Legislature(2007 - 2008)BUTROVICH 205
01/23/2008 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
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| Start | |
| SB212 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 212 | TELECONFERENCED | |
SB 212-MEDICAL ASSISTANCE ELIGIBILITY
1:33:31 PM
CHAIR DAVIS announced the consideration of SB 212.
1:36:13 PM
TOM OBERMEYER, Legislative Aide to Senator Davis, sponsor of SB
212, presented an overview of the bill, an act that describes
eligibility requirements for medical assistance for children and
pregnant women and re-instates qualifying income standards.
He said that SB 212 reinstates the qualifying income standards
for children and pregnant women receiving Medicaid benefits
under the Denali Kid Care (DKC) program to poverty guidelines
used when the program was established in 1997 at 200 percent
Federal Poverty Guideline (FPG) for Alaska. Reduced and frozen
at 175 percent FPG by the Legislature in 2003, the equivalent
income limits were reduced in the following four years to 154
percent by the time SB27 was implemented to reinstate current
levels of the FPG at 175 percent in 2007. Children and pregnant
women with household incomes between 176 percent and 200 percent
FPG still have not regained eligibility. SB212 also increases
allowable premiums or cost-sharing by families whose incomes are
between 150 percent-200 percent FPG.
The fiscal notes anticipate 2 percent enrollment growth after
2009 and an annual cost increase of 8.6 percent, allowing for 5
percent 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
State Children's Health Insurance Program (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. The Department of Health and Social Services
(DHSS) has requested additional support for Denali Kid Care in
the Governor's FY09 budget.
Forty one-states allow participation by families at or above 200
percent FPG with many over 300 percent. The reason for higher
State Children's Health Insurance Program (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 people, 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 Kid Care 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
revenues.
1:37:47 PM
SENATOR COWDERY arrived online.
1:38:18 PM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services, thanked Chair Davis for last year's bill that got the
agency to 175 percent of poverty for DKC and for her help on the
Governor's Health Care Strategies Planning Council including the
recommendation to raise the amount to 200 percent of poverty.
The governor's main question to the Commissioner was the federal
government's re-authorization of SCHIP.
1:40:27 PM
SENATOR DYSON asked Chair Davis if she's planning to pass the
bill out today. He expressed concern about the sustainability of
the expense attached to the bill and asked if the amount to
cover the expansion is in the governor's budget.
MS. JACKSON replied she doesn't think the additional amount is
in the governor's operating budget. If it's passed out it would
need to have a fiscal note. She said his concerns are valid.
1:42:51 PM
CHAIR DAVIS said her goal is to have the bill go forward as soon
as possible. She sees the cost as an investment. She pointed out
that it will receive a full hearing in the Finance Committee.
Her concern is not the finances; it is the services that are
needed for the most vulnerable kids. She said she didn't know if
the bill would pass that day.
SENATOR ELTON asked Ms. Jackson if the governor is supportive of
the bill.
MS. JACKSON said she didn't want to imply there was more support
from the governor than there is. She said the governor wanted to
know what the recommendations were from the health council. In
the governor's State of the State address, she included a couple
of recommendations from the council in the Health Care
Transparency Act. This was not one of those. However, it was not
dismissed, just considered worthy of more attention depending on
what the federal government does.
1:45:03 PM
SENATOR ELTON suggested the commissioner nail down the
governor's position because he doesn't see the point of
continuing if the governor would veto it. Waiting for a federal
decision is not necessarily what's best for the services
provided to Alaskans. The President has vetoed this twice now.
MS. JACKSON agreed with Chair Davis that this part of the
discussion needs to be in the Finance Committee.
1:46:54 PM
CHAIR DAVIS said she has been told by the administration that at
the very least the money will be in place for continuing at the
175 percent level. She told Ms. Jackson that if this is not true
the state would have to provide funding beginning in March.
MS JACKSON said she would defer the question to her staff.
1:48:21 PM
SENATOR COWDERY asked what the eligible income would be for a
family of 4 if this was to take affect.
MR. OBERMEYER said if they go to the 200 percent level,
according to the federal guidelines, it says up to $53,000 for a
family of 4 as of the January 2008 poverty guideline level.
