3901 – Brief

SUPPLEMENTAL NOTE ON
2021 SILVER-HAIRED LEGISLATURE BILL NO. 3901
Brief

SHL Resolution No. 3901 urges the Kansas Legislature to support the expansion of Medicaid. The resolution includes these findings:

● An estimated 150,000 Kansans, including around 16,000 uninsured Kansans aged 60 to 64 years, fall into a Medicaid coverage gap, being too young to qualify for Medicare but with income too high to qualify for Medicaid and too low to afford private insurance;
● Federal funds would pay for 90.0 percent of services provided to the Medicaid expansion population;
● Medicaid expansion would improve health outcomes by reducing the number of uninsured Kansans, improving preventive and primary care access, providing substance abuse treatment and mental health counseling, and reducing the mortality rate;
● Medicaid expansion likely would yield new jobs, increase wages and salaries, and increase economic activity throughout the state; and
● Medicaid expansion would significantly reduce the burden of uncompensated care.

Background

Several bills related to Medicaid expansion were introduced over the past several legislative sessions, as described below.

HB 2032, introduced in the 2013 Session, and HB 2434, introduced in the 2014 Session, would have expanded Medicaid eligibility for non-pregnant adults younger than age 65 to include those with incomes less than 133.0 percent of the federal poverty level (FPL); neither was adopted.

Two House Concurrent Resolutions were introduced in 2013, stating the Legislature’s intent not to expand Medicaid eligibility (HCR 5011 and HCR 5013); neither were adopted.

In 2014, HB 2552 was enacted; it prohibits the expansion of Medicaid eligibility without the express consent and approval of the Legislature (KSA 2018 Supp. 39-709(e)(2)).

During the 2015 Session, three Medicaid expansion bills were introduced: HB 2045, HB 2270, and HB 2319. Like the bills from 2013 and 2014, HB 2045 would have expanded eligibility for adults younger than age 65 who are not pregnant to those with incomes up to 133.0 percent of the FPL, while HB 2270 and HB 2319 would have expanded this further to 138.0 percent of the FPL. HB 2045 and HB 2270 were referred to the House Committee on Health and Human Services; neither received a hearing, and both died in the House Committee at the end of the 2016 Session.

The House Committee on Health and Human Services held a two-day bill hearing on HB 2319 during the 2015 Session.

Proponent testimony was submitted by nearly 160 proponents, including individuals and representatives of health care providers, health care organizations, and businesses.

Opponent testimony was submitted by approximately ten individuals, including the representatives of five organizations. In addition, neutral testimony was submitted by representatives of the Kansas Department of Health and Environment and Kansans for Life. The last action on HB 2319 in 2015 was the bill’s withdrawal from the House Committee on Appropriations and re-referral to the House Committee on Taxation. During the 2016 Session, the bill went through a series of withdrawals and re-referrals to multiple committees (House Committees on Taxation, Health and Human Services, and Appropriations). The bill died in the House Committee on Taxation on June 1, 2016.

In the 2016 Session, two identical Medicaid expansion bills were introduced: SB 371 and HB 2633. The bills would have created the KanCare Bridge to a Healthy Kansas Program, expanding Medicaid to U.S. citizens or legal residents at least 18 years of age and less than 65 years of age who had resided in the state for at least 12 months, had been without health care coverage for more than 90 days, had a household income of less than 133.0 percent of the FPL, were not participating in the federal Medicare program, and were not otherwise eligible for medical assistance.

The bills would have allowed the State to discontinue the program if the federal matching funds dropped below the Federal Medical Assistance Percentage (FMAP) rate in the federal Patient Protection and Affordable Care Act. SB 371 and HB 2633 were referred to the Senate Committee on Public Health and Welfare and the House Committee on Health and Human Services, respectively, and both bills died in committee without a hearing.

In the 2017 Session, additional Medicaid expansion bills were introduced, with some bills carrying over to the 2018 Session. HB 2112 would have expanded Medicaid to all military veterans and their families with household incomes less than 138.0 percent of the FPL. Implementation of this type of expansion would require a federal waiver. HB 2112 was referred to the House Committee on Taxation. HB 2154 would have removed the portion of KSA 2018 Supp. 39-709(e) enacted in 2015 prohibiting expansion of Medicaid eligibility without the express consent and approval of the Legislature. In addition, HB 2112 would have expanded Medicaid eligibility to non-pregnant adults younger than the age of 65 with incomes less than 138.0 percent of the FPL. HB 2112 was referred to the House Committee on Health and Human Services. Neither HB 2112 nor HB 2154 received a hearing, and both died in committee at the end of the 2018 Session.

