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Congress Advancing Budget Reconciliation Bill with Cuts to Medicaid and SNAP

This week, the House plans to vote on the Budget Reconciliation Bill - a.k.a. “Big Beautiful Bill”. At 1:00 a.m. tonight, the House Rules Committee will take up the latest version, make some adjustments, and then advance it for consideration by the full House. 

Please take a moment to contact your congressional representatives in Washington D.C. to oppose the bill’s $715 billion cuts to Medicaid, $290 billion cuts to SNAP (food benefits) and increasing the numbers of uninsured Americans by 8.7 million by removing people from Medicaid and Affordable Care Act coverage. It is also a great concern the bill pushes additional costs and administrative burdens to the states without adding federal funds to cover those new duties. Work requirements are being spread across Medicaid, TANF, SNAP, and even ACA insurance and experience indicates that whether or not people are able to meet the work requirements, the administrative reporting requirements will likely push people off of their coverage when they fail to meet all of those requirements. All of these concerns add up to more barriers to care for people who live with mental health and substance use issues.

Scroll down for more details about the legislation.

Use the NAMI advocacy link to express your opposition to these Medicaid changes:

More Information about the Medicaid Provisions in the Budget Reconciliation Bill 

It took 27 hours last week for the House Energy and Commerce Committee to “mark up” their version of the budget reconciliation proposal that includes Medicaid changes projected to reduce the deficit by $715 billion over ten years and increase the number of people without health insurance by 8.7 million. They worked through the night, and advanced their portion of the reconciliation bill May 14.

In the weeks leading up to the emergence of the House Medicaid cuts proposal on May 12 – the first time the selected cuts were revealed to the public -  leaders changed the outline of the targeted reductions multiple times. An original concept to focus mostly on Medicaid expansion states and populations was modified significantly. A proposal for per capita Medicaid limits had been widely predicted, but was not included. Democrats criticized the rush to push the bill through by working through the night, arguing that the debate showed many members did not understand the changes.

The work of the House Energy and Commerce Committee was taken up by the House Budget Committee and combined to create the Big Beautiful Bill promoted by the White House to extend tax cuts and reduce spending across many programs. On Friday, a motion to move the full bill failed – with four Republicans joining 16 Democrats voting no. Those Republicans were ultimately convinced to vote “present” on Sunday, to allow the bill to pass 17-16.

The cuts to Medicaid mostly focus on states with Medicaid Expansion and those that use state funds to cover immigrants, but include many provisions that will impact non-expansion states as well – including work requirements, capped provider taxes, increased administrative burdens, increased state cost sharing, limiting the lookback period (retroactive coverage) to one month, limiting inpatient hospital and nursing home rates to the Medicare rate, prohibiting implementation of the minimum staffing rule for long term care facilities and eliminating enhanced match for states that choose to expand Medicaid in the future. 

The following includes a full summary of the Medicaid provisions included in the legislation approved by the Energy and Commerce Committee compared to current law.  Please view this table – it is the best list I have found thus far.

Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF

There are significant additional reductions above and beyond Medicaid that will impact Kansans including:

SNAP: Food benefits reductions more than $290 billion over ten years – pushing major portions of SNAP costs to states. An amended cost-sharing formula would be connected to payment error rates. SNAP would also see additional work documentation requirements.

ACA: Reduce access to federal subsidies that help people pay for health insurance through the Health Insurance Marketplace (Affordable Care Act). Participants would face stricter minimum work requirements or lose their subsidies.

The bill will now go to the House Rules Committee to set parameters for floor debate before it can go to the House floor for a vote. The lack of unanimity amongst Republicans in the Budget Committee vote suggests changes will need to be made in the Rules Committee to get the votes necessary to pass on the House floor. 

President Trump met with Republicans Tuesday morning to attempt to gather the votes necessary to keep the Budget Reconciliation Bill moving, but there is a group of conservatives pushing for deeper cuts. The House Rules Committee already released revisions that include cuts to federal employee benefits. Rumors suggest those changes might include expediting the work requirements – currently delayed until 2029.

Because the House Budget Committee vote took place in the middle of the night, the 48 hour rule means the House Rules Committee is scheduled to begin its work at 1:00 a.m. Wednesday (tonight). They hope to have a vote in the House Thursday. Speaker Johnson says Congress will work into the holiday weekend if necessary.

Please note that due to the changing nature of the activities in Washington D.C., there may be further changes as the legislation moves through the process.

Contact:  Amy Campbell - email 

The Legislature passed it's Turnaround Deadline February 21 - when bills are supposed to pass either the House or Senate and then move to the other chamber for consideration.  Some bills are exempt from deadlines, but the 2025 Legislature is working to push legislation at a pace that is expedited this year.

Sub HB 2007 was passed by the House and is now in the process of being revised by the Senate Ways and Means Committee.  The 2025 budget process is different than previous years.  In past years, the House would create its budget bill and the Senate would create its budget bill.  Then, the two would meet in conference committee to negotiate a compromise, that would then be approved by the House and Senate once again.

