COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1868H.01I Bill No.:HB 842 Subject:Medicaid/MO HealthNet; Health Care; Insurance - Health Type:Original Date:April 20, 2025Bill Summary:This proposal requires MO HealthNet and health benefit plans providing for
maternity benefits to cover a home blood pressure monitoring device for
pregnant and postpartum women.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028
General
Could exceed
($62,500 to $543,640)
$0 to
Up to ($496,164)
$0 to
Up to ($512,165)
Total Estimated Net
Effect on General
Revenue
Could exceed
($62,500 to $543,640)
$0 to
Up to ($496,164)
$0 to
Up to ($512,165)
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028State Road Fund
(0320)(Unknown)(Unknown)(Unknown)
Total Estimated Net
Effect on Other State
Funds*(Unknown)(Unknown)(Unknown)
* Oversight assumes the fiscal impact to the State Road Fund would not exceed $250,000
annually.
Numbers within parentheses: () indicate costs or losses. L.R. No. 1868H.01I
Bill No. HB 842
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on FTE 000
☒ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Local Government$0$0$0 L.R. No. 1868H.01I
Bill No. HB 842
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FISCAL ANALYSIS
ASSUMPTION
§ 208.152 - Requires MO HealthNet to cover home blood pressure monitoring devices for
pregnant and postpartum women
Officials from the Department of Social Services (DSS), MO HealthNet Division (MHN)
state this legislation repeals § 208.152, RSMo, and enacts two new sections relating to payments
for home blood pressure monitoring. It adds, for pregnant and postpartum women, a home blood
pressure monitoring device, under additional benefit payments for medical assistance.
The blood pressure monitoring device should be validated for clinical accuracy, device
calibration and the patient should receive education and training services on the setup and use of
the device. MHD plans to implement coverage of Self-Monitoring Blood Pressure devices for
pregnant and postpartum women subject to medical necessity, effective February 1, 2025.
Coverage for this benefit is already provided for individuals age 20 and under.
This legislation also adds § 376.1960. It states health benefit plans delivered, issued for delivery,
continued, or renewed in this state on or after January 1, 2026, and providing for maternity
benefits, shall provide coverage for a home blood pressure monitoring device for pregnant and
postpartum women.
Since this legislation is under § 208.152, it applies to MO HealthNet and would have an impact.
This change would result in an impact to the Managed Care capitation rates of up to $650,000
(annually) and the actuarial cost to evaluate this program change would be no more than
$25,000. For FY27 and FY28, a 6.5% medical inflation rate was used. Because the language
does not limit the service to medical necessity, it is implied that services that are not medically
necessary shall be provided. The fiscal estimate for the benefit is limited to the incremental
increase to remove medical necessity and does not represent the entire cost of the Self Measured
Blood Pressure (SMBP) benefit for pregnant and postpartum women.
DSS estimates for the costs of this proposal are as follows:
FY26 Total: $25,000 to $675,000 (GR: $12,500 to $243,640; Federal: $12,500 to $431,360)
FY27 Total: $0 to $692,250 (GR: $0 to $246,164; Federal: $0 to $446,086)
FY28 Total: $0 to $737,246 (GR: $0 to $262,165; Federal: $0 to $475,081)
Oversight does not have information to the contrary and therefore, Oversight will reflect the
estimates as provided by DSS, MHD. L.R. No. 1868H.01I
Bill No. HB 842
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§ 376.1960 - Requires health benefit plans to cover home blood pressure monitoring devices for
pregnant and postpartum women
Officials from the Department of Commerce and Insurance (DCI) state the Affordable Care
Act (ACA) requires all non-grandfathered individual and small group health plans to cover a
core set of healthcare services within 10 essential health benefit (EHB) categories. In 2012,
Missouri, like other states, adopted a benchmark plan that defined the core benefits these plans
must offer in the state. The benchmark plan was updated in 2017, based on a plan that was sold
in 2014. Missouri has not made any further updates to its EHB benchmark plan. The ACA also
requires that the cost of a new coverage mandate added by a state after adoption of its benchmark
plan that is above and beyond the EHB benchmark will be the responsibility of the state.
