Transcript Highlights:

• I work as a PCA and CNA, and I am here today representing all my consumers with catastrophic disease
• There are fewer nurses, fewer CNAs, fewer PCAs, and fewer beds and services. in the history of America
• ones when we have less when we have less we provide less care there are less nurses there are less CNAs
• less PCAs and there are less beds and services Less CNAs, less PCAs, and there are less beds and services

Keywords: 995, all

Summary: The Joint Committee on Revenue, chaired by Senator James Eldridge and Representative Adrian Madaro, opened its hearing with a moment of silence for the late Lowell State Senator Ed Kennedy and reviewed hearing procedures and deadlines. The committee then took testimony on several corporate tax bills, including S. 2033/H. 3110 on offshore tax avoidance, H. 3248 on a manufacturing tax exemption, H. 3057 on a tiered corporate minimum tax, and S. 2041 on a corporate tax haven blacklist, along with a separate business interest deduction bill. No votes were taken during the hearing. Supporters of S. 2033/H. 3110, including labor unions, health care workers, educators, public health advocates, seniors, and several legislators, argued that Massachusetts needs new revenue to offset federal cuts to Medicaid, SNAP, health care, education, and other services. They said the bill would raise roughly $400 million annually by increasing the share of offshore profits included in the state tax base from 5% to 50%, and they framed it as a fairness measure that would require large multinational corporations to pay more while leaving most local businesses and workers unaffected. Testimony emphasized risks to MassHealth, PCA services, adult dental care, hospitals, schools, and public health programs if new revenue is not raised. Opponents, including the Mass Taxpayers Foundation and the Council on State Taxation, argued the proposal is poor tax policy and likely unconstitutional because it would tax foreign-source income without allowing foreign tax credits or a comparable apportionment method. They said Massachusetts should take a broader, coordinated approach to federal tax changes rather than a standalone bill, and warned of litigation risk and possible double taxation. Supporters such as MassBudget and former tax counsel Don Griswold countered that the bill is a reasonable rough-justice approach, consistent with federal and neighboring-state treatment, and that it would primarily affect a small number of very large multinationals. On S. 2041, the Global Business Alliance opposed the proposed tax haven blacklist, while supporting a separate bill allowing business interest deductibility.

Transcript Highlights:

• and guardian, the fallen and those who love and miss them, the infirm and the elderly, nurses and CNAs
• 00:01:52.960><c> elderly,</c><00:01:53.759><c> nurses</c><00:01:54.159><c> and</c><00:01:54.479><c> CNAs
• ,</c> infirm and the elderly, nurses and CNAs, infirm and the elderly, nurses and CNAs, and<00:01:56.000

Keywords: 1183, house

Transcript Highlights:

• Um, maybe they were going to be a nurse and now they're a CNA at a nursing home.
• them</c><00:03:50.159><c> so</c><00:03:50.239><c> they're</c><00:03:50.400><c> a</c><00:03:50.560><c> CNA
• </c><00:03:50.879><c> at</c><00:03:51.040><c> a</c> it's not for them so they're a CNA at a it's not
• for them so they're a CNA at a nursing<00:03:51.519><c> home.

Keywords: 1183, house

Transcript Highlights:

• The bonuses would be paid to all current and new CNAs taking a position with the agency.
• That includes the CNAs, LPNs, and the RNs. And so they have freedom to hire all the people.

