to avoid state subsidy if local revenues fall short. CalSTA and Caltrans said the state has made major investments, including $125 million for San Clemente emergency resiliency work, and that more than $25 billion in funded rail projects are moving toward construction. They said work on the SB 1098 report is underway, with a LOSSAN working group to be convened, and described a new Caltrans transit-and-rail reorganization with a deputy director to improve accountability. Caltrans also reported restoration of Surfliner service to 13 weekday round trips between Los Angeles and San Diego, planned service increases to Santa Barbara and San Luis Obispo, fleet overhauls, and a new project-tracking and service-planning tool to prioritize capital projects by service outcomes. The panel also discussed zero-emission strategy, saying hydrogen fuel-cell trains are being procured for longer-distance service while battery-electric options are being pursued where feasible, and that San Clemente long-term planning is being scoped with local partners. Metrolink CEO Darren Kettle said the agency has shifted from a commuter-only model to all-day regional service through its “Metrolink Reimagined” schedule, with improved transfers, more weekend and off-peak ridership, and a 25% increase in monthly pass sales under a new fare pilot. He warned, however, that Metrolink faces a fiscal cliff: member agencies now cover about 72% of operating costs while fares cover about 11%, and without a dedicated revenue source the agency may need to cut service, reduce stations, or end later-evening and weekend trips. He said Metrolink has limited ability to monetize stations or parking because it does not own most of the relevant property or rights. Caltrain’s Jason Baker described the success of electrified service, with ridership up 57% year over year and customer satisfaction at record highs, but said Caltrain also faces a projected $75 million annual operating deficit and may need to consider service cuts if stable funding is not found. He highlighted revenue efforts such as energy regeneration compensation, parking and concession reviews, station development, and a planned battery-electric pilot to extend zero-emission service south of San Jose.

Transcript Highlights:

• </c> ancillary service costs. ancillary service costs.
• </c> default service. default service.
• service territory.
• service territory.
• Maybe they do..." service. Um, in Massachusetts we have service.

Committee: Senate Energy and Natural Resources

Transcript Highlights:

• That article relates to aging and disability services.
• Section 12 from the DHS policy bill adds financial management services, community-first services and
• These services include education and enrichment for kids, employment services, life skills like budgeting
• I serve as a Social Services Deputy Director at Ramsey County, leading the Aging and Disability Services
• With the organization they received services from, and 80% of those were satisfied with the services

Bills: HF2115 , HF2276 , HF1644 , HF99 , HF2068 , HF2707 , HF2704 , HF2406 , HF1674 , HF1579

Committee: House Human Services Finance and Policy

Transcript Highlights:

• of Managed Health Care Services, and the Emergency Medical Services Authority.
• Managed Healthcare Services, and the Emergency Medical Services Authority.
• We have two crisis services.
• , child welfare services, and adult protective services, and with our local hospitals.
• losing funding for these vital services, and the services are being cut.

Summary: The Assembly Select Committee on California’s Mental Health Crisis held an informational hearing focused on the 988 suicide and crisis lifeline and the broader crisis response system around it. Chair Pellerin and Assembly Member Schiavo opened with personal remarks about the importance of the issue and the need to strengthen California’s crisis infrastructure, especially as federal actions and funding uncertainty threaten services for youth and LGBTQ+ callers. The hearing was organized into panels covering state implementation, county coordination, and community crisis services, with public comment to follow. State officials from CalHHS, DHCS, Cal OES, and the 988 California Consortium described progress since AB 988 and the five-year implementation plan, including governance structures, statewide network buildout, call-routing technology, public awareness campaigns, and integration with Medi-Cal mobile crisis services. They said California has created or enhanced more than 485 mobile crisis teams, built crisis stabilization and residential facilities, and expanded youth behavioral health supports such as BrightLife Kids and Soluna. They also noted ongoing work to replace lost Trevor Project support with enhanced LGBTQ+ youth training, and to develop a 988 resource directory and future public awareness campaign. Cal OES explained that the 988 surcharge is recalculated annually based on budgeted needs and fund balance, and that text-to-911 and next-gen 911 interoperability are being expanded. County and community witnesses emphasized that the system is still strained by rising demand and uneven local integration. Lake County described a peer-led rural mobile crisis model that has reduced law-enforcement holds and helped place residents into housing, but said 988 calls still do not reliably route to the county’s mobile crisis team and that rural counties need more flexible funding, vehicles, technology, and reimbursement support. Santa Clara County reported strong performance metrics and major growth in 988 call and text volume, but said sustained funding is needed to support staffing, text/chat expansion, and commercial payer reimbursement. The Mental Health Association of San Francisco said the California Peer Run Warm Line is a key part of the continuum of care, but recent budget changes forced cuts to Spanish-language services, federation support, and hours, despite high demand. Across the hearing, members and witnesses agreed that 988 is saving lives but still misses thousands of calls each month and needs more stable, multi-year funding, better coordination, and clearer roles among state agencies, counties, and crisis centers. Witnesses repeatedly called for stronger feedback loops, better integration between 988 and mobile crisis dispatch, and more investment in staffing, technology, and outreach so Californians can be connected to the right help without unnecessary law enforcement or emergency room involvement.

