Video & Transcript Research : 'enrollee'

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TX
Transcript Highlights:
  • We were surprised to learn during an interim hearing that MCOs are not allowed to inform enrollees about
  • health plans. and other health MCOs are not allowed to inform enrollees about other health plan options
  • Bill ensures that MCOs can inform enrollees. is about the availability of qualified health plans offered
  • Well, the sub will clarify that current and former Medicaid enrollees are also included in MCOs.
CA

California 2025-2026 Regular Session

Assembly Health Committee May 6th, 2025

Transcript Highlights:
  • , to handle enrollee grievances, and more.
  • It really is up to the enrollee.
  • those of Kaiser enrollees, can continue to persist.
  • those of Kaiser enrollees, can continue to persist.
  • engagement with stakeholders, including enrollees.
Summary: The Assembly Health Committee held an informational hearing on Kaiser Permanente’s behavioral health care system, focusing on Department of Managed Health Care enforcement actions, Kaiser’s corrective action work plan, and testimony from patients, advocates, and union representatives. DMHC officials reviewed a long history of complaints, surveys, fines, and settlements involving Kaiser’s access to behavioral health services, including deficiencies found in 2012 and 2016, a 2022 non-routine survey, and a 2023 settlement that imposed a $50 million penalty and required $150 million in community investments over five years. DMHC said it continues to monitor Kaiser through quarterly meetings, complaint review, follow-up surveys, and a reimbursement process for members who could not obtain timely in-network care. Committee members pressed DMHC on what “timely access” and continuity of care mean in practice, how virtual care and group therapy fit into the standards, and what triggers a non-routine survey. DMHC said initial behavioral health appointments generally should not take more than two weeks, urgent care should be within days, and follow-up care within 10 days, with out-of-network care required when plans cannot meet standards. Officials also said Kaiser’s initial corrective action work plan lacked detail, but the revised plan was accepted and will be tracked through quarterly reporting and possible additional enforcement if Kaiser fails to comply. The second panel featured testimony from a Kaiser enrollee, a behavioral health policy expert, a Kaiser therapist, and the NUHW president. The enrollee described serious delays and inadequate treatment for his daughter after a suicide attempt, while the therapist and union leader said Kaiser’s behavioral health system is understaffed, relies too heavily on short appointments, group therapy, and webinars, and treats behavioral health as less important than medical-surgical care. They argued Kaiser’s one-appointment-at-a-time scheduling rule and limited treatment time violate parity requirements and harm continuity of care. Several members criticized Kaiser for not appearing at the hearing and said the testimony underscored the need for stronger oversight, clearer metrics, and faster remedies for patients.
AR

Arkansas 2026 1st Special Session

ALC-HOSPITAL, MEDICAID, & DEVELOPMENTAL DISABILITIES STUDY SUBCOMMITTEE Jun 15th, 2026

ALC-HOSPITAL, MEDICAID, & DEVELOPMENTAL DISABILITIES STUDY SUBCOMMITTEE

Transcript Highlights:
  • The average household size was two, which included 227,825 enrollees.
  • The average household size was two, which included 227,825 enrollees.
  • The average household size was two, which included 227,825 enrollees.
  • Enrollees with dependents under 14 by age, with and without income.
  • This is the enrollees without income, also broken down by age.
Keywords: 1204, all
MN

