House Committee on Social Services Budget 01/26/2026

State Hospital Recommendations and Budget Discussions

Overview of Committee Work

• The committee is reviewing recommendations for state hospitals, including Lawrence Ocelotomy Parsons, South Central, and K&I.

• The appropriations process is moving quickly; the committee anticipates a long week ahead with adjustments to meeting times.

Bill Introductions and Recommendations

• No new bill introductions were made; the focus shifts to recommendations for state hospitals.

• Chardae Kane from legislative research discusses actions taken by the special budget committee regarding Larned State Hospital's funding.

Budget Adjustments for Larned State Hospital

• The special committee removed $14,754 in SGF re-appropriation and two supplemental requests for fiscal year 2026 related to nursing staff and security programs.

• Representative Carpenter proposes reinstating $32 million in contract nursing funds for both years due to ongoing staffing challenges.

Discussion on Nursing Staffing Issues

• There is acknowledgment that simply cutting funding will not resolve the persistent issues surrounding contract labor in nursing.

• Representative Carpenter emphasizes that attracting nurses involves multiple factors, indicating a complex problem requiring comprehensive solutions.

Financial Implications of Nursing Contracts

• Representative Rivas questions the cost comparison between hiring state nurses versus using contract labor.

• Scott Brunner provides insights into financial implications: filling all vacant positions at Larned would cost approximately $31 million compared to current expenditures on contract nursing.

Current Budget Allocations and Future Considerations

• The total spent on staff at Larned was $57 million in 2025, with $26 million allocated specifically for contract nursing.

• Due to budgetary constraints, some full-time equivalent (FTE) positions were deleted as part of budget actions aimed at accurately reflecting salary allocations.

Budget Discussion on State Security Program

Overview of Budget Cuts

• A motion was made to eliminate certain positions, leading to a discussion about budget actions including a deletion of $1.1 million for the State Security Program and $14.74 million for reappropriated operating funds for the sexual predator treatment program.

Details on State Security Program Funding

• The deletion of $1.1 million from the State Security Program Competency Unit in FY26 raised concerns among members regarding its implications.

• The State Security Program provides mental health services to individuals referred by district courts, often resulting in longer stays due to their circumstances upon admission.

Concerns Regarding Mental Health Services

• There is concern that without adequate funding, individuals may not receive necessary treatment and could remain incarcerated longer than needed.

• Scott clarified that the missing $1.1 million was intended to reopen a 20-bed unit within the state security program, which had been closed due to staffing shortages.

Implications of Staffing Issues

• Reopening the 20-bed unit would allow for treating criminal defendants currently waiting in county jails, addressing both mental health needs and jail overcrowding issues.

• President Ballard highlighted that individuals can wait excessively long periods (100+ days) in jail without receiving treatment, raising ethical concerns about their care.

Financial Considerations and Reimbursements

• Representative Carpenter asked about the balance of funds used to reimburse counties housing these individuals; it was noted that there is an annual appropriation of $5 million primarily for hospitals observing patients awaiting state hospital admission.

• The reimbursement process involves validating requests from counties before transferring money directly from the general fund, indicating no remaining balance at any time.

Cost Analysis and Potential Savings

• It was reported that last fiscal year approximately $8 million was spent on housing these individuals while they awaited treatment, highlighting inefficiencies in current spending practices.

• Representative Carpenter suggested potential savings if beds were opened at Larnard instead of paying counties; estimates indicated serving up to 200 people annually through this approach could reduce costs significantly.

Budget Discussion for Larner and Osawatomie State Hospitals

Overview of Bed Capacity and Budget Implications

• Representative Revis inquires about the operational capacity of a 12-bed unit compared to the proposed 20 beds, suggesting a smaller budget might still meet needs.

• The current unit is designed for 20 sleeping rooms, with potential for double occupancy; however, reducing capacity would mean serving fewer individuals.

• A recommendation suggests that while 20 beds are optimal based on staffing models, a reduction to around 10 beds may be more feasible but less efficient.

• A placeholder recommendation of $1.1 million is made pending further information on savings from current daily costs.

Fiscal Year 2027 Budget Clarifications

• Discussion centers on the budget summary for FY 2027, specifically regarding funding for reopening a competency unit with an allocation of $4.6 million SGF for 30 beds.

• Clarification is provided that the secure unit has a capacity of 20 beds, while discussions also reference a larger configuration involving up to 60 total beds across units.

