Session of 2025
HOUSE BILL No. 2375
By Committee on Appropriations
Requested by Representative Ballard on behalf of the Office of the Governor
2-11
AN ACT concerning health and healthcare; relating to health insurance
coverage; expanding medical assistance eligibility; enacting the
healthcare access for working Kansans (HAWK) act; directing the
department of health and environment to study certain medicaid
expansion topics; adding meeting days to the Robert G. (Bob) Bethell
joint committee on home and community based services and KanCare
oversight to monitor implementation of expanded medical assistance
eligibility; amending K.S.A. 39-7,160 and 40-3213 and repealing the
existing sections.
Be it enacted by the Legislature of the State of Kansas:
New Section 1. (a) Sections 1 through 11, and amendments thereto,
shall be known and may be cited as the healthcare access for working
Kansans (HAWK) act.
(b) The legislature expressly consents to expand eligibility for receipt
of benefits under the Kansas program of medical assistance, as required by
K.S.A. 39-709(e)(2), and amendments thereto, by the passage and
enactment of the act, subject to all requirements and limitations established
in the act.
(c) The secretary of health and environment shall adopt rules and
regulations as necessary to implement and administer the act.
(d) As used in sections 1 through 11, and amendments thereto, unless
otherwise specified:
(1) "138% of the federal poverty level," or words of like effect,
includes a 5% income disregard permitted under the federal patient
protection and affordable care act.
(2) "Act" means the healthcare access for working Kansans (HAWK)
act.
New Sec. 2. (a) The secretary of health and environment shall submit
to the United States centers for medicare and medicaid services any state
plan amendment, waiver request or other approval request necessary to
implement the act. At least 10 calendar days prior to submission of any
such approval request to the United States centers for medicare and
medicaid services, the secretary of health and environment shall submit
such approval request application to the state finance council.
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(b) For purposes of eligibility determinations under the Kansas
program of medical assistance on and after January 1, 2026, medical
assistance shall be granted to any adult under 65 years of age who is not
pregnant and whose income meets the limitation established in subsection
(c), as permitted under the provisions of 42 U.S.C. § 1396a, as it exists on
the effective date of the act, and subject to a 90% federal medical
assistance percentage and all requirements and limitations established in
the act.
(c) The secretary of health and environment shall submit to the
United States centers for medicare and medicaid services any approval
request necessary to provide medical assistance eligibility to individuals
described in subsection (b) whose modified adjusted gross income does
not exceed 138% of the federal poverty level.
New Sec. 3. (a) The secretary of health and environment shall require
each applicant for coverage under the act to provide employment
verification at the time of initial application or renewal application. Such
verification shall be a prerequisite for coverage under the act.
(b) "Employment verification" means documentation demonstrating
employment during the preceding 12 months that meets the eligibility
requirements of the act. "Employment verification" includes, but is not
limited to:
(1) Federal form W-2 wage and tax statement;
(2) a pay stub demonstrating gross income;
(3) employment records;
(4) federal form 1099 demonstrating payments for contract labor;
(5) compliance with the requirements of K.S.A. 39-709(b), and
amendments thereto; and
(6) any other documentation as determined by the secretary of health
and environment.
(c) The following individuals shall be exempt from the requirements
of this subsection:
(1) A full-time student enrolled in a postsecondary educational
institution or technical college, as defined by K.S.A. 74-3201b, and
amendments thereto, for each year the student is enrolled in such
educational setting;
(2) a parent or guardian of a dependent child under 18 years of age or
a parent or guardian of an incapacitated adult;
(3) an individual who is mentally or physically unfit for employment,
as defined by the secretary of health and environment, or has a pending
application for supplemental security income or social security disability
insurance;
(4) an individual who has a permanent partial disability, as such term
is used in K.S.A. 44-510e, and amendments thereto;
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(5) an individual who is engaged in volunteer work for at least 20
hours per week at a nonprofit organization, as such term is defined in
K.S.A. 17-1779, and amendments thereto;
(6) an individual experiencing homelessness, as such term is defined
in 42 U.S.C. § 11302, as in effect on the effective date of this act;
(7) an individual who served in the active military, naval, air or space
service and was discharged or released from such military service under
conditions other than dishonorable;
(8) an individual who is not more than 22 years of age and in the
custody of the secretary of children and families on the date that the
individual reached 18 years of age; and
(9) any individual who the secretary determines is experiencing
hardship.
