Transcript Highlights:

• So, this is a high-acuity population that we are supporting.
• lends to why PDS wasn't included, because this is intended to be, again, the highest of the high-acuity
• So, this is a high-acuity population that we are supporting.
• <00:31:55.840> and of state and have the highest acuity and of state and have the highest
• acuity and it<00:31:56.080> makes<00:31:56.520> absolute<00:31:57.080> sense<00:

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board met on September 24, 2025, approved the minutes from the September 9 meeting, and then continued its discussion of Medicaid waivers with Leslie Hoffman and Carmen Hancock from the Department for Medicaid Services. Members asked for updates on the 2024 waiver waitlist management assessment recommendations, including aligning waiver policies, standardizing applications and waitlist placement, and modernizing data systems. DMS said that work is being done jointly with Aging and Independent Living and Behavioral Health/Developmental and Intellectual Disabilities through task forces, that ARPA spending delayed action, and that implementation timelines extend through March 2027. The board also reviewed per-member waiver cost averages for fiscal years 2023 through 2025 for ABI, ABI long-term care, HCBS, Model II, Michelle P, and SCL. DMS emphasized these figures were benefit-only averages based on paid claims, not full waiver costs, and explained that true budget neutrality is calculated on an aggregate basis against institutional care comparisons approved by CMS. DMS said all six waivers remain in compliance with budget neutrality and that the most recent 18-month lag review for FY 2022 and FY 2023 found costs at or below institutional care. Members also asked about unused waiver slots; DMS said slots generally cannot be reallocated mid-year if they have been used, except in cases such as death or reserved capacity, because CMS treats participants as unduplicated for the waiver year. A major portion of the meeting focused on the new child waiver created under House Bill 6. Legislators questioned whether the waiver’s design, including the exclusion of participant-directed services and the emphasis on high-acuity children with behavioral health, DCBS, or juvenile justice involvement, matched the bill’s intent to keep children at home. DMS said it used the $14.7 million appropriated for FY 2026 to develop the program, that there is no priority list, and that the waiver is intended to serve the highest-acuity children while also addressing residential needs for those sleeping in offices or placed out of state. Members also raised concerns about the rapid growth of the HCBS waiting list and asked for more detail on age and timing patterns, which DMS said it would provide later. Finally, DMS gave average processing times from application to eligibility determination and from approval to service start, and said the overall average from application to services beginning was about 80 days, while members requested follow-up information on the Carewise assessment contract and related costs.

Transcript Highlights:

• go through and do an assessment of the needs in order to look at those higher-priority or higher-acuity
• terms of also is not a priority list in terms of looking<00:35:02.480> at<00:35:03.119> acuity
• looking at acuity of that individual. looking at acuity of that individual.
• 17.680> higher at those higher priority um or higher at those higher priority um or higher acuity
• uh individuals uh in order to acuity uh individuals uh in order to take<00:35:21.040> uh<00:35

Keywords: Meeting Start 00:00:00 Roll Call 00:00:15 HB 1 Discussion 00:02:00 HB 1 Vote 00:15:05 HB 2 Discussion 00:17:20 HB 2 Vote 01:13:20, 958, all

Summary: The committee met on House Bill 1, which would implement Kentucky’s participation in the federal education freedom tax credit program. Sponsors said the bill would allow donors to receive a federal dollar-for-dollar tax credit for contributions to scholarship granting organizations, with no state dollars involved, and that public school districts could potentially create their own SGOs. Members asked about the removal of state tax language in the committee substitute, the meaning of the 11th Amendment waiver, whether SGOs could serve only public school students, and whether data collection could be added. The sponsors said the state tax language was unnecessary because the credit is federal, the waiver would allow federal-court litigation over the act, and a district could establish an SGO if it met federal requirements. The committee adopted the substitute and then reported HB 1 favorably with 16 yes votes, one nay, three pass votes, and one abstention. The committee then took up House Bill 2, an act relating to Medicaid and making an appropriation. The sponsor described the bill as a response to federal HR 1 and to concerns raised by the Medicaid oversight board, saying it would address program integrity, eligibility redeterminations, cost sharing, and managed care organization contracts. He said the bill would require periodic eligibility verification for expansion Medicaid enrollees, add modest cost-sharing for some services to encourage use of primary care over emergency rooms, and strengthen enforcement of MCO contracts, with penalties going into a restricted compliance fund. Members asked about the committee amendment, and the sponsor explained it restored flexibility on the number of MCOs in future procurement rather than locking in a reduction. Members also asked whether the bill had gone before the Medicaid oversight advisory board and whether a fiscal note was available; the sponsor said the board’s recommendations were incorporated and fiscal notes were included in the packet. After discussion, the committee adopted committee amendment one to PHS2 and then adopted PHS2 as amended for consideration. The sponsor continued outlining the bill’s provisions, emphasizing that it applied to the expansion population and was intended to align Kentucky law with federal requirements while improving oversight and accountability.

