Legislature(2007 - 2008)SENATE FINANCE 532

04/08/2008 09:00 AM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SB 212 Out of Committee
Moved CSSB 8(FIN) Out of Committee
Scheduled But Not Heard
Heard & Held
Moved SCS CSHB 166(FIN) Out of Committee
Scheduled But Not Heard
Scheduled But Not Heard
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
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."                                                                                               
9:49:16 AM                                                                                                                    
TOM OBERMEYER,  STAFF, SENATOR  DAVIS, presented  an overview                                                                   
of the bill by reading the Sponsor Statement:                                                                                   
     SB 212  reinstates the  qualifying income standards  for                                                                   
     children and pregnant women  receiving Medicaid benefits                                                                   
     under  the  Denali  KidCare  (DKC)  program  to  poverty                                                                   
     guidelines  used  when the  program  was established  in                                                                   
     1997  at  200%  Federal   Poverty  Guideline  (FPG)  for                                                                   
     Alaska.  Reduced   and  frozen   at  175%  FPG   by  the                                                                   
     Legislature in  2003, the equivalent income  limits were                                                                   
     reduced in the following  four years to 154% by the time                                                                   
     SB27 was implemented to reinstate  current levels of the                                                                   
     FPG at  175% in 2007.  Children and pregnant  women with                                                                   
     household incomes  between 176% and 200%  FPG still have                                                                   
     not   regained   eligibility.   SB212   also   increases                                                                   
     allowable  premiums or  cost-sharing  by families  whose                                                                   
     incomes are between 150%-200% FPG.                                                                                         
     The fiscal  notes anticipate 2% enrollment  growth after                                                                   
     2009 and an  annual cost increase of 8.6%,  allowing for                                                                   
     5%   medical   inflation   in   Alaska.   The   $249,600                                                                   
     appropriation  required for  2009 does  not reflect  the                                                                   
     indirect  savings  by fewer  emergency  room visits  and                                                                   
     many  avoided long-term  illnesses  for SCHIP  children.                                                                   
     The  addition  of one  employee  and office  expense  at                                                                   
     $73,800  provides   for  the  anticipated   increase  in                                                                   
     enrollment  of 218  pregnant  women  and 1277  children.                                                                   
     DHSS  has   requested  additional  support   for  Denali                                                                   
     KidCare in the Governor's FY09 budget.                                                                                     
     Forty one-states  allow participation by families  at or                                                                   
     above  200% FPG  with  many over  300%.  The reason  for                                                                   
     higher  SCHIP eligibility  coverage in  other states  is                                                                   
     that  the  federal  government reimburses  SCHIP  at  an                                                                   
     enhanced rate,  and higher SCHIP eligibility  has proven                                                                   
     to be  an efficient  use of  health care dollars.  While                                                                   
     most  patients   enrolled  in  Medicaid   are  children,                                                                   
     children  utilize  only  a fraction  of  the  resources.                                                                   
     Early intervention and preventative  care greatly reduce                                                                   
     visits   to  emergency   rooms   and  costly   long-term                                                                   
     illnesses.  Hospitals regularly  write-off  the cost  of                                                                   
     emergency  room  visits   by  non-emergency  low-income,                                                                   
     indigent,  or uninsured  patients whom  they must  serve                                                                   
     when  patients  cannot  pay.  The costs  of  these  non-                                                                   
     emergency  visits to  hospitals for  SCHIP children  and                                                                   
     other low-income  and uninsured,  who have no  other way                                                                   
     of obtaining health care,  are passed along in increased                                                                   
     costs to  patients who do  pay and/or are  insured under                                                                   
     private  or  state health  benefit  plans.  There is  no                                                                   
     effect on  eligibility for  Denali KidCare if  the SCHIP                                                                   
     allotment is  fully expended. If costs  exceed available                                                                   
     SCHIP funds, claims are simply  reimbursed at the lower,                                                                   
     regular  Medicaid  rate,  resulting in  reduced  federal                                                                   
9:52:16 AM                                                                                                                    
Senator Dyson  asked what would  be the financial  difference                                                                   
for a family of four.                                                                                                           
Mr.  Obermeyer explained  that  the amount  is predicated  on                                                                   
income but he did not have the  dollar amount. He referred to                                                                   
a Medicaid expert online.                                                                                                       
9:53:07 AM                                                                                                                    
STEVE  HORN,  EXECUTIVE DIRECTOR,  ALASKA  BEHAVIORAL  HEALTH                                                                   
ASSOCIATION  testified   via  teleconference  and   spoke  in                                                                   
support of the  bill. He reported that Alaska  has the fourth                                                                   
most  stringent  eligibility   level  for  children's  health                                                                   
insurance  in  the country  resulting  in many  children  not                                                                   
receiving  needed  basic  health  care.  He  believed  Denali                                                                   
KidCare  will save  Alaska money  in the  long run.  Children                                                                   
without health care receive less  preventative care resulting                                                                   
in  higher  health   risks  and  greater  use   of  expensive                                                                   
emergency rooms.                                                                                                                
9:54:38 AM                                                                                                                    
JERRY  FULLER, MEDICARE  DIRECTOR, DEPARTMENT  OF HEALTH  AND                                                                   
SOCIAL  SERVICES testified  via teleconference  and noted  he                                                                   
did not  have the  income chart  with him  to answer  Senator                                                                   
Dyson's question  to describe the  income level for  a family                                                                   
of four at the 200% level. He  acknowledged that the Governor                                                                   
has not taken a position on this bill.                                                                                          
9:55:37 AM                                                                                                                    
BRENDA  MOORE, MEMBER,  MEDICAL HEALTH  BOARD AND  COUNSELOR,                                                                   
SUICIDE PREVENTION  testified  via teleconference in  support                                                                   
