Legislature(2007 - 2008)BUTROVICH 205


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01:32:23 PM Start
01:33:31 PM SB212
02:31:47 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
<Bill Held Over to 1/25/08>
             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                                                               
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                                                               
MS. FITZGERALD said  she doesn't have the exact  numbers in terms                                                               
of  enrollment but  said she  would get  that information  to the                                                               
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                                                               
SENATOR  THOMAS  asked  about  people  with  insurance  that  has                                                               
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                                                               
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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