Transcript Highlights:

• If you look at the higher acuity children, which are the ones at my agency, we actually have more challenges
• If you're looking at higher acuity children, it could go up to $72,000 for that six-month subsidy, which

Bills: SB500, SB1522, SB1137, SB1266

Keywords: SB 500, Texas adoption law, Family Code, DFPS, Department of Family and Protective Services, child-placing agency, prospective adoptive parents, adoption records, confidential information, nondisclosure agreement, child history report, health history, social history, educational history, genetic history, termination of parental rights, permanency plan, single source continuum contractor, privacy, redaction

Bills: SJR 12, SCR 39, SB 27, SB 29, SB 241, SB 406, SB 414, SB 464, SB 568, SB 578, SB 609, SB 660, SB 689, SB 693, SB 785, SB 857, SB 879, SB 921, SB 922, SB 955, SB 985, SB 993, SB 996, SB 1008, SB 1035, SB 1036, SB 1059, SB 1098, SB 1120, SB 1122, SB 1147, SB 1188, SB 1197, SB 1209, SB 1227, SB 1245, SB 1267, SB 1307, SB 1321, SB 1332, SB 1386, SB 1396, SB 1453, SB 1484, SB 1494, SB 1536, SB 1537, SB 1596, SB 1610, SB 1664, SB 1741, SB 1814, SB 1822, SB 1841, SB 1948, SB 2065, SB 2155, SB 2188, SB 2230, SB 2406, SB 2407

Keywords: parental rights, education, constitutional amendment, school choice, child education, business organization, internal management, corporate governance, partnerships, liability reduction, public camping, homelessness, local governance, enforcement, state authority, local entity, complaints, housing, public safety, birth certificate

Transcript Highlights:

• We expedite triaging them based on the diagnosis and acuity.
• We expedite triaging them based on the diagnosis and acuity.
• So it all depends on the patient acuity and how they present.
• If someone... ...it all depends on the patient acuity and how they present.

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

Transcript Highlights:

• We also have experienced a spike in acuity of the youth that we serve.
• I know there's some other legislation pending that's going to address some of that acuity level.
• What I have noticed in our review is I say the level of acuity...
• On slide 14, there are some graphs. there that really show the spike in acuity.

Keywords: 1184, house, all

Transcript Highlights:

• 00:10:45.760> higher counties, but we also see a higher counties, but we also see a higher acuity
• 47.440> are<00:10:47.680> served<00:10:48.079> by<00:10:48.640> seven acuity
• of those who are served by seven acuity of those who are served by seven counties.<00:10:49.440>
• Um, but we also have a higher acuity of folks being served.
• "Explain what you mean by higher acuity." "Yes. That means that people need longer-term services.