Motion Approvals and Further Discussions

• A motion passes to approve the amended fiscal year 2026 budget after brief discussion.

• Transitioning into FY 2027 discussions, emphasis is placed on understanding differences in Governor's recommendations versus committee requests.

Key Changes in Governor's Recommendations

• Major changes highlighted include contract nursing costs amounting to $32.2 million and funding requests not included in House Bill 2434.

• The absence of full-year funding for the SSP competency unit raises concerns about future evaluations and necessary judicial changes.

Recommendations for Contract Labor Funding

• Representative Carpenter proposes restoring $32 million in contract labor funds for Larner State Hospital’s FY 2027 budget; motion passes without opposition.

• For Osawatomie State Hospital's FY 2026 budget, there’s an emphasis on restoring $7 million allocated towards agency nursing staff as part of the governor's recommendation.

Finalizing Budgets for Osawatomie State Hospital

• Discussion continues regarding additional staffing needs including therapists and physicians within the context of contract nursing budgets.

• A motion is made to restore $5 million in contract nursing funds specifically designated for Osawatomie State Hospital’s FY 2027 budget; this motion also passes unanimously.

Budget Discussion for Parsons State Hospital

Overview of Budget Requests

• The agency is requesting a total of $43.9 million, which includes $25 million SGF and 505.2 FTE positions. A reappropriation of $39,700 SGF was deleted in House Bill 2434.

Differences from Governor's Recommendations

• The only difference noted from the governor's budget recommendation is the deletion of the reappropriation amount.

Fiscal Year 2026 Budget Approval

• Representative Ballard raised questions regarding the source of the reappropriated funds, specifically if they were from a specific program or general operational expenses.

• It was clarified that the funds were unspent funding that had been swept up and reappropriated, indicating it wasn't needed at that time.

• A motion to accept the budget recommendations for fiscal year 2026 for Parsons State Hospital was made and seconded; it passed without opposition.

Fiscal Year 2027 Budget Discussion

• For fiscal year 2027, there are no adjustments from the agency’s revised request, making it straightforward to approve.

• The agency requests $45.9 million, including $43.9 million SGF and 400.5 FTE positions; however, enhancement requests totaling $30.9 million were removed due to a global motion.

Funding Concerns Raised

• Representative Carpenter expressed concerns about adequately funding a new hospital project and proposed restoring previously cut funding.

• Representative King questioned whether transfers between agencies would be dollar-for-dollar, seeking clarification on how funds would be allocated.

Clarifications on Fund Transfers

• It was confirmed that $15 million appropriated to KDADS will transfer directly to South Central Regional Hospital starting July 1, 2026; this is considered new funding included in the governor's budget recommendation.

Motion for Budget Recommendation

• A motion was made by Representative King to recommend the South Central Regional Mental Health Hospital budget as presented; this included an amendment to restore previously cut funding.

Final Approvals and Additional Requests

• There was discussion about needing motions to approve budgets for both fiscal years 26 and 27; Representative Rivas moved to approve FY27 with revisions including a supplemental work request for certified medication aid positions totaling $1.2 million SGF, which had been deleted from previous discussions.

Funding for Certified Medication Aids and Cooks

Discussion on CMA Positions

• The hiring of Certified Medication Aids (CMAs) is proposed to alleviate stress on current LPNs and RNs, potentially saving the state approximately $22,000 per year for each CMA hired.

• A motion was made to allocate $1.2 million from the State General Fund (SGF) to fund CMA positions for FY 2026, which received unanimous support.

Overview of Agency Requests

• For FY 2027, the agency's request totals $44.8 million, including $20.9 million SGF; this includes enhancement requests for CMAs and cooks.

• Last year's budget did not fund either CMAs or cooks, indicating a recurring issue in staffing needs.

Importance of Cook Positions

• There is a pressing need for trained cooks due to dietary requirements of residents; CNAs currently perform cooking duties alongside their primary responsibilities.

• The proposal includes hiring one cook manager, one cook supervisor, and 19 senior cooks across various living units to ensure proper meal preparation.

Dietary Considerations in Care

• Representative Steens emphasized the complexity of dietary needs among seniors, highlighting that specific diets require specialized knowledge beyond basic cooking skills.

• Different food textures (e.g., pureed or mechanical soft foods) are crucial for preventing aspiration risks during feeding.

Concerns Over Staffing Proposals

• Dr. Zemking expressed skepticism about adding 20 new cook positions but supported the CMA initiative due to its necessity.

