Legislature(2019 - 2020)BUTROVICH 205
02/15/2019 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB7 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 7 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 7-MED. ASSISTANCE WORK REQUIREMENT
1:31:38 PM
CHAIR WILSON announced the consideration of SB 7. He stated his
plan was to hear the bill, take public testimony, and hold the
bill in committee.
1:32:18 PM
SENATOR PETER MICCICHE, Bill Sponsor, Alaska State Legislature,
Juneau, Alaska, said SB 7 is about opportunity. "This is taking
the long view toward breaking a negative cycle, in my view. SB 7
asks one question, which is 'Should Alaskans who receive
Medicaid benefits have the requirement to work?' I think the
answer is yes, and SB 7 is a direct path to achieving that end
and realizing that opportunity," he said.
SENATOR MICCICHE said that the Centers for Medicare and Medicaid
(CMS) is allowing states to impose work requirements under the
structure of the federal 1115 waiver. This waiver is intended to
allow states to approve experimental or demonstration projects
that give states additional flexibility to design and improve
their Medicaid program.
SENATOR MICCICHE said he wanted to address the facts regarding
work requirements for Medicaid recipients. SB 7 does not require
the elderly, the disabled, or new mothers to work to get their
health benefits. Work requirements will not interfere with the
ability of recipients with a substance abuse disorder to get
appropriate treatment. The bill provides for exemptions for
individuals who are not employed, volunteering, or otherwise
exempt if they are in an education or training program that will
lead to employment. There is an extensive list of exemptions on
page 2, lines 6-21.
SENATOR MICCICHE said that with SB 7, Alaska will join at least
16 other states moving forward with similar Medicaid
requirements. Since 2015, there has been a huge increase in the
number of Medicaid recipients in Alaska. He said he thinks the
current estimate is nearly 210,000 people. SB 7 will apply to a
relatively small portion of these individuals. Specifically,
those who can work but do not. Some have assumed that requiring
Medicaid recipients to work is primarily about saving money. In
the short term the legislation would not save a significant
amount of money. It is about a break even. "But think about the
long-term view. Think about what it will be like to break the
cycle not only for those that will become employed, but their
children and grandchildren that break that cycle of some
families that have struggled to find employment for a very long
time," he said.
SENATOR MICCICHE said other states have developed creative
incentives to getting Medicaid recipients back to work. This
legislation is a conversation starter to do just that. SB 7 is
not designed as an immediate spending reduction, but rather as a
way to encourage people to join the community of people who
contribute every day to make Alaska a better place to live.
There is hope that getting people off government rolls will lead
to savings in the long term. It will encourage people to get
involved in the larger workforce population, become engaged in
their communities, build skills, get experience, build
confidence, and connect with others who are doing the same. They
should be able use those positive experiences to work themselves
out of the Medicaid system.
SENATOR MICCICHE said the default position of Americans and
Alaskans should be that those who can work, should work. He said
we don't know if the next person to cure cancer or be the best
in whatever field they choose is not relying on the state to
carry them through every day and missing that opportunity to be
the very best they can be every day and also be an example for
their families and communities.
1:37:11 PM
EDRA MORLEDGE, Staff, Senator Peter Micciche, Alaska State
Legislator, Juneau, Alaska, said SB 7 would direct the
Department of Health and Social Services (DHSS) to apply for a
Section 1115 waiver from the federal government to implement
work requirements as a condition of continued eligibility for
Medicaid coverage for the able-bodied population. A Section 1115
is broad and a way to ask the federal government to bend the
rules for specifics the state faces.
MS. MORLEDGE said that for the first time the Centers for
Medicare and Medicaid (CMS) will accept waivers that test the
hypothesis that requiring work or community engagement as a
condition of eligibility will result in more beneficiaries being
employed and engaged in other productive activities. The goal is
that this will result in increased health and well-being for the
beneficiaries and communities. In April last year the president
signed an executive order about reducing poverty in America
which is intended to promote economic mobility, strong social
networks, and accountability. The executive order has a strong
focus on work requirements for work-capable people.
