Legislature(1999 - 2000)
04/26/2000 04:17 PM House 207
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CO-CHAIR LYDA GREEN called the Conference Committee on SB 207 to order at 4:17 p.m. Present were Senators Taylor and Elton and Representatives Whitaker and Brice and Co-Chair Dyson. Representative Coghill was also present. CO-CHAIR GREEN announced the committee would be considering HCS SB 207(RLS) because Senators felt it would be advantageous to make changes to the bill in this forum rather than on the Senate floor. She asked Senator Taylor to outline his concerns. SENATOR TAYLOR stated that SB 207 was originally four or five pages. HCS SB 207(RLS) was then lengthened to 13 pages by the House yet the Senate has never heard any explanation of the modifications. CO-CHAIR DYSON explained that SB 207 was introduced at the request of the Governor. When the House started to work on it, several issues came up. First, the Governor's bill assumes that the only way parents can meet their child's health needs is to have health insurance. He felt that might be the practical answer but in cases in which no support order has been issued, meaning the parents have independently agreed on the financial aspects of child custody, a non-custodial parent with a lot of financial resources may be able to meet the child's medical needs without insurance. Second, the House did not want CSED to be able to bypass a court decision using an administrative procedure. The House wanted to keep the obligation for the child's health care with the parents when possible. The House directed Terri Lauterbach, the legislative drafter, to make those changes. She advised them that those changes would require incorporating a court rule into statute. Co- Chair Dyson noted that the House amendments significantly improve the bill and that the Child Support Enforcement Division (CSED) agrees, but the changes make the bill longer. CO-CHAIR GREEN asked Ms. Lauterbach to address the committee. Number 073 MS. TERRI LAUTERBACH, an attorney with the Division of Legal and Research Services, Legislative Affairs Agency, informed committee members that she prepared the committee substitute (CS) for the House. Had she done a CS for the Senate, she would have recommended the same sections for review. Often, the Division of Legal Services' first chance to have input and determine whether a bill contains ambiguities occurs when a Governor's bill gets changed in a committee. The phrase "child support" or "child support payments" is referred to in several places in statute. The phrase "child support" can refer to financial support, medical support or both. The goal of SB 207 was to make sure that CSED could issue a medical support order without a financial support order, but that change would make the phrase "child support" ambiguous in seven sections of statute, which was not addressed in SB 207. Consequently, Sections 1-5, 18 and 19 of SB 207 needed to be changed. MS. LAUTERBACH explained that Section 1 in the House CS is new. It pertains to a criminal law about aiding a person in the nonpayment of child support. Section 1 clarifies that a person can be in violation of the statute not only for nonpayment of financial support but also for not providing health coverage for their children. She noted the policy call could go the other way but she recommends the legislature decide whether the statute will cover only child support payments or health care, otherwise the phrase "child support" will be ambiguous in this statute. CO-CHAIR GREEN asked if that is the "corporate stamp" for the expansion. MS. LAUTERBACH repeated that Sections 1-5, 18 and 19 fit that explanation. When redrafting the bill, she also made changes to Sections 8, 21, and 22 that she assumed the original drafter missed. She pointed out the sectional analysis contains an explanation of those changes. CO-CHAIR GREEN asked Ms. Lauterbach if, essentially, she changed the phrase "child support order" to "child support order or medical support order." MS. LAUTERBACH said that is pretty much true although the context is slightly different in each of the sections. The goal was to clean up all of the ambiguous statutes while maintaining the policy that medical support could be separate from periodic payments. SENATOR ELTON asked Ms. Lauterbach to explain the difference between a court rule change and an indirect amendment on a court rule. MS. LAUTERBACH explained that a direct amendment of a court rule happens when a court rule is referred to in a bill and amended. An indirect amendment is made when a statute is simply changed in a way that differs from how the court rule reads; it is done through a statute instead of amending the rule directly. CO-CHAIR GREEN asked which was done in SB 207. MS. LAUTERBACH replied HCSSB 207(RLS) contains an indirect amendment to a court rule. CO-CHAIR GREEN asked if it is an indirect amendment because Ms. Lauterbach changed