Bills: HB4440, HJR1067, HJR1087, HJR1089

Keywords: Medicaid, low-income adults, healthcare, eligibility restrictions, constitutional amendment, Medicaid expansion, SoonerCare, health coverage, federal matching funds, FMAP, Article XXV-A, state question, special election, Title 63, public assistance, healthcare funding, federal-state match, Medicaid eligibility, Oklahoma Constitution, ad valorem

Transcript Highlights:

• So that allows us nine months there with a higher FMAP, a higher match.
• So that allows us nine months there with a higher FMAP, a higher match.
• So, I mean, if, The preliminary FMAP to be around 52.4%.
• If the FMAP changed drastically from what the expectation was.
• We were off on our FMAP.

Bills: SB2399

Keywords: mental health, psychiatric treatment, reimbursement, medical assistance, legislative report, 908, all

Summary: The committee reconvened and first reconsidered House Bill 1612, the aerospace medical and mental health support center bill. Senator Cleary offered an amendment to reduce the general fund appropriation from $500,000 to $250,000 and require the university or project sponsors to find the remaining funding from other sources. The amendment passed, and the bill was then recommended do pass as amended, with members citing concerns about university funding, but others supporting the project as a one-time seed investment. The committee also discussed a possible future FMAP increase beginning October 1, 2026, which could reduce general fund costs by roughly $9 million, though members noted the figures were still preliminary and could be addressed later if needed. The committee then returned to Human Services budget items, including early childhood and child care funding, a community cultural center grant, and several other adjustments. Members discussed reducing the “best in class” amount, changes to child care grants and quality/infrastructure funding, and clarifying that prior child care assistance appropriations were in fact being spent. They also agreed to reduce the 1915(i) Medicaid waiver line by $2 million, with the understanding that the entitlement would still be funded as needed. The committee also considered taking guardianship funding out of House Bill 1012 because a separate bill, Senate Bill 2029, would move that funding elsewhere; members agreed that removing it from the budget could help the overall bill and could be restored if the separate bill failed. Several study amendments were discussed. Senator Cleary proposed adding a maternal health study related to prenatal services, doulas, midwives, and Medicaid, and members expressed support. The committee also discussed a software/case-management study proposal, but the department said it had not requested it and would not support it as presented, so members leaned against advancing it unless the department first evaluated it. Another amendment would authorize the department to work with the city of Grafton on a long-term plan for the LSTC campus and require a report back to the legislature; members supported that as legislative intent. The committee also agreed to remove a truancy study section for later conference discussion, and it reviewed other possible study ideas, including assistive technology, before adjourning to await updated long sheets and bill text.

Transcript Highlights:

• FMAP. But our benefits FMAP would not be impacted by that. I’m a little confused.
• They’re not discussing dropping the FMAP for that.
• They’re not discussing dropping the FMAP for that.
• We're very concerned about the FMAP as well.
• We're very concerned about the FMAP as well.

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:

• FMAP percentage change: 50% to 50.99%. That is the change for this year.
• Senator Cleary on the FMAP. Do you have the long sheet, right? Yes.
• So we do reference the 2027 FMAP there. FMAP there, and include that for budget purposes.
• So if our FMAP is going up... States, I believe it's 55%.
• So, well, it's good for this committee that the FMAP would be increasing.

Bills: SB2015

Keywords: corrections, rehabilitation, prison budget, department of corrections, adult services, youth services, correctional facilities, Heart River correctional center, Missouri River correctional center, James River correctional center, minimum security facility, county jails, regional jails, deferred maintenance, capital construction, strategic investment and improvements fund, Bank of North Dakota, line of credit, tasers, body cameras

