Legislature(2007 - 2008)

04/12/2008 12:40 PM HES

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12:40:33 PM Start
12:40:33 PM SB212
07:59:52 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
SB 212-MEDICAL ASSISTANCE ELIGIBILITY                                                                                         
12:40:33 PM                                                                                                                   
CHAIR WILSON  announced that  the first  order business  would be                                                               
SENATE BILL NO. 212 "An  Act relating to eligibility requirements                                                               
for medical  assistance for certain children  and pregnant women;                                                               
and providing for an effective date."                                                                                           
12:41:32 PM                                                                                                                   
TOM  OBERMEYER,  Staff  to Senator  Bettye  Davis,  Alaska  State                                                               
Legislature,  introduced the  bill  on behalf  of Senator  Davis,                                                               
sponsor.   He  informed  the  committee that  SB  212  is an  act                                                               
relating to  eligibility requirements for medical  assistance for                                                               
certain  children and  pregnant women.   The  bill is  called the                                                               
Denali  Kid  Care bill,  following  the  State Children's  Health                                                               
Insurance  Program (SCHIP),  which  is a  national  program.   He                                                               
informed the committee  that Alaska is participating  in SCHIP at                                                               
rate of  175 percent  of federal poverty  guidelines, which  is a                                                               
lower rate than many other states.   The original rate was set at                                                               
200  percent  of poverty  level;  moreover,  inflation drops  the                                                               
effective rate to about 154  percent.  Mr. Obermeyer advised that                                                               
the current bill would reinstate  1,277 children and 218 pregnant                                                               
women that were  excluded by previous changes in the  rate.  At a                                                               
higher rate, Alaska would again  be able to assist those children                                                               
who have no  regular health care and no insurance.   He urged the                                                               
committee  to   recognize  that  the  federal   government  would                                                               
reimburse at  the enhanced rate  of two-thirds up to  70 percent.                                                               
Furthermore,  if costs  exceed the  SCHIP funds,  the claims  are                                                               
reimbursed at the Medicaid rate.   Mr. Obermeyer pointed out that                                                               
the fiscal  notes are  very good; in  fact, the  federal receipts                                                               
are about two-thirds of the cost in each case.                                                                                  
12:44:23 PM                                                                                                                   
CHAIR WILSON asked about the  financial consequences to the state                                                               
if the federal government decides not to fund SCHIP.                                                                            
12:44:59 PM                                                                                                                   
MR. OBERMEYER  said that the  Medicaid rate was about  50 percent                                                               
as compared  to the 70  percent reimbursement through SCHIP.   He                                                               
understood  that  a  reduction  in  funding  would  be  based  on                                                               
population and would adversely affect all of the states.                                                                        
12:45:29 PM                                                                                                                   
REPRESENTATIVE CISSNA asked for the  number of children that were                                                               
left without insurance coverage by the state reductions.                                                                        
12:45:57 PM                                                                                                                   
MR. OBERMEYER  referred to  the fiscal  notes that  indicate that                                                               
there was  a substantial loss  of about 2,500 to  3,000 children.                                                               
He  suggested that  the Department  of Health  & Social  Services                                                               
(DHSS) may have more information.   He stressed the importance of                                                               
the numbers  and pointed out  that the Alaska State  Hospital and                                                               
Nursing  Home  Association  (ASHNHA) supports  this  increase  in                                                               
order to prevent additional expenses  later in life and expensive                                                               
visits to emergency rooms.                                                                                                      
12:48:20 PM                                                                                                                   
JON  SHERWOOD, Office  of the  Commissioner, Medicaid  and Health                                                               
Care Policy,  Department of Health  & Social  Services, indicated                                                               
that  his office  could not  report  an exact  number because  of                                                               
other  activities   in  addition   to  the   eligibility  action;                                                               
however, the DHSS anticipates that  the bill would add 1,300 kids                                                               
and 200 pregnant women to the program.                                                                                          
12:49:16 PM                                                                                                                   
REPRESENTATIVE CISSNA  observed that, after the  loss of programs                                                               
like this,  along with the  increased cost of health  care, there                                                               
has  been an  increase  in homeless  families  in her  community.                                                               
Further, the most  frequent cause of bankruptcy is  the high cost                                                               
of health care.   She asked whether the DHSS  studies issues such                                                               
as these to determine the cause of problems in communities.                                                                     
12:50:26 PM                                                                                                                   
ELLIE  FITZJARRALD,  Director,  Division  of  Public  Assistance,                                                               
Department  of  Health  & Social  Services,  clarified  that  the                                                               
passage of last  year's bill restored eligibility  to about 1,277                                                               
children  and 1,100  have re-enrolled.   However,  pregnant women                                                               
are not enrolling at the rate anticipated.                                                                                      
12:51:53 PM                                                                                                                   
REPRESENTATIVE CISSNA  also asked  whether the  legislation would                                                               
cover more people, such as those who are in institutions.                                                                       