45 C.F.R 155.170 requires states to defray the cost of additional required benefits mandated by a
state on or after January 1, 2012. States may require qualified health plans to offer benefits in
addition to essential health benefits. States will identify which state-required benefits are in
addition to the EHB and must make payments to defray the cost of additional benefits either to
enrollees in qualified health plans or directly to the qualified health plans, on behalf of their
enrollees.
Documentation provided by the U. S. Department of Health and Human Services, Center for
Consumer Information & Insurance Oversight (CCIIO) in October 2018 instructed states as
follows:
[A]lthough it is the state’s responsibility to identify which state required benefits require
defrayal, states must make such determinations using the framework finalized at
§155.170, which specifies that benefits required by state action taking place on or before
December 31, 2011, may be considered EHB, whereas benefits required by state action
taking place after December 31, 2011, other than for purposes of compliance with federal
requirements, are in addition to EHB and must be defrayed by the state. For example, a
law requiring coverage of a benefit passed by a state after December 31, 2011, is still a
state mandated benefit requiring defrayal even if the text of the law says otherwise.
This proposal requires, in pertinent part, that “Health benefit plans delivered, issued for delivery,
continued or renewed in this state on or after January 1, 2026, and providing for maternity
benefits, shall provide coverage for a home blood pressure monitoring device for pregnant and
postpartum women.” This provision appears to create a new mandate for which the state must
defray payments, as required under federal law. As a result, the state may be required to defray
the actuarial cost of new coverage requirement and make payments to either issuers or
beneficiaries to negate potential premium increases. DCI does not know the increased utilization
that may be created by the provisions of this proposal. As a result, there is a zero to unknown
negative impact to General Revenue.
In 2011, the Missouri General Assembly enacted section 376.1190, which states that “any health
care benefit mandate proposed after August 28, 2011, shall be subject to review by the oversight L.R. No. 1868H.01I
Bill No. HB 842
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division of the joint committee on legislative research. The oversight division shall perform an
actuarial analysis of the cost impact to private and public payers of any new or revised mandated
health care benefit proposed by the general assembly after August 28, 2011, and a
recommendation shall be delivered to the speaker and the president pro tem prior to mandate
being enacted.
Officials from the Missouri Department of Conservation (MDC) state they anticipate an
unknown fiscal impact of less than $250,000.
Oversight does not have information to the contrary and therefore, Oversight will reflect the
estimates as provided by the MDC as “Up to $250,000” annually.
Officials from the Missouri Department of Transportation (MoDOT) state this bill requires
health providers to provide coverage for blood pressure monitoring devices for pregnant and
postpartum women. This will negatively impact the MoDOT-MSHP medical plan. The negative
impact on the State Road Fund would depend on usage by pregnant and postpartum enrollees.
Oversight does not have any information to the contrary. MoDOT did not provide an estimate of
the fiscal impact to their organization. Therefore, Oversight will reflect MODOT’s costs to the
State Road Fund as “Unknown”. However, Oversight assumes insurance coverage for the
maternity services in this proposal would not exceed $250,000 annually.
Officials from the Oversight Division
section 376.1190, which states, “any health care benefit mandate proposed after August 28,
2011, shall be subject to review by the oversight division of the joint committee on legislative
research. The Oversight Division shall perform an actuarial analysis of the cost impact to private
and public payers of any new or revised mandated health care benefit proposed by the general
assembly after August 28, 2011, and a recommendation shall be delivered to the speaker and the
president pro tem prior to mandate being enacted.”
The customary process for an actuarial analysis involves Oversight contracting with an outside
firm who will request experience data from the largest insurance carries in the State of Missouri.
