Amends, repeals, and adds to existing law to provide that legislative approval is required for certain state plan amendments and waivers and to provide legislative approval for certain state plan amendments and waivers.

The Act includes one-time development costs for waivers and ongoing implementation costs if approved. These are offset by ongoing savings from the bill, including the removal of primary care case management and increased patient cost-sharing in line with other states. While the timing with which these are implemented will depend on federal approval, it is anticipated that the state will see net savings of $15.9 million total fund savings ($5.3 million general fund) in FY 2026, and $27.2 million total fund savings ($9.0 million general fund) in FY 2027 and annually thereafter. The state can reasonably expect that, if approved, the longer-term Medicaid waivers will generate additional cost savings on top of these projections.