New Sec. 4. (a) Except to the extent prohibited by 42 U.S.C. §
1396u-2(a)(2), as it exists on the effective date of this act, the secretary of
health and environment shall administer medical assistance benefits using
a managed care delivery system using organizations subject to assessment
of the privilege fee under K.S.A. 40-3213, and amendments thereto. If the
United States centers for medicare and medicaid services determines that
the assessment of a privilege fee provided in K.S.A. 40-3213, and
amendments thereto, is unlawful or otherwise invalid, then the secretary of
health and environment shall administer state medicaid services using a
managed care delivery system.
(b) In awarding a contract for an entity to administer state medicaid
services using a managed care delivery system, the secretary of health and
environment shall:
(1) Not provide favorable or unfavorable treatment in awarding a
contract based on an entity's for-profit or not-for-profit tax status;
(2) give preference in awarding a contract to an entity that provides
health insurance coverage plans on the health benefit exchange in Kansas
established under the federal patient protection and affordable care act; and
(3) require that any entity administering state medicaid services
provide tiered benefit plans with enhanced benefits for covered individuals
who demonstrate healthy behaviors, as determined by the secretary of
health and environment, to be implemented on or before July 1, 2027.
New Sec. 5. If the federal medical assistance percentage for coverage
of medical assistance participants described in section 1902(a)(10)(A)(i)
(VIII) of the federal social security act, 42 U.S.C. § 1396a, as it exists on
the effective date of this act, becomes lower than 90%, then the secretary
of health and environment shall terminate coverage under the act over a
12-month period, beginning on the first day that the federal medical
assistance percentage becomes lower than 90%. No individual shall be
newly enrolled for coverage under the act after such date.
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New Sec. 6. (a) Section 5, and amendments thereto, shall be
nonseverable from the remainder of the act. If the provisions of section 5,
and amendments thereto, are not approved by the United States centers for
medicare and medicaid services, then the act shall be null and void and
shall have no force and effect.
(b) A denial of federal approval or federal financial participation that
applies to any provision of the act not enumerated in subsection (a) shall
not prohibit the secretary of health and environment from implementing
any other provision of the act.
New Sec. 7. (a) On or before January 10, 2027, and on or before the
first day of the regular session of the legislature each year thereafter, the
secretary of health and environment shall prepare and deliver a report to
the legislature that summarizes the cost savings achieved by the state from
the movement of covered individuals from the KanCare program to
coverage under the act, including, but not limited to, the MediKan
program, the medically needy spend-down program and the breast and
cervical cancer program.
(b) State cost savings shall be determined by calculating the cost of
providing services to covered individuals in the KanCare program less the
cost of services provided to covered individuals under the act.
(c) If the secretary of health and environment implements other
initiatives using cost savings achieved through the implementation of the
act, the secretary shall include such initiatives as part of the report required
in subsection (a).
New Sec. 8. (a) The secretary of corrections and the secretary of
health and environment shall coordinate with a county sheriff or such
sheriff's deputy who requests assistance in facilitating medicaid coverage
for any individual committed to a county jail or correctional facility during
any time period that such individual is eligible for coverage under state or
federal law.
(b) If an individual is enrolled in medicaid when such individual is
committed to a county jail or correctional facility, such medicaid status
shall not be suspended or terminated based on such individual's
incarceration for a minimum of 30 days. After 30 days, medicaid coverage
may be suspended, but not terminated, up to the maximum amount of time
permitted by state and federal law.
(c) The secretary of health and environment shall coordinate with a
county sheriff or such sheriff's deputy and the department of corrections to
assist any individual who is committed to a county jail or correctional
facility in applying for medicaid coverage prior to such individual's release
from custody if such individual is likely to meet the requirements for
medicaid coverage to allow adequate time for medicaid coverage to begin
promptly upon release.
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(d) The secretary of health and environment shall adopt any rules and
regulations and supporting policies and procedures as necessary to
implement and administer this section prior to January 1, 2026.
New Sec. 9. On or before February 15, 2027, and on or before
February 15 of each year thereafter, the secretary of health and
environment shall present a report to the house of representatives standing
committee on appropriations and the senate standing committee on ways
and means that summarizes the costs of the act and the cost savings and
additional revenues generated during the preceding fiscal year.
New Sec. 10. (a) There is hereby established the rural health advisory
committee.
(b) The rural health advisory committee shall consist of 15 members
appointed by the governor. The membership shall be comprised of
individuals with a variety of backgrounds including medicine, education,
farming, finance, business and individuals representing community
interests in rural Kansas.