Since current law (§ 376.1190) requires any “proposed” mandate receive an actuarial analysis,
the timing may not allow for such in-depth reviews. In 2013 Oversight contracted with a
company to perform an actuarial analysis for Senate Bill 262, Senate Bill 159, and Senate Bill
161. Due to the timing of the analysis, the company noted requesting outside data was not
possible. This limited analysis in 2013 cost almost $25,000. Given the cost increases over the last
ten years, the varying degree of available information to the outside firm and the potential for
more in-depth analysis if the information and timing allow, Oversight assumes that a current
analysis “could exceed $50,000”.
The Oversight Division does not currently have the appropriation to cover the costs of an
actuarial analysis and would need to request such additional funding through the budget process. L.R. No. 1868H.01I
Bill No. HB 842
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Responses regarding the proposed legislation as a whole
Officials from the Department of Health and Senior Services and the Missouri Consolidated
Health Care Plan each assume the proposal will have no fiscal impact on their respective
organizations. Oversight does not have any information to the contrary. Therefore, Oversight
will reflect a zero impact in the fiscal note for these agencies.
Officials from the Department of Public Safety - Missouri Highway Patrol defer to the
Missouri Department of Transportation for the potential fiscal impact of this proposal.
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVENUECosts – DSS, MHD (§ 208.152) Actuarial costs p. 3($12,500)$0$0 Increased capitation rates p. 3$0 to
($231,140)
$0 to
($246,164)
$0 to
($262,165)
Total Costs - DSS, MHD($12,500 to
$243,640)
$0 to
($246,164)
$0 to
($262,165)
Costs - DCI (§ 376.1960) Blood
pressure monitoring devices p. 4
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
Costs - MDC (§ 376.1960) Blood
pressure monitoring devices p. 5
Up to
($250,000)
Up to
($250,000)
Up to
($250,000)
Costs – Oversight Division
(§ 376.1960) Actuarial analysis/impact
study p. 5
Could exceed
($50,000)$0$0
ESTIMATED NET EFFECT ON
GENERAL REVENUE
Could exceed
($62,500 to
$543,640)
$0 to Up to
($496,164)
$0 to Up to
($512,165) L.R. No. 1868H.01I
Bill No. HB 842
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FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028STATE ROAD FUND (#0320)Costs – MoDOT (§ 376.1960) –
increase in share of health care costs p.5(Unknown)(Unknown)(Unknown)
ESTIMATED NET EFFECT ON
THE STATE ROAD FUND(Unknown)(Unknown)(Unknown)
FEDERAL FUNDSIncome -
Reimbursement for actuarial costs and
increased capitation rates p. 3
$12,500 to
$431,360$0 to $446,086$0 to $475,081
Costs – DSS, MHD (§ 208.152) Actuarial costs p.($12,500)$0$0 Increased capitation rates p. 3$0 to
($418,860)
$0 to
($446,086)
$0 to
($475,081)
Total Costs - DSS, MHD($12,500 to
$431,360)
$0 to
($446,086)
$0 to
($475,081)
ESTIMATED NET EFFECT ON
FEDERAL FUNDS$0$0$0
FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028$0$0$0
FISCAL IMPACT – Small Business
Small business medical equipment providers may see increased sales or rentals of blood pressure
monitoring equipment. L.R. No. 1868H.01I
Bill No. HB 842
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FISCAL DESCRIPTION
This bill provides that MO HealthNet plans providing for maternity benefits must provide
coverage for a home blood pressure monitoring device and home blood pressure monitoring
device services, as defined in the bill, for pregnant and postpartum women. (§ 208.152)
Beginning January 1, 2026, all health benefit plans that provide maternity benefits are required to
provide coverage for these services. (§ 376.1960)
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Department of Commerce and Insurance
Department of Health and Senior Services
Department of Public Safety - Missouri Highway Patrol
Department of Social Services
Missouri Department of Conservation
Missouri Department of Transportation
Missouri Consolidated Health Care Plan
Oversight Division
Julie MorffJessica HarrisDirectorAssistant DirectorApril 20, 2025April 20, 2025