Legislature(2015 - 2016)HOUSE FINANCE 519
04/07/2015 09:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB148 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 148 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
April 7, 2015
9:03 a.m.
9:03:02 AM
CALL TO ORDER
Co-Chair Thompson called the House Finance Committee
meeting to order at 9:03 a.m.
MEMBERS PRESENT
Representative Mark Neuman, Co-Chair
Representative Steve Thompson, Co-Chair
Representative Dan Saddler, Vice-Chair
Representative Bryce Edgmon
Representative Les Gara
Representative Lynn Gattis
Representative David Guttenberg
Representative Scott Kawasaki
Representative Cathy Munoz
Representative Lance Pruitt
Representative Tammie Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Representative Liz Vazquez, Valerie Davidson, Commissioner,
Department of Health and Social Services; Jon Sherwood,
Deputy Commissioner, Medicaid and Health Care Policy,
Department of Health and Social Services;.
SUMMARY
HB 148 MEDICAL ASSISTANCE COVERAGE; REFORM
HB 148 was HEARD and HELD in committee for
further consideration.
9:03:20 AM
Co-Chair Thompson discussed housekeeping.
HOUSE BILL NO. 148
"An Act relating to medical assistance reform
measures; relating to eligibility for medical
assistance coverage; relating to medical assistance
cost containment measures by the Department of Health
and Social Services; and providing for an effective
date."
9:04:08 AM
VALERIE DAVIDSON, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES, shared that the bill would accomplish
Medicaid reform and expansion. She relayed that the
original legislation had been based on Governor Walker's
Healthy Alaska Plan, which could be found on the
department's website at dhss.alaska.gov. Additional
information on Medicaid expansion and reform could also be
located on Governor Walker's homepage at gov.alaska.gov.
She stressed that the legislation would be beneficial for
Alaskans, for the economy, for the state general fund, and
would be a catalyst for reform. She detailed that Medicaid
expansion would extend healthcare to an additional 42,000
Alaskans including low income Alaskans, Alaskans without
dependent children between the ages of 19-64, who were not
otherwise eligible for Medicaid or Medicare. She added that
these individuals had incomes of up to 138 percent of the
federal poverty level: $20,314, for a single adult and
$27,500, combined income for a married couple. The bill
would extend coverage to adults that were in the "donut
hole" that was created when the U.S. Supreme Court decided
that Medicaid expansion for states would be optional and
not mandatory; these Alaskans did not earn enough money to
qualify for a Marketplace Plan, did not qualify for the
regular Medicaid program, and earned approximately $14,720,
single income, per year. She relayed that under the
legislation more Alaskans would receive preventive, as well
as primary care, and behavioral health services. She
revealed the 5 most common causes of death in the state:
cancer, heart disease, unintentional injury, stroke, and
chronic lower respiratory disease; four of the causes were
preventable if caught early enough. She stressed that
people could not work, hunt, or fish if they were not well
enough to do so, and the bill would provide a mechanism for
them to access healthcare services.
9:09:03 AM
Commissioner Davidson discussed the possible positive
impacts on the economy. She stated that the bill would
bring in $146 million in new federal dollars for FY 16, and
over $1 billion by 2021. She said that the bill would
provide for the expansion group a higher federal match,
which would result in an immediate economic boost to the
state. In the first calendar year of 2016, the federal
match would be 100 percent. In transitions over the next 3
years, from 95, to 94, to 93 percent federal match, then to
90 percent from 2002, and beyond. She offered that the
current match for Medicaid was 50/50. She said that the
department had already indicated to the centers of Medicare
and Medicaid services, who administered and authorized the
program, in addition to the state, that Alaska's
participation was conditioned upon a 90 percent match. She
stressed that the new federal dollars in the economy
offered an opportunity for the state in the form of $1
billion pumped into the economy over the next 6 years. She
believed that the legislation would be healthy for the
state's general fund budget. She explained that, currently,
the state paid for healthcare services with 100 percent
state general fund dollars; transitioning the state's
healthcare costs to Medicaid through the expansion would
save the state approximately $6 million in the first year:
$4 million in corrections spending; $1 million in the
Chronic and Acute Medical Assistance Program; and $1.5
million in behavioral health grants. She shared that the
general fund off-sets would cumulatively total $108 million
in the first 6 years. She spoke to potential savings in the
area of recidivism. She opined that the projected numbers
for the state inmate population predicted the need for
another prison, similar to Goose Creek Correctional Center,
using resources that the state did not have. She offered
that the state could either invest in the health of
Alaskans through Medicaid expansion, or invest in the
construction of a new prison. She said that other states
had shown that investing state general fund dollars in
behavioral health services had resulted in significantly
reduced recidivism rates.
9:12:44 AM
Commissioner Davidson asserted that the best opportunity to
finance an effort to reduce recidivism rates was to expand
Medicaid. She revealed that the majority of the prison
population would be eligible for Medicaid. She said that
when individuals currently in prison received care, medical
or behavioral, continuing care once the inmate was released
was a challenge.
Representative Wilson wondered whether the commissioner
would take questions during the introduction.
Commissioner Davidson replied that she was nearly finished
with her presentation. She explained that the bill
contained reform opportunities; the department believed
that expansion would be a catalyst to reform and were
building on reforms that were already underway. She stated
that the legislation would direct the department to examine
all available options for improving the Medicaid program,
and to limit costs. She asserted that the department
recognized that the existing Medicaid program was not
sustainable given the current budget constraints; Medicaid
reform was necessary not only for the expansion population,
but for the entire population of the state. She spoke to
reforms found within the legislation and noted that the
bill would provide broad demonstration authority for the
examination of payment reform, care management, workforce
development, innovation, and innovative service delivery
models.
9:16:16 AM
JON SHERWOOD, DEPUTY COMMISSIONER, MEDICAID AND HEALTH CARE
POLICY, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, provided
a sectional analysis:
Section 1 Adopts intent language and legislative
findings related to Medicaid expansion and the need to
reform the existing Medicaid program, including
instructing the Department of Health and Social
Services (DHSS) to propose legislation to implement a
provider tax in January 2016, to help offset the cost
of the Medicaid program.
Section 2 Amends AS 44.23.075 to exclude the expansion
population from the current Permanent Fund Hold
Harmless program.
He added that with the advent of the Affordable Care Act
states were required to use a new methodology to count
income for certain eligibility groups: children, pregnant
women, parents and caretaker relatives, and the expansion
population. The methodology was referred to as modified
adjusted gross income (MAGI), a tax based methodology of
counting income that was used by the Internal Revenue
Service (IRS). He explained that the methodology eliminated
the disregards that states had previously applied to income
before making an eligibility determination. Section 2
amended the statute for the Permanent Fund Dividend (PFD)
Hold Harmless Program, which was a program working under
the premise that the state should not count the yearly
dividend as income when making determinations for people
applying for public assistance, including Medicaid, unless
required by federal law. If required by federal law, a Hold
Harmless benefit would be provided for up to four months.
He reiterated that the program was intended to protect
individuals from loss of a benefit for one time income and
provided up to four months of benefits. He said that under
the MAGI rules, the department was forced to count the PFD
as income. He stated that the department had struggled to
reconcile the different pertinent statutes. He added that
individuals that might be ineligible as a result of
receiving the PFD would be eligible to receive health
insurance through the federally facilitated marketplace,
the insurance would be significantly subsidized through the
income tax credits provided by the market place. He
explained that unlike the situation where a person lost
their benefits as a result of receiving the PFD, the person
would be ineligible for the Medicaid expansion group but
eligible for health insurance coverage subsidized through
the exchange.
9:21:34 AM
Mr. Sherwood relayed that the expansion group would be
exempt from the Hold Harmless Program. He continued with
the sectional analysis:
Section 3 Amends the duties of the department under AS
47.05.010 to include a requirement that DHSS develop a
health care delivery model that encourages good
nutrition and disease prevention.
Section 4 Amends AS 47.05.200(a) to clarify the
minimum number of audits that DHSS should conduct each
year, along with instructions that DHSS should to the
extent possible, minimize duplicative state and
federal audits for Medicaid providers.
Section 5 Amends AS 47.05.200(b) to allow DHSS to
impose interest penalties on identified overpayments
using the post-judgment statutory rate.
Section 6 Adopts AS 47.05.250 that authorizes DHSS to
develop provider fines through regulation for
violations of AS 47.05, AS 47.07 or regulations
adopted under those chapters.
9:26:14 AM
Mr. Sherwood addressed Section 7:
Section 7 Amends AS 47.07.020(b) including technical
corrections related to eligibility for Medicaid
authorized under the Affordable Care Act. This section
also provides the authority for DHSS to expand
Medicaid to adults aged 19-64 who are not caring for
dependent children, are not disabled or pregnant, and
who earn at or below 138 percent of the federal
poverty guidelines for Alaska including the five
percent income disregard.
Mr. Sherwood explained that by converting to MAGI, the
federal government had collapsed several categories of
coverage, including many categories for children; AS
47.07.020(b) would be amended in order to better describe
the group of children that would be covered. He furthered
that existing categories of Medicaid that were converted to
the MAGI methodology were required by the federal
government to convert the old income standards to new
standards in order to reflect the fact the disregards were
no longer being used. The federal government would perform
a calculation to determine the change of income that
prompted the loss of the disregards.
9:29:54 AM
Mr. Sherwood moved to Sections 8 and 9 of the bill:
Section 8 This section amends AS 47.07.020(g) to
clarify that, for a person whose Medicaid eligibility
is not calculated using the modified adjusted gross
income standard established in federal regulations,
DHSS may not deny or delay the person's eligibility
for medical assistance on the basis of a transfer of
assets for less than fair market value if the person
establishes to the satisfaction of the department that
the denial or delay would work an undue hardship. It
further requires that DHSS may only consider
information provided by a person claiming undue
hardship that the department has verified through a
source other than the person's own statement.
Section 9 Amends AS 47.07.020 (m) to clarify that, for
persons whose Medicaid eligibility is not calculated
using the modified adjusted gross income standard
established in federal standards and as provided in
Section 8 (above), the department shall impose a
penalty period of ineligibility for the transfer of an
asset for less than fair market value by an applicant
or applicant's spouse consistent with federal rules.
Mr. Sherwood related that the sections provided the
technical adjustments necessary to reflect that Alaska was
compliant with federal requirements.
Section 10 Amends AS 47.07.030(d) to require the
department to develop a primary care case management
system or managed care organization contract including
super-utilizers, who must enroll in the program and
seek approval from a case manager before receiving
certain services.
Mr. Sherwood noted that the section had been added by the
House Health and Social Services Committee. The previously
discretionary provision would be mandatory.
Section 11 Amends AS 47.07.030 to require a report to
the legislature describing the costs for mandatory and
optional Medicaid services.
Section 12 Amends AS 47.07.036(b) to make conforming
edits so this section of the statute is consistent
with Section 13 of the bill.
Section 13 Amends AS 47.07.036(d) to outline cost
containment and reform measures that DHSS must
undertake, including seeking demonstration waivers
related to innovative service delivery models, and to
include applying for other options under the Medicaid
Act and improving telemedicine for Medicaid
recipients. This section also requires DHSS to apply
for an 1115 waiver for a demonstration project for one
or more groups of Medicaid recipients in one or more
geographic area. The demonstration project may include
managed care organizations, community care
organizations, or patient-centered medical homes, but
at least one project will be a coordinated care
project that operates within a fixed budget to reduce
medical cost inflation, improve the quality of health
care for recipients, and result in a healthier
population. DHSS shall design the managed care system
to reduce the growth in medical assistance
expenditures by at least two percentage points, and
the system must implement alternative payment
methodologies and create a network of patient-centered
primary care homes. The department shall prepare a
report regarding the progress of this demonstration
project and shall deliver it to the legislature by
February 1, 2019.