MS. MORLEDGE noted that SB 7 has many exemptions. The bill
targets a narrow band of people on Medicaid. The estimate is
20,000-25,000 people.
SENATOR MICCICHE said the committee will hear arguments, such as
this is asking people to find employment where there's no work.
But considering the state fiscal crisis, the volunteer
requirement could significantly reduce the cost of what the
state is providing in services as these people become more
engaged, gain skills, gain confidence. When looking at the
fiscal note, he said to remember that this is the long-term
view.
1:40:27 PM
SENATOR STEVENS asked if he said that 210,000 people or about
one in four are Medicaid recipient.
SENATOR MICCICHE responded that the reality is that less than
half the people in the state work, a third are on Medicaid, and
more than half the children born in Alaska last year were born
on Medicaid. He said he is not disparaging people in need of
medical help. Rather, he wants to provide opportunities so they
learn to provide for themselves and accomplish the most they can
accomplish in their lifetimes.
1:41:30 PM
MS. MORLEDGE presented the following sectional analysis for SB
7:
Section 1:
• Amends AS 47.07.036 to add a new subsection (h)
requiring the department to apply for a section
1115 waiver to establish a work requirement for
adults who are eligible for Medicaid assistance.
• Subsection (h)(1) requires a recipient to submit
proof of employment or proof of seeking
employment, participation in an educational or
training program, volunteering, engaging in
subsistence programs, or caregiving.
• Subsection (h)(2) allows a recipient to meet the
requirements above if they participate in the
Alaska temporary assistance program and are in
compliance with the work requirement in AS
47.27.035.
• Subsection (h)(3) provides for exemptions from
the work requirement in subsection (h).
• Subsection (h)(4) provides for additional
temporary exemptions from the work requirement in
subsection (h).
• Subsection (h)(5) ensures the work requirement
will not prevent a recipient from obtaining
substance abuse treatment.
• Subsection (h)(6) provides for notification of
the work requirement to all recipients as soon as
practicable, and requires termination of medical
coverage for recipients who become ineligible as
a result of noncompliance after 90 days.
MS. Morledge said that the list of exemptions in subsection 3 is
modeled after Alaska's temporary assistance program. The
guidance letter from CMS asks states to align work requirements
with various state programs.
CHAIR WILSON suggested that age 65 may be too high for a work
requirement considering that the average age of state workers is
between age 41 and age 44. He asked why that age was chosen.
MS. MORLEDGE replied that she will doublecheck where that came
from but she believes age 65 is contained in the CMS guidance
letter. She noted the bill was modeled after legislation
introduced in a previous legislature.
CHAIR WILSON asked if the guidance letter allowed states to
select a different age or if it had to be consistent with other
work program requirements such as the exemption for caretaking
for a child up to 12 months of age. He offered his understanding
that other states have raised that cap to school-age children.
He noted the committee had received a lot of written testimony
expressing concern about that. Finally, he said the committee
received comments about the exemption for participating in a
tribal work program. For example, Arizona has an exemption for
tribal beneficiaries of federally recognized tribes.
MS. MORLEDGE said she will investigate but she believes the
guidance letter allows states a generous amount of flexibility.
CHAIR WILSON noted who was available to answer questions.
1:48:46 PM
SENATOR GIESSEL asked for the names of the states that have had
their programs approved.
MS. MORLEDGE said the information in the packets indicates that
waivers from Arizona, Arkansas, Indiana, Kentucky, Maine,
Michigan, and New Hampshire have been approved. A portion of
Utah's waiver was approved.
SENATOR GIESSEL asked how the age range of 18 to 65 compares to
age ranges of the state plans that have been approved.
MS. MORLEDGE said the ranges vary widely in the states she
looked at. Arkansas increased the lower cap to age 19 and
reduced the upper cap to somewhere in the 50s in response to
pending lawsuits. She said she believes there is flexibility but
she will investigate and see how much ages vary in other states.
SENATOR GIESSEL suggested Alaska follow in the footsteps of
states that have successfully withstood challenges to their
programs.
