Bills: SB2275, SB2390, SB2540, SB3142, SB2414, SB2340, SB2848

Keywords: Medicaid, disability, buy-in program, workers with disabilities, income eligibility, premium structure, biomarker testing, health insurance, medical coverage, state law, health maintenance organization, juvenile justice, youth penalties, minors, court fees, court costs, fines, surcharges, restitution, fee waiver

Summary: The House Committee on Health heard testimony on a series of bills related to public health, pharmacy regulation, disability access, and health care infrastructure. HB 1535, creating an income tax credit for automated external defibrillator installations, drew support from the Department of Health, tax department comments, and public testimony emphasizing AED access in community and transit settings. HB 1765, requiring safety warnings for spear fishing gear, received comments from DLNR and strong support from a free-diving safety advocate who described blackout risks and argued for point-of-sale warnings. HB 1549, which would repeal the law prohibiting drug paraphernalia, drew mixed testimony: the Department of Health, the Public Defender, and harm-reduction advocates supported repeal as a public health measure, while HPD and a county prosecutor opposed it, warning it could encourage drug use and create public safety issues. The committee also heard HB 1550, which would exclude drug testing products from the definition of drug paraphernalia. The Department of Health and harm-reduction advocates supported the bill, saying drug checking tools save lives and help prevent overdoses, while one written opponent was noted. HB 1995, allowing people who are blind or deaf to receive disabled parking permits, drew opposition from the State Council on Developmental Disabilities, the Disability and Communication Access Board, and other opponents, while a few written supporters were also noted. HB 1671, allowing licensed dental hygienists to place interim therapeutic restorations in public health settings, received support from the Department of Health and several oral health organizations, with the Board of Dentistry offering comments. HB 1643, establishing a framework for pharmacy audits and record retrieval, prompted the most extended discussion. The Board of Pharmacy and independent pharmacy representatives supported the bill as a needed framework to limit burdensome audits and protect patient care, while HMSA raised concerns about possible conflicts with upcoming federal PBM reforms and potential unintended consequences. Committee members questioned both sides about timing and workload, and supporters argued the bill was needed now to protect rural and independent pharmacies. Finally, HB 1978, appropriating funds for a new outpatient care center in North Kona, received strong support from Hawaii Health Systems Corporation, Queen’s Health Systems, the Kona-Kohala Chamber, and others, who described it as a long-term investment in West Hawaii’s health care capacity and economy. No votes or final actions were taken in the portion of the hearing provided.

Bills: HF4525, HF3002, HF3665, HF4420

Keywords: human services, background studies, NETStudy 2.0, licensing, license suspension, license revocation, provider enrollment, program integrity, fraud, medical assistance fraud, Medicaid, payment withholding, credible allegation of fraud, background check, disqualification, variance, set-aside, foster care, family foster setting, adult foster care

Transcript Highlights:

• Both institutional LTSS as well as HCBS.
• Adults receiving Medicaid HCBS or institutional LTSS.
• Equity for people who are receiving HCBS. Next slide, please.
• So you could, if you only want to look at HCBS, for example.
• Because DDS doesn't provide, it's not in our regular HCBS.

Keywords: 995, all

Summary: The Massachusetts Commission on the Status of Persons with Disabilities’ Long-Term Services and Supports and Health Equity Subcommittee met to hear a presentation from the Lurie Institute for Disability Policy at Brandeis University. Monica Mitra introduced the institute’s work on disability health equity and long-term services and supports, and staff described several research centers focused on community living policy, disability and pregnancy, and parents with disabilities. The presentation emphasized participatory research, accessible dissemination, and the connection between health equity and access to home- and community-based services. Joe Caldwell discussed the Community Living Policy Center’s work on Medicaid HCBS, the direct care workforce crisis, housing, and policy advocacy, including efforts related to the Money Follows the Person program and the Medicaid access rule’s interested parties advisory group. Sid Pickern highlighted a workforce study interviewing direct care workers, a forthcoming policy brief on the access rule, and housing research including Massachusetts’ Alternative Housing Voucher Program. Teresa Nguyen described the Community Living Equity Center’s focus on disparities in community living for people of color, especially a study on self-direction and community living outcomes, and asked for help recruiting participants. Lauren Bixby demonstrated the community living data dashboard, which compares adults who need LTSS with those receiving Medicaid LTSS using ACS and TMSIS data. She explained that the dashboard can be filtered by state and demographics, but noted major race and ethnicity data gaps for Massachusetts and other states. Commissioners praised the dashboard and the institute’s work, asked questions about data sources and the 1115 waiver, and discussed possible connections to the Health Equity Compact. No votes were taken; the meeting ended with an invitation for follow-up, including a forthcoming direct care workforce brief and the institute’s October 28 lecture.

