Transcript Highlights:

• I mean, in short, right now, everyone pays to put on our primaries.
• Third parties don't have primaries.
• Well, but it also goes locally and helps you put on the primary.
• We are not getting subsidized by taxpayers. payers to put on these conventions.
• think of our primaries.

Bills: HB2139, HB2253, HB3632, HB4171, HB4309, HB4508, SB760, SB1470

Keywords: voting access, polling place, disability, caretaker provisions, ballot delivery, election code, HB 2253, Texas Election Code, bond election, bond issuance, local government, election cancellation, disaster declaration, natural disaster, emergency election, county election officer, polling place notice, open meeting, election workers, voter safety

Transcript Highlights:

• Single-payer health care.
• We understand that single payer isn't free.
• There's a total crisis in primary care.
• the gift shop than primary care.'
• Pass this bill for a single-payer system.

Keywords: 995, all

Summary: The Joint Committee on Health Care Financing held a public hearing on 16 bills, with the chairs noting a busy legislative day and asking speakers to keep testimony brief. The committee first heard testimony on Senate 860/House 1405, the Medicare for All bill, with Sen. Jamie Eldridge and many advocates, clinicians, municipal officials, and patients arguing that a single-payer system would make care a right, reduce administrative waste, lower costs, and protect residents from rising premiums, medical debt, and hospital closures. Several speakers cited the Steward hospital crisis, affordability problems, and polling or ballot questions showing public support for single-payer coverage. No vote was taken during the hearing. The committee then took testimony on S. 863, a bill on non-opioid options for chronic pain. Pain specialists, patients, and advocates said the bill would improve care coordination for MassHealth members, expand access to non-opioid medications, require provider education, and collect data on chronic pain. Testifiers described long delays in diagnosis and treatment, stigma toward pain patients, and the need for multidisciplinary care and transportation support. Again, the committee heard testimony only and took no action. A large portion of the hearing focused on H. 1360/S. 869, which would prevent discrimination against people with disabilities in health care. Disability advocates, clinicians, and patients described being denied or delayed care, pressured into DNR orders, or treated based on assumptions about quality of life rather than medical facts. Speakers referenced COVID-era crisis standards of care, discriminatory metrics, and personal stories involving canceled procedures, inadequate accommodations, and poor treatment in hospitals. Committee members thanked speakers for their testimony and said they would review the bill and its implications, but no vote was announced. The committee also heard testimony on H. 1399, an individual Medicare marketplace option for municipal retirees, where supporters said it would give cities and towns a lower-cost alternative for retiree health benefits through HRAs and individual Medicare plans. The hearing then returned to Medicare for All testimony, with additional supporters repeating arguments about cost, access, municipal budget pressure, and the need for global budgeting and universal coverage. The transcript ends with continued testimony and no recorded committee vote or final action on any bill.

Transcript Highlights:

• Primary care... Primary care for you is how we can invest in our future.
• And here's the irony: the payers... Meet the payers' concern.
• , they preserve the chaotic and inequitable multi-payer system that imposes on primary care practices
• It does include enough payers to reach that tipping point for primary care investment.
• Pediatric primary care, much like primary care for adults, is struggling.

Keywords: 995, all

Summary: The Joint Committee on Health Care Financing held a public hearing on a large docket focused on primary care, workforce development, and medical debt. Chairs Cindy Friedman and John Lawn outlined hearing procedures and noted that testimony would be taken on 17 matters. The committee first heard testimony on bills to establish a community health center nurse practitioner residency program and to strengthen mental health centers. Senator Keenan, Rep. Keefe, and health center leaders described the Worcester nurse practitioner residency as a successful pipeline and retention strategy, citing workforce shortages, training needs in community health centers, and the cost of the program. Rep. O’Day also supported the mental health centers bill, saying it would raise payment rates, improve reimbursement for behavioral health services, and help clinics retain staff and expand access. The committee then took testimony on bills to address medical debt through hospital financial assistance reform. The Attorney General’s Office, Health Care for All, Health Law Advocates, the Leukemia and Lymphoma Society, and individual patients supported the measure, arguing that hospital financial assistance policies are inconsistent, hard to find, and difficult to navigate. Witnesses said the bill would standardize eligibility criteria, create a uniform application, improve notice requirements, and expand access to discounted care up to 400% of the federal poverty level. Several personal stories described medical bills being sent to collections, confusion over insurance billing, and the burden of debt on low-income and chronically ill patients. Committee members asked about hospital concerns, the role of the health safety net, and whether the bill addressed root causes of medical debt; testimony emphasized that the proposal was meant to improve transparency and access rather than replace broader insurance reforms. The hearing also focused heavily on “Primary Care for You” legislation, H. 1370 and S. 867, which would increase primary care investment and create a new payment model. Rep. Haggerty, physicians, a patient, community health center leaders, and the Massachusetts League of Community Health Centers described a primary care crisis marked by low reimbursement, staffing shortages, long waits, burnout, and difficulty recruiting clinicians. Supporters said the bills would shift spending toward preventive, team-based care, improve access and equity, and reduce long-term costs. The Massachusetts Association of Health Plans said it was directionally supportive of increased primary care investment but warned that any new spending must stay within the cost growth benchmark and preserve existing contracting structures. The hearing ended with additional testimony on a community health center workforce and loan repayment grant bill from Rep. Stanley, and with further discussion from Dr. Alan Garo about the need for payment reform in primary care.