Summary: The committee first took up several personnel and compensation requests. It approved a Department of Parks, Heritage and Tourism reclassification that would trade three administrative coordinator positions for one park superintendent, one maintenance supervisor, and one park manager. It also approved one-time bonus and recruitment plans for the Department of Commerce and Department of Veterans Affairs, including up to $5,000 bonuses tied to the unemployment insurance modernization project and $2,000 bonuses for certified nursing assistants at the state veterans homes. A Department of Health request to reinstate a previously frozen fiscal support manager position for the State Medical Board was also approved; members were told the position was already authorized and would not increase total positions. The committee then reviewed a Department of Commerce reduction in force affecting the Division of Workforce Services for the Blind and Employment and Training divisions. Secretary Hugh McDonald and Workforce Connections Director Cody Waits explained that the cuts were driven by over-obligated federal funds, a prior realignment, and what they described as long-standing fiscal mismanagement in the Division of Services for the Blind. They said 56 employees remained furloughed, five employees in a separate grant group were still working, and 17 positions were on the permanent RIF list. Senators questioned the division’s accountability structure, the role of the independent board, and whether the layoffs were being handled fairly, including a request for racial composition data on the workforce and the RIF group. Members also discussed quarterly employment and overtime reports. Staff explained that the reports cover average staffing levels over each quarter, and members focused on overtime spending, especially in DHS, the Department of Correction, and the Department of Transportation. OPM said overtime is being reviewed, direct care positions remain exempt from the hiring freeze, and agencies have been hiring more staff since the new pay plan took effect. The committee asked for additional reporting on overtime trends, and the meeting adjourned without further action.

Transcript Highlights:

• Their CNAs, LPNs, RNs, and so many people that are in those buildings need to see better care, as they
• And as a CNA myself, I took an oath for everyone's care..." Young concluded: "...needs.
• And as a CNA myself, I took an oath for everyone's care.

Summary: The Civil Justice and Claims Subcommittee considered one bill, HB 603, which would repeal section 768.21(8), the Florida medical negligence wrongful death exception often referred to by supporters as the “Free Kill” law. The sponsor argued the current statute unfairly bars certain families—especially adult children or parents of unmarried adults without minor children—from recovering non-economic damages when a loved one dies from medical negligence, while such damages are available in other wrongful death cases. Supporters, including family members, AARP, and some legal advocates, testified that the law is discriminatory and denies equal access to justice for grieving families and vulnerable adults. Opponents, including physicians, hospital and insurer representatives, and business groups, argued that repeal would increase malpractice exposure, raise premiums, worsen access to care, and accelerate physician retirements or departures from Florida. Several urged that if the bill moves forward, it should be paired with caps on non-economic damages to balance the impact on the health care system. Supporters countered that negligence must still be proven, that the law creates unequal treatment, and that existing tort reforms have not lowered premiums. The sponsor closed by rejecting claims that the bill is “jackpot justice” and emphasizing that families deserve court access and accountability. After debate, the committee voted on HB 603 and passed it 16-2. The meeting then adjourned.

Transcript Highlights:

• Is it CNAs, RNs, or what?” “It's absolutely CNAs.
• Most of our vacancies, 39 of them are not CNAs; 240 agency-wide are CNAs.”
• “So we train CNAs in-house to be CNAs. You can't just walk in the door.
• But what I hear from talking with these CNAs is that a lot of them are more worried about putting a roof

Keywords: 959, house, all

Transcript Highlights:

• Also on that is some more granular data showing you how many people are applying for CNA positions across
• Like, for example, on one CNA position, we had 195 people apply for it.
• For example, on one CNA position, we had 195 people apply for it.

Keywords: 1204, all

Transcript Highlights:

• On behalf of CNA, we are proud to co-sponsor SB 81.
• This is why today CNA nurses ask that you pass Senate Bill 81.
• This is why today, CNA nurses ask that you pass Senate Bill 81 because health care is a human right and