SENATOR STEVENS asked if anything in SB 7 relates to helping
people find job or if other programs do that.
MS. MORLEDGE responded that the bill has nothing about
employment assistance, but Senator Micciche is open to all
suggestions to accomplish that end.
SENATOR STEVENS said he did not want to expand the bill, but it
would be worthwhile knowing about the programs that do help
people find jobs.
MS. MORLEDGE deferred to the Department of Labor and Workforce
Development.
CHAIR WILSON asked Mr. Harvey to respond to Senator Steven's
question about the state work programs to help people find
employment or case management services that help people retain
jobs.
1:52:50 PM
JAMES HARVEY, Assistant Director, Division of Employment and
Training Services, Department of Labor and Workforce Development
(DOLWD), Juneau, Alaska, said the job center system has 14
offices and also operates on the Internet. The opportunities are
mostly for individuals seeking work voluntarily. The Alaska
state labor exchange system is a job posting board to allow
employers to connect with job seekers. In the case of
unemployment insurance claimants, which is an exemption for SB
7, those individuals must register in that system and do active
job searches. There are other programs throughout the state
system, notably in the Department of Health and Social Services
(DHSS), Division of Public Assistance, with TANF [Temporary
Assistance for Needy Families]. Individuals are in compulsory
status and they receive some case management provided by DPA
staff or their contractors. Case management goals are set for
those individuals. DOLWD operates several programs to help
people in voluntary status with such things as resume
preparation, interview assistance, and possible skills
attainment. Public Assistance, Division of Employment and
Training Services, Division of Vocational Rehabilitation, and
Alaska Housing Finance are partners in the workforce system.
There is a myriad of programs for individuals, whether they are
compelled or not compelled to seek employment.
SENATOR STEVENS asked how this will improve things for the third
of Alaskans who have never had a job in their lives.
MR. HARVEY replied that a figure of 200,000 was put forth as
individuals participating in Medicaid with perhaps 20,000 to
25,000 falling into this group. A number of individuals in that
group are working and a number of those individuals have
demonstrated work because they receive unemployment benefits. He
said he does not know the number of individuals who have never
worked. The Division of Employment and Training Services
routinely works with individuals who have little to no work
experience. Many are young adult Alaskans. One program in the
workforce system is the Workforce Innovation and Opportunity Act
(WIOA) youth program. The division administers that program
using grantees throughout the state to engage providers that
work with at-risk youth in and out of school. That program is
making headway. The division also operates the Mature Alaskans
Seeking Skills Training program for individuals 55 and older.
Individuals are placed in a work environment to achieve skills
that can translate to unsubsidized employment. Many hard-working
individuals work collectively in the workforce system to help
people who have little to no work experience.
CHAIR WILSON noted that the committee heard that about seven
different work programs across four different departments that
are working on similar goals. He asked if any consideration had
been given to consolidating the workforce programs in the state.
MR. HARVEY said that action is federally driven and ongoing. It
is put in place through the Workforce Innovation and Opportunity
Act (WIOA). That act defines the partner programs and
collaboration under that Act. As far as repetitiveness or cross-
over, these programs are offered in many varieties of services.
Some programs may be for dislocated workers. Another may be for
those receiving assistance through Alaska Housing Finance. Then
there is a program specific to individuals receiving TANF
benefits. Some programs have a compelling factor for the
individual to be there while others are for individuals seeking
change voluntarily.
CHAIR WILSON related that he previously worked for an agency in
Mat-Su that had two of these work service programs; none were at
full capacity and they all did similar work services. He said it
seems that the state could do better of consolidating programs
and the end user would see no difference. He commented that it
seems that a more coordinated approach would make better use of
resources.
CHAIR WILSON asked a DHSS representative to give a summary of
the overall costs reflected in the nine or ten fiscal notes for
SB 7. He also asked what the timeline would be to get the
program up and ready.