Similar to the 2016 bills, two bill introduced in the 2017 Session (SB 38 and HB 2064) would have created the KanCare Bridge to a Healthy Kansas Program. The bills would have expanded Medicaid to non-pregnant adults younger than 65 years of age with incomes less than 133.0 percent of the FPL. SB 38 was assigned to the Senate Committee on Public Health and Welfare in the 2017 Session and received a hearing in the 2018 Session. The Senate Committee recommended SB 38 favorably for passage; however, the bill died on General Orders in the Senate in the 2018 Session. HB 2064 was heard by the House Committee on Health and Human Services, and the language of the bill was later inserted into HB 2044. HB 2064 died in committee in the 2018 Session.

HB 2044 (2017), as amended to contain the language of HB 2064 that included an amendment adopted by the House Committee on Health and Human Services regarding citizenship and legal residency, would have established the KanCare Bridge to a Healthy Kansas Program. The bill would have modified the eligibility requirements for the Kansas Medical Assistance Program to include any non-pregnant adult under 65 years of age who is a U.S. citizen or legal resident, who has been a resident of Kansas for at least 12 months, and whose income does not exceed 133.0 percent of the FPL.

The bill also would have required referral to workforce training programs, created a Drug Rebate Fund and a Privilege Fee Fund for the KanCare Bridge to a Healthy Kansas Program, created a health insurance coverage premium assistance program, addressed federal denial and approval of financial participation, required submission of a waiver request to the federal government, required various Program reports to the Legislature, and created a Program Working Group. The bill passed both chambers; however, it was vetoed by the Governor. The motion to override the veto failed in the House Committee of the Whole.

HB 2768 (2018) would have increased tax on cigarettes, using proceeds for the expansion of Medicaid to any adult under 65 years of age who is not pregnant and whose income does not exceed 138.0 percent of the FPL, to the extent permitted under federal law. The bill was referred to the House Committee on Appropriations and died in the House Committee without a hearing.

The 2018 Session also included several offers of Medicaid expansion amendments to various bills during chamber floor sessions.

During the 2019 Session, two Medicaid expansion bills were introduced: SB 54 and HBSimilar to bills introduced in 2016 and 2017, both bills would have established the KanCare Bridge to a Healthy Kansas Program. The bills would have expanded Medicaid to nonpregnant adults younger than 65 years of age with incomes less than 133.0 percent of the FPL. The bills contained the same program requirements as 2017 HB 2044, with the exception of the U.S. citizenship and legal residency requirements. SB 54 and HB 2102 were referred to the Senate Committee on Public Health and Welfare and the House Committee on Appropriations, respectively. Neither SB 54 nor HB 2102 received a hearing, and both bills remained in committee at the end of the 2019 Session.

Similar to bills introduced during the 2015 and 2017 Sessions, 2019 HB 2030 would have removed the portion of KSA 2018 Supp. 39-709(e) enacted in 2015 prohibiting expansion of Medicaid eligibility without the express consent and approval of the Legislature. In addition, the bill would have expanded Medicaid eligibility to non-pregnant adults younger than 65 with incomes less than 138.0 percent of the FPL. The bill was referred to the House Committee on Health and Human Services. HB 2030 did not receive a hearing and remained in the House Committee at the end of the 2019 Session.

HB 2066 (2019), as amended by the House Committee of the Whole, would have established the Kansas Bridge to a Healthy Kansas Program, with additional amendments. The bill, as introduced, would have amended the Kansas Nurse Practice Act to establish advanced practice registered nurse (APRN) requirements for certification and address other matters related to APRN practice. The introduced bill was referred to the House Committee on Health and Human Services, amended, and recommended favorably for passage, as amended. The bill was removed from the House Calendar, then re-referred to the House Committee on Health and Human Services, which again recommended the bill favorably for passage, as previously amended.

Subsequently, the House Committee of the Whole amended the bill by removing the contents, as amended by the House Committee on Health and Human Services, and inserting new language establishing the Kansas Bridge to a Healthy Kansas Program. The language was like that of 2019 SB 54 and 2019 HB 2102, which did not include the U.S. citizenship and legal residency requirements found in 2017 HB 2044. The House Committee of the Whole then amended the language to require enrollees pay a monthly fee for participation in the program, with the moneys collected deposited in the State Treasury to the credit of the State General Fund; provide for the suspension and termination of an enrollee’s coverage for non-payment of the monthly fee under certain conditions and allow for a one-time reinstatement; and prohibit coverage or reimbursement for any abortion services under the program. The House passed HB 2066, as amended by the House Committee of the Whole, and the bill was referred to the Senate Committee on Public Health and Welfare. The bill did not receive a hearing in the Senate Committee.