Summary: The Assembly Privacy and Consumer Protection Committee heard several bills focused on AI, immigration-related health care protections, digital financial assets, and online cannabis/hemp sales. SB 69 by Senator McNerney would create an AI-focused team within the Department of Justice to build enforcement expertise on civil rights, public safety, and legal issues tied to AI. SB 81 by Senator Arreguín would codify hospital and health facility policies limiting disclosure of patient immigration status and restricting immigration enforcement access without a judicial warrant. SB 97 by Senator Grayson would update and clarify California’s digital financial assets licensing law. SB 243 by Senator Padilla would impose guardrails on AI companion chatbots, including disclosures, anti-addictive design limits, self-harm protocols, and a private right of action. SB 378 by Senator Wiener would allow civil penalties against online marketplaces that advertise illicit intoxicating hemp and unlicensed cannabis products. Testimony on SB 69 emphasized that California needs in-house AI enforcement expertise at the DOJ; supporters said AG offices generally lack tech-policy specialists, while members asked about the Attorney General’s role and noted the office was neutral. SB 81 drew broad support from nurses, immigrant advocates, hospitals, labor, and community groups, who argued that hospitals should remain safe places for care regardless of immigration status; there was no opposition. SB 97 was described as a technical cleanup bill with stakeholder consensus, and the main public comment focused on ensuring blockchain-based nonfinancial products are not unintentionally swept into the law. SB 243 generated the most debate. Supporters, including the mother of a Florida teen who died by suicide after interacting with a chatbot, urged stronger protections for minors and vulnerable users. Opponents argued the bill’s definitions were too broad and could capture general-purpose AI systems, and raised concerns about privacy, cost, and a private right of action. Committee members largely supported the bill’s intent and discussed the need for guardrails without stifling innovation. SB 378 was supported by cannabis workers, retailers, and local government representatives who said online sales of untested intoxicating hemp and illegal cannabis are harming public health and the legal market; opponents from hemp and tech groups argued the bill could sweep in lawful hemp businesses and that definitions need refinement. The committee ultimately passed SB 69, SB 81, SB 97, SB 243, and SB 378, with SB 81 and SB 243 amended, and all five bills were sent onward to their next committees.

Transcript Highlights:

• It's staffing cuts and costs to nurses and nursing, CNAs, residents, activities, and social work.
• It's staffing cuts and costs to nurses and nursing, CNAs, residents, activities, and social work.
• It's staffing cuts and costs to nurses and nursing, CNAs, residents, activities, and social work.
• It's staffing cuts and costs to nurses and nursing, CNAs, residents, activities, and social work.

Keywords: 1183, house

Transcript Highlights:

• The average for CNA wages went up by $1.75 during that same time frame here, and if we extrapolate that
• Chair, I would argue that we're getting pretty good value if we can raise the wages for our CNA workers
• wages during that presented on was CNA wages during that time<00:50:32.480><c> what</c><00:50:32.599
• wages went up by $1.75 average for CNA wages went up by $1.75 during<00:50:37.400><c> that</c><00:50
• </c> raise uh the the wages for our CNA raise uh the the wages for our CNA workers<00:51:16.440><c> the

Keywords: 1183, house

Transcript Highlights:

• So with nursing here, we have this example starting with the CNA program.
• in this example, we have someone, let's say, is at a community center and they're working through a CNA
• They'll get that CNA training certificate, and then the pre-apprenticeship would help place them into

Keywords: 995, all

Summary: The Workforce Support Subcommittee met to discuss using registered apprenticeships to help address workforce shortages in disability services, human services, and other high-need fields. Co-chairs and staff introduced the session as a follow-up to earlier discussions with state labor officials and representatives from developmental disability and behavioral health provider associations. The panel focused on how apprenticeships can create paid, structured pathways into jobs while also supporting credentialing and retention. Amara Ramon of the Division of Apprenticeship Standards explained how Massachusetts apprenticeship programs are registered and supported, including the roles of apprenticeship liaison staff, operations, quality assurance, and grant support. She described the core features of apprenticeships—paid on-the-job training, related technical instruction, wage progression, and industry credentials—and contrasted them with internships or co-ops. Melissa Chabelli of the MassHire Hampden County Workforce Board described the intermediary role her board plays in designing programs, registering apprentices, coordinating employers, and handling compliance. She emphasized flexibility, employer investment, tax credits, retention benefits, and the importance of mentors and local workforce partnerships. Lisa Morris of UMass Chan/For Health Consulting described a developing apprenticeship for medical interpreters, built from an existing training foundation and designed to address the gap between classroom preparation and work experience. She said the model would combine pre-apprenticeship training, employer interviews, 2,000 hours of apprenticeship, and related technical instruction tied to national certification. Speakers also discussed examples for nursing, early childhood education, CNC machining, and programs serving neurodivergent learners, including Bridgewater State’s Excel program. In response to audience questions, panelists said state agencies can serve as intermediaries, recruitment can come through career centers, youth programs, community colleges, ESL centers, and incumbent workers, and accommodations or modified curricula can support apprentices with disabilities. No votes were taken; the session ended with encouragement for attendees to contact the presenters and Division of Apprenticeship Standards for help developing programs.