Bills: HB6, HB27, HB123, HB210, HB213, HB222

Keywords: hemp, consumable hemp products, hemp-derived cannabinoids, CBD, cannabidiol, CBG, cannabigerol, Texas hemp law, hemp regulation, cannabinoid products, delta-9 THC, intoxicating hemp, hemp gummies, hemp vape, retail registration, product registration, QR code labeling, child-resistant packaging, youth access, minor sales

Transcript Highlights:

• , self-payers, and insurance payers, I wouldn't say that we are doing anything nefarious.
• So I guess the question I would have is that if we're going to invest more in primary care, Primary care
• We as a community, we as taxpayers, we as premium payers...
• When I think about primary care, those are the specialists I'm thinking of.
• So here in Cheyenne, we have a couple of primary care...

Keywords: 916, all

Transcript Highlights:

• <01:19:23.480> Clinicians primary care providers. Clinicians primary care providers.
• care, Blueprint primary care, clinically affiliated primary care.
• our primary care providers. our primary care providers.
• <01:28:59.600> So residents overall and by payer. So residents overall and by payer.
• [clears throat] support primary care. [clears throat] support primary care.

Keywords: 927, senate, all

Transcript Highlights:

• Second, our payer mix. So our public members' payer...
• Second, our payer mix. So our public members' payer Thank you.
• Second, our payer mix: our public members’ payer mix is atypical, and costs for Medicaid and uninsured
• The payer looks at that... ...goes to the payer.
• Direct Primary Care Alliance.

Keywords: 1185, senate, all

Transcript Highlights:

• The recommended primary care physician supply is 60 to 80 per 100,000.
• I'll share a bit more about our Song-Brown Primary Care residency programs.
• current programs and enables the creation of new primary care residency programs.
• Seventy-two percent of its payer mix are government payers, with over 20% of those being from Medi-Cal
• Twenty other States have similar all-payer state-run data systems.

Keywords: 988, house, all

Transcript Highlights:

• payer.
• payer.
• referrals within their primary care practice.
• mix and the prices that they charge commercial payers.
• different based on where they serve, their volumes, the payer mix, or the client payer mix.

Keywords: 1184, house, all

Transcript Highlights:

• for primary care services.
• Primary care has a triple superpower.
• Without adequate reimbursement from all payers, providing primary care in this new constrained environment
• I want to also emphasize that Medicare, Medicaid, other payers in Massachusetts, and other payers in
• It allows patients to designate their direct primary care physician as their primary care provider for

