02/21/2012 03:00 PM House HEALTH & SOCIAL SERVICES

         HB 288-MED. ASSISTANCE ELIGIBILITY: PRISONERS                                                                      
                                                                                                                                
3:04:04 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the first order of business would be                                                                
HOUSE BILL NO. 288, "An Act prohibiting denial or withholding of                                                                
medical assistance eligibility or coverage for a prisoner."                                                                     
                                                                                                                                
3:04:32 PM                                                                                                                    
                                                                                                                                
JIM POUND, Staff, Representative Wes Keller, Alaska State                                                                       
Legislature, introduced HB 288, on behalf of the prime sponsor,                                                                 
Representative Keller.  He read from a prepared statement:                                                                      
                                                                                                                                
     House  Bill  288  is  based  on the  fact  that  if  an                                                                    
     individual is  convicted of a crime,  he's sentenced to                                                                    
     jail.  The  State of Alaska assumes custody  ... but we                                                                    
     also assume  the medical costs.   Some of these  can be                                                                    
     extremely expensive,  and under our  current regulatory                                                                    
     process,  we  cannot  share   that  cost  with  anyone,                                                                    
     including  Medicaid.   Medicaid sharing  by inmates  is                                                                    
     forbidden  by state  regulation,  not state  law.   The                                                                    
     regulation is  based on a federal  understanding of the                                                                    
     rules; in  fact there is  no federal law  that requires                                                                    
     it, either.   It's a grey area that  says inmates under                                                                    
     state   custody  cannot   receive  Medicaid,   but  the                                                                    
     interpretation  of that  is  rapidly  changing in  that                                                                    
     several   states  already   seek  Medicaid   funds  for                                                                    
     inmates.    For  those  inmates  in  facilities  in  an                                                                    
     infirmary,  the  rule is  essentially  the  same as  in                                                                    
     state custody.   Where the condition  places the inmate                                                                    
     under the care of a  hospital, the rules are different.                                                                    
     Medicaid may  be used for that  type of care.   For the                                                                    
     State  of Alaska,  up to  50 percent  of that  money is                                                                    
     federal  money.   The state  needs to  look at  ways to                                                                    
     save money.   This  is a golden  opportunity for  us to                                                                    
     look at a $32 million  budget for this coming up fiscal                                                                    
     year.  How  much we can save will depend  on the number                                                                    
     of inmates who qualify.   Potential changes in the U.S.                                                                    
     health care laws may also  greatly increase that amount                                                                    
     in 2014.   We urge your support of this  bill; it moves                                                                    
     us in the right direction.                                                                                                 
                                                                                                                                
CHAIR KELLER asked the committee if there were any questions.                                                                   
                                                                                                                                
3:06:41 PM                                                                                                                    
                                                                                                                                
JON   SHERWOOD,  Medicaid   Special  Projects,   Office  of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
explained that,  although the  area of  coverage by  Medicaid for                                                               
inmates  was "somewhat  ambiguous,"  states were  able "to  cover                                                               
inmates  when they  are staying  overnight in  in-patient medical                                                               
institutions."   He expressed a  need to move carefully,  as this                                                               
issue  had "a  good deal  of  federal oversight."   He  commented                                                               
that, as  Medicaid billing was  monthly, the billing  of Medicaid                                                               
coverage   solely  for   an   in-patient   setting  outside   the                                                               
correctional  facility  would  be   a  challenge  for  the  DHSS,                                                               
requiring some structural adjustments to the billing system.                                                                    
                                                                                                                                
3:08:40 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  reflected on  the irony for  his introduction  of a                                                               
bill to expand Medicaid, but,  as it was balanced against general                                                               
fund funding,  he declared  "it just  seemed like  something that                                                               
just is the right thing to do."                                                                                                 
                                                                                                                                
3:09:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLER asked  for a  definition of  prisoner, and                                                               
when there would be [Medicaid] coverage.                                                                                        
                                                                                                                                
LESLIE   HOUSTON,   Director,   Central   Office,   Division   of                                                               
Administrative  Services,  Department  of Corrections  (DOC),  in                                                               
response, stated that the focus  was to those people incarcerated                                                               
in  the state  correctional facilities.   She  admitted that  the                                                               
proposed bill  could include  people with  electronic monitoring,                                                               
as well as those in community residential centers (CRCs).                                                                       
                                                                                                                                
REPRESENTATIVE SEATON asked for  clarification about a person who                                                               
was in the custody of the state.                                                                                                
                                                                                                                                
MS.  HOUSTON  explained  that the  proposed  bill  would  include                                                               
people   under  electronic   monitoring,  supervised   probation,                                                               
residents of  half way  houses (CRCs),  as well  as those  in DOC                                                               
facilities.                                                                                                                     
                                                                                                                                
3:11:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, noting a  difference between her testimony                                                               
and the proposed  bill, asked to clarify  whether, initially, the                                                               
state  was  only going  to  claim  coverage  for prisoners  in  a                                                               
correctional institution, and not  claim coverage for everyone in                                                               
custody.                                                                                                                        
                                                                                                                                
MS. HOUSTON,  in response, said  that it would begin  the process                                                               
with  those incarcerated  in facilities,  as this  was an  easier                                                               
point  to  assess eligibility.    She  agreed  that it  would  be                                                               
expanded "to reach every single area possible."                                                                                 
                                                                                                                                
3:12:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  asked to  clarify  that  proposed HB  288                                                               
allowed DOC and DHSS to narrow or broaden the coverage.                                                                         
                                                                                                                                
MS. HOUSTON expressed her agreement.                                                                                            
                                                                                                                                
3:13:12 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER,  directing attention  to the formula  on page  2 of                                                               
the memorandum  from Legislative  Research Services  [Included in                                                               
members' packets], stated  that the savings to  the state general                                                               
fund would  be a  minimum of  $3 million.   He allowed  that this                                                               
savings  did  not  calculate  any   cost  for  administering  the                                                               
program.                                                                                                                        
                                                                                                                                
3:15:42 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER closed public testimony.                                                                                           
                                                                                                                                
3:16:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DICK moved to report  HB 288 out of committee with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There  being no  objection, HB  288 was  reported from  the House                                                               
Health and Social Services Standing Committee.