9:34:21 AM
Mr. Sherwood addressed Sections 14 and 15:
Section 14 and 15 Amends AS 47.07.900(4) and (17) to
remove the requirement that behavioral health
providers be a grantee of the State of Alaska in order
to bill Medicaid.
Mr. Sherwood explained that the amendment would expand the
base of providers for behavioral health services for
Medicaid and align the state with federal law.
Section 16 Authorizes DHSS to investigate the design
of a demonstration project to help reduce pre-term
births to include voluntary enrollment of
approximately 500 recipients eligible for medical
assistance. DHSS shall offer pregnancy counseling,
nutritional counseling, and, as necessary, vitamin D
supplementation. The project can be modeled after a
project implemented in South Carolina.
Mr. Sherwood said that the amendment, added by the House
Health and Social Services Committee, instructs the state
to develop a proposal to improve the pre-term birth rate in
the state through the use of nutritional counselling and
vitamin supplements.
9:36:01 AM
Mr. Sherwood continued with the sectional analysis:
Section 17 Authorizes DHSS to engage in a
demonstration project for super-utilizers as outlined
in section 13, and report to the legislature on the
project.
Mr. Sherwood said that the amendment was added in the CS
consistent with the changes in Section 13. He continued
with the analysis:
Section 18 Outlines a series of records that DHSS must
provide to the legislature relating efficacy of the
reform measures taken by the Department, including any
cost savings.
Section 19 Authorizes DHSS to immediately amend its
state plan and seek all necessary approvals consistent
with this Act.
Section 20 Authorizes DHSS to engage in emergency rule
making under the Alaska Administrative Code to
implement Medicaid reform measures and the provisions
of this Act.
Section 21 Provides that Section 20 of the Act is
repealed on June 30, 2017.
Section 22 Provides instructions to the revisors of
the statutes to amend the title of AS 47.07.036 to
include Medicaid Reform.
Section 23 Provides that Section 19 and 20 are
effective immediately.
Section 24 Provides that all other sections of the Act
are effective on August 1, 2015.
Co-Chair Thompson provided members with a list of
department staff available for questions. He reminded
members that the meeting would end at 10:20 a.m.
9:39:55 AM
Vice-Chair Saddler asked about Section 17 of the CS
regarding managed care for super-utilizers. He pointed to
Page 13, lines 21 through 26 of the bill:
(1) establish a primary care case management system or
a managed care organization contract under AS
47.07.030(d), as amended by sec. 10 of this Act, for
super- utilizers, as identified by the department; and
(2) deliver a report on the system or contract to the
senate secretary and the chief clerk of the house of
representatives and notify the legislature that the
report is available.
Vice-Chair Saddler queried the expected timeline for the
reports to be completed and the systems to be up and
running.
Mr. Sherwood replied that the program would be an extension
of a program already in operation for the managed care of
super-utilizers, and that the department hoped to expand
the program further.
Vice-Chair Saddler asked if the program was for primary
care management system or a management care organization
(MCO).
Mr. Sherwood answered that the primary care management
model would be used.
Vice-Chair Saddler reiterated his question about the report
deadline.
Mr. Sherwood responded that the report would be due January
2017.
Vice-Chair Saddler asked when the super-utilizer program
had begun.
Mr. Sherwood replied that the program had begun in December
2014.
Representative Wilson asked about the make-up of the 40,000
additional individuals that would be added due to
expansion.
