Legislature(2009 - 2010)HOUSE FINANCE 519
02/26/2010 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB300 || HB302 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 280 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 300 | TELECONFERENCED | |
| += | HB 302 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HOUSE BILL NO. 300
"An Act making appropriations for the operating and
loan program expenses of state government, for certain
programs, and to capitalize funds; making supplemental
appropriations; making appropriations under art. IX,
sec. 17(c), Constitution of the State of Alaska; and
providing for an effective date."
HOUSE BILL NO. 302
"An Act making appropriations for the operating and
capital expenses of the state's integrated
comprehensive mental health program; and providing for
an effective date."
1:40:12 PM
Co-Chair Hawker commented on the importance of today's
topic. He shared that the task of the committee professional
consultant was to explain the increased funding for
Medicaid. He informed that the consultant's task was to
research the numbers and project a trend analysis. This
would be a cross checking of the facts and funding. Co-Chair
Hawker stated that after her commentary, William Hogan,
Commissioner, Department of Health and Social Services will
present his observations.
JANET CLARKE, CONSULTANT, HOUSE FINANCE COMMITTEE, contended
that her task was to look at the Medicaid numbers and
analysis to answer a few basic questions. She noted that she
had compiled a 21 page report and a PowerPoint presentation
(Analysis Alaska Medicaid Trends, FY2010 & FY2011, Prepared
for the House Finance Committee, February 2010 by Janet
Clarke Consulting, referred to as the Report, and PowerPoint
Analysis Alaska Medicaid Trends FY 2010 & FY 2011, Prepared
for the House Finance Committee, February 2010, copies on
file).
Ms. Clarke commenced with her PowerPoint presentation. She
declared that the purpose of this analysis was to review the
Medicaid program, determine what is contributing to the
skyrocketing costs and assist the finance committee in
determining what the appropriate level of spending would be.
She added that the Department of Health and Social Services
(DHSS) had requested a large supplemental for FY2010
totaling $88.4 million. The department also submitted a
large budget amendment of $95 million which would bring the
overall incremental spending for Medicaid in FY2011 to
$166.6 million. She referred to page 2 in the Report and
page 3 in PowerPoint to define Medicaid. Medicaid is an
entitlement program created in 1965 by the federal
government, but administered by the state to provide payment
for medical services for low-income citizens. The federal
and state governments share the cost of Medicaid, which is
referred to as the Federal Medicaid Authorized Percentage
(FMAP). If the stimulus bill had not passed, Alaska's FMAP
would have been approximately 50 percent, but because of the
stimulus the FMAP is 61.12 percent for the federal
contribution. She referred to the chart, Annual Medicaid
Spending FY2000 to FY2011 that reflects some of the history
and growth in Medicaid. In FY2000 to FY2005, there was rapid
growth in the program, doubling the program costs. The blue
line shows Total Funds and the red line shows General Funds.
In 2005 there were efforts to do some cost containment of
Medicaid. From FY2005 to FY2010 the costs were flat; they
even declined in FY2007 and FY2008.
Co-Chair Hawker interjected this was achieved without any
reduction in the services or programs.
Ms. Clarke explained that was true, but it also had to with
a good economy where people had higher incomes and did not
need the coverage. She noted the 17.4 percent increase in
FY2010 and the 5.8 percent increase in FY2011.
1:50:13 PM
Representative Austerman referred to page 2 in the Report
noting on the chart the initial growth starting with FY2000
and asked Ms. Clarke if that was in federal dollars. Ms.
Clarke replied that most of it was federal dollars, but
added that the general funds also doubled even though it
took longer. She mentioned some special-to-Alaska FMAP rules
written into law by former Senator Murkowski. This FMAP had
the federal government paying at 60 percent instead of 50
percent. There was also a child health startup program and
efforts by the federal government to pay a higher part.
Representative Austerman asked if the negative in FY2007 and
FY2008 were in both federal and state contributions. Ms.
Clarke replied yes; there were many efforts to control
spending.
Co-Chair Hawker added that the growth of the Personal Care
Attendant Program was a major concern of many groups in the
state.
1:53:33 PM
Representative Gara questioned if the huge spike in total
Medicaid payments compared to the less steep spike in the
state payments was attributable to the higher FMAP. He asked
Ms. Clarke for a historical perspective of the FMAP. Ms.
Clarke responded that historically the FMAP was 50/50
percent for number of years, but former Senator Murkowski
bumped the federal payment up to 60 percent which came to an
end when Congress lowered it back down to 50 percent.