Summary: The committee met to review revised long sheets and section-by-section language for a human services/health budget bill, with much of the discussion focused on how to present block grant funding and full-time equivalent (FTE) positions for behavioral health clinics and CCBHCs. Members debated whether to keep FTE counts in the budget at all, ultimately leaning toward removing or zeroing out the FTE references while keeping the dollar authority, and reducing the salaries-and-wages block grant by about $4.75 million. They also discussed public health federal authority, agreeing to remove about $60 million in unused federal spending authority tied to COVID-era funds, and clarified that if federal money later becomes available it could be requested through the Emergency Commission. A major topic was the provider inflation increase. The House version had 2% and 2%, while members debated alternatives and appeared to settle, at least for further work, on 2% in the first year and 1.5% in the second year, with staff asked to recalculate the fiscal impact. The committee also reviewed FMAP changes, noting a revised 2027 FMAP estimate and its effect on general fund and other funds, and discussed whether to adjust public health and other line items accordingly. Several members emphasized that many of these numbers are still tentative and will be refined before final action. The committee also touched on several policy items and capital-related provisions, including behavioral health services, Medicaid expansion, the moratorium on new ICF beds, and a proposed amendment for a medical homes/fourplex-related item that would show a $400,000 legislative investment with repayment from a developer. There was extended discussion of the All True hospital/facility proposal, with some members favoring leaving it in with a smaller initial commitment and others preferring to remove it and revisit later in conference committee. The meeting ended with staff asked to continue updating the bill language and members instructed to review remaining sections before the next meeting; no final votes were taken in the portion provided.

Transcript Highlights:

• We have a federal medical assistance percentage, which is the FMAP.
• Personnel is also considered administrative, and it is a 50% FMAP.
• However, nurses are a 75% FMAP because they are in medical.
• And the FMAP, I would like to say, is based on the state's per capita income.
• The lower your per capita income, the higher your FMAP.

Keywords: 958, all

Summary: The subcommittee met to review the Department for Medicaid Services’ program integrity work. Commissioner Lisa Lee and Program Integrity Director Jennifer Dudinsky outlined Kentucky Medicaid’s structure, funding, enrollment, and spending, including FMAP rates, the size of the Medicaid and KCHIP populations, the number of providers, and 2024 expenditures. They also described the managed care and fee-for-service populations, noting that managed care serves most members while fee-for-service is concentrated in long-term care and waiver populations. Most of the discussion focused on fraud, waste, abuse prevention, and provider oversight. The department described its provider enrollment and certification checks, revalidation requirements, site reviews, fingerprinting for some high-risk providers, and termination grounds such as false application information, Medicare actions, unreported ownership changes, and abandonment of a provider number. Members asked about nonprofit ownership reporting, MCO fraud oversight, and how the department tracks unusual CPT code utilization, especially in behavioral health. The department said it uses data analytics, audits, policy review, and collaboration with behavioral health staff to monitor those trends. Dudinsky explained the division’s four branches: provider licensing and certification, audits and compliance, recovery, and third-party liability/estate recovery. She described prepayment and postpayment audits, referrals of credible fraud allegations to the Attorney General, monthly meetings with the AG’s office, and coordination with the Office of Inspector General, CMS, HHS OIG, MCOs, and other partners. She also explained payment suspensions, stand-downs during law enforcement investigations, and recovery efforts for overpayments, provider/member fraud, and third-party liability. The department said its recovery and avoidance efforts produced more than $251 million in savings so far in 2025. No votes or formal actions beyond approving the minutes were taken.

Transcript Highlights:

• Overall, our state FMAP, its base percentage, is 50%.
• That helps bring the FMAP up.
• Using a provider assessment helps bring that FMAP up.
• They have a higher FMAP than Washington.
• They have a higher FMAP than Washington.

Summary: The Ways and Means Committee held a work session to review how H.R. 1 (the One Big Beautiful Bill Act) could affect Washington’s Medicaid, long-term care, developmental disabilities, and food assistance programs, with a focus on implementation challenges, fiscal impacts, and likely coverage losses. Staff and agency officials explained Washington’s Medicaid financing structure, eligibility categories, caseload trends, and the role of the Health Care Authority and DSHS in administering Apple Health and related services. They also described how Medicaid expansion increased access to behavioral health services and how H.R. 1’s provisions are expected to affect the expansion population most directly. Health Care Authority and DSHS officials outlined several major H.R. 1 changes: new work and community engagement requirements for the Medicaid expansion population, six-month redeterminations instead of annual renewals, changes to immigrant eligibility, limits on provider taxes and state-directed payments, new cost-sharing requirements, reduced retroactive coverage, and changes affecting long-term care eligibility. They said Washington is still awaiting federal guidance on many details, but estimated that about 620,000 Apple Health expansion enrollees could be subject to work requirements, that roughly 30,000 immigrants could lose Medicaid eligibility under the new definition of qualified alien, and that some long-term care and developmental disability clients could be indirectly affected. Officials also said the state is working with other agencies to build shared verification systems and may seek a delay waiver, though they do not expect broad federal flexibility. The committee also heard that H.R. 1 immediately blocks Medicaid reimbursement for Planned Parenthood services for one year, with the state planning to backfill about $11 million to preserve access. In addition, officials warned that the law could reduce federal Medicaid revenue by billions over time and strain hospitals and emergency rooms as more people become uninsured. They noted that Washington’s rural health transformation grant application is due November 5 and could bring some funding, but not to offset coverage losses. No votes were taken; the session was informational only. The committee then heard a separate presentation on food assistance, where staff and DSHS described H.R. 1’s SNAP changes, including expanded work requirements, immigrant eligibility restrictions, higher state administrative costs, and a possible future state share of benefit costs tied to payment error rates. DSHS estimated a four-year fiscal impact of about $750 million for food assistance changes and said the state is working on system and policy changes across agencies before the new requirements take effect.

