Healthcare (Medicaid)

Amend KRS 205.5371 to require the Cabinet for Health and Family Services to condition eligibility for enrollment or continued enrollment in the Medicaid program on demonstrated community engagement as required under federal law; require the cabinet to continue to condition eligibility on demonstrated community engagement if federal requirements are abolished, repealed, or otherwise diminished; amend KRS 205.6312 to require the cabinet and any contracted Medicaid managed care organization to impose cost-sharing requirements for Medicaid enrollees as required under federal law no later than January 1, 2027; establish minimum cost-sharing amounts; amend KRS 205.556 and 205.618 to conform; create new sections of KRS Chapter 205 to require the cabinet to, no later than July 1, 2026, begin conducting Medicaid eligibility redeterminations once every 6 months as required under federal law; require the cabinet to access and review certain data when conducting eligibility redeterminations; establish a process for identifying and, when appropriate, disenrolling individuals who are concurrently enrolled in the Kentucky Medicaid program and a Medicaid program administered by another state or states; amend KRS 205.178 to require the cabinet to receive and review information from the Kentucky Lottery Corporation, Department of Corrections, and the Kentucky Horse Racing and Gaming Corporation on at least a monthly basis, the Kentucky Department of Revenue on at least an annual basis, and the Kentucky Transportation Cabinet on a quarterly basis; require the Department for Medicaid Services to enter into a data sharing agreement with the Social Security Administration to receive the full file of death information on at least a quarterly basis; prohibit the cabinet from seeking or requesting an exemption or waiver from federal community engagement requirements related to county unemployment rates unless specifically authorized by the General Assembly to do so; amend KRS 205.5375 to require hospitals to assist presumptively eligible individuals in submitting a full Medicaid application; amend KRS 205.200 to prohibit the cabinet from accepting self-attestation of income, residency, or age for the purpose of determining eligibility for Medicaid or compliance with community engagement requirements; create new sections of KRS Chapter 205 to establish Medicaid managed care organization contracting requirements and penalties; establish the Medicaid managed care organization compliance fund within the State Treasury; establish that amounts in the fund not appropriated at the close of a fiscal year shall not lapse and shall be carried forward; prohibit the expenditure of funds in the account unless expressly appropriated by the General Assembly; require the Department for Medicaid Services to submit recommendations for use of monies in the fund to the Legislative Research Commission by November 1, 2027, and November 1, of each following odd-numbered year; amend KRS 205.533 to require Medicaid managed care organizations to include certain information for providers on their websites; amend KRS 205.534 to require managed care organizations to allow providers 120 days to file an appeal or grievance related to a reduction of denial of a claim; establish penalties for a managed care organization's failure to ensure the timely disposition of any appeal or grievance; require payment of any amount owed to a provider following an appeal to be paid within 30 days; require payments made following an appeal to include interest and reasonable attorney's fees; establish standards and requirements for provider audits; require the inclusion of additional information in the monthly report filed by managed care organizations; require the Department for Medicaid Services to submit an annual report to the Legislative Research Commission related to Medicaid claims, appeals, and grievances; authorize the Department for Medicaid Services to promulgate administrative regulations; create new sections of KRS Chapter 205 to establish requirements for administration of the Medicaid-covered nonemergency medical transportation services; establish requirements for the administration of 1915(c) Medicaid waiver programs; require the Department for Medicaid Services to develop and implement a tiered priority system for assigning 1915(c) Medicaid waiver program slots by January 1, 2027; require administration of Medicaid-covered dental services by an administrative service organization; establish that the administrative service organization