Transcript Highlights:

• We always pay below the upper payment limit, and that's actually a CMS regulatory requirement.
• CMS refers to the amount that otherwise would have been paid, and that's really if these individuals
• That is the cap, and CMS requirements require the PACE payments to be below that UPL cap.
• in Florida, the agency and the PACE organizations have operated under a three-way agreement between CMS
• collaboration with the PACE organizations to do, is really a two-party contract beyond the standard CMS

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:

• We've got a of CMS Medicare rates.
• CMS, the Center of Medicaid, Medicare, just released a study.
• Your report from CMS, uh, does >> Yes, sir.
• So so we know that CMS sets the >> Right.
• done in the last few years from CMS? done in the last few years from CMS?

Bills: HB185, HB378, SB28, HB400, SB155, HB312, HB185, HB378, SB28, HB400, SB155, HB312

Keywords: appropriation, transportation, judicial system, funding, state budget, Pickens County, local act, vehicle tag fee, registration fee, issuance fee, motor vehicle registration, license plate, replacement tag, transfer tag, renewal fee, county revenue, earmarked funds, ambulance service, emergency medical services, EMS

Transcript Highlights:

• CMS is enforcing these requirements.
• these regulated by CMS.
• CMS is enforcing these regulated by CMS.
• <00:44:36.400> these Rayel said that CMS monitors these Rayel said that CMS monitors these
• >> Well, you you said that well CMS >> Well, you you said that well CMS monitors<00:

Bills: HB1853, HB1591, HB1961, HB1854, HB1965, HB1962, HB1959, HB2505, HB2576, HB1801, HB1804, HB1864, HB2319, HB2314, HB2115

Keywords: HB1853, dementia, Alzheimer's disease, cognitive impairment, memory care, memory clinic, Hanai Memory Network, Executive Office on Aging, aging services, kupuna, caregiver support, long-term care, elder care, geriatrics, public health, dementia screening, care coordination, referral network, neighbor islands, rural health

Summary: The committee heard testimony on SB 2047, relating to pharmacy benefit managers. The Insurance Division said the bill would require new enforcement resources and estimated an appropriation of about $1.5 million and five positions. Kaiser Permanente asked for an amendment to exclude HMOs from the definition of third-party PBMs, saying the bill should not interfere with integrated care models. PCMA and the Hawaii Pharmacist Association supported narrowing amendments, with pharmacists objecting to section 3 and warning the bill as amended could create major operational burdens and a significant general fund cost. No vote was taken in the portion provided, and the chair moved on to the next measure after questions. The committee then took up SB 2080, which would allow Hawaii to join the psychology interjurisdictional compact. Supporters, including DCR, the Hawaii Association of Health Plans, the Hawaii State Association of Counties, the Grassroot Institute, and others, said the compact would expand access to psychology services, especially for people in rural areas or those needing continuity of care while traveling. Opponents, including the Board of Psychology and a Shamanad University psychology professor, raised concerns about client safety, crisis-response procedures, enforcement costs, FBI background checks, and possible loss of state control over training and specialization standards. The board said Hawaii’s current 1,900-hour internship/postdoc requirement is higher than the compact’s standard and that the state is still implementing a separate provisional licensing law that may address some access issues. The discussion focused on whether the compact would meaningfully reduce shortages and whether Hawaii should instead pursue changes within its existing licensing system. Finally, the committee heard SB 2277 on hospital price transparency. The Office of Consumer Protection initially noted the bill could require significant staffing, but later testimony from SHIP suggested the measure could be handled more simply by working with the Healthcare Association of Hawaii and publicly posting violations. The Healthcare Association of Hawaii opposed the bill, arguing hospitals already must comply with federal CMS transparency rules and that adding state requirements would increase costs and legal exposure, especially if violations were treated as unfair or deceptive trade practices. Steve Fenberg testified in support, saying the bill would simply codify existing federal requirements in state law and that he was open to amendments removing state enforcement and the unfair trade practice language. No final action was taken in the excerpt provided.

Transcript Highlights:

• I can also Submit successfully our application to CMS on Monday of this week.
• We are now sitting there on November 5th where all state applications are due to CMS.
• All states or CMS is required. Around state applications.
• So we do anticipate to still receive a notice from CMS before the 1st of January, 2026.
• This is mandated by the CMS conditions of participation.

