House substitutes HB 122 to let private carriers mirror Medicaid 1115 waiver options, adds reporting and intent language

Representative Rebecca Lockhart introduced first substitute House Bill 122, explaining it responds to a Department of Health application for a Medicaid 1115 waiver that expands coverage to a broader population while reducing benefit levels for cost neutrality. Lockhart said the substitute enables market carriers (insurers) to offer the same-or-similar benefit designs to the population targeted by the waiver and requires an annual report to the Legislature from the insurance commissioner and the Department of Health on waiver development, enrollment and claims experience.

Members asked whether the private market would be required to follow changes if the health department altered the waiver’s benefit design and whether the bill contains protections against 'crowd-out' (private purchasers dropping coverage to enroll in the public program). Lockhart said carriers would need to apply for amendment approvals and that the insurance commissioner would enforce compliance and could sanction noncompliant carriers. Representative Beck and others supported the bill, noting required disclosures of coverage exclusions and a reporting mechanism to track the program. The House substituted the bill (first substitute HB 122) and forwarded it to the Senate; the sponsor also had intent language spread on the journal supporting combined government and private-market approaches to expand coverage.