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Kansas bill would require legislative approval for Medicaid coverage expansions, drawing split testimony
Summary
House Bill 2,240 would bar state agencies from pursuing Medicaid coverage expansions or changes that increase state costs without explicit legislative approval, proponents said; opponents warned it could delay federal compliance and risk federal funds.
House Bill 2,240 would prohibit Kansas state agencies from seeking or implementing a Medicaid state plan amendment, demonstration or waiver that expands coverage to additional classes of individuals or increases costs to the state unless the Legislature expressly consents, witnesses told the Committee on Government Efficiency.
Testimony described an amendment that would allow the Legislative Coordinating Council (LCC) to approve requests when the Legislature is not in session or to designate a standing or special committee to review an agency’s request and make recommendations to the LCC. Proponents and opponents took sharply different views in committee testimony about the bill’s likely effects on accountability, program costs, stakeholder engagement and the state’s ability to meet time-sensitive federal requirements.
Proponents, including Brian Sigma (identified in testimony as a visiting fellow at Opportunity Solutions Project), argued the measure would restore legislative oversight and accountability for major changes to Kansas’ Medicaid program. Sigma cited what he described as the state’s continuous-eligibility policy and estimated fiscal effects for the state; he said that “this policy was never debated, it was never approved by the legislature” and described the bill as ensuring those kinds of changes receive explicit legislative approval. Family members and provider representatives—among them Jim Hoover, Laurie Feldkamp, Matt Fletcher of Interhab, and Rachel Newman of COF Training Services—testified in support saying the requirement would force meaningful stakeholder engagement and protect providers and people served from abrupt implementation of complex changes.
Opponents included KanCare, Kansas Action for Children, the Alliance for a Healthy Kansas, the Kansas Council on Developmental Disabilities, Kansas Department of Health and Environment (KDHE) representatives, and the Kansas Department for Aging and Disability Services (KDADS). Opponents warned HB 2,240 could delay time-sensitive federal-mandated changes, create backlogs, and put federal matching funds at risk. Christine Osterlund, Deputy Secretary of Agency Integration and State Medicaid Director, told the committee she received a Centers for Medicare & Medicaid Services (CMS) notification that required submission of a state plan amendment on a three-week timetable and said the state must comply with CMS timelines or risk loss of federal funds.
KDADS Secretary Laura Howard said the bill’s provisions related to home- and community-based services (HCBS) could jeopardize timely submission of a new community supports waiver intended to reduce the IDD (intellectual and developmental disabilities) waiver waiting list. Testimony from Kansas Council on Developmental Disabilities representatives and other advocates said Kansas has an IDD wait list of approximately 4,300 people with average waiting times of 8 to 10 years; witnesses noted the House had funded 320 new waiver slots in the current session as part of efforts to reduce the list. Opponents recommended alternative oversight approaches—such as improving transparency of caseload and appropriations processes or expanding existing joint oversight committees—rather than the statutory bar HB 2,240 would create.
Committee members questioned witnesses about which changes are genuinely emergency or time-sensitive and how the Legislature might provide oversight without creating compliance risk. No committee vote on HB 2,240 is recorded in the transcript excerpts provided; testimony in committee cited a prior House vote on the bill of 89 to 34.
The transcript excerpts reflect competing claims about background policy: proponents attributed a 2022 implementation date to continuous eligibility changes; KDHE and KDADS witnesses testified that continuous eligibility for adults was implemented in 2010 and that some authorities cited by proponents were longstanding policy. Committee testimony also referenced federal regulatory requirements including CMS’s “final settings” rule for HCBS and a December 2024 CMS letter urging Kansas to address corrective action items. Witnesses gave examples of specific administrative actions and timelines they said would be impaired if the statutory veto were enacted as written.