9:42:31 AM
Commissioner Davidson replied that the nearly 42,000 that
would be eligible under expansion were people who earned
$9.52 per hour, based upon a 40 hour work week. She
elaborated that 44 percent of the majority of the eligible
population were Alaskans who were actively employed, 29
percent of the population were collecting unemployment
insurance, which required them to be recently employed and
actively seeking work; over 70 percent of people who would
benefit from the expansion were employed or actively
seeking employment. She said that 54 percent of the
eligible population were male, 20 percent of that group
were 19-34 years old. She said that experience had shown
that this population was cheaper to cover because men did
not get pregnant and generally did not actively seek
healthcare coverage.
9:44:48 AM
Representative Wilson understood that the majority of those
covered by expansion were employed, but questioned why the
employers were not covering healthcare costs.
Commissioner Davidson replied that the number of employers
offering health care to their employees had declined
steadily over the past 20 years. She related that many of
the employers in the state were small businesses who had
not been able to afford to provide healthcare to their
employees.
Representative Wilson asked whether the option for
providing healthcare at a discount had been explored. She
expressed concern as to how the state providing healthcare
would affect employers who were already providing
healthcare. She wondered whether those small businesses
could be added to the state healthcare system, rather than
creating a new program.
Commissioner Davidson replied that the option was not
included in the legislation. She said that some might
already have access to healthcare service through the
Tribal Health System, Indian Health Service, 330 Clinics,
or Community Health Centers, but that those programs were
not health insurance - not a portable benefit, they were
limited health coverage. She added that specialist services
were not typically available through those centers, and
without healthcare insurance people would not have access
to those services. She said that 20 percent of Alaskan's
did not have healthcare coverage, the bill reduced that
number by 10 percent, and 90 percent of the expense would
be covered by the federal government.
Representative Wilson did not understand exactly who the
bill was aiming to cover. She mentioned Texas corrections
healthcare reform. She understood that there had been
positive change in the Texas corrections system as a result
of solely expansion.
9:49:48 AM
Commissioner Davidson replied in the negative. She
explained that she had chosen Texas as a comparison to
Alaska due to a similar "tough on crime" mentality, which
had failed to reduce recidivism rates. She detailed that
Texas had invested with 100 percent general fund dollars in
behavioral health services to reduce recidivism; Alaska now
had the opportunity to achieve the same outcome using 90
percent federal dollars.
Representative Wilson asserted that Medicaid expansion
would not result in less people in jail.
Representative Gara discussed savings listed by the
administration that would occur under expansion. He
believed the state was facing what could be a recession. He
pointed to the department's claim that expansion would
generate 4,000 jobs. He asked what the department could do
to convince the committee that the numbers were real.
9:53:46 AM
Commissioner Davidson explained that while inmates were
incarcerated they were not eligible for Medicaid and had
not been included as a part of the anticipated savings. She
shared that the Department of Corrections (DOC) had deduced
that the services for which inmates were eligible, or could
be eligible, under expansion would be for contracted
services not provided by the DOC. She explained that under
federal law if the inmate required an overnight stay for
their procedure they would be eligible for Medicaid under
the expanded group. She said that the expected savings by
DOC were reflected on the fiscal note. She noted that the
first year of savings were targeted to be conservative, but
would increase as the program gained inertia. The second
area of savings was anticipated in the Chronic and Acute
Medical Assistance (CAMA) program. Individuals in the CAMA
program were typically high-dollar beneficiaries, paid for
with 100 percent general fund dollars. She said that the
savings numbers had been built on what the department
expected to save based upon what was currently paid. She
explained that behavioral health providers who received
grants were going to have populations who would be covered
under Medicaid expansion. She relayed that the dollar
amounts in the fiscal notes had been based on trends over
the past few years. She asserted that there were other ways
to diversify the state's revenue, but that those would take
time to provide financial results. She contended that
Medicaid expansion was an immediate opportunity to
diversify the state's portfolio, with $145 million in
savings projected in the first year, and a cumulative total
of over $1 billion. She spoke to the 4,000 projected new
jobs. She said that the numbers came from an independent
analysis, performed by Northern Economics. She clarified
that the 4,000 jobs were not expected in the healthcare
industry alone, but from other multiplier effects in the
economy.
