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-CHAPTER 139
-Legislative Research Commission PDF Version
+HOUSE OF REPRESENTATIVES
 
-1
-CHAPTER 139
-( SCR 9 )
-A CONCURRENT RESOLUTION directing the Legislative Research Commission to conduct a feasibility
-study for an Accountable Communities for Health Medicaid delivery model pilot project.
-WHEREAS, Kentucky persistently ranks among the worst states nationally for key health indicators, including
-chronic disease prevalence, maternal health outcomes, tobacco use, and preventable hospitalizations; and
-WHEREAS, many Kentuckians are living with three or more chronic health conditions, including asthma,
-kidney disease, heart disease, cancer, and diabetes; and
-WHEREAS, Kentucky's health issues are deeply tied to the social and economic conditions of rural
-communities, which remain inadequately and insufficiently addressed; and
-WHEREAS, Kentucky has operated its Medicaid program primarily under a managed care delivery model
-since 2010; and
-WHEREAS, the current Medicaid delivery model employed in the Commonwealth has failed to produce
-valuable outcomes as Medicaid expenditures have continued to increase while health outcomes have deteriorated and
-disparities have widened; and
-WHEREAS, the transition from a fee -for-service Medicaid program to a managed care model was chiefly
-motivated by a belief that contracting with Medicaid managed care organizations to administer large portions of the
-Medicaid program would result in budget stability and predictability; and
-WHEREAS, despite the transition to managed care under former Governor Steve Beshear, since 2010 the cost
-of the Kentucky Medicaid program has skyrocketed, increasing from approximately $5,900,000,000 a year in 2010 to
-a projected amount of over $20,600,000,000 a year in 2026; and
-WHEREAS, since 2010, the number of Kentuckians enrolled in the Medicaid program has risen from roughly
-920,000 to approximately 1,400,000 in 2025, an increase of roughly 50 percent r esulting largely from former
-Governor Steve Beshear's decision to expand Medicaid eligibility under the Affordable Care Act in 2014; and
-WHEREAS, expanded Medicaid eligibility and the resulting 50 percent increase in enrollment fails to explain
-the nearly 400 percent increase in the cost of the program over the same period of time; and
-WHEREAS, the historic trend of rapid cost increases in the Medicaid program has not resulted in enhanced
-reimbursement rates for rural healthcare providers; and
-WHEREAS, acce ss to essential, comprehensive healthcare services in rural communities continues to erode
-under the managed care delivery model, underscoring the urgent need for targeted interventions to reverse this trend;
-and
-WHEREAS, under federal law, Medicaid manage d care organizations are required to achieve a minimum
-medical loss ratio of at least 85 percent, which means that at least 85 cents of every dollar paid to a managed care
-organization by a state Medicaid program must be spent on the delivery of healthcare  services for Medicaid enrollees;
-and
-WHEREAS, current contracts between the Department for Medicaid Services and the Commonwealth's five
-contracted Medicaid managed care organizations require managed care organizations to achieve at least a 90 percent
-medical loss ratio; and
-WHEREAS, federal and state established medical loss ratios for Medicaid managed care organizations have
-the effect of limiting a managed care organization's profit from a Medicaid managed care contract to no more than 10
-percent of the total contract value; and
-WHEREAS, the five managed care organizations currently under contract with the Department for Medicaid
-Services to administer Medicaid benefits in Kentucky are all either publicly traded, for -profit corporations or owned
-by publicly traded, for-profit corporations; and
-WHEREAS, publicly traded, for-profit corporations have a legally binding fiduciary duty to their shareholders
-to increase profits quarter over quarter and year over year; and
-ACTS OF THE GENERAL ASSEMBLY 2
-WHEREAS, existing medical loss ratio req uirements effectively mean that the only way a contracted
-Medicaid managed care organization can fulfill its fiduciary duty to shareholders to increase profits is to see an
-increase in the overall cost of the Medicaid program, typically by increasing the p er member per month capitation
-payments made by the state to the managed care organizations; and
-WHEREAS, Kentucky's current health data landscape is fragmented and lacks a unified, inclusive dataset
-spanning the full continuum of care, limiting its effect iveness in guiding informed health policy and appropriations;
-and
-WHEREAS, Kentucky's healthcare system remains fragmented, with hospitals, clinics, schools, social service
-organizations, and managed care organizations often operating in silos, which has r esulted in reactive care that seeks
-to treat symptoms rather than coordinated strategies that tackle root causes of illness; and
-WHEREAS, Kentucky must identify proven strategies to unite healthcare providers, coordinate care, and
-connect communities while holding the entire system accountable for both outcomes and costs; and
-WHEREAS, the current cost of the Kentucky Medicaid program, paired with the historical trend of rapid cost
-increases, is unsustainable and represents a catastrophic threat to the stability and solvency of the Commonwealth's
-entire biennial budget; and
-WHEREAS, given the current Medicaid landscape in Kentucky, as described above, the Commonwealth must
-endeavor to identify a less costly and more sustainable alternative to the current  managed care delivery model; and
-WHEREAS, transformative healthcare delivery models are reshaping access to care and improving health
-outcomes across the United States; and
-WHEREAS, an increasing number of states are seeing positive results, including red uced costs and significant
-improvements in healthcare outcomes, by transitioning away from managed care toward an accountable care delivery
-model; and