Keywords: 995, all

Summary: The committee held a public hearing with testimony on several health care bills, with most of the discussion focused on primary care access, community health center reimbursement, midwifery and birth centers, telehealth, hospital-at-home, direct primary care, and trans-inclusive health care access. Chair Feeney and Chair Murphy opened by noting the large number of signups and asking testifiers to keep remarks brief because of time constraints. Legislators and witnesses repeatedly emphasized that Massachusetts’ primary care system is under strain and that federal policy changes and reimbursement gaps are worsening financial pressure on providers. On community health centers, Representative Blay, Senator Lovely, Michael Curry, Bethany Keeley, Jag Deep Trevetti, Sean Cahill, and Christina Severin all supported H. 1096/S. 711, which would require commercial insurers to pay federally qualified health centers at least the MassHealth prospective payment system rate. They argued that commercial plans currently reimburse health centers below Medicaid rates, threatening sustainability, staffing, and access, especially as federal cuts and coverage losses could increase uncompensated care. Testifiers said the bill would stabilize health centers, protect primary care access, and not cost the state money. A second major topic was H. 1117/S. 784 on sustaining birth centers and the midwifery workforce. Senator Lovely, Senator Miranda, Emily Anesta, Rebecca Orden, Catherine Rushworth, Nishira Burrill, Joel Sutherland, Rachel Blessington, Joelle Ward, and others described the 2024 maternal health omnibus as an important first step, but said birth centers and midwives still face low reimbursement, workforce shortages, and financial instability. They urged reimbursement parity, a workforce development fund, and support for freestanding birth centers, citing improved outcomes, lower C-section rates, better patient experience, and racial equity in maternal health. Several speakers shared personal birth stories and said the bill would help preserve and expand birth options in communities like Roxbury, Worcester, and the North Shore. The committee also heard support for H. 1343 on direct primary care from Dr. Garofalo, Dr. Altman, Dr. Nair, Stephanie Cameron, Dr. Haley Moke-Blessed, and others, who said current insurance rules force patients to use a separate in-network primary care doctor for referrals and sometimes prevent physicians from dispensing medications. They argued the bill would reduce delays, administrative burden, and costs while improving continuity of care. In addition, Dr. Miklides and Sue Stempeck supported H. 1141 on hospital-at-home parity, saying the model has strong outcomes and should be reimbursed at the same rate as brick-and-mortar hospital care. Heather Myers and Katrina Cook testified on telehealth and digital health equity, urging broader coverage for asynchronous care, remote monitoring, interpreter services, and digital literacy supports. SEIU Local 509 supported H. 1188/S. 681 on trans-inclusive health care access, saying it would remove arbitrary insurance barriers to gender-affirming care. No votes or committee actions were taken during the hearing.

Transcript Highlights:

• our best payer source.
• mentioned that's our largest payer mentioned that's our largest payer Source<00:37:03.280> uh
• <00:37:05.720> uh Source uh definitely our best payer uh Source uh definitely our best payer
• <01:22:13.960> Care don't want them to take Primary Care don't want them to take Primary Care
• Thank you very much. commercial payers portion and so they commercial payers portion and so they would

Keywords: 1191, senate, all

Transcript Highlights:

• for providers it's not true for payers for providers it's not true for payers it's<01:53:07.599>
• uh Dr Christine R snow I am a primary uh Dr Christine R snow I am a primary care<02:02:27.079>
• prevention and primary care.
• primary primary care<02:42:36.720> so<02:42:37.600> just<02:42:37.840> overall<
• DMC Primary Care the largest<03:19:04.319> Primary<03:19:04.640> Care<03:19:04.840>

Keywords: 928, house, all

Summary: The committee heard testimony on House Bill 224, which would redirect most money from New Hampshire’s renewable energy fund back to electric ratepayers. The bill sponsor argued the measure would lower energy costs, noting recent utility rate increases and estimating annual savings of roughly $2.5 million to $7.3 million for ratepayers. Supporters said the fund has accumulated money that should be returned to customers rather than used for subsidies, and they emphasized that the state has already rebated similar funds from RGGI for years. Opponents, including Rep. Kat McGee, argued the renewable energy fund is a successful, nonlapsing dedicated fund that supports local clean-energy projects, energy resilience, emissions reductions, and private investment. McGee said the fiscal note overstated the benefit of rebates and understated the loss of investment, claiming the average annual rebate would amount to less than $10 per customer while the program has helped leverage significant private dollars and nearly 10,000 projects. She urged the committee to reject the bill as a poor deal for the state and ratepayers. Committee members questioned the fiscal note, the size of the rebate, whether the bill would set a precedent for other dedicated funds, and whether the program’s incentives amount to picking winners and losers. The Department of Energy testified neutrally, explaining how the renewable energy fund works, including renewable energy credits, alternative compliance payments, and the fund’s use for renewable energy initiatives. No vote was taken in the portion of the hearing provided.

Transcript Highlights:

• A recent study from Massachusetts all-payer insurance claims data estimates...
• It would be very impactful to simply have this benefit extended to all payers.
• Initial reviews from payers are now functionally prior authorizations under another name.
• Inconsistency across payers adds to the confusion.
• Some payers want this information via a web portal, via fax, a phone call, and email.