Transcript Highlights:

• of those county behavioral health services, we will only see demand for our services increase just as
• of services are they getting?
• and all mobile crisis services delivered by unlicensed staff ...services and all mobile crisis services
• Also just want to start by saying thank you for your public service on this first day of Public Service
• And my colleague at the Department of Health Care Services noted that the decision to recast the service

Transcript Highlights:

• Services that are covered are both Medicare and Medicaid services that include acute care services, adult
• services, behavioral services, therapeutic services, residential services, and medical services, including
• But we don't want—we want to make sure the services are there that are not covered or very specific services
• besides emergency dental services.
• And they give me great advice on where we need to do as service organization, service officers to support

Committee: Senate Appropriations Committee on Health and Human Services

Summary: The Appropriations Committee on Health and Human Services heard a base budget overview for the 2025-26 fiscal year, which was presented as a $46.8 billion starting point for the silo. Staff explained that HHS accounts for about half of the state base budget and roughly 36% of general revenue, with AHCA and Medicaid making up the largest share. The committee then reviewed the PACE program for the elderly, including its eligibility, service model, growth in applications, slot funding and reversions, and the agency’s plan to move from the federal three-way agreement to a more detailed two-party contract to improve accountability, transparency, and reporting. Members raised concerns about unfilled slots, reversions, rural access, and the need for clearer return-on-investment data; the agency said it would follow up on some of those questions. The committee also heard from the Agency for Persons with Disabilities on its statewide dental program. APD described its history of appropriations, the failed January 2024 solicitation, and a new up-to-$11.5 million solicitation focused on preventive care, community partnerships, teledentistry, and coordination with other services. Members questioned overlap with Medicaid dental coverage, the effect of Medicaid unwinding on APD clients, and whether state dollars were duplicating federally supported services; APD said it tries to act as payer of last resort and that services would continue during procurement. Public testimony from an APD stakeholder and the Florida Dental Association emphasized Medicaid eligibility problems for waiver recipients, low reimbursement rates, limited access to anesthesia and hospital-based dental care, and concerns that proposed Medicaid changes could reduce access for special-needs patients. The Department of Veterans’ Affairs then presented on state veterans service officers and benefits assistance. FDVA highlighted its role in helping veterans access federal benefits, reporting about $27.9 billion in federal dollars flowing into Florida and a high return on state investment. The department said it has increased outreach, claims processing, and services, and has trained staff to identify mental health concerns through its Overwatch program. In response to questions, FDVA discussed plans to expand adult day health care at a new veterans nursing home and possibly at existing locations with additional state funding. At the end of the meeting, the committee completed its presentations and adjourned without objection.

Transcript Highlights:

• So to the person, there might be services that they receive or services that have been sustained.
• of Social Services and health care services and others are experiencing now, and you'll get to hear
• Some of their services in-house. They may choose to contract out for services.
• the Department of Social Services—that is, for our In-Home Supportive Services system.
• the Department of Social Services—that is, for our In-Home Supportive Services system.