12:52:49 PM                                                                                                                   
MR. SHERWOOD answered that the  legislation reproduces the entire                                                               
list of all those presently  eligible for Medicaid under optional                                                               
categories.  The only change  to eligibility occurs by the change                                                               
in the percentage  of the poverty line for  children and pregnant                                                               
women;  in fact,  the other  categories are  listed for  drafting                                                               
12:53:30 PM                                                                                                                   
REPRESENTATIVE CISSNA further asked  whether the bill would allow                                                               
coverage for those with impairments.                                                                                            
12:53:59 PM                                                                                                                   
MR.   SHERWOOD  explained   that   Medicaid   is  a   categorical                                                               
eligibility  and  there  are different  standards  for  different                                                               
categories.  A  number of the categories do  not involve children                                                               
or pregnant women;  thus most  of the categories are not affected                                                               
by these changes.                                                                                                               
12:54:32 PM                                                                                                                   
REPRESENTATIVE  ROSES recalled  recommendations that  state SCHIP                                                               
eligibility should not be increased  until federal funding levels                                                               
were  authorized.    He  asked for  projections  of  the  federal                                                               
funding levels.                                                                                                                 
12:55:28 PM                                                                                                                   
MR.  SHERWOOD  said  that  the  federal  funding  was  uncertain.                                                               
Congress extended  the SCHIP through  March of 2009,  but without                                                               
re-authorization of  the program.   Alaska's SCHIP is  a Medicaid                                                               
expansion;  therefore,   without  SCHIP   funding,  reimbursement                                                               
defaults to Medicaid at a 50 percent rate.                                                                                      
12:56:20 PM                                                                                                                   
REPRESENTATIVE  ROSES further  asked  whether  the extension  was                                                               
authorized at the same funding level.                                                                                           
12:56:46 PM                                                                                                                   
MR. SHERWOOD responded  that the extension was at  the same level                                                               
of funding;   however, Alaska  receives supplemental  funding and                                                               
there is  a potential  for shortfall.   In further  response, Mr.                                                               
Sherwood said  that the percentage  of the shortfall  is unclear.                                                               
The federal reimbursement  would default to the  Medicaid rate of                                                               
50  percent with  the exception  of Indian  Health Service  (INH)                                                               
beneficiaries which are reimbursed at 100 percent.                                                                              
12:58:38 PM                                                                                                                   
REPRESENTATIVE  ROSES  estimated  that the  decrease  in  federal                                                               
funding was about six to eight percent.                                                                                         
12:59:09 PM                                                                                                                   
MR. SHERWOOD re-stated the uncertainty  of the SCHIP funding.  He                                                               
opined  that the  question would  likely be  resolved by  the new                                                               
administration and Congress.                                                                                                    
12:59:46 PM                                                                                                                   
REPRESENTATIVE ROSES  summarized that the National  Conference of                                                               
State  Legislatures  warned  states about  expanding  eligibility                                                               
when federal support  is uncertain.  He drew a  comparison to the                                                               
Alaska  budget  that  may  not  be  sustainable  in  the  future.                                                               
Representative Roses stated  that SB 212 was a  far reaching bill                                                               
that  was hard  to review  in a  limited period  of time,  and he                                                               
asked whether  the bill  was also referred  to the  House Finance                                                               
1:01:47 PM                                                                                                                    
CHAIR WILSON said no.                                                                                                           
1:02:00 PM                                                                                                                    
REPRESENTATIVE SEATON asked  whether the bill was  an addition to                                                               
the budget.                                                                                                                     
1:02:19 PM                                                                                                                    
MS. FITZJARRALD  understood that  there was  an amendment  to the                                                               
operating budget in the expectation that this bill would pass.                                                                  
1:02:47 PM                                                                                                                    
REPRESENTATIVE KELLER asked for the eligibility income level.                                                                   
1:02:58 PM                                                                                                                    
MR. SHERWOOD answered  that, for a family of one,  200 percent of                                                               
the federal poverty  level is an annual gross  income of $26,000;                                                               
for a family of two, it is $35,000;  for a family of three, it is                                                               
$44,000; for a family of four, it is $53,000.                                                                                   
1:03:30 PM                                                                                                                    
REPRESENTATIVE GARDNER  observed that a  family of one  would not                                                               
be affected by this bill.                                                                                                       
1:04:00 PM                                                                                                                    
MR.  SHERWOOD clarified  that there  are cases  of a  child whose                                                               
caregiver's  income is  not  considered; that  child  would be  a                                                               
family of one.  Also, pregnant women count as a family of two.                                                                  