Keywords: 995, all

Summary: The committee held a hearing on a large group of behavioral health and insurance-related bills. Topics included expanding access to mental health services by allowing physician assistants to authorize Section 12 emergency holds and be recognized as licensed mental health professionals (H. 1131/S. 773); improving coverage for community behavioral health centers so commercial insurance matches MassHealth’s bundled outpatient and crisis services (H. 1276/S. 703); eliminating cost sharing for certain behavioral health services (S. 718); extending detox and clinical stabilization coverage from 14 to 30 days and adding transitional support services (H. 1319/S. 772); requiring coverage for dual-diagnosis treatment in psychiatric facilities (H. 1277/S. 771); and preserving access to treatment for serious mental illness through coverage of coordinated specialty care and assertive community treatment (H. 1135/S. 709). The committee also heard bills on preventive behavioral health services for children (H. 1228/S. 802) and post-pregnancy mental health care, including postpartum depression and pregnancy loss-related care (H. 1314/S. 823).

Transcript Highlights:

• We're not a primary care specialty practice group.
• <01:34:25.199> care revenue streams which is primary care revenue streams which is primary
• <01:37:13.760> care primary care primary care offices<01:37:15.679> I<01:37:15.760>
• <01:38:14.960> Care care centers to hospitals Primary Care care centers to hospitals Primary
• prescription happened or the payer that prescription happened or the payer that was<02:13:39.159

Keywords: 1191, senate, all

Transcript Highlights:

• Prior to its dissolution, UCare was our biggest HHS's biggest payer, healthcare payer.
• Prior to its dissolution, UCare was our biggest HHS's biggest payer, healthcare payer.
• Prior to its dissolution, UCare was our biggest HHS's biggest payer, healthcare payer.
• , healthcare payer.
• The end of the payer, healthcare payer.

Keywords: 1187, senate, all

Transcript Highlights:

• to the challenges at every level, whether it be hospitals, home health, long-term care, hospice, primary
• But then, on the more long-term round-the-clock care, the primary payer source is going to be Medicaid
• The bulk of payers in West Virginia, yeah... It is very, very few and far between.
• The bulk of payers in West Virginia: 77% is Medicaid, you see Medicare about 10% of the payer source,
• private payer insurance makes up about 12%, and then this one niche long-term care insurance is 1%.

Keywords: 994, senate, all

Summary: The committee met with a quorum present and heard a presentation from Marty Wright, CEO of the West Virginia Healthcare Association, on the state’s long-term care system. He described the continuum from home care to assisted living to skilled nursing facilities, emphasizing that these settings increasingly serve short-term rehab-to-home patients as well as older adults needing round-the-clock care. He also outlined the number of facilities in West Virginia, the predominance of Medicaid as the payer for long-term nursing home care, the private-pay nature of assisted living, and the role of OFAC/CMS in regulation. A major focus of the presentation was workforce shortages and turnover, especially for CNAs, LPNs, and RNs, along with declining interest in nursing careers and the impact of regulatory burden and burnout. Wright said the system is also struggling to serve younger patients with substance use disorder, mental illness, or other behavioral needs, who are often not well suited for traditional nursing home placement but have limited alternatives. Senators raised concerns about where such patients are being housed, the long-term effects of opioid and behavioral health issues, and the gap between school-age special needs populations and adult care needs. Wright said Medicaid can cover long-term nursing home care for those who meet financial and medical eligibility requirements, but affordability and spend-down requirements remain major barriers. He also warned that Medicare Advantage can create confusion and shorter covered stays for rehab patients, and he urged early planning around long-term care insurance and estate planning. No votes were taken on the presentation, and the committee adjourned after questions and discussion.

Transcript Highlights:

• At a time when the state is calling for meaningful reforms and investment in primary care, House Bill
• And when people have primary care practices, what they really want to do is take...
• For example, if a patient is suddenly short of breath but cannot reach their primary care doctor.
• However, the other payers did not, and it's basically an unfunded mandate.
• So we are here to ask for the private payers to follow suit.

