Legislature(2011 - 2012)BUTROVICH 205
03/23/2011 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
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| Start | |
| SB5 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 5 | TELECONFERENCED | |
SB 5-MEDICAL ASSISTANCE ELIGIBILITY
1:33:13 PM
CHAIR DAVIS announced the first order of business would be SB 5,
the Denali KidCare Bill.
KAREN PURDUE, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNA), established in 1953, said
ASHNA has consistently supported Denali KidCare and continues to
support its passage today. They are involved in children's lives
at delivery and also when they need acute medical care. It is a
huge concern when you have a very sick child and coverage is not
available.
Denali KidCare has allowed families to seek medical care at the
most appropriate time for their children. ASHNA was disappointed
in the governor's veto last year. Fourteen years ago she was
involved as Commissioner of the Department of Health and Social
Services in fashioning Denali KidCare.
1:35:56 PM
THOMAS OBERMEYER, staff to Senator Bettye Davis, gave an
overview of the bill. SB 5 is an act relating to eligibility
requirements for medical assistance for certain children and
pregnant women. SB 5 establishes and restores to the original
levels of fourteen years ago the qualifying income eligibility
standard to 200 percent of the federal poverty level for the
State Children's Health Insurance Program (SCHIP), called Denali
KidCare in Alaska. Although one of the wealthiest states, Alaska
is one of only four states which funds its SCHIP program below
200 percent of the federal poverty level.
This bill makes health insurance accessible to an estimated
1,077 more uninsured children and 225 pregnant women in Alaska.
These are the people who were dropped from the system when the
level was reduced to 175 percent. Denali KidCare is an enhanced
Medicaid reimbursement program receiving up to 70 percent
matching funds.
Denali KidCare serves an estimated 7,900 Alaska children and
remains one of the least costly medical assistance programs in
the state. Intervention and preventive care will greatly improve
Alaska children's health and yield substantial savings to the
state and private sector hospital emergency rooms. Uninsured
children are five times as likely not to have a regular doctor
as insured children and four times more likely to use emergency
rooms. A similar bill was overwhelmingly passed with bipartisan
support in 2010. Governor Parnell vetoed the bill over concern
of increased eligibility which would require an increase in
state funded induced terminations of pregnancies.
Medicaid funds 51 percent of all births in Alaska. In order to
receive continued funding for the state Medicaid program and to
comply with state law, constitutional provisions, and Alaska
Supreme Court rulings, the state must provide medical services
for pregnant women including medically necessary terminations as
well as prenatal and postpartum care.
The Alaska Department of Health and Social Services (DHSS)
estimated that no more than 22 induced terminations would
result. Induced terminations under Denali KidCare cost about
$384,000 annually, or less than .18 percent of the $217 million
Denali KidCare budget. While the governor understandably is
concerned about the mushrooming costs of the state Medicaid
program, Denali KidCare should not be among first cuts at the
expense of Alaska's most vulnerable children and pregnant women.
Increasing eligibility to 200 percent is uncomplicated,
manageable, and could take effect immediately.
1:40:58 PM
SENATOR MEYER asked if indeed this is the same bill as last year
and we still have the same governor, isn't it destined for the
same fate.
CHAIR DAVIS responded she did have a brief meeting with the
governor at the beginning of the session, and they could not
agree on this issue. He has not had a change of mind. People
within the department are trying to come up with a solution. She
would like to at least move the bill from Health and Social
Services to Finance. She did contact the commissioner's office
and let them know she was going to move forward.
SENATOR MEYER said it sounds like discussions are still ongoing.
CHAIR DAVIS answered yes, the department has said it would get
back to her with possible solutions or suggestions.
1:43:58 PM
JOHN SHERWOOD, Medical Assistance Administrator, Department of
Health and Social Services (DHSS), said he was here primarily to
answer questions. The department is continuing to analyze
possible options.
CHAIR DAVIS asked if moving the bill forward at this time would
interfere with those conversations.
MR. SHERWOOD replied to the best of his knowledge DHSS has no
position on movement of the bill.
CHAIR DAVIS opened public testimony on SB 5.
1:45:56 PM
KATIE CHAPMAN, representing Planned Parenthood, said Planned
Parenthood Votes Alaska supports the increase in Denali KidCare
eligibility. The increase is good policy for the health and
economics of our state. It reflects sound fiscal policy;
children and pregnant women without access to health care are
four times as likely to use emergency room care. SB 5 simply
brings eligibility back to the original level approved by the
legislature in 1999. Alaska continues to be one of the few
states that do not prioritize the needs of children and pregnant
women.