Summary: The committee met to hear introductory briefings from the Department of Health and the Health Care Authority on agency priorities, federal changes, and implementation challenges. Secretary of Health Dennis Worsham said his department’s listening tour is focused on strengthening governmental public health, improving health care quality and access, and responding to federal funding disruptions and the shutdown’s effects on programs such as WIC. HCA Director Ryan Moran said the agency is prioritizing coverage preservation, oversight of major contracts, affordability, behavioral health integration, rural health transformation, and internal agency operations. Members asked about licensure delays; Worsham said the backlog had been reduced from about four months to six weeks and should be caught up by January 1, with possible further process changes if needed. A major portion of the meeting focused on H.R. 1 and its Medicaid-related implementation. Governor’s health policy advisor Caitlin Stafford, HCA staff, and interim Medicaid Director Trinity Wilson said the state is working with DSHS, the Health Benefit Exchange, tribes, and other partners to prepare for eligibility changes, work requirements, and six-month redeterminations. They said the state expects up to 30,000 Apple Health enrollees could lose coverage under the law’s non-citizen eligibility changes, and that the work requirement/redetermination provisions could affect about 620,000 adults, with roughly 80,000 also enrolled in SNAP. HCA said it hopes to automate most verification, but about 15% to 20% of cases may require manual review, with technology costs estimated at up to $30 million. Staff also said they are trying to keep H.R. 1 implementation mostly in budget language rather than statute, and that communication and navigator support will be important to minimize confusion and coverage loss. The committee also received an update on the Rural Health Transformation Program created in H.R. 1. HCA said Washington submitted its application to CMS on November 5 after extensive stakeholder engagement, including more than 310 written comments, webinars, and tribal consultation. The application centers on six initiatives: rural hospital innovation, community care and prevention, tribal investments, technology and data, workforce development, and rural behavioral health. HCA said the state is likely to receive less than the full $200 million annual amount assumed in the federal program, and that an advisory committee may be created to help guide spending over the five-year program. Members asked about palliative care, small business impacts, and communication with enrollees; HCA said it expects to share outreach toolkits and that no 2026 statutory changes are currently anticipated, though that could change. The final panels covered organ donation and transplant services. Department of Health staff explained the 2023 “Lights and Sirens” law for organ transport vehicles, including licensing, driver qualifications, insurance requirements, and use of emergency lanes and traffic preemption; the department said one company is currently licensed and there have been no complaints. LifeCenter Northwest described the organ procurement process, the legal framework under the Uniform Anatomical Gift Act, and the rarity and complexity of deceased donation, noting Washington has seen strong growth in donation and transplants over the past decade. University of Washington Medical Center staff then outlined its transplant programs for kidney, liver, heart, lung, pancreas, and multi-organ transplants, describing the multidisciplinary evaluation and waitlist process and the coordination required with donor organizations and hospitals.

Transcript Highlights:

• However, prior to the bill passing, our state was already engaged with CMS on mitigation plans.
• Our state was already engaged with CMS on mitigation plans, as we are non-compliant with our non-MAGI
• CMS no longer has the ability to give any good-cause waivers.
• Another 40% will be awarded again at the discretion of CMS.
• We're updating CMS. They've told us to do that.

Summary: The committee first received an update on the effects of HR1 and related federal Medicaid and marketplace changes from Governor’s Office and Health Care Authority staff. Presenters said the most immediate coverage losses are expected in the individual market beginning in January, with premium increases and an estimated 80,000 people potentially unable to afford coverage. They warned that larger Medicaid impacts will follow over the next year and beyond, including tighter eligibility checks, work requirements, reduced retroactive coverage, limits on state-directed payments and provider taxes, new cost-sharing, and changes affecting certain non-citizen adults. They also said the state plans to seek a waiver or extension for work requirements and will continue to analyze impacts, including on rural providers and Planned Parenthood-related services. Members asked about the effect on nursing homes, rural hospitals, and how the state can help providers and enrollees navigate the new requirements; staff said timelines and a state-specific implementation chart are being developed. The committee then heard a report on the International Medical Graduate Work Group and Washington’s efforts to create pathways for internationally trained physicians. Testimony described the clinical experience license, the clinical evaluation assessment tool, grant funding for IMG support organizations, and a new hardship waiver process enacted this year. National presenters said many states have adopted similar pathways because of physician shortages, but Washington and Tennessee are among the few states that have actually issued licenses so far. They recommended clear guardrails, an employment offer before application, ECFMG certification, supervised practice, and data collection to avoid exploitation and protect patients. Members asked about state-to-state variation, retention of IMGs, and whether Washington should pursue dedicated residency or preceptorship options; presenters said the key next step is moving successful participants from supervised experience to a durable long-term license. The final topic was implementation of Washington’s Apple Health doula benefit and the statewide doula hub and referral system. Senator T’wina Nobles highlighted the state’s $3,500 per-birth Medicaid reimbursement rate for doulas and the importance of the hub for referrals, training, and billing. Health Care Authority staff said the benefit launched January 1, 2025, and covers prenatal intake, labor and delivery, postpartum visits, and telehealth-supported services. They reported 336 state-certified doulas, 134 enrolled in Apple Health, 287 unique clients served, and 641 claims paid so far. Testimony emphasized doulas’ role in improving birth outcomes, reducing unnecessary interventions, and addressing racial disparities in maternal health, while noting that implementation is still early and ongoing.