Transcript Highlights:

• So HCB, if you from a previous year.
• HCBS waiver, you have an original HCB HCBS waiver, you have an original HCB assessment<01:00:13.440
• So, um, the HCBS assessors as well, we actually have the assessors that do HCB.
• that were approved for HCB that really that were approved for HCB that really didn't<01:18:43.840>
• going to be a denial within the HCB going to be a denial within the HCB waiver,<01:21:58.080>

Keywords: 958, all

Summary: The Medicaid Oversight Advisory Board’s fourth meeting focused primarily on a presentation from University of Kentucky and University of Louisville health leaders about the state university directed payment program. Mark Birdwhistle and Ken Marshall described the program as a long-running, value-based Medicaid arrangement that began in 2019, uses university-provided matching funds rather than provider taxes, and ties a portion of payments to quality outcomes. They said the program has improved measures such as tobacco cessation, diabetes control, depression screening, and cancer screening, while supporting access to specialty care, medical education, and workforce training. They also emphasized that Kentucky’s model is nationally notable and has helped improve health rankings and generate cost savings. A major topic was the federal reconciliation bill signed July 4, which the presenters said will reduce directed payments by 10% annually for 10 years beginning in 2028. UL Health estimated a first-year loss of about $75 million and a cumulative loss of about $600 million over the decade; UK estimated about $100 million in the first year, for a combined first-year impact of roughly $175 million. Both speakers warned the cuts could affect access to care, training capacity, and the sustainability of Kentucky’s value-based model, though they expressed hope that congressional action could alter or delay the changes. They also noted that 340B drug pricing changes could further strain already thin operating margins, but did not provide exact figures during the meeting. Committee members responded positively to the program’s reported outcomes and the institutions’ role in Kentucky health care. Senator Berg praised the quality of care and shared a personal example of being advised to stay at UofL for breast cancer treatment. Representative Moer highlighted Kentucky’s strong cancer-control score and asked for more explanation of the value-based payment structure; the presenters said the system is built around ongoing measurement, accountability, and collaboration with the Cabinet for Health and Family Services. No votes or formal actions were taken beyond approving the amended August 27 minutes by voice vote.

Transcript Highlights:

• So there are 150 for HCB.
• So there are 150 for HCB.
• So there are 150 for HCB.
• Um, the HCBS field is the orangish red and the HCBS wait list is in the green.
• HCBS weight list around 2022. HCBS weight list around 2022.

Keywords: 958, all

Summary: The Health and Family Services committee heard an informational presentation on Kentucky personal care homes from representatives of the Kentucky Association of Healthcare Facilities, Management Systems of Kentucky, and Elder Care Partners. Witnesses described personal care homes as a lower-cost, 24/7 residential option for adults, often with serious mental illness, who do not meet nursing home criteria but need structured supervision, medication assistance, meals, and daily support. They said the homes are regulated by the Cabinet for Health and Family Services, are not Medicaid-funded, and are supported largely through state supplementation payments and residents’ SSI income. The presenters argued that the current reimbursement rate of about $50.70 per day is no longer sufficient to cover staffing, food, insurance, utilities, maintenance, and other costs, and said the sector has shrunk significantly over time. They cited figures showing a decline from 64 to 34 homes serving the seriously mentally ill since 2002, with 30 closures over 23 years, and said the loss of beds contributes to homelessness, hospital overcrowding, and longer psychiatric stays. They also gave examples of residents who had spent many months in hospitals before being successfully placed in personal care homes, which they said can prevent more costly institutional care. Committee members asked about staffing credentials, fraud controls, referral processes, and how reimbursement works in other states. The presenters said Kentucky does not require licensed or certified staff in these facilities, though some homes use certified medication technicians or an LPN, and they described a county case-manager-based assessment process used to set individualized rates in other states such as Minnesota. Members expressed support for the work but emphasized the need for documentation of savings and budget offsets. The presenters said they are seeking an incremental reimbursement increase over two years, roughly 25% to 50% in the first year and another 50% after that, and urged the committee to support the homes to prevent further closures.