Keywords: 958, all

Summary: The Government Contracts Committee first approved the minutes from its July 8 meeting and then moved through a large agenda of contracts and deferred items. The committee deferred a Kentucky Education Television contract because the vendor was still not registered with the Secretary of State, and also deferred a University of Louisville contract to the September meeting at the university’s request. Both motions passed by roll call. The committee then took up a contract with the Department for Behavioral Health, Developmental and Intellectual Disabilities for Seven Counties Services. Committee members questioned why the state continues funding the provider despite its ongoing bankruptcy tied to unpaid retirement contributions, how the funding split is determined, whether the state had explored other providers or direct state delivery, and whether all services in the contract are truly required by statute. Agency officials said Seven Counties is the statutorily designated community mental health center for the region, serves about 24,500 people, and provides core safety-net services that would be difficult to replace; they also said the bankruptcy dispute is still ongoing and the contested amount is about $20 million. The committee ultimately deferred the contract to the next meeting and requested additional information on the scope of services and potential offsets or recovery of unfunded liabilities. The final deferred item was a Department for Community Based Services contract with Youth Villages for the Intercept program. DCBS explained that the program is used because it is an approved evidence-based service under the Family First Prevention Services Act, that Youth Villages has Kentucky staff and offices even though it is headquartered in Tennessee, and that the contract is intended to support intensive in-home services, foster care stabilization, and family reunification. Members asked why the services could not be provided in-house, whether Medicaid should cover more of the cost, and whether the state requires the provider to bill Medicaid as a payer of last resort. DCBS said it would verify billing and funding details and provide them back to the committee. The committee then voted to defer the contract to the next meeting.

Transcript Highlights:

• And the other is we have some higher level acuity If you look at what the costs of your traditional nursing
• I'm about 95% male with high acuity issues. Civilian nursing home is probably 92% female.
• And so just the acuity of when we're getting folks and our costs are rising up because they have more
• I mean, clearly, our intent is to those folks that I'll get paid for people who will have less acuity
• So we get them very late in life with much more acuity, and they don't stay with us.

Keywords: 914, all

Transcript Highlights:

• one relates to the need to transition to a new federal system for determining daily rates based on acuity
• one relates to the need to transition to a new federal system for determining daily rates based on acuity
• one relates to the need to transition to a new federal system for determining daily rates based on acuity
• more guidelines around how much services, you know, are appropriate for a person with a level of acuity
• and so we're kind of looking into Acuity and so we're kind of looking into Solutions<00:53:29.200>

Keywords: 1187, senate, all

Transcript Highlights:

• I think the department agrees that some of those projections did not accurately reflect the acuity of
• on the blended rate, for example, if you saw a decrease in kids in care or you saw a decrease in acuity
• And then on the in our situation to where we have more kids and more acuity.

Bills: SB596, SB961, SB1398, SB1183, SB1952

Keywords: DFPS, Department of Family and Protective Services, child protective services, foster care, child welfare, Family Code, conservatorship, managing conservator, parental child safety placement, authorization agreement, temporary authorization order, child abuse, child neglect, placement reporting, court-ordered removal, investigation, family preservation, transparency, public reporting, data reporting

Transcript Highlights:

• I know specifically for us, we have structured these levels of care to try and map to what the acuity
• So we've heard a lot about patients presenting with higher and higher levels of acuity.
• But what you do have, what's interesting is that the acuity is basically the same on both sides of the
• What's interesting is that the acuity is basically the same on both sides of the fence.
• But I don't know, lower-acuity patients mostly? No, not necessarily.

Keywords: 1185, senate, all

Transcript Highlights:

• Slide eight essentially is to just give you a bit of a visual.
• c> a<00:26:11.240> bit<00:26:11.360> of<00:26:11.480> a<00:26:11.640> visual
• this is the number you a bit of a visual this is the number of<00:26:13.000> children<00:26:13.679
• clinical needs and clinical care needs, they go into the long-term care setting with some sort of acuity
• And the amount of money that gets reimbursed is dependent upon that acuity rating.

Keywords: 928, house, all

Summary: The committee held a Division 3 budget work session focused on the Department of Health and Human Services’ Division of Economic Stability. Karen Hebert, the division director, and Nathan White, DHHS chief financial officer, walked members through the governor’s operating budget pages and a briefing book, explaining that the division was consolidated in 2018 and serves programs aimed at financial stability, poverty reduction, child care access, and related supports. Members repeatedly asked for clearer breakdowns of general fund spending, historical growth since consolidation, and how the division’s broad mission areas map onto specific budget lines. A major portion of the discussion centered on the Bureau of Child Development and Head Start collaboration and the child care subsidy program. Hebert said the child care scholarship/subsidy helps low- and moderate-income families access daycare so parents can work, attend school, or receive treatment, and that eligibility is based on state median income up to 85%. She reported a 45% increase in utilization, 4,032 children receiving daycare support as of the end of January, and about 15% of eligible children being served. She also described the quality improvement system “Granite Steps for Quality,” with 160 providers enrolled out of 717 licensed programs, and noted that 1,200 child care professionals added credentials in the last year. Members pressed for cost-benefit information, asking for data on how much the state pays, how many providers and children are served, and whether the department could quantify unmet need. The witnesses said some projects were funded with short-term ARPA child care dollars and that detailed cost data for specific examples, such as the Gorm Community Learning Center expansion, would need to be looked up. They also explained that the child care fund is a federal block grant with required spending set-asides of 9% for quality, 3% for infants and toddlers, and up to 5% for administration, and that unused funds remain available. The committee also reviewed slide 10’s accounting units, including that the Child Care Workforce Fund is 100% general funds and was created as a priority item under HB 2 from the 2024 session, while some other child care-related units are 100% federal funds.

