Kansas committee hears argument to require legislative approval for Medicaid waivers and costly state plan changes

The Committee on Welfare Reform on the statehouse heard testimony on House Bill 2240, a proposal that would require legislative approval before any Medicaid state plan, state plan amendment, demonstration or waiver that expands coverage or increases state costs could be sought or implemented. Supporters said the bill would restore legislative oversight; opponents warned the measure could prevent timely responses to federal mandates and urgent health needs.

Proponents focused on process and cost. Brian Sigma, visiting fellow with Opportunity Solutions Project, said the bill would stop “unacceptable” unilateral changes by state agencies and cited Kansas’ continuous eligibility policy as an example. "Medicaid, as you know, is one of the largest expenditures in the Kansas state budget," Sigma said, arguing that waivers and state-plan amendments have been used to make major changes without a legislative vote. He told the committee Kansas data from the public‑health‑emergency redetermination showed 43.7% of enrollees were not approved for renewal and estimated that continuing coverage for people who no longer qualified has cost the state between $4,000,000 and $9,600,000 per year.

Advocates for people with intellectual and developmental disabilities (IDD) pressed the committee to add language so the bill’s oversight would explicitly cover large IDD system changes. Matt Fletcher, executive director of Interhab, urged an amendment so the legislature would review “large scale system changes” for the IDD service network, saying providers and families were excluded from development of the state’s proposals. Fletcher said he was "about 140 days away" from the implementation of one system change and that key pieces remained incomplete; he asked that the legislature be allowed to serve as a check to prevent harm to a vulnerable population.

Leaders of regional provider organizations described how proposed waiver and funding changes could alter eligibility, case management, day services and gatekeeping for the IDD network. Gerard (Jerry) McCod, president and CEO of Developmental Services of Northwest Kansas, described organizations that have performed multiple administrative and service roles for decades and asked for legislative oversight to ensure design changes work in practice. Rachel Newman, chief operating officer of COF Training Services, gave a staff-and-accessibility example about taking a group bowling to illustrate the logistical challenges of replacing center‑based day services with community‑based hours. "This single event was exhausting, and very challenging," she said, arguing that changes to day services and funding should be better vetted with providers and families.

Opponents argued the bill’s language is too broad and could hinder the state’s ability to respond quickly to federal rules, emergencies and mandatory program changes. Heather Braum, senior policy advisor at Kansas Action for Children, noted roughly 61% of Kansas Medicaid (KanCare) members are children and said many program changes happen during the year in response to federal guidance or urgent health needs. "If the process to pursue changes can only occur with legislative authorization, the medical assistance program will no longer be able to quickly pivot," she said, offering an example in which a medication coverage change was made within 24 hours during an out‑of‑season RSV outbreak.

Other opponents, including Jenny Tapman of Thrive Allen County and Sean Gatewood of the KanCare Advocates Network, warned the bill could add bureaucracy that slows enrollment assistance and public comment response. Gatewood questioned whether large unilateral expansions actually have occurred, saying he was not aware of recent major expansions enacted without legislative action and asked what constitutes an "increase" in cost for the statute’s purposes.

State Medicaid officials answered committee questions about federal mandates and timing. Christine Osterlund, deputy secretary of agency integration and the state Medicaid director, said many federal changes are mandatory and can carry short implementation windows. "We typically get deadlines to implement those services that are 30 to 60 days," she said, and cautioned that failure to comply can place federal matching funds at risk; she cited an example of a prior change that carried a roughly $51 million state impact that required appropriations work.

Committee members asked whether existing interim legislative committees or the Legislative Coordinating Council (LCC) could be used to provide oversight when the legislature is not in session. Staff explained that LCC policy 33 limits interim committees from speaking for the legislature without prior LCC approval, and members discussed whether the LCC itself could be delegated authority to act between sessions.

The hearing produced no formal action on the bill. Several proponent organizations requested an amendment to ensure the proposed oversight explicitly covers current and planned IDD waiver changes; opponents urged more-targeted alternatives such as increased transparency in consensus caseloads or expanded interim committee authority to review urgent changes.

The committee closed the hearing on House Bill 2240 without a recorded vote. Sponsors and stakeholders signaled they would provide proposed amendment language and additional material for committee consideration in subsequent work sessions.