Legislature(2015 - 2016)BUTROVICH 205
04/01/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES
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SB78 | |
SB74 | |
Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
+= | SB 74 | TELECONFERENCED | |
+= | SB 78 | TELECONFERENCED | |
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SB 78-MEDICAL ASSISTANCE COVERAGE; REFORM 1:36:01 PM CHAIR STEDMAN announced the consideration of SB 78 and noted that Legislative Finance would give a presentation. 1:36:56 PM AMANDA RYDER, Fiscal Analyst, Legislative Finance Division, Legislative Affairs Agency, presented information on SB 78. She said she is responding to the request by the committee to produce graphs related to Medicaid history, growth rate, and inflation impacts. She showed graphs comparing the fiscal impact of the Governor's amended budget and SB 74 and SB 78 on state general funding and on state and federal total spend. 1:39:40 PM MS. RYDER turned to two graphs that show the budget history of Medicaid, for general funds and for total funds, as well as cost per recipient. She showed graphs depicting inflation-adjusted numbers for Anchorage and for Anchorage health care. 1:42:44 PM MS. RYDER discussed a graph of Alaska's population growth and Medicaid enrollee growth. She turned to graphs of historical Medicaid growth adjusted for Anchorage inflation and cost per enrollee. 1:46:09 PM She showed graphs of historical and projected Medicaid appropriations adjusted for medical inflation and cost per recipient. 1:48:11 PM She highlighted graphs of the projected Medicaid growth rates for general funds and for all funds from 2006 to 2016, and from 2012 to 2016. 1:49:11 PM CHAIR STEDMAN commented that it is not as scary when inflation and population growth is considered, but state revenue is not tied to those, unfortunately. 1:49:41 PM JON SHERWOOD, Deputy Commissioner, Department of Health and Social Services (DHSS), presented information on SB 78. He began by answering a previous question from Senator Stoltz about the PFD hold harmless provision, a complicated piece of the bill. He provided background about changes in the Affordable Care Act (ACA) that dealt with old Aid to Families with Dependent Children rules. Under ACA, rules were changed from income rules to those based on modified adjusted gross income, as well as who is considered in the household. One difference is that the old rules would take a gross income amount and apply income "disregards," like child care expenses and other deductions. Alaska applied for the disregard of the PFD and it also provided for a hold harmless provision that says if a person is required to count the PFD and it makes them ineligible for a program, they can continue to receive benefits at state expense, but it is paid out of the dividend account, not general funds. The person can continue to receive benefits for up to four months if the "disregard" makes them ineligible. Under the old rules income was considered at "point of time." Under the new modified gross income rules, income is annualized. That is significant so people can move back and forth smoothly between the exchange and Medicaid as their income changes, and not lose eligibility. States were required to raise income standards to reflect the loss of the "disregards. Because the expansion group was not an existing category, there is no provision for making such a conversion. Income for the expansion group is annualized and the PFD hold harmless no longer provides protection. There was no easy solution to this problem. If members of the expansion group received a PFD that made them ineligible for Medicaid, they would be eligible to receive subsidized insurance coverage through the exchange with minimal premiums or cost-sharing. It would be a relative minor loss of benefits and it would solve a difficult administrative problem. MR. SHERWOOD summarized that the most practical solution was to exempt these individuals from the hold harmless provision and they would receive subsidized coverage from the exchange. All existing beneficiaries would not be impacted; the expansion group would be the only one this applies to. 1:58:46 PM SENATOR STOLTZE clarified that the hold harmless provision is such that, "We pay up to four months of benefits so people on welfare can continue to receive the dividend. That comes out of every other Alaskan's dividend." He asked Mr. Sherwood if he would like to extend that benefit to the potentially new 42,000 beneficiaries. MR. SHERWOOD said state law would compel them to do it, so they proposed the exemption to satisfy the requirement. SENATOR STOLTZE asked if the first approach was to try to continue the hold harmless provision. MR. SHERWOOD said yes. SENATOR STOLTZE asked if the exemption would apply to all dividend recipients in a family. He wondered if there was an option for declining a PFD. MR. SHERWOOD explained that in the Medicaid application there is a requirement for a person to apply for income they are eligible for, which would include one's PFD. SENATOR STOLTZE asked if families can decline to apply for minor's PFD's, which they then can collect when they reach 18. MR. SHERWOOD said he would have to look into that. It generally does not happen. Expansion cases are primarily adults without children. 2:02:50 PM SENATOR STOLTZE asked if a dependent's dividend is calculated as part of the family's income. MR. SHERWOOD said for the Medicaid population all income is included. There are some exceptions. Those who do not have to file tax returns, their incomes don't count. SENATOR STOLTZE requested a written explanation. CHAIR STEDMAN asked the department to prepare that information for the committee. SB 78 was held in committee.
Document Name | Date/Time | Subjects |
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SB 74 Supporting Documents - Legislative Finance Graphs.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Sponsor Statement.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Supporting Documents - NPR HSAs for Medicaid.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Ver H.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Bill Hearing Request SHSS.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
Fiscal Note 17.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
Fiscal note narrative 031715.doc |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
Governor Walker Medicaid Expansion and Reform - House Bill.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
Governor Walker Medicaid Expansion and Reform - Senate Bill.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
Hearing Request from Governor Walker.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
SB 74 Supporting Documents - LRS Report 15.284.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
Medicaid expansion and reform fact sheet.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
SB 74 Sectional Analysis.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB078 S HSS hearing request.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
Fiscal Note SB 23.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 23 |
SB 78 S-HSS.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
SB 74 Fiscal Notes 233.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 242.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
Walker_Medicaid_Fiscal_Note_Overview.PDF |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
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SB 74 Fiscal Notes 317.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 354.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 2077.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 2660.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 78 Sectional.docx |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
SB 74 Fiscal Notes 2662.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 2663.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 2696.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 2787.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 2880.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 3099.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Congregation Sukkat Shalom.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
SB 74 Fiscal Notes 309.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
Supporters of Medicaid Reform.docx |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
SB 74 Supporting Document - Aetna Letter 3.27.15.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
3-30-15 Medicaid History and Projection PPT (SB74 and SB78).pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 SB 78 |
APRN Info page.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |