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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72" style='word-wrap:break-word'><div class=WordSection1><div><div style='border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b>Good Morning:<o:p></o:p></b></p><p class=MsoNormal><b><o:p> </o:p></b></p><p class=MsoNormal><b>Please see Justin Jeter\u2019s report below.<o:p></o:p></b></p><p class=MsoNormal><b><o:p> </o:p></b></p><p class=MsoNormal><b>Respectfully,<o:p></o:p></b></p><p class=MsoNormal><b><o:p> </o:p></b></p><p class=MsoNormal><b>Todd<o:p></o:p></b></p><p class=MsoNormal><b>From:</b> Jeter, Justin (DD Council) <justin.jeter@ky.gov> <br><b>Sent:</b> Thursday, June 26, 2025 9:57 AM<br><b>Subject:</b> Senate Health Provisions Thrown Out<o:p></o:p></p></div></div><p class=MsoNormal><o:p> </o:p></p><p>This morning,<o:p></o:p></p><p>The following Healthcare-provisions were thrown out of the Senate budget based on the Byrd Rule<o:p></o:p></p><p><b><u>High Kentucky Impact<o:p></o:p></u></b></p><p><strong><span style='font-family:"Calibri",sans-serif'>Provider Taxes</span></strong>. (Section 71120)<o:p></o:p></p><ul type=disc><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3'><b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Why this is impactful: </span></b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif;background:yellow;mso-highlight:yellow'>Removing this section helps KY retain ~$3.3 billion in funds for Medicaid</span><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'><o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3'><b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>How: </span></b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Kentucky taxes certain providers to help pay for our portion of Medicaid match. We tax 4 categories above 3.5% (the proposed limit)<o:p></o:p></span></li><ul type=circle><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level2 lfo3'><b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Ambulances & Hospitals (through additional, separate programs), </span></b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Nursing Facilities, ICF-IDD (quasi-institutional settings), and the <b><i>Supports for Community Living </i></b>waiver providers<o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level2 lfo3'><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>The language would have \u2018grandfathered\u2019 in provider taxes on nursing facilities and ICF-IDD, but would impact <b><u>SCL, Hospitals, Ambulances. </u></b>See chart below.<o:p></o:p></span></li><ul type=square><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level3 lfo3'><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Total Funding Loss to KY <b><u>Without Hospitals: </u></b><span style='background:yellow;mso-highlight:yellow'>,<b>***$136 million</b></span><o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level3 lfo3'><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Total Funding Loss to KY <b><u>With Hospitals : </u></b><span style='background:yellow;mso-highlight:yellow'>,<b>***$3.3 billion</b></span><o:p></o:p></span></li></ul><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level2 lfo3'><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'><img width=634 height=224 style='width:6.6041in;height:2.3333in' id="Picture_x0020_1" src="cid:image001.png@01DBE680.9F989160"></span><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'><o:p></o:p></span></li></ul></ul><p><strong><span style='font-family:"Calibri",sans-serif'>Spread pricing in Medicaid.</span></strong> (Section 71116)<o:p></o:p></p><ul type=disc><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l1 level1 lfo3'><b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Why this is impactful: </span></b><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Unfortunately, this section would have been helpful to rural pharmacies, especially retail pharmacies \u2013 it also would have reduced fraudulent billing practices<o:p></o:p></span></li></ul><p><b><u>Non-Citizen Eligibility<o:p></o:p></u></b></p><ul type=disc><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo7'><strong><span style='font-size:12.0pt;font-family:"Calibri",sans-serif'>Limiting Medicare coverage of certain individuals.</span></strong><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'> (Section 71201)<o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo7'><strong><span style='font-size:12.0pt;font-family:"Calibri",sans-serif'>Immigrant Medicaid Eligibility.</span></strong><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'> Section 71110)<o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo7'><strong><span style='font-size:12.0pt;font-family:"Calibri",sans-serif'>Permitting premium tax credits only for certain individuals.</span></strong><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'> (Section 71301)<o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo7'><strong><span style='font-size:12.0pt;font-family:"Calibri",sans-serif'>Prohibiting federal financial participation under Medicaid and CHIP for individuals without verified citizenship, nationality or satisfactory immigration status.</span></strong><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'> (Section 71109)<o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo7'><strong><span style='font-size:12.0pt;font-family:"Calibri",sans-serif'>Disallowing premium tax credit during periods of Medicaid ineligibility due to immigrant status.</span></strong><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'> (Section 71302)<o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo7'><strong><span style='font-size:12.0pt;font-family:"Calibri",sans-serif'>Prohibiting Federal Medicaid and Children's Health Insurance Program (CHIP) Funding for Gender Affirming Care.</span></strong><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'> (Section 71117)<o:p></o:p></span></li><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo7'><strong><span style='font-size:12.0pt;font-family:"Calibri",sans-serif'>Expansion of FMAP for certain states providing payments for health care furnished to certain individuals.</span></strong><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'> (Section 71111)<o:p></o:p></span></li><ul type=circle><li class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level2 lfo7'><span style='font-size:12.0pt;font-family:"Aptos",sans-serif'>Lowers FMAP from 90% -> 80% for states providing Medicaid to noncitizens<o:p></o:p></span></li></ul></ul><p class=MsoNormal><o:p> </o:p></p></div></body></html>