Transcript Highlights:

• County involvement varies depending on the acuity of those treatment needs.
• Patient acuity is rising across the waterfront.
• That acuity often ends up in the emergency room, so we know that very well.
• Patient acuity is rising across the state.
• That acuity often ends up in the emergency room, so we know that very well.

Keywords: 1183, house

Transcript Highlights:

• If you look at the higher-acuity children, which are the ones that my agency actually places, you're
• If you look at the higher acuity children, which are the ones that my agency actually places, you're

Bills: SB500, SB1522, SB1137, SB1266

Keywords: SB 500, Texas adoption law, Family Code, DFPS, Department of Family and Protective Services, child-placing agency, prospective adoptive parents, adoption records, confidential information, nondisclosure agreement, child history report, health history, social history, educational history, genetic history, termination of parental rights, permanency plan, single source continuum contractor, privacy, redaction

Summary: The Committee on Human Services met with a quorum and first voted out Senate Bill 1589, relating to contract requirements between a single-source continuum contractor and DFPS. The motion to report the bill favorably to the full House with a recommendation that it do pass and be printed prevailed on a 7-0 vote. The committee then heard Senate Bill 500, which would set deadlines for providing foster care adoption records, including health, social, educational, and genetic history reports, to speed adoptions. The bill’s author and witnesses from Addie’s Hope Social Services supported it, saying delays in redacted files can take months, slow permanency for children, and increase costs to the state. Members asked about redactions and sibling/family information, and witnesses explained the bill would mainly speed the preliminary file used to decide whether to proceed with placement. SB 500 was left pending. Members also heard Senate Bill 1266, which would require regular reevaluation of the Medicaid provider support team and add written notice of provider disenrollment at least 30 days in advance. There were no witnesses, no questions, and the bill was left pending. Senate Bill 1522, concerning continuing care retirement communities, was then laid out and supported by LeadingAge Texas and counsel, who said it updates outdated definitions, clarifies licensing and disclosure rules, and strengthens consumer protections for seniors. It was also left pending. After a brief recess, the committee heard Senate Bill 1137, which would prohibit group home consultants from referring people to unlicensed or unpermitted group homes except in limited circumstances, require disclosure of complaints, and create a Class B misdemeanor for violations. Members discussed whether consultants are regulated and noted concerns about unlicensed referral practices. The bill was left pending, and the committee adjourned after completing its agenda.

Transcript Highlights:

• This also includes pushing patients to higher acuity sites of service that includes ERs and hospitals
• There's a national trend to push lower acuity care and surgeries to lower cost side of services.
• This is contrary to that trend. higher acuity sites of service that higher acuity sites of service that
• 12.880> lower There's a national trend to push lower There's a national trend to push lower acuity
• care and surgeries to lower cost acuity care and surgeries to lower cost side<00:57:15.720> of

Keywords: Meeting Start 00:00:00 Call to Order and Roll Call 00:00:02 Discussion HB 144 00:00:58 Vote HB 144 00:02:40 Discussion HB 169 00:03:21 Vote HB 169 00:05:02 Discussion HB 568 00:05:56 Vote HB 568 00:28:27 Discussion HB 627 00:32:26 Vote HB 627 01:00:26, 958, all

Transcript Highlights:

• It's about, you know, how do we address those costs, the acuity levels.
• I mentioned in this committee last time that I presented about the acuity levels are changing, and one
• I'm talking about the overall acuity level, the total population.
• what I meant by that was the healthier people are dropping off, the sicker are staying on, so my acuity
• level I'm talking about the same acuity level I'm talking about the overall overall overall acutity<

