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Committee advances bill letting parents buy children into Medicaid waiver for nonmedical supports
Summary
The House committee voted to pass House Bill 881, which would allow parents of children with severe disabilities to pay a premium to enroll their children in a Medicaid waiver program that covers nonmedical community services not typically paid by private insurance.
House Bill 881, sponsored by Representative Mary Cafaro, would let parents of children with severe disabilities buy into a Medicaid waiver by paying a premium so the children can receive nonmedical community services not covered by private insurance. Representative Mary Cafaro introduced the bill to the House Appropriations Committee and described the provision as modeled on the Katie Beckett buy-in approach that has been used in other states.
The bill’s sponsor told the committee the waiver would cover services such as adaptive equipment, wheelchairs, therapies and personal care assistance — supports families say private insurance often does not pay for. “All this bill does is it allows parents whose children have disabilities to buy into the Medicaid program by paying a premium,” Cafaro said, adding that 44 states already have some version of the buy-in.
Department of Public Health and Human Services officials answered fiscal and program questions. Gene Hermanson, Medicaid chief financial manager, told the committee the fiscal note estimated roughly 1,000 children could be eligible under the bill’s 300% of federal poverty level income cap and that the department assumed about 20% of those would enroll, producing an estimated 218 enrolled children. Hermanson summarized the department’s rounding of costs: “The cost I’m rounding here is about $4,000,000 a year total cost…about $1,500,000 of that being state share,” after anticipated premium revenue and other assumptions.
Proponents including Jackie Mohler, executive director of Family Outreach, urged support, saying the buy-in fills a gap for families whose private insurance covers medical treatment but not the community-based supports needed to keep children at home. Mohler said the program helps families who earn too much to qualify for standard Medicaid but still face intense care needs.
Committee members asked technical questions about premium design, offsets when children have private insurance and how fiscal assumptions were derived. Hermanson said the fiscal note did not attempt to offset private insurance payments because reliable data were unavailable. Representative Gillette pressed for clarification of the premium and state/federal match mechanics; Hermanson said the department assumed premium revenue would be less than the total state share cost.
During executive action the committee voted to pass HB 881. The roll call showed 19 members voting yes and 4 voting no; the bill was approved by the committee and will move forward in the process.
The bill includes an appropriation consistent with the fiscal note but committee members and agency staff asked for additional clarifying language and data collection on enrollment and premium amounts if the bill moves ahead. Supporters noted the waiver is capped enrollment and budgeted like other waivers; opponents and some members pressed for clearer premium and offset details before final enactment.