the statutory language to include medical support. MS. LAUTERBACH answered the indirect court rule amendment clarifies that a medical support order can be issued separately by a court, as well as by CSED. Currently, Rule 90.3 does not address whether medical support orders can be issued separately from child support orders. It also places most of the sections of Rule 90.3 that apply to health insurance and medical coverage in statute. HCS SB 207(RLS) differs a little. The court rule says that when medical expenses are more than $5,000 in a calendar year, the cost will be split between the parents based on their financial situations at the time the expenses were incurred. HCS SB 207(RLS) says that all costs not covered by health insurance should be split evenly unless there is good cause to do otherwise. CO-CHAIR GREEN asked if that provision in HCS SB 207(RLS) only applies to health care expenses above the cost of insurance. MS. LAUTERBACH replied it would apply to all out-of-pocket expenses for health care. It does not create a separate category of costs above $5,000. Number 174 SENATOR ELTON asked, "I may have missed this Terri, so I just want to bore in a little bit more on the indirect amendment. What prevails? I mean, does a court rule that is directly - I mean do the statutes prevail or does this force a change in the court rules?" MS. LAUTERBACH said the answer to that question, in the context of SB 207 only, is that Rule 90.3, which applies to child support, was specifically adopted by the Alaska Supreme Court under its interpretive authority. A two-thirds vote of the Legislature is not required to change it, unlike most other court rules. In this situation, the statute will prevail. SENATOR ELTON commented that Rule 90.3 was put in place because there was no controlling statute. MS. LAUTERBACH agreed, and added at the time the federal government required states to have child support guidelines. SENATOR TAYLOR asked an inaudible question. MS. LAUTERBACH replied as part of a welfare reform bill, in about 1986 or 1988, the federal government required each state to adopt child support guidelines in order to make child support awards more uniform within the states. About two years later, the federal government required states to enforce those guidelines. The Legislature did not act so the Alaska Court System did. SENATOR TAYLOR asked if part of HCS SB 207(RLS) is meant to resolve that federal obligation. Number 243 CO-CHAIR DYSON noted that the federal government requires that a custodial parent who applies for Medicaid or government health care services have a medical support order in place. Custodial parents have to jump over many hoops to get Medicaid for their children in Alaska because Rule 90.3 does not separate medical support orders for children. CSED has been forced to establish somewhat phony financial support orders for families that do not have one in place so that the custodial parent can jump over that hoop to get Denali KidCare. [Due to static, part of CO-CHAIR DYSON's testimony is inaudible.] At the same time, the phony support order might have an enforcement action which is absolutely bizarre. He believes CSED wants to get out of the awkward situation of not being able to satisfy the federal requirements for Denali KidCare because no medical support order is available. SENATOR TAYLOR said his concern is that this bill has nothing to do with the subject at hand. It expands the Denali KidCare program and will have a huge financial impact in the future, which is primarily a policy call. Although he probably supports that program, people should be aware that SB 207 is not just an innocuous bill that will merely take care of some paperwork. He cautioned that next session the Legislature will be looking at a significant increase in the Denali KidCare budget if this bill passes. CO-CHAIR DYSON pointed out the Administration would claim that the purpose of SB 207 is to meet the needs of those children because the parents could go through all of the hoops anyway. This bill makes the hoop more fair and direct. He added the Administration has said that the cost to the State of the Denali KidCare program is 28 cents for each federal dollar. REPRESENTATIVE BRICE commented that he has received a lot of phone calls from people who said they do not need child support but they do need health insurance. He believes this bill gets to the heart of the problem and he is comfortable with it. HCS SB 207(RLS) will set up a system where divorced parents can cooperatively ensure that their child gets medical coverage. He noted that medical support orders appear to be exempted from Sections 18 and 19 so that a parent cannot lose an occupational or driver's license if they are at odds with the custodial parent. He asked Ms. Lauterbach to address those sections. MS. LAUTERBACH explained that Sections 18 and 19 make reference to the payment of child support