Legislature(2003 - 2004)
02/26/2003 01:35 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SB 78-MEDICAID FOR BREAST & CERVICAL CANCER CHAIR FRED DYSON announced SB 78 to be up for consideration and noted that another bill on the same subject, sponsored by Senator Davis, was referred to the Senate HESS Committee. That bill is scheduled for a hearing next week. SENATOR LYDA GREEN, sponsor, said SB 78 removes the sunset provision of the 2001 legislation to allow women who have been participating the program to continue treatment and to provide treatment for women who will be diagnosed in the future. This bill gives DHSS the authority to impose allowable cost sharing under federal authority for the breast and cervical cancer category. The state would then be able to submit an amended state plan to the federal government that would also provide for the implementation of a system by which these funds would be collected. The language in the bill is the same as the language that was used for the original Denali Kid Care program. SENATOR GRETCHEN GUESS asked her to describe how other Medicaid programs are dealt with and how many have the cost sharing contribution language in section (e). SENATOR GREEN explained that the more established Medicaid programs have very high standards, meaning participants must have low levels of income and very limited asset ownership to qualify. The more recent programs have a general reference to an income limit, but not to an asset limit. She suggested that at some future time a co-pay requirement or client participation in rates might allow the program to be extended to other people who might qualify without creating a great expense to the state or the federal government. SENATOR GUESS asked what co-pays are in effect and would remain in effect if this bill passes. MR. LINDSTROM said the governor strongly supports this legislation. He explained the current co-pay is $50 per day up to a maximum of $200 for discharge of inpatient hospital services, 5% of allowable charges for outpatient hospital services, $3 per day for physicians services and $2 per day for each prescription and [indisc.]. SENATOR GUESS asked if the language on page 1, line 11, is problematic because it says, "to the maximum extent allowed by federal law," but then later indicates a sliding scale by household income. MR. LINDSTROM replied that he didn't think so by virtue of the permissive language on line 10, which says, "may require premiums...." CHAIR DYSON commented the co-pay limits are ridiculously low and asked if federal law requires them. MR. LINDSTROM replied that is correct and said he was speaking to the maximum that DHSS would be allowed to implement at this point according to federal law. CHAIR DYSON said he understood the sponsor's comments to mean that to qualify for this benefit a person will have to be at 200% of poverty level, the same as Denali Kid Care. MR. LINDSTROM replied for this program, Medicaid eligibility is tied directly to eligibility for the screening program and that is 250 percent of the federal poverty level. CHAIR DYSON said he understood this administration was going to recommend altering some of the qualifying levels and asked Mr. Lindstrom if he was saying those two will not be altered. MR. LINDSTROM replied the administration supports the bill as drafted and he is unaware of any suggestion to alter the federal poverty level for this program. The point that Senator Green made is why it's important to have this discussion about what the committee might want to consider relative to cost sharing. He pointed out: It's been a long-standing desire of this administration that if and when we are allowed to do so by the federal government, it is perfectly fair and very appropriate for individuals who are in these relatively higher income categories to support the medical costs to the extent they are able to do so in a reasonable manner. This is language that we are very comfortable with. CHAIR DYSON asked how much 250 percent of annual income at the federal poverty level amounts to. AN UNIDENTIFIED SPEAKER said he thought the poverty level in Alaska is about $11,000 per year, so 250 percent would be about $25,000 for a single person. MS. ANNE GORE, Program Director, Breast and Cervical Health Check, said she thought the amount is about $23,000 per year for a single individual. CHAIR DYSON said he understood that there are no asset limitations to qualify. MS. GORE responded that to be eligible for the screening program, a woman must have an income below the poverty level, be between the ages of 18 - 64 and she may or may not have medical insurance. She may have medical insurance that would preclude her from receiving those screening services (i.e. if the insurance wouldn't pay for preventative health care, such as an annual exam or a mammogram). If she is below the income level, has insurance and the physician submits proof that the insurance carrier denied her claim because those services are not covered, she is eligible to have her screening and diagnostic services paid for. Once she undergoes treatment, even if she has an unmet