Transcript Highlights:

• 100% FMAP for direct UIO traditional healing.
• You will receive standard FMAP.
• No state has been able to receive 100% FMAP beyond IHS 638 facilities.
• What... how... for UIOs, but you will not receive 100% FMAP. You will receive standard FMAP.
• No state has been able to receive 100% FMAP beyond IHS 638 facilities.

Bills: SB1112, SB1517, SB1537, SB1584, SB1673, SB1776

Keywords: mental health, hearings, acquaintance witnesses, patient rights, treatment evaluation, barbering, cosmetology, appropriation, funding, licensing, board operations, peace officer, training, public safety, traffic offenses, judicial system, corrections, recruitment, state budget, crime victims

Summary: The Appropriations Committee met on March 25 for what was described as its last regular meeting, with a possible special meeting tentatively planned for the following Tuesday. The committee first took up Senate Bill 1112, as amended by a strike-everything amendment that would appropriate $1 million from the Special Services Fund in FY2027 to the Arizona Department of Corrections for holistic, studio-based rehabilitative programming, with a required report due by June 30, 2028 on spending and outcomes such as self-harm, discipline, and recidivism. Testimony from the founder of Art of Our Soul and a formerly incarcerated peer facilitator emphasized trauma-informed art and music therapy, reductions in disciplinary violations and self-harm, and benefits for both incarcerated people and staff. The committee adopted the amendment and then gave SB 1112 a do-pass recommendation. The committee then heard Senate Bill 1776, which would allow urban Indian organizations to provide traditional healing services reimbursable through AHCCCS or the Arizona Long-Term Care System. The sponsor said the bill was intended to align Arizona with federal approval and other states’ models. AHCCCS testified neutral but said the bill would require a waiver change, likely at standard FMAP rather than 100%, and estimated a $1.3 million general fund impact; the chair said a COW amendment and fiscal note were needed. Members raised concerns about cost and access, and the sponsor clarified the bill was meant for American Indians and family members served through IHS-related facilities. The committee ultimately passed the bill out with a do-pass recommendation, though several members voted no or present over funding concerns. Senate Bill 1537, which would rename the Peace Officer Training Equipment Fund as the Public Safety De-escalation and Life Safety Fund and repeal an inactive advisory commission, failed after testimony from a legislative liaison explaining the fund’s history and use for equipment and de-escalation tools. Some members supported the cleanup, but others objected after the Arizona Police Association opposed the change and argued the commission should be reformed rather than repealed. The committee then considered Senate Bill 1584, as amended, which would provide $1 million for Department of Corrections recruitment and training, funded instead from the Peace Officer Training Equipment Fund. Testimony supported the need to address DOC staffing shortages, but some members objected that the fund was restricted to peace officer equipment; the committee adopted the amendment and passed the bill out. Finally, the committee heard Senate Bill 1673, which would fund the law enforcement crime victim notification system. A chair amendment shifted the source from the general fund to the victim compensation fund and reduced the amount to about $2.5 million. Testimony from the Arizona Sheriffs Association, a vendor, and the City of Phoenix described the notification system as constitutionally required, widely used, and important for victim safety and communication, but several members argued the amendment would take money from victim compensation and “rob Peter to pay Paul.” The committee adopted the amendment and then gave SB 1673, as amended, a do-pass recommendation. The chair closed by noting the committee was adjourned and that a special meeting might be posted for the following week.

Transcript Highlights:

• That's not FMAP. Mr. Chair.
• Okay, FMAP percentage change. Yep, so when we budget, we use the projected FMAPs...
• As the final FMAP came out, it was determined that that rate was 50.99%.
• They have just released preliminary FMAPs for fiscal year 2027.
• Chair, it would take an act of Congress to change the FMAP formula.