2:03:06 PM
SHAWNDA O' BRIEN, Director, Division of Public Assistance,
Department of Health and Social Services (DHSS), Juneau, Alaska,
said the fiscal notes reflect the costs DHSS believes would be
necessary to implement the bill. She said the savings from
recipients not in compliance with the bill are reflected in the
Medicaid-related fiscal notes. The administrative costs are in
the fiscal notes for Public Assistance. Those are based on the
same case management staffing needs as the TANF program. The
fiscal note for Work Services programs is for supported
services. Those are the costs related to job aids and barriers
to receiving employment. It could be things like training
programs, clothing, tools, and childcare. Average costs per
person are built in based on the average costs for work services
program for TANF.
CHAIR WILSON asked for the total cost of all the fiscal notes.
MS. O' BRIEN said she had not totaled them up.
2:05:02 PM
At ease
2:05:06 PM
MS. MORLEDGE directed attention to a document she received from
DHSS that lists the amounts for each of the fiscal notes.
SENATOR STEVENS asked for an explanation.
MS. O' BRIEN said the net savings in FY 2020 is estimated to be
$17.9 million. The department expects to see savings in the
Medicaid component based on their estimate of the number of
people who will be in noncompliance. The numbers are calculated
based on an estimate of the overall enrollment, required
participants, and similar programs across state and nation.
MS. O' BRIEN said in FY 2021, the savings is about $8.8 million.
Beyond FY 2022, the savings level off to about $18 million. At
some point, the number of people enrolled in the program and the
number of new people entering the program will level off so
there will be little change in participation rates the out
years.
CHAIR WILSON asked how long it would take for the department to
fully staff and implement this program if it becomes law.
MS. O' BRIEN answered that a CMS waiver approval can take
several months or longer. The department is hopeful it can
mirror its request to states that have received approval to
expedite that approval process. In a perfect world, where the
approvals are in place and all the regulations can be updated
accordingly, it would probably take six months to get fully
staffed and trained. The department believes that existing case
management system has the capacity to take on this additional
work but it will need to be replaced in the next two years. That
additional capacity will be built that into the capital request
at that time.
CHAIR WILSON opened public testimony.
2:09:29 PM
JEANNIE MONK, Senior Vice President, Alaska State Hospital and
Nursing, Home Association (ASHNHA), Juneau, Alaska, stated that
Alaska State Hospital and Nursing, Home Association (ASHNHA)
understands and appreciates the interest in workforce engagement
in Alaska, and agrees with efforts to support Alaskans being
part of the workforce. She said she appreciates that the sponsor
is clear about defining the goal. It is not about saving money
but about engaging people in the workforce and that a number of
important exemptions are provided. For a number of reasons
ASHNHA opposes SB 7 but is willing to work with the sponsor to
improve and address these concerns.
MS. MONK maintained that the new Medicaid eligibility standards
could restrict needed access to health care for Alaskans who
have jobs, who have disabilities, chronic illnesses, or other
health care needs. The majority of adults enrolled in Medicaid
are working, but many work in low-wage jobs with no health
insurance and inflexible conditions. Adding these requirements
would add to existing stressors. Losing health care coverage can
make it harder for Alaskans to work. She described the $17
million cost savings as a cost shift. Those people's health
needs won't go away, but their coverage will, and those health
care needs will be absorbed elsewhere in the health care system,
probably in the emergency room. ASHNHA is concerned about less
coverage for people who are already working and about adding
another layer of administrative paperwork. There is already a
huge backlog in processing Medicaid applications. The program
lacks the capacity to implement and assess additional
eligibility requirements. ASHNHA is also concerned that the
legislation lacks detail. DHSS needs more guidance in the
development and implementation of the work requirements and
clear guidelines on how support will be provided to help people
find employment, training, or volunteer opportunities.
MS. MONK said ASHNHA believes there are options to improve SB 7.
For example, Michigan has a robust IT system that allows people
to report their work activities online on a monthly basis. That
state started with a work requirement of 20 hours a week and
then moved to 80 hours per month to better accommodate shift
work. There should also to be an allowance for seasonal work.
