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Department of Health and Human Services presents multiple rule packages on Medicaid eligibility, rates and caregiver pilot
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Summary
DHHS presented several rule packages updating Medicaid eligibility definitions, nursing‑home and psychiatric facility rate setting, and new programs including a family paid‑caregiver pilot and rental‑assistance programs; testimony included fiscal impact estimates, public‑notice summaries, and member questions about fee increases and waiver interactions.
The Department of Health and Human Services (DHHS) presented a series of rule amendments spanning Medicaid eligibility, nursing‑home rate setting, psychiatric residential treatment facility (PRTF) classifications, family paid‑caregiver pilot rules, and housing‑assistance programs.
Joyce Johnson (Medical Services) summarized amendments to the Medicaid eligibility code to implement 2025 legislation (SB 2076, HB 1067 and HB 1485) that adjust disregarded income rules (including MAGI updates), clarify inmate/institution provisions, and implement annual medical‑necessity certifications for certain multi‑drug regimens. Johnson provided an agency estimate of anticipated fiscal impact of $1,515,084 for the Medicaid rule amendments and noted public‑notice procedures and a single written comment during the public‑comment period.
Leanne Theo and other DHHS witnesses explained changes to nursing‑home and basic care facility rate setting, including a move to a payment‑driven classification model and a December 31 historic‑cost reporting cutoff; DHHS explained that federal changes informed the new assessment and classification approach. Leanne Theo said the payment‑driven model increases classification granularity while leveraging federal assessment tools used in Medicare.
Tina Bay and program leads described the family paid‑caregiver pilot (created by SB 2305) and its rule amendments. The program removes a prior numerical cap on participants and adds an annual attestation requirement that family caregivers will not seek reimbursement for extraordinary care on days when waiver services are paid by the department; DHHS said the 2025 appropriation included $7.3 million in general funds for the pilot. Committee members asked whether overlapping waiver services and the pilot could cause duplication; the department said up to four hours per day of family‑care payments were allowed in certain scheduling arrangements to balance respite and waiver participation.
DHHS also described new chapters implementing rental‑assistance and community transition/diversion programs tied to HB1012, with estimated fiscal impacts included in the department’s 2025–27 budget. For several rule packages DHHS provided the costs of public notice (typically around $3,000) and performed small‑entity analyses when required.
What's next: The committee discussed fee levels, whether the increased license/annual fees should be revisited by the Appropriations Committee, and how the family paid‑caregiver pilot will interact with existing waiver services. Agencies were asked to provide clarifying language and policy documents referenced by DHHS for how classification and payment models work.