9:59:47 AM
Mr. Sherwood informed the committee that the cost of
expansion included one waiver and two new Medicaid options.
The 1115 waiver was a demonstration waiver that would
provide an innovative service delivery model with the
tribal health system. He said that services provided to an
Indian Health Services (IHS) beneficiary through a tribal
health facility were reimbursed at 100 percent by the
federal government. He stated that the demonstration waiver
would focus on travel and accommodations. He relayed that
the waiver would broaden its scope to treat tribal health
organizations as accountable care, or community care,
organizations. The department anticipated savings due to
the change in funds, from 50 percent federal funds to 100
percent general funds, by bringing more services directly
under the umbrella of tribal health facilities. He said
that a reduction in overall spending was expected through
better management of services. He continued to the 1915i
option, which was a home and community based option that
would provide coverage for services similar to the current
waivers. The current waivers required that an individual
meet a certain institutional level of care, primarily
nursing home or intermediate care facilities for
individuals with intellectual disabilities. He said that
the 1915i would provide coverage to people that did not
meet the current criteria.
10:04:27 AM
Mr. Sherwood stated that the 1915k option would cover a
variety of services that provided a level of personal
assistance to an individual, and was limited to people that
met an institutional level of care. He said that when the
federal government passed the option, a provision was added
that services under the option would receive an additional
6 percent in federal funds, for a total of 56 percent. He
believed that a substantial amount of the state's home and
community based waivered services, and a portion of the
personal care services provided to waiver eligible
individuals, could be converted to this option to receive
the enhanced federal match.
10:05:48 AM
Co-Chair Thompson noted that Co-Chair Neuman had joined the
committee.
Co-Chair Thompson asked about the administration's plan for
managed care.
Commissioner Davidson pointed out to the committee that the
language in the bill was necessarily broad and included a
host of payment reform. She explained that "managed care"
was a defined legal term. She said that the rest of the
country had moved away from managed care as a legal
structure because it was outdated. She relayed that other
states had looked into different models that were a hybrid
of options, and could be more efficient and provided better
value. She felt that managed care would limit the state;
there was a difference between managing the care of a
population, and a managed care organization. She mentioned
that in Wyoming, managed care had not proven to work for
that state prompting them to choose the super-utilizer
program and to explore the patient center medical home
model. She said that there were three demonstrations in
Alaska that were testing patient centered medical homes.
She shared that the department had issued a request for
proposal (RFP) to would allow then to study what other
states were doing on the issue of Medicaid reform. She
relayed that Alaska was one of the last states using a fee
for service system, which was an unsustainable model.
10:09:41 AM
Co-Chair Neuman asked whether managed care could include
private insurance companies.
Commissioner Davidson replied that managed care in other
states were often insurance companies but sometimes went
through a broker. She related that the kind of innovation
that the bill discussed could be accomplished through an
insurance company.
Co-Chair Neuman asked whether the state could buy private
insurance, through managed care, for all uninsured
Alaskans.
Commissioner Davidson replied that the bill would begin
expansion as soon as possible in order to immediately
benefit from the federal dollars. The department hoped to
look at additional models as the process moved forward. The
expansion program written in the legislation mirrored the
Medicaid program; as reforms were implemented in the
Medicaid program, the expansion group would follow those
reforms.
10:12:03 AM
Co-Chair Neuman stated that the question was a yes or no
question.
Commissioner Davidson replied in the affirmative.
Vice-Chair Saddler asked about the 1915 waivers and whether
the state was required to consult with tribes before
submitting a waiver request.
Commissioner Davidson replied in the affirmative.
Vice-Chair Saddler queried whether tribes had any veto
power over the waiver requests.
Mr. Sherwood replied that under the terms of consultation
tribal communities did not have the ability to veto a
proposal; however, the state would not force cooperation if
tribal providers did not want to work with the state. He
stated that the effort would have to be collaborative. He
clarified that the state was required to consult with
tribal entities on any changes to the Medicaid program that
could potentially impact tribal beneficiaries.
