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Minutes for HB2240 - Committee on Welfare Reform

Short Title

Requiring legislative approval of any medicaid state plan, state plan amendment, demonstration or waiver that expands coverage or increases cost to the state.

Minutes Content for Tue, Feb 11, 2025

Chairman Awerkamp called the meeting to order at 1:36 p.m.

The Chair opened the hearing on HB2240.

Assistant Revisor Jenna Moyer briefed the Committee on the bill (Attachment 1).  She explained that the bill requires legislative approval of any Medicaid state plan or waiver that expands coverage or increases costs to the state. 

Brian Sikma, Visiting Fellow, Opportunity Solutions Project, via Web-ex, testified as a proponent for the bill (Attachment 2).  Noting that Medicaid costs are one of the largest expenditures in the Kansas budget, he stated that the bill is a common-sense measure to ensure major policy changes in Kansas Medicaid programs receive legislative approval and to assure agency accountability. Referencing  Kansas' Continuous Eligibility waiver, which was instituted unilaterally in 2022, he said that during redetermination 43.7% of enrollees were not approved for renewal.  He cited other states with waivers that had no legislative oversight, a lack which resulted in massive budget overruns.  He called the bill a reasonable necessary step toward transparency.

Matt Fletcher, Executive Director, InterHab, spoke in support of the bill (Attachment 3).  He focused specifically on the Intellectual and Developmental Disabilities (IDD) waiver and the the large-scale system changes that the Kansas Department for Aging and Disability Services (KDADS) is proposing for the IDD waiver over the next two years; he said the agency has excluded stakeholder input and stakeholder support.  He referenced the 2014 CMS (Centers for Medicare and Medicaid Services) Final Rule that created Home- and Community-Based Services (HCBS), a rule that promotes person-centered programs.  He reported that 80% of the CDDOs (Community Developmental Disabilities Organizations) are not prepared to implement KDADS system changes, a failure which could have been mitigated by giving consideration to their input.  He offered an amendment to the bill to resolve IDD issues.

Gerard Michaud, President/CEO, Developmental Services of Northwest Kansas, speaking as a proponent, provided background history to show the developing interactions of CMS, KDADS, and the IDD community (Attachment 4).  He said that direct legislative involvement is vital to ensure that the Kansas plan for meeting CMS requirement is one that engages the IDD system so that practical and effective solutions can be developed.

Rachel Neumann, Chief Operating Officer, COF Training Services, provided details regarding the extensive simultaneous system changes being proposed by KDADSp, each of which impacts service providers and clients.  She called on KDADS to collaborate with providers to build capacity before instituting these changes, and she urged members to use the bill as a start toward that goal (Attachment 5).

Jim Huber, Parent, spoke in support of the bill (Attachment 6).  He explained that the bill will allow more thorough input, discussion, and agreement for a crucial process that is vital to his son.

The following written-only proponent testimony was offered:

Members offered the following comments:

  • Stories from constituents indicate the need for more effective services.
  • Changes may be needed, but it is important to accomplish them without disrupting the lives of those being served.
  • The testimonies indicate interpersonal issues rather than addressing policies.
  • The interim Special Committee on Target Case Management addressed some issues highlighted by conferees.

Heather Braum, Senior Policy Advisor, Kansas Action for Children, testified as an opponent to the bill (Attachment 13).    She expressed concern that the broad language of the bill would require legislative action for even minor changes in program services.  The complex process of moving from the 1115 waiver to the 1915 waivers, which must be approved by CMS, will be unnecessarily delayed by the bill; it will create inefficiencies in program delivery limit an agency's ability to respond to emergencies.

Tanya Dorf Brunner, Executive Director, Oral Health Kansas, speaking an an opponent, said the bill adds barriers to ensuring health and dental care access.  It will curtail the efficient delivery of health care and will complicate the state's ability to improve the well-being of citizens (Attachment 14).

Jenny Tatman, Assistant Director, Thrive Allen County, testified in opposition to the bill (Attachment 15).  Commenting that even minor changes in the federal programs may cause delays in service delivery if the bill's broad language is applied indiscriminately, she stated that the bill will slow the operations of the CMS navigators.  She said the bill adds redundant government red tape and wastes legislative resources on duplicative bureaucratic checks..

Sean Gatewood, Co-Administrator, KanCare Advocates Network, explained that the bill has not been thoroughly vetted to determine its long-term impact or unintended consequences.  He said the bill adds a layer of governmental bureaucracy that will hamstring the state as it begins to implement the Community Support Waiver and the new KanCare contracts (Attachment 16).

The following testimony is written-only opposition to the bill:

  • Christine Osterlund, Deputy Secretary of Agency Integration and Medicaid Director, Kansas Department of Health and Environment (KDHE) (Attachment 17);
  • April Holman, Executive Director, Alliance for a Healthy Kansas (Attachment 18);
  • Jason White, Mid-America Regional Council Emergency Rescue (Attachment 19);
  • Jonathan Smith, Executive Director, Lawrence-Douglas County Public Health (Attachment 20);
  • Brenda Bandy, Executive Director, Kansas Breastfeeding Coalition (Attachment 21);
  • Dena Hubbard, Chair, Public Policy Committee, Kansas Chapter American Academy of Pediatrics (Attachment 22); and
  • Charlie Hunt, Director, Johnson County Department of Health and Environment (Attachment 23).

Christine Osterlund was asked by members to give an overview of the Medicaid program in Kansas.  She explained that the federal government outlines the parameters for Medicaid and often directs the state to make program adjustments, sometimes limiting the time for those adjustments to 30-60 days.

Regarding the Committee's authority, Ms. Moyer said that LCC (Legislative Coordinating Council) Policy 33 prohibits any committee from speaking on behalf for the legislature without the LCC approval.

The Chair closed the hearing on HB2240.