Keywords: 908, all

Summary: The Senate Appropriations HR Division met with all members present to review the medical services portion of the HHS budget. Sarah Aker, Executive Director of Medical Services, walked the committee through several budget items, including HCBS cost-to-continue adjustments, the DD bed assessment, expansion of value-based purchasing, targeted rate increases for home health and QSP services, and the cross-disability waiver. Members generally supported the targeted increases for home health and QSP, and Aker explained that the cross-disability waiver funding would support startup work, service design, and infrastructure ahead of a planned July 1, 2028 implementation. The committee spent significant time on rate-setting and provider payment issues. Members discussed ambulance rate rebasing, with several senators expressing concern that the proposed increase was too high relative to peer states; the committee ultimately moved toward reducing that item to $1 million rather than zero so it could be revisited in conference committee. They also discussed a House-added critical access hospital networking grant and similarly leaned toward reducing it to $1 million. Aker explained the department’s value-based purchasing plans, including use of a vendor selected through RFP, and clarified how the department’s existing Medicaid managed care and hospital value-based programs work. A major portion of the meeting focused on long-term care and basic care payments, including a House-added extension of the $5 per day basic care add-on and a proposed shift in nursing facility incentive grants toward a withhold-based model. Senator Mathern indicated he would bring an amendment to delay or modify the withhold change, and Aker said the department would prefer language that directly addresses whether a withhold may be implemented. Members also discussed 1915(i) services, FMAP changes, the Medicaid legacy system modernization carryover, and a House-added legislative intent section on medical assistance. The committee adjourned for the morning with plans to return later to continue Human Services budget work and revisit unresolved items in conference committee.

Transcript Highlights:

• I think your intent was if FMAP drops. Are you aware that FMAP is recalculated every year?
• So part of that recalculation then is a new rate, which is a modification of FMAP.
• When the economy is doing well, FMAP, unfortunately, is up.
• We're now projected to have an FMAP drop.
• Yes I mean, I was aware of FMAP projections. Thank you.

Bills: SB1090, SJR49, SB633, HR1059, SB650, SB2063, SB122, SB1614, SB1884, SJR52, SJR53, HJR1101, SJR50, HB3021, HR1058, SB514, SB382, HB3320, SB740, SB833, SB2143, SB1209, SB244

Keywords: wildlife, conservation, Oklahoma, regulations, permanent rules, Leo's Law, child endangerment, fentanyl testing, drug screening, child welfare, Oklahoma Children's Code, substance abuse, Asian/Pacific American Heritage Month, AAPI, Asian American, Pacific Islander, Oklahoma House resolution, commemorative resolution, heritage month, cultural recognition

Transcript Highlights:

• Does it have— I mean, there hasn't been a change in the FMAP until when does that kick in, Mr.
• So, there has been an annual change in FMAP every year.
• It's been quite a few years now, every year, which is good, but our FMAP has gone down.
• Beautiful bill, is there a change in the FMAP that's in that? And if so, when does that kick in?
• Chairman, Representative Thompson, H.R. 1, the one big beautiful bill, does not address the FMAP.

Transcript Highlights:

• The other part of the bill is the fact that in the event that the FMAP changes comes off the 90%, if
• The second part simply says that the FMAP changes. Then it goes from constitution to statute.
• The other part just does not happen unless the FMAP changes.
• A lot of other states also have triggers in their statutes that talk about the FMAP changing.
• That only happens in the event that the FMAP number changes. Follow up. Thank you, Mr.

Bills: HB3312, HB3700, HB2981, HB2961, HB3016, HB4478, HB4326, HB3025, HB3710, HB4125, HB2951, HB3082, HB4142, HB4106, HB1752, HB3268, HB4440, HJR1067, SB1144, SB1145, SB1146, SB1147, SB1148, SB1156, SB1157, SB1158, SB1159, SB1161, SB1162, SB1163, SB1164, SB1165, SB1166, SB1149, SB1167, HJR1024, SB1174, SB1175, SB1176, HB3419, HB3748, HB4335, HB3057, HB3279, HB4428, HB3420, HB3040, HB4140, HB1638, HB3298, HB4113, HB1082, HB4301, HB3269, HB3587, HB4226, HB4324, HB4339, HB4342, HB3278, HB3996, HB4236, HB4352

