Parents fight insurance caps on home nursing care in commerce conference committee

Nick Keis’ 5-year-old daughter has spent most of the past 10 weeks in the hospital, including nearly a week of being intubated and sedated.

He received a hospital bill for $246,000 for 10 days of that stay.

His daughter is medically complex and requires daily ICU-level care that has been provided by her nurses and parents at home for her entire life.

“That nursing is the only reason she has been able to live at home instead of in a hospital or an institution,” he said.

At issue before the conference committee on the omnibus commerce policy bill, HF4188, is how “home care nursing services” in state law has been interpreted for coverage by health insurance providers.

State law requires home care nursing services to be covered under a commercial health plan for people who are covered by both a commercial health plan and Medical Assistance.

However, parents told the House Commerce Finance and Policy Committee in March that they were notified by their health insurance providers, some after open enrollment closed for 2026, that they would be limited to 120 home care nursing visits, leaving them to solely care for their children with complex medical needs after that. Medica and HealthPartners officials said the change stemmed from re-evaluating their home health care benefits for people who were also enrolled in Medical Assistance.

While a bill in the House banning health plans from imposing quantity limits on coverage didn’t advance out of the commerce committee, the companion bill is included the Senate’s omnibus commerce policy bill. Testifiers spoke in support of the provision during the conference committee’s first meeting Tuesday. No action was taken.

[MORE: Side-by-side comparison summary]

When the coverage cap began on his daughter’s nursing care in March, Keis said nothing had changed about his daughter’s medical necessities or state law. After the cap began, his insurance provider began referring to his daughter’s 24-hour care as “visits.” His insurance provider had previously assessed that his daughter had a medical necessity need of 127 hours of care per week, but under the new cap, the company is now covering 240 hours per year.

“It is not enough to keep a child like my daughter alive and safely at home,” he said.

The insurance provider’s shift of the cost for his daughter’s care onto the state means that her Medical Assistance waiver budget won’t cover the cost for a nurse for 40 hours a week. Unable to hire a nurse, his daughter is currently hospitalized and his family and his daughter’s county case worker have been “scrambling” to figure out how to safely bring her home, he said.

“The fragile stability we have built collapsed overnight,” he said.

[MORE: Read written testimony]

Rep. Tim O'Driscoll (R-Sartell), co-chair of the commerce committee, hasn’t been able to get an answer from the Department of Commerce on what it has approved for health plans because “there seems to be ambiguity or confusion” by health insurance providers.

Commerce Commissioner Grace Arnold said the department annually reviews health insurance policies in comparison to state and federal requirements and the state benchmark plan.

“In general, all of the plans — and this has been the case since 2014 — have limits on that type of coverage of 120 days. Our understanding is that maybe those limits weren’t enforced until more recently, but they’ve had that in place for at least 10 years,” she said.

The department’s approval process for health insurance plans hasn’t changed, she said. The department will receive a complaint if a person isn’t receiving their benefits, but it doesn’t typically hear from people when they are receiving more coverage than required.

State law isn’t specific about an amount, but the state has had a limit since 2014, she said. The amount of 120 visits has been filed with the federal government. While they need to work toward a solution for the affected families, the state will be asked to defray the payment to the federal government beyond that amount.

Rep. Robert Bierman (DFL-Apple Valley), who sponsors the bill addressing the issue, said the intent was clear when the Legislature passed the law in 2010 that commercial plans are responsible for covering home care nursing services and the state won’t pay for it via Medical Assistance. Its purpose was to stop shifting the cost onto the state and to keep people who are medically complex safely at home instead of in hospitals where the cost would be higher.

There hasn’t been an issue with the law until two health insurance providers reinterpreted the statute to cap coverage, Bierman said, adding that it’s a “dramatic departure” from the Legislature’s intent. That reinterpretation will shift millions of dollars for the cost of care onto the state budget.

“If the commercial plans no longer wanted to cover this care, they should come to the Legislature with a bill to change it. Health plans are not lawmakers,” he said.

Notable omnibus bill provisions

Other notable provisions in the bills before the conference committee include increasing the maximum meat raffle prize value to $200, banning TV ads for prescription drugs, banning children’s access to AI chatbots, banning the sale of dogs and cats at pet shops and making permanent the restrictions on manufacturers interfering with the delivery of a covered outpatient drug to a pharmacy that’s under contract with a 340B covered entity.

Both the House and Senate omnibus bills include a provision that’d modify the unclaimed property statute to determine when virtual currency is considered abandoned. Arnold said the statute hasn’t been updated in decades, and the proposed provision is the beginning of modernizing it.

On Tuesday, several testifiers encouraged the committee to add a provision that would cap annual deposits into the Consumer Protection Restitution Account at $10 million and implement a formula for restitution payouts. The provision was heard by both the House and Senate, but wasn’t in either bill.

Omnibus bill provisions

Notable similar provisions contained in the House and Senate omnibus bills would:

• amend student loan standards;
• require insurance lead generators to keep records; and
• amend unclaimed property statutes to define when prepayment of funeral expenses is considered abandoned.

Notable provisions in the Senate omnibus bill passed by the House as individual bills would:

• allow a financial service to communicate with a customer through a trusted contact; and
• establish requirements for banks and credit unions related to virtual currency custody services.

Notable provisions found in only the Senate omnibus bill would:

• authorize a limited lines travel insurance producer license to be issued;
• set consumer protections for travel insurance;
• create an exemption in the unclaimed property statute for certain property in tax-deferred accounts;
• repeal the Prescription Drug Affordability Advisory Council due to its duplication with the state’s Prescription Drug Affordability Board;
• require health insurers and nonprofit health service plan corporations to notify the Department of Commerce if they experience a significant increase in total enrollees;
• allow people whose Medicare supplement policies have involuntarily ceased due to one of several reasons to have a guarantee issue right to any Medicare supplement policy offered by any issuer, including for plan year 2027 for people whose enrollment ceased in 2025; and
• ban the exclusive use of artificial intelligence to make an adverse determination for benefit coverage and require a clinician review.

Notable provisions that have already been signed into law as individual bills include:

• a ban on virtual currency kiosks;
• a ban on nudification technology; and
• a ban on homeowner’s insurance policies from excluding coverage for damage done to a property by peace officers’ use of chemical irritants, smoke screens or diversionary devices.