HB 125 Summary

• Division of Medicaid must submit applications by December 31, 2025 for federal waivers to expand Medicaid coverage to individuals at or below 100% of federal poverty level with essential health benefits.

• Creates Section 1115 waiver program to expand coverage to uninsured individuals earning 101-200% of federal poverty level through individual qualified health insurance plans with state premium assistance on a sliding scale (100%, 75%, or 50% depending on income).

• Establishes employer health insurance premium assistance program for individuals earning 101-200% of federal poverty level who have or are offered employer coverage, with same tiered premium assistance.

• If CMS fails to approve requested waivers by December 31, 2026, Medicaid eligibility shall automatically expand to include all eligible populations and essential health benefits under the Affordable Care Act.

• Requires 12 months continuous enrollment without procedural termination, annual wellness visits, and wraparound services including benefits navigation and community health workers; effective July 1, 2025.