Transcript Highlights:

• HCBS services standards First mistake.
• Section three establishes a new HCBS Section three establishes a new HCBS service<00:04:39.240><
• providing HCBS services. providing HCBS services.
• those records for, uh, all HCBS those records for, uh, all HCBS services,<00:13:05.960> so
• <00:13:47.560> and language, uh, related to HCBS and language, uh, related to HCBS and positive

Keywords: 1187, senate, all

Transcript Highlights:

• Person-centered planning, prioritizing assessments based on preference, and expanded HCBS slots, which
• we're not we haven't maxed out our HCBS we're not we haven't maxed out our HCBS slots<00:22:46.000
• there is the potential to carve out HCBS there is the potential to carve out HCBS as<00:24:54.080
• I think in terms of the transition for HCBS, whether it was with other populations or alone, I think
• I think in terms of the transition for HCBS, whether it was with other populations or alone, I think

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:

• This is the institutions to HCBS.
• So we have supported all initiatives that have been out there to increase the funding for HCBS.
• So we have supported all initiatives that have been out there to increase the funding for HCBS.
• So we have supported all initiatives that have been out there to increase the funding for HCBS.
• funding for HCBS. funding for HCBS.

Keywords: 928, house, all

Summary: The Committee to Study Long-Term Managed Care met to approve prior minutes and outline its schedule, with meetings set for September 24 and September 29 ahead of an October 1 report deadline. The chair said the committee would use the first two meetings to digest testimony, likely ask follow-up questions of DHS, and then work toward conclusions and a report format. The minutes from the previous meeting were approved unanimously. The main testimony came from Sharon Alexander of Amera Health, who argued in favor of moving from fee-for-service Medicaid long-term services and supports to a managed LTSS model. She described managed LTSS as a capitated, quality-driven system used in about 26 states, and said it can improve care coordination, accountability, access to home- and community-based services, and budget predictability. She cited Amera Health’s experience in Pennsylvania and Delaware, including care coordination, housing and transportation support, caregiver programs, and quality benchmarks tied to state oversight. She also said nursing facilities would remain an important option for people who need that level of care. Committee members asked about how the programs are administered, how rates are set, how care managers work, and how quality is measured. Alexander said states contract with managed care organizations at actuarially sound capitated rates, with annual contracts, reporting, and oversight. She explained that care managers typically conduct quarterly assessments and follow up after trigger events such as hospitalization, and that housing coordinators may assist with transitions to the community. On quality, she said states use CMS-related and HCBS benchmark measures covering service timeliness, care planning, transitions, and other outcomes, and that New Hampshire could build on existing metrics rather than starting from scratch. She also noted that rural areas face workforce and transportation challenges, which managed care plans try to address through technology and self-direction options.

Transcript Highlights:

• managers had the skills and the knowledge to comply with informed decision-making for people who use HCBS
• managers had the skills and the knowledge to comply with informed decision-making for people who use HCBS
• managers had the skills and the knowledge to comply with informed decision-making for people who use HCBS
• managers had the skills and the knowledge to comply with informed decision-making for people who use HCBS

Bills: HF1662, HF2115, HF2159, HF1095, HF2160

Keywords: veterans, veterans affairs, State Soldiers Assistance Program, Veterans Stable Housing Initiative, MAXIS, human services data, data sharing, eligibility verification, informed consent, private data, benefits coordination, veteran housing, veteran assistance, Department of Human Services, Children Youth and Families, state benefits, federal benefits, privacy, public assistance, human services

Transcript Highlights:

• Also, cuts to HCBS services, if the legislature does in fact do that, would result in loss of the 50%
• Also, cuts to HCBS services, if the legislature does in fact do that, would result in loss of the 50%
• We only offer 27,000 individuals access to a capped HCBS waiver.
• HCBS services is a big cost savings for the state.
• We've cuts to HCBS service.