this  bill   and  encouraged   the  bill  being   moved  from                                                                   
9:56:55 AM                                                                                                                    
NAOMI TIGNER,  ALASKA ASSOCIATION FOR HOMES  FOR CHILDREN AND                                                                   
PRESBYTERIAN HOSPITALITY  HOUSE testified via  teleconference                                                                   
in support  of this  bill. She believed  in the necessity  of                                                                   
raising the eligibility  level to 200% to enable  children to                                                                   
receive basic needed health care.                                                                                               
AT EASE: 9:58:09 AM                                                                                                           
RECONVENED: 9:58:50 AM                                                                                                        
9:59:05 AM                                                                                                                    
ROD  BETIT, PRESIDENT,  ALASKA  STATE HOSPITAL  NURSING  HOME                                                                   
ASSOCIATION  testified via teleconference  and supported  the                                                                   
bill.  As a  member of  the Governor's  Health Care  Strategy                                                                   
Council,  the Association  listed this  as one  of their  key                                                                   
recommendations to bring coverage to the 200 percent level.                                                                     
10:00:24 AM                                                                                                                   
LAWRENCE WEISS, EXECUTIVE DIRECTOR,  ALASKA CENTER FOR PUBLIC                                                                   
POLICY testified via teleconference  in support of this bill.                                                                   
He  presented  the  economic  issues  for  the  1,200  Alaska                                                                   
children  with no  access to  health care.  For every  thirty                                                                   
cents   the  state   spends,  the   federal  governor   would                                                                   
contribute seventy  cents. Children  without health  care are                                                                   
at highest risk  to use expensive emergency  rooms where they                                                                   
do not receive preventive health  measures. This program will                                                                   
save the state money in the future.                                                                                             
10:03:15 AM                                                                                                                   
ANGELA LISTAN  spoke in support  of the bill. She  noted that                                                                   
the cost  of health  care has  risen faster  than almost  any                                                                   
other living  expense.  She noted that  forty-six states  use                                                                   
the  200 percent  federal poverty  level  rate. She  remarked                                                                   
that  the federal  poverty  level  for a  family  of four  is                                                                   
$53,000 which  is not enough to  cover all expenses  with the                                                                   
additional expense for health insurance.                                                                                        
10:05:24 AM                                                                                                                   
GERAN TARR,  ALLIANCE FOR REPRODUCTIVE JUSTICE  testified via                                                                   
teleconference in  support of the  bill. She agreed  with the                                                                   
previous comments from the others testifiers.                                                                                   
10:06:45 AM                                                                                                                   
GUS  MARX, GRANTS  MANAGER, JUNEAU  YOUTH SERVICES  supported                                                                   
the bill. His family has used  Denali KidCare in the past and                                                                   
he applauded the state for helping families in need.                                                                            
10:08:11 AM                                                                                                                   
JEFF JESSEE,  CHIEF EXECUTIVE  OFFICER, ALASKA MENTAL  HEALTH                                                                   
TRUST AUTHORITY  spoke in  support of  the bill. He  declared                                                                   
that Medicaid  is a crucial part  of funding for  children in                                                                   
need and this bill will assist  in financing future projects.                                                                   
10:08:55 AM                                                                                                                   
Co-Chair Stedman reviewed the  three Department of Health and                                                                   
Social Services fiscal notes attached to this bill.                                                                             
10:09:50 AM                                                                                                                   
Senator  Thomas  appreciated  those who  brought  forth  this                                                                   
bill. He  mentioned that  other people  were covered  by this                                                                   
bill, such as the aged, blind and mentally retarded.                                                                            
10:10:42 AM                                                                                                                   
Co-Chair  Hoffman MOVED  to REPORT  SB 212  out of  Committee                                                                   
with  individual  recommendations  and  the  attached  fiscal                                                                   
Senator Dyson OBJECTED for discussion.                                                                                          
Senator Dyson  warned of putting  into Statute  programs that                                                                   
the Legislature may  not be able to sustain in  the long run.                                                                   
He suggested the bill have a provision  that in three or four                                                                   
years the percentage  reverts back to the 175  percent unless                                                                   
the  Legislature  takes action.  The  state  may run  into  a                                                                   
deficient problem  in the future.  He reminded  the Committee                                                                   
of another state program that  allows people with significant                                                                   
health issues to get state financing.                                                                                           
Senator Dyson WITHDREW his OBJECTION.                                                                                           
Senator Elton OBJECTED for discussion.                                                                                          
Senator  Elton reported  his  enthusiastic  support for  this                                                                   
bill. He remarked  that one of the biggest  debates this year                                                                   
was whether to  provide energy assistance, across  the board,                                                                   
regardless  of need  or  income level.  In  his opinion,  the                                                                   
beauty of  SB 212  is the it  provides medical assistance  to                                                                   
Alaskans in need  and this is one of the  preeminent concerns                                                                   
and rights  of all  citizens. This  program would receive  $2                                                                   
from the federal government for  every $1 spent by the state.                                                                   
Senator  Elton   WITHDREW  his  OBJECTION.  There   being  NO                                                                   
OBJECTION, it was so ordered.                                                                                                   
SB 212 was REPORTED out of Committee  with no recommendations                                                                   
and  three  accompanying previously  published  fiscal  notes                                                                   
from the Department of Health and Social Services.                                                                              
10:15:19 AM                                                                                                                   

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