At this stage of the legislative process, public hearings are mostly done with the exception of Appropriations and Finance. HCMA physicians have been outstanding in advocating for their peers’ needs during the hearing process. Committees have reported out key bills, moving them to the House and Senate for further action. Federal action will impact budget discussions here in Connecticut, including concerns over Medicaid. Key issues of interest to HCMA include:
Medicaid/Budget
Governor Ned Lamont’s proposed budget includes several healthcare-related provisions: increased Medicaid reimbursement rates, expanded drug discounts, and a cap on generic drug price hikes. These steps aim to improve care access, but concerns remain around their effects on out-of-network costs and the growing role of private equity in healthcare.
Both Governor Lamont and Democratic leadership support raising Medicaid reimbursement rates, though their proposals differ. The Governor’s plan calls for a $70 million increase over FY 2026–2027. Legislative leadership proposes a more ambitious four-year, $250 million plan to bring Medicaid rates to 75%–80% of Medicare levels, beginning with a $75 million investment in 2026.
Physicians across Connecticut have strongly supported these investments. During the Human Services Appropriations hearing, providers testified on the importance of sustainable reimbursement for continuing to serve Medicaid patients and ensuring care for underserved communities. Your continued advocacy is crucial as budget negotiations begin and stakeholders including the Governor and legislative leaders begin discussing priority policies and programs.
Prior Authorization
Senate Bill 10: AAC Health Insurance and Patient Protection
Prior authorization remains a top concern for physicians, leading to delayed care, excessive administrative burden, and patient frustration. SB 10 aims to address these issues through several key reforms including enforcing penalties for insurers violating mental health/substance use disorder parity, prohibiting the automatic “downcoding” of billing claim, limiting the use of step therapy protocols.
These measures are designed to reduce obstacles that interfere with timely, appropriate care—freeing up physicians to focus on patients instead of paperwork.
Prescription Drug Costs
Senate Bill 11: AAC Prescription Drug Access and Affordability
House Bill 6870: AA Addressing Patients Prescription Drug Costs
The high cost of prescription drugs continues to burden patients, often resulting in delayed or skipped treatments. Two key bills aim to address prescription drug affordability. Senate Bill 11 would regulate pharmacy benefit managers (PBMs), requiring them to act in the financial interest of plan sponsors. House Bill 6870 proposes allowing low-cost drug purchases to count toward insurance deductibles, capping annual increases in generic drug prices, and exploring the importation of medications from Canada to expand access to affordable treatment options.
Both bills aim to expand access to affordable medications, reduce out-of-pocket costs, and ensure patients can follow prescribed treatment plans.
Out of Network
House Bill 6871: An Act Limiting Out-of-Network Healthcare costs
In an effort to combat excessive hospital bills, Governor Lamont has proposed misguided legislation capping out-of-network hospital charges at 240% of Medicare rates. While aimed at protecting patients, this proposal could severely undercut reimbursements to physicians—especially those providing emergency care or practicing in high-overhead specialties.
The proposed cap may not reflect the true cost of care, threatening practice sustainability and reducing access to care in certain regions. During public testimony, HCMA President Dr. Atique Mirza outlined the risks this bill poses to Connecticut’s healthcare system. FOCUS and HCMA are working in coalition with the Connecticut Hospital Association and specialty groups to oppose the current language and seek a more balanced solution.
Private Equity
HB 6873: An Act Strengthening the Review of Healthcare Entity Transactions
Prompted by the financial instability of Prospect Medical Holdings, several pieces of legislation have been introduced aimed at increase state oversight of healthcare mergers, acquisitions, and asset transfers. Supported by Governor Lamont, legislation including HB 6873, Expands the Attorney General’s review authority, establishes a coordinated review process, requires 60-day advance notice for major changes and reserves the “certificate of need” process.
The intent is to improve transparency, protect patients, and prevent disruptions caused by profit-driven transactions. However, some specialty groups have raised concerns that the bill may unfairly impact independent practices and surgery centers, calling for clearer distinctions between private equity models and traditional ownership structures.
As the legislature approaches adjournment, the coming weeks will be decisive for many key healthcare proposals. FOCUS Government Affairs will continue tracking developments closely and working with stakeholders to advocate on behalf of Connecticut’s physician community.