• Representative Carpenter raised concerns about budget constraints and questioned the need for such a large number of new positions without clear justification from previous years' budgets.

Discussion on Hospital-Based Services and Staffing

Overview of Current Facilities and Staffing Needs

• The speaker highlights existing hospital-based services in the town, emphasizing the presence of dietary personnel and catering services. They suggest a reevaluation of service delivery models to reduce costs without significantly increasing staff.

• A question is raised regarding whether new positions will replace existing staff or simply add to the workforce, indicating concerns about staffing efficiency.

Concerns About Staffing Levels

• It is clarified that there will be no reduction in current positions; any new roles are purely additive.

• Discussion revolves around the need for specialized roles to improve service delivery, as current staff manage multiple responsibilities without dedicated support.

Future Planning for Staff Adjustments

• A proposal is made to develop a plan for reducing full-time equivalent (FTE) positions over time rather than making drastic cuts immediately. This approach aims for a more sustainable transition.

Budget Recommendations and Approvals

• The committee discusses budget recommendations, with Representative King proposing an addition of approximately $1.2 million for Certified Medication Aides (CMAs).

• Another recommendation is made to pass the amended K and I budget for fiscal years 2026 and 2027, indicating progress in budget discussions.

Overview of Department of Health and Environment's Budget

Introduction to Budget Review Process

• Amanda provides an overview of the Department of Health and Environment's budget, promising a quick review due to time constraints.

Key Components of Healthcare Finance

• The discussion includes healthcare finance oversight related to state Medicaid and CHIP programs, highlighting their importance in public health funding.

Budget Snapshot Analysis

• A snapshot reveals KDHE's approved budget exceeding $4 billion with significant allocations tied to state aid and caseload management.

Reappropriations Explained

• Details are provided on reappropriated funds from unspent amounts in previous fiscal years, which must be allocated according to legal requirements.

This structured summary captures key discussions from the transcript while providing timestamps for easy reference.

D-CAS Storage Charges and Agency Requests

Overview of D-CAS Storage Charges

• The agency is requesting an additional million SGF to cover unexpected charges from OITS related to cloud server hosting.

• OITS recently rebid the statewide cloud server contract, revealing costs that emerged post-session.

• Current data storage costs are 25 cents per gigabyte per month, with the agency holding approximately 419,000 gigabytes of data.

Supplemental Requests for Office of Vital Statistics

• The agency's request includes funding to assist the Office of Vital Statistics in their relocation due to shuffling involving Kansas Highway Patrol moving into the Curtis building.

• This request addresses moving costs and ongoing rent increases anticipated in the next fiscal year.

Changes in Agency's Request

• Items six through nine detail changes primarily funded by special revenue federal funds, including a transfer of two million from general public health operating expenditures to women's wellness accounts.

Enhancement Requests for Fiscal Year 27

Funding for OITS and Disease Intervention Specialists

• The agency seeks a million SGF for salaries of 15 staff members in the Disease Intervention Specialist Program, crucial for managing infectious disease reporting and partner tracing.

• Anticipated increased costs are expected as they renegotiate their EQRO contract with KFMC, which ends in June; four million is requested for this purpose.

Gainwell Technology Vendor Funding

• Funding is also requested for Gainwell, responsible for implementing CMS final rule 0056F regarding electronic transaction standards within Medicaid systems. This involves updating communication formats between states and pharmacies.

• Additional requests include funding for lab scientists at Cahill and further support related to vital statistics relocation efforts.

CMS Final Rule Implications

Interoperability Requirements

• A separate CMS final rule mandates Medicaid managed care plans respond electronically on prior authorizations and share data securely via APIs; approximately 3.4 million SGF is requested to implement these system changes.

Community Access Registry Funding

• The agency requests $17,000 to maintain access to a registry that collects data on out-of-hospital cardiac arrests aimed at improving survival rates across participating counties in Kansas.

CHIP Caseload Increases and Rural Health Transformation Program

CHIP Funding Request

• A significant ask of $26 million is made to address caseload increases under CHIP following new CMS guidance eliminating lockout periods; further details will be provided by the agency later on this matter.

Rural Health Transformation Program Update

• Recent pages discuss outdated information about rural health transformation funding received from federal sources; initial funding was reported at $221 million during year one but lacks current relevance as it has not been updated since then.

Governor's Recommendations Overview

Three Column Document Analysis

• A new document outlines comparisons between agency requests, special committee recommendations, and Governor’s recommendations side-by-side for clarity on budgetary decisions made last week on the Senate side.

