Transcript Highlights:

• He said these are the first 10 drugs that Medicare can now negotiate, because Medicare can now negotiate
• the first 10 drugs that Medica Medicare the first 10 drugs that Medica Medicare because<00:17:17.600
• :17:19.039> a because Medicare can now negotiate a because Medicare can now negotiate a limited
• Medicare or something right okay um so Medicare or something right okay um so just<00:32:38.840> moving
• included that in the report the Medicare included that in the report the Medicare Savings<00:49:

Keywords: 928, house, all

Summary: The working session focused on the New Hampshire Prescription Drug Affordability Board’s budget request and its recent work. Early discussion centered on a technical question about a statutory dedicated fund for donations: members asked why the budget did not show a line item for accepting donations, and DHHS CFO Nathan White explained that the statute already authorizes the fund, but because no revenue has been received yet, it does not appear in the budget. He said any future donations would go through the normal process under RSA 14:30-a, with fiscal committee and Governor and Council approval and a memo to the Department of Revenue Administration. The chair clarified that the account was not a prerequisite to soliciting donations, and White said the fund would supplement, not replace, General Fund support. Kirk Williamson, the board’s executive director, then presented the board’s mission and budget. He said the governor’s budget provides about $256,500 in the first year and slightly more in the second, all General Funds, and that the board had distributed a technical amendment to continue the executive director position. He described the board’s role as analyzing prescription drug costs, identifying savings opportunities, monitoring market trends, promoting transparency, and making recommendations to the legislature and public payers. He also emphasized that the board operates publicly, with live-streamed meetings and a stakeholder advisory council that includes unions, state agencies, Medicaid, corrections, higher education, and other stakeholders. A major topic was the board’s estimate of $6 million in potential savings, based on Medicare’s newly negotiated prices for 10 drugs. Williamson explained that the board used those federal negotiated prices as a benchmark to estimate what New Hampshire public payers might be missing by not having similar leverage, and said the board is trying to build evidence for future recommendations rather than directly setting prices. Members asked how those potential savings could become actual savings, and Williamson said the board is sharing findings through its advisory council and feedback loops, though it has not yet sent a formal recommendation letter to specific purchasers. He also discussed the difference between pharmacy-benefit spending, which relies heavily on PBM-negotiated rebates, and medical-benefit spending, which is administered differently and is being added to the board’s next report. Williamson highlighted other work, including a model on Humira and a pending legislative effort to improve biosimilar competition, plus a proposed state-backed pharmacy savings card that would be no cost to the state and could save users about $240 per prescription based on Connecticut’s experience. No votes were taken during the session.

Transcript Highlights:

• supplement Medicare.
• The bill provides that an individual who was enrolled in a Medicare supplement policy, also referred
• If no such policy is available, the individual would be able to purchase a Medicare supplement policy
• At the request of an applicant, the effective date of a replacement Medicare supplement policy could
• During the guaranteed issue period, the individual could purchase any Medicare supplement policy that

Keywords: 994, senate, all

Summary: The Senate Banking and Insurance Committee met with a quorum present and approved the March 4, 2026 minutes by voice vote. The committee first considered House Bill 55, which updates and modernizes workers’ compensation statutes to reflect the privatized system, remove obsolete provisions, and adjust the Workers’ Compensation Board of Review from five members to three. The Insurance Commissioner testified that the bill is part of the cleanup from privatization and would give the governor more flexibility in appointments. After adopting a strike-and-insert amendment and a title amendment, the committee reported HB 55 to the full Senate with a recommendation that it do pass. The committee then took up House Bill 5463, which would reduce BRIM’s required liability coverage for county boards of education from $1.25 million to $1 million per occurrence and eliminate the separate $5 million excess coverage requirement. BRIM’s director testified that the excess market was difficult to access and costly, but several senators raised concerns that lowering coverage could reduce protection for victims and school-related claims. After a divided vote, the motion to report the bill failed, and HB 5463 was not passed by the committee. Next, the committee considered House Bill 4869, creating guaranteed issue rights for Medicare supplement policies, including annual birthday replacement rights and a special right for certain Medicaid recipients losing eligibility. Counsel said the bill would prohibit underwriting barriers during the guaranteed issue periods and require an annual report on premium trends. With no amendments offered, the committee reported HB 4869 to the full Senate with a recommendation that it do pass. Finally, the committee considered House Bill 5462 on mine subsidence insurance. The bill would allow the mine subsidence fund to offset payments by amounts received from other sources and limit lawsuits over claims reported to BRIM. Members debated a proposed strike-and-insert amendment that would have softened the litigation limits and added notice and remedy provisions, but the amendment was rejected. The committee then reported HB 5462 to the full Senate with a recommendation that it do pass, and the meeting adjourned.