Transcript Highlights:

• So if you have people in shopping malls offering RN programs, then they may be doing CNAs or something
• In my district, there is a school that will give you a prep and it’ll say that you are this CNA individual

Summary: The Education and Employment Committee met with a quorum and considered one bill, HB 121 by Representative Overdorf, relating to nursing education programs. The sponsor said Florida’s nursing shortage is projected to worsen and argued that low NCLEX passage rates show some programs are not adequately preparing students. The bill would tighten probation for underperforming programs, require program directors to be accountable, authorize Department of Health on-site inspections, require admission criteria and public posting of NCLEX passage rates, and require tuition reimbursement and free remediation for students at programs with passage rates below 30 percent. Members asked about how the bill would interact with the Board of Nursing, the Commission for Independent Education, and other agencies, and whether it would address fraudulent or low-quality schools. An opponent from the Florida Association of Independent Nursing Schools said current law already requires Board of Nursing and commission review, institutional accreditation, and provisional status for programs on probation, and argued the bill could reduce the supply of nurses. He also said Florida’s NCLEX results had recently improved. A representative of the Florida Nurses Association supported the bill, saying weak programs waste students’ time and money and do not produce licensed nurses. During debate, several members described concerns about diploma mills, fraudulent programs, student debt, and the need for stronger screening and accountability. Others emphasized that raising standards would improve patient safety and help ensure better-prepared nurses. The chair noted the importance of private nursing colleges in the state’s nursing pipeline. The committee then voted 19-0 to report HB 121 favorably and adjourned.

Transcript Highlights:

• So those should be done by a CNA under chapter 457, under nurses, and then using nurse delegation for
• CNAs to be doing those services under private duty nursing and not home care agencies.
• </c><00:59:43.760><c> uh</c><00:59:43.920><c> under</c> those should be done by a CNA uh under those
• should be done by a CNA uh under you<00:59:44.720><c> know</c><00:59:45.200><c> um</c><00:59:45.599><
• </c> and then using nurse delegation for CNAs and then using nurse delegation for CNAs to<00:59:50.240

