Connecticut SB 499: AN ACT CONCERNING MEDICAID RATE INCREASES.

Bill Text

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General Assembly Substitute Bill No. 499
February Session, 2026

AN ACT CONCERNING MEDICAID RATE INCREASES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. (NEW) (Effective July 1, 2026) (a) As used in this section, (1) 1
"Medicaid rate study" means the study commissioned by the 2
Department of Social Services pursuant to section 1 of public act 23-186, 3
(2) "five-state rate benchmark" means the average of rates for the same 4
health care services in Maine, Massachusetts, New Jersey, New York 5
and Oregon, and (3) "Medicare Economic Index" means a measure of 6
inflation for physicians with respect to their practice costs and wage 7
levels as calculated by the Centers for Medicare and Medicaid Services. 8
(b) Within available appropriations, the Commissioner of Social 9
Services shall phase in increases to Medicaid provider rates in 10
accordance with the Medicaid rate study. The commissioner shall phase 11
in the rate increases commencing on July 1, 2026, such that by June 30, 12
2029, all such rates equal (1) not less than seventy-five per cent of the 13
most recent Medicare rates for the same health care services, or (2) for 14
such services with no corresponding Medicare rates, a percentage of the 15
five-state rate benchmark that results in an equivalent rate increase. 16
(c) On and after June 30, 2029, the commissioner shall adjust such 17
rates every year (1) to not less than seventy-five per cent of the most 18
recent Medicare rates for the same health care services, (2) to an 19
equivalent percentage of the five-state rate benchmark for such services 20

Substitute Bill No. 499

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with no corresponding Medicare rates, or (3) by increasing such rates by 21
any percentage increase in the Medicare Economic Index. 22
(d) Any review or rebasing of Medicaid rates shall include those rates 23
(1) required to be studied pursuant to the Medicaid rate study; and (2) 24
with no corresponding (A) Medicare rate for the same health care 25
service, or (B) average five-state rate benchmark rate included in the 26
Medicaid rate study. If any one state within the five-state rate 27
benchmark group has a corresponding rate for the same or substantially 28
similar health care service, such rate shall be used for comparison in 29
such review. 30
(e) The commissioner shall streamline and consolidate existing fee 31
schedules used for provider or service reimbursement so that every 32
provider is reimbursed using the same fee schedule. In streamlining and 33
consolidating existing fee schedules, the commissioner shall 34
incorporate, to the extent applicable, the most recent Medicare fee 35
schedule for services covered by Medicare as well as Medicaid. 36
Sec. 2. (NEW) (Effective July 1, 2026) (a) The Council on Medical 37
Assistance Program Oversight, established pursuant to section 17b-28 38
of the general statutes, shall develop and implement an ongoing 39
systemic review of Medicaid provider reimbursement rates to ensure 40
rates are adequate to sustain a sufficient provider pool to provide 41
Medicaid member access to high-quality care. 42
(b) Not later than January 15, 2027, and annually thereafter, the 43
council shall file a report, in accordance with the provisions of section 44
11-4a of the general statutes, with the joint standing committees of the 45
General Assembly having cognizance of matters relating to 46
appropriations and the budgets of state agencies and human services. 47
The report shall include the council's recommendations on necessary 48
appropriations to ensure Medicaid providers are compensated for 49
health care services in accordance with section 1 of this act. 50

Substitute Bill No. 499

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This act shall take effect as follows and shall amend the following
sections:

Section 1 July 1, 2026 New section
Sec. 2 July 1, 2026 New section

Statement of Legislative Commissioners:
In Section 1(b) and (d), "five-state benchmark" or "benchmark" was
changed to "five-state rate benchmark" and "public act 23-186" was
changed to "the Medicaid rate study" for consistency with the defined
term.

HS Joint Favorable Subst. -LCO