Transcript Highlights:

• What we are working to do is work with CMS to determine what some Virginia add-ons might look like.
• But this does not... ...work with CMS to determine what some Virginia add-ons might look like.
• So you see the federal award from CMS.
• We need to make sure that we are CMS compliant, that we’re Commonwealth of Virginia compliant.
• So this isn't something that would sneak up on us or sneak up on CMS that there is an issue with.

Keywords: House Select Committee on Advancing Rural and Small Town Health Care, 976, house, all

Summary: The Rural Health Care Committee met to reorganize for the new interim, adopt its annual electronic meetings policy, and hear member priorities for the coming work. Members emphasized recurring rural health issues including access to primary and specialty care, workforce shortages, transportation barriers, maternal health and OB-GYN shortages, dental care, telehealth and broadband limitations, and the financial strain on rural hospitals. Several members also highlighted the value of mobile clinics, community colleges and K-12 pipeline programs, and bringing providers and local health departments into future meetings. Secretary of Health and Human Resources Marvin Figueroa briefed the committee on the worsening condition of rural hospitals and the impact of federal H.R. 1, saying Virginia’s rural health system faces major financial pressure and that the state’s Rural Health Transformation Fund is not a replacement for lost Medicaid-related support. He described the fund as a temporary opportunity to test new models such as mobile care, community paramedicine, workforce pipelines, and remote monitoring, while warning that coverage losses and service reductions are likely if the state cannot adapt quickly. Heidi Hertz, director of rural health transformation, then outlined Virginia’s approved plan and implementation timeline. She explained that Virginia will receive $189.5 million in year one, with funds needing to be obligated by October 30, 2026, and that the state must meet CMS metrics to avoid clawbacks or rescoring. She described the plan’s major workstreams: Care IQ for technology and innovation, Homegrown Health Heroes for workforce development, Connected Care Closer to Home for access and maternal care, and Live Well Together for prevention and chronic disease management, including Food is Medicine and consumer health technology. Committee members asked about local health department involvement, contracting structure, metrics, and funding sustainability, and Hertz said the committee would receive the presentation and that regional meetings and RFAs would roll out over the coming months. A public commenter thanked the committee for supporting a midwifery work group, and the meeting adjourned after members were encouraged to continue sharing ideas and helping publicize the program.

Transcript Highlights:

• director of CMS director of CMS telling<00:04:17.840> you<00:04:18.000> well<00:04
• You don't have the director of CMS say the state can pick it up, which is not true.
• And when you're dealing with CMS on an appeal, 12 to 18 months is not unusual.
• And when you're dealing with CMS on an appeal, 12 to 18 months is not unusual.
• for the timeline on that CMS appeal for the state?

Keywords: 1183, house

Summary: The governor discussed Minnesota’s budget outlook ahead of a supplemental budget release next month, saying the state remains financially strong but should be cautious because of federal uncertainty and a structural imbalance in spending. He said the administration’s approach will be measured, with limited new spending and possibly modest revenue measures, while prioritizing a bonding bill and maintaining the state’s AAA bond rating, reserves, and middle-class tax cuts. He also praised the 2023 legislative session and bipartisan cooperation as the basis for the state’s current position. A major topic was spending growth in special education and the broader human services system. The governor said special education is a fundamental service the state is legally and morally obligated to provide, but costs need to be managed more efficiently. He pointed to legacy IT systems in the Department of Human Services and county service delivery as expensive, antiquated, and error-prone, and said the state needs a multi-year modernization plan and continued reorganization. He argued that reforms such as prepayment verification and other fraud controls should reduce costs without cutting services. The governor also addressed federal actions affecting Medicaid and other programs, sharply criticizing efforts to withhold funds and claims of widespread fraud. He said Minnesota’s Medicaid error rate is lower than the national average and argued that the federal government’s approach would harm children, pregnant women, and seniors without improving fraud prevention. He also said the state’s gun violence prevention and fraud-fighting packages are expected to be relatively close to budget neutral. No formal votes or legislative actions were taken in the meeting, which was primarily a press availability and Q&A.

