Legislature(2011 - 2012)Anch LIO Rm 220

10/13/2011 09:00 AM HEALTH & SOCIAL SERVICES

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09:09:40 AM Start
09:12:54 AM Hearing on Denali Kidcare
02:15:26 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Teleconference --
TOPIC: Denali KidCare
9:00 am Welcome
9:20 am Invited Testimony
11:45 am Questions/Responses
1:00 pm Open - Public Testimony
4:00 pm Closing Comments
^Hearing on Denali KidCare                                                                                                      
                         DENALI KIDCARE                                                                                     
9:12:54 AM                                                                                                                    
CHAIR  DAVIS  said the  committee  is  meeting  because of  SB  5                                                               
(currently  in Senate  Rules) that  made it  to the  Senate floor                                                               
last session, but  didn't have the votes to move  out. The reason                                                               
she is having the hearing is  to inform the public of the dilemma                                                               
and try to come up with some solutions.                                                                                         
JON  SHERWOOD, Medicaid  Special Projects,  Department of  Health                                                               
and Social  Services (DHSS), said  Denali KidCare  (DKC) provides                                                               
health care  for children  and pregnant  women in  Alaska through                                                               
the Medicaid program.  It provides coverage to  individuals up to                                                               
175  percent of  the  poverty  level and,  unlike  many kinds  of                                                               
categories of  eligibility for  Medicare, it  has no  asset test.                                                               
Generically, the categories included  in DKC are sometimes called                                                               
poverty level  Medicaid because those  income standards  are tied                                                               
to the poverty level standards.                                                                                                 
He said one  of the unique aspects  of DKC is that  it includes a                                                               
component of  higher income children without  insurance (Medicaid                                                               
Child Health  Insurance Program  (CHIP) expansion).  He explained                                                               
that  states  have the  option  to  have  a separate  program,  a                                                               
Medicaid expansion  or a  combination of the  two and  Alaska has                                                               
chosen to have a Medicaid  expansion. The significance of CHIP is                                                               
that it  comes with enhanced  funding; the current  federal match                                                               
rate  is 65  percent as  opposed to  50 percent  for the  regular                                                               
Medicaid match.                                                                                                                 
MR. SHERWOOD said  the program provides a wide  range of services                                                               
to  children:  primary  care,  acute   care  and  many  kinds  of                                                               
supportive  care. It  has the  federally mandated  early periodic                                                               
screening  diagnosis and  treatment,  which basically  says if  a                                                               
child is  diagnosed with  a condition that  can be  treated under                                                               
Medicaid the state  has to provide that treatment.  It covers all                                                               
the pregnancy services for pregnant  women and the other services                                                               
that are available to adults in the Medicaid program.                                                                           
9:16:56 AM                                                                                                                    
ILONA  JOHNSON, Eligibility  Office  Manager  I, Denali  KidCare,                                                               
Division of  Public Assistance, Department  of Health  and Social                                                               
Services (DHSS),  said she has  23 eligibility technician  IIs, 2                                                               
eligibility technician IIIs, a  supervisor, a clerical supervisor                                                               
plus 10  clerical staff. She said  she has an office  assistant I                                                               
(entry level clerical  position) and an office  assistant II that                                                               
is tasked with doing pregnant  women Medicaid. She said her staff                                                               
has  journey-level experience  and  a PCN  position is  currently                                                               
being  changed  to  an  eligibility technician  IV,  which  is  a                                                               
supervisor, and that will be added  to DKC. She said her staff is                                                               
"very experienced in this program."                                                                                             
MS. JOHNSON  related that eligibility  is strictly  determined on                                                               
the basis of  state and federal guidelines and  the law primarily                                                               
looking  at  income  and household  composition.  Currently  they                                                               
serve   23,000  families   and  more   individual  clients,   the                                                               
statistics of which are available online.                                                                                       
The  division is  quite busy  and uses  the new  "lean approach;"                                                               
their turnaround  time for an  application is now within  8 days;                                                               
for pregnant women on Medicaid  have a priority and turnaround is                                                               
within  5 days.  She said  quite often  someone comes  in with  a                                                               
child  that   has  an  emergency   medical  condition   and  they                                                               
"absolutely stop  everything" to  work that application.  She was                                                               
proud of the work being done in both areas.                                                                                     
MS. JOHNSON  said they currently  have an  eligibility technician                                                               
sitting in the  lobby area so anyone coming in  with an emergency                                                               
or with  a complete  application will  get "worked"  right there.                                                               
This is part of a new  process to get applications through faster                                                               
and more efficiently.                                                                                                           
9:22:32 AM                                                                                                                    
CHAIR DAVIS  asked the total  number of  clients she has  on DKC.                                                               
She noted that  she heard a number of around  10,000 and asked if                                                               