Summary: The committee heard testimony on the effects of H.R. 1 on Washington’s Medicaid, developmental disability, long-term care, and food assistance systems, followed by a separate discussion of juvenile rehabilitation caseloads and placement capacity. DSHS officials said HR1 could affect home equity rules, immigration-related eligibility, work requirements for some expansion-population enrollees, and provider taxes, while also creating a future opportunity for a new 1915(c) waiver. Advocates and providers warned that any state response that cuts home and community-based services would worsen already thin provider networks, increase waiting lists, push more people into hospitals or out-of-state placements, and strain families and workers. A pediatric behavioral health expert and a supported living provider said Medicaid reimbursement is already too low and further reductions would threaten outpatient, residential, and inpatient services for people with intellectual and developmental disabilities and severe behavioral needs. The committee then turned to SNAP and the state food assistance program. DSHS said HR1 would tighten work requirements and exemptions, end some immigrant eligibility for the federal program, eliminate the SNAP education program, raise state administrative costs, and eventually require Washington to share in benefit costs based on its error rate. Officials estimated large numbers of residents could lose or see reduced benefits, with significant added state costs. Anti-hunger advocates, a food bank director, and a SNAP recipient described the program as essential for low-income families, seniors, and people with disabilities, and said the changes would increase paperwork, reduce benefits, and worsen food insecurity while also harming local food economies. Testimony emphasized that food banks cannot replace SNAP and that work requirements may be difficult to meet for caregivers, people with disabilities, and those facing child care or transportation barriers. In the juvenile justice portion, the Caseload Forecast Council presented the JR forecast, which is currently mostly flat through the end of the biennium but expected to grow modestly over the longer term. Members discussed how policy choices, including the 2019 JR-25 law, have increased lengths of stay for adult-sentenced youth in JR, while diversion and other reforms have affected regular JR trends. A court researcher explained the data available to help forecast admissions and noted ongoing efforts to improve data sharing with JR, AOC, and county systems, though staffing and system-lag issues limit how quickly data can be produced. Juvenile court administrators and DCYF officials described the community-based juvenile justice continuum, rising complexity in the JR population, overcrowding at Green Hill and placement constraints at Echo Glen and Harbor Heights, and the need for more flexible community transition and mental health capacity. No votes were taken.

Transcript Highlights:

• Adult daycare waiver services is an HCBS.
• >> clarify and streamline overlapping HCBS >> clarify and streamline overlapping HCBS
• that that overlap with HCB that that overlap with HCB services.
• streamline overlapping HCBS streamline overlapping HCBS and<00:15:03.320> remove<00:15:04.600
• clarify and streamline overlapping HCBS clarify and streamline overlapping HCBS services<00:15:35.760

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board met on January 12, 2026, to approve the December 10, 2025 minutes and continue finalizing its findings and recommendations. Members reviewed findings on administrative inefficiencies, Medicaid and workforce participation under HR 1, Medicaid budget growth, rural health transformation fund development, and provider tax/state-directed payment changes. The board approved a motion to change “pilot” to “partnership” in the workforce-related recommendation, and also adopted a technical amendment clarifying overlapping HCBS services by removing reference to adult daycare waiver services and revising the language to focus on reducing duplication, simplifying provider contracting, and standardizing processes across programs. A separate technical correction was noted to change “DMS” to “DPH” in the rural health transformation finding, to be handled in the final edits. Several findings drew discussion but no final substantive vote during the meeting. On the rural health transformation fund, Dr. Berg said Kentucky had done well in federal funding and noted limits on what could be shared publicly, while Commissioner Lee said a public website had been created and recommended the department reference be changed to the Department for Public Health. Finding five prompted extended discussion about provider taxes, state-directed payment reductions under HR 1, and whether the board should address the relationship between actuarial studies, MCO payments, and actual provider reimbursement more directly. Senator Meredith and others argued for a broader, more transparent baseline review of rates across provider groups, while Commissioner Lee said CMS will require certain fee schedule comparisons to Medicare beginning July 1, 2026, and that quarterly expenditure reports already go to LRC. The board did not finish resolving finding five during the meeting and agreed to return to it after staff prepared more explicit language. Members also discussed the possibility of an all-payers claims database as a better way to understand what is being paid across payers and services. No final vote on the full findings package was taken in the portion of the meeting provided, but the board did adopt the noted amendments and continued working through the remaining language.

