Legislature(2007 - 2008)SENATE FINANCE 532
05/07/2007 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB168 | |
| SB80 | |
| SB27 | |
| SB116 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 168 | TELECONFERENCED | |
| + | SB 80 | TELECONFERENCED | |
| + | SB 27 | TELECONFERENCED | |
| + | SB 116 | TELECONFERENCED | |
| + | TELECONFERENCED |
9:42:58 AM CS FOR SENATE BILL NO. 27(HES) "An Act relating to eligibility requirements for medical assistance for certain children, pregnant women, disabled persons, and persons in medical or intermediate care facilities; and providing for an effective date." This was the first hearing for this bill in the Senate Finance Committee. Co-Chair Stedman announced intent to hear bill but not take action on it at this time. 9:43:28 AM TOM OBERMEYER, Staff to Senator Bettye Davis, sponsor of the bill, presented the bill, reading the following statement into the record. This was an Act relating to medical assistance for certain children, pregnant women and persons in medical or immediate care facilities, and providing for an effective date. The focus of this bill initially is the Denali KidCare portion of the State's children's health insurance program that is sponsored throughout all 50 states. In Alaska there are an estimated 18,000 uninsured children, or about nine percent of the children under age 18 and under. Private health care coverage for children has declined over 30 percent in the last ten years. It is estimated that children with a medical need are five times as likely that are uninsured as to not to have a regular doctor as those insured children and four times more likely to use emergency rooms at a much higher cost. The eligibility rates in Alaska dropped dramatically for children after the formula was changed in 2003. The eligibility rates had been frozen in 2003 at the federal poverty levels at that time, which was a fixed dollar amount. It was reduced from 200 percent to 175 percent and under Senate Bill 27, eligibility for persons under 19 would increase to 200 percent of the poverty level and requires others who qualify and can afford to make contributions toward that coverage. Without Senate Bill 27, it's estimated that our eligibility rate in, since it was a fixed dollar amount in 2003 and now floating with the federal poverty guidelines, as all the other states, that our eligibility rate would drop to 154 percent and it may drop below 150 percent, at which point Alaska will loose immediately 3 million in federal funding and the State has already had 2,553 children drop off of this program. There were 7,600 children covered by this program as of December of 2006. We've lost over 30 percent of them already due to this fixed guideline and these children are going to also incur greater health coverage later on. So you essentially have a transfer costs here to other elements of government as they require additional health care coverage later on for failure to help them when they're children. So nothing has really changed on this other than the fact that there have been other bills addressed regarding similar subjects. We do have people from the department here that might assist with some of the dollar amounts, but I must note for the record, that the children provide the least costly types covered under this type of program. It's an estimated at about $1,700 per child compared to many thousands for severely disabled and elderly and health care facilities and so forth. The numbers that came across from other bills can be addressed by the State, but it may be as little as $783,000 out of the federal fund. Federal share again at an enhanced share rate of 70 percent, which is a bargain in anyone's analysis would be a total Denali KidCare cost of maybe two million six or seven hundred thousand dollars. 9:47:33 AM SENATOR BETTYE DAVIS spoke to the need of this legislation and the many people dependant upon the legislature to address the Denali KidCare program during this session. This bill included a component that would "alleviate some of the problems that we will have if we don't implement this." She indicated a figure [not specified] related to the bill, as well as another figure [not specified] of 175. If passage were dependant upon the lower figure, she would agree to it "because that would be better than nothing". 9:48:35 AM Senator Dyson directed attention to AS 47.17.020(b)(6) amended by Section 1 on page 2, lines 15 through 19. This subparagraph related to "persons in a medical or intermediate care facility" and amended the income qualification to "not exceed 300 percent of the supplemental security income benefit". The existing statute specified the income qualification as not exceeding $1,656 a month. He asked the current dollar amount of 300 percent of supplemental security income. 9:49:23 AM Mr. Obermeyer deferred to the Department of Health and Social Services. He noted that seven other states utilized a qualification of 300 percent or more and that 39 states provided services for those whose income did not exceed 200 percent of the supplement security benefit. Existing Alaska statute fixed the income amount at "the very lowest level was something like $1,635 per month". This amount had been established utilizing the federal poverty guideline as a base. The change from a fixed income amount to a percentage of the supplemental security benefit was intended to eliminate the need for each state to annually amend its statute to reflect the current federal guideline level. 