Transcript Highlights:

• </c> it's great to kick off uh Human Services it's great to kick off uh Human Services for<00:02:10.200
• </c> presentation on the Human Services presentation on the Human Services budget<00:15:15.079><c> so
• </c> with the health and human services with the health and human services committee<00:21:19.640><c>
• </c> and transparency of government services and transparency of government services and<00:35:37.160
• It includes SUD services, mental health services, gambling, and tobacco.

Committee: Senate Human Services

Transcript Highlights:

• and the Department of Social Services.
• and the Department of Social Services.
• before providing services.
• Require them to be licensed through the Department of Social Services before providing services through
• Julia Leau, Regional Services, in strong support.

Summary: The committee heard a series of child care, social services, immigrant support, disability services, and language access bills, with many measures drawing strong support and no opposition. Early in the hearing, AB 450 proposed a Department of Aging task force to study and recommend policies for undocumented adults age 55 and older; AB 593 would let CDSS identify data-sharing opportunities to improve CalFresh administration and participation; and AB 904 would clarify child care subsidy eligibility so families do not lose care during pregnancy leave, family leave, caregiving, or job search periods. All three were presented as ways to reduce barriers and improve access to essential services, and AB 904 was moved out on a 1-0 call after support testimony from child care advocates and a member of the public. AB 617, which would expand and standardize respite care access for people with intellectual and developmental disabilities by requiring licensing and registry participation, drew both support and significant opposition from respite providers and disability service organizations concerned about added regulation, cost, and possible delays; the author said she would continue working with opponents, and the bill was moved out on a 2-0 call. The committee also heard AB 1220, which would require regional centers to document denials, notices of action, and appeals in individual program plans and include that data in annual reports to improve transparency and equity in developmental services. The bill drew extensive public support from parents, advocates, and disability organizations, with no opposition, and passed 5-0. AB 752 would make child care centers by right in certain residential zones when co-located with multifamily housing or institutional uses, and supporters argued it would reduce zoning barriers and help expand child care capacity; it also passed 5-0. AB 1242 would create a CalHHS language access director, require human review of machine translation, and improve language coverage determinations for state and local agencies; supporters emphasized health equity and the need for better access for limited-English communities, and the bill was moved out on a 4-0 call. Later, AB 548 would continue and expand the Asylee and Vulnerable Non-Citizen Program, which provides case management and integration services for asylees and certain visa holders; supporters said the program had been effective but had run out of funding, and the bill passed 4-0. AB 495, the Family Preparedness Plan Act, would strengthen family safety planning for immigrant families, standardize acceptance of caregiver authorization affidavits, and create a joint guardianship process for temporary separations; testimony focused on fear of family separation and the need for clear school and medical procedures, and the bill passed 4-0. AB 1357 would exclude guaranteed income payments from being counted as income for state public assistance eligibility, with supporters arguing it would prevent recipients from falling off the “benefits cliff”; it passed 4-1. Finally, AB 1201, the Reunity Act, was introduced to require individualized court assessments before denying reunification services to parents with certain violent felony convictions after a five-year period, with the author and a witness describing the bill as a trauma-informed approach to family reunification.

Transcript Highlights:

• </c> required and critical nursing services required and critical nursing services that<00:03:59.120>
• c> then require nursing Services I would then require nursing Services I would very<00:04:32.919><c>
• Senator Rasmusson, Home and Community-Based Services standards, out-of-home respite care services for
• , including 24-hour daily services to unit-based services that are provided a few hours a week.
• , including 24-hour daily services to unit-based services that are provided a few hours a week.