Keywords: 910, house, all

Summary: The joint hearing opened with SB 1442, which would update the statute governing the Child and Adolescent Mental Health Division and clarify its role as the state Medicaid provider of intensive mental health services for children and adolescents with serious emotional disturbance. The Department of Health testified in strong support, saying the current statute is outdated and warning against any unfunded mandate because the division relies on federal funding and faces uncertainty about future resources. Written testimony from several organizations also supported the bill. The committees took no immediate action and said they would hold decision-making until later. The hearing then moved to SB 479 on ABLE savings accounts. The Hawaii State Council on Developmental Disabilities and the Hawaii Disability Rights Center supported the measure, arguing that ABLE accounts help people with disabilities save money without losing benefits and that the state needs more outreach and staffing to expand participation. A testifier with a disability said the bill would help people keep Social Security and housing stability. The chair indicated an intention to move the bill forward, and asked about funding; the discussion settled on a requested appropriation of about $75,000 for incentives. Next, SB 1245 on reimbursement of pharmacists drew broad support from the Hawaii Pharmacists Association, rural pharmacies, the Hawaii Primary Care Association, and others, who said the bill would improve access to care, especially on neighbor islands and in rural communities, and help pharmacies participate in 340B-related services. The Insurance Division and HMSA raised concerns about bill language, saying it could be read to cover pharmacists outside an insurer’s network and that the scope of reimbursable services needed clarification; the pharmacists’ association said the bill is intended to apply only to in-network pharmacists and should continue to reference existing scope-of-practice law. The hearing also took up SB 1279, which would allow pharmacists to authorize medications via telehealth under certain circumstances. The State Board of Pharmacy opposed the bill, citing patient safety, a pilot project with reported errors, concerns about controlled substances and unregulated technicians, and the view that in-person pharmacist services are safer and already available on the affected islands. Several pharmacies and health care groups supported the measure as a way to preserve 340B access and improve service on Lānaʻi and Molokaʻi, while some local pharmacies said they already provide in-person service and opposed remote dispensing. No votes were taken in the portion of the hearing provided.

Transcript Highlights:

• my parents' insurance," you know, and if you can become a travel nurse or a travel LNA or a travel CNA
• my parents' insurance," you know, and if you can become a travel nurse or a travel LNA or a travel CNA
• my parents' insurance," you know, and if you can become a travel nurse or a travel LNA or a travel CNA
• my parents' insurance," you know, and if you can become a travel nurse or a travel LNA or a travel CNA
• my parents' insurance," you know, and if you can become a travel nurse or a travel LNA or a travel CNA

Keywords: 928, house, all

Summary: The committee first handled routine business, approving the prior meeting minutes with one abstention from a member who had been absent. It then received an update from DHHS Commissioner Lori Weaver on the department’s rural health transformation grant submission. Weaver said the grant was submitted ahead of the deadline, reflected input from communities and providers statewide, and would now enter a CMS review and negotiation phase. She explained that the governor’s office will oversee the grant with DHHS, that some proposals may be limited by federal parameters, and that the department may need to hire some staff to administer the grant, within the grant’s administrative cap. Members also discussed DHHS budget pressures and staffing. The department’s CFO, Nathan White, reviewed the agency’s budget mix, noting that DHHS accounts for a large share of the state’s operating and general fund budgets, and explained projected general fund lapse estimates, which he said are currently just under $20 million for the department. He also described why lapse projections are difficult to predict in DHHS because many costs are driven by utilization and because some funds are statutorily non-lapsing. White reported that vacancy rates have risen, citing about 400 unfunded positions in the current biennium and the department’s hiring freeze, while emphasizing that direct-care positions are being prioritized. Committee members raised concerns that back-of-the-budget cuts and weak revenue collections could affect the department’s ability to manage lapse projections. The committee then heard from Division of Public Health Director Ian Watt on vaccine policy and federal changes. Watt said New Hampshire continues to support access to safe and effective vaccines, including through the universal purchase program and seasonal respiratory virus guidance. He explained a recent CDC change regarding the MMRV vaccine, which now discourages the combined shot for the first dose in children under four because of febrile seizure risk, while still allowing it for the second dose. Watt said New Hampshire’s school and child care vaccine mandates remain stable, with nine vaccines required for schoolchildren and 10 for child care, and that the state continues to review federal recommendations cautiously. He also said there have been no supply or funding disruptions affecting vaccine access, and that childhood vaccine funding through commercial insurers remains intact. Finally, the Permanent Subcommittee on Alzheimer’s Disease and Other Related Dementias presented its annual report. The subcommittee said it met about six times, heard presentations on state services, silver alerts, brain health awareness, and palliative/hospice care, and began work on updating the state’s Alzheimer’s plan, which had last been updated in 2015-2016. To gather more direct input, the subcommittee formed a needs-assessment work group to develop a survey for people living with dementia, caregivers, and service providers. It recommended integrating Alzheimer’s and dementia materials into chronic disease, aging, and public health outreach; embedding cognitive health into systems of care and the state health improvement plan; adding cognitive health measures to BRFSS; and continuing partnerships with aging and advocacy organizations. Members praised the report and suggested it should clearly identify the subcommittee and include page numbers in future versions.