which, in this case, refers only to the periodic payments. She clarified those sections for the House committee because that definition seemed most consistent with what had passed before. She noted that the sentence on page 10, lines 28-29, refers to arrearages and she interpreted that to apply only to the monthly payment amount. She was not sure how to apply that concept to medical support so she clarified it in the easiest way possible for the committee to review at the time. REPRESENTATIVE BRICE said the sections are specific to periodic payments so that if CSED takes a person's driver's license or means to make a living it must be for hard dollars. He pointed out that quite often medical benefits are tied to a person's job. SENATOR TAYLOR stated that he thinks the ongoing system assumes everyone works for the State of Alaska and takes home a regular check every month. He said this bill not only makes a person criminally responsible for non-payment of child support, but for non-payment of health care, and the bill adds a section [Section 1] which contains draconian penalties. He stated when people are out of work in his district, married or not, they cannot pay their bills and their kids have no coverage. He surmised that the fastest way to get health care coverage for kids is to get divorced. Now, under this bill, CSED can throw the non-custodial parent and that person's employer in jail if medical coverage is not made available. He expressed concern that this policy creates a significant disparity between married people with children and those who are divorced. He thought the Legislature is going way overboard in its attempt to make sure that all children are always taken care of. He noted it is a great goal but in his district he has a hard time getting "that blood out of that turnip." MS. LAUTERBACH pointed out that Section 1 of the bill is not aimed at the obligors; it is aimed at people who employ the obligors and do not give information about whether they provide health insurance or what the price is. This is not a new crime. SENATOR TAYLOR stated there is a new section for obligors separate from this one. MS. LAUTERBACH replied it is not in the bill so it has not been amended to do anything about medical payments. CO-CHAIR GREEN asked if Section 1 is about the employer. MS. LAUTERBACH said it is. CO-CHAIR GREEN asked if that section is not new but that it is being amended. MS. LAUTERBACH explained the crime is not new but a new section had to be added to the bill. CO-CHAIR GREEN asked what CSED's procedure is when it asks for information from an employer. MS. SHIRLEY DEAN, CSED, explained that CSED sends a letter to employers asking if a person is an employee and how much that person earns. CO-CHAIR GREEN asked if CSED will now supplement that request with information about health care coverage. MS. DEAN said CSED currently asks employers whether the employee is offered health care coverage for children through the employer's insurance plan. If health care coverage is not available, CSED takes no action. CO-CHAIR GREEN asked what CSED would do if an employer gave incorrect or inadequate information. MS. DEAN replied the case worker would turn the case over to the investigative unit. To her knowledge, CSED has never prosecuted any employer for failing to provide medical information. SENATOR TAYLOR surmised that CSED never prosecuted anyone for failure to give medical information because CSED only has the authority to request information. This bill will create a new area. MS. DEAN remarked if CSED requested that information from an employer and was given false information, CSED could prosecute the employer under current law. Number 364 CO-CHAIR GREEN expressed concern that the federal government will eventually get out of the Denali KidCare program leaving the cost of the entire program to the State. She asked whether any of the language in HCS SB 207(RLS) creates a direct link to the Denali KidCare program. MS. DEAN replied not as far as she knows. The only link that CSED has occurs when a parent applies for Denali KidCare. CSED is then required to set up a child support order on behalf of the child. CO-CHAIR GREEN asked if it is for the reason mentioned earlier. MS. DEAN acknowledged that is part of it but some parents have independently made financial agreements and get along fine but have no insurance available. Those parents only want the medical support order. SENATOR TAYLOR surmised that in 99 per cent of those cases, if either parent has insurance available, it covers the children. MS. DEAN answered sometimes, but there are parents for which everything is fine except the insurance. SENATOR TAYLOR said he understands this will give CSED a huge hammer to make them do it but he hates to see the Legislature restructure all of the laws in this State to do something for the federal government. MS. DEAN pointed out that under current law, if a parent