9:50:49 AM Senator Dyson commented that the legislature "had always faced pressure to put escalator clauses" into its budget. Although this was a simple method, it concerned him, as it embedded these clauses into the operating budget. A discussion on this practice should be held. He also wanted to know the actual dollar amount calculated for this bill for comparison purposes. 9:51:47 AM Co-Chair Stedman agreed with Senator Dyson's concern and advised that this issue should be monitored. 9:52:07 AM Co-Chair Stedman requested information regarding the fiscal notes accompanying this bill. 9:52:22 AM JANET CLARKE, Assistant Commissioner, Department of Health and Social Services, testified to a table titled, "SB 27 Summary" that outlined the costs to implement this legislation [copy on file]. The provision Senator Dyson questioned was not included in other legislation addressing the Denali KidCare program. Four years ago, eligibility for the program was codified at 175 percent of the federal poverty level and the income amount to qualify for care in an intermediate care facility was codified in statute. The population served by the latter program qualified for nursing home care or had a disability as determined by the federal Social Security Administration, was a different population than that served by the Denali KidCare program, and was more expensive. 9:54:55 AM Ms. Clarke pointed out that because of the addition of the change to the nursing home and intermediate care facility program, the fiscal notes for this bill were significantly higher than the fiscal notes accompanying the other bills. This bill would "unfreeze" the eligibility requirements for both programs. Ms. Clarke explained that SB 27 would unfreeze the eligibility requirement for the Denali KidCare program at 200 percent of the federal poverty level and unfreeze the "special population group at 300 percent as well." Ms. Clarke noted the fiscal note estimates did not include administrative costs. Ms. Clarke overviewed the aforementioned table, which provided an enrollment summary of children, pregnant women and the "special income group". The fiscal notes reflect that in 2008 an additional 2,553 children, 436 pregnant women and 106 special income individuals would be eligible for the Medicaid services. Expenditures to serve the additional children would be $3,905,000, expenditures to serve the additional pregnant women would be $1,401,000, and expenditures to serve the additional special income individuals would be $6,103,000. These amounts total $11.4 million, not including administrative costs. Ms. Clarke reemphasized that the majority of the cost of this legislation would be the additional participants eligible through the special income group. Nursing home care and services for those with disabilities are the most costly. 9:57:03 AM Ms. Clarke stated that the total cost to implement the legislation before the Committee would be $4.6 million. 9:57:23 AM Senator Elton asked if the ratio of federal funds to general fund matching funds was the same for services for pregnant women and children and services for the special income group. 9:57:50 AM Ms. Clarke answered that the State did not receive an "enhanced rate" for services provided to the special income group. The regular Medicaid rate was currently 57.58 percent. 9:58:06 AM Senator Elton clarified that a higher percentage of general fund matching funds was required for services to the special income group than was required for services to pregnant women and children. 9:58:24 AM Ms. Clarke affirmed and pointed out that the spreadsheet demonstrated the "melding" of the different rates. 9:58:37 AM Senator Olson, in reviewing the annual costs of services to the special income group, noted that the cost increases between 2008 and 2013 would only be $3 million. He asked the validity of the projections. 9:59:00 AM Ms. Clarke told of a study conducted by the Lewin Group and released the previous year that developed a Medicaid forecasting model to estimate future Medicaid costs. The report predicted that the special income population would remain "fairly flat" for approximately eight years after which it "really takes off". The cost estimates for the years listed on the spreadsheet reflected that period of flat population growth. 9:59:37 AM CLOVER SIMON, Chief Executive Officer, Planned Parenthood of Alaska, testified via teleconference from an offnet location that she also was a social worker with approximately eight years' experience working with low income women and children. She read her testimony into the record as follows. I support the increase in eligibility for Denali KidCare to the 200 percent of the federal poverty level. Providing health care early in a woman's pregnancy improves the health outcomes for both the woman and the child. I really feel it should be a priority in Alaska to have the healthiest children that we can. I urge the members to consider this increase. I understand the members' concern regarding fiscal escalators in the budget. However, I want to remind you that spending money now saves money in the long run for the management of chronic preventable illnesses. 