Transcript Highlights:

• HCB um seemed to be the second choice to HCB um seemed to be the second choice to go<00:30:06.040>
• Michelle P waiver, um but went to HCB. Michelle P waiver, um but went to HCB.
• trickling over to to HCB. trickling over to to HCB.
• quickly that uh HCB was the place to go. quickly that uh HCB was the place to go.
• HCB,<00:35:33.040> 54<00:35:33.640> days. HCB, 54 days. HCB, 54 days.

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:

• So, I'll just mention this includes<00:09:37.279> uh<00:09:37.519> HCBS<00:09:38.160>
• > provider<00:09:38.640> accountability includes uh HCBS provider accountability includes
• uh HCBS provider accountability uh<00:09:39.680> through<00:09:39.920> documentation<00
• the commissioner to establish an HCBS the commissioner to establish an HCBS provider<00:39:34.880
• and billing of HCBS services. and billing of HCBS services.

Keywords: 1187, senate, all

Transcript Highlights:

• So your request is to move $3.3 million out of HCBS into the state, the case management state-only line
• Does HCBS have a current shortfall projected for fiscal year 26? Mr.
• Fletcher, because there's a shortfall in the HCBS line item and there's a shortfall in the state-only
• So by moving $3.3 million from the HCBS line item to the...
• By moving $3.3 million from the HCBS line item to the case management state-only line item, the HCBS

Keywords: 1182, all

Summary: The committee first went into executive session and then returned to approve settlements in three risk management cases based on a motion to accept the Attorney General’s proposed settlement. After that, JLBC staff presented item 1 on the School Facilities Division construction cost index, recommending a 4.8% increase for fiscal year 2027 with retroactive application to December 10, 2025; members asked about why prior years had zero adjustments during the Great Recession, and the committee approved the item. Items 2A and 2B concerned Arizona Department of Education reports. For 2A, staff reviewed ADE’s annual federal monies report, noting fiscal 2026 federal funds of $1.38 billion, up from $1.27 billion the prior year, and the committee gave favorable review. For 2B, staff summarized the annual Career and Technical Education District report, including enrollment, expenditures, retention, and credential completion rates; members questioned the low 37% retention rate and asked for more comparative and explanatory data, but the committee still gave favorable review. Item 3A addressed a DES transfer of $3.3 million from the Home and Community-Based Services Medicaid line item to the state-only case management line item for developmental disability services. DES said both areas faced shortfalls and that the transfer would help immediate cash-flow needs, but members raised concerns about growth in the state-only program, possible migration into Arizona for services, fraud controls, and whether the department had formally notified the Legislature of the deficiency. The committee attached conditions requiring formal deficiency letters, monthly reporting on DDD populations by diagnosis, and a review of Minnesota audit findings, then approved the item. Item 3B, the Arizona Training Program at Coolidge annual review, was also approved. Finally, item 4 proposed transferring $650,000 from unused special election funds to the Secretary of State’s cybersecurity monitoring and management budget. The Secretary of State’s office said the money would support 24/7 monitoring, endpoint protection, and remediation of identified vulnerabilities, and members debated the office’s federal outreach and the March 1 deadline tied to county reimbursement for AVID-related costs. Despite concerns from some members about communication and the size of the remaining appropriation, the committee gave favorable review to the $650,000 transfer and then adjourned.