Minnesota 2025-2026 Regular Session

House Health Finance and Policy Working Group 1/15/25

Minnesota House Floor Meeting

Transcript Highlights:
  • Most MA enrollees are enrolled in managed care.
  • So, just quickly, an overview of who MA enrollees are.
  • You can see on the left side of the slide that most MA enrollees are parents and children: 63% of enrollees
  • You can see on the left side of the slide that most MA enrollees are parents and children: 63% of enrollees
  • money flows for those enrollees.
Keywords: 1183, house
Summary: The meeting was an informational walkthrough for the Health Finance and Policy Working Group, focused on committee structure, budget basics, and major health-related accounts and programs. Staff explained the roles of House Research and House Fiscal, then reviewed key funds used by the committee, including the general fund, government special revenue fund, federal funds, the health care access fund, remediation account, and drinking water revolving fund. They also outlined the committee’s main budget areas, noting that medical assistance is the largest general fund item and that the Department of Health is a substantial agency funded by a mix of federal, general fund, and special revenue dollars. A major portion of the presentation covered subsidized health coverage programs. Staff described Medical Assistance (Minnesota’s Medicaid program) as an entitlement for eligible Minnesotans, with no premiums or cost sharing, and explained its managed care and fee-for-service delivery systems. MinnesotaCare was presented as a separate federal-state basic health program for people who are not eligible for MA, with income limits, premiums for adults age 21 and older, and cost-sharing requirements; staff noted that federal premium tax credit changes affect MinnesotaCare premium ranges. The presentation also summarized MNsure’s role in the individual market and in determining eligibility for premium tax credits, cost-sharing reductions, MinnesotaCare, and MA. The committee also received an overview of health-related licensing boards and occupational regulation. Staff said Minnesota has 16 health-related licensing boards, funded mainly through the state government special revenue fund and subject to legislative appropriation, and explained that health occupations may be regulated by the Department of Health, the Office of Emergency Medical Services, or the boards under chapter 214. Interstate licensure compacts were briefly noted as a way to ease practice across states. No bills were debated and no votes or formal actions were taken during the meeting.
MN
Transcript Highlights:
  • And if they don't get it back, the withhold for that enrollee will not be returned to the managed care
  • The capitation payments will discontinue on that particular enrollee, and then the enrollee will be disenrolled
  • A form and then the enrollee completes the form and sends it back to the managed care organization.
  • The capitation payments will discontinue on that particular enrollee, and then the enrollee will be disenrolled
  • The capitation payments will discontinue on that particular enrollee, and then the enrollee will be disenrolled
Keywords: 918, senate, all
Summary: Senate Republican leaders held a press event to roll out a package of anti-fraud proposals focused on state welfare and human services programs. Mark Johnson opened by citing recent fraud scandals, including a shuttered housing program and reports of vulnerable adults being left without care while providers billed for full services, and said Republicans want top-down reform, stronger accountability, new technology, and tighter oversight of taxpayer dollars. Michael Kreun said Republicans support an independent Office of Inspector General and argued the Senate-passed bill should not be weakened in the House; he also said the Senate should restore its role in confirming agency commissioners, especially at DHS, which he described as central to the fraud problem. Jordan Rasmusson outlined a plan to stop “blank checks” for DHS and DCYF services by requiring legislative audit review when a program exceeds budget by 5 percent and legislative approval for additional spending at 10 percent over budget. He also said DHS should adopt basic integrity tools such as electronic visit verification and client sign-off. Steve Drazkowski described two bills: a statewide “do-not-pay” list to block payments to ineligible people or entities, and an “I’m Not a Robot” proposal for Medicaid managed care that would require enrollee verification forms, with a 2 percent payment withhold used to encourage compliance and potentially fund county system upgrades. Mark Krueger said the state should improve technology and data use for eligibility determinations, citing other states’ rapid fraud-fighting systems, and proposed penalties for false reporting to the Legislative Auditor after a DHS audit found falsified site-visit records. Steve Gruenhagen said his bill would require DHS and DCYF to resume annual fraud-prevention and oversight reports to the legislature, which he said had stopped after 2017 despite rising fraud cases. Michael Holmstrom proposed unannounced site visits for all DHS and DCYF providers before enrollment, reenrollment, and revalidation, funded through provider service fees, and cited a recent case involving a woman with autism who was billed for far more care than she received. In the Q&A, Kreun said House Democrats’ delete-everything amendment to the inspector general bill removed the law enforcement division and stripped the bill of its “teeth,” and he suggested the governor’s office may have been involved in efforts to replace the bill with a weaker coordination council model. No votes were taken in the press conference.
AR