Budget Discussion on Behavioral Health and Funding Adjustments

Overview of Key Budget Items

• The discussion begins with a comparison of various budget items, highlighting significant differences in funding amounts. For instance, the DECAST storage charge is noted as being lower than previously recommended by the governor.

Behavioral Health Funding

• A notable item on the list is the adult inpatient behavioral health sciences enhancement request, which includes an additional $5 million for hospitals maintaining open inpatient behavioral health beds. This funding has been included in previous budgets.

• In the current budget proposal, the governor allocated $5 million for this purpose, down from $10 million in the prior year. It is emphasized that this funding is intended to be temporary and should cease once a new hospital opens.

Changes to Early Childhood Programs

• The Kansas Office of Early Childhood Transition will see a deletion of funds due to the establishment of a new agency focused on early childhood services.

• Specific programs affected include infant and toddlers initiatives, SIDS Network Grant, and Smoking Prevention Grants. These programs are transitioning away from reliance on Children's Initiative Fund (CIF).

Funding Source Adjustments

• The governor's bill proposes replacing CIF funding with state general funds (SGF) for certain programs like infant and toddlers initiatives and SIDS Network Grant due to their unsustainable nature under CIF.

• The smoking prevention grant will now be funded directly from the key fund instead of CIF, indicating a shift in how these programs are financed.

Legislative Clarifications

• During discussions, Representative Wilcott seeks clarification regarding where current funding for Infant and Toddlers Program and SIDS Network Grant originates. It’s confirmed they were previously funded through CIF dollars.

• Concerns arise about sustainability; as expenditures continue without adjustments, there could be negative balances in future years if these programs remain under CIF.

Financial Implications

• There’s recognition that if legislators wish to maintain support for these programs, they must transition them to SGF due to ongoing financial constraints within CIF.

• Questions arise regarding zero allocations for smoking prevention grants; it’s clarified that while currently funded through CIF, future requests will seek direct funding from key fund sources instead.

Overall Budget Dynamics

• Acknowledgment that while Governor proposed $15 million out of requested $26 million for CHIP (Children's Health Insurance Program), other adjustments reflect reductions totaling $29 million across various categories including federal funds.

• Discussions highlight potential trade-offs between different budget items as representatives question how smaller special revenue funds might impact overall budgeting strategies moving forward.

Key Fund Status Inquiry

• Representatives inquire about current status of key fund balances; it’s indicated there may be around a $10 million deficit this year affecting program viability linked to tobacco settlement money.

• Ongoing concerns are raised about diminishing returns from tobacco funds over time as committee members seek clarity on future revenue expectations related to these sources.

Budget Consideration Requests from KDHE

Overview of Reappropriations

• Secretary Janet Stanek introduces the budget consideration requests, highlighting the importance of reappropriations and asking for committee support.

• The special enhanced FMAP request of $11,786 is linked to ARPA funds that need to be spent by the end of 2027; this funding is currently in process.

• Discussion on the public health early childhood data management system indicates delays in implementation; stopping now would render it ineffective.

• The breast cancer screening program relies on federal funds first to avoid waiting lists, emphasizing variability in patient numbers year-to-year.

• A child abuse review program requires more training for physicians due to fewer children being seen, necessitating investment in training rather than system costs.

Specific Program Funding Needs

• PKU treatment funding is crucial for diagnosed children needing medications and nutritional products; these funds are highly restricted.

• The tobacco cessation program remains a priority despite federal restrictions on some redirected funds; it aims to continue supporting public health initiatives.

• CHIP (Children's Health Insurance Program) has a small funding request aimed at continuing care for enrolled patients, with further enhancements planned for 2027.

• Pregnancy maintenance initiative ensures safe care throughout pregnancy; aid to local units involves direct financial support for partners involved in healthcare delivery.

• State trauma fund money has already been expended and needs budgeting adjustments to carry forward into future planning.

Clarifications and Questions

• A question arises regarding whether some requested funds have already been spent; clarification about bolded items indicating those already utilized is provided.

• Non-bolded items may be funded differently if not approved as part of this request, indicating prioritization based on discussions with committee leadership.

• Further clarification confirms that bolded items total approximately $17 million while the entire table amounts to $19 million overall.

• There’s an emphasis on prioritizing requests based on necessity and previous discussions with committee members regarding funding allocation strategies.

• Representative Steens questions if vaping initiatives are included under tobacco cessation programs, confirming that they are indeed covered.