1:50:00 PM
ELLIE FITZGERALD, Director, Public Assistance, DHSS, said the
poverty guidelines for 2008 have just been released and
confirmed the figures Obermeyer stated.
SENATOR COWDERY said in 2003 the legislature voted to change the
eligibility from 200 to 175 and was told 100 people would be
affected by the change. He asked how many people have been
affected.
MS. FITZGERALD said she doesn't have the exact numbers in terms
of enrollment but said she would get that information to the
chair.
1:52:03 PM
SENATOR COWDERY asked how the disbursement of energy funds would
affect the income level.
1:53:27 PM
MS. FITZGERALD said there is a proposal for an energy dividend
of $250. It was determined the last time we did something like
this that it would not count towards Medicaid eligibility.
GERRY FULLER, Medicaid Project Director, Commissioner's Office
of Program Review, Department of Health and Social Services,
gave a brief overview of the federal scene in which today there
was an override in the House vote. Therefore, an authorization
of the SCHIP is not on the horizon. In considering the temporary
extension of SCHIP through March 31, 2009 there appears to be
enough funding to fund the Alaskan Kid Care Program. The final 3
months of the 2009 fiscal year, however, may not be covered so
within the fiscal note there is a small General Fund increase to
cover that.
1:55:35 PM
MR. FULLER said there will also be a temporary increase in the
Federal Medical Assistance Percentage to provide some relief.
1:56:46 PM
MS. FITZGERALD said they do have a fiscal note for the
eligibility piece for determining eligibility. It would require
one additional position for the additional workload.
1:57:4 PM
CHAIR DAVIS said other people not from the administration wish
to testify.
BRAD OHS, Administrator, North Star Behavioral Health Systems,
Palmer Residential Treatment Center, a member of the Alaskan
Association of Homes for Children (AAHC). He said his agency
serves 124 Alaskan youth in psychiatric residential treatment
centers. 100 percent rely on DKC for payment of these services.
In the beginning they used the eligibility standard of 200
percent. In 2004 the legislature scaled it back to 175 percent.
The result is that Alaska is now ranked the 4th lowest in DKC
eligibility rates in the country and Alaska is missing out on
federal funds. 3500 children of working families have no access
for medical care. AAHC supports restoration of the DKC
eligibility to the minimum level of 200 percent.
1:59:47 PM
SENATOR DYSON questioned Mr. Ohs about the fact that these
children have no access to medical care.
MR. OHS said that in terms of the treatment they provide, many
of these families don't qualify. Private insurance only pays for
partial services. The children they work with require longer
term intervention.
SENATOR DYSON said he realized that Mr. Ohs was talking only
about the care his agency provides and not over-all medical
care.
SENATOR THOMAS asked about people with insurance that has
limitations.
MR. OHS said 5 percent of the children from working families do
have private insurance. Their facility serves 30 teenage boys,
and they typically have one or two families with private
insurance who can pay from 14 to 20 days. After that the private
insurance terminates. Their average length of stay is 10 to 12
months.
2:03:26 PM
ROD BETIT, President and CEO of Alaska Hospital and Nursing Home
Association, said it has 37 members representing nursing homes,
hospitals, assisted living and some military facilities. He said
their entire membership supports SB 212. He also serves on the
Health Care Strategies Planning Council, and the majority is
supportive of the bill. He is also a former state health
commissioner for 12 years. He said there are many working
parents who cannot obtain coverage through their employer. The
$53,000 that was mentioned is gross income.
SENATOR THOMAS said $53,000 seems like a lot but he recognized
that it is a gross number. He said it would be helpful to know
what potential lengths of stays are for particular problems and
the amount of money involved when insurance is absent.
MR. BETIT said he'd be happy to provide that information.
SENATOR ELTON said it would also be helpful to know what the
cost of hospitalization is. Since the change in 2003 required
the drop of 2500 children and about 400 to 500 pregnant woman
from the program, he asked if raising the percentage would
bring half that number back into the program.
MR. BETIT said that what happened in 2003 was a double whammy.
The percentage wasn't just going down to 175 percent, it was
freezing at that level and not adjusted according to cost of
living so there was a dramatic decline in eligibility.
2:09:47 PM
CHAIR DAVIS pointed out that even though they were supposed to
be at 175 percent they had actually eroded to 155 percent so
they do have the numbers of how many children were brought back
on to the service when the bill passed at 175 percent.