Arkansas 2026 1st Special Session

ALC-HOSPITAL, MEDICAID, & DEVELOPMENTAL DISABILITIES STUDY SUBCOMMITTEE Jun 15th, 2026

ALC-HOSPITAL, MEDICAID, & DEVELOPMENTAL DISABILITIES STUDY SUBCOMMITTEE

Transcript Highlights:
  • The average household size was two, which included 227,825 enrollees.
  • And then the next slide looks at enrollees who have no dependents.
  • And then similar information on income breakdown for enrollees with income. 303,425 of our Medicaid enrollees
  • This is the enrollees without income. And disability types.
  • This is the enrollees without income, also broken down by age.
Summary: The meeting focused on Arkansas’s workforce development reorganization and a set of federal waiver requests intended to consolidate and streamline the state’s WIOA system. Commerce officials said the department has already centralized shared services, split the old workforce agency into reemployment and Arkansas Workforce Connections, and submitted a combined WIOA/Perkins state plan. They described nine waiver requests, including replacing local workforce boards with a single statewide board, creating one planning and accountability structure, allowing more flexible movement of funds across regions, easing the “last-dollar” requirement for training and supportive services, reducing required youth program elements, and allowing affiliate sites instead of mandatory comprehensive centers. Officials said the goal is to reduce administrative costs and redirect more money to training, supportive services, and employer-driven programs. Legislators raised concerns about rural representation, local employer relationships, and whether local offices would close. Commerce officials said local offices would remain open, some current staff could be rehired, and regional business councils would preserve local employer input. They said the current system is fragmented and expensive, with roughly $14 million in federal workforce funds flowing through local boards but only about $1.9 million spent on training and supportive services last year; they argued the reorganization could raise training spending to about $6 million to $7 million annually. Questions also addressed board composition, performance accountability, and how funds could be shifted between regions when needs change. The State Board of Workforce Development had approved the waiver package 11-3 before it was submitted to the U.S. Department of Labor. Members also discussed workforce access for people with disabilities, child care and transportation supports, and the role of Arkansas Launch, apprenticeships, and career and technical education. Officials said vocational rehabilitation now has better access to the state job board and that referrals and data-sharing with DHS and other partners still need improvement. Several legislators emphasized the need for training to align more closely with employer demand, especially in manufacturing, technology, health care, and rural areas. The committee also heard a brief overview of Workforce Pell, with staff explaining that the new federal short-term Pell option has narrow eligibility rules and may not fit many existing programs, including some CDL and CNA programs.
AR

Arkansas 2026 Regular Session

ALC-HOSPITAL, MEDICAID, & DEVELOPMENTAL DISABILITIES STUDY SUBCOMMITTEE Jun 15th, 2026

ALC-HOSPITAL, MEDICAID, & DEVELOPMENTAL DISABILITIES STUDY SUBCOMMITTEE

Transcript Highlights:
  • Enrollees with dependents under 14... Status.
  • Enrollees with dependents under 14 years old disability status by age.
  • Total enrollees disabled or not disabled. The non-disabled number is 157,000.
  • This is the enrollees without income, also broken down by age.
  • And enrollees with no dependents under 14 years old...
Summary: The meeting focused on Arkansas’s proposed workforce system overhaul, including a combined WIOA/Perkins state plan and a package of federal waiver requests intended to consolidate workforce governance, reduce administrative costs, and redirect more funding to training and supportive services. Commerce officials said the plan would replace the current structure of 10 local workforce boards and more than 200 board members with a single statewide board and one administrative entity, while keeping local offices open and using regional business councils to preserve employer and local input. They said the state has already reduced Commerce headcount and operating costs, and that the changes would improve coordination with higher education, adult education, vocational rehabilitation, DHS, and Arkansas Industry Connect. Much of the discussion centered on the waiver package, especially the proposal to make the state board function as the local board, allow more flexible movement of funds across regions, eliminate the WIOA “last dollar” requirement for training and supportive services, create affiliate sites instead of requiring every area to maintain a comprehensive center, and relax the 14 youth program element requirement. Officials said the State Board of Workforce Development approved the waiver package 11-3 before it was submitted to the U.S. Department of Labor, and that implementation would begin only after federal approval and a closeout process, likely taking up to a year. They also described plans to streamline referrals and data sharing, expand mobile and virtual services, and use a more centralized model to improve customer service and employer engagement. Members raised repeated concerns about rural representation, local control, board composition, and whether jobs and relationships would be lost if local boards were eliminated. Commerce officials responded that local offices would remain open, some current staff could be rehired by the state, and regional business councils would help ensure local employer voice. Several members also questioned how the funding was being used, citing audit findings that only about $1.8 million to $1.9 million of roughly $14 million to $15 million in federal workforce funds had gone to training and supportive services. Officials said the reorganization could increase annual training spending to roughly $6 million to $7 million by reducing overhead, one-stop operator contracts, and board administration. The committee also discussed how the changes might support workforce training facilities, apprenticeships, child care and transportation assistance, and employer-driven training in fields such as manufacturing, health care, technology, and welding. The Division of Higher Education also briefed members on Workforce Pell. Officials explained that the new federal program would extend Pell eligibility to short-term programs, but only within narrow limits, such as 150 to 599 clock hours and 8 to 15 weeks of instruction, with additional completion and employment benchmarks. They said Arkansas is working with colleges and universities to identify programs that fit the criteria and that the governor has designated the Division of Higher Education to lead implementation. No votes were taken by the committee during this portion of the meeting.
WA