Transcript Highlights:

• So right now it clearly says CNAs, home health aides, RNs, LPNs, top demands, manufacturing, truck drivers
• So right now it clearly says CNAs, home health aides, RNs, LPNs, top demands, manufacturing, truck drivers
• So right now it clearly says CNAs, home health aides, RNs, LPNs, top demands, manufacturing, truck drivers
• So right now it clearly says CNAs,<00:51:45.920><c> home</c><00:51:46.160><c> health</c><00:51:46.400
• ><c> aids,</c><00:51:46.720><c> RNs,</c><00:51:47.559><c> LPNs,</c><00:51:48.559><c> top</c> CNAs, home

Bills: HF2440

Keywords: labor market, employment, economic development, funding, data analysis, 1183, house

Transcript Highlights:

• So CNAs is another professional type that the state has really focused on increasing the pipeline.
• We have... ...seen an increase in the number of CNAs in Massachusetts over the last few years, but this

Keywords: 995, all

Summary: The Massachusetts Commission on the Status of Persons with Disabilities subcommittee on workforce supports met with Chair Andrew Lerault presiding. Members completed roll call, approved the August 2025 minutes, and then heard a presentation from Amy Doyle, director of the Behavioral Health Workforce Center at the Massachusetts Health Policy Commission. Doyle described the center’s launch in September 2024 and its legislative mandate to study behavioral health payment rates, workforce needs, and licensure/certification barriers, with an emphasis on recruitment, retention, capacity building, diversity/equity, and sustainability. She also shared data on unmet behavioral health needs, ED boarding, workforce shortages, aging and turnover in nursing and direct care, and the need to improve data collection on non-licensed workers and populations such as people with developmental disabilities and autism. Committee members asked questions about what provider types were included in the workforce data and whether DDS-related residential and direct support roles were captured. Doyle said the center is still working to define and measure the full behavioral health workforce, including non-licensed roles, and welcomed follow-up on missing data sources. Members suggested additional sources such as CHIA and the Association of Developmental Disability Providers’ workforce survey. Doyle noted that the center is working with CHIA and that new licensure renewal surveys for behavioral health and allied mental health professionals will begin in 2025, which should improve future workforce data. The discussion also touched on the Health Policy Commission’s broader workforce findings, including nurse attrition, burnout, low wages, and the importance of career ladders and advanced training. Doyle said the center’s first policy recommendations will come from its rate study, expected in the next one to two months, and will likely focus on capacity building and sustainability. After the presentation, members thanked Doyle and discussed subcommittee leadership. Chair Lerault announced he was stepping down, and Chris White volunteered to serve as co-chair; the committee agreed to move forward with that arrangement and to revisit FY26 goals once new leadership is in place. The meeting then adjourned by motion and second.

Transcript Highlights:

• But more broadly, the nursing, the CNA program—are we finding or is there any data kept on the number
• of those CNAs that have gone on then to become our ends?
• I know we're especially during COVID, we were trying to fill that need for CNAs, and my hope is that
• And, you know, we're actually appreciative of the opportunity to kind of start, you know, as a CNA as
• </c><01:08:18.199><c> into</c><01:08:19.040><c> somebody</c> specifically from the CNA into somebody

Keywords: 1183, house

Transcript Highlights:

• things I would say from an assessment point of view, because we do a lot of that, we certified 107 CNAs
• It costs $110 to take the CNA exam, clinical portion and the written.
• Well, Jenny Seiper over at Pontotoc, we just recently had this conversation, and they had tons of CNAs