Committee: Senate Human Services

Transcript Highlights:

• So those funding for those services, as well as all other long-term care services, are in the budget,
• What is the total amount of funding for ALF services? For the ALF services? For the ALFs?
• There was also an emphasis on making sure that there were residential services and outpatient services
• The service is very important. The service is excellent. We want to provide the service.
• Bernard. providing mental services if you're aware yeah absolutely we do have Medicaid school services

Summary: The Health Care Budget Subcommittee held a panel discussion on Florida’s mental health and substance abuse system, with representatives from DCF, AHCA, two managing entities, and two providers describing how the state’s behavioral health network is funded and operated. Members focused on the implementation of prior legislative investments, especially the $50 million in recurring funding from Representative Maney’s bill and the earlier $126 million community behavioral health appropriation. Witnesses said the newer funds were used mainly for crisis beds, discharge planning, outpatient services, regional collaboratives, and a USF Marchman Act report, while the larger behavioral health appropriation supported CAT, FACT, FIT, forensic teams, residential and outpatient services, and crisis care, with most dollars going directly to services and only a small share to administration. A major theme was access to crisis care and the role of mobile response teams, 988, and central receiving facilities in diverting people from Baker Act admissions and reducing readmissions. DCF and providers said mobile response teams have expanded, are being used to de-escalate crises and connect people to care, and have shown strong diversion results and reductions in Baker Acts in some regions. Members also asked about waitlists, children in crisis, and how to handle people without housing or support; providers said discharge planning is individualized but often constrained by homelessness, transportation, and a lack of safe placements, and several witnesses identified housing as one of the biggest barriers to recovery and stability. The committee also examined provider sustainability, reimbursement, and funding gaps. Witnesses described delays caused by contract timing, cost allocation rules, and Medicaid reimbursement rates that do not always keep pace with labor and operating costs, especially for smaller providers and rural networks. DCF and AHCA said managing entities can provide advances, retroactive rate adjustments, and technical assistance, and that Medicaid managed care plans have network standards and complaint/dispute processes. Members raised concerns about a reported $7 million loss in federal non-sustainable funds, provider closures, and whether there is a formal ombudsman process for disputes; DCF said the federal reductions were known and tied to one-time funds, and that the department generally handles provider issues informally while working with managing entities to preserve continuity of care.

Transcript Highlights:

• Safe services for individuals.
• Urgent care and emergency services.
• services, similar to many of the services that are provided in schools through telehealth programs that
• That would be a year past the date of service for any services provided in July, but they would have
• Any services provided today, for example, they have time to submit all of those claims, but for any services

Transcript Highlights:

• services.
• services.
• More IMD services.
• Crisis services also connect individuals with other needed services.
• housing services.

Committee: Joint Tribal and State Relations Committee

Summary: The meeting focused on Turtle Mountain’s public health and behavioral health priorities, especially access to rural health transformation funding and a long-running data use agreement with the state. Tribal public health leaders described how, during COVID, a temporary data-sharing arrangement allowed them to do their own contact tracing and case management, and they argued that a similar agreement is now needed to respond more quickly to very high syphilis rates and other infectious disease concerns. Committee members generally expressed support and said they would follow up with state officials, while tribal representatives emphasized that they already have the staff and infrastructure to use timely data effectively. A major portion of the meeting was devoted to the Turtle Mountain Recovery Center and the broader issue of the IMD exclusion and residential treatment capacity. Tribal leaders described the center’s opening, its five levels of care, its 16-bed limit, and its efforts to become financially sustainable through billing, grants, and partnerships. They shared success stories and argued for an IMD waiver or similar flexibility so the center could expand to 32 beds and better meet local need. Committee members discussed the policy barriers to expanding residential treatment, including federal approval timelines, state funding choices, and the need to preserve a continuum of care that includes outpatient and community-based services. The committee then heard a detailed presentation from Hector Hernandez-Dogato of the National Health Law Program on the history and mechanics of the IMD exclusion and Section 1115 waivers. He explained that the exclusion limits Medicaid payment for services in facilities with more than 16 beds, but noted existing exceptions and alternatives such as state plan options, managed care arrangements, telehealth, and community-based services. He also reviewed mixed results from states that have used IMD waivers, warning that they do not automatically improve overdose deaths, emergency room use, or access to community care, and may risk reinforcing institutionalization if not paired with strong upstream services. The committee discussed a draft bill to appropriate $49,000 and one FTE for HHS to pursue an IMD waiver, with members suggesting the bill may need to explicitly include serious mental illness as well as substance use disorder and asking for department input at a future meeting.