Keywords: firearm safety, public schools, education policy, student safety, gun control, opt-out option, grading system, student assessment, academic integrity, state funding, opinion conduct, open meetings, school boards, transparency, public access, education governance, HB2961, TSgt Marshal Dakota Roberts Gold Star Survivor Act, Gold Star family, Gold Star recipient

Transcript Highlights:

• <00:49:49.280> As FMAP or which is the federal share.
• As FMAP or which is the federal share.
• I just wanted to ask about the enhanced FMAP for the AC expansion.
• I just wanted to ask about the enhanced FMAP for the AC expansion.
• <01:09:03.359> So, FMAP rate. So, FMAP rate.

Keywords: 1183, house

Transcript Highlights:

• But the funding of Medicaid is a state-federal partnership at this point, what we refer to as FMAP.
• The general FMAP percentage every year, the federal government issues a report that says the FMAP percentage
• The general FMAP percentage every year, the federal government issues a report that says the FMAP percentage
• The general FMAP percentage every year, the federal government issues a report that says the FMAP percentage
• But the funding of Medicaid is a state-federal partnership at this point, what we refer to as FMAP.

Keywords: 1183, house

Summary: The committee met for an introductory overview of its jurisdiction and staff roles. Nonpartisan House Research and House Fiscal staff explained that they draft bills and amendments, prepare bill summaries and background research, answer legal and fiscal questions, and help track revenue and budget effects. They also distributed a Budget Overview Brief intended to condense the larger budget materials into a more usable format for members. Staff then walked through the Human Services budget and the committee’s areas of responsibility. They described the department structure, noting that DHS oversees administration, compliance, rulemaking, and county support, and that the overall Human Services budget is large, with medical assistance as the dominant program. They also explained recent and upcoming reorganizations: many children and family-related functions are moving to the new Department of Children, Youth, and Families, Direct Care and Treatment is becoming its own agency, and some homelessness-related functions remain at DHS. Staff reviewed how the budget is organized by program and budget activity, the difference between direct appropriations and standing appropriations, and how forecasted programs and “tails” work in the budget process. The presentation also covered Medicaid financing and long-term care. Staff explained the federal-state FMAP match, including Minnesota’s current 51.16% federal match for most Medicaid spending, the CHIP match, and the 90% federal share for the expansion population. For long-term care, they outlined Medical Assistance services for elderly and disabled people, state-funded long-term care supports, and Board on Aging programs. They highlighted the personal care assistance program’s phaseout and replacement by Community First Services and Supports, and reviewed the five home- and community-based waivers. Members asked one question about refugee resettlement funding, specifically whether it covers flights; staff said they would need to follow up on the exact use of the federal funds. No bills were heard, and no formal votes or other committee actions were taken during this meeting.

Transcript Highlights:

• But in terms of FMAP, which we'll get into a little bit, it varies by state in terms of the minimum FMAP
• you might hear ffp or or fmap you might hear ffp or or fmap essentially<01:11:59.880> they're
• Representative Stringham, uh, just on the issue of FMAP, so we're at the lowest at 50%.
• FMAP, so we're at the lowest at 50%. Let's say the national average is 60%.
• You have to claim FMAP. You have to have a person who’s involved, enrolled in Medicaid.

Keywords: 928, house, all

Summary: The House Finance Division III held an informational hearing on Medicaid, Medicare, Choices for Independence, and related financing, while postponing nursing facility financing and the county cap discussion to a later date. DHHS officials Ann Landry, Jonathan Ballard, and Medicaid Director Henry Litman provided an overview of Medicaid’s role, noting it is a federal-state partnership with state-specific eligibility and benefits, and emphasizing that Medicaid is a major funding and programmatic support for other DHHS initiatives. They also distinguished Medicaid from Medicare and explained that Medicaid funding is not the same as grant funding, though some providers may also receive federal grants through other channels. The presentation focused on New Hampshire’s relatively small Medicaid program and why it differs from national averages. Officials said about 184,000 residents are covered, roughly one in seven Granite Staters compared with one in five nationally, and attributed the difference largely to the state’s higher per-capita income and older population. They highlighted that about 65% of Medicaid-enrolled adults in New Hampshire are working, that only 22% of births are covered by Medicaid versus 42% nationally, and that the state’s uninsured rate is lower than the national rate. Members asked about covered services, income limits, federal matching rates, and the names of optional eligibility groups; staff explained that New Hampshire offers the optional groups discussed, with matching rates varying by category, including 90% for Granite Advantage and certain other groups, and 65% for children above the required level. A substantial portion of the hearing covered eligibility rules and recent policy changes. Officials reviewed the history of Medicaid, including HCBS waivers, the CFI program, Katie Beckett, the Olmstead decision, the ACA, and the end of continuous enrollment after the public health emergency. They also discussed the 2023 legislative expansion of postpartum coverage from 60 days to 12 months and child eligibility changes. In response to questions, DHHS said it is tracking utilization and costs for the postpartum expansion and reported that many maternal deaths occur after the prior 60-day coverage period, often involving substance use disorder or suicide; they said the longer coverage is intended to improve access to treatment and prevention. The committee also walked through household-income examples, clarified that Medicaid eligibility is based on household income and categorical rules, and confirmed that Granite Advantage ends at 138% of the federal poverty level unless another categorical basis applies. No votes were taken, and the hearing remained informational.