(c) The governor shall designate one of the appointed members to be
chairperson of the committee. The members of the advisory committee
shall select a vice chairperson from the membership of the advisory
committee.
(d) Upon first appointment, five of the members shall serve for a term
of one year, five of the members shall be appointed for a term of two years
and five of the members shall be appointed for term of three years, as
designated by the governor. The member designated as chairperson shall
serve for a term of three years. Subsequent appointees shall serve terms of
three years.
(e) (1) The advisory committee may meet at any time and at any
place within the state on the call of the chairperson. The advisory
committee shall meet regularly, but shall meet at least once every calendar
quarter.
(2) A quorum of the advisory committee shall be eight voting
members. All actions of the advisory committee shall be adopted by a
majority of those voting members present when there is a quorum.
(f) The advisory committee shall:
(1) Advise the governor and other state agencies on rural health
issues;
(2) recommend and evaluate mechanisms to encourage greater
cooperation between rural communities and rural health providers;
(3) recommend and evaluate approaches to rural health issues that are
sensitive to the needs of local communities;
(4) develop methods to identify individuals who are underserved by
the Kansas rural healthcare system; and
(5) beginning in 2026, provide an annual report to the governor
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containing the advice, recommendations and conclusions of the advisory
committee.
(g) The secretary of health and environment shall facilitate the work
of the committee by providing access to meeting space and other necessary
staff and office support. The secretary of health and environment may
adopt any rules and regulations and supporting policies and procedures
that are necessary to support the work of the advisory committee.
New Sec. 11. The healthcare access for working Kansans (HAWK)
act shall not provide coverage for abortion services, except in cases where
coverage is mandated by federal law and federal financial participation is
available.
Sec. 12. K.S.A. 39-7,160 is hereby amended to read as follows: 39-
7,160. (a) There is hereby established the Robert G. (Bob) Bethell joint
committee on home and community based services and KanCare
oversight. The joint committee shall review the number of individuals who
are transferred from state or private institutions and long-term care
facilities to the home and community based services and the associated
cost savings and other outcomes of the money-follows-the-person
program. The joint committee shall review the funding targets
recommended by the interim report submitted for the 2007 legislature by
the joint committee on legislative budget and use them as guidelines for
future funding planning and policy making. The joint committee shall have
oversight of savings resulting from the transfer of individuals from state or
private institutions to home and community based services. As used in
K.S.A. 39-7,159 through 39-7,162, and amendments thereto, "savings"
means the difference between the average cost of providing services for
individuals in an institutional setting and the cost of providing services in a
home and community based setting. The joint committee shall study and
determine the effectiveness of the program and cost-analysis of the state
institutions or long-term care facilities based on the success of the transfer
of individuals to home and community based services. The joint
committee shall consider the issues of whether sufficient funding is
provided for enhancement of wages and benefits of direct individual care
workers and their staff training and whether adequate progress is being
made to transfer individuals from the institutions and to move them from
the waiver waiting lists to receive home and community based services.
The joint committee shall review and ensure that any proceeds resulting
from the successful transfer be applied to the system of provision of
services for long-term care and home and community based services. The
joint committee shall monitor and study the implementation and operations
of the home and community based service programs, the children's health
insurance program, the program for the all-inclusive care of the elderly
and the state medicaid programs including, but not limited to, access to
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and quality of services provided and any financial information and
budgetary issues. Any state agency shall provide data and information on
KanCare programs, including, but not limited to, pay for performance
measures, quality measures and enrollment and disenrollment in specific
plans, KanCare provider network data and appeals and grievances made to
the KanCare ombudsman, to the joint committee, as requested.
(b) The joint committee shall consist of 11 members of the legislature
appointed as follows: (1) Two members of the house committee on health
and human services appointed by the speaker of the house of
representatives; (2) one member of the house committee on health and
human services appointed by the minority leader of the house of
representatives; (3) two members of the senate committee on public health
and welfare appointed by the president of the senate; (4) one member of
the senate committee on public health and welfare appointed by the
minority leader of the senate; (5) two members of the house of
representatives appointed by the speaker of the house of representatives,
one of whom shall be a member of the house committee on appropriations;
(6) one member of the house of representatives appointed by the minority
leader of the house of representatives; and (7) two members of the senate
appointed by the president of the senate, one of whom shall be a member
of the senate committee on ways and means.