Transcript Highlights:

• supplement Medicare.
• The bill provides that an individual who was enrolled in a Medicare supplement policy, also referred
• If no such policy is available, the individual would be able to purchase a Medicare supplement policy
• At the request of an applicant, the effective date of a replacement Medicare supplement policy could
• During the guaranteed issue period, the individual could purchase any Medicare supplement policy that

Keywords: 994, senate, all

Summary: The Senate Banking and Insurance Committee met with a quorum present and first approved the March 4, 2026 minutes. It then took up Engrossed Committee Substitute for House Bill 55, a workers’ compensation cleanup bill from the Insurance Commissioner’s office. Counsel explained that the bill modernizes outdated code after privatization of the workers’ compensation system, repeals obsolete provisions, updates references to the Insurance Commissioner, reduces the Workers’ Compensation Board of Review from five members to three, and makes related technical changes. The committee adopted a strike-and-insert amendment and a title amendment, and then reported the bill to the full Senate with the recommendation that it do pass. The Insurance Commissioner and a senior senator both spoke in support, describing the bill as part of the long-term cleanup of the privatized system and noting the reduced caseload on the Board of Review. The committee next considered Engrossed House Bill 5463, which would lower the required insurance coverage for county boards of education from $1.25 million to $1 million per occurrence and eliminate the separate $5 million excess coverage requirement. BRIM’s executive director testified that the agency had difficulty finding a market partner for the excess coverage and that the premium cost exceeded $5 million, creating a burden for county boards. Some senators raised concerns that reducing coverage could limit recovery for victims in serious claims and that the change might reduce protections for school systems. When the motion to report the bill was put to a vote, the result was tied, and the chair declared the bill not passed. The committee then approved Engrossed Committee Substitute for House Bill 4869, which creates guaranteed issue rights for Medicare supplement policies in West Virginia. Counsel explained that the bill allows certain policyholders to replace a Medicare supplement policy during an annual birthday period without medical underwriting, and also grants a guaranteed issue right for certain individuals losing Medicaid eligibility. The bill also requires annual reporting on premium trends and gives the Insurance Commissioner rulemaking authority. The motion to report the bill to the full Senate with the recommendation that it do pass was adopted. Finally, the committee considered Engrossed Committee Substitute for House Bill 5462 on mine subsidence insurance. Counsel explained that the bill would allow the mine subsidence fund to reduce payments by amounts already received by a policyholder and, as introduced, would bar actions against insurers for claims reported to the board. A proposed strike-and-insert amendment would have replaced the blanket bar with a 90-day pre-suit notice requirement and limits on damages, but after discussion from senators, counsel, BRIM, and the Insurance Federation, the committee rejected the strike-and-insert and also rejected a separate amendment to strike the setoff language. The committee then reported the bill to the full Senate with the recommendation that it do pass, and adjourned.

Transcript Highlights:

• Medicare is a sliding at all. Okay? Medicare is a sliding scale. scale. scale.
• knows how to bill for Medicare already. knows how to bill for Medicare already.
• Pretty much every doctor takes Medicare. Every hospital takes Medicare.
• I turned 70 last year and I have Medicare, traditional Medicare.
• Medicare for all. Medicare for all.

