PREPARED BY: Mikayla Findlay
LB 22 DATE PREPARED: March 11, 2025
PHONE: 402-471-0062
Revision: 03
Revised to include provisions in AM 258 and AM 348 FISCAL NOTE
LEGISLATIVE FISCAL ANALYST ESTIMATE
ESTIMATE OF FISCAL IMPACT – STATE AGENCIES (See narrative for political subdivision estimates)
FY 2025-26 FY 2026-27
EXPENDITURES REVENUE EXPENDITURES REVENUE
GENERAL FUNDS
CASH FUNDS $347,143 $705,755
FEDERAL FUNDS $728,457 $1,445,445
OTHER FUNDS
TOTAL FUNDS $1,075,600 $2,151,200
Any Fiscal Notes received from state agencies and political subdivisions are attached following the Legislative Fiscal Analyst Estimate.
As amended, this bill establishes the Family Home Visitation Act and requires the Department of Health and Human Services (DHHS)
to submit a State Plan Amendment (SPA) for the Medicaid program by October 1, 2025 to implement targeted case mana gement
(TCM) for evidence-based nurse home visiting serv ices for families who have children younger than six months of age who are enrolled
in Medicaid. The Act requires an annual report on home visiting starting in 2026 through 2028. The bill states legislative intent to fund
new Medicaid home-visit ing services with cash funds from the Medicaid Managed Care Excess Profit Fund and not General Funds.
Due to availability of Federal Medical Assistance Percentage (FMAP) for Medicaid, it is assumed that the cash f unds would make up
the state’s matching requirement and not be the exclusive fund source of this initiative. Note that revenue to the Medicaid Managed
Care Excess Profit Fund is not guaranteed and lack of funding may result in failure to execute the provis ions of the program.
DHHS notes that current Medicaid regulations do not define evidence-based nurse home visiting. In seeking a SPA approval from
CMS, the Centers for Medicare & Medicaid Services, the definitions would be explicated for TCM for a specific patient population which
may be considered similar to populations that are exempt from coverage. This may extend the approval process. DHHS assumes
implementation by January 1, 2026 noting the possibility of later implementation depending on approval.
DHHS indicates that in FY24 there were approx. 86,048 member months for individual children under the age of six months. The
agency uses a utilization assumption of 25% and assumed monthly rate of $100 to calculate a total aid cost of $2,151,200. Assuming
implementation of January 1, 2026, the aid cost in FY26 would represent half a fiscal year. This fiscal note assu mes a blended FMAP of
67.23% for FY26 and 66.69% for SFY27. This blended FMAP assumes half of Medicaid home visiting will be for clients who are
covered at the proxy FMAP (56.15% in SFY26 and 5 5.36% in SFY27), a quarter CHIP (68.6% in SFY26 and 68.05% in SFY27), and a
quarter Medicaid Expansion (90%). Only services billed to the parent would qualify for the Ex pansion federal participation as infants
only qualify for either regular Medicaid or CHIP. Actual aid expenditures depend on utilization of the program.
DHHS indicates potential administrative expenses upwards of $103,000 annually for a program manager depending on which division
the program will fall within the Department. Should the provi sions of this bill warrant additional personnel the agenc y may request
additional admin funds via the budget process.