signs up for Medicaid for the children, CSED must set up a child support order. This bill will allow CSED to only set up a medical support order only. SENATOR TAYLOR said if an indirect amendment of court rules was possible, he would have all kinds of legislation that would indirectly affect a court rule. MS. LAUTERBACH asked committee members to look at Section 25 of HCS SB 207(RLS). She pointed out that the reason a two-thirds vote of the Legislature is not required for this court rule change has nothing to do with whether it directly or indirectly amends the court rule. A two-thirds vote is not required because Rule 90.3, by the Alaska Supreme Court's own admission, was adopted under its interpretive authority under Article IV, sec. 1 of the Alaska Constitution. It was not adopted under Article IV, sec. 15, which pertains to rules of practice and procedure and rules of administration. The Legislature must have a two-thirds vote to amend a rule of practice and procedure. SENATOR TAYLOR recalled that the Supreme Court asked the Legislature to set policy in this area on three different occasions but, having failed to do so, the Supreme Court exercised its interpretive authority. The Supreme Court knew it was creating a substantive law of whole cloth and asked the legislature to take it up but no one has had the courage to do so. He tried several times but each time his efforts were shot down. He does not believe it was an appropriate thing for the court to do, but what frightens him are the very words "notwithstanding Article IV, sec. 15,". He found that language to be shocking. MS. LAUTERBACH stated that Section 25 of the bill could have been reworded to read something like, "Even though sec. 15 says a rule of practice and procedure needs a two-thirds vote, this is not a rule of practice and procedure so two-thirds is not required." She emphasized that the word "Notwithstanding" does not mean the Legislature knows it is doing something unconstitutional but chooses to do so anyway. She pointed out that same provision is included in any bill that refers to Rule 90.3. CO-CHAIR GREEN asked if a two-thirds vote has never been required of the Senate to change Rule 90.3. SENATOR TAYLOR noted not much has been done with Rule 90.3. MS. LAUTERBACH added it is a hard policy call. SENATOR TAYLOR asked if Rule 90.3 has been amended by the Legislature. CO-CHAIR GREEN said the Legislature tried but nothing passed. MS. LAUTERBACH clarified that one amendment to HCS SB 207(RLS) was added to make sure that Indian Health Service (IHS) coverage is considered. That was not included in Rule 90.3 but it was put in statute so the court had to amend Rule 90.3. The second change is in regard to payment of support to 18 year olds who are emancipated. SENATOR TAYLOR said he thought the Legislature passed a law but left it up to the court to make the decision about changing the court rule. Number 461 CO-CHAIR DYSON said that one thing that helped him philosophically with the changes made to the bill was the possibility that a very wealthy non-custodial parent could self insure his or her own medical care. If one of the children suddenly had a significant medical emergency and the custodial parent went to Denali KidCare, the non-custodial parent could never be held accountable for any costs because that parent had no insurance, which is the only standard that can be applied. HCS SB 207(RLS) now allows the non- custodial parent to meet that obligation with means other than insurance. He added that the House's experience with Governor's bills is that they have been drafted very narrowly. The legislative legal team takes a broader view and looks at the bill's affect on other statutes. SENATOR TAYLOR asked if the bill contains an exemption for parents of certain religious beliefs, such as a Christian Scientist. CO-CHAIR GREEN noted that issue was brought up in a hearing about long term care. MS. LAUTERBACH thought that issue would arise when a child needs health care, regardless of whether child support is involved. If the health care is provided, an expense is incurred and both parents are obligated to pay that expense. If the health care is not provided because of a religious objection, then no expense will be incurred. She asked why an exception should be included in HCS SB 207(RLS). SENATOR TAYLOR said he was thinking of a case in which one parent is a Christian Scientist and the custodial parent is not. MS. LAUTERBACH stated both parents are responsible for the child's expenses. SENATOR TAYLOR noted that even before an expense is incurred, a court order will be issued and CSED will have all kinds of authority including lien authority, withholding of wages authority, etc. MS. LAUTERBACH said she was confused to the extent that this is a conference committee talking about two versions of a bill and the issue of religious beliefs is outside of either bill. SENATOR TAYLOR said a free