10:00:31 AM LEONARD FANCHER, lifelong Alaskan, representing Mighty Bikes, testified via teleconference from an offnet location in favor of the bill. For eight years he has volunteered for a youth recreation program teaching children to ride bicycles. The program encouraged children to get physical exercise "off the couch away from T.V. and video games." It was important that kids stay physically active and to have the best access to health care possible so they could remain healthy. Approximately 18,000 children were currently not covered by health insurance. These children were from working families whose employers did not provide insurance. The federal government was willing to contribute 70 percent of the cost to provide insurance for these children. With the State contribution of 30 percent, this was a "bargain" and the State could "well afford" the expense. 10:02:05 AM DAVID ALEXANDER MD, Retired Pediatrician, testified via teleconference from Anchorage, about the wide support of the Denali KidCare program and this legislation. He recently attended a gathering of Anchorage Faith in Action Congregations Together - the AFACT, along with approximately 200 others. The attendees were all in favor of improving health care coverage. He read the following testimony into the record. There is absolutely no question that routine health care provides better health and therefore better living both for kids and for adults. Poor health means you miss work or school or else you just miss-perform. Since 2003 when Denali KidCare was cut back, most of these cut out [from the program] could not afford buying health care. So many of them did not get routine care. They missed a lot more school and if needed, went to an emergency room; and because the federal government says ERs must be willing to give free care if needed, so Alaska emergency rooms are now having some $90 million of unpaid emergency room charges. So the rest of us therefore have to pay a lot more to cover those unpaid fees. There is no question that the State Legislature did save some money - obviously the rest of us lost money. In addition, since the federal government pays 70 percent of the charges under each state's CHIP, children health insurance program, that meant the State lost a couple million dollars in federal support. It is also very important to realize 35 to 40 percent of money that goes to insurance companies goes to their overhead expenses, while only five to eight percent of money that goes to government health coverage goes into the maintenance of those programs. Therefore government programs provide about 50 percent more actual health coverage than insurance companies do with the same amount of funding. So supporting these new proposals will improve health care for the kids; improve their ability to attend school and actually greatly decrease the health expenses of the whole State. 10:04:34 AM JANICE TOWER, Executive Director, American Academy of Pediatrics, Alaska Chapter, testified via teleconference from Anchorage about the organization's long term goal of insuring all children in Alaska. The Alaska chapter currently consisted of 87 pediatricians located throughout the state. She understood the Committee's time constraints and the necessity to make important priority decisions. Children should be considered the highest priority. Ms. Tower reported that 39 other states provide coverage for children living at up to 200 percent of the federal poverty level. Alaska was ranked "in the bottom five". The states of Montana and South Carolina covered children at 150 percent of the federal poverty level. Only North Dakota and South Dakota provided coverage to a lower rate of 140 percent of the federal poverty level; however, that coverage was not "artificially restricted". With the "poverty percentage reduction", the coverage provided in Alaska had decreased to 154 percent of the federal poverty level. Ms. Tower stated that the states of California, Connecticut, Maryland, Massachusetts, Missouri and Vermont provided coverage for participants with up to 300 percent of the federal poverty level. New Hampshire provided coverage for children living up to 400 percent of the federal poverty level. Illinois provided "unlimited coverage" with a "program buy-in" to allow some level of coverage to all children at an affordable rate. Ms. Tower disapproved of the coverage provided by the state of Alaska in comparison to other states. Significant revenue sources existed for the State from natural resources, tourism and other activities. 