Seasonal workers could lose health benefits because of
inconsistent work. She urged the committee to take care to
create a well-designed, efficient program that will encourage
work engagement while maintaining health care benefits for
Alaskans.
2:14:12 PM
ALYSON CURRY, Legislative Liaison, Planned Parenthood Votes,
Juneau, Alaska, said she too was testifying to express concerns
and oppose SB 7. She explained that Planned Parenthood works to
ensure that everyone has access to health care regardless of
their income or circumstances. About a quarter of their patients
are Medicaid recipients and about 90 percent are women. She said
the enrollment restrictions in SB 7 will decrease access to
health care and have a disproportionate impact on women. Most
Medicaid enrollees who can work already do so. If they don't
work, typically it is because of barriers like transportation,
housing, job training and availability, and education. While SB
7 has exemptions, they are inadequate and vague. These work
requirements and the administrative burden of seeking exemption
would result in even eligible enrollees losing basic
preventative care without increasing their economic stability.
Research has shown that implementing work requirements does not
reduce poverty but can push people deeper into poverty. SB 7
would harm the state budget. Investing in preventative care is
highly cost effective. The state saves $7 for every dollar it
invests in family planning. She asked the committee to oppose SB
7 and instead invest in proven, cost-effective strategies to
improve access to health care and improve economic security.
2:16:27 PM
ERIN WALKER-TOLLES, Executive Director, Catholic Community
Service, Juneau, Alaska, said she previously was Chief of Policy
and Program Development for the Division of Public Assistance
(DPA), as well as the director of TANF and SNAP [Supplemental
Nutrition Assistance Program], so she is familiar with work
requirements involved with TANF. She echoed Ms. Monk's comments.
In addition to what Ms. Monk noted, Ms. Walker-Tolles said she
is most concerned about rural Alaskans. She reported that when
implementing TANF work requirements, DPA found there were no
volunteer opportunities in rural Alaska. It took a tremendous
effort to create some volunteer opportunities that did not
provide enough hours, much less for a larger population of
Medicaid recipients. She said she applauds efforts to align work
requirements, but there are pros and cons. The federally
mandated TANF work verification requirements make it
prohibitively difficult to collect and verify that work has
happened. If the bill goes forward, she asked the committee to
consider allowing self-attestation for people doing volunteer
and community work and for self-employment. It takes a great
deal of work to get employers and supervisors at volunteer
activities to attest and people who do subsistence had to have
nonrelatives verify their subsistence activity.
MS. WALKER-TOLLES highlighted that TANF exempts Native villages
with unemployment rates of 50 percent or more from work
requirements. She urged the committee to include a similar
exemption if the bill goes forward. She said she supports the
exemptions for medical conditions and disabilities but in rural
Alaska, local health providers are not available to give
verification of medical conditions and disability. DPA found
that in rural Alaska the people most in need of Medicaid, those
with existing conditions, simply fell off the program because
they couldn't access a doctor.
2:20:02 PM
AMALY OLFEN, representing self, Juneau, Alaska, stated
opposition to SB 7 because it will overburden people with more
paperwork for a service that already requires a lot of paperwork
to qualify. It will also create additional paperwork for the
department, which could delay life-saving medical procedures.
She said Alaska is unique in many issues and is one of the most
expensive states to live in. Many are employed full time and
still require Medicare. If one of the goals of the state is to
save money, the conversation should first be about helping
people find jobs before talking about limiting people's access
to health care. She suggested the state first pay attention to
the root causes of unemployment before it implements
restrictions and limitations on medical assistance.
2:22:25 PM
JUDY ELEDGE, representing self, Anchorage, Alaska, stated
support for SB 7. She offered her understanding that Medicaid is
for the elderly, the disadvantaged, and young children and she
supports that 100 percent. She related that she testified
against Medicaid expansion out of concern that it would spread
the money so thin that people who really needed it would not get
full services. She said she sees that happening with people who
work with disabled children. She shared that she is over 65 and
continues to work so she has no objection to raising the work
requirement to 65. She related that she has lived and worked in
the school system in rural Alaska since 1997 and has seen many
jobs go unfilled in the school. Volunteer positions are also
available. She emphasized that the State of Alaska should not
give money to able-bodied people who are not working. She
maintained that people and the people who have been working
want to know where it ends. She concluded that nobody should
oppose the requirement to work 20 hours a week.