conference committee just met that morning and incorporated an issue outside of a bill. CO-CHAIR GREEN asked if the subject of religious beliefs would be part of the divorce decree. SENATOR TAYLOR said it may but it may not. He thought it is possible that one parent may insist on medical coverage while the other does not believe in it. MS. LAUTERBACH thought in that situation the parents would probably go back to court and one parent would get custody because if the parents cannot agree, the court will not award joint custody. She added that once custody is imposed on one parent or the other, both share the expenses. SENATOR TAYLOR pointed out that this bill does not address who has custody. It states that both parents are obligors. He thought if the Legislature is going to impose this bill, it should contain an escape valve for parents in that situation. He recounted the story of a man from Wrangell who became frustrated because his union was deducting money from his wages to be used for various purposes, some of which violated his religious beliefs. He took that case to the U.S. Supreme Court and the union was found to be in violation. The court ruled that the employer was to deduct the same amount of money but it was to be donated to the employee's church or another charity. He thought this issue to be significant because the bill could impose obligations that conflict with a person's religious beliefs. CO-CHAIR DYSON said, considering the late date in the session, if this legislation does not pass, the same bad things will happen with the added complications of the bogus financial support orders. He assumes that when a court issues a medical support order or a financial support order, a parent would make a case before the court at that time if the order conflicts with the parent's religious beliefs. If, indeed, a parent finds out later that his or her money is being used to pay for medical services that the parent is uncomfortable with, the parent would go back to court to reconcile the issue. SENATOR TAYLOR said CO-CHAIR DYSON is assuming the parent has the money to go to court. He noted that 90 percent of these cases will be handled administratively by CSED. CO-CHAIR DYSON said the House strengthened SB 207 so that CSED, through administrative procedures, can go beyond the court's ruling. SENATOR TAYLOR noted that the bill on long term care was amended to provide for a very narrow exception for patients who do not want to have certain treatments. He suggested the exception would be used by very few people but an exception should be considered. Number 564 CO-CHAIR GREEN suggested amending line 13 on page 7 (Section 7) so that a parent could establish religious beliefs as good cause. She said she believes there is a compelling reason to have everyone involved in the rearing of a child involved in their general care. She asked Ms. Lauterbach if the phrase "good cause" allows room for an argument about religious beliefs. She also noted that just because a parent has an objection to hospitalizing a child for religious reasons, that parent could pay for other expenses incurred. SENATOR ELTON thought Senator Green was making a good argument. He asked Ms. Lauterbach if she believes that a religious objection could be adjudicated under the phrase, "unless there is good cause to allocate the costs unequally." MS. LAUTERBACH replied she believes this is an avenue that could be used both with CSED or in court. She pointed out it goes both ways because the other parent may have to pay charges for a Christian Scientist practitioner. TAPE 00-1, SIDE B SENATOR TAYLOR said he is not certain that the previously mentioned language is sufficient but he hopes it is. He added that he thinks it is a good discussion to have on the record. CO-CHAIR GREEN agreed. CO-CHAIR DYSON asked if the conference committee has the authority to amend HCS SB 207(RLS). SENATOR TAYLOR answered not at this point. CO-CHAIR DYSON noted the House HESS Committee was relatively pleased with the work it did on SB 207 and believed it improved the bill. He encouraged Senators to concur with those changes. He stated if the Senators find a solution to the question of religious beliefs and amend the bill on the Senate floor, he will encourage House members to support that change. REPRESENTATIVE COGHILL informed Senators that House members started from the absurd and worked their way through the problem of having medical support orders when needed. Through the discussion, it came out that the IHS is the last payer of resort, Denali KidCare or Medicaid is the next payer, and the first payer is the parent obligor. The House tried to broaden the bill to get as close as it could to requiring that private insurance be applied when there is a need. House members were satisfied that this bill goes in that direction. He questioned how Section 2(b)(2) on page 2, lines 21 and 22, applies to the employer. MS. LAUTERBACH