This year, HB 2007 began in the House, with the Appropriations Committee compiling the recommendations of various agency budget committees and inserting its own revisions.  Then, the bill was passed as amended by the House of Representatives and goes to the Senate for consideration.  This has drastically compressed the amount of time each chamber has to consider the budgets for every state agency.  

Now, the Senate Ways and Means Committee begins its work but will not host traditional public hearings.  Instead, interested citizens and groups must submit written testimony to the Committee 24 hours ahead of the hearing for their agency of interest and deliver 20 copies of the testimony before 10:30 the day prior to the hearing.  It has been a challenge to meet with the committee members, as stakeholders scramble to have conversations about their budget requests.

In early committee action, Ways and Means has amended 2007 to strip House enhancements for Dept of Commerce programs and higher education.  This seems to indicate the Senate will carve out space for its own recommendations by reducing the House version rather than adding Senate spending on top.

Hearing dates:

March 4   KDADS and State Hospitals

March 5   KDHE 

March 5   DCF

NOTE:  The budget bill and process was discussed in detail at the February 26 KMHC meeting.  You may find more information at that agenda.

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LIST OF KMHC LEGISLATION TO WATCH

House Health Committee Hears Update on 988 Suicide & Crisis Lifeline

Drew Adkins, KDADS Behavioral Health Commissioner provided an update on the 988 Suicide and Crisis Lifeline.   See report attached.

The 988 Suicide and Crisis Lifeline was implemented nationally, and in Kansas, on July 16, 2022. 988 is currently answered in Kansas by HeadQuarters Kansas, COMCARE of Sedgwick County, Johnson County Mental Health Center, Wyandot Behavioral Health Network, and HealthSource Integrated Solutions. 988 is overseen by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by Vibrant Emotional Health.

The 988 system in Kansas has continued to grow since its implementation in July 2022. The state is working to meet the increasing demand for services by expanding chat and text capabilities to several other centers. These enhancements aim to improve accessibility and ensure that Kansans have more options to connect with 988 services when needed. Geo-routing capabilities went live in Fall 2024, providing connections for callers to the closest call center based on their physical location instead of area code.

House Health Committee Hears Update on Mental Health Intervention Teams program for K-12 Schools

Drew Adkins, KDADS Behavioral Health Commissioner provided an update on the MHIT program last week.  The creation of MHIT by the Legislature in 2018 responded to the increased number of students and families needing behavioral health services and removed barriers that made it difficult to link students with effective mental health support. HB 2236 will be heard by House Health and Human Services next Tuesday to establish the program in statute.

The pilot proviso authorized nine school districts to enter into agreements with their local community mental health centers to provide school-based services. The latest KDADS report states the program serves 130 schools and partners with 20 CCBHCs, several Federally Qualified Health Centers (FQHCs), and private providers. The partners link services into the school buildings to reduce time away from the classroom, provide after-hours resources and maximize the use of mental health professionals through partnerships – reducing competition for those professionals. Each MHIT participating school selects their preferred mental health provider(s).  Link to KDADS Program Update

Link to KMHC Testimony for HB 2236

The House and Senate Calendars are posted every day with the schedule for hearings and legislative action.  https://www.kslegislature.gov/li/b2025_26/chamber/calendars/

Below is an example of how committee schedules are publicized, with the contact information for the Committee Assistant at the top, and the time and location.  Here is the current schedule for the Senate Public Health and Welfare Committee from the Senate Calendar:

Public Health and Welfare

8:30 a.m.      Suzanne Nelson, Committee Assistant–785-296-5123      142-S

Tuesday, January 21

Request for bill introductions

Presentation on:

Kansas Department for Health and Environment Agency Overview by Secretary Janet Stanek; Ashley Goss, Deputy Secretary for Public Health; and Christine Osterlund, Deputy Secretary for Agency Integration and Medicaid Director

Presentation on: Overview of Kansas Association of Local Health Departments by Randy Bowman, Executive Director

Wednesday, January 22

Request for bill introductions

Presentation on: Overview of Kansas Department for Children and Families (DCF) by Andrea Warnke, DCF Legislative Liaison

Presentation on: Office of the Child Advocate by Kerrie Lonard, Acting Kansas Child Advocate

Thursday, January 23

Request for bill introductions

Presentation on: KanCare Ombudsman (Virtual) by Suzanne J. Lueker, J.D., LL.M, KanCare Ombudsman and Executive Director

Presentation on: Kansas Legislative Division of Post Audit: Osawatomie State Hospital Audit by Kristin Rottinghaus, Deputy Post Auditor, Legislative Post Audit

Presentation on: TANF Audit by Matt Etzel, Performance Audit Manager, Legislative Post Audit

Presentation on: Association of Community Health Centers of Kansas, Inc. by Kyle Kessler, Executive Director and Michelle Ponce, Associate Director

To listen to the livestream of committee hearings or House/Senate chamber proceedings, select Audio/Video in the upper right corner of the screen at https://www.kslegislature.gov/li/  and select the committee.  There are also archived recordings at this link.  OR you can subscribe to the Kansas Legislature channel at YouTube. 