Representative Gara referred to the Annual Medicaid Spending
graph which makes it look like the federal rate of total is
much steeper than the state rate, but he did not think that
was true. Ms. Clarke replied that was correct. The general
funds look artificially low for FY2010 and FY2011. She added
that when the stimulus FMAP goes away in December 2010,
although it could be extended through FY2011 in President
Obama's budget, the state will face a $100 million cost to
the state in FY2012.
1:56:30 PM
Vice-Chair Thomas asked how large the Medicaid bill would be
if there were no tribal clinics and hospitals. Ms. Clarke
responded that it would be a $150 million more.
Representative Salmon mentioned a report of nonprofits in
Anchorage and that the state was funding their programs. He
questioned where this money was coming from. Ms. Clarke
answered that did not know.
Representative Doogan surmised that if this was a 50/50
match on those numbers, than the cost would equal $900
million each, but because there is a 60/40 mix, the state's
share would still be higher. He queried if the difference
was because there are 100 percent federal programs in this
mix as well. Mr. Clarke responded that he was absolutely
right that some services and programs qualify for 70 to 100
percent federal money.
1:59:17 PM
Representative Doogan remarked if there is a return to a
50/50 match on those numbers after the stimulus ends, he
wondered how much of the total will be affected. Ms. Clarke
replied that it would depend on the national formula, but it
could be anywhere from $100 million to $120 million.
Co-Chair Hawker added that the current year benefit of the
federal stimulus FMAP was $125 million for the fiscal year.
2:00:32 PM
Ms. Clarke explained the Factors of Medicaid Growth
(PowerPoint, page 5, Report, page 4). Medicaid is an
entitlement program therefore if people meet the eligibility
requirements for the services, then they get those services.
She reported three key components to growth in the Medicaid
program: Price, Population and Utilization. The price
changes are measured by looking at the change to the
Consumer Price Index (CPI). The change in the Anchorage CPI
is approximately 3 percent for the first 6 months of 2009.
She noted other increases could be rate increases. The
department and legislature have worked to increase some
rates given to Medicaid providers. Last year there was 15
percent rate increase for physicians that were built into
the overall budget.
Ms. Clarke continued with the PowerPoint chart, page 6, on
Medicaid Enrollment FY2010. The bar chart shows three
population groups in Medicaid: elderly (green), adult (red),
and children (blue). In the overall enrollment from July to
December 2009 grew by 6900 individuals, 6100 were children.
This shows that 90 percent of the overall growth is due to
more children in the program with the elderly and adult
statistics fairly stable at approximately 1 percent to 2
percent. On page 7, Medicaid Children Monthly Enrollment
going back to July 2008, the blue bar is Regular Medicaid-
below 150 percent of the Federal Poverty Level (FPL) and the
red is the Denali KidCare program from 150 percent to 175
percent FPL. In July 2008 there were 60,000 enrolled
children and in January 2010, there were over 70,000. This
translates into 11,000 additional children in eighteen
months.
2:06:11 PM
Co-Chair Hawker commented on the acceleration of Medicaid
starting in FY2009. When working on the budget there was a
stable trend line, but the point of inflection hit as the
budget was being closed out.
Ms. Clarke said it was interesting that there was a decline
in the number of children then a big surge occurred in March
2009. She continued to page 8, showing Medicaid Recipients
Total back to July 2008. This covers the adults (blue),
children (red), disabled adults (green), disabled children
(purple) and the elderly (aqua). She noted the volatile ups
and downs of the red (children) line. On page 9, the
Medicaid Children Monthly Recipients showed in the bottom
chart that one year ago the trend in recipients was in
decline as the wave had not yet hit. She emphasized that it
is the children in Medicaid that have help trend the rise in
costs.
Ms. Clarke moved to the Cost per Medicaid Enrollee, page 10.
This chart looks at the cost from 2006 to 2010 looking at
three different forecasts models: High, Low, and Checkwrite.
High uses a statistical model based on enrollment that is a
higher forecast. In this chart the High forecast would be
$9,000. The Low forecast is a hybrid of the statistical
model which is $8,662. There is also a Checkwrite projection
that reflects the average weekly checks written. This is at
$8,334, the lowest projection.
2:13:53 PM
Representative Austerman asked if the numbers for 2006,
2007, and 2008 are actual numbers. Ms. Clarke responded that
they were. He asked if the numbers for 2010 are known so
far. Ms. Clarke replied that $680 million has been spent in
the past seven months through January.
