Healthcare (Medicaid)

This bill requires health insurers to review coverage requests for medically fragile children differently, considering their unique medical needs rather than using standard adult guidelines. It mandates case-by-case decisions for services like skilled nursing, therapy, and home health care to help these children reach age-appropriate functional capacity. Insurers must pay for inpatient hospital or residential care days when specialized home services aren't available or when waiting for a residential facility bed. The law directly affects children with complex medical conditions requiring 24/7 care, their families, and health insurers managing Medicaid or private plans.

Senate Bill 2113 allows Medicaid accountable care organizations (ACOs) comprised of private physician practices to purchase group health insurance for their members and employees. The bill amends insurance law to create a new category for these specific ACO policies, requiring the organizations to be established for purposes other than just obtaining insurance and to have been active for at least two years. These policies must cover a minimum of 100 individuals at the time of issue and can be funded by the ACO, members, or both. It also exempts qualifying ACO policies from certain small group rating rules, enabling them to access experience-rated health insurance.

Requires Medicaid to cover gender-affirming care regardless of federal funding; prohibits discriminatory practices by health care entities including hospitals, certain professionals, and insurers; requires insurance coverage for services or treatments for gender dysphoria or gender incongruence.