Legislature(2011 - 2012)BUTROVICH 205

03/23/2011 01:30 PM HEALTH & SOCIAL SERVICES

Download Mp3. <- Right click and save file as

Audio Topic
01:33:07 PM Start
01:33:13 PM SB5
02:25:06 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Bills Previously Heard/Scheduled
             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                                                              
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                                                              
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                                                              
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                                                              
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                                                              
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.                                                                                             

Document Name Date/Time Subjects