Representative Austerman asked how this equates to a dollar
figure on the graph. Ms. Clarke answered that it figures
between the Low and the Checkwrite projection.
Representative Austerman inquired if this is following a
trend. Ms. Clarke contended that spending tends to
accelerate faster in the spring. Representative Austerman
asked if he can interpret that payments will continue to go
up through the year. Ms. Clarke responded yes.
2:16:12 PM
Ms. Clarke continued to the Alaska Public Assistance
Caseload Trends, page 11. This chart shows caseloads in
Medicaid (green), Food Stamp Program (red), Adult Public
assistance (purple), Alaska Temporary Assistance & Tribal
(yellow) and Unemployment rate (blue). The Unemployment line
shows a lot of similarity to the Food Stamp program and the
Medicaid growth line. Unemployment in December was at 8.8
percent, the highest in ten years. The economy in Alaska is
having an impact on the caseloads of public assistance. She
indicated that the growth between unemployment and Medicaid
was almost the same.
Representative Gara asked if the qualifier for basic
Medicaid and food stamps was 150 percent of the poverty
level. Ms. Clarke said she would get that information to
Representative Gara.
Representative Salmon asked what the yellow line letters
refer to. Ms. Clark replied that the yellow line is the
Alaska Temporary Assistance and Tribal Assistance program.
She elaborated that this program has been a great success in
Alaska with the Department of Health and Social Services
(DHSS), the Division of Public Assistance, and the Tribal
partners. The program has a five year life-time limit where
people are encouraged to go to work. Representative Salmon
asked if this trend was higher five years ago. Ms. Clarke
responded that there is a chart that shows the program back
to 1997 reflecting a decline in caseloads.
2:21:21 PM
Ms. Clarke continued that in addition to looking at the
unemployment rate, it was noted that the population increase
in 2009 grew at its highest rate in years. The birth rate
was also higher than it had been since 1992 and previous
studies have shown Medicaid pays for 40 to 50 percent of
births in Alaska. There could also be a delayed impact from
SB27, the Denali KidCare program which in 2003 was changed
from 200 percent to 175 percent poverty level. In the
statute it was changed to a fixed rate, tagged to whatever
the income standard was in 2003 at 175 percent, so by 2007
it equated to 154 percent of the Federal Poverty Level. The
legislature made a change and put in statute the income
level at 175 percent. In the fiscal note it was believed
that half the children, who had dropped off the Denali
KidCare, about 2500, would return by FY2008. There has been
a delayed impact on the children's return to the program.
She remarked that another contributor has been the H1N1
virus inoculations and the talk of federal health care
reform. Studies have shown that when the talk of health care
reform occurs, there is an increase in Medicaid.
2:24:58 PM
Ms. Clarke referred to page 14 in the Report and page 11 on
the PowerPoint presentation, Alaska Public Assistance
Caseloads Trends.
Representative Salmon noted that the Adult Public Assistance
(purple) line is straight and asked why it did not follow
the Unemployment Rate (blue) line. Ms. Clarke responded that
Adult Public Assistance provides cash payments to the
elderly and disabled who qualify.
Representative Foster requested that for the future it would
be interesting to see the correlation between the cost of
energy and the public assistance programs and if there is a
greater impact in the rural or urban areas. Ms. Clarke
responded that the Medicaid program could provide these
reports.
2:27:16 PM
Co-Chair Hawker asked for the primary focus and interplay
between rural and urban when it comes to Medicaid and other
public assistance services. Ms. Clarke replied that Medicaid
demographics follow Alaska demographics. In rural areas if
someone qualifies for tribal health then the state will see
100 percent coverage from the federal government. This helps
support Alaska's infrastructure and afford better health for
the entire state.
Co-Chair Hawker speculated that in looking at the
significant growth of total funds, in the federal more
rapidly than the general funds, there may be a higher demand
in the rural areas where they are receiving 100 percent from
the federal government.
2:30:08 PM
Ms. Clarke turned to page 12 in the PowerPoint presentation
that looks at the three different forecasts in the Medicaid
enrollment program issued every month. In April 2008 the
High forecast (red line) number was $1.13 billion and the
Low forecast (green line) was $1.04 billion and the
Checkwrite forecast (blue line) was $984 million. These
forecasts converge when the actual spending numbers are
listed in June. In FY2009 the forecast converged again at
$1.07 billion in spending. She indicated that this is a
billion dollar program and growing. The Medicaid projections
for January FY2010 are for the High forecast at $1.26
billion, the Low forecast is $1.21 billion and the
Checkwrite at $1.16 billion. There is a difference of $100
million between the forecasts. Ms. Clarke continued to page
17 in the Report and page 13 in the PowerPoint presentation,
the FY2010 Monthly Medicaid Spending. She noted that in
FY2010 there are 53 weeks of Checkwrite spending.