Keywords: 1189, house, all

Transcript Highlights:

• Medicare, and what are known as Medicare Advantage plans.
• Sorry, you're stuck on Medicare Advantage.
• Advantage plan and go back to original Medicare.
• Some of them might have wanted to go to original Medicare because original Medicare doesn't have networks
• That is too much choice for people who are on Medicare.

Transcript Highlights:

• <00:02:31.120> and across both kind of Medicare and across both kind of Medicare and Medicaid
• How does that work when the Medicare people aren't eligible for Medicare until 62?
• So are they on Medicare early because of disability, or does Medicare pay even if people aren't on Medicare
• <00:34:56.679> Medicare people aren't on Medicare Medicare people aren't on Medicare Medicare
• because they wouldn't have the Medicare because they wouldn't have the Medicare so<00:36:07.960>

Keywords: 1183, house

Transcript Highlights:

• Kennedy, President Trump has sworn to protect Medicare.
• Does Medicare pay more? Does Medicare pay less? Medicaid pay more? Medicaid pay less?
• Whether patients who are on Medicare fee-for-service, on traditional Medicare?
• Medicare Advantage, roughly half and half.
• They like Medicare, and they like private insurance.

Transcript Highlights:

• So, um, if the base rate plus ProShare, MQUIP, anything else exceeds the Medicare rate, which is about
• <00:11:43.040> And<00:11:43.760> because Medicare cost equivalent.
• And because Medicare cost equivalent.
• <00:11:50.320> So they've been paid more than Medicare.
• So they've been paid more than Medicare.

Keywords: 928, house, all

Summary: The Committee to Study Long-Term Managed Care approved the prior meeting minutes as amended after correcting the first paragraph. The chair then outlined the committee’s plan to produce a preliminary report by October 1, with additional meetings to follow, since some questions remain about the federal One Big Beautiful Bill (OB3) and its effects on Medicaid financing and managed care. The main discussion focused on New Hampshire nursing home funding and how ProShare and MQUIP work. Members reviewed Medicaid rates, supplemental payments, intergovernmental transfers, and the role of federal matching funds. The chair and Mr. Litman concluded that OB3’s phase-down of payments above the Medicare rate likely would not directly eliminate ProShare or MQUIP in New Hampshire, but uncertainty remains about intergovernmental transfers and about how these payments would function if the state moved nursing facilities into managed care. Mr. Litman said managed care would likely require waivers for supplemental payments, and Texas was cited as an example of a state operating under such waivers. The committee also discussed dual eligibles, DNIP, PACE, and the possibility of carving out HCBS from nursing facility services. DHS said its managed care contract would allow the state to use MCOs for DNIP, with the goal of better coordination between Medicaid and Medicare, while PACE would likely require more study and might be more feasible in populated counties. Members also reviewed OB3’s new presumptive eligibility provisions and a state waiver request modeled on Washington’s approach, plus a separate grant for transitioning people from facilities back to the community. The rural health transformation fund was discussed as a possible source for workforce, telehealth, mobile integrated health, and other support investments, but not for direct construction or major building renovation. County representatives emphasized that any county role in PACE or DNIP would require significant vetting, infrastructure, capital investment, and a realistic timeline. The meeting ended with the chair saying the draft report would outline issues and possible alternatives, but not recommendations yet, and the committee adjourned without taking further action.

Transcript Highlights:

• Imagine a 67-year-old on Medicare who finds out they have throat cancer, kidney disease, various kinds
• of diseases where Part B medications in Medicare will cover part of it, and they find out there is this
• It contains provisions from Representative Elkins' bill, House 2235, dealing with Medicare supplements
• Imagine a 67-year-old on Medicare who finds out they have throat cancer, kidney disease, various kinds
• :04:31.520> finds<00:04:31.840> out 67year-old on Medicare who finds out 67year-old on

Keywords: 1183, house

Transcript Highlights:

• Medicare when they turn 65.
• Every year Medicare goes up. This year, Medicare Part B is costing people $185.
• cost on Medicare where Medicare just covers 80%, so the beneficiary is left with a 20% bill.
• on Medicare paying for drugs.
• insurance uh including Medicare insurance uh including Medicare Advantage I do too.