Transcript Highlights:

• up. when the FMAP It goes right back up. when the FMAP changed<00:56:51.520> back<00:56:51.839
• FMAP in the Medicaid program. FMAP in the Medicaid program.
• FMAP has gone back down to our normal FMAP. That's correct.
• That is reflective of our FMAP.
• reflective of our FMAP there. Yes sir. reflective of our FMAP there. Yes sir.

Keywords: 924, joint, all

Transcript Highlights:

• We went to like 75/25 FMAP, the federal matching percentages, and so that's what drove that.
• For example, um, uh, reduced FMAP. Uh, there are some provisions related to, um, as Mr.
• For example, um uh reduced<00:20:10.560> uh reduced uh reduced uh FMAP.<00:20:12.520> Uh
• Uh there are some provisions FMAP.
• So, if 90/10 at that 90/10 they at first were discussing making that the same as our traditional FMAP

Keywords: 958, all

Summary: The Budget Review Subcommittee for Health and Family Services met for its first meeting, established quorum, and heard a presentation from Department for Medicaid Services Commissioner Lisa Lee and CFO Steve Becktold. The department reviewed its compliance with House Bill 695, which requires legislative approval before certain Medicaid eligibility, service, benefit, or waiver changes, along with fiscal impact reporting to the Legislative Research Commission. They described current waivers, including home and community-based waivers, managed care and transportation waivers, and the 1115 re-entry waiver, and said the community engagement waiver is in public comment and on track for submission to CMS. They also said required reports and other HB 695 tasks, including a pharmacy rebate fund, budget analyses, expenditure reports, and a behavioral health scorecard, are underway or completed as required. The CFO outlined Medicaid’s budget, saying the department has two appropriation units and projecting near-full use of state funds while leaving some federal funds unspent because of matching-rate differences. They reported roughly 211 filled positions and 11 vacancies. Members asked about the vacancy makeup, the behavioral health scorecard, and whether a provider involved in quality metrics could have a conflict if used in the scorecard process; the department said it would follow up. Members also asked about the community engagement waiver and its interaction with federal policy, and the department said CMS guidance is still pending and that it will proceed under HB 695. A substantial portion of the discussion focused on federal Medicaid policy changes under a reconciliation bill, including possible limits on provider taxes, directed payments, cost-sharing, and community engagement requirements. Department officials said the final federal impact is still uncertain because the Senate bill is not finalized, but they have modeled several scenarios and warned that any reduction in federal support or benefits would be harmful, especially for hospitals and rural hospitals. They estimated Medicaid benefits are funded about 80% federal and 20% state overall, with expansion populations closer to 90% federal funding, and said administrative costs would also rise if federal requirements change. Members also asked about work requirements and eligibility. The department said the community engagement waiver would mainly affect the expansion population, which they estimated at about 450,000 people out of roughly 1.5 million total Medicaid enrollees, and that many groups are exempt, including children, the aged, blind, disabled, and people in substance use disorder treatment. Officials said they can provide data on how many enrollees are working or work-ready and explained that their eligibility system is designed to prevent duplication by automatically placing people in the correct category and correcting errors quickly. They also noted a federal proposal to require expansion eligibility reviews every six months, compared with current annual renewals.