1:47:43 PM
CAREN ROBINSON, representing the Alaska Women's Lobby, said the
Alaska Women's Lobby has been at the table in support of Denali
KidCare since 1999. They were defeated in 2004, and were pleased
when the eligibility changed last year, and crushed when the
governor vetoed the bill. Nearly 200 organizations have joined
in asking the legislature to put us back up to 200 percent. Her
grandson was a Denali KidCare baby; the hospital bill for his
birth was $65,000; this would have been a crushing debt for his
parents. She reminded the committee that the legislature has the
veto override power.
1:50:37 PM
SENATOR MEYER said the committee is supportive of SB 5, but
there is that issue that is a concern to the governor and other
legislators. He asked if she had any suggestions.
MS. ROBINSON responded that because of the constitution there
are no real solutions. She would like to get a better handle on
coding; there is some confusion regarding what is considered
medically necessary. Even if a woman receives counseling but
does not actually have an abortion, it could be coded as an
abortion related service. There is also a national waiver
program which involves intensive family planning services. The
most recent study shows that states with this waiver have cut
abortion rates in half. This helps families to make good
decisions, and brings down the number of abortions instead of
penalizing women who make the decision to have a child and who
need this health care. She said she understands and respects the
issue.
SENATOR MEYER said he had heard the same thing. Sometimes a
miscarriage could be coded as an abortion. So this does need to
be researched. A miscarriage is a loss.
MS. ROBINSON agreed.
1:54:59 PM
CHAIR DAVIS asked Mr. Sherwood to return to the stand. Noting
that many women say miscarriages are classified as abortions,
she asked him to speak about the medical coding.
MR. SHERWOOD said he was not an expert on the coding, but he
could provide some information. He said that the department
reviewed the statistics for "abortion related services" and they
did not find instances where miscarriages were reported as
abortions. For purposes of clarification, they are not grouping
every termination of pregnancy together. He could provide more
specific information on the actual coding.
CHAIR DAVIS asked what the state actually pays towards abortions
and how are they billed.
MR. SHERWOOD answered eligibility categories are not changed.
Denali KidCare is a subset of the larger Medicaid program. When
anyone with Medicaid eligibility has an abortion, the state pays
and does not claim federal funds. These women may be eligible
for family or disability related Medicaid. At the payment level
it is all just Medicaid.
CHAIR DAVIS asked why the state doesn't claim the federal funds
for abortions.
MR. SHERWOOD responded there is a federal law restricting use of
federal funds for abortions, the Hyde amendment. This mandates
that federal funds can only be used for abortions in the case of
rape, incest, or to save the life of the mother. The state will
claim federal funds if they receive a form from the physician
certifying those conditions have been met. Generally speaking
the form is not submitted. So they lack the documentation to
justify making the federal expenditure.
CHAIR DAVIS asked if DHSS could make that a requirement.
MR. SHERWOOD responded that court cases prevent us from limiting
our coverage.
CHAIR DAVIS asked if they could be paid by the federal
government, why providers are not required to submit forms.
2:00:21 PM
MR. SHERWOOD answered the state doesn't know what cases might be
involved. Providers might not always know with certainty.
2:00:52 PM
STACIE KRALY, Assistant Attorney General, Department of Law,
(DOL), said the question is can we require providers to submit
certification in order to seek federal matching dollars for Hyde
Amendment abortions. She said she did not know whether the
department has evaluated that question, but it warrants further
investigation. DHSS could potentially increase its reporting
requirements to require providers to submit that certification
for purposes of federal reimbursement. She said she could look
into this.
SENATOR DYSON said his memory is we had this debate a year or
more ago; for a family of two, at 175 percent; they could be
making $45 or $58 thousand dollars.
MR. SHERWOOD said he had the chart in his folder. Annual income
for a family of 2 at 175 percent of poverty is $32,165; for a
family of four it is $48,895.
2:03:34 PM
JOY LYON, Executive Director, Alaska Association for the
Education of Young Children (AEYC), said Denali KidCare
expansion is high on their list of priorities. AEYC also
represents many local Juneau partners with its Best Beginnings
partnership. They want to get families away from the emergency
room. Partnership for Families in Juneau is working with
pediatricians and health providers. All are using a screening
tool around the risk factors for stress in the family. Doctors
are able to guide families to appropriate services. Lowering the
eligibility level for Denali KidCare would result in stronger,
healthier children.