2:25:26 PM
DIANA REDWOOD, representing self, Anchorage, Alaska, stated
strong opposition to SB 7. She opined that work requirements do
not help low income people get medical services. Instead, it may
lead to low income people losing health care coverage. Studies
show that work requirements, including under the TANF program,
do not increase work or decrease poverty. In fact, the majority
of people subject to work requirements remain poor, became poor,
or lost access to health care services. She said she wonders how
many people would fall under SB 7 since the majority of Medicaid
recipients already work. She suggested there are better ways to
promote work such as such as programs to boost education and
skills and helping provide childcare for women returning to
work. Otherwise, it looks like the state is trying to increase
bureaucracy to reduce people's access to health care and that is
the wrong way to go.
2:27:18 PM
AMBER SAWYER, representing self, Anchorage, Alaska, related that
she worked until September 1, 2012, when she had a car accident
because she had a seizure due to undiagnosed epilepsy. She is
now officially disabled, but it took many years even though she
had a mass in her brain. She said it is not easy to qualify for
Medicaid. She tried to work, but when people found out when she
had seizures, she lost jobs. Now she's had brain surgery and is
not allowed to work. These are the types of people that need
considerations, she said.
2:30:07 PM
ANDREW CUTTING, Fellow, Alaskan Children's Trust (ACT),
Anchorage, Alaska, stated that ACT values parents working. The
data shows that dual income families do better than single-
income families. He related that ACT had a webinar on work
requirements and how they are being implemented in other states.
He suggested the committee consider that it is not just the
number of people on the rolls but what happens to the rest of
the community. Oftentimes, when work requirements exclude people
from services, they hit the safety net, so there is a transfer
of cost. Instead of low prevention costs on Medicaid, emergency
rooms costs increase and everyone shares those costs. He posited
that even if the bill had zero cost, there are not enough people
in the system to make this a cost savings for the state. Even on
the aggressive side, this would apply to perhaps 9,000 people
and the rough savings would be about $4 million. Some states
spent more than $100 million enacting similar programs and some
are fighting legal battles to push a program through. He urged
the committee to look at the Montana model as an example of one
state where it worked.
SENATOR STEVENS asked whether he was saying this program would
cost $100 million and save $4 million.
2:33:15 PM
MR. CUTTING said the $100 million was an example from Kentucky
or Arkansas. Both of those states had a very aggressive model to
remove people from the system. That is not what is proposed
here, but he encouraged the committee to look at those states as
examples of red tape and bureaucracy that was put in place. He
acknowledged that Alaska is a different model that has smaller
numbers.
2:33:45 PM
MAUDE BLAIR, Southcentral Foundation, Anchorage, Alaska, said
that she appreciates that Senator Micciche wants to build people
up to make them self-sufficient and they could volunteer in
places with few jobs, but Southcentral Foundation is opposed to
the bill. She echoed the sentiments of Ms. Monk and Ms. Walker-
Tolles and predicted that the bill would be difficult for rural
Alaska. She explained that many people who meet the work
requirement may be removed from the rolls because they don't
understand how to report to the state. In much of the state
English is not the first language and many places are without
access to the Internet for reporting compliance. For Alaska
Native and American Indian people, Medicaid expenses are 100
percent reimbursable to the state by the federal government. If
another hurdle is created for Alaska Native and American Indian
people to have access to Medicaid, they won't apply. That would
reduce money coming into the state to help pay for health care.
2:35:52 PM
JOSH HEMSATH, Volunteer Board Member, Anchorage Neighborhood
Health Center (ANHC), Anchorage, Alaska, informed the committee
that the Anchorage Neighborhood Health Center (ANHC) began in
Anchorage nearly 45 years serving people out of a trailer. Now
it has more than 80 staff members. About 45 percent of the
patient population at ANHC uses Medicaid when the state average
is 20 percent. He expressed three key concerns about SB 7. It
will decrease access to care, increase costs and complexity, and
punish people with significant challenges. Only the most
vulnerable 25,000 Alaskans will be impacted by this bill.
