KRS § 205.5372 — KY Code / Title XVII / Chapter 205 / Section 205.5372
205.5372 Specific authorization from General Assembly required to exercise state's option to develop basic health program under federal law or make changes to eligibility, coverage, or benefits -- Fiscal impact assessment required -- Construction
Status: in_force

205.5372 Specific authorization from General Assembly required to exercise state's

option to develop basic health program under federal law or make changes to

eligibility, coverage, or benefits -- Fiscal impact assessment required --

Construction.

(1) Notwithstanding any provision of law to the contrary, including but not limited to

KRS 205.460 and 205.520, the cabinet shall not, unless required by federal law,

exercise the state's option to develop a basic health program as permitted under 42

U.S.C. sec. 18051 or make any change to eligibility, coverage, or benefits in the

Medicaid program, including by pursuing or applying for a waiver of federal

Medicaid law under Title 42 of the United States Code, seeking to amend or renew

an existing waiver granted under Title 42 of the United States Code, or pursuing a

state plan amendment, without first obtaining specific authorization from the

General Assembly to do so.

(2) If the cabinet seeks authorization from the General Assembly to establish a basic

health program, apply for a waiver under Title 42 of the United States Code, amend

an existing waiver granted under Title 42 of the United States Code, submit a state

plan amendment, or make any other change to eligibility, coverage, or benefits in

the Medicaid program, the cabinet shall submit a detailed assessment of the

potential fiscal impact of the change for which it is seeking authorization to the

Legislative Research Commission for referral to the Medicaid Oversight and

Advisory Board, the Interim Joint Committee on Appropriations and Revenue, the

Interim Joint Committee on Families and Children, the Interim Joint Committee on

Health Services, and the Office of Budget Review. The fiscal impact assessment

required by this subsection shall include a review of any anticipated expenditures

related to the change and any projected savings that may be generated by the

change for at least two (2) consecutive state fiscal years.

(3) If the cabinet seeks authorization from the General Assembly to renew an existing

waiver granted under Title 42 of the United States Code, the cabinet shall be

required to submit a fiscal impact assessment as described in subsection (2) of this

section and an assessment of the efficacy and necessity of the existing waiver. The

assessments required by this subsection shall be submitted to the Legislative

Research Commission for referral to the Interim Joint Committee on Appropriations

and Revenue, the Interim Joint Committee on Families and Children, the Interim

Joint Committee on Health Services, and the Office of Budget Review at least

twelve (12) calendar months prior to the date on which the existing waiver is set to

expire.

(4) (a) This section shall not be interpreted as limiting the General Assembly's ability

to direct the cabinet to make changes to the Medicaid program, including but

not limited to changes to existing waivers, eligibility, coverage, or benefits.

(b) Any act of the General Assembly directing the Cabinet for Health and Family

Services or the Department for Medicaid Services to make a change to the

Medicaid program shall constitute authorization for that change as required by

subsection (1) of this section.

(5) (a) This section shall not be interpreted as limiting the cabinet's ability to make

changes to the Medicaid program that it determines are necessary:

1. To comply with any requirements that may be imposed by federal law or

by the federal Centers for Medicare and Medicaid Services;

2. In response to a national emergency declaration issued by the President

of the United States;

3. In response to a federal disaster declaration issued by the President of

the United States; or

4. In response to a state of emergency declared by the Governor of the

Commonwealth.

(b) If the cabinet determines that a change to the Medicaid program is necessary

to comply with requirements imposed by federal law, the cabinet shall, at least

ninety (90) days prior to implementing the necessary changes, submit an

assessment of the potential fiscal impact, as described in subsection (2) of this

section, of those changes to the Legislative Research Commission for referral

to the Medicaid Oversight and Advisory Board, the Interim Joint Committee

on Appropriations and Revenue, the Interim Joint Committee on Families and

Children, the Interim Joint Committee on Health Services, and the Office of

Budget Review.

(c) If the cabinet determines that a change to the Medicaid program is necessary

to respond to a national emergency declaration or federal disaster declaration

issued by the President of the United States or a state of emergency declared

by the Governor of the Commonwealth, any such change shall be temporary

in nature and shall only be in effect for the duration of the emergency or

disaster declaration.

(6) Subsection (1) of this section shall not apply to:

(a) Medicaid directed or supplemental payment programs initially approved by

the federal Centers for Medicare and Medicaid Services prior to March 27,

2025, including but not limited to:

1. Those payment programs established in KRS 205.5601 to 205.5603,

205.6405 to 205.6408, 205.6411, and 205.6412, and 907 KAR 10:015

and 907 KAR 10:830; and

2. Any other payment program for a university hospital as defined in KRS

205.639; or

(b) The Medicaid preferred drug list established by the Department for Medicaid

Services as required under KRS 205.5514.

(7) As used in this section, the term "Medicaid program" includes the Kentucky

Medical Assistance Program established in KRS 205.510 to 205.5630 and the

Kentucky Children's Health Insurance Program established in KRS 205.6483.