10:07:28 AM SARA JACKSON, Board Member, Anchorage Faith in Action Congregations Together, and "human services professional", testified via teleconference from Anchorage that the organization was comprised of 15 local churches "concerned about this issue". She told of her family's experience in which her granddaughter received "inconsistent and inadequate" health care although her mother worked full time. Her granddaughter experienced complex medical conditions and during most crises, the family incurred significant medical debt and had to rely on the "mercy of a kind doctor." The family "celebrated" the creation of Denali KidCare and the granddaughter qualified for services under the income provision of less than 200 percent of the federal poverty level. She was able to receive dental preventative care, an eye examination and other needed services. Two years later, however, she was "dropped" from the program because her mother earned $100 per month over the allowable income amount. Ongoing counseling and other medical care was no longer available. As a child of the working middle class, the granddaughter was part of a significant population that was "medically neglected." Ms. Jackson spoke to the hesitancies and delays of parents in seeking medical care for their children. This could exacerbate simple medical conditions. 10:10:51 AM SANDRA CASTLE testified via teleconference from Anchorage that she had previously received health care through the Denali KidCare program under the 150 percent of federal poverty level income provision. However, she was "cut" and was no longer able to continue her counseling treatment or receive care from a pediatric endocrinologist for her diabetes. To receive treatment, she had to go to an emergency room. Children in the state of Alaska need health care whether or not their parents have funding to pay for it. 10:11:56 AM ANGELA LISTON, Anchorage Faith in Action Congregations Together, testified via teleconference from Anchorage that over 200 people recently gathered in a local church to speak about Denali KidCare. Many family members shared "one horror story after another" about caring for their children's health needs since the reduction to the Denali KidCare program four years prior. These family members were employed and therefore could not be present to testify at this hearing. They represented every ethnic group, 15 faith communities and all social economic groups. Additionally, religious leaders in the state, including Catholic bishops, Presbyterian ministers, a Russian Orthodox bishop and Lutheran bishops, had joined the AFACT organization in supporting an increase to the Denali KidCare program. Recently AFACT met with US Senator Lisa Murkowski and were assured that she and US Senator Ted Stevens were seeking an S- CHIP reauthorization to allow states the "broadest possible latitude". If that latitude were granted, it would be unfortunate if Alaska did not take advantage of it. Coverage should be extended at least to those children living at 200 percent of the federal poverty level. 10:13:38 AM WALTER MAJOROS, Executive Director, Juneau Youth Services, President, Alaska Association of Homes for Children, and Vice President, Alaska Behavioral Health Association, testified in Juneau, in support of this legislation. He spoke to the impact of Denali KidCare on children's behavioral health services, specifically for children with severe mental health problems as well as children with substance abuse problems. Juneau Youth Services (JYS) serves approximately 700 of these children each year. Mr. Majoros informed that Denali KidCare was the primary funding source for children's behavioral health services in Alaska, providing 75 to 80 percent. Effective implementation of the Bring the Kids Home initiative was impossible without a viable funding source. A diminished funding source results in fewer children able to access care in the state and subsequently more children transferred to receive treatment in residential psychiatric facilities in the Lower 48. The number of children eligible for services through JYS had declined from 75 percent to 69 percent. This trend is similar statewide. Alaska was ranked the third lowest "eligibility threshold" at 154 percent of the federal poverty level. Additionally fewer children were covered by private health care insurance. All Alaskan children should have access to health care services and the State should "invest early" in children's health to prevent serious problems from developing. 10:16:18 AM Senator Davis considered this legislation one of the most important bills under consideration this legislative session. She advised the Committee to "do the right thing", to debate the issue and report the bill from Committee. She would not dictate the exact percentage of the federal poverty level to be adopted for income eligibility, but stressed it should not be less than 175 percent. 10:17:35 AM Senator Olson requested comment on the inclusion of the special income group. 10:18:06 AM Senator Davis admitted extension of services to those in this group living at 300 percent of the federal poverty level would triple the cost to implement this legislation, but stated it was an important issue that must be addressed. However, if extension of the Denali KidCare program were dependant upon the deletion of the provision to accommodate the special income group, she would not oppose the change. The bill was HELD in Committee.
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