On April 5, 2019, a motion was made in the Senate pursuant to Senate Rule 11 to withdraw HB 2066, as amended by the House Committee of the Whole, from the Senate Committee on Public Health and Welfare and place the bill on the Senate Calendar under the order of business of General Orders. The cited purpose of the motion was to allow the Senate to debate and vote on Medicaid expansion during the 2019 Session. Since the motion was made on the date of first adjournment, the motion to withdraw the bill from the Senate Committee was considered on the first day of the Legislature’s return for veto session. The Senate considered the motion on May 1, 2019, but the motion failed on a vote of 23 to 13, having failed to receive the required 24 affirmative votes. HB 2066, as amended by the House Committee of the Whole, remained in the Senate Committee at the end of the 2019 Session.

The Legislative Coordinating Council approved a Senate Select Committee on Healthcare Access (Senate Select Committee) and a Special Committee on Medicaid Expansion (Special Joint Committee) to meet during the 2019 Interim. The Senate Select Committee was approved for two meeting days (scheduled for October 22 and 23, 2019) and charged with considering solutions to improve access to health care in Kansas and report the information to the Special Joint Committee. The Special Joint Committee was approved for two meeting days (scheduled for November 13 and 14, 2019) and directed to study the issues and options surrounding the subject of Medicaid expansion. Both committees were required to submit a report to the 2020 Legislature, including any recommendations adopted by the committees.

During the 2020 Session, two Medicaid expansion bills were introduced: SB 246 and SB SB 246 would have established the KanCare Bridge to a Healthy Kansas Program and expanded Medicaid to non-pregnant adults younger than 65 years of age with incomes less than 133.0 percent of the FPL. SB 246 was referred to the Senate Committee on Public Health and Welfare, did not receive a hearing, and died in committee at the end of the 2020 Session.

SB 252 would have expanded Medicaid to non-pregnant adults younger than 65 years of age with incomes less than 138.0 percent of the FPL and implemented a health insurance plan reinsurance program. SB 252 also included language to terminate the Act should a reduction in the FMAP below 90.0 percent occur and to require enrollees to pay a monthly fee for participation. SB 252 was referred to the Senate Committee on Public Health and Welfare.

Proponent testimony was heard in the Senate Committee on Public Health and Welfare hearings on January 23 and 24, 2020. Proponent testimony was provided by approximately 120 proponents, including individuals and representatives of health care providers, health care organizations, and businesses. On January 28, 2020, neutral testimony was provided by representatives of the Kansas Catholic Conference, Kansas Chiropractic Association, Kansas Health Institute, and Kansas Insurance Department.

Opponent testimony was provided on January 29, and 30, 2020, by nine opponents, including representatives of Americans for Prosperity, Kansas Chamber of Commerce, and Texas Public Policy Foundation. Additional opponent testimony was provided on February 11, 2020, by an additional four opponents, including an attorney in private practice specializing in state and federal constitutional law and representatives of the Family Policy Alliance of Kansas.

On February 20, 2020, the committee amended the bill to include language that would prohibit the use of Medicaid funds for abortions; establish a requirement that participants engage in 20 hours per week in work, education, or volunteering; protect conscious and religious exemptions for providers; and make the enactment of Medicaid expansion contingent upon the passage of a constitutional amendment concerning the regulation of abortion and the outcome of the Texas vs. United States lawsuit (a lawsuit regarding the constitutionality of the individual mandate included in the federal Patient Protection and Affordable Care Act). The bill failed to be passed out of committee on a voice vote.

During the 2021 Session, two new Medicaid expansion bills were introduced: SB 287 and HB 2436. These companion bills would have enacted the Kansas Medical Marijuana Regulation Act and the Kansas Innovative Solutions for Affordable Healthcare Act. The bills would have created the Medical Marijuana Business Entity Regulation Fund, and moneys from that fund could have been used to fund the expansion of Medicaid to individuals with income less than 138.0 percent of the FPL. Moneys from the Medicaid Expansion Privilege Fee Fund that would have been created by the bill would also have been available for Medicaid medical assistance payments for covered individuals. SB 287 was referred to the Committee on Public Health and Welfare, and HB 2436 was referred to the Committee on Federal and State Affairs. Neither bill was heard in committee, and the 2021 Session adjourned without any additional action on these bills.