deductible of $5,000, she is considered to have creditable coverage and is not eligible to receive treatment under Medicaid. CHAIR DYSON asked about the asset requirements. MS. GORE replied there is no asset test for the screening and diagnostic program or for the treatment program. CHAIR DYSON asked if a person would qualify who had a home worth $1 million that was paid for but had just lost his job and medical coverage. MS. GORE said technically that person could, but she thought one would have enough assets if one owned a million dollar home to pay for screening. CHAIR DYSON asked Mr. Lindstrom if the preceding administration had moved away from having an asset qualification. MR. LINDSTROM said this program is peculiar because eligibility is tied to the screening program. Historically, the cash assistance programs have always had an asset test attached. MR. KEVIN HENDERSON, Eligibility Program Officer, Division of Medical Assistance, DHSS, said some Medicaid programs have been around for 10-12 years that do not have an asset test. However, most of the traditional categories do have asset tests. CHAIR DYSON said he understood that asset requirements have been on the books, but they have largely been ignored. MR. HENDERSON replied: Medicaid is pretty complicated and as you get into the law, there are 30 some different categories of eligibility - all of those authorized under some federal law - some are mandatory, some are optional.... He explained that the Denali Kid Care program and the Breast and Cervical Program don't have an asset test under the federal provisions. Many of the traditional Medicaid categories that have been around a long time have always had an asset test requirement. CHAIR DYSON asked if federal law precludes the state from having an asset test. MR. HENDERSON replied it does in the breast and cervical cancer category. He added: It ties eligibility directly to whether they have been screened by the Breast and Cervical Screening Program and that program, I believe by federal law, does not have an asset test attached to it. Adding an asset test to it is not, to my knowledge, an option for the state. SENATOR BETTYE DAVIS asked if the division had been denied a waiver once for Denali Kid Care and under what circumstances that happened. MR. LINDSTROM explained that DHSS petitioned the federal government and asked for the ability to do more in the way of co-payments and cost sharing but were told no. SENATOR DAVIS said according to the bill, the state is already drawing the maximum amount of money it can get based upon the guidelines. MR. LINDSTROM agreed. SENATOR DAVIS thought Section 2 was redundant and asked why it is needed. MR. LINDSTROM replied the governor and commissioner think it is worthwhile to reiterate the notion that with these programs, particularly when someone is above the typical income level for Medicaid, the state be allowed to implement a reasonable cost sharing mechanism. SENATOR DAVIS said she thought that language should be clarified. MR. LINDSTROM responded that he thought the language made that clear and he didn't think it was inconsistent with other language. SENATOR DAVIS asked if Mr. Lindstrom was preparing a new plan or waiting for the federal government to give out new guidelines. MR. LINDSTROM said he thought allowing the state to go further would require a change in federal law. CHAIR DYSON said the state could change the 250% of the federal poverty level amount if it wanted to. MR. LINDSTROM replied that is correct, although it wouldn't be in the context of the Medicaid program; it would refer back to the screening program. 2:04 p.m. MS. CAREN ROBINSON, Alaska Women's Lobby, supported SB 78. MS. CARLA WILLIAMS, President of Alaska Breast Cancer Advocacy and the state field coordinator for the National Breast Cancer Coalition said that both organizations support SB 78. CHAIR DYSON thanked her for her efforts on behalf of all Alaskans, particularly people suffering from these devastating maladies. MS. EMILY NENON, American Cancer Society, stated support for SB 78 and told members, "It is unconscionable to look a woman in the face and tell them they have cancer when you know they don't have the means to get treatment." She said Congress recognized this and created the 70 percent federal match to state dollars spent on this program. This month President Bush requested a $10 million line-item increase for the screening and diagnostic side of the program. She also has questions about the future implications of setting up cost sharing provisions and expressed concern about placing an undue burden on cancer patients now or in the future. The American Cancer Society is flatly opposed to changing the current eligibility requirements for the treatment program. It has to match the eligibility for the screening program otherwise they haven't gotten around the issue of screening uninsured low- income women, knowing that they have no means to get treatment. SENATOR GREEN moved to pass SB 78 from committee with individual recommendations and the accompanying fiscal note. There were no objections and it was so ordered.