State health budget hearing highlights Medicaid funding, long HCBS registries and opioid-settlement grant planning

Department of Health (MDH) leaders and Department of Legislative Services analysts briefed the subcommittee Jan. 29 on the fiscal 2026 overview, covering Medicaid spending, home- and community-based services (HCBS) registries, opioid-settlement spending and the cigarette restitution fund.

DLS analyst Naomi Kimura said the department’s total fiscal 2026 budget is approximately $21.5 billion, a slight decline from fiscal 2025 driven by projected Medicaid enrollment and utilization decreases. DLS flagged proposed fiscal 2025 deficiencies that add roughly $2.25 billion to the enacted fiscal 2025 budget, largely to cover unanticipated Medicaid and DDA (Developmental Disabilities Administration) spending. The fiscal 2026 allowance includes 7,391 regular positions and 349 contractual FTEs; DLS told the committee MDH had a 15% vacancy rate as of Dec. 31, 2024.

On long-term services and supports, Anne Braun of DLS highlighted HCBS waiver registries. MDH’s community options registry exceeded 20,000 individuals at the end of fiscal 2024 while DDA waivers’ combined waiting lists were under 4,000. Braun said registry reductions are influenced by outreach, low return rates of mailed applications and staffing shortages handling eligibility…