Enhancements Discussion

• Secretary Stanek transitions into discussing enhancements starting with CHIP, noting an increase in services needed due to higher-than-predicted demand among children.

Funding Requests and Program Updates in Health Services

Overview of Funding Requests

• The request includes $15 million for the CHIP program, which has a total budget of $86 million SGF and approximately $260 million across all funds.

Specific Budget Allocations

• A request for $500,000 SGF is made to meet OITS storage needs for data centers, highlighting the significant amount of data managed by KDHE.

• Compliance with CMS regulations is critical; failure to comply could result in losing Medicaid funding. This includes necessary system modifications.

Office Relocation and Associated Costs

• The Office of Vital Statistics must relocate due to space being taken over by the Highway Patrol, with a relocation cost estimated at $810,817.

Medicaid Program Changes

• An additional request involves compliance with the interoperability final rule affecting Medicaid data management, necessitating system changes and costing $300,000 SGF related to maternal health initiatives.

Maternal Health Initiatives

• The MAFIS grant supports efforts against intimate partner violence. This funding is crucial as it strengthens care coordination for affected patients.

Behavioral Health Funding Continuation

• A continuation of previous funding requests includes $5 million allocated for behavioral health beds across seven hospitals based on their bed count.

Enrollment Trends in CHIP Program

• Representative King questions about enrollment increases in the CHIP program. The Deputy Secretary notes an unexpected increase of about 10,000 children, raising costs significantly.

Impact of CMS Regulations on Enrollment

• New CMS rules prevent disenrollment due to nonpayment of premiums, leading to increased financial responsibility for covering all months regardless of payment status.

Current Enrollment Figures

• Current enrollment figures indicate that around 57,000 children are served, with an expected increase adding up to approximately 150,000 covered kits at a cost of $15 million.

Relocation Details

• About 80 FTEs (Full-Time Equivalents) will be involved in the relocation process coordinated by the Department of Administration.

Behavioral Health Service Structure

• Patients voluntarily opt into behavioral health services at participating hospitals; there are no involuntary programs reported within these facilities.

Funding for Behavioral Health Services

Voluntary Hospital Services and Early Intervention

• The discussion highlights the potential benefits of funding voluntary hospital services to encourage clients and citizens to seek help before reaching a crisis point. This proactive approach aims to provide support earlier in the process, reducing future overwhelm.

Challenges with State Hospital Capacity

• There is an acknowledgment of the limitations faced by state hospitals in accommodating patients, leading to financial burdens as they pay private hospitals for care. The need for larger state facilities is emphasized but remains unaddressed.

CHIP Funding Adjustments

• A question arises regarding the requested funding for the Children's Health Insurance Program (CHIP), initially set at $26 million but later adjusted to $15 million due to budget constraints. The necessity of adequate funding is stressed, as resources must be redirected accordingly.

Impact of Funding Shortages on Coverage

• If funding runs out, there could be drastic consequences such as ending the CHIP program, which is not an entitlement like Medicaid. This situation would require careful management and notification processes if it were to occur.

Sliding Scale and Eligibility Criteria

• The CHIP program operates on a sliding scale based on family income, allowing families earning up to approximately $90,000 with five children to qualify for assistance. This structure aims to ensure that children's health needs are met effectively within available resources.

Behavioral Health Funding Concerns

Inpatient Behavioral Health Funding Clarification

• Questions arise about a specific $5 million allocation intended for inpatient behavioral health services at hospitals, aimed at supporting individuals awaiting placement in state facilities while receiving necessary care in psychiatric units.

Legislative Changes Affecting CHIP Enrollment

• Recent legislative changes have removed states' ability to cap enrollment in CHIP during budget shortfalls, limiting options for managing costs and increasing risks associated with maintaining program sustainability without sufficient funds.

Financial Risks Associated with Program Closure

• Closing the CHIP program could affect around 57,000 children if funding issues persist; this scenario underscores the importance of securing adequate financial resources ahead of time to avoid catastrophic outcomes for vulnerable populations.

Agency Relocation Challenges

Uncertainty Surrounding Agency Moves

• Discussion includes concerns about agency relocations due to budget cuts affecting various departments; specifics about new locations remain unclear as planning continues amidst operational challenges related to public accessibility requirements similar to those faced by DMV offices.

This structured summary captures key discussions from the transcript while providing timestamps linked directly back to their respective points in the video for easy reference and further exploration.