10:15:25 AM
Vice-Chair Saddler whether the state would not pursue a
waiver over an objection from tribal entities.
Mr. Sherwood answered that the state would have to come to
an understanding agreement with tribal organizations in
order to carry out the waiver.
Commissioner Davidson elaborated that tribal health
organizations in Alaska had been trying to pursue 1915
waivers with the state for the last 10 years. She said that
three things were needed in order for the requests to be
successful: tribal organizations needed to be willing, have
a strong partnership with the state, and have approval from
the Centers for Medicare and Medicaid Services (CMS). She
stated that over the past few years CMS had approved 1915
waivers with tribes and tribal organizations in other
states.
Vice-Chair Saddler asked if the state had sought 1915i and
1915k waivers in the past.
Mr. Sherwood replied in the negative. He elaborated that
there had been past work done developing proposals for the
use of 1915k waivers, but it had not been pursued by the
prior administration.
Vice-Chair Saddler understood that there had been prior
consideration but not been a formal request.
Mr. Sherwood replied in the affirmative. He said that a
number of initiatives had been put on hold during the
transition to the new claims payment system.
Vice-Chair Saddler assumed that challenges with the
computer system had precluded the department from going
forward with the 1915i and 1915k waivers.
Mr. Sherwood responded that the primary consideration had
been the timing of making a substantial change in the
waiver system, while simultaneously making a change in the
new claims payment system.
Commissioner Davidson interjected that the 1915i and 1915k
options had been available under the Affordable Care Act
since October 2010. She furthered that this was an
opportunity to refinance programs that were currently
provided, in order to benefit from the additional 50
percent federal match under the 1915i option, and an
additional 6 percent match under the 1915k option. She gave
that 6 percent might not seem like a lot, but given the
state's fiscal climate it would be significant.
Vice-Chair Saddler understood that there had been a decline
in Medicaid providers in the state, and wondered whether
that would affect the delivery of services to the expansion
group.
Mr. Sherwood did not believe the decline was continuing. He
asserted that a significant part of past decline had been
due to the fact that, historically, Medicaid had not
required periodic program reenrollment. He explained that
the department had a process of dis-enrolling inactive
providers. He offered to provide more information on the
matter at a later date.
Vice-Chair Saddler asked whether dis-enrolling providers
would affect the expanded number of people seeking
services.
Commissioner Davidson replied that approximately 40,000
people would be eligible - and 20,000 would sign up in the
first year, with 26,000 signing up in the out years. She
said that concerns existed as to whether providers would be
able to deliver services, particularly in the area of
behavioral health, which was why the prerequisite that a
behavioral health providers had to be a grant recipient in
order to bill Medicaid would be removed. She stated that
the demand for behavioral health services in the state were
significant and that the department looked forward to
providing those services to Alaskans in need.
Vice-Chair Saddler queried whether the removal of the
behavioral health grantee status requirement would be
sufficient to address the impact of 20,000 additional
recipients.
Commissioner Davidson believed it would be a start. She
furthered that one of the reform opportunities included in
the bill would pursue alternative provider types. She said
that there were providers in the state that currently
provided services, but at a limited capacity, and
additional work could be done on the issue.
Co-Chair Thompson discussed housekeeping.
HB 148 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
10:23:33 AM
The meeting was adjourned at 10:23 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Expansion Reform Timeline.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB 148 NEW DHSS Fiscal Notes PKT.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB148 Corrections White Paper.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB148 Summary of Changes ver A to ver H.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB148 Supporters of Medicaid Reform.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB 148 Medicaid Support letter.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB 148_Medicaid_Board-11.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB 148 Evergreen Response to Report Differences 033115.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB 148 Support Packet Gov Walker 4-6-15 for House Finance - opt.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| CS HB 148 (HSS) sectional.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |
| HB 148 Sponsor Statement - Transmittal Letter.pdf |
HFIN 4/7/2015 9:00:00 AM |
HB 148 |