1:04:40 PM                                                                                                                    
REPRESENTATIVE CISSNA encouraged the  committee to hear testimony                                                               
from physicians who  could speak to the benefits  of a year-long,                                                               
strong, preventive program.  She  referred to research indicating                                                               
that  the  most  effective  action  for  long  term  benefits  is                                                               
preventative care.                                                                                                              
1:06:26 PM                                                                                                                    
REPRESENTATIVE ROSES  pointed out  that this  was not  a one-year                                                               
funding mechanism, but a permanent change in statute.                                                                           
1:07:05 PM                                                                                                                    
REPRESENTATIVE KELLER  recalled an attempt to  reduce the funding                                                               
to  Denali Kid  Care and  the  negative impact  on families  that                                                               
depended  on  this  entitlement.    He  re-stated  the  need  for                                                               
additional time to study this issue.                                                                                            
1:08:09 PM                                                                                                                    
REPRESENTATIVE GARDNER stressed  that the root of  good health is                                                               
prevention,  starting  with pregnant  women  and  children.   She                                                               
stressed  that 50  percent to  70 percent  of the  cost would  be                                                               
matched by federal funds and that  Alaska is a wealthy state that                                                               
ranks  41st in  the nation  in the  amount of  care provided  for                                                               
children of  the working poor.   She informed the  committee that                                                               
hospital  write-offs in  Alaska increased  by 55  percent in  the                                                               
last year, compared  to 14 percent nationally, which  is a result                                                               
of uncompensated emergency care.   Representative Gardner further                                                               
noted that  41 states  allow participation  by families  who earn                                                               
200  percent  of   the  poverty  level  and   some  states  allow                                                               
participation at the 300 percent  level.  She opined that support                                                               
for this  effort should  be obvious  for House  Health, Education                                                               
and Social Services Standing Committee members.                                                                                 
1:10:09 PM                                                                                                                    
CHAIR WILSON recessed to the call of the chair.                                                                                 
7:54:44 PM                                                                                                                    
CHAIR WILSON  reconvened the House  Health, Education  and Social                                                               
Services  Standing  Committee  back   to  order  at  7:55:00  PM.                                                             
Representatives Wilson,  Seaton, Gardner and Cissna  were present                                                               
at the call to order.                                                                                                           
7:55:35 PM                                                                                                                    
REPRESENTATIVE  SEATON  stated  his interest  in  forwarding  the                                                               
7:55:59 PM                                                                                                                    
CHAIR WILSON called for public testimony.                                                                                       
7:56:17 PM                                                                                                                    
PAT  HEFLEY,   Director,  Behavioral  Health,   Southeast  Alaska                                                               
Regional Health Consortium (SEARHC),  agreed that the uncertainty                                                               
[of federal  funding] is  a concern.   However,  as a  student of                                                               
health  care financing,  he pointed  out the  future cost  of not                                                               
funding this bill.  He opined  that the question to be considered                                                               
is  whether money  for housing,  court action,  police work,  and                                                               
emergency  room  visits  is  saved.     Mr.  Hefley  assured  the                                                               
committee that $1 spent by  the passage of this legislation would                                                               
save $6 to $7 in future cost elsewhere in the budget.                                                                           
7:57:49 PM                                                                                                                    
BRENDA MOORE,  Secretary, Alaska  Mental Health  Board, expressed                                                               
her wish for the bill to be moved out of committee.                                                                             
7:58:04 PM                                                                                                                    
CHRISTINA  VAN   CLEVE,  Representative,  Alaska   School  Nurses                                                               
Association, urged the  committee to pass the bill.   As a school                                                               
nurse,  she knows  children of  hard-working parents  who receive                                                               
essential medical care through Denali Kid Care.                                                                                 
7:58:54 PM                                                                                                                    
REPRESENTATIVE SEATON asked whether  there were any witnesses who                                                               
would be testifying in opposition to the passage of SB 212.                                                                     
7:59:10 PM                                                                                                                    
PATRICIA  SENNER,  Alaska   Nurses  Association,  encouraged  the                                                               
committee to pass the bill.                                                                                                     
7:59:16 PM                                                                                                                    
LORIE  MORRIS, Representative,  Alaska Human  Services Coalition,                                                               
encouraged passage of the bill to the House floor.                                                                              
7:59:30 PM                                                                                                                    
CHAIR WILSON closed public testimony.                                                                                           
7:59:39 PM                                                                                                                    
REPRESENTATIVE GARDNER  moved to report  SB 212 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.   There being no objection,  SB 212 was reported  from the                                                               
House Health, Education and Social Services Standing Committee.                                                                 

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