Transcript Highlights:

• Those HCBS services are optional. Home- and community-based services, waivered services.
• It's important to remember non-mandatory HCBS Medicaid programs.
• We can serve more people through HCBS. They live more vibrant lives in the community.
• And reduced state funding for HCBS Medicaid waiver programs will likely result...
• And reduced state funding for HCBS Medicaid waiver programs will likely result in large increases in

Keywords: 995, all

Summary: The Massachusetts Commission on the Status of Persons with Disabilities held its quarterly meeting on September 10, with roll call, approval of the June minutes as amended, and welcoming remarks for newly appointed commissioner Rachel Caprilyan and reappointed commissioners. Chair Denise Garlick outlined plans for a statewide community hearing series, beginning with a November 4 hybrid hearing at Needham Town Hall focused on the Boston/Metro West region, and described the creation of a nonvoting advisory council to broaden the commission’s expertise across health care, transportation, housing, education, employment, business, and local disability commissions. Commissioners discussed the nomination process, the need for geographic diversity, and the goal of having the council in place by the December quarterly meeting. The main presentation addressed proposed federal Medicaid and SNAP changes in H.R. 1, with Jennifer Bertrand of the Massachusetts Developmental Disabilities Council warning that the law could cut federal Medicaid spending by $1 trillion over 10 years, impose work requirements, require redeterminations every six months, restrict provider taxes, and reduce SNAP benefits. She said these changes could increase uninsurance, create administrative barriers, and threaten home- and community-based services, with a Massachusetts analysis projecting 141,000 to 203,000 MassHealth members could lose coverage over six months. Commissioners and attendees responded that the changes could harm people with disabilities, caregivers, and provider organizations, increase institutionalization risk, and intensify competition for limited state resources; several emphasized the need for disability groups and broader health care stakeholders to coordinate advocacy. Subcommittee reports highlighted recent and upcoming work. The Disability Employment Subcommittee reported on a June “Strength and Support” event, an August presentation by Run the Gamut, and an upcoming MAPC/Employment First workshop in Worcester, while the Long-Term Services and Supports and Health Equity Subcommittee discussed a presentation from the Lurie Institute for Policy Research on community living dashboards and disparities in Medicaid and LTSS. Commissioners also shared announcements about upcoming events, including the Paul Spooner Generational Leisure Summit, the Disability Policy Consortium’s John Winsky Memorial Award ceremony, the Massachusetts Health Council’s annual celebration, and a September 17 hearing on insurance coverage for hearing aids. The meeting ended with congratulations to commissioner Carl Richardson for an accessibility award and a motion to adjourn, which passed.

Transcript Highlights:

• And you have the form. and 26 to develop an HCBS section 1915C and 26 to develop an HCBS section 1915C
• community based waiver service um HCBS community based waiver service um HCBS section<00:19:31.039
• So it becomes very costly for an HCBS program.
• So that's costly for an HCBS program.
• the ages of 0 and 21 who are on an HCB the ages of 0 and 21 who are on an HCB waiting<00:39:42.720

Keywords: 958, all

Summary: The committee met with a quorum and first heard brief presentations on Kentucky’s 2025 Preventive Health and Health Services Block Grant and Title V Maternal and Child Health Block Grant. Department for Public Health staff explained that the preventive health block grant provides about $2.3 million annually and supports programs such as accreditation and performance improvement, local health department grants, community health workers, prescription assistance, asthma and COPD programs, workforce development, and a sexual assault programs set-aside. They said the Title V block grant provides about $11.7 million, with 35% directed to children and youth with special health care needs and 65% to maternal and child health populations, largely through local health departments and a five-year needs assessment process. After no questions, a motion was made and seconded to approve both block grants. The roll call vote passed 19-0, and the two block grants were approved. The committee then approved the minutes from the prior meeting. The next item was a discussion of the child waiver created in House Bill 6. Committee members raised concerns that the proposed 1915(c) waiver did not match the legislature’s intent, which they said was to move children from the Michelle P. waiver to free slots for adults. Cabinet officials from DCBS, behavioral health, and Medicaid described the proposed “Community Health for Improved Lives and Development” waiver as a targeted home- and community-based program for children under 21 with severe behavioral health or developmental needs, including those stepping down from inpatient or residential care or at risk of out-of-home placement. They said the waiver is designed for about 100 slots, uses a standardized needs-based assessment, and includes case management, community living supports, home modifications, respite, supervised residential care, and clinical therapeutic services. Officials said the public comment period ended July 15, responses are being compiled for August submission to CMS, and the waiver is part of the broader Families First initiative.

