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Lawmakers told Medicaid expansion is enshrined in state constitution; changing it would require repeal
Summary
During questioning Secretary Bullard told the Appropriations subcommittee there is no cap on expansion and that changing the constitutional Medicaid expansion would require repeal via both legislative chambers and a public state question.
Lawmakers pressing the Health Care Authority on the budget also asked whether the state's Medicaid expansion carries any statutory cap. Secretary Bullard told the Appropriations Budget Subcommittee that the expansion is part of the state constitution and that the only remedy to limit it would be a constitutional repeal.
"Remedy would be a repeal of the state constitution," Bullard said when asked whether the Legislature has tools to cap expansion costs. He added that such a repeal would require passage in both chambers and then approval by voters as a state question.
Committee members asked whether federal action could impose spending stipulations on expansion instead of going through the constitution. Agency staff said federal constraints or conditions on the expansion are not an avenue they have seen as permissible and that the expansion population benefits from an enhanced federal match (noted elsewhere in the hearing as roughly 90% for expansion members).
Why it matters: Several lawmakers expressed concern about open-ended growth in expansion-related utilization and state fiscal exposure. Bullard noted HR 1 will add protections for the expansion population beginning in October 2028 and that legal protections around the expansion population limit the state’s discretion over benefit changes.
Next steps: Lawmakers asked staff to identify any policy levers or trigger mechanisms they could use to flag fiscal stress earlier in the budget cycle; Bullard agreed to outline potential notification triggers for the Legislature.