Summary: The meeting focused primarily on planning for an upcoming AI symposium and related commission work. Members reviewed nomination and registration timelines, attendance categories, site logistics, and microcredential requirements for participants. They discussed the symposium’s structure, including slots for K-12, higher education, career tech, libraries, tribal groups, and innovation grant recipients, and noted that the event would likely be held in early June with a follow-up planning meeting on April 2. The group also discussed launching a newsletter via Substack and publishing a monthly podcast to share updates and build public awareness. A major portion of the discussion centered on School AI and a proposed $45 million AI initiative. Members described School AI pilot activity at OCCC and broader plans to work with K-12, career tech, higher education, and libraries, while emphasizing privacy, data governance, and the need for local training and agency-level negotiation. The $45 million proposal, referenced as House Bill 1782, would create a revolving fund, an advisory council, and broad allowable uses including tools, professional development, curriculum, research, student programs, infrastructure, and public outreach. Representative Williams said the bill was moving through the House appropriations process and that the goal was to keep the funding intact. The group also raised concerns about other AI-related proposals and initiatives, including three bills by Representative Cody Maynard and the Oklahoma AI Roundtable, which some members viewed skeptically because of its paid membership model. A podcast episode on ethics and legal issues in AI was previewed, including a controversial example about using AI to survey students for safety risks; members agreed the example was hypothetical but potentially sensitive. The meeting ended with broader discussion of workforce needs, especially nursing and corrections education, including efforts to expand LPN/RN pathways, address certification costs, and connect training to rural health and reentry programs.

Transcript Highlights:

• reimbursement rate to the agency for that same level of care that's being done by the home health aide or CNA
• 890 Do you know what the reimbursement rate is for the CNA home health aide employed by the agency?
• The number I'm thinking, if it's 24-hour round-the-clock care needing a CNA in the home during certain

Summary: The Health Facilities Subcommittee met to receive implementation updates from the Agency for Health Care Administration on three bills passed in prior sessions. First, Deputy Secretary Brian Meyer reported on the transfer of the Children’s Medical Services managed care plan from the Department of Health to AHCA under HB 1085. He said the move was administrative only, with no change to enrollment, providers, services, or clinical eligibility functions, and that it was intended to create efficiencies by aligning procurement and shifting staff resources between agencies. Members then questioned AHCA about reports of reductions in private duty nursing and therapy services for medically fragile children, including concerns about appeals, provider credentialing, and whether families were losing services or being transitioned appropriately. AHCA said it was reviewing denials, monitoring the plan, and using contractual remedies while focusing on maintaining access for members. The committee also reviewed implementation of a bill creating permanent Medicaid eligibility for individuals with permanent disabilities. AHCA staff explained that the agency had submitted a federal 1115 waiver request after public comment and stakeholder meetings, but CMS had indicated it did not anticipate approving the requested authority. Members pressed AHCA on why the waiver was submitted later than the bill’s directive date and on whether the delay was avoidable. AHCA said the waiver was complex and required review, drafting, and public input, and noted that DCF already has a specialized unit to help with redeterminations while the agencies work on operational changes. The committee discussed the practical impact on families who struggle with annual eligibility renewals and the need for clearer communication and faster follow-up from the agency. Finally, AHCA presented on the home health aide program for medically fragile children and related Medicaid eligibility changes. The agency described the 2023 law that created a family caregiver provider type and the 2025 changes that increased the hourly rate, expanded hours, reduced training requirements, and removed caregiver earnings from Medicaid eligibility calculations, subject to federal approval. AHCA said it had completed state public comment, submitted the waiver amendment to CMS, and was awaiting federal action. Members raised concerns that some families may have enrolled or begun work before the eligibility fix was in place and may have lost benefits, especially in Broward County. AHCA said it would work with affected families and plans, review outreach through DCF and the health plans, and continue rulemaking, system updates, and provider training. The meeting ended with the chair noting that the committee had received the updates and adjourned without objection.

