KDHE seeks to expand charity‑care protections by raising medically indigent threshold to 300% of FPL; lawmakers press for fiscal data

The Kansas Department of Health and Environment proposed raising the income threshold that defines “medically indigent” for the charitable health care provider program from 200% to 300% of the federal poverty level, a change KDHE said will broaden protections for providers offering uncompensated care while aligning Kansas with neighboring states.

Amy Swanson, section director for community health access at KDHE, told the Joint Committee on Administrative Rules and Regulations that the charitable health care provider program provides limited legal protections—through the Kansas Tort Claims Act—for health care providers who offer free or discounted medical and dental care to patients who cannot afford services. KDHE proposed amending KAR 28‑53‑3 to raise the eligibility threshold to 300% FPL and to update agency names to current organizational structure.

KDHE said the proposed change would allow more uninsured Kansans to receive free care while extending tort‑claims coverage to the providers who serve them. Swanson asserted the change is “not expected to create any new costs for businesses, individuals, or local governments” because the Kansas Tort Claims Act provides indemnification only for uncompensated charitable care. She said KDHE held two roundtable meetings (Dec. 18, 2024 and Jan. 15, 2025) with roughly 15 participants and received no negative feedback.

Lawmakers pressed KDHE on fiscal exposure and the practical effects of the change. Senator Warren asked which stakeholders attended the roundtables; KDHE said the meetings included federally qualified health centers and look‑alike clinics (FQHCs) and would provide a participant list later. Representative Wagner and others challenged KDHE’s assertion that costs would be negligible; KDHE staff cited a five‑year history of only one claim under the charitable program (for about $10,000) and said increases would depend on how many additional uninsured persons sought care at participating safety‑net clinics.

Committee members noted KDHE’s own calculation that raising the threshold to 300% FPL would expand eligibility by roughly 3% of the state population. Senators estimated that could represent tens of thousands of Kansans (one figure cited during the hearing: roughly 90,000). Lawmakers asked KDHE to provide more detailed estimates of how many of the newly eligible would actually seek care at participating clinics, how many already have insurance, and any expected changes to Kansas Tort Claims Act payouts.

KDHE explained the proposed change covers medical and dental services provided under the charitable health care program and does not alter private providers’ coverage unless those providers participate in the charitable program. KDHE also said the change was requested by a Wichita provider that reported already serving patients near the 300% FPL threshold but lacking Tort Claims Act protection for that group.

The committee did not adopt the rule and requested follow‑up information, including clearer estimates of the number of newly eligible Kansans, regional distribution, historic usage of charitable care, and any projected fiscal impact on the tort‑claims fund or related state allocations.

Ending: KDHE will provide the committee additional data on population impact and any potential fiscal exposure before the regulation advances.