Legislature(2003 - 2004)

02/26/2003 01:35 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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.                                                                                               

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