Previous attempts to pass similar legislation show that three-
quarters of those people will qualify for an exemption, leaving
only 5,000 to 6,000 people unable to qualify with these
requirements. Because this is a new program, it is hard to say
who those are, but they are probably people who work temporary
or seasonal jobs and cannot meet the weekly 20 hour requirement.
He suggested that the work requirements of SB 7 create more
complexity and administrative overhead. The bill is a major
undertaking with little to no cost savings. Previous fiscal
notes show it will cost $300 to $500 million to start the
program. This is inconsistent with efforts to contain costs.
Finally, the majority of Medicaid recipients are working, many
in low-wage jobs that do not provide coverage. The 5,000
Alaskans who would not be able to prove their exemptions are
already struggling.
2:39:15 PM
LAURA RHYNER, representing self, Kenai, Alaska, said SB 7 adds a
lot of red tape to an overburdened system, which can cause
delays for people seeking essential medical services. Several
years ago, she was on Medicaid while between seasonal jobs that
did not provide insurance. Just recently she received a letter
dated November 6, 2018, from the Division of Public Assistance
stating that her November 2016 application had been received and
additional information was requested. She said most Alaskans on
Medicaid are working, many in jobs that are seasonal, low wage,
and with no insurance.
2:41:49 PM
CINDY GILDER, representing self, Anchorage, Alaska, said she can
appreciate the philosophy that someone capable of working should
not use federal tax dollars and limited state resources for
their medical care, but based on data she questions whether
there is a problem and this is the right fix. A 2017 Kaiser
Foundation study looked at nonelderly family work status and it
showed that nonwork status for Alaska was 21 percent. Given the
administrative burdens associated with this bill, she questioned
whether this legislation was the right mechanism to help people
who want to work get back to work.
CHAIR WILSON noted that were about 20 people waiting to testify.
He reminded everyone that they could submit written testimony.
2:43:58 PM
BESSIE ODAM, representing self, Anchorage, Alaska, stated that
she was speaking in opposition to SB 7. She emphasized that
Medicaid should be accessible to anybody who seeks it. The
process is already difficult and overly complex. She suggested
that the conversation surrounding Medicaid and accessing
services should be about making access easier, not more
requirements. SB 7 assumes people on the Medicaid program aren't
willing to work or volunteer, which is not the case. If the
concern is that too much money is spent on Medicaid, another
option should be considered. Studies in other states that
require work or volunteering for eligibility, show it is more
expensive to implement the program. Alaska is already short on
funds and implementing this program will cost Alaskans more than
the system already in place.
2:45:59 PM
ERIC REIMERS, Policy Coordinator, Alaska Native Health Board,
Anchorage, Alaska, stated that the Alaska Medicaid program is a
critical component of the Alaska Tribal Health System (ATHS).
Imposing work requirements would have systematic impacts across
the system. He explained that ATHS is a system of care comprised
of the voluntary agreements with 30 tribes and tribal health
organizations. It is the most comprehensive health system in the
state and country and is critical to the Alaska public health
system. He said the high unemployment in the state
disproportionately impacts rural communities. The Bristol Bay
Borough has an unemployment rate double the statewide average.
Imposing work requirements in these rural communities will
increase administrative costs and uncompensated costs and lead
to delays in care that will lead to more expensive care.
Imposing work requirements will cause people to be removed from
the rolls. This will impact the Medicaid expansion population,
which receives one of the highest federal matches. Not getting
the federal reimbursement leaves money on table that Alaskans
have paid for with taxes. As previously mentioned, the federal
government has a moral, legal, and fiduciary responsibility for
the health and well-being of Alaska Natives and American
Indians, so it reimburses the state for all Medicaid expenses.
He said ATHS' written testimony further explains the statewide
impact of imposing work requirements.