Keywords: 1191, senate, all

Transcript Highlights:

• If they don't deal with Medicare, if you're not Don't deal with Medicare if you're not Medicare age.
• or traditional Medicare and what are known as Medicare Advantage plans.
• or traditional Medicare and what are known as Medicare Advantage plans.
• go back to original Medica Medicare. go back to original Medica Medicare.
• original Medicare Medicare because original Medicare doesn't<03:03:17.359> have<03:03:17.640>

Keywords: 1183, house

Transcript Highlights:

• and they do um have Medicare Advantage. and they do um have Medicare Advantage.
• <01:04:03.480> just and Medicare just and Medicare just initially<01:04:04.920> being
• insurance, it's not covered by Medicare. insurance, it's not covered by Medicare.
• Medicare level benefit right there. Medicare level benefit right there.
• roles that accepts Medicare, and Mr. roles that accepts Medicare, and Mr.

Keywords: 916, all

Transcript Highlights:

• We've got the Medicare enrollments here.
• It might cover—you might get some tax records, but I—the Medicare, yeah, the Medicare enrollees.
• The Medicare enrollees data, the data for older people, is not that good.
• The reason why they use the Medicare role. The answer is the vital records.
• The reason why they use the Medicare rolling here.

Keywords: 995, all

Summary: The Senate Committee on the Census met on December 8 at 9:32 a.m. to examine the dynamics that drive census undercounts and overcounts, with testimony first from Joseph Salvo and then from Susan Strait of the UMass Donahue Institute. Salvo explained the Census Bureau’s two main evaluation tools: demographic analysis, which uses vital records, migration estimates, and Medicare data to produce a national benchmark, and the post-enumeration survey (PES), which compares a separate sample-based count to the census. He said the 2020 census showed a small national net undercount, but larger age- and race-based disparities, including the highest undercount among children ages 0 to 4, higher undercounts for men, substantial undercounts for Black, Hispanic, and American Indian/Alaska Native populations, and overcounts among some older and college-age groups. He also described how self-response, non-response follow-up, administrative records, proxy responses, and imputation affected data quality, arguing that proxies and imputation were especially weak and that outreach remains critical for 2030. Committee members asked Salvo to clarify the methods and error bands, the role of international migration estimates, and how the PES differs from the census address list and LUCA. He explained that PES is based on a separate sample of blocks and can add units within sampled blocks, but it does not measure units missed entirely from the original address list; LUCA matters because it improves that list before enumeration. He also discussed age heaping, duplicate responses among older adults, and why group quarters and COVID-related disruptions complicated the 2020 count. Senator Driscoll briefly interrupted to describe Randolph’s successful appeal of its 2020 count after an undercount in disability care homes, and Salvo noted that the post-census group quarters review helped correct some missed facilities. Susan Strait then focused on Massachusetts-specific results. She said Massachusetts’ 2020 count was strong overall, with population growth above the national average and a PES-based finding that the state was overcounted by 2.24 percent, though she emphasized that this did not mean all areas were accurately counted. Using demographic analysis, she said Massachusetts had an estimated 4.15 percent undercount of children ages 0 to 4, with the largest county-level undercounts in Hampden, Suffolk, and Essex, and she linked higher child undercounts to lower educational attainment and female-headed households. Strait also reviewed operational metrics showing that Massachusetts had relatively strong internet self-response, but that non-response follow-up relied heavily on household interviews, administrative records, proxies, and imputation in different counties. She highlighted higher proxy use in college-heavy counties such as Hampshire and Suffolk, and said counties with more minority residents were more likely to have population-count-only cases and other indicators of harder-to-count populations. The hearing ended with discussion of how these findings could inform outreach and census planning for 2030.

