Committee weighs Medicaid access program: covered-lives assessment would fund rate increases, critics warn of cost to small-market consumers

Senate Health and Long Term Care Committee members held a public hearing Feb. 20 on Senate Bill 5,372, a measure that would create a Medicaid access program funded by a covered-lives assessment on Medicaid managed care organizations and on health carriers regulated by the Office of the Insurance Commissioner (OIC). The Health Care Authority (HCA) would be required, by Sept. 1, 2025, to submit a state plan amendment or waiver request to the Centers for Medicare & Medicaid Services (CMS) to obtain federal financial participation. Assessment collection and disbursement would be conditioned on CMS approval.

Under the bill as described by staff, beginning the first plan year after federal approval HCA would assess $18 per covered member per month from Medicaid managed care organizations and OIC-regulated carriers would be assessed $0.50 per member per month. Assessment revenue would…