Transcript Highlights:

• Um however, CMS in um extension.
• <00:13:11.200> um also in my direct meetings with CMS um also in my direct meetings with CMS
• are able to make the application to CMS. are able to make the application to CMS.
• receipt of that to file with CMS. receipt of that to file with CMS.
• 1st we are submitting our plan to CMS. 1st we are submitting our plan to CMS.

Keywords: 1189, house, all

Transcript Highlights:

• Designation or classification in response to CMS, the Centers for Medicare and Medicaid Services, a new
• Has AHCA reviewed the CMS announcement, and do you intend to apply for any Florida share of the rural
• We've had recent conversations with CMS about this.
• However, we continue to engage with CMS on this. Okay, are you finished with this section?
• So, you know, we've had conversations with CMS as well at the higher levels of CMS, and they're also

Summary: The committee met to receive implementation updates on recently enacted health care laws from AHCA and the Department of Health. AHCA reported on rural emergency hospitals, explaining the new Class 4 hospital designation, rule changes completed June 1, 2025, and that no Florida hospitals have yet converted, though one North Walton/DeFuniak Springs-area hospital has expressed interest. AHCA also reviewed the non-emergent care access plan requirement for hospitals with emergency departments, saying 83 plans had been received since July 1 and 63 approved, with plans emphasizing patient education, referrals to primary care or urgent care, and coordination for Medicaid managed care enrollees through the Florida HIE/ENS system. Members asked about HIE capacity, data collection, and whether the plans would identify shortages or trigger accountability measures; AHCA said it had moved to a new HIE vendor and would continue gathering data. AHCA also updated the committee on the TEACH workforce program, reporting $6.8 million in FY 2024-25 spending across 59 parent organizations and 229 facilities, with more than 1,800 students and nearly 380,000 clinical hours reimbursed, and said a federal 1115 workforce waiver was unlikely to move forward under CMS. On KidCare, AHCA said House Bill 121’s expansion to 300% of the federal poverty level remains blocked by federal litigation and CMS action tied to premium nonpayment rules, and members and public witnesses urged prompt implementation and asked for enrollment/disenrollment data and the rural health transformation funding outlook. Public testimony largely supported the NCAP and TEACH programs and pressed for action on KidCare. Representatives from health centers said NCAP has strengthened hospital-health center relationships and improved care coordination, including reduced recidivism in some hospitals. A Bond Community Health Center physician said TEACH is helping offset the burden of training students and could help address workforce shortages, especially in rural and underserved areas. Advocacy groups urged the committee to push for implementation of the KidCare expansion, citing children in the coverage gap and rising uninsured rates. The Department of Health then presented on several programs from the 2024-25 session. It reported on the Florida Reimbursement Assistance for Medical Education (FRAME) program, including 78 dentists and 15 dental hygienists funded under the dental track and nearly 1,300 medical professionals funded overall, with 123 dental applications and 71 funded dentists in the most recent cycle. DOH also updated the Screening and Services Grant Program, the Health Care Innovation Revolving Loan Program, the statewide telehealth maternity care program, and the swimming lesson voucher program, noting strong participation and outcomes such as reduced ER visits and improved postpartum follow-up in the maternity program. Finally, DOH said implementation of the HIV prevention drug/pharmacist dispensing law is underway, with three certification courses approved and five certifications issued. Members asked about barriers to wider use of HIV prevention drugs, more detailed maternal outcome data, and the dental workforce program report; DOH said more detailed reports would follow.