2:34:08 PM
Representative Fairclough noted on page 15, paragraph 5, of
the Report that the state lost three different court cases
that restored access and services restricted by the 2006
legislative intent. She inquired if Ms. Clarke was going to
address if something could be done legislatively to control
cost. Ms. Clarke recommended talking with the Department of
Law about what might be done in that area. She furthered
that when the legislative intent was put into place the
spending for the program dropped from $90 million to $70
million. Ms. Clarke urged the legislature to think about the
stimulus FMAP in terms that if the money is accepted
eligible groups and services cannot be cut, therefore there
is a built in restraint to do anything regarding these
services. She believed that in the future if the legislature
needs to contain the costs in Medicaid it needs to be put
into legislation not just legislative intent, but she
emphasized that there will be challenges if services or
eligibility is changed making it difficult for anyone to
make changes.
Co-Chair Hawker suggested that the Department of Law might
have some thoughts on ways to deal with situations presented
in the lawsuit.
Representative Fairclough indicated her interest in knowing
what was reinstated by the court cases and, if the changes
were not the intent of legislature, then what would be the
best way to talk to the courts.
2:37:46 PM
Ms. Clarke reiterated that $680 million has been spent
through January 2010 which equates to $97.3 million a month.
If the monthly spending for the next five months reaches
$105 million, then the year-long budget will be $1.2
billion.
Representative Gara contended that people with no health
insurance who often go to the emergency room for services
are probably not people covered by Medicaid, so he believed
adjusting that population would not affect the budget. Ms.
Clarke responded if they go into a hospital and are
qualified for Medicaid then they are probably already signed
up. Representative Austerman asked for a repeat of the
numbers projected Medicaid numbers. Ms. Clarke repeated the
figures and indicated that the numbers were getting close to
the $1.2 billion she earlier indicated.
2:40:12 PM
Ms. Clarke pointed out the charts on page 16 of the Report,
FY2010 Medicaid Supplemental Requests. The $88.4 million
supplemental request reflects the High forecast. She
suggested that spending is trending toward $1.2 billion
which is $60 million less than being requested. She cited
that there can be unexpected costs and unforeseen efforts
that happen at end of year. She recommended a 2 percent
cushion for the department, funding the Medicaid Low
forecast. This would save $7 million in general funds.
Co-Chair Hawker reiterated that the $7 million differential
is between Ms. Clarke's analysis and the department's
supplemental request. He believed this speaks well to how
the two groups have worked together. Ms. Clarke agreed that
judgment calls were being made around the margins.
Representative Gara responded that these will not impact the
costs in the department only if they need a supplemental for
the future. Ms. Clarke interjected that the supplemental is
for current year spending through the end of FY2010.
Representative Gara asked if Ms. Clarke is projecting the
need for an estimated $7 million less this year. He restated
that this will not affect the amount being spent, but what
is put into this budget. Ms. Clarke responded that she had
been asked to give her best recommendation of what would
happen. She agreed that Medicaid spending is what it is
because as an entitlement program, if a person is eligible
then they must receive it.
2:45:13 PM
Representative Gara reaffirmed that if the extra money was
overestimated then the department could not spend that extra
money. Ms. Clarke responded that typically there are
controls on supplemental spending, but it could not be spent
in other areas.
Co-Chair Hawker interjected that there is the ability of the
agency to use that extra money, but historically they have
not.
Representative Austerman commented that the department is
guessing the need for $88 million and Ms. Clarke is
estimating $74 million. Ms. Clarke clarified that her belief
is that Medicaid spending would be at the Low forecast.
Representative Austerman restated that this increases the
base for FY2011. Ms. Clarke believed this would be an
independent decision for FY2010. Representative Austerman
maintained that the decision made for FY2010 affects the
base for FY2011. Ms. Clarke answered that it does not affect
the base. Co-Chair Hawker interjected that supplemental
appropriations are not rolled into the base for the
following year budget.
2:47:39 PM
Representative Foster mentioned that an area of control in
Medicaid could be if there were more IHS facilities around
the state then the state could be paying less than the FMAP
50 percent. Ms. Clarke agreed that was correct on individual
basis.