Keywords: Meeting Start 00:00:00 Attendance Roll Call 00:00:36 Department for Medicaid Services 00:01:44, 958, all

Summary: The House Budget Review Subcommittee on Health and Family Services met for an overview of the Department for Medicaid Services budget. Commissioner Lisa Lee and CFO Steve Beal described Kentucky Medicaid enrollment at about 1.4 million members, including more than 600,000 children, and said the agency’s 2025 total budget was $20.6 billion. They reviewed enrollment trends before, during, and after the COVID-19 public health emergency, noting that redeterminations begun in 2023 reduced enrollment from its peak but that total membership remains above pre-COVID levels. They also explained the difference between the fee-for-service population, which includes long-term care and waiver members, and managed care members, and gave examples of the kinds of services and diagnoses seen in each group. A major focus was the governor’s recommended Medicaid budget and the department’s forecast process. Lee said the budget is split into benefits and administration, with benefits covering fee-for-service services, managed care capitation, transportation, and Medicare premiums, while administration covers contracts, personnel, operating costs, and IT-related advanced planning documents. She said the department uses a consensus forecasting group and actuary input, and that its forecasts have been within 1% of actual spending in recent years. The department also said the governor’s budget includes new waiver slots to address waiting lists, a 2% staff COLA, and a 10% phase-down on state-directed payments beginning in January 2028. Much of the discussion centered on House Resolution 1 and the funding needed to implement its Medicaid-related provisions, including community engagement requirements, six-month redeterminations, and future cost sharing. Lee said the department requested about $35 million in total funds for fiscal 2027, including about $8.2 million in general funds for system changes to the integrated eligibility system, claims processing, notices, and monitoring; and about $11 million in fiscal 2028 for ongoing maintenance, with about $1.6 million in general funds. She said the department expects to seek federal APD matching funds for the IT work. In response to questions, she explained that community engagement would apply to Medicaid expansion members, with qualifying activities including work, school, volunteering, or equivalent income, and that certain groups such as pregnant women, children, caretaker relatives, and some people with chronic disease or substance use disorder would be excluded. She said the department identified roughly 70,000 expansion members who could be subject to the requirement. No votes or formal actions were taken.

Transcript Highlights:

• You can see that in Chart 6, which visualizes what those potential cost shares will look like.
• That is going to change the cost and risk acuity for our population, so those are... really important

Transcript Highlights:

• entity is in violation of the data-sharing provisions of the bill, remove the definitions of high-acuity
• services, low-acuity services, moderate-acuity services, and perform care, and eliminate the requirement
• that DCF submit to... ...acuity services and perform care, and they would eliminate the requirement

Keywords: 1146, all

Transcript Highlights:

• day: fragmented care, poor coordination, and limited effectiveness for individuals with the highest acuity
• day: fragmented care, poor coordination, and limited effectiveness for individuals with the highest acuity
• day: fragmented care, poor coordination, and limited effectiveness for individuals with the highest acuity
• day: fragmented care, poor coordination, and limited effectiveness for individuals with the highest acuity

Bills: HCR18, HCR32, HCR35, HCR105, HCR173

Keywords: hospice, health care, aging population, regulations, Medicare, working group, fraud prevention, quality of care, mental health, recidivism, civil commitment, Hawaii State Hospital, justice system, shelter, treatment pathways, biomarker testing, health insurance, precision medicine, healthcare access, medical necessity