Washington 2025-2026 Regular Session

Joint Select Committee on Health Care and Behavioral Health Oversight Nov 5th, 2025

Joint Select Committee on Health Care and Behavioral Health Oversight

Transcript Highlights:
  • I want to just put forward the question: how do we ensure that our constituents, our Medicaid enrollees
  • But I think just want to recognize that there's going to be a need for hand-holding enrollees through
  • I don't think any of us want to have enrollees, current enrollees, or anybody who kind of goes back and
  • themselves I don't think any of us both with our provider and navigator partners and with enrollees
  • I don't think any of us want to have enrollees, current enrollees, or anybody who kind of goes back and
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.
FL

Florida 2025 Regular Session

November 19, 2025 - 04:00 PM

Transcript Highlights:
  • ADDITIONALLY FOR REGIONS THE IN IN ELIGIBLE AGE WAS 18 AND OVER AND IT WAS ELIGIBLE FOR ENROLLEES AND
  • PREET MOMENT CATEGORIES ONE THROUGH SIX WITH WAS 18 AND OVER AND IT WAS ELIGIBLE FOR ENROLLEES AND PREET
  • CURRENTLY WE HAVE AN ADDITIONAL 26 MEMBERS PENDING ENROLLMENT TOTALING 857 ENROLLEES AND THAT NUMBER
  • UP UNTIL VERY RECENTLY WE HAD A VERY SMALL NUMBER OF ENROLLEES.
  • AND WE ARE MEETING OUR STANDARD TO BE FACE-TO-FACE WITH THE ENROLLEE.
FL

Florida 2025 Regular Session

February 11, 2025 - 03:30 PM

Transcript Highlights:
  • And as of January 31st, we have 157 enrollees in Region D.
  • And as of January 31st, we have 157 enrollees in Region D and 124 enrollees in Region I.
  • And in 2014, when this program started, there were roughly 46,000 long-term care enrollees.
  • It was a lot of money, $217 million, and just over 1,200 people, net new enrollees.
  • These next few slides are showing you some of the characteristics of our enrollees.
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.
MN

Minnesota 2025-2026 Regular Session

Committee on Health and Human Services - 03/03/26

Health and Human Services

Transcript Highlights:
  • The impact would be out-of-pocket costs for enrollees.
  • So, one, we want to maintain coverage for eligible enrollees.
  • And so this is a guiding principle for us to mitigate impacts to enrollees.
  • Recipient and enrollee outreach is really important.
  • We are planning for mailings and text messages to impacted enrollees.
Keywords: 1187, senate, all
MN

