Legislature(2003 - 2004)
03/03/2003 09:03 AM FIN
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE BILL NO. 78 "An Act relating to an optional group of persons eligible for medical assistance who require treatment for breast and cervical cancer; relating to cost sharing by those recipients under the medical assistance program; and providing for an effective date." This was the first hearing for this bill in the Senate Finance Committee. Co-Chair Wilken stated that this bill continues the optional breast and cervical cancer Medicaid coverage due to terminate in June 2003. He stated that this bill would authorize the Department of Health and Social Services to impose recipient cost sharing procedures as allowed by federal regulations. Co-Chair Green, the bill's sponsor, stated that the purpose of this bill is to extend the termination date for this program. She reminded the Committee that those individuals who have begun treatment would continue to receive Medicaid coverage as previously mandated by separate Legislation. Additionally, she noted, the bill would allow the Department of Health and Social Services to impose allowable cost sharing between the State and program recipients. She furthered that the bill's language is consistent with language of the Denali KidCare program. She noted that the bill would allow the State the flexibility required to align with any upcoming federal "re-workings" of the program. She noted that were the existing legislation to include this flexibility, the State would have been eligible for additional federal funding. ELMER LINDSTROM, Special Assistant, Office of the Commissioner, Department of Health and Social Services voiced the Department's support of this legislation. He specified that the Office of the Governor would welcome legislation that would make Medicaid coverage of breast and cervical cancer treatment "permanent," and he noted that the bill's fiscal note would be included in the Governor's amended FY 04 budget. He affirmed that the bill's fiscal note is consistent with the Department's projections as there has been no unexpected growth in the program. Senator Olson, a medical doctor, thanked the sponsor on behalf of the individuals provided coverage by this bill. He questioned whether the State is charging patients the maximum co-pay amount allowable under federal law. Mr. Lindstrom specified that, "the language in the proposal is consistent with current practice relative to co-pays." He continued that the issue of the co-payment amount "is something worth reiterating" as this program provides coverage to people whose income is "significantly" above the typical qualifying level. He stated that the Murkowski Administration is committed to the broader qualification coverage. Furthermore, he noted, the Administration supports a co-payment "cost sharing" contribution by the beneficiaries of the program. He noted that further expansion of qualifications into the program would require changes in federal regulations. Senator Olson asked whether the State is charging participants the maximum co-payment amount. Mr. Lindstrom responded that the Department would collect the same level of co-payments under the proposed legislation as collected under the current legislation. Senator Olson asked whether the State collects the maximum co- payment amount allowed under federal law. Mr. Lindstrom replied that is correct. Senator Olson asked whether the proposed bill would change the amount of money that the State would either pay or collect through the program. Co-Chair Green clarified that, rather than the State collecting the co-payments, the co-payments would be paid to service providers. She shared some the co-payment amounts. She reiterated that the State's broadened "asset eligibility" requirements allow Medicaid coverage for individuals earning significantly higher incomes than normally allowed. Senator Olson surmised that this legislation would not result in cost savings to the State. Mr. Lindstrom agreed. SFC 03 # 13, Side A 10:41 AM AT EASE 10:41 AM / 10:41 AM Senator Hoffman asked the reason the legislation includes cost sharing language if there is no related reduction in the cost to the State. Mr. Lindstrom responded that language is included in the proposed legislation to allow the State to pursue higher cost-sharing co- payment levels with program-eligible women in "significantly higher" income brackets, provided that future changes in federal regulations allow for that option. Senator Hoffman asked whether the State has attempted to expand the existing cost-sharing language in the Denali KidCare program, which also provides benefits to those with incomes higher than the normal qualifying amounts. Mr. Lindstrom responded that, as a result of a State inquiry, the federal government ruled against including additional cost sharing language in the Denali KidCare program "barring some change in federal law." Senator Hoffman asked whether the Department anticipates a different federal ruling pertaining to the additional cost sharing language included in this breast and cervical cancer legislation. Mr. Lindstrom responded that the Department does not currently anticipate a different ruling; however, he reiterated, the language is included in this legislation in anticipation of future federal changes regarding cost-sharing allowances. Co-Chair Wilken asked the testifier to clarify information in the fiscal note regarding whether Alaska Native women, who receive 100 percent medical coverage through Indian Health Services, are eligible for this program. Mr. Lindstrom responded that the federal government has determined that Native women could participate in this program. He stated, however, that the reason for there being "fewer billings than anticipated" for Native women is unclear. Co-Chair Green informed the Committee that a financial arrangement has been established whereby the Indian Health Services would reimburse the State for the breast and cervical cancer treatment provided to Native women. She continued that Native women could not be denied this program. Mr. Lindstom concurred with Co-chair Green's comments. Senator Hoffman specified that, while many health providers contract with the federal government to provide services, the provider and the client have the option to determine whether or not to bill Indian Health Services, an insurance company, or the State. Co-Chair Wilken asked for further clarification regarding language in the fiscal note regarding the expected growth rate; specifically whether the growth rate would be five or ten percent. Mr. Lindstrom clarified that, while there has been a five percent increase in the number of program participants, there has been a ten percent increase in program expenses due to the rising cost of health care. Co-Chair Wilken summarized that program expenditures are expected to increase at twice the rate of the number of program recipients. Mr. Lindstrom agreed. Senator Taylor moved to report SB 78 from Committee with individual recommendations and the accompanying fiscal note. There being no objections, SB 78 reported from Committee with a $970.0 fiscal note, dated February 24, 2003 from the Department of Health and Social Services.