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• All committee hearings and chamber proceedings can be found on the Kansas Legislature’s YouTube page.
• All legislation, committee membership, and meeting times can be found on the Kansas Legislature's Website page.

House Social Services Budget Committee  is beginning public hearings for social services agencies now.

The 2025 Kansas Legislative Session began January 13.  The Governors Budget Report was released January 16 - see report here   https://budget.kansas.gov/budget-report/    The budget process this year is happening much faster than in previous years and the Governor’s Budget Report is an advisory document, instead of the starting point for the Legislature’s budget legislation.  

To testify on agency budgets before the House Social Services Budget Committee, email Francisca Hernandez at Social.Svc.Budget@house.ks.gov or call 785-296-7660.  Testimony will be due the day before the public hearing, and the hearing is at 3:30 p.m. in the House Social Services Budget Committee room 152-S.  The Committee has many new members, so it is worthwhile to get to know them as soon as possible if you have items to come before the committee. 

HSSBC Schedule:

Jan 22 – Wednesday – State Hospitals Public Hearing

Jan 23 – Dept. for Children and Families Agency Overview

Jan 24 – Dept. for Children and Families Public Testimony 

Jan 27 – KDHE – Overview – includes Division of Health and KanCare

Jan 28 – KDHE Public Testimony 

Jan 29 – KDADS Agency Overview

Jan 30 – KDADS Public Testimony

To testify regarding the State Hospitals budget, email Francisca Hernandez at Social.Svc.Budget@house.ks.gov.  Testimony will be due on Tuesday, January 21, and the hearing is at 3:30 p.m. in the House Social Services Budget Committee.  The Committee has many new members, so it is worthwhile to get to know them as soon as possible if you have items to come before the committee.  See Committee information here:  https://www.kslegislature.gov/li/b2025_26/committees/ctte_h_soc_srvcs_bdgt_1/

Legislative Leadership established an expedited budget process this session with budget hearings beginning this week.  Typically, we wouldn't start attending budget hearings for another 2 weeks or so, but the Legislature decided not to wait for the Governors Budget Report to be presented and analyzed first.  Instead, a Special Committee on Legislative Budget established a legislative budget proposal in December and has already introduced HB 2007 to begin hearings immediately.  We will talk more about this and other 2025 issues at our monthly KMHC Meeting next Wednesday.  

The House Appropriations Committee intends to pass the session's major budget bill through the House and pass it on to the Senate for action in February.  This will require budget subcommittees to work very quickly to get their recommendations to the Appropriations Committee.  Appropriations will put together the major budget bill for the full House to consider - with the Senate intending to work on whatever the House passes to them.  There will not be a parallel budget subcommittee process in the Senate this year.  It appears the full House budget will be worked on by the Senate Ways and Means Committee before going to the full Senate.  It is unclear how much opportunity for public input will be scheduled in the Senate - so advocates should plan to participate in House budget committee hearings if possible.

Additionally, the House Appropriations Committee has asked state agencies to provide a list of potential budget cuts of 7.5% (excluding caseloads, aid to public schools, and debt service).  There is also talk of maybe implementing a "pay go" rule at the committee level - requiring any additional expenditures to be offset by cuts elsewhere.  If that happens, committee members may be surprised to see how their options are limited.  The Legislative Budget (HB 2007) as proposed by the interim committee was based on the agency requests as submitted to the Governor and approved by the 2024 Legislature, but stripped out most reappropriations, funding that was identified as "one time" funding, all enhancement requests and pay increase proposals.  So, there are approved programs that will require new authorization this year - such as the academic workforce initiative approved last session called the Behavioral Health Centers of Excellence.  We are all learning the new process, so hopefully there will be flexibility built in.  

The Kansas Legislature convened the 2025 Session on Monday, January 13.  The new session brings newly elected policymakers and some significant changes in the schedule and process.  Specifically, the Legislature plans to end the session by April 12.  That is significant, because it is about a week before the spring consensus estimates are reported, which usually allows for some budget adjustments in a typical veto session that has traditionally taken place at the end of April.  

The House of Representatives has 20 brand new representatives plus one experienced legislator - Richard Wilborn held leadership positions in the Senate but ran for the House seat held by Rep. Les Mason when he unexpectedly passed away after the 2024 session.   There are also four representatives who were appointed in 2024 and could be considered relatively new, as well.  Former Reps Steve Huebert and Marty Long have also returned to the House this session.  

The Senate has 14 newly elected senators - six who were elected after already serving in the House of Representatives.  

With 35% of the Senate seats changing hands - observers are interested to see how if there are new policy issues brought forward.  Both the Senate and House elected more Republicans than before, creating a solid super-majority, and Democrats will have to find support from across the aisle to pass any of their priorities.

Regardless, there are plenty of new policymakers to meet and educate about the importance of mental health and substance use services.  The Kansas Legislature website is kslegislature.gov.