The act limits the benefits pregnant women and children with a certain family household income and citizen or immigration status are eligible for under the state medical assistance program and the medical assistance program. Eligible pregnant women and children are subject to the following limitations on benefits:Beginning July 1, 2026, there is an annual cap on dental services in the amount of $1,100;Beginning January 1, 2027, behavioral health services offered must be provided on a fee-for-service basis only;Beginning January 1, 2027, services offered through the accountable care collaborative are no longer covered; andBeginning January 1, 2027, managed care services through the medical assistance program are no longer covered. Beginning January 1, 2027, children under 19 years old whose family household income does not exceed 260% of the federal poverty line, adjusted for family size, and who are not eligible for the medical assistance program due to their immigration status, are not eligible for home- and community-based services, community first choice, long-term home health, private duty nursing, hospice care, and nursing home care unless those children already receive those services on or before December 31, 2026. Beginning January 1, 2027, the act caps enrollment of children in the state medical assistance program at 25,000 children if either enrollment exceeds 25,000 or the expenditures for a fiscal quarter exceeds one-quarter of the appropriation for state medical assistance plus 5% to account for seasonality fluctuations. If one of the conditions is met, the enrollment cap begins on the first day of the month following 60 days after the department of health care policy and financing (state department) determines that the condition was met. The act repeals provisions requiring the state department to develop an outreach and enrollment strategy for enrolling eligible groups into new coverage options and repeals the state children's basic health plan. The act appropriates $3,378,166 from the general fund to the state department to implement the act and reduces appropriations to the state department by $14,202,723 if certain conditions are met.(Note: This summary applies to this bill as enacted.)
The bill prohibits a person, health-care provider, or mental health professional from knowingly performing surgery on, or prescribing, administering, or providing hormones or puberty blockers to, a minor for the purpose of altering the minor's biological sex characteristics, or providing mental health therapy, counseling, or referrals that promote or affirm a minor's belief that the minor was born in the wrong body or that the minor needs medical intervention to address distress related to the minor's biological sex (prohibited interventions). The bill prohibits the state from investigating or penalizing a minor's parent, or terminating the parent's rights, for refusing to consent to a prohibited intervention for the minor. A public school, health-care provider, or a governmental entity is prohibited from withholding information from a minor's parent regarding the minor's express desire to transition the minor's biological sex. The bill prohibits state or federal funding, medicaid reimbursement, and health insurance coverage from being used to pay for a prohibited intervention. A person who, as a minor, was subjected to a prohibited intervention may bring a civil action within 20 years after attaining the age of 18 years against the person, health-care provider, or mental health professional who performed or provided the prohibited intervention. The bill requires a regulator to revoke a health-care provider's or mental health professional's license for performing or providing a prohibited intervention. A person who knowingly performs or provides a prohibited intervention commits a class 5 felony, and the court is required to sentence the person to the maximum term of imprisonment and impose the maximum fine.(Note: This summary applies to this bill as introduced.)