Summary: The committee heard testimony on SCR 21 SD1, which asks Hawaii Health Systems Corporation’s East Hawaii Regional Health Care System to study the feasibility of a rural health clinic or similar access point for the Volcano community. Testimony in strong support came from HHSC representatives, Volcano residents, the Volcano Health Collaborative, the Rotary Club of Volcano, and others, who said the area has a clear need and that local primary and urgent care would align with regional plans. HHSC said it had already looked at the area, found no suitable temporary buildings, and would need a longer-term, capital-intensive solution, but that the study could help accelerate next steps. The committee then took up SCR 50 SD1, proposing a Hawaii Health Plan Working Group to design a basic affordable health plan for residents. Dr. Jack Lewin of SHIPTA said the state faces a growing uninsured population and argued for a short-term, lower-cost plan focused on preventive and primary care, drawing on the old State Health Insurance Plan as a possible model. Members asked about whether that prior program still exists and whether the working group should include the Hawaii Medical Association and Hawaii Primary Care Association; Dr. Lewin said the statute still exists but is unfunded, and that the group should be inclusive. The Department of Labor and other organizations also provided comments. For SCR 75 SD1, which urges a coordinated interdepartmental effort to reduce fetal alcohol spectrum disorder, Dr. Lewin and others said prevention, prenatal screening, and early intervention are needed because FASD is often hidden until later problems appear. Amanda from Hawaii FASD Action Group said current implementation under Act 192 is still largely a landscape analysis and that Hawaii lacks the infrastructure and specialists for a full system. Darlene Chance Govor urged adding the judiciary as a partner so juvenile justice and probation staff can be trained and referral pathways improved, while the Department of Health said it supports prevention but prefers a broader, systems-based approach focused on child needs and upstream care. The Disability Rights Center supported the resolution and asked for an earlier reporting date. The committee also heard SCR 149 SD1, which seeks an informal working group to address complex patients with multiple diagnoses involving substance use, mental health, or chronic physical illness. The Hawaii Substance Abuse Coalition and Ke Nui Malo strongly supported the measure, saying current siloed systems leave people bouncing between medical, mental health, and substance use providers without coordinated care, often ending up in crisis, emergency rooms, or the justice system. They said integrated residential care and a coordinated working group could improve outcomes and align with federal funding opportunities. The transcript ended before any final vote or action on the measures was announced, and SCR 109 was noted as withdrawn from the agenda.

Transcript Highlights:

• failures within AHCCCS to verify eligibility, and the data that we found, it was an analysis of 87,829 acuity
• system that has become opaque, unmanageable, and misaligned with the realities of delivering high-acuity
• function as both Medicaid authority and the operational health plan of AIHP. ...especially for high-acuity

Keywords: 1182, all

Summary: The Senate Committee on Health and Human Services held a fourth hearing in its ongoing review of alleged fraud, waste, and abuse involving AHCCCS/Access and DHS, with a major focus on Medicaid eligibility verification for the aged, blind, and disabled (ABD) population, behavioral health and sober living oversight, and payment delays to providers. Senator Shamp presented findings she said showed major gaps in ABD asset verification, including claims that only a fraction of enrollees were checked and that many ineligible members may remain on the rolls. She urged referrals to law enforcement, tighter verification requirements, better PARIS data sharing, and legislative changes to close what she described as a compliance and taxpayer-risk gap. Reva Stewart also testified that patient brokering and fraudulent recruitment of vulnerable people, including Native Americans, continues through social media and other channels, and she called for stronger enforcement and transparency. Heather Dukes, representing behavioral health and sober living operators, argued that the state’s response to fraud has become overly punitive toward legitimate providers. She said ADHS often sends technical paperwork deficiencies straight to enforcement instead of allowing plans of correction, that zoning approvals are being questioned despite not being within ADHS authority, and that long Access approval timelines are creating licensing and billing delays. ADHS Deputy Assistant Director Tiffany Slater said the department has seen a large volume of unlicensed complaints, that it is trying to improve staffing and data systems, and that some enforcement tools have been expanded for sober living homes. She also said many sober living operators are in recovery themselves and provide low-cost housing and support rather than direct billing to Access. Access Director Virginia Roundtree said the agency is trying to balance fraud prevention with support for legitimate providers. She reported steps such as daily internal huddles, live dashboards, added project management support, an outside review of the Division of Fee-for-Service Management, and a new external claims vendor to help reduce backlogs. Senators pressed her on a specific provider’s long-delayed payments and prepayment review, and she said the agency would provide answers early the following week. Access staff also described provider resolution roundtables and said unadjudicated claims had been reduced to zero, though members questioned whether that was due to denials rather than resolution. The hearing ended with the chair announcing legislation to preserve the American Indian Health Plan as a fee-for-service option while requiring Access to contract administrative and care management functions to another entity, citing structural failures in Access’s ability to operate the plan safely and effectively.