that included pregnant women.                                                                                                   
MR. SHERWOOD replied that August  data indicated that over 10,000                                                               
children were  in the  CHIP category  for which  enhanced funding                                                               
could be  claimed. A little  over 40,000  children are in  all of                                                               
the DKC  categories and  about 3,100  pregnant women.  The 10,000                                                               
CHIP children  are included  in the  40,000 figure;  about three-                                                               
quarters of  the children  fall under  regular Medicaid  and one-                                                               
quarter get  the enhanced  CHIP funding. In  the month  of August                                                               
about  35,000 other  children  were in  other  kinds of  Medicaid                                                               
categories throughout the state.                                                                                                
CHAIR DAVIS  asked if  they have  a waiting  list for  people who                                                               
might qualify for the enhanced program.                                                                                         
MR.  SHERWOOD  replied  no;  it's a  Medicaid  expansion  and  an                                                               
entitlement. She  explained that  some states have  separate CHIP                                                               
programs that aren't Medicaid expansions  and they are allowed to                                                               
have waiting lists  and do cut-off enrollment at  a certain point                                                               
if they meet their target numbers.                                                                                              
9:25:09 AM                                                                                                                    
CHAIR  DAVIS  asked  if  everything  statewide  ends  up  in  the                                                               
Anchorage office.                                                                                                               
MS. JOHNSON answered yes.                                                                                                       
9:27:54 AM                                                                                                                    
DR. ILONA FARR, representing herself,  said she grew up in Alaska                                                               
and  has been  practicing  here  for 25  years.  She thanked  the                                                               
committee for  their service  and expressed  the view  that their                                                               
hearts  were in  the right  place with  this bill,  but said  she                                                               
disagreed with  it for a  couple of  reasons. She said  she would                                                               
run through those and then propose better solutions.                                                                            
Basically,  she disagreed  with taking  health dollars  away from                                                               
senior citizens  on Medicare  because that  is how  this Medicaid                                                               
expansion  is  being funded.  It  takes  $500 billion  away  from                                                               
Medicare and  uses it to  increase Medicaid. She didn't  think it                                                               
was right to  take dollars away from senior citizens  that are at                                                               
the end  of their  lives and  have no  potential for  earning and                                                               
giving it to young people that do have that potential.                                                                          
Second, physicians take the Hippocratic  Oath which prevents them                                                               
from giving  a woman  abortive remedy  and, further,  tax dollars                                                               
should not pay  for any procedure that kills  the future children                                                               
of Alaska.                                                                                                                      
DR. FARR  said she thought  the DKC income limits  were extremely                                                               
high and  for a family  of five the  2011 guideline is  more than                                                               
she made  in her first  19 years  of practicing medicine!  If she                                                               
could  do it,  so  could others.  In her  practice  she has  seen                                                               
people gaming  the system by deliberately  being underemployed or                                                               
becoming low  income to qualify  for Medicaid. One of  the things                                                               
that made  her chose to opt  out of the system  was seeing people                                                               
fly up here  from other states to take advantage  of Medicaid and                                                               
then  leaving  the  state  after they  were  done  getting  their                                                               
A  national study  estimated a  cost  of $15,000  per family  for                                                               
private insurance  and that will  increase by 25-85  percent over                                                               
the next few years as ACA  is instituted. Part of this is because                                                               
the more mandates  there are the more insurance will  cost. So, a                                                               
lot more  people will not  be able  to afford insurance.  That is                                                               
why  some solutions  are  needed  not only  for  the  175 to  200                                                               
percent  of poverty  level  issue,  but for  a  wider variety  of                                                               
DR.  FARR  said  she  was  also concerned  that  the  program  is                                                               
unsustainable because  of the state's declining  oil revenues and                                                               
she would  prefer a  program that is  more sustainable  and would                                                               
cover a lot  more individuals. Right now the  budget for Medicaid                                                               
and  Medicaid-related  services is  over  $1.7  billion; this  is                                                               
close to the total annual budget of a lot of states.                                                                            
She said  the ACA  and stimulus bill  are creating  entities that                                                               
are  producing guidelines  that will  actually restrict  care for                                                               
individuals. One of  her pet peeves is that  mammograms for women                                                               
under the age of 50 will not  be permitted, but 50 percent of her                                                               
breast cancer  patients were  diagnosed under the  age of  50 and                                                               
the last  three men she  diagnosed with prostate cancer  were all                                                               
under the age of 50, as well.                                                                                                   