Transcript Highlights:

• SOME BACKGROUND, 1990 CMS AUTHORIZE THE FIRST PACE PROGRAM AND IN 1998 THE FIRST FLORIDA PACE PROGRAM
• APPLICATION CONSISTS OF A NOTICE OF INTENT TO APPLY AS WELL AS THE PACE APPLICATION DEVELOPED WITH CMS
• AND THE APPLICATION PROCESS PACE ORGANIZATIONS ENGAGED WITH THE AGENCY AND CMS AND PROGRESS THROUGH A
• WOULD BE ENROLLED IN ANOTHER PROGRAM SO WHAT WOULD WE HAVE PAID IN THIS PROGRAM THAT IS THE CAP END CMS
• SINCE THE MEDICAID WAIVER HAS NOT BEEN SUBMITTED TO CMS TO CHANGE THIS WE BELIEVE IT MAY GET WORSE.

Keywords: 999, senate, all

Transcript Highlights:

• little bit, in the process, every year, the Medicare Advantage plans have to go and negotiate with CMS
• awaiting the final responses through the final rate-setting exercise that UnitedHealth Care is doing with CMS
• then 25% until reaching the donut hole, then 100% until reaching the out-of-pocket maximum, and then CMS
• Manufacturers would pay 50% of brand drugs, and CMS would pick up a different portion over 10 years to
• And so CMS recognizes there's a big difference between those. So when they put this in 2025...

Summary: The committee received an update from Grant Wallace on the rebid and possible decoupling of the state’s Medicare Advantage retiree coverage. He said the state is exploring splitting medical and pharmacy benefits for post-65 retirees, with UnitedHealthcare as the incumbent vendor, and that preliminary estimates suggested savings of about $100 to $200 per participant per month. He outlined the expected timeline for final CMS rate announcements in April 2026, with contract amendments likely to come before the committee in May or June after review by the EBD Advisory Commission and State Board of Finance. Representatives from Segal Consulting then reviewed the history and current structure of the Medicare Advantage prescription drug plan, explaining that the plan was adopted after a 2021 recommendation and launched in 2023 alongside the existing Med-Sup option. They said the Medicare Advantage option has produced substantial savings, including a lower monthly rate than the Med-Sup plan and about $40 million in savings from initial enrollment, while also restoring pharmacy benefits for some retirees. The presenters then explained recent federal changes under the Inflation Reduction Act, including major changes to Part D funding, the direct subsidy, and risk-score methodology, which they said have made risk adjustment much more important and are driving interest in separating medical and pharmacy contracts. In response to questions from senators, the presenters said the Medicare Advantage plan covers post-65 teacher and state employee retirees, including retirees from state agencies and K-12 public schools. They also explained that the new Part D structure has reduced out-of-pocket costs for members, with a $2,000 annual cap and lower average member spending to reach it, while shifting more cost to the plan. No votes were taken and no formal action was reported; the committee simply received the update and was told to expect further information after the April rate notice. The meeting adjourned with the committee scheduled to return on May 13.

Transcript Highlights:

• So the CMS price will be the billed price.
• Because those are the CMS fixed price limits for that rendered service.
• So if they're within that CMS fixed price list, then that's what Access has agreed to.
• Because those are the CMS fixed price limits for that rendered service.
• We are audited by CMS, and we have a single state audit.

Bills: HB2775, HB2874, HB2940, HB4014, HB4067, HB4115, HCM2010, HCR2051

Keywords: international organizations, government resources, public institutions, Arizona Board of Regents, foreign adversaries, campaign finance, contributions, termination statements, reporting, penalties, electoral processes, healthcare, public benefits, eligibility verification, fraud prevention, Medicaid, SNAP, transparency, accountability, state land

Summary: The Committee on Federalism, Military Affairs, and Elections heard several election, health care, and sovereignty-related measures. HB 4115 and mirror resolution HCR 2051 would extend existing statewide rules for paid petition circulators and initiative/referendum disclosures to municipal and county measures, including badge/display requirements for paid circulators and disclosure of expenditures and revenue sources. Speaker Montenegro and supporters framed the bills as transparency and anti-out-of-state influence reforms; the committee recommended HB 4115 do pass by 5-2 and HCR 2051 by 4-3. The committee also considered HCM 2010, urging Congress to repeal the Seventeenth Amendment and return selection of U.S. senators to state legislatures. Sponsor Rep. Powell argued it would restore state sovereignty and accountability, while other members raised concerns about direct democracy, deadlock, and the need for broader public support. The memorial failed on a 3-3-1 vote after a present vote was recorded, despite some members expressing sympathy for the concept. HB 2940 proposed major changes to AHCCCS and DES eligibility verification and procurement, including expanded data checks, a unified eligibility rules engine, new contracting concepts, and a fixed benefit price list. The sponsor said the bill was intended to increase competition, transparency, and fiscal discipline; AHCCCS testified neutrally, noting it already uses many data matches but would need additional work and costs for some provisions, while health plan representatives opposed the bill as a major operational shift that could limit negotiated rates. The committee recommended the bill do pass 4-3. HB 2874, which would ease termination-statement requirements and penalties for committees that never raised money, passed unanimously 7-0. HB 467, requiring inactive-voter status information to appear in precinct registers, signature rosters, or e-poll books, was amended to change a mandatory “shall” to permissive “may” and then passed 5-2. Finally, HB 2775, as amended, would bar state and higher-education participation in implementing international-organization rules or agreements; after removing rulemaking authority for ABOR and adding a higher-education review process, it passed 4-3. The committee then adjourned.