Transcript Highlights:

• I have been a CNA for 23 years and currently work at the Pines of Plastable Health Care with Pax.
• I'm a CNA. I've been working at a facility for 15 years.
• I've been working over 30 years as a CNA, and I'm from Sacramento County.
• I've been working over 30 years as a CNA. And I'm for Sacramento County.
• I used that money to pay for many of the CNAs that you saw come up front.

Summary: The subcommittee heard a lengthy Department of Health Care Services presentation on the governor’s Medi-Cal budget, including a $229.1 billion total-funds proposal, projected Medi-Cal enrollment declines as redeterminations continue, and several major cost drivers such as managed care growth, Medicare-related costs, pharmacy spending, and changes tied to federal policy. Members focused heavily on the elimination of Prop. 56 dental supplemental payments beginning July 1, 2026, questioning the likely impact on provider participation and utilization. DHCS said it is completing the required rate reduction/access analysis for CMS, has been holding stakeholder meetings and issuing provider bulletins, but could not yet quantify the real-world effect. The committee also discussed a $50 million savings proposal tied to new hospice utilization management authority and asked about possible effects on emergency dental care and provider participation. The hearing then moved through the November 2025 family health estimate and several county and program administration issues, including CCS, GHPP, and Every Woman Counts. DHCS said family health costs are rising despite slight caseload declines because of higher utilization and medical costs, and members raised concerns about CCS website accessibility, county administrative funding, and the transition of youth aging out of CCS. The department said most CCS beneficiaries are also on Medi-Cal, that counties have long raised funding concerns, and that it had clarified use of maintenance-and-operations dollars to address some county workload issues. Members also asked about Every Woman Counts potentially seeing higher demand as Medi-Cal changes take effect; DHCS said that is possible and that the program has multiple funding sources including General Fund. A major portion of the hearing focused on provider taxes and federal changes under H.R. 1, especially the Medi-Cal managed care organization tax and the hospital quality assurance fee. DHCS explained that H.R. 1 restricts new or increased health care-related taxes, phases down allowable tax levels over time, and tightens “generally redistributive” rules, which could sharply reduce the state’s ability to use the MCO tax for Medi-Cal financing. Members asked whether the Legislature could amend Prop. 35 or whether voters would need to act; DHCS said a three-fourths legislative amendment may be possible if it aligns with the measure’s purpose, but the department is still evaluating options. The committee also discussed hospital financing, with DHCS describing recent increases in state-directed payments and the effect of H.R. 1 in capping those payments at Medicare levels, and the LAO noting the tradeoff between preserving provider taxes and maintaining Medi-Cal funding. The subcommittee also reviewed a series of DHCS budget change proposals and trailer bill items, including managed care final-rule implementation, managed care operations, a hospital value strategy, a one-year extension of skilled nursing facility financing, long-term care payment transparency, and interoperability/prior authorization requirements. Members repeatedly questioned the use of limited-term versus permanent positions, the overlap among proposals, and the timing of new financing reforms. DHCS said the SNF extension would preserve current workforce standards, sanctions, growth limits, and the SNF quality assurance fee while the department develops a broader 2027-28 redesign. No votes were taken; items were repeatedly held open for later action. Covered California then presented on the expiration of the federal enhanced premium tax credit and the resulting affordability crisis. The agency said Californians will lose about $2.5 billion in premium assistance for 2026, average premiums could nearly double for many enrollees, and as many as 400,000 people could eventually leave marketplace coverage. Open enrollment ended with 1.9 million sign-ups, down 3% from the prior year, with especially steep declines among middle-income consumers and increased movement into bronze plans. Covered California said the state’s $190 million affordability subsidy is helping lower-income enrollees retain coverage, but cannot fully replace the lost federal assistance. Members also asked about the Health Care Affordability Reserve Fund, repayment of loans from that fund, the status of federal review of California’s essential health benefits benchmark, and implementation of the new gender-affirming care benefit under AB 144.