Transcript Highlights:

• Individuals that are in a pre-enrollment category and are Medicaid eligible are not eligible to receive HCBS
• in a pre-enrollment category and that are not Medicaid eligible, they are not eligible to receive HCBS
• they are also not eligible to receive medical services through the Medicaid not eligible to receive HCBS
• Again, because they're in a pre-enrollment category, they're not eligible to receive HCBS services through
• If they are in a pre-enrollment category and eligible, they're not able to get HCBS services through

Summary: The Health and Human Services Committee received an overview of Florida’s intellectual and developmental disabilities (IDD) managed care pilot, created by legislation in 2023 to test whether a managed care model could integrate Medicaid medical services with iBudget waiver home- and community-based services for adults in pre-enrollment categories. AHCA explained the existing system, the pilot’s scope in Regions D and I, and the rollout timeline, including federal approval, contract execution with Florida Community Care, and the October 2024 go-live. Officials reported that, as of early February, 370 individuals had been sent for onboarding and 168 more were in queue, with about $35.8 million of the appropriation remaining. APD also clarified the difference between the pre-enrollment categories and the waiver waitlist, and noted that crisis cases can be enrolled more quickly depending on eligibility and funding. Florida Community Care described the pilot as a comprehensive managed care model offering medical, long-term care, and iBudget services, plus enhanced benefits such as bed-hold days, caregiver transportation, and help with legal guardianship costs. The plan said it uses one care coordinator, a 1:18 coordinator ratio, a face-to-face assessment within five days of enrollment, and 180 days of continuity of care for existing providers. The company emphasized that it is recruiting providers by offering higher rates than some iBudget rates, lower administrative burden, and network adequacy incentives, while APD said it continues to monitor provider supply and demand and recruit across service types and regions. Members repeatedly questioned whether the pilot’s costs, provider rates, and service levels were truly comparable to the iBudget system, and AHCA and APD said it was too early to draw firm conclusions because claims data are still lagging. Committee members also raised concerns about communication, enrollment delays, provider shortages, and whether the pilot could scale statewide. APD said it has used letters, phone calls, texts, emails, and community meetings to reach eligible individuals, and that some delays stem from required assessments, Medicaid eligibility checks, and level-of-care determinations. Several members asked for more detailed comparisons of costs and provider reimbursement between the pilot and iBudget, and APD said it would provide additional data. Public testimony at the end was strongly critical of managed care, with a participant and his mother describing poor service, transportation failures, and loss of control under prior managed care arrangements, and urging the committee not to expand such a model without safeguards. No votes or formal committee action were taken before adjournment.

Transcript Highlights:

• Um, we talked a little bit last time about HCBS and, you know, there were a carveout.
• Um, we talked a little bit last time<00:19:21.360> about<00:19:21.760> HCBS<00:19:22.480
• and you know there were time about HCBS and you know there were a<00:19:23.600> carveout.
• The third option is to adopt the HCBS carveout model, where we're preserving a fee-for-service model
• The third option is to adopt the HCBS carveout model, where we're preserving a fee-for-service model