Transcript Highlights:

• Designation or classification in response to CMS, the Centers for Medicare and Medicaid Services, a new
• Has AHCA reviewed the CMS announcement, and do you intend to apply for any Florida share of the rural
• We've had recent conversations with CMS about this.
• However, we continue to engage with CMS on this. Okay, are you finished with this section?
• So, you know, we've had conversations with CMS as well at the higher levels of CMS, and they're also

Summary: The committee opened with roll call, welcomed members back for the first committee weeks, and heard brief personal updates from several senators before moving into agency implementation updates on recently enacted health care laws. The Agency for Health Care Administration reported on Senate Bill 64 creating rural emergency hospitals, explaining that AHCA adopted the required rules effective June 1, 2025, but that no hospitals have yet been designated. Members asked about possible hospital conversions, accreditation and survey responsibilities, and whether Florida would apply for federal rural health transformation funding; AHCA said it intends to apply and has already been working on the issue with federal officials. AHCA also reviewed the non-emergent care access plan requirement under Senate Bill 7016. The agency said hospitals with emergency departments must submit plans that help redirect non-emergent patients to appropriate care settings while complying with EMTALA, and that 83 plans had been received and 63 approved as of September 30. Members asked about data collection, managed care coordination, and the state’s health information exchange; AHCA said it has moved to a new HIE vendor and will continue monitoring implementation and possible care gaps. AHCA then updated the committee on the TEACH program, saying $6.8 million was spent in 2024-25 across 59 parent organizations and 229 facilities, with more than 1,800 students and nearly 380,000 clinical hours reimbursed. The agency said rulemaking is nearly complete, a new nursing student category and expanded facility eligibility were added, and a federal 1115 workforce waiver remains stalled after CMS signaled it will not approve new workforce demonstrations. AHCA also reviewed House Bill 121 on KidCare eligibility, explaining that implementation of the 300% poverty-level expansion remains blocked by federal litigation and waiver issues tied to premium nonpayment rules; members and public speakers urged action to close the coverage gap. Public testimony on AHCA’s presentation came from representatives of health centers and advocacy groups, who said the non-emergent care access plan has improved hospital-health center coordination and reduced repeat emergency use, and who urged implementation of KidCare expansion for children in the coverage gap. The Department of Health then presented updates on FRAM, the Sanadi screening grant program, the Health Care Innovation Revolving Loan Program, telehealth maternity care, swimming lesson vouchers, and House Bill 159 on pharmacist dispensing of HIV post-exposure prophylaxis. DOH reported strong participation in FRAM and the telehealth maternity program, 24 Sanadi grant awards in 42 counties, 4,945 swimming lesson vouchers issued last year and 2,371 so far this year, and three approved certification courses with five pharmacist certifications issued under HB 159. Committee members asked about recruitment of dentists and other providers, telehealth maternity outcomes, and why participation in the maternity program remains below expected levels; DOH said outreach and regional referral networks are expanding and more detailed outcome data will be included in the upcoming legislative report.

Transcript Highlights:

• We have received preliminary CMS.
• Um we do need a state guidance from CMS.
• Um, and this one would require a CMS.
• <01:23:47.760> in receiving any guidance um from CMS in receiving any guidance um from CMS
• We do know CMS is monitoring government.