2:05:46 PM
GUS MARKS, Juneau Youth Services, said about 75 percent of their
clients are on Denali KidCare. One issue is that grants are
becoming more competitive and they receive less funding each
year. The expansion of Denali KidCare would help them.
2:06:50 PM
MARY SULLIVAN, Alaska Primary Care Association, testified in
support of SB 5. Children with access to primary care have
healthier lives and do better in school. She has a family member
who got pregnant early in life, and having the option of Denali
KidCare was part of her decision to keep the baby. Now the
mother is off of public support and is a productive citizen.
Denali KidCare helps people make better choices. Anchorage
Senior Citizen Advisory Commission also unanimously voted to
support this bill; 8,000 seniors are raising grandchildren in
Alaska, and many are on limited incomes.
2:09:06 PM
RANDY SWEET, United Way of Anchorage, said the United Way
supports the increase in eligibility. They do appreciate the
complexities of this issue; Alaskans have a tradition of working
together to solve problems. Together we can respect diverse
viewpoints and promote and protect the health of vulnerable
women and children.
2:10:56 PM
DEBBIE LEFLECHE, YWCA of Anchorage, testified in support of SB
5. She said preventive care saves us all money.
2:11:55 PM
WEETA MORRISON, representing herself, said she was a single
parent and fortunately had insurance but she knows others who
have used Denali KidCare. Receiving preventive care prevents
future problems.
2:13:11 PM
KATHY DIAMOND, Tanana Chiefs, testified in support of SB 5. They
have seen many patients benefit from this coverage. There will
be many children and pregnant women who would be covered and be
eligible to receive medical care.
2:14:19 PM
RICHARD PECK, Board President, Liuliuk Clinic, Unalaska,
testified in support of SB 5. He said that expansion of Denali
KidCare would help them to sustain their number one priority,
which is the youth of their community. He would like to remind
the governor that Unalaska is America's number one fishing port
and this program would help them sustain and maintain the port.
This would add coverage for about 30 to 40 families in their
community.
2:15:12 PM
REBECCA HOWE, Raven's Way in Sitka, said she works with
teenagers who have addiction issues and Denali KidCare has
helped them receive appropriate treatment, including aftercare
services. Increasing eligibility will help these youth and their
families.
2:16:41 PM
CHAIR DAVIS asked if any committee members had comments.
SENATOR MEYER said he didn't know the meaning of "medically
necessary" abortions, and wondered if it was as easy as a woman
saying she might be depressed. Obviously that is a big issue.
CHAIR DAVIS said she doubted it was that easy.
JOHN SHERWOOD said the DHSS does not have a standard in statute
or regulation about "medical necessity." The coverage of
abortions came about through court order. That determination of
"medical necessity" is made by the physician.
CHAIR DAVIS asked if he had requested a definition of the term.
2:19:50 PM
MR. SHERWOOD noted that prior to 1998 abortions were covered for
Medicaid eligible women through the general relief medical
program. There was a definition of therapeutic abortion in that
regulation. DHSS could provide that to the committee.
CHAIR DAVIS said she would like that.
MR. OBERMEYER said Senator Davis' office had a legal memorandum
prepared last November, by Jean Mischel of Legislative Legal
Services, and they asked about types of abortions and
definitions. Jean Mischel said that for general relief funding,
7 AAC 47.290 provides as follows:
"(7) Elective abortion means a procedure other than a
therapeutic abortion to terminate a pregnancy. (8)
Therapeutic abortion means the termination of a
pregnancy certified by a physician as medically
necessary to prevent the death or disability of the
woman or to ameliorate a condition harmful to the
woman's physical or psychological health, or that
resulted from actions that would constitute a crime of
sexual assault, a crime of sexual abuse of a minor, or
the crime of incest under 11.41.450".
So there are some administrative code provisions that do define
it currently, and there are federal definitions as well.
SENATOR MEYER said he would like a copy of the memo.
MR. OBERMEYER said the Supreme Court writes "it is instructive
to note the trial court definition of 'medically necessary'
includes the professional judgment of the physician."
CHAIR DAVIS said all the information would be provided to
committee members.
SENATOR DYSON said "medically necessary" is not defined for
Denali KidCare by statute or regulation or by court decision in
the State of Alaska.
2:24:36 PM
CHAIR DAVIS closed public testimony on SB 5 and said she would
bring it before the committee on Monday. She stated she would
like to move the bill on that date.
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