shall not assume any financial or insurance risk; limit compensation paid to the administrative service organization to no more than 2% of the actual Medicaid-covered dental service claims paid on an annual basis; require the Department for Medicaid Services to establish a Dental Program Advisory Panel; require the Department for Medicaid Services to employ a dental director; require the Department for Medicaid Services to submit an annual report on the Medicaid dental program to the Legislative Research Commission; create new sections of KRS 7A.270 to 7A.290 to establish legislative findings; require the cabinet to provide the Legislative Research Commission with access to all databases, datasets, electronic records, and files pertaining to any aspect of the Medicaid program determined by the director of the Legislative Research Commission to be necessary for the meaningful and effective discharge of the General Assembly's legislative duties; require the Legislative Research Commission, the University of Kentucky, and the University of Louisville to enter into a partnership to design and develop a web-based healthcare transparency dashboard; require the dashboard be overseen by a subcommittee of the Medicaid Oversight and Advisory Board; require the dashboard be maintained and operated by the Legislative Research Commission; amend KRS 7A.283 to allow the appointment of individuals who are not members of the board to advisory committees or subcommittees upon approval of the Legislative Research Commission; create a new section of KRS Chapter 43 to require the Auditor of Public Accounts to conduct an examination of the state's Medicaid program and Kentucky Children's Health Insurance Program; establish audit reporting requirements; require the Auditor to conduct a review of the Medicaid program and Kentucky Children's Health Insurance Program to assess progress in addressing issues identified in previous examinations; establish that the Office of Program Performance in the Commonwealth Office of the Ombudsman shall conduct all quality control reviews of the Department for Community Based Services for the Medicaid program, Supplemental Nutrition Assistance Program, and Temporary Assistance for Needy Families to comply with federal law and regulations; establish that no other state agency shall conduct these quality control reviews unless otherwise authorized by the General Assembly; amend KRS 7A.286 to establish that examinations conducted by the Auditor may constitute fulfillment of certain duties assigned to the Medicaid Oversight and Advisory Board at the discretion of the Legislative Review Commission; repeal KRS 205.515 related to administration of the Medicaid program; repeal KRS 311A.172 related to nonemergency medical transportation services; appropriate $500,000 in General Fund moneys in fiscal year 2025-2026 for staffing and technology needs in the Office of the Auditor of Public Accounts; create a new section of KRS Chapter 6 to establish a Medicaid impact statement; require any legislation that makes or directs a change to the Medicaid program to be accompanied by a Medicaid impact statement; require certain factors to be analyzed and included in a Medicaid impact statement; require Medicaid impact statements to be completed by an economic consulting firm retained by the Legislative Research Commission; create a new section of KRS Chapter 13A to require the cabinet to provide a draft copy of certain administrative regulations related to the Medicaid program to the Medicaid Oversight and Advisory Board for comment at least 30 days before filing the administrative regulation with the regulations compiler; direct the Medicaid Oversight and Advisory Board to establish a Dental Services Transition Subcommittee; establish membership and duties of the Dental Services Subcommittee; require any contract between the Department for Medicaid Services and a Medicaid managed care organization entered into, renewed, or extended after the effective date of this Act to include notice to the managed care organization of the department's intent to transition to an administrative service organization delivery model for Medicaid-covered dental services; require the cabinet or the Department for Medicaid Services to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1); direct the Medicaid Oversight and Advisory Board to evaluate the nonemergency medical transportation program and submit findings and recommendations to the Legislative Research Commission by December 31, 2026; APPROPRIATION; EMERGENCY.