Minnesota 2025-2026 Regular Session

House Health Finance and Policy Committee 2/10/25

Health Finance and Policy

Transcript Highlights:
  • enrollees, and within that Medicaid number, about 837,000 people were families with kids.
  • enrollees, and within that Medicaid number, about 837,000 people were families with kids.
  • enrollees, and within that Medicaid number, about 837,000 people were families with kids.
  • enrollees, and within that Medicaid number, about 837,000 people were families with kids.
  • enrollees, and within that Medicaid number, about 837,000 people were families with kids.
Keywords: 1183, house
Summary: The committee met for a Health and Finance Policy hearing, began with member and staff introductions, and noted that Representative Keeler was participating as a non-voting member. The chair outlined committee rules on decorum and then introduced the day’s first agency presentation from the Minnesota Department of Health (MDH), with Commissioner Cunningham appearing to present the department’s budget priorities. Commissioner Cunningham described MDH’s broad public health role and emphasized that public health is underfunded relative to health care, with significant reliance on federal dollars. The department’s main budget request was for infectious disease prevention and response to offset anticipated federal funding losses. MDH also outlined several fee increases tied to public water systems, wells, licensing and certification, assisted living and health care facilities, HMO regulation, food/pools/lodging inspections, radioactive materials, X-ray equipment, and asbestos abatement. The commissioner said these changes were needed because costs, workload, and regulatory complexity have increased, while many fees have not been updated in years. MDH also presented budget-neutral proposals, including continuing the Early Hearing Detection and Intervention Advisory Committee, converting the Maternal and Child Health Advisory Task Force into a standing advisory committee, restoring some local and tribal public health cannabis and substance misuse prevention grants, creating direct American Indian Health Special Emphasis Grants, reauthorizing the State Trauma Advisory Council, and extending firefighter PFAS biomonitoring work. The department also requested an operations adjustment for rising employee, insurance, fuel, utility, and legal costs, and referenced additional Clean Water Legacy Fund proposals. No votes or formal actions were taken in the portion provided. Representative Bierman then offered supportive comments, praising MDH’s work and backing the funding and fee proposals, especially the restoration of local public health prevention grants.
FL

Florida 2025 Regular Session

December 10, 2025 - 01:00 PM

Transcript Highlights:
  • BOTH IN TOTAL AND PER THOUSAND PER PLAN ENROLLEE.
  • REPORT TO ENSURE PLANS ARE RESOLVED AND COMPLETE GRIEVANCES AND APPEALS TIMELY AND ARE NOTIFYING ENROLLEES
  • THESE REVIEWS AND INCLUDE ENSURING 90 PERCENT OF ENROLLEES ARRIVE ON TIME FOR APPOINTMENTS MINIMIZING
  • MANAGED CARE PLAN MONTHLY TO ENSURE COMPLIANCE WITH CONTRACT STANDARDS AND QUALITY OF CARE FOR ENROLLEES
  • JUST TO CLOSE, THESE ARE SOME EXAMPLES OF THE TYPES OF MONITORING WE DO SPECIFICALLY FOR ENROLLEE ACCESS
CA
Transcript Highlights:
  • Additionally, $67 million is appropriated to provide financial assistance to Covered California enrollees
  • This is about 200,000 more enrollees than we've ever had, and nearly 1.3 million of those enrolled are
  • Under this scenario, our enrollees with income under 400% of the federal poverty level.
  • We'll receive less premium support, and our enrollees with income over 400% of the federal poverty level
  • Covered California has reached a record number of enrollees this past January, as mentioned, due in large
Keywords: 988, house, all
MN

Minnesota 2025-2026 Regular Session

House Health Finance and Policy Committee 4/15/26

Health Finance and Policy

Transcript Highlights:
  • And this is Minnesota Care enrollees.
  • or adults without children to enrollees or adults without children to renew<00:26:31.800> their
  • those who are um, expansion enrollees those who are required<00:26:56.480> to<00:26:56.560>
  • <00:27:14.520> who<00:27:14.640> are identify any MA enrollees who are identify any
  • and then the 1 month for expansion enrollees.
Bills: HF4401, HF4466
MN

Minnesota 2025-2026 Regular Session

Committee on Health and Human Services - 04/15/26

Health and Human Services

Transcript Highlights:
  • for some Medicaid enrollees, and then restrictions on legal non-citizen Medicaid coverage.
  • um a requirement to obtain enrollee um a requirement to obtain enrollee address<00:02:55.000>
  • ,<00:03:03.480> work um some Medicaid uh enrollees, work um some Medicaid uh enrollees, work
  • , um for some Medicaid enrollees, um for some Medicaid enrollees, um<00:03:10.239> and<00:
  • <01:08:20.799> who exemptions, or deal with enrollees who exemptions, or deal with enrollees
Keywords: 1187, senate, all
NV
Transcript Highlights:
  • Currently, we and our enrollees do not pay PBMs an administration fee to manage the rebates and the processing
  • This cost would shift directly to enrollees who currently receive the service at no cost.
  • This cost shift will result in higher premiums and increased out-of-pocket expenses for our enrollees
  • and provisions on cost sharing in SB 316 unintentionally shields manufacturers while exposing our enrollees
  • Since this provision would require PBMs to simultaneously prioritize the interests of health plans, enrollees
Bills: AB93, AB204, AB414, AB504, AB598
MN