Transcript Highlights:

• When we think about Kentucky, that $245 does not include the FMAP, or the federal medical assistance
• 00:38:50.960> or<00:38:51.280> the<00:38:51.599> federal does not include the FMAP
• or the federal does not include the FMAP or the federal medical<00:38:52.880> assistance<00:38
• It gets pretty close to a break-even for a state such as Kentucky with a higher FMAP.
• Uh again, both of with a higher FMAP.

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board met on February 23, 2026, approved the January 12 minutes, and then focused primarily on Kentucky Medicaid’s coverage and potential expansion of GLP-1 drugs, especially for weight loss. Department for Medicaid Services Commissioner Lisa Lee explained that Medicaid currently does not cover drugs for weight loss, anorexia, or weight gain, but the department had filed a regulation to remove that blanket exclusion so GLP-1s could be covered when used for an underlying health condition. She said the administrative regulation review subcommittee found the regulation deficient, and the co-chairs wanted the board to discuss the policy and financing implications before any change. DMS also said it would be open to adding caveats to ensure coverage would not extend to cosmetic weight loss alone. The department provided several data points on current utilization and spending. In 2025, Kentucky Medicaid paid for appetite-stimulating drugs such as Megestrol, Dronabinol, and Marinol, but did not pay for weight-loss drugs. For GLP-1s, DMS said coverage began in 2025 and is limited to FDA-approved medical conditions, with prior authorization requiring a type 2 diabetes diagnosis code and A1C documentation. DMS reported $234.6 million in GLP-1 spending in 2025 before rebates, about 240,931 prescriptions, and said GLP-1s accounted for 7.3% of pharmacy spend in 2024 and 8.3% in 2025. It also said there were 24,844 expansion members and 13,638 non-expansion members using GLP-1s, with spending of about $156 million and $78.5 million respectively, and that 10 pediatric weight-loss prescriptions were covered under EPSDT. The department said outcome analyses, including whether GLP-1 use reduces insulin or other diabetes treatment, are underway and should be completed in a couple of months. Members asked about cost, rebates, and whether the state should wait for more outcomes data before expanding coverage. DMS said average reimbursement to pharmacies was $975 per prescription and the average dispensing fee was $109; it also said 2025 rebate invoices totaled $90.8 million, with $7.6 million collected so far. Several members expressed concern about the high cost and the need to evaluate whether the drugs improve health outcomes before expanding access, while others noted the potential benefits for obesity and diabetes treatment. Some members also discussed whether GLP-1s are effectively being used for weight loss in diabetic patients and whether broader data collection should be used to assess long-term value. After the Medicaid discussion, Eli Lilly executive Tracy Sims presented on obesity as a chronic disease and the economic burden it creates in Kentucky. She said Kentucky’s adult obesity rate is a little over 37%, that obesity is linked to about 200 diseases, and that untreated obesity costs the state billions in GDP and hundreds of millions in state budget impact. She highlighted recent federal access programs for GLP-1s, including a Medicaid-related program that she said could lower the state share of a Zepbound prescription to about $71 per month after federal matching. No votes were taken on the GLP-1 policy question during the meeting, and the main action was the receipt of testimony and discussion of the department’s proposed regulatory change.

Transcript Highlights:

• Are you asking about FMAP? I'm sorry, TANF.
• What's our current FMAP? Current FMAP, I believe, is 69.23.
• What's our current FMAP? Current FMAP, I believe, is 69.23.
• The current FMAP rate is at 69.23.
• We usually have a blended FMAP rate of close to 70% because admin is at a different FMAP, and so it's