replied that Section 2 provides a defense to a person who is being prosecuted under Section 1(a) and it contains two defenses: paragraphs (1) and (2). The defendant could prove that he or she did not intend to assist in the nonpayment of support. CO-CHAIR GREEN asked if the word "defendant" could be replaced by the word "employer." MS. LAUTERBACH thought that relates more to Section 1(a)(2)(C), which pertains to an arrangement with the obligor to sell something at less than fair market value. The defense would be that the obligor might have sold something at less than fair market value but did not intend to avoid paying child support by doing so. REPRESENTATIVE COGHILL asked if a person could be held criminally negligent if he or she did not have health care coverage. CO-CHAIR GREEN asked if he is implying one is able to pay. MS. LAUTERBACH clarified that nothing in the bill requires anyone to have insurance that is not available to them through their employer. REPRESENTATIVE COGHILL said the scenario of a person who is independently wealthy but has no health insurance came up in the House HESS Committee. MS. LAUTERBACH said subsection (C) on page 2, lines 6-14, talks about selling things for less than fair market value, not about a general situation of not paying. It is specific to a scheme to get out of paying child support. She added if a person did sell something at less than fair market value and still paid child support and health care coverage, no criminal charges would apply. SENATOR TAYLOR referred to a previous statement about first, second and third payers of choice and asked for clarification. CO-CHAIR GREEN said she did not think anything was set up in this bill to that affect, she thought that is just the way it is. Number 524 SENATOR TAYLOR cautioned that this bill may be moving a lot of people on to Denali KidCare or on to Medicaid so they will no longer qualify for IHS benefits. MS. LAUTERBACH explained that language on page 6, Section 7, lines 29-31, speaks to that issue and reads, "The court or agency shall consider whether the child is eligible for services through Indian Health Service or other insurance before ordering either parent to provide health coverage through insurance or other means." REPRESENTATIVE COGHILL noted that House HESS Committee members were told that IHS is the payer of last resort when it comes to Medicaid. REPRESENTATIVE BRICE pointed out that IHS is only available to Natives. He understood that the State would look at IHS as being the primary payer of resort and Medicaid the last. CO-CHAIR GREEN asked a representative of Denali KidCare to explain the rank of the payers. MR. KEVIN HENDERSON, Division of Medical Assistance, DHSS, explained that under federal law, Medicaid is the payer of last resort with the exception of IHS. But, in all regular Medicaid claims, Medicaid requires private insurance carriers to pay first. CO-CHAIR GREEN asked if he is using the term "Medicaid" interchangeably with Denali KidCare. MR. HENDERSON said yes. He clarified that Denali KidCare is a new coat on a Medicaid expansion that was authorized under federal law and the State receives enhanced federal matching funds. While Denali KidCare was an impetus behind HCS SB 207(RLS), the bill applies to all Medicaid recipients. REPRESENTATIVE COGHILL said that point needs clarification because there was some confusion in the House HESS Committee about whether the parent was initially expected to pay first or whether Medicaid was expected to pay first. CO-CHAIR GREEN asked Mr. Henderson to give the committee the "pecking order" of how medical obligations are fulfilled. MR. HENDERSON explained that if a child receives medical care and is Medicaid eligible, Medicaid will not pay on the claim if private health insurance is available. CO-CHAIR GREEN asked Representative Coghill to repeat his question. REPRESENTATIVE COGHILL read the following from page 6, lines 29 through 31, "The court or agency shall consider whether the child is eligible for services through the Indian Health Service or other insurance coverage," and said he was questioning whether the "other insurance coverage" means first the parent and then Medicaid if there is indigence or whether it is the other way around. MR. HENDERSON replied it is not Medicaid. He thought where this bill refers to the IHS and other insurance, it is talking about establishing a medical support order which is different. When a medical support order is established, CSED will look at whether IHS coverage is available or whether private health insurance coverage is available. If either is available, CSED is probably not going to pursue a medical support order. CO-CHAIR DYSON noted that nothing in the bill occurs unless someone applies for Medicaid - that is the triggering event. If a person does apply, DHSS cannot offer Denali KidCare without a medical support order. When CSED does the medical support