Bill > SB371

This bill establishes the "KanCare bridge to a healthy Kansas" program, administered by the Department of Health and Environment, to promote health coverage for eligible individuals in medically underserved rural areas of Kansas as an alternative to existing federal healthcare programs like Medicaid (Title XIX of the federal Social Security Act). The program's continuation is contingent on receiving specific federal medical assistance percentages, and it will terminate if these percentages fall below certain levels. The health plan will cover a comprehensive range of services including mental health, hospital care, prescription drugs (including certain addiction treatments), emergency services, physician visits, diagnostic services, outpatient and therapy services, disease management, home health, urgent care, preventive care, family planning (excluding abortion), hospice, and substance abuse services, with the option to include dental and vision coverage for which participants may pay a portion of the premium, capped at 5% of their household income. Preventive services are generally covered at no cost, with some exceptions subject to a $500 cap. Program funds must allocate at least 85% to healthcare services, with the remainder for administrative costs and insurer profits. Eligibility requires individuals to be between 18 and 65 years old, a Kansas resident for at least 12 months, uninsured for 90 days, and have a household income not exceeding 133% of the federal poverty level, excluding those already on Medicare or eligible for other medical assistance. Participants will have a health care account funded by themselves, employers, the state, or non-profits, which is used to pay deductibles, and monthly contributions are required, generally 2% of household income or $1, but not less than $1. Unemployed or part-time working adults are referred to workforce training programs, with exemptions for full-time students and parents with minor children. Participation is for 12-month periods, with renewal requirements and provisions for unused funds in health care accounts. A $25 co-pay for non-emergency emergency room visits is required, waived if a nurse hotline is contacted beforehand. The bill also allows for a premium assistance program for those who cannot afford employer-sponsored insurance or have incomes up to 133% of the federal poverty level, requiring similar eligibility criteria and a health care account component. The program's implementation is subject to federal approval, and the Secretary of Health and Environment can make necessary changes based on federal requirements. The bill defines a "phase out period" related to federal program changes and establishes various funds for program fees, drug rebates, and privilege fees, with reporting requirements to the legislature on expenditures, revenues, and cost savings, including a working group to identify non-state funding sources for any shortfalls.