Keywords: 995, all

Summary: The Joint Committee on Financial Services held a lengthy public hearing with testimony on a wide range of health insurance and access-to-care bills. Early testimony focused on prescription drug pricing and pharmacy reimbursement, with supporters of H. 1326 arguing that pharmacy benefit managers and MassHealth managed care arrangements reimburse independent pharmacies too little, contributing to pharmacy closures and “pharmacy deserts.” The committee also heard repeated support for H. 1151/S. 742 on cognitive rehabilitation for acquired brain injury, H. 1288/S. 716 on telehealth parity for nutrition counseling, H. 1309/S. 761 on full-spectrum pregnancy care without cost-sharing, H. 1312 on insurance coverage for doula services, H. 309 on prompt access to health care by removing deductibles for certain services, H. 809/H. 1227 on biomarker testing, H. 1162/S. 810 on reducing inequities in access to medical procedures by limiting insurer cuts tied to Modifier 25, and S. 726 on insurance coverage for mobile integrated health. Testifiers included legislators, physicians, pharmacists, dietitians, emergency and rehabilitation clinicians, and patients and family members. Supporters of the brain injury bill said cognitive rehabilitation is medically necessary, improves long-term outcomes, and can reduce institutional care and public costs; they noted the bill has been heard repeatedly and has support from the Brain Injury Commission and prior favorable committee action. Supporters of the pregnancy care and doula bills described out-of-pocket costs as a barrier to maternal health and shared personal stories of high bills and unmet support needs. Biomarker testing advocates and cancer patients said coverage gaps deny patients access to precision treatment, can lead to avoidable suffering, and should be standardized across insurers; several speakers said insurers often deny claims despite clinical benefit. Dermatology witnesses said insurers’ use of Modifier 25 cuts reimbursement for same-day evaluation and procedure visits, forcing separate appointments and increasing patient burden. Mobile integrated health supporters described home-based care as a way to reduce emergency department use and hospital readmissions, especially for patients with transportation or mobility barriers. No votes or formal committee actions were taken during the hearing itself.

Transcript Highlights:

• So the first question, you know, how do hospitals submit PAs to payers?
• payers.
• Sometimes we are instructed by the payer to submit by fax.
• But, again, all payers have probably different guidelines and rules.
• I think everybody gets very nervous about payers using any type of AI.

Keywords: 908, all

Summary: The committee met to review the history and current treatment of North Dakota health insurance mandates, with presentations from Blue Cross Blue Shield of North Dakota, Sanford Health Plan, the Public Employees Retirement System (PERS), and the Insurance Department. The discussion focused on how mandates apply differently to fully insured, self-funded, ACA, Medicaid, and PERS plans; how the state’s benchmark plan and federal essential health benefits affect coverage; and how the existing process requires cost-benefit analysis and, for certain measures, a PERS pilot period before broader application. Presenters also reviewed the long list of existing state mandates, including provider, beneficiary, and coverage requirements, and noted that many were enacted decades ago and have not been revisited despite changes in medical evidence and treatment options. Witnesses from the carriers argued that mandates should be reviewed periodically because some are outdated, can create unintended costs, and may not align with current medical guidance. Examples cited included PSA screening, off-label drug coverage, prior authorization rules, step therapy, and cost-sharing provisions for mental health and substance use treatment. They emphasized that carriers often cover services without a mandate when supported by clinical evidence, and that mandates can shift costs to employers and employees, especially in the fully insured small-group market. They also suggested possible policy improvements such as clearer mandate definitions, better transparency around cost-benefit analyses, a regular 10-year review of mandates, and more timely submission of proposals through the interim process. PERS and the Insurance Department highlighted a recurring tension over what counts as a mandate and when a measure triggers the state’s defrayal obligation under federal law. PERS described its interim committee process, the April 1 deadline for fiscal-impact proposals, and the limited pilot program used for certain measures, noting that only a few bills have gone through the full pilot process. The Insurance Department explained that it views new benefit mandates through the lens of the ACA benchmark plan and essential health benefits, distinguishing true new benefits, such as infertility coverage, from changes to existing benefits, such as telehealth or insulin cost-sharing caps. No votes were taken on policy changes; the meeting was informational, with members asking questions about costs, applicability, transparency, and whether a periodic mandate review should be established.