Minnesota 2025 1st Special Session

House Health Finance and Policy Committee 2/17/25

Health Finance and Policy

Transcript Highlights:
  • Actuarial modeling suggests 70% of this program's enrollees will move to it from private coverage in
  • Actuarial modeling suggests 70% of this program's enrollees will move to it from private coverage in
  • Actuarial modeling suggests 70% of this program's enrollees will move to it from private coverage in
  • Actuarial modeling suggests 70% of this program's enrollees will move to it from private coverage in
  • Bentley Graves: Doctors and hospitals are paid to care for these enrollees.
Bills: HF10, HF27
CA

California 2025-2026 Regular Session

Assembly Health Committee Apr 29th, 2025

Transcript Highlights:
  • AB 1032 also specifies that an enrollee is entitled to these benefits until ...1032 also specifies that
  • an enrollee is entitled to these benefits until one year from the date the local or state emergency
  • As noted in the committee analysis, enrollees in commercial and Covered California policies captured
  • Specifically, this notification must include information demonstrating that enrollees and insureds have
  • Specifically, this notification must include information demonstrating that enrollees and insureds have
Summary: The Assembly Health Committee heard a long agenda of health bills focused on access to preventive care, behavioral health, hospital services, and patient safety. Early items included AB 554, which would expand and protect access to HIV prevention drugs like PrEP, including injectable forms and coverage protections; supporters said it would shore up access amid federal threats, while insurers opposed it as a costly benefit mandate. AB 577 would limit insurer and PBM practices that steer medications away from physician offices and require more transparency and patient consent; doctors and patient advocates supported it, while health plans and insurers warned it could raise drug costs and disrupt specialty pharmacy networks. AB 546 would require coverage for portable HEPA purifiers for vulnerable enrollees during declared emergencies, especially wildfire smoke events, with support from air quality and public health groups and opposition from insurers concerned about benefit expansion and cost. The committee also heard AB 224, which would codify California’s updated essential health benefits benchmark plan after a public review process, adding infertility treatment, hearing aids, and durable medical equipment if approved by CMS for the 2027 plan year. DMHC said the state had completed the review and needed legislation to meet federal timing, and the measure drew broad support. AB 1032 would require plans and insurers to reimburse up to 12 additional behavioral health visits for enrollees in wildfire-affected counties for a limited period after an emergency; supporters argued it would fill gaps in trauma care after disasters, while insurers said existing parity and continuity-of-care rules already address the issue and that the bill could create inequities. AB 849 would require trained chaperones for sensitive ultrasound exams and training on how to observe and intervene; it was backed by a survivor and patient advocates, with hospitals and health districts raising staffing concerns. Later, AB 1196 would direct the Department of Public Health to update outdated rules requiring three surgeons for certain heart surgeries using cardiopulmonary bypass; supporters said the rule no longer reflects modern practice and strains staffing, while cardiology representatives had no formal opposition but wanted to review amendments. AB 1113 would codify a right to wear a mask for health reasons in public spaces, with support from disability and public health groups. AB 1386 sought to add perinatal care to the list of basic hospital services, prompting testimony about maternity ward closures, workforce shortages, and rural access; the author said the bill would be amended further and that the committee would need to revisit timelines and implementation details. The committee also heard AB 1429, which would address Kaiser’s repeated mental health parity violations and improve access to behavioral health care, though the transcript cuts off before any action on that bill is shown. Several bills were moved with motions and seconds, but many were held for quorum; AB 1196, AB 1113, and AB 1386 were among the measures advanced to a roll call or held on call, and the committee repeatedly noted that final votes would occur when quorum was available.