2:48:16 PM
MARY SCHALLERT, representing self, Anchorage, Alaska, advised
that she is testifying in opposition to SB 7. She said she
worked 15 years as a psychiatric mental health outpatient nurse.
Sometimes severely mentally ill patients would have great days
and other days they could only survive as inpatients at Alaska
Psychiatric Institute. She said it does not make sense to think
these people should be required to work. She described her
sister with Down syndrome who would like to but cannot work to
demonstrate that each person is unique in their disability.
Putting this extra requirement on a vulnerable population is
wrong.
CHAIR WILSON apologized for the technical difficulties
preventing people from the Fairbanks Legislative Information
Office from testifying.
2:50:40 PM
KATHRYN BOLAK, representing self, Chugiak, Alaska, opposed SB 7.
She said she has heard from family and friends in Arkansas that
the work requirement has been a nightmare because of computer
glitches and a complex online reporting system. She suggested
they look at the McGonigal case. She asked if this bill makes
sense in a time of budget cuts for a department that is already
understaffed and underwhelmed. She has serious doubts it can
deal with all the individual cases and the many appeals. She
asked if the money for the program will come from lesser care
for the most vulnerable. She is now covered by Medicaid. She got
sick a few years ago and lost her business. She never thought
she would need a program like Medicaid.
2:53:32 PM
JON ZASADA, Policy Integration Director, Alaska Primary Care
Association (APCA), Anchorage, Alaska, said the Alaska Primary
Care Association is Alaska's primary care safety net provider
that guarantees access regardless of ability to pay. He noted
that thirty-five percent of their patients are on Medicaid. He
said APCA submitted a letter outlining their concerns with SB 7.
First, the work requirement does not adequately encourage
Medicaid beneficiaries to find and keep jobs. He said APCA is
interested in the Montana Health and Economic Livelihood
Partnership. Second, the loss of Medicaid coverage and loss of
treatment is dangerous to beneficiaries and patients and
expensive to Alaska's health care system. He agreed with other
testimony that care provided without coverage is shifted to more
expensive systems, such as the emergency room and legal and
correction system. Third, the state is ill equipped to
administer the program when more than 16,000 Medicaid
applications are still pending. Finally, every APCA clinic
spends a lot of time supporting clients in gaining,
understanding, and maintaining coverage. The churn, especially
in smaller communities with seasonable employment, will be
profound for those patients and staff at clinics.
2:56:30 PM
XOCHITL LOPEZ-AYALA, representing self, Homer, Alaska, said she
opposes SB 7 and as a constituent urges Senator Stevens to vote
no. She said she came from a family that accessed health and
social services for low-income people and this bill won't help
those working to come out of poverty. Governor Dunleavy's
proposed budget slashes funding for many programs so effort
should be focused on helping Alaskans to find employment and not
make being on Medicaid a job in itself. It is just more hoops to
find health care, she said. She encouraged the committee to
improve access to health care and workforce engagement, not
create more barriers.
2:57:44 PM
BETHANY MARCUM, Executive Director, Alaska Policy Forum,
Anchorage, Alaska, stated that in 2017 the Walker administration
projected that 23,273 able-bodied adults would enroll in
Medicaid expansion at the cost of $7,500 per person. The actual
expansion population enrollment in 2017 reached over 35,000 at a
cost of nearly $10,500 per person. She agreed that the federal
government is responsible for a portion of Medicaid expansion
costs, but it will not subsidize the program indefinitely. Able-
bodied adults should not be prioritized over the truly needy on
traditional Medicaid. She opined that the solution for Alaska is
more work. She said she would be happy to share the research
that shows that work requirements offer enrollees a better
future through the power of work. Able-bodied adults leaving
welfare found work in diverse industries and more than tripled
their income. Adding Medicaid work requirements makes sense.
This can emphasize the power of work to transform lives and
break the cycle of dependency and preserve resources for truly
needy Alaskans.
3:00:17 PM
CHAIR WILSON held SB 7 in committee and kept public testimony
open.