-WHEREAS, accountable care organizations (ACO) prioritize whole -person care, adopt value -based payment
-models over volume-driven approaches, and incorporate mechanisms for shared savings and financial risk; and
-WHEREAS, accountable communities for health (ACH) aim to improve population health by fostering
-regional collaboration, investing in community -based su pports, and advancing policies that promote and sustain
-healthier communities; and
-WHEREAS, ACO and ACH models represent more strategic, provider -endorsed, community-led models that
-enhance health outcomes while driving cost efficiencies; and
-WHEREAS, ACO and ACH models are proven Medicaid delivery models currently producing positive
-outcomes for state Medicaid programs across the United States and have demonstrated that smarter investments in
-prevention and access to care can reduce the costs of a state's Medicaid program while improving healthcare
-outcomes; and
-WHEREAS, by implementing a comprehensive community -driven alternative healthcare delivery model that
-integrates physical, behavioral, and spiritual care while addressing the social conditions in whi ch people live, work,
-play, and learn, the Commonwealth could realize a 20 percent improvement in both patient and provider satisfaction
-and significant, measurable gains in overall population health by 2030; and
-WHEREAS, Kentucky's area development districts have an established track record for delivering community -
-based Medicaid services tailored to the needs of specific geographic regions; and
-WHEREAS, Kentucky's area development districts serve a large enough population to effectively evaluate and
-benchmark the impact of an ACH delivery model on improving outcomes and reducing costs;
-NOW, THEREFORE,
-Be it resolved by the Senate of the General Assembly of the Commonwealth of Kentucky, the House of
-Representatives concurring therein:
-Section 1.   The Legislative Research Commission is hereby directed to conduct a feasibility study for an
-Accountable Communities for Health Medicaid delivery model pilot project. The feasibility study shall assess,
-consider, and make recommendations concerning the following:
-(1) Examples of state Medicaid programs that have implemented an accountable care Medicaid delivery
-model, including but not limited to accountable care organizations, accountable communities for health, and
-CHAPTER 139
-Legislative Research Commission PDF Version
+KENTUCKY GENERAL ASSEMBLY AMENDMENT FORM
 
-3
-accountable health community models, to iden tify best practices and potential governance structure suitable for
-Kentucky;
-(2) Opportunities, barriers, and organizational capacity for implementing an Accountable Communities for
-Health Medicaid delivery model pilot project under the Kentucky Medicaid program;
-(3) Potential geographic regions and partners suitable for an Accountable Communities for Health
-Medicaid delivery model pilot project, including specific assessment of the Lincoln Trail Area Development District,
-Barren River Area Development Dis trict, and Green River Area Development District as an appropriate geographic
-region for the pilot project;
-(4) Existing health information exchange, data -sharing capacity, and interoperability of various data
-systems, including eligibility data, across Me dicaid, providers, and social service systems to identify any necessary
-infrastructure developments for a successful Accountable Communities for Health Medicaid delivery model pilot
-project;
-(5) Options for financing an Accountable Communities for Health M edicaid delivery model pilot project,
-including anticipated costs, potential cost savings, sustainability, and funding sources with specific emphasis on
-identifying options for diverting current per member, per month capitation payments made to managed car e
-organizations to the pilot project;
-(6) Creation of a nonprofit mutual insurance company as an alternative to for -profit insurance companies
-and Medicaid managed care organizations for administering an Accountable Communities for Health Medicaid
-delivery model pilot project, including claims processing and provider payments;
-(7) Potential pilot models, policy changes, and implementation pathways, including necessary next steps to
-design and implement an Accountable Communities for Health Medicaid delivery  model pilot project;
-(8) Strategies and metrics for evaluating the success of a future Accountable Communities for Health
-Medicaid delivery model pilot project, including key metrics and outcomes to be reported, monitored, and evaluated;
-and
-(9) Any other issues or aspects of a feasibility study or an Accountable Communities for Health Medicaid
-delivery model pilot project determined to be necessary or appropriate by the Legislative Research Commission.
-Section 2.   The results of the feasibility study required under Section 1 of this Resolution shall be submitted
-to the Legislative Research Commission by November 1, 2026, for referral to the Interim Joint Committee on Health
-Services, the Interim Joint Committee on Appropriations and Revenue, and the Medi caid Oversight and Advisory
-Board.
-Section 3.   A pilot project resulting from the feasibility study required under Section 1 of this Resolution
-shall be known as the 20 by 30 Accountable Care Pilot Project.
-Section 4.   Provisions of this Resolution to the contrary notwithstanding, the Legislative Research
-Commission shall have the authority to alternatively assign the issues identified herein to an interim join committee
-or subcommittee thereof, and to designate a study completion date.
-Signed by Governor April 13, 2026.
+2026 REGULAR SESSION
+
+Amend printed copy of SCR 9/GA
+TITLE AMENDMENT
+
+Amendment No. TITLE  Rep. Rep. Kimberly Poore Moser
+
+Committee Amendment   Signed:
+
+Floor Amendment   LRC Drafter:
+
+Adopted:   Date:
+
+Rejected:   Doc. ID: XXXX
+
+Page 1 of 1
+  Amend the title to read "A CONCURRENT RESOLUTION directing the Legislative
+Research Commission to conduct a feasibility study for an Accountable Communities for Health
+Medicaid delivery model pilot project.".