Transcript Highlights:

• been my passion to provide primary care to predominantly Medicaid and Medicare patients.
• Thanks for being a primary care physician. Really, really appreciate it.
• Brown talk about how we went through 11 years of training to be a primary care doctor, right?
• Brown talk about how we went through 11 years of training to be a primary care doctor, right?
• They surveyed payers representing a majority of Americans and found that 77% of health plan payers believe

Keywords: 995, all

Summary: The Joint Committee on Health Care Financing held a public hearing on a broad set of health care bills focused on cost, market oversight, pharmaceutical access, transparency, hospital closures, and pharmacy access. Chairs John Lawn and Cindy Friedman opened by emphasizing recent health care reforms and the need for further action on the drug supply chain, PBMs, private equity, and affordability. The committee heard testimony on several measures, including a Betsy Lehman Center bill to make technical changes and create a permanent trust account for federal and private funding, and bills on hospital profits and fairness, hospital closures and health planning, pharmacy deserts, and health care market oversight and pharmaceutical access. No votes were taken during the hearing. On the hospital profits bill, physicians and labor advocates strongly supported capping hospital CEO compensation at 50 times the lowest-paid worker, requiring greater financial transparency, and directing penalties from high-margin public hospitals into a Medicaid reimbursement fund. Testifiers argued that executive pay is excessive while frontline staff and safety-net services are under strain. Committee members raised concerns about unintended consequences, including whether hospitals might shift workers to contract status or lose executive talent, and whether the bill would actually direct money to the safety net. Supporters responded that the measure is one piece of a larger effort and that the bill’s Medicaid reimbursement provisions would help underserved hospitals. Testimony on market oversight and pharmaceutical access centered on rising health care and drug costs, PBM practices, and the proposal to give the Health Policy Commission authority to set upper payment limits for certain drugs. Consumer advocates, disability advocates, an independent pharmacist, the Attorney General’s office, and others supported stronger oversight, citing premium increases, affordability problems, and the impact of high drug prices on patients and community pharmacies. Pharma and some industry witnesses opposed parts of the bill, warning that upper payment limits could disrupt access, create legal issues, and fail to address the broader supply chain. The committee also heard support for stronger hospital closure notice and public hearing requirements, and for a pharmacy deserts bill aimed at identifying and addressing closures like the one in Roxbury that affected thousands of patients.

Transcript Highlights:

• People are struggling to get a primary care doctor.
• people choose to go into primary care.
• The primary care task force is meeting to look at some of the disparities in primary care, but we need
• I want to touch on two primary areas.
• And it starts with primary care. And I have to come back to primary care.

Keywords: 995, all

Summary: The Joint Committee on Ways and Means held a Health and Human Services budget hearing in Clinton, with opening remarks from Chairs Meg Kilcoyne and Robin Kennedy, local officials, and many House and Senate members introducing themselves. The hearing focused on Governor Healey’s FY27 EOHHS and MassHealth budgets, with repeated themes of rising health care costs, federal funding uncertainty, workforce shortages, and access to care in underserved regions. Members also raised concerns about primary care shortages, rural and regional disparities, behavioral health access, maternal health, food insecurity, and the impact of federal policy changes on Massachusetts programs. EOHHS Secretary Kiame Mahaniah said the FY27 EOHHS budget totals $33.7 billion, reflecting mostly non-discretionary growth from health care costs, labor costs, caseload increases, and provider rate pressures. He highlighted targeted investments in foster care, family resource centers, maternal health, youth services, nutrition programs, immigrant legal services, and human service workforce rates, while warning that federal actions could strip roughly $3.5 billion annually from the state’s health care funding. In response to questions, he defended the administration’s cooperation with federal audits and program integrity efforts, discussed the primary care crisis, and said the state is trying to preserve core services while preparing for a more difficult FY28 budget cycle. MassHealth Undersecretary Mike Levine then described two major FY27 challenges: double-digit cost growth and the expected effects of the federal One Big Beautiful Bill Act. He said MassHealth’s proposed $22.7 billion gross budget includes a 7.5% increase and relies on a moratorium on new expansions plus targeted reductions, including a $1,000 annual adult dental cap, ending GLP-1 coverage for weight loss only, reducing care management to peer-state levels, and work groups to slow growth in PCA, adult foster care, and adult day health spending. Members questioned the impact on Boston Health Care for the Homeless, preventive care, and regional access; Levine said the changes are meant to preserve sustainability, that children and certain disabled populations remain protected, and that the administration will continue working with providers, advocates, and the Legislature on implementation and longer-term reforms.