2:48:55 PM
Ms. Clarke returned to the PowerPoint presentation on page
15, FY2011 Medicaid Budget Amendments. The Department of
Health and Social Services presented a $95 million budget
and Ms. Clarke declared her review at $78 million. She
referred to page 21 in the Report, FY2011 Medicaid Budget:
DHSS & Consultant Comparison. The blue line shows the
department requests for FY2010 and FY2011. The red line is
Ms. Clarke's analysis. She noted the interesting conclusion
is that in FY2011 they both reached the same place. This
verifies that the budget amendment from the department is
reasonable and fairly accurate. The only difference is the
path getting there; she did not believe that the increase
would be 17 percent, but more like 12 percent.
Representative Austerman requested a return to look at the
containment issues in 2006-2008 and how they were handled.
Co-Chair Hawker interjected that William Hogan,
Commissioner, Department of Health and Social Services could
probably offer some help in that direction. Representative
Austerman requested that information in writing. He
suggested looking back at the FMAP stimulus money, the
timeframe, and what changes that will take place at end. He
related his desire to explore the issue of legislation to
control the costs.
Representative Gara remarked that for those individuals who
qualify for Indian Health Service funding, the payment would
be at 100 percent federal, which helps the state. He asked
for clarification if an individual goes to a regular
hospital who qualifies for IHS program if they would still
qualify to receive the 100 percent payment. Ms. Clarke
replied no. The services must be in a qualified Indian
Health Service facility. Representative Gara asked if there
would be a savings if there were more Indian Health Service
facilities. Ms. Clarke responded that an opportunity is to
look at more long term care and nursing homes in rural
Alaska.
Representative Doogan asserted that he did not understand
the big spike in Medicaid costs starting in the beginning of
FY2009. He reiterated all the before mentioned information,
but his only assumption was that more people were using the
service.
Ms. Clarke replied that not all the tables and charts were
in the PowerPoint presentation. She indicated on page 10 of
the Report covering Recipient Trends that it compared the
enrollment and recipient growth rates. Enrollment growth for
FY2010 is 7 percent, recipient growth is 5 percent and
utilization is about 3 percent. She suggested that
enrollment growth is still growing and spending will be
about 12 percent above FY2009. The Department of Health and
Social Services requested 17 percent.
Representative Fairclough elaborated that Denali KidCare
implemented in at the High 175 percent and new enrollees are
in the back half of the year. Ms. Clarke agreed that was the
case. She believed there was a delay in the children
returning to the program.
2:59:20 PM
WILLIAM HOGAN, COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, responded to Ms. Clarke's report. He referred to
the Report on page 13 which covers a more concise analysis
of the various factors that led to the increases. He
emphasized that the growth in Medicaid is to be taken
seriously. The governor has committed to work with the
legislature to develop a process that can be used to look at
the Medicaid budget in preparing for the budget in FY2012.
The enhanced FMAP rate is available through January 2011 as
a result of the economic stimulus money. There are about six
different vehicles at the federal level that will extend the
FMAP rate through June 30, 2011. There are concerns that
beginning in FY2012, the department will need $120 million
in general funds to sustain the Medicaid program. Although
he emphasized that he did not like coming forward with a
supplemental budget, there have been occurring circumstances
that has driven much of this. He thought the best way to
deal with the growth in Medicaid is through economic
development and creating jobs.
Co-Chair Hawker interjected that during the budget process
last year Mr. Streur had a clearer picture that there was a
change in the state's economy on the horizon.
Representative Fairclough asked if it would it be possible
to look at the industries where unemployment is happening.
Commissioner Hogan responded that there is data on where
people go when they leave the public assistance rolls. Co-
Chair Hawker agreed following up on this data made a lot of
sense.
Representative Austerman requested an analysis of people
moving to Alaska for work. Co-Chair Hawker stated that
applications for the Permanent Fund Dividend were up
astronomically this year.
3:10:20 PM
Commissioner Hogan answered Representative Salmon's earlier
question that the department provides grants to a number of
native health organizations and two primary partners are
Southcentral Foundation and Cook Inlet Tribal council. These
services are for things that are not Medicaid reimbursable.
