Appropriations committee reviews $122.3 million supplemental for developmental disabilities and debates paid‑parent caregiver caps

The Arizona House Appropriations Committee on Oct. 12 reviewed House Bill 2945, an emergency supplemental that would appropriate $122,300,300 from various state funds and $403,000,000 in Medicaid expenditure authority in fiscal 2025 to the Department of Economic Security for developmental disabilities services and would change how AHCCCS pursues waiver amendments affecting parents‑as‑paid‑caregivers.

As amended in committee, the bill "is an emergency measure that appropriates a total of $122,300,300 from various funds and $403,000,000 in Medicaid expenditure authority in fiscal year 2025 to the Department of Economic Security for the developmental disabilities Medicaid program," an Appropriations Committee staff member told the panel. The staff member summarized additional provisions that would require AHCCCS (referred to in the hearing as "Access") to obtain legislative authorization before submitting new waiver or waiver‑amendment requests to the Centers for Medicare & Medicaid Services (CMS) and would require AHCCCS to implement a CMS‑approved 40‑hour weekly cap for the PPCG program by July 1, 2025, with a mechanism in the bill for AHCCCS to request a 20‑hour weekly cap to take effect July 1, 2026, if CMS approves a waiver amendment submitted by Oct. 1, 2025.

Why it matters: the provisions in HB 2945 would both fund the state’s developmental disabilities (DD) system and change who may be authorized to provide paid care for minor children in the PPCG program. Implementation of the 20‑hour cap requires federal approval, so the decision would be contingent on CMS. Committee members pressed staff on timelines, notice to families, and how the legislative authorization requirement would interact with the federal waiver process.

Committee discussion and staff clarifications

Representatives asked several procedural and substantive questions during the discussion. In response to whether amendments were expected before the floor, an Appropriations Committee staff member said, "I can't speak on any possible amendments, but it's my understanding that conversations are ongoing." When Representative Blackman asked whether the bill as drafted would require the legislature to authorize future waiver requests and whether that might require a special session, the staff member replied that under the bill language any future waiver or waiver‑amendment request would need an authorizing statute and, "if the legislature were to not be in regular session, it's a possibility you would have to come into special session to approve that waiver."

On the PPCG caps, staff clarified the current and proposed sequence: the 40‑hour weekly cap is already in the state’s Medicaid waiver language and is scheduled to be implemented July 1, 2025; the bill would require AHCCCS to apply to CMS for a 20‑hour weekly cap that, if approved by CMS, would take effect July 1, 2026. As staff put it, "The change in this bill, as far as the cap, it's requiring Access to go to CMS ...and the bill specifies that if that is approved by CMS, that would take effect, one year after the 40 hour cap on July first of next year." (quotations are verbatim from the hearing transcript and attributed to Appropriations Committee staff.)

Members raised concerns about family impacts and data. Representative Carter said, "I am very concerned about this capping at 20 hours," and asked whether parents would receive notice and whether the committee could see data from other states that have lower caps. Staff said some precedent exists — for example, Oregon has a 20‑hour cap in some programs — but that direct apples‑to‑apples data about a 40→20 cut in the PPCG context may not be available. Committee members asked staff to follow up with comparative information where possible.

The bill also contains a line item intended to prevent institutionalization for cases where in‑home care costs more than institutional care; Appropriations staff described that funding as a continuation of previously funded gap payments. The staff member said, "There is a special line item that's a part of this appropriation ... The state does fill that gap, therefore, letting that client stay in the home and community based setting and not losing that funding, making them go institutionalized. That is funded in this measure." That funding was presented as part of the appropriation for the DD program.

What the committee did not do in the hearing

There was no formal roll‑call vote on HB 2945 recorded in the transcript. Staff and members discussed potential amendments and implementation questions but did not record a committee action or final outcome during the segment. The bill was not shown on a published calendar at the time of the hearing, according to staff comments.

Key dates and numeric details from the hearing

- Supplemental appropriation: $122,300,300 (state funds) and $403,000,000 in Medicaid expenditure authority for FY2025 (from the committee staff summary). - PPCG caps: 40‑hour weekly cap scheduled for implementation July 1, 2025 (per staff); bill requires AHCCCS to submit a waiver amendment by Oct. 1, 2025, to seek approval for a 20‑hour weekly cap to take effect July 1, 2026, if CMS approves. - Legislative oversight: bill language would require an authorizing statute before AHCCCS could submit new waiver requests or waiver amendments to CMS; staff said that could require a special session if the legislature were not in regular session when a waiver request is needed.

Ending

Committee members requested follow‑up information on precedent in other states and on how AHCCCS would notify families if caps changed. Staff said they would provide additional materials. The transcript shows continued discussion and general interest in funding and guardrails, but no final committee action on HB 2945 was recorded in the hearing excerpt.