(c) Members shall be appointed for terms coinciding with the
legislative terms for which such members are elected or appointed. All
members appointed to fill vacancies in the membership of the joint
committee and all members appointed to succeed members appointed to
membership on the joint committee shall be appointed in the manner
provided for the original appointment of the member succeeded.
(d) (1) The members originally appointed as members of the joint
committee shall meet upon the call of the member appointed by the
speaker of the house of representatives, who shall be the first chairperson,
within 30 days of the effective date of this act. The vice-chairperson of the
joint committee shall be appointed by the president of the senate.
Chairperson and vice-chairperson shall alternate annually between the
members appointed by the speaker of the house of representatives and the
president of the senate. The ranking minority member shall be from the
same chamber as the chairperson. On and after the effective date of this act
Except as provided in paragraph (2), the joint committee shall meet at
least once in January and once in April when the legislature is in regular
session and at least once for two consecutive days during each of the third
and fourth calendar quarters, on the call of the chairperson, but not to
exceed six meetings in a calendar year, except additional meetings may be
held on call of the chairperson when urgent circumstances exist which
require such meetings. Six members of the joint committee shall constitute
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a quorum.
(2) During calendar year 2026 and calendar year 2027, the joint
committee shall meet for one additional day per meeting pursuant to
paragraph (1) in order to monitor the implementation of the healthcare
access for working Kansans act and to review the following topics relating
to such implementation:
(A) Payment integrity and eligibility audits;
(B) outcomes related to section 3, and amendments thereto;
(C) health outcomes for individuals covered under the act;
(D) budget projections and actual expenditures related to
implementation of the act; and
(E) expenses incurred by hospitals arising from charity care and
services provided to patients who are unwilling or unable to pay for such
services.
(e) (1) At the beginning of each regular session of the legislature, the
committee shall submit to the president of the senate, the speaker of the
house of representatives, the house committee on health and human
services and the senate committee on public health and welfare a written
report on numbers of individuals transferred from the state or private
institutions to the home and community based services including the
average daily census in the state institutions and long-term care facilities,
savings resulting from the transfer certified by the secretary for aging and
disability services in a quarterly report filed in accordance with K.S.A. 39-
7,162, and amendments thereto, and the current balance in the home and
community based services savings fund of the Kansas department for
aging and disability services.
(2) Such report submitted under this subsection shall also include, but
not be limited to, the following information on the KanCare program:
(A) Quality of care and health outcomes of individuals receiving state
medicaid services under the KanCare program, as compared to the
provision of state medicaid services prior to January 1, 2013;
(B) integration and coordination of health care healthcare procedures
for individuals receiving state medicaid services under the KanCare
program;
(C) availability of information to the public about the provision of
state medicaid services under the KanCare program, including, but not
limited to, accessibility to health services, expenditures for health services,
extent of consumer satisfaction with health services provided and
grievance procedures, including quantitative case data and summaries of
case resolution by the KanCare ombudsman;
(D) provisions for community outreach and efforts to promote the
public understanding of the KanCare program;
(E) comparison of the actual medicaid costs expended in providing
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state medicaid services under the KanCare program after January 1, 2013,
to the actual costs expended under the provision of state medicaid services
prior to January 1, 2013, including the manner in which such cost
expenditures are calculated;
(F) comparison of the estimated costs expended in a managed care
system of providing state medicaid services under the KanCare program
after January 1, 2013, to the actual costs expended under the KanCare
program of providing state medicaid services after January 1, 2013;
(G) comparison of caseload information for individuals receiving
state medicaid services prior to January 1, 2013, to the caseload
information for individuals receiving state medicaid services under the
KanCare program after January 1, 2013; and
(H) all written testimony provided to the joint committee regarding
the impact of the provision of state medicaid services under the KanCare
program upon residents of adult care homes.
(3) The joint committee shall consider the external quality review
reports and quality assessment and performance improvement program
plans of each managed care organization providing state medicaid services
under the KanCare program in the development of the report submitted
under this subsection.
(4) The report submitted under this subsection shall be published on
the official website of the legislative research department.
(f) Members of the committee shall have access to any medical
assistance report and caseload data generated by the Kansas department of
health and environment division of health care finance. Members of the
committee shall have access to any report submitted by the Kansas
department of health and environment division of health care finance to
the centers for medicare and medicaid services of the United States
department of health and human services.