Keywords: 928, house, all

Summary: The committee approved the previous meeting minutes and then reviewed a draft preliminary report on long-term managed care. The chair explained the report is intended to frame issues and outline legislative options, not make a final recommendation, especially given unresolved questions about the federal One Big Beautiful Bill (OB3). The report’s key issues included the current financing of county and private nursing homes through Medicaid rates, ProShare, MQUIP, and related funding mechanisms, and the concern that those payments could be affected or eliminated under a managed care model. Members also discussed managed care organizations’ role in Medicaid and cited other states’ experiences, noting examples of savings in Florida and Tennessee but higher costs in California. One member raised Indiana as another important comparison, and the committee agreed to add it to the report’s state examples. The committee also reviewed sections on dual eligibility, D-SNP, PACE, and CFI waivers. The chair raised concerns about whether OB3 creates incentives for states to move toward D-SNP and whether federal changes could affect provider taxes, state-directed payments, and intergovernmental transfers. Henry Litman, the state Medicaid director, said he would confirm details on D-SNP incentives and explained that ProShare is based on certified public expenditure rather than an IGT, while county cap financing is the relevant intergovernmental transfer issue. He said IGTs are not going away and that the main risk is whether current financing mechanisms could be preserved if the state later changed course. Members discussed the possibility of a waiver not being granted or renewed and the high fiscal impact that could have on counties and property taxes. The committee then discussed the population that any long-term managed care model should cover. Members agreed that there is no appetite to move developmental disability or acquired brain disorder populations into long-term managed care at this time, and the chair changed the report’s terminology from “elderly” to “aging population.” The chair also noted that the status quo option should reflect the recent shift toward home and community-based services and reduced nursing home utilization since earlier county reports. The report’s four policy options were summarized as: maintain the status quo; pursue D-SNP for dual eligibles, with DHHS potentially submitting an application as early as 2027; adopt an HCBS carveout; or move fully to managed care for the aging population. No final policy recommendation was made, and the committee discussed making edits to the draft before circulation, including adding Indiana, clarifying OB3-related issues, and changing the report title from “final” to “preliminary” or “interim.”

Transcript Highlights:

• The new regulation called the HCBS access rule is very data intensive.
• for people using HCBS services.
• It is a pretty sweeping change for states that accept funding under HCBS authorities and must comply
• <00:43:21.359> settings<00:43:21.720> role roles um and then the HCBS settings role
• roles um and then the HCBS settings role rule<00:43:22.400> that<00:43:22.559> I<00:43

Keywords: 912, senate, all

Summary: The Committee on Health and Human Services held an informational briefing on the Developmental Disabilities Council and related agencies. The Hawaii State Council on Developmental Disabilities outlined its 2025 legislative priorities, including a pilot project for guardian ad litem and capacity evaluations in guardianship/conservatorship cases, a supported decision-making bill, a health disparities study for people with disabilities, an ABLE savings outreach/staffing measure, a Medicaid buy-in proposal, an adult changing tables equity bill, and a resolution on fetal alcohol spectrum disorder. Council representatives emphasized that supported decision-making would complement tools like powers of attorney and medical releases, and that the health disparities study would help identify unmet needs by ZIP code and improve state data on the intellectual and developmental disability population. The Center on Disability Studies at the University of Hawaii described its role as the research and training arm within the DD system, working with the DD Council and the Hawaii Disability Rights Center. It reported activities such as interdisciplinary training, community education, technical assistance, research collaborations, the Pacific Rim International Conference on Disability and Diversity, publications, telehealth, ECHO Autism, and counseling for Maui fire survivors. The center said it leveraged about $16 million in outside funding last year and highlighted goals focused on workforce development, community capacity, research with direct participation from people with disabilities, and accessible dissemination of information. The Hawaii Disability Rights Center, the state’s protection and advocacy agency, supported the Council’s priorities, especially supported decision-making, which it said could help some people avoid guardianship while preserving liberty and reducing state resource use. The center also raised concerns about the DD system budget and urged legislators to review whether the Developmental Disabilities Division is requesting enough funding, noting possible backsliding in services and eligibility. The Developmental Disabilities Division of the Department of Health then outlined its statewide waiver program serving just over 3,500 people, its service array, and its budget request for increased waiver funding, a federal initiatives coordinator, and IT upgrades to comply with the new HCBS access rule; no votes or formal actions were taken during the briefing.

Transcript Highlights:

• The department is assessing gaps in all home and community-based services (HCBS).
• In February, we published a statewide HCBS gap analysis report that will serve as a foundation for a
• multiyear roadmap for integrating HCBS...
• Payment sustainability is critical to building the foundation of HCBS integration.
• However, at this time, the department does not expect integration of HCBS...

Keywords: 988, house, all