03/03/1999 01:35 PM Senate HES

                                                                                                                                
        SB  58-SERVICES FOR ADULTS WITH LONG-TERM NEEDS                                                                         
                                                                                                                                
VICE-CHAIRMAN KELLY brought up SB 58 and invited Deputy                                                                         
Commissioner Alison Elgee to provide an overview for the                                                                        
committee.                                                                                                                      
                                                                                                                                
MS. ELGEE stated SB 58 creates a new program for home and                                                                       
community based care for people who, for two reasons, may not                                                                   
meet the Medicaid eligibility requirements.  People either do not                                                               
meet the financial criteria to make them eligible for Medicaid,                                                                 
or they do not meet the level of need determination to be                                                                       
eligible for the department's home and community based care                                                                     
waivers.  The level of need under the waiver programs requires an                                                               
individual to need nursing home level of care.                                                                                  
                                                                                                                                
A number of older Alaskans who are struggling to retain their                                                                   
independence and stay at home have some financial resources that                                                                
are not significant enough to cover the cost of their home care.                                                                
These individuals have not reached the nursing home level of                                                                    
care, but they will end up in a nursing home without some inter-                                                                
vention and early supports.  This legislation establishes a "new                                                                
pot of money" to be available to people in those circumstances.                                                                 
                                                                                                                                
MS. ELGEE continued, stating it is not intended to supplement or                                                                
supplant existing state programs.  It would be available to those                                                               
people who have no other public financing mechanisms.  It is not                                                                
an entitlement program and would only operate to the degree that                                                                
the department has money to provide assistance to people.  The                                                                  
department would look first at an individual's personal                                                                         
resources, including insurance and other third-party payment                                                                    
sources, before making available the monies in this fund.                                                                       
                                                                                                                                
Number 318                                                                                                                      
                                                                                                                                
SENATOR WILKEN noted that this bill relates to Recommendation #13                                                               
in the LTCTF final report and it carries a $425.0 fiscal note. He                                                               
said that of the four bills, SB 58 will require the most caution                                                                
in financing so that it does not balloon out of proportion.                                                                     
Nonetheless, the task force felt that the state should help                                                                     
people to stay in their homes without financial burden.  SENATOR                                                                
WILKEN stated this bill will require a lot of work.                                                                             
                                                                                                                                
VICE-CHAIRMAN KELLY asked for a clarification of the level of                                                                   
services needed by people who would not qualify for Medicaid.                                                                   
                                                                                                                                
MS. ELGEE explained that participation in the Choice Waiver for                                                                 
the Elderly and the Adult with Physical Disabilities Waiver                                                                     
requires meeting two eligibility criteria including income and                                                                  
level of need, e.g., nursing home level of care.                                                                                
                                                                                                                                
Number 362                                                                                                                      
                                                                                                                                
VICE-CHAIRMAN KELLY asked how the state gets around the Medicaid                                                                
criteria to allow those who don't normally qualify to receive it.                                                               
                                                                                                                                
MS. ELGEE repeated that this legislation proposes a new program                                                                 
and new funding that would be available to people who don't                                                                     
qualify for Medicaid.                                                                                                           
                                                                                                                                
SENATOR ELTON asked if this client base is being served in any                                                                  
other way now, or will these be new clients.                                                                                    
                                                                                                                                
MS. ELGEE replied that the senior population is rapidly expand-                                                                 
ing. The department is presently serving those who meet the                                                                     
Medicaid eligibility or who are in the Pioneer Homes.  Beyond                                                                   
that, the department has few public resources to provide to                                                                     
seniors.  Frequently those who need this kind of support and                                                                    
can't make it work at home are leaving the state to seek afford-                                                                
able care elsewhere. This will allow the department to provide                                                                  
some supports for people who want to remain in Alaska. DOA also                                                                 
views it as cost avoidance because with early intervention, a                                                                   
number of people will never reach the nursing home level of care.                                                               
Spending a little money early on will save a lot of money later.                                                                
                                                                                                                                
VICE-CHAIRMAN KELLY asked if the task force looked at ways of                                                                   
using private care givers to achieve this same end.                                                                             
                                                                                                                                
SENATOR WILKEN replied private care givers are providing some of                                                                
those services now to a group of people who are not Medicaid                                                                    
eligible yet under a financial strain to afford the services.                                                                   
                                                                                                                                
MS. ELGEE explained the department would not directly provide                                                                   
these services with state employees, nor does it directly provide                                                               
the waiver programs.  DOA uses the services of nonprofits and                                                                   
private care givers, and it is providing a financing mechanism in                                                               
this legislation.