Amend KRS 304.17A-258 to require health benefit plans to provide coverage for certain formulas; suspend the coverage requirement's application to qualified health plans if the state would be required to make cost defrayal payments; amend KRS 304.17A-145 to require coverage for breastfeeding and lactation services in conjunction with the birth and without a prescription; amend KRS 304.17A-099 to conform; amend KRS 205.522 to require Medicaid to comply with the coverage requirements for formulas; amend KRS 205.560 to conform; amend KRS 205.6485, 164.2871, and 18A.225 to require KCHIP, self-insured employer group health plans provided by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the coverage requirements for formulas; provide that certain provisions apply to health benefit plans issued or renewed on or after January 1, 2027; require the Cabinet for Health and Family Services or the Department for Medicaid Services to seek federal approval, if necessary, and to comply with notice requirements; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1); EFFECTIVE, in part, January 1, 2027.

Propose to create a new section of the Constitution of Kentucky to enshrine Medicaid expansion coverage; direct the Secretary of State to advertise the proposed constitutional amendment prior to a general election vote; provide ballot language; submit to voters for ratification or rejection.

Create new sections of KRS Chapter 216B to define terms; require hospitals to disclose prices for certain items and services provided by hospitals; require hospitals to make public a digital list of all standard charges and a consumer-friendly list of charges for a set of shoppable services; require hospitals to provide descriptions of different services and standard charges of those services; require the Cabinet for Health and Family Services to promulgate administrative regulations to establish a template for each hospital; require the cabinet to monitor each facility's compliance; provide for administrative penalties; require health care providers to provide patients with written pricing sheets for health care services provided except in an emergency; require the cabinet to promulgate administrative regulations to establish a template for the written pricing sheets; require the cabinet or the Department for Medicaid Services to seek federal approval if they determine that such approval is necessary to comply with KRS 205.5372(1).

Create a new section of KRS Chapter 205 to prohibit the Department for Medicaid Services, any Medicaid managed care organization contracted by the department, and the Medicaid state pharmacy benefit manager from denying coverage for a nonopioid analgesic in favor of opioid analgesic or establishing more restrictive or more extensive utilization controls for nonopioid analgesics than the least restrictive or extensive utilization controls for any opioid or narcotic analgesic; require the Cabinet for Health and Family Services or the Department for Medicaid to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes to the Medicaid program as required under KRS 205.5372(1).

Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to cover at least 2 medically necessary epinephrine devices per covered person; limit a covered person's cost-sharing amount to $100 annually; amend KRS 304.17A-099 to exempt the epinephrine device coverage requirement from being suspended under state law due to the triggering of federal cost defrayment requirements; amend KRS 205.522, 205.6485, 164.2871, and 18A.225 to require Medicaid, KCHIP, self-insured employer group health plans offered by the governing board of a state postsecondary education institution, and the state employee health plan to comply with the epinephrine device coverage requirement; provide that various sections apply to health benefit plans issued or renewed on or after January 1, 2027; require the Department of Insurance to determine whether the epinephrine devices coverage requirement would be in addition to essential health benefits required under federal law; require the Department of Insurance to obtain federal approval, if necessary; require the Cabinet for Health and Family Services or the Department for Medicaid Services to obtain federal approval, if necessary; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1); EFFECTIVE, in part, January 1, 2027.

Create a new section of KRS Chapter 205 to define terms; require Medicaid-enrolled providers prescribing psychotropic drugs to children to provide an FDA Medication Guide to parents or legal guardians; require medical care providers prescribing psychotropic drugs to children covered by Medicaid to obtain signed informed consent from a parent or guardian; require the Cabinet for Health and Family Services to develop and maintain an adverse drug reaction online reporting system; require the cabinet to compile and submit an annual report of the adverse drug reaction online reporting system to the Legislative Research Commission; require the cabinet to submit an annual report summarizing the implementation efforts and compliance statistics of Medicaid-enrolled providers; establish penalties; require the cabinet to promulgate administrative regulations to implement the system.

Direct the Cabinet for Health and Family Services to withdraw the 1115(a) demonstration waiver application that was submitted on June 25, 2025, to the federal Centers for Medicare and Medicaid Services to implement a mandatory community engagement program; EMERGENCY

Amend KRS 205.522 and 205.6485 to require Medicaid and KCHIP to comply with pharmacy reimbursement requirements established in KRS 304.12-237; require the Cabinet for Health and Family Services or the Department for Medicaid to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes to the Medicaid program as required under KRS 205.5372(1).

Create a new section of KRS Chapter 205 to define terms; direct the Cabinet for Health and Family Services to prepare and submit a waiver amendment application to the federal Centers for Medicare and Medicaid Services to amend the 1915(c) HCB waiver program to include coverage for assisted living services; establish coverage limits; require the cabinet to promulgate administrative regulations; require the cabinet or the Department for Medicaid Services to seek federal approval if it is determined that such approval is necessary; provide authorization from the General Assembly to make changes in the Medicaid program as required under KRS 205.5372(1).