JORDAN NIGRO, Residential Services Director, Juneau Youth
Services, said she also represented the Alaska Association of
Homes for Children and the Alaska Behavioral Health Association.
They believe that raising the percentage would allow more
children in Alaska to receive proper health care including
behavioral health services. Children who do not have health
services often do not get needed prevention causing more
physical and emotional problems later in life which can then
cost the state and private businesses when the youth end up in
hospitals or jails. DKC is the primary method of payment for
behavioral health care in the state and is critical to the
success of Bring the Kids Home, a statewide initiative. She also
mentioned the fact that Alaska has the 4th lowest eligibility
rate in the US. 70 percent of the youth at her agency receive
DKC. The agency would be able to serve more children if the
eligibility rate was raised.
2:13:38 PM
SENATOR THOMAS asked if it's true that about 60 percent of kids
in youth facilities around the state have mental, emotional and
behavioral issues.
MS.NIGRO said that is probably true.
2:14:08 PM
MEGAN JOHNSON, Chair, statewide advocacy coalition for children,
Voices for Alaska's Children and Youth (VACY). It represents
public and non-profit organizations caring for 1,800 uninsured
children and youth. Recommendations made by the National Academy
of Sciences are to insure health care for all by 2010. There are
many connections between having a healthy and reliable work
force and the quality of that work. She mentions retention
issues in the job market. She says at times it feels like this
is a third world country and suggests that health care be seen
as a human right versus a privilege.
2:17:32 PM
SENATOR THOMAS asked how effective agencies are at identifying
early stage intervention needs.
MS. JOHNSON replied that some of this happens in the 18 instant
learning programs throughout the state. Some agencies have
developmental screenings. There are also programs to qualify
children for early intervention - they must have a 50 percent
delay in one area to qualify, which means that there are a lot
of children that fall through the gap. The state has one of the
highest rates of abuse and neglect in the country and it is
missing a lot of kids with language and emotional development
problems. Since they don't fall within the 50 percent delay they
are often not identified as having problems until much later.
She said this is such a critical time in brain development.
2:19:25 PM
CAREN ROBINSON, Alaska Women's Lobby, said that her organization
strongly supports this bill and it has been their number one
priority. She pointed out that this is just a moment in time, in
crisis, when the families might need care. It is not forever.
She said it's not just families that are poor. She said she
knows of ten families here in the capitol building whose
children have utilized this service.
2:21:58 PM
LARRY WEISS, Alaska Center for Public Policy, talked about a
study in 2002, called the impact of Medicaid on Alaska's
economy. He said the researchers showed that Medicaid
contributed over one billion dollars to Alaska's economy and
over 9,000 jobs and income to those people equaling about a
third of a billion dollars. The Alaska Department of Labor, in
an upcoming publication of Alaska Economic Trends, focuses on
health care and points out that it is the fastest growing
industry for the past 18 years in Alaska. Medicaid is a bargain
for the state as investment. With federal matching funds, for
every dollar spent there's more than a dollar federal match, and
if the child is native, the federal government pays the whole
bill. The average Medicaid cost per year in Alaska per child is
$3,800, and there are about 21,000 uninsured children in Alaska,
most of who would qualify at the 200 percent level. This is a
great opportunity for the state to contribute to the economy
using federal dollars.
2:25:18 PM
NAOMI TIGNER, Alaska Association of Homes for Children and
Program Development Director for Presbyterian Hospitality House
in Fairbanks. The program in Fairbanks is similar to Juneau
Youth Services. For many of the youth they treat from the
villages, this is their first opportunity for medical services.
Most are severely emotionally disturbed and many are diagnosed
with fetal alcohol syndrome. She supports SB 212.
2:28:05 PM
LAURIE MORRIS, President, Alaska Association of Homes for
Children, said the association represents 20 organizations in
the state that provide behavioral health services to children
and families. She said children without health care are four
times more likely to use emergency services. Her organization
supports SB 212.
CHAIR DAVIS said she was pleased with the testimony. She would
not call for a vote, but will bring it back on Friday.
SENATOR DYSON asked what else would be discussed on Friday.
CHAIR DAVIS said the bill for Friday would be SB 245. She said
she'd like all of the members to be present.
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