Keywords: 1187, senate, all

Transcript Highlights:

• Can you tell us when AHCA submitted the model to CMS and provide some details as to why it was so late
• attestations, we have received attestations from all the hospitals, and those have been submitted to CMS
• But it sounds as if that was a big concern for CMS.
• forward, exactly what is your understanding of what may have created any kind of that holdup at the CMS
• When I personally, we were trying to get approval on these from CMS, the Florida Cancer Hospital program

Summary: The Legislative Budget Commission met with a quorum present and considered two Agency for Health Care Administration budget amendments related to Medicaid supplemental payments. The first amendment, EOGB 2026-0831, authorized $2.1 billion in budget authority for the Low-Income Pool to support safety-net providers with uncompensated charity care. Members asked about the timing of AHCA’s submission to CMS and whether the program addressed hospital shortfalls for insured patients and CHIP-related concerns. AHCA said approvals have generally been slower under the current federal review process, and the amendment was adopted without objection. The second amendment, EOGB 2026-0875, placed $7.9 billion in reserve for Florida’s Directed Payment Program for Hospitals pending final CMS approval. Senators and representatives questioned the role of hospital attestations regarding hold harmless agreements, whether any agreements had to be unwound, and how long final approval might take. AHCA said all hospitals had submitted attestations, no unwinding was known to be necessary, and approval was expected soon. Members also raised concerns about cancer hospitals, including Moffitt and the University of Miami, not participating in the directed payment program. AHCA responded that those institutions participate instead in a separate Florida Cancer Hospital supplemental payment program, which had already been approved. Both amendments were adopted without objection, and the commission then adjourned.

Transcript Highlights:

• We had a hard summer and fall and winter about that topic, but, like, it was CMS that said we have to
• CMS later gave states flexibility to select a new benchmark plan, and Oregon exercised this option to
• Early in the implementation of the ACA, CMS guidance indicated that it is the responsibility of each
• Previously, CMS had never provided this level of guidance. Yeah, it's not made clear.
• There has been, in no event, has CMS taken action to enforce.

Keywords: 907, all

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

Transcript Highlights:

• to note is we have heard um so CMS to note is we have heard um so CMS retains<00:14:17.120> discretion
• on CMS guidance.
• So, CMS Rural Health Transformation Program. It's part of HR1.
• , get to the CMS website and read the 124-page document for your enjoyment.
• And then hopefully<00:53:21.200> CMS hopefully CMS hopefully CMS um<00:53:23.440> gives

Keywords: 958, all

Summary: The committee met and approved the minutes from its August 27 meeting. It then received a presentation from Katherine Castanza of the National Conference of State Legislators on the Medicaid provisions in the 2025 budget reconciliation bill, referred to as HR1. She explained that the bill is estimated by CBO to save the federal government $911 billion over 10 years, with more than 20 Medicaid-specific provisions, most of the savings concentrated in five policies and largely backloaded into 2030-2034. She emphasized that the bill’s effects will vary by state, but that expansion states and hospitals are expected to be most affected, in part because of changes to eligibility, provider taxes, and state-directed payments. Castanza highlighted several new funding and flexibility provisions, including a $50 billion Rural Health Transformation Fund for 2026-2030 and a new home- and community-based services waiver option effective July 1, 2028, with $100 million in grants in fiscal year 2027. She also outlined major eligibility changes for Medicaid expansion adults: work or community engagement requirements effective January 1, 2027; twice-yearly redeterminations for the expansion population effective the same date; and new cost sharing for certain expansion adults effective October 1, 2028. She noted that Kentucky, as an expansion state, would be subject to these changes and that state agencies would face significant implementation demands, especially because federal guidance and timelines are tight. A substantial portion of the presentation focused on financing changes. Castanza described new limits on provider taxes, including a 0% safe harbor for new taxes and a phased reduction for existing taxes in expansion states beginning in 2028, while nursing facilities and intermediate care facilities are exempt from the reduction if already taxed. She also explained that state-directed payments will be capped and phased down over time, with existing arrangements grandfathered only briefly; she said Kentucky has 11 approved state-directed payments and could see significant fiscal effects. She added that the bill also bars Medicaid payments to Planned Parenthood or similarly situated providers for one year, changes immigrant eligibility rules effective October 1, 2026, lowers the federal match for certain emergency services, and expands the scope of the federal erroneous payment recoupment provision effective October 1, 2029. Throughout, she stressed that federal savings may translate into state cost shifts and that implementation timing will be critical.

