Summary:

 House Bill 55  (HB 55) relates to labor by requiring the Health Care Authority to set a minimum Medicaid fee schedule for reimbursement for personal services and requiring at least seventy percent of Medicaid reimbursement for personal care services to be used for compensating direct care workers. Also, HB 55 makes an appropriation.  

Legislation Overview:

 House Bill 55  (HB55) A new section of the Personal Assistance Act is provided to state that the authority shall implement a minimum Medicaid fee schedule for personal care services that requires managed care organizations and fee-for-service arrangements to reimburse personal care services providers at least twenty-three dollars fifty cents ($23.50) per hour for providing personal care services.   
A personal care services provider agency that receives Medicaid reimbursement for providing personal care services shall use at least seventy percent of the Medicaid reimbursement as compensation to direct care workers for furnishing their services.  
Before calculating the minimum amount of Medicaid reimbursement that a personal care services provider agency is required to use to compensate direct care workers, the costs of providing training, travel and personal protective equipment to direct care workers shall be deducted from the total amount of medicaid reimbursement that the personal care services provider agency receives.
The sum of twenty million eight hundred thousand dollars ($20,800,000) is appropriated from the general fund to the health care authority for expenditure in fiscal year 2026 to update the Medicaid personal care services fee schedule and increase Medicaid reimbursement for personal care services.  Any unexpended or unencumbered balance remaining at the end of fiscal year 2026 shall revert to the general fund.
Certain definitions are provided to mean: personal care services which means services provided to an individual to assist with activities of daily living; and personal care services provider agency, which means an entity that: (a)  has entered into a Medicaid provider participation agreement with the Medical Assistance Division of the Authority and:  1) is contracted with a managed care organization to provide personal care services to Medicaid recipients; or 2) provides personal care services to Medicaid recipients through fee-for-service arrangements.



Analysis: A new section of the Personal Assistance Act is provided to state that the authority shall implement a minimum Medicaid fee schedule for personal care services that requires managed care organizations and fee-for-service arrangements to reimburse personal care services providers at least twenty-three dollars fifty cents ($23.50) per hour for providing personal care services.   
A personal care services provider agency that receives Medicaid reimbursement for providing personal care services shall use at least seventy percent of the Medicaid reimbursement as compensation to direct care workers for furnishing their services.  
Before calculating the minimum amount of Medicaid reimbursement that a personal care services provider agency is required to use to compensate direct care workers, the costs of providing training, travel and personal protective equipment to direct care workers shall be deducted from the total amount of medicaid reimbursement that the personal care services provider agency receives.
The sum of twenty million eight hundred thousand dollars ($20,800,000) is appropriated from the general fund to the health care authority for expenditure in fiscal year 2026 to update the Medicaid personal care services fee schedule and increase Medicaid reimbursement for personal care services.  Any unexpended or unencumbered balance remaining at the end of fiscal year 2026 shall revert to the general fund.
Certain definitions are provided to mean: personal care services which means services provided to an individual to assist with activities of daily living; and personal care services provider agency, which means an entity that: (a)  has entered into a Medicaid provider participation agreement with the Medical Assistance Division of the Authority and:  1) is contracted with a managed care organization to provide personal care services to Medicaid recipients; or 2) provides personal care services to Medicaid recipients through fee-for-service arrangements.