Transcript Highlights:

• They aren't paying on Medicare; they're covered by Medicare.
• And I think that the Medicare part is assumed because we don't have jurisdiction over Medicare billing
• be charged to Medicare. be charged to Medicare.
• is clearly governed by federal Medicare is clearly governed by federal law,<01:48:41.920> Medicare
• medical assistance rate to Medicare medical assistance rate to Medicare rates.<01:56:05.040>

Keywords: 1187, senate, all

Transcript Highlights:

• We increased rates from around 100% of Medicare. We benchmark our rates to what Medicare spent.
• Over the last couple of years, we increased it first to 120% of Medicare, and then to 150% of Medicare
• If we're using Medicare as a basis, do you know?
• You heard my question about using Medicare.
• Medicare to the extent permitted by applicable law.

Transcript Highlights:

• We offer various services, and many of these services are not covered by Medicare, nor are they covered
• Again, these services are not covered by Medicare and not covered by commercial insurance, so there is
• Again, these services are not covered by Medicare and not covered by commercial insurance, so there is
• So the Centers for Medicare and Medicaid Services says if your services are covered in the state plan
• So the Centers for Medicare and Medicaid Services says if your services are covered in the state plan

Keywords: 958, all

Summary: The Budget Review Subcommittee on Health and Family Services met with a quorum still coming together and first handled roll call and minutes. The main presentation came from the Department for Medicaid Services, with Commissioner Lisa Lee and CFO Steve Beckle giving an overview of Kentucky Medicaid, its federal-state financing structure, and the department’s 1915(c) home- and community-based waiver programs. They explained FMAP funding levels for traditional Medicaid, administration, IT, expansion adults, and CHIP, and noted the size of the program, including more than 600,000 Kentucky children eligible for Medicaid or CHIP, about 485,000 expansion adults, over 69,000 enrolled providers, and $18.5 billion in 2024 expenditures. A major focus was the waiver system, including the acquired brain injury waivers, model waiver, independence waiver, Michelle P. waiver, and Supports for Community Living waiver. The department said these waivers are intended to keep people with physical or developmental disabilities in home and community settings rather than facilities, and that many services are not covered by Medicare or commercial insurance. Officials described participant-directed services, interagency administration, and eligibility rules, including that some waiver programs use the child’s income only rather than family income. They also reported an unduplicated waiver wait list of 13,930 people and said the General Assembly had added waiver slots in the last budget, including 650 ABI slots and 1,275 more to be allocated July 1, 2025. The department also discussed a waiver rate study conducted by Guidehouse, explaining that CMS requires a defensible rate methodology because there is no Medicare or commercial benchmark for many waiver services. They said the study used cost and wage surveys, provider and stakeholder input, and aimed to improve transparency, provider stability, and rate parity. Officials reviewed prior COVID-era Appendix K rate increases and budget-driven increases, and said the budget ultimately funded rates at about 70% of the benchmark study, while preserving higher existing rates where needed so no provider would be cut. They highlighted larger differences in behavioral support and case management rates, and said a public report is available. Members asked several questions about the potential impact of federal FMAP changes, especially possible reductions in the enhanced match for expansion adults and Medicaid IT/admin activities. DMS said any FMAP reduction would require more state general fund dollars, estimating about $75 million for each 1% drop in the expansion match, while impacts on administrative IT funding would depend on the systems being built or implemented in a given year. Members also pressed for clarification on waiver wait-list procedures, funded versus filled slots, and what happens when someone on the wait list is later found ineligible. DMS said people on the wait list may not yet have been assessed, can be reevaluated if conditions change, and are still eligible for regular Medicaid state-plan services if they qualify, even if they are waiting for waiver services.