Summary: The committee heard budget presentations and took executive recommendations on several Department of Human Services divisions, including Aging, Adult and Behavioral Health Services; Children and Family Services; County Operations; Developmental Disability Services; and Medical Services, with most divisions showing little or no significant change in total appropriations. Staff and agency witnesses repeatedly explained that many large appropriations are maintained for flexibility, federal matching requirements, or contingency needs, even when actual spending is much lower than the authorized amount. Members also raised concerns about staffing vacancies, long-vacant budgeted positions, and the use of excess appropriation authority across DHS. In Aging, Adult and Behavioral Health, members questioned federal funding levels for mental health and substance abuse grants, the status of senior centers and Meals on Wheels, the Medicaid tobacco settlement program, community alcohol safety grants, and the veterans mental health grant. Agency officials said federal block grants are largely committed, that senior center funding had been delayed by shutdown timing but was now back on track, that the tobacco settlement program had been moved internally within DHS, and that the veterans mental health appropriation remains unfunded. Senators also criticized the adequacy of support for seniors and asked for more detail on how transportation, meal services, and local contributions are funded. In Children and Family Services, members asked about rising appropriation levels, foster care and adoption subsidies, professional fees, the number of children in foster care, and the Children’s Trust Fund. DHS said increases reflect added flexibility for residential treatment, adoption subsidies, and prevention services, while the foster care population has remained fairly steady at about 3,400 children. The Children’s Trust Fund was described as supporting primary prevention programs such as Baby and Me and community schools, and members asked whether it could be administratively combined with other efforts. Questions also covered TANF subgrants, with DHS explaining that it had reduced outside subgrants after discovering over-obligation and was rebuilding reserves. In County Operations, members focused on the summer EBT program, SNAP employment and training, the farmer’s market program, and the state’s TANF reserve position. DHS said summer EBT is still being funded through temporary appropriations because it is a newer program, SNAP employment and training is largely federally funded and may expand under a pending policy change, and TANF reserves were drawn down after prior over-obligation but are now being stabilized. In Developmental Disability Services, members asked about vacancies, human development center staffing, facility construction funds, and the Booneville work program, and DHS said the program has reopened and staffing recruitment continues. In Medical Services, members asked about FMAP, the Our Kids B CHIP program, school-based Medicaid reimbursements, nursing home distress funds, and several large appropriation lines that far exceed actual spending; DHS said these are maintained for claims payment, nursing home receivership contingencies, and other flexibility needs. Each division reviewed was adopted by executive recommendation after questions concluded.

Transcript Highlights:

• So, Medicaid funding, you know, as most people know, an FMAP, which is the federal medical assistance
• <00:36:34.400> which<00:36:34.560> is as as most people know an FMAP which is as as
• most people know an FMAP which is the<00:36:34.880> federal<00:36:35.280> medical<00:36
• The FMAP we get a percentage.
• The FMAP we get a significant<00:36:38.960> federal<00:36:39.440> match<00:36:39.920>

Keywords: Call to Order and Roll Call – 00:00:00 Introduction of Board Members – 00:02:04 Overview of the Purpose and Goals of the Medicaid Oversight and Advisory Board – 00:12:46 Medicaid Legislative Update - 00:20:26 Discussion of Next Steps and Future Meeting Dates – 01:04:06 Adjournment – 01:06:37, 958, all

Summary: The first meeting of the Medicaid Oversight Advisory Board opened with Chair Ken Fleming and Co-Chair Rocky Adams welcoming members, explaining the board’s purpose, and introducing the diverse membership of legislators, providers, advocates, and state officials. Fleming said the board would meet monthly, allow public comment at the end of meetings, and operate transparently with materials posted online and distributed in advance. Both chairs emphasized that the board’s work would focus on improving Medicaid outcomes, efficiency, and oversight, while preparing for possible federal changes and avoiding premature assumptions about what Congress may do. Members then gave brief introductions describing their backgrounds in medicine, nursing, hospital administration, behavioral health, insurance, budgeting, pharmacy, and Medicaid administration. Several noted direct experience with Medicaid populations or managed care, including the Department for Medicaid Services commissioner, health plan representatives, hospital and clinic leaders, and legislators with health care backgrounds. The board also heard from Stephanie Bates of the LRC Office of Health Data Analytics, who said her office supports the General Assembly with health-related data, policy, and research and would serve as a resource to the board. Bates then began a presentation on Medicaid basics, explaining that House Bill 695 created the board and that the presentation would cover eligibility, enrollment, covered benefits, waivers, managed care, the budget, and the federal reconciliation bill. She described Medicaid eligibility as complex, noted that Kentucky had more than 1.4 million enrollees, and explained enrollment churn and the unwinding of pandemic-era continuous coverage. She also outlined mandatory and optional Medicaid benefits, the requirement that services be medically necessary and provided by enrolled providers, and the main waiver types used in Kentucky, including 1115, 1915(b), and 1915(c) waivers. No votes or formal actions were taken at this meeting beyond organizational setup and receiving the initial informational presentation.

Transcript Highlights:

• So the FMAP affects that.
• Our FMAPs are just a little below 75%, so every dollar spent, 75 cents of that dollar is paid for by
• We have one of the highest FMAP rates in the country.
• We have one of the highest FMAP rates in the country.

Keywords: 994, senate, all