order, it will first see if the applicant qualifies for IHS and, if not, it will determine whether private insurance is available. If the bill passes, CSED will also determine whether either parent is capable of paying the cost out of pocket. The House HESS Committee inserted language so that before a child qualifies for Medicaid, CSED must see whether a parent is capable of paying the medical costs out of pocket. MR. HENDERSON said that is generally accurate but, when CSED is deciding whether to establish a medical support order, it will look at whether the child is already covered by private health insurance. If so, CSED will not bother with a medical support order. SENATOR TAYLOR pointed out that lines 25 and 26 on page 6 read, "Regardless of whether a support order for periodic payments is issued, the court or agency shall issue a medical support order." He noted this is not only triggered when a person applies for Medicaid. MS. LAUTERBACH stated that Section 7 applies to any child, whether on Medicaid or not. Section 7 allows any child to have either a medical support order or a periodic financial payment support order, or both. It allows CSED and the court to split those two concepts for any child, not just one on welfare. SENATOR TAYLOR remarked Section 7 applies to every court proceeding involving divorce and custody. MS. LAUTERBACH added, "Where the support of a minor child is at issue." SENATOR TAYLOR stated that this bill will require the court or agency to establish a medical support order for every child in every divorce or dissolution case, regardless of whether a financial support order is issued. MS. LAUTERBACH pointed out that current law requires the court to issue a medical support order. The whole purpose of SB 207 is to allow a medical support order to be issued separately from a financial support order. SENATOR TAYLOR stated the court will be required to consider whether services are available through IHS. He said he can guarantee that there are a lot of children eligible for IHS whose parents choose to use Denali KidCare instead. MR. HENDERSON agreed and said federal rules allow a person the freedom of choice of providers. The person can choose to use a private provider and have Denali KidCare or Medicaid cover the cost. SENATOR TAYLOR said he has a problem with a person choosing State coverage, which the State has to pay for, when the person has IHS coverage, which is covered by the federal government. CO-CHAIR GREEN asked if the Legislature has the ability to change that since it is a federal provision. REPRESENTATIVE BRICE said his understanding is that the IHS does not have a program similar to Denali KidCare. He thought, however, the State was reimbursed by IHS for providing services to IHS eligible patients. MR. HENDERSON said he believes that is true but he is not an expert in that area. SENATOR TAYLOR asked how one would know. He asked if the Medicaid application asks for a racial designation so that a determination can be made. MR. HENDERSON replied the applicants are only asked if they are IHS eligible. SENATOR TAYLOR asked if once applicants say they are IHS qualified, all of their bills are sent to IHS. He pointed out he finds this significant because HCS SB 207(RLS) will allow support orders to demand parents to provide coverage through their workplace and meanwhile the whole family might be covered by IHS. MS. DEAN emphasized that CSED requires parents to take medical insurance if it is available at a reasonable cost. That is what this bill would do. There is also a place on the DR 300 where parents can check whether they have other health coverage, such as IHS, when getting a divorce. If a parent has IHS coverage, CSED considers the DR 300 to be the medical support order. CO-CHAIR GREEN asked if a person gave false information about being IHS eligible, whether CSED would consider that fraud. MS. DEAN thought that would be turned over to CSED investigators. She pointed out that CSED only gets involved when a parent applies for CSED services or when a child receives Medicaid. SENATOR TAYLOR said his only thought is that each time a divorce proceeding occurs, judges now have to be attuned to the Supreme Court decision on which tribe is turned to regarding which person the judge can grant custody to. He noted he always worked with Tlingit and Haida and never had any problems because they always did what was best for the child but he does not think that is long lived. MS. DEAN replied CSED would consider IHS as medical coverage or a parent could provide double coverage. The committee took a brief at-ease from 5:30 to 5:31 p.m. SENATOR TAYLOR recommended that HCS SB 207(RLS) be moved back to the Senate floor for action. There being no objection, it was so ordered. There being no further business to come before the committee, CO- CHAIR GREEN adjourned the meeting at 5:32 p.m.
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