Transcript Highlights:

• Can you tell us when AHCA submitted the model to CMS and provide some details as to why it was so late
• attestations, we have received attestations from all the hospitals and those have been submitted to CMS
• But it sounds as if that was a big concern for CMS.
• forward, exactly what is your understanding of what may have created any kind of that holdup at the CMS
• When I personally, we were trying to get approval on these from CMS, the Florida Cancer Hospital program

Summary: The Legislative Budget Commission met with a quorum present and considered two budget amendments for the Agency for Health Care Administration. The first, EOGB 2026-0831, authorized $2.1 billion in budget authority for the Low-Income Pool to support safety-net providers for uncompensated charity care. Members asked about the timing of CMS approval and whether the program addressed hospital shortfalls for insured patients and children; AHCA said the program is for uncompensated care and would follow up on specific questions. The amendment was adopted without objection. The second amendment, EOGB 2026-0875, placed $7.9 billion in reserve for Florida’s Directed Payment Program for hospitals, pending final CMS approval. Discussion focused on hospital attestations that no hold harmless agreements were in place, the meaning of those federal requirements, and whether any agreements had to be unwound; AHCA said attestations had been received from all hospitals and submitted to CMS. Members also asked about the approval timeline and whether another amendment would be needed after final approval, and AHCA said approval was hoped for soon but could not confirm the budget process. Representative Woodson raised concerns about cancer hospitals not participating in the DPP; AHCA responded that those hospitals participate instead in a separate Florida Cancer Hospital supplemental program, which had already been approved. This amendment was also adopted without objection, and the commission then adjourned.

Transcript Highlights:

• the Department of Human Services sent a request to the Centers for Medicare and Medicaid Services, CMS
• CMS agreed on Halloween last year to have this program stopped.
• Medicare Medicare and Medicaid Services, Medicare Medicare and Medicaid Services, CMS,<00:00:51.080><
• c> to CMS, to CMS, to close<00:00:53.000> the close the close the >> [clears throat]
• c> last<00:01:14.440> year<00:01:14.720> to CMS agreed on Halloween last year to CMS

Keywords: 1183, house

Transcript Highlights:

• and that is under review at CMS. and that is under review at CMS.
• <00:39:51.440> required encounters and that's a CMS required encounters and that's a CMS required
• It would have to be reviewed by CMS.
• , how CMS would see a potential change.
• <00:44:19.200> a um and what CMS how CMS would see a um and what CMS how CMS would see a potential

Keywords: Medicaid - Room 216, 4 February, 2026; 2:00 PM, 925, all

Summary: The committee heard presentations on several Medicaid-related topics. First, a pharmacy representative discussed nonopioid pain medications as a way to reduce opioid dependence and overdose risk, emphasizing that options such as acetaminophen, NSAIDs, and topical diclofenac can be useful for pain management. She cautioned that nonopioids can still have risks and said any policy should avoid requiring patients to step through opioids before accessing safer alternatives, while still allowing reasonable step therapy among nonopioid options. The presenter said the goal is to keep patients from being pushed toward opioids by cost or insurance design. The committee also heard emotional testimony from parents of a child with Prader-Willi syndrome, who described the condition as a rare genetic disorder that causes severe, lifelong hyperphagia and requires rigid supervision and ongoing treatment. They argued that alternative funding programs can disrupt access to medically necessary drugs such as human growth hormone, forcing families into costly and uncertain coverage gaps. They asked lawmakers to ensure insurance coverage remains stable for rare disease patients and thanked Senator Blackwell for prior support of rare disease legislation. Next, a Livanova representative urged the committee to support higher Medicaid reimbursement for vagus nerve stimulator surgery for drug-resistant epilepsy. He said inadequate hospital reimbursement has reduced access in Mississippi, causing patients to travel long distances or go without treatment, and argued that better reimbursement would improve outcomes and save money over time. He cited studies showing seizure reductions, lower ER use, and a projected $2.8 million in five-year savings for Medicaid based on 40 patients, and asked that hospitals be reimbursed at 100% of Medicare rates for the procedure codes. Finally, a Medicaid official gave a broad overview of hospital payment structure, including fee-for-service, managed care, MHAP, DSH, UPL, provider taxes, and related funding mechanisms. She explained that hospital payments are interrelated and have shifted over time, with major changes tied to managed care, MHAP/UPL increases, and provider taxes. At the end of the discussion, the committee was running short on time and asked her to skip ahead to the provider tax component; no votes or formal actions were taken in the portion provided.