Transcript Highlights:

• Services that don't have a Medicare Services that don't have a Medicare equivalent<00:08:34.000>
• It is time to update MA payments to at least the Medicare level.
• It is time to update MA payments to at least the Medicare level.
• being covered in this with Medicare being covered in this with Medicare Medicaid<00:30:58.720>
• Medicaid being raised up to the Medicare Medicaid being raised up to the Medicare rates<00:31:01.360

Keywords: 919, house, all

Summary: House File 105 was presented by Representatives Beerman and Baker and then laid over for possible inclusion in a future omnibus bill. The bill would implement the remaining mental health and physician service recommendations from DHS’s rate study, including raising certain Medicaid reimbursement rates to at least 100% of Medicare where a Medicare equivalent exists, increasing community-based children’s and adult mental health rates and behavioral health home rates, and phasing in additional increases over three years. The authors said the proposal also addresses master’s-level clinician reimbursement and fee-for-service hospital inpatient mental health services, and they emphasized that the changes are intended to improve access, transparency, and provider stability. Both authors argued that low MA reimbursement rates are driving access problems across Minnesota, especially for children, families, and rural communities. They said providers are struggling to hire and retain staff, clinics are closing or shrinking, and patients are facing long waits, boarding in hospitals, or delayed care. Representative Baker said the issue is personal and described the bill as a phased, long-term approach because of state budget limits and the size of the cost, which he said is in the hundreds of millions but still awaiting a fiscal note. Public testimony was strongly supportive overall. A family physician said higher rates would improve access, keep clinics open, and help patients avoid emergency care, while a Children’s Minnesota mental health leader described more than 1,200 pediatric boarding episodes in 2024 and said outpatient investment is needed to reduce pressure on emergency and inpatient services. A rural provider said her organization had to close an in-home children’s mental health program because of insufficient reimbursement, harming access in underserved counties. A psychologist testifying for the Minnesota Psychological Association supported the bill’s general direction but objected to repealing the pay differential for doctoral-level psychologists, arguing that doctoral training is more extensive and that eliminating the differential could worsen workforce shortages. After testimony and member questions about the bill’s scope and cost, public testimony was closed and the bill was laid over.

Transcript Highlights:

• <00:35:19.000> in um would be allowed under Medicare in um would be allowed under Medicare
• <00:35:54.480> and fact finding the center for Medicare and fact finding the center for Medicare
• <00:36:35.920> fee the amendments to the Medicare fee the amendments to the Medicare fee schedule
• <00:47:55.599> fee they linked costs to the Medicare fee they linked costs to the Medicare
• rules um the being CED our our Medicare rules um the Medicare<00:50:30.000> rules<00:50:30.880

Keywords: 910, house, all

Summary: The House Health Committee held its first hearing of 2025, with Chair Greg Takayama and Vice Chair Representative Leoy opening the meeting and outlining housekeeping rules, including a two-minute limit for testifiers and Zoom etiquette. The committee first heard HB 303 on health care preceptors. The Department of Health, Department of Taxation, University of Hawaiʻi, Hawaii State Center for Nursing, and several health care organizations supported the bill, saying the existing preceptor tax credit program has been successful and that expanding eligibility to additional professions and students would help address workforce shortages. In response to questions, the Department of Health said the annual tax credit cap is $1.5 million, about 650 to 670 credits are currently used each year, and the bill applies only to unpaid preceptors. The committee then moved on to HB 441, which would raise cigarette taxes. The Attorney General, Department of Health, University of Hawaiʻi Cancer Center, Hawaii Public Health Institute, American Cancer Society Cancer Action Network, and others supported the measure as a way to reduce smoking, especially among youth, and to support tobacco control and cancer-related programs. Opponents, including the Taxpayers Protection Alliance and the Cigar Association of Hawaii, argued the tax is regressive and unreliable as a revenue source. The Department of Health noted the last cigarette tax increase was in 2011, and one witness urged a larger increase than proposed. No vote was taken on either bill in the portion of the hearing provided. The committee also heard HB 557 on telehealth. The Department of Health supported the bill so long as it did not displace executive budget priorities, and the Hawaii State Health Planning and Development Agency and Hawaii Primary Care Association supported it. HPCA said the bill would conform state insurance law to recent Medicare changes expanding audio-only telehealth coverage beyond mental health services, and it emphasized access for rural residents, kupuna, and people with disabilities. HMSA opposed the bill as written, saying it strayed from the intent of Act 107 and that audio-only telehealth should remain limited because of quality-of-care concerns, though it supported continued access and asked for a different amendment approach. A telehealth provider also testified that payment disparities limit provider expansion and that audio-only access remains important for patients with serious illness. The hearing ended in the excerpt before any committee action or vote on HB 557.