Commissioner Hogan referred to the Personal Care Attendant
lawsuits with regulations made on some cost containment
measures. The intent was make sure that only those people
who were eligible for the program were getting the program
and they were only getting the right amount of service. Co-
Chair Hawker interjected there were documented abuses of the
system. Commissioner Hogan stated that one reform was a
reduction of hours that people were eligible for the
services. One of the lawsuits came about because many legal
entities did not believe that there were adequate criteria
or objective criteria for showing that the person's physical
status was being fairly determined. Commissioner Hogan
referred to it as "material improvement" and the department
was not able to show that they reduced the number of hours
based on the assessment tool. The department since adopted a
more objective tool for assessment.
3:14:03 PM
Commissioner Hogan answered Representative Gara's question
regarding people coming to emergency rooms. When someone
goes to an emergency room without insurance, the
department's providers, in conjunction with staff, work to
sign the person up for Medicaid, if they are eligible.
However, many individuals in Alaska do not qualify for
Medicaid and do not have insurance. This is referred to by
the hospital as uncompensated care; care given without
compensation from any third party payer.
Representative Gara queried if it was an expense to the
department when someone uses the emergency room for non-
emergency care and if it was possible to redirect these
people to an urgent care facility.
WILLIAM STREUR, DEPUTY COMMISSIONER, MEDICAID & HEALTH CARE
POLICY, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, MEDICAID,
addressed frequent users of emergency rooms. The system has
been increasingly able to identify these people and there is
an attempt to contact and direct them towards a primary care
practice to manage their care. He acknowledged it is a
constant problem and thought the new system would help.
Mr. Streur continued that a focus will be with "medical
home" to assign a person to work with a particular provider
to get the entire individual's care through this provider.
3:18:08 PM
Representative Gara asked if there were any federal funds
that could be captured, such as through more Indian Health
Care services. Mr. Streur remarked that there is a constant
focus to encourage more recipients to use the Indian Health
Services programs. Representative Gara suggested better use
of the neighborhood health centers.
Representative Doogan wanted an answer as to why in 2000
Medicaid was at $600 million a year program and over the
following ten years it tripled to $1.8 billion.
Co-Chair Hawker noted that over the years Medicaid kept
growing and when asked, the department was not sure why.
There was a funded study to focus and understand the growth
patterns. The report showed that in 20 years the Medicaid
program would be at $3 billion. After that there was an
attempt to stabilize the program. Now outside factors such
as population growth and economic factors are starting the
rise again.
ALISON ELGEE, ASSISTANT COMMISSIONER, FINANCE AND MANAGEMENT
SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, agreed
that the department had developed a model to project long
term expenses in the Medicaid program. There is an annual
report giving a ten year projected Medicaid costs. She
acknowledged that today the program costing $1.2 billion
will in twenty years cost $3.5 billion. She contended that
there was no plan to reduce the services of Medicaid only
"bending the curve," so costs do not grow as steeply as
projected. The need to replace stimulus funds with general
funds will be larger in the future.
3:26:12 PM
Representative Foster asked how many IHS qualified
individuals there were under the Medicaid program and what
would the dollar amount translate to. He inquired if the
state could help fund building more IHS facilities and if
this would save the state money in the long run.
Commissioner Hogan replied there was very specific
information available on IHS beneficiaries. He spoke about
the long term care facilities being planned in Anchorage,
Kotzebue, and Bethel. All of these facilities have been
given initial state capital dollars to begin planning,
design and construction.
Representative Austerman noted that the population portion
is partially dictated on how eligibility is set. He
indicated that if the poverty level was fixed the numbers
could be changed to keep costs down. He encouraged that this
conversation needs to occur.
3:31:00 PM
Co-Chair Hawker stressed that this has been a recurring and
constant theme within this committee. In this year's
legislative cycle, Co-Chair Hawker believed that the
university had the most difficult financial decisions;
therefore the subcommittee was restructured to include the
entire finance committee. He contemplated taking a
department each year that has economic challenges and
instead of assigning a subcommittee, the finance committee
would deal with the issue as a whole.
Commissioner Hogan responded that one of the advantages is
that Co-Chair Hawker understands the budget. He had great
confidence that solutions could be met. He believed that
there were things that could be done to contain Medicaid
costs and bring it under control. He emphasized that there
will be difficult decisions to make and encouraged working
together. He stated that the governor is committed to
working with the legislature to arrive at good solutions.
3:34:16 PM
Representative Fairclough stressed that prevention and
healthy people in Alaska would be a better way for the state
to invest its money. She noted that some services are
duplicated and emphasized that rather than bending the
curve, the committee needs to research new methods of
serving the people of Alaska for the state's long term
future.
Commissioner Hogan agreed that prevention is important and a
challenge, but Medicaid does not pay for prevention.
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