(g) Members of the committee shall be paid compensation, travel
expenses and subsistence expenses or allowance as provided in K.S.A. 75-
3212, and amendments thereto, for attendance at any meeting of the joint
committee or any subcommittee meeting authorized by the committee.
(h) In accordance with K.S.A. 46-1204, and amendments thereto, the
legislative coordinating council may provide for such professional services
as may be requested by the joint committee.
(i) The joint committee may make recommendations and introduce
legislation as it deems necessary in performing its functions.
Sec. 13. K.S.A. 40-3213 is hereby amended to read as follows: 40-
3213. (a) Every health maintenance organization and medicare provider
organization subject to this act shall pay to the commissioner the following
fees:
(1) For filing an application for a certificate of authority, $150;
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(2) for filing each annual report, $50; and
(3) for filing an amendment to the certificate of authority, $10.
(b) Every health maintenance organization subject to this act shall
pay annually to the commissioner at the time such organization files its
annual report, a privilege fee in an amount equal to the following
percentages 5.77% of the total of all premiums, subscription charges or
any other term that may be used to describe the charges made by such
organization to enrollees: 3.31% during the reporting period beginning
January 1, 2015, and ending December 31, 2017; and 5.77% on and after
January 1, 2018. In such computations all such organizations shall be
entitled to deduct therefrom any premiums or subscription charges
returned on account of cancellations and dividends returned to enrollees. If
the commissioner shall determine at any time that the application of the
privilege fee, or a change in the rate of the privilege fee, would cause a
denial of, reduction in or elimination of federal financial assistance to the
state or to any health maintenance organization subject to this act, the
commissioner is hereby authorized to terminate the operation of such
privilege fee or the change in such privilege fee.
(c) For the purpose of insuring the collection of the privilege fee
provided for by subsection (b), every health maintenance organization
subject to this act and required by subsection (b) to pay such privilege fee
shall at the time it files its annual report, as required by K.S.A. 40-3220,
and amendments thereto, make a return, generated by or at the direction of
its chief officer or principal managing director, under penalty of K.S.A.
21-5824, and amendments thereto, to the commissioner, stating the amount
of all premiums, assessments and charges received by the health
maintenance organization, whether in cash or notes, during the year ending
on the last day of the preceding calendar year. Upon the receipt of such
returns the commissioner of insurance shall verify such returns and
reconcile the fees pursuant to subsection (f) upon such organization on the
basis and at the rate provided in this section.
(d) Premiums or other charges received by an insurance company
from the operation of a health maintenance organization subject to this act
shall not be subject to any fee or tax imposed under the provisions of
K.S.A. 40-252, and amendments thereto.
(e) Fees charged under this section shall be remitted to the state
treasurer in accordance with the provisions of K.S.A. 75-4215, and
amendments thereto. Upon receipt of each such remittance, the state
treasurer shall deposit the entire amount in the state treasury to the credit
of the medical assistance fee fund created by K.S.A. 40-3236, and
amendments thereto.
(f) (1) On and after January 1, 2018, In addition to any other filing or
return required by this section, each health maintenance organization shall
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submit a report to the commissioner on or before March 31 and September
30 of each year containing an estimate of the total amount of all premiums,
subscription charges or any other term that may be used to describe the
charges made by such organization to enrollees that the organization
expects to collect during the current calendar year. Upon filing each March
31 report, the organization shall submit payment equal to ½ of the
privilege fee that would be assessed by the commissioner for the current
calendar year based upon the organization's reported estimate. Upon filing
each September 30 report, the organization shall submit payment equal to
the balance of the privilege fee that would be assessed by the
commissioner for the current calendar year based upon the organization's
reported estimates.
(2) Any amount of privilege fees actually owed by a health
maintenance organization during any calendar year in excess of estimated
privilege fees paid shall be assessed by the commissioner and shall be due
and payable upon issuance of such assessment.
(3) Any amount of estimated privilege fees paid by a health
maintenance organization during any calendar year in excess of privilege
fees actually owed shall be reconciled when the commissioner assesses
privilege fees in the ensuing calendar year. The commissioner shall credit
such excess amount against future privilege fee assessments. Any such
excess amount paid by a health maintenance organization that is no longer
doing business in Kansas and that no longer has a duty to pay the privilege
fee shall be refunded by the commissioner from funds appropriated by the
legislature for such purpose.
Sec. 14. K.S.A. 39-7,160 and 40-3213 are hereby repealed.
Sec. 15. This act shall take effect and be in force from and after its
publication in the Kansas register.
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