Transcript Highlights:

• It caps any new state directed payments at 100% of Medicare, or if there is not a Medicare equivalent
• Well, the bill caps any new state directed payments at 100% of Medicare, or if there is not a Medicare
• It caps any new state directed payments at 100% of Medicare, or if there is not a Medicare equivalent
• But what you need to know is that the Medicare rates in Kentucky are so low that Medicare and Medicaid
• <01:31:31.360> rates health rates to 100% of Medicare rates health rates to 100% of Medicare

Keywords: 00:00:22 - Call to Order and Roll Call 00:03:00 – Approval of June 25, 2025 Minutes 00:03:22 - Update on Federal Changes to the Medicaid Program 01:03:44 - State Directed Payments, Provider Taxes, and the Rural Health Transformation Fund: How Medicaid Changes Could Impact Kentucky Hospitals 01:29:42 – Public Comments 01:45:25 – Announcements 01:46:19 - Adjournment, 958, all

Summary: The Medicaid Oversight and Advisory Board met on July 30, 2025, approved the June 25 minutes, and received a presentation from Katherine Castanza of the National Conference of State Legislatures on Medicaid provisions in H.R. 1. The presentation outlined more than 20 Medicaid-related provisions, emphasizing that the largest federal savings come from work/community engagement requirements, changes to provider taxes, limits on state-directed payments, more frequent eligibility redeterminations for expansion populations, and related eligibility/enrollment changes. She said the fiscal effects are backloaded, with most reductions occurring in the later years of the 10-year window, and noted potential significant impacts on hospital payments and state financing. She also described new funding opportunities, including a $50 billion rural health transformation fund and a new home and community-based services waiver with associated grants. A substantial portion of the discussion focused on Kentucky’s pending community engagement 1115 waiver and how it would interact with the new federal requirements. Board members asked whether the waiver had been approved, what the cabinet’s contingency plan would be if CMS does not approve it, and what the timeline is for compliance. Cabinet representatives said the waiver has not yet been approved by CMS, remains under public comment, and that the state will wait for CMS guidance before moving forward; if needed, the state would amend the waiver or submit a new one. They said the work requirement must be in place by January 1, 2027, with a possible extension to 2028. Castanza also explained that expansion adults with incomes between 100% and 138% of the federal poverty level would face new cost-sharing requirements beginning October 1, 2028, and that eligibility redeterminations would move from annual to every six months starting January 1, 2027. She then walked through provider tax changes, including a moratorium on new provider taxes beginning October 1, 2026, and a phased reduction in the hold-harmless threshold for existing taxes beginning January 1, 2028, with exemptions for nursing facilities and ICF/IID providers. Board members questioned the timing and likely impact on Kentucky, and Castanza responded that the effect would depend on each tax’s current rate and would phase in over time.

Transcript Highlights:

• But under Medicare, if you're elderly and on Medicare, or if you have Medicaid, If you're on Medicaid
• The hospital would file a lien against Medicare or Medicaid or Tricare rather than filing a hospital
• would have to file it on your Medicare rather than filing a hospital lien against you.
• Do we want their health insurance, be it Medicare, Medicaid, or insurance, be it Medicare, Medicaid,
• Um, Medicare has a subrogation right, a lien on there.

Bills: SB210, SB292, HB360, HB233, HB66, HB356, HB164, HB238, HB209, SB223, HB307, SB210, SB292, HB360, HB233, HB66, HB356, HB164, HB238, HB209, SB223, HB307

Keywords: hospital liens, medical billing, government healthcare, insurance claims, patient rights, education oversight, subpoena authority, investigation, State Superintendent, school misconduct, drug courts, accountability, veterans, mental health, substance abuse, rehabilitation, criminal justice, court intervention, terrorist threat, terroristic threat