9:31:08 AM                                                                                                                    
She said  one of  her ideas  is to have  middle income  women and                                                               
children  put their  PFDs  directly into  a  health care  savings                                                               
account using  a "VISA like  system," because VISA has  much less                                                               
fraud than Medicare and Medicaid.                                                                                               
CHAIR DAVIS asked  if she was talking about  solutions other than                                                               
DKC increasing to 200 percent.                                                                                                  
DR. FARR answered yes.                                                                                                          
CHAIR  DAVIS  asked  her  to  submit  that  in  writing,  so  the                                                               
committee could  continue hearing  testimony on the  issue before                                                               
9:32:23 AM                                                                                                                    
KAREN  PERDUE,  CEO  and President,  Alaska  State  Hospital  and                                                               
Nursing   Home   Association   (ASHNHA),  Anchorage,   said   her                                                               
background  includes  a  long  history  with  DKC;  she  was  the                                                               
commissioner of  DHSS and  the deputy  commissioner in  charge of                                                               
Medicaid  for  a long  time  and  watched  the evolution  of  the                                                               
state's   coverage   of   pregnant  women   and   children   from                                                               
categorically eligible  (parents needing  to be stuck  in poverty                                                               
and on "welfare" in order for  their children to get health care)                                                               
to this concept of the  State Children's Health Insurance Program                                                               
(SCHIP), which is really about  working parents and allowing them                                                               
to  access  coverage  just  for  their  children.  They  may  get                                                               
coverage through  their employer  for their  own care,  but often                                                               
don't  have access  to dependent  coverage. She  said this  large                                                               
national bipartisan  debate, led by  Ted Kennedy and  Orin Hatch,                                                               
occurred  almost  a decade  ago  when  it established  the  SCHIP                                                               
program  with  the  funds from  the  tobacco  settlement.  Alaska                                                               
adopted  the SCHIP  program as  a  bipartisan measure  and it  is                                                               
called Denali KidCare.                                                                                                          
She  said  that  DKC  enjoys   wide  support  among  legislators,                                                               
families and  providers and the  last time she looked  Alaska had                                                               
6,000  medical providers  enrolled in  Medicaid along  with every                                                               
single hospital and  nursing home. While some  providers chose to                                                               
limit  what  they  do  with regards  to  their  family  practice,                                                               
doctors in general actively use  Medicaid and she knows that most                                                               
hospitals in the state actively use it, too.                                                                                    
MS. PERDUE asked for and was  given indulgence to explain how the                                                               
SCHIP program  fits into  the children's  coverage. She  said the                                                               
notion that Medicaid  covers only seniors and  disabled people is                                                               
a misperception; it has always  been an active children's program                                                               
and at least  half of the people on Medicaid  today in Alaska are                                                               
children.  It covers  seniors and  disabled people  because their                                                               
help is very  expensive per unit of service and  they can't often                                                               
get their insurance  in other ways. Children, on  the other hand,                                                               
are  extremely cheap  to cover  especially when  compared to  the                                                               
needs of seniors and the disabled.                                                                                              
Last year the  Division of Legislative Finance  found that 60,000                                                               
children under  age 21 received physician  services from Medicaid                                                               
for  a  total  of  $47  million, an  average  cost  of  $788  per                                                               
recipient. The  average children's cost  per unit of  service was                                                               
brought up  by the  inpatient hospital  care primarily  for 8,600                                                               
neonatal children at  about $11,000 per child.  But some children                                                               
cost more than $1 million.                                                                                                      
MS. PURDUE  said her point  is that  while parents can  cover the                                                               
$788 cost  in one  year if  that's all that  is wrong  with their                                                               
children or  they are getting  preventative care, if  their child                                                               
is born with an anomaly or if  there is a traumatic event, it can                                                               
bankrupt a family. So, it's  really an insurance program and that                                                               
is  why it  was founded,  because  kids are  generally cheap  and                                                               
usually families  can keep up with  preventative care, especially                                                               
at the higher income levels, but  if a horrible thing happens, it                                                               
can keep a family from going bankrupt.                                                                                          
She said the SCHIP  program that Alaska has was set  up as a very                                                               
efficient government  service and is  a model in the  nation. You                                                               
do not stand in a line or get  put on hold. You can work over the                                                               
Internet to  get your help and  it's even gotten better  over the                                                               
years.  The  state has  even  received  awards for  its  service.                                                               
Future things should be modeled on this "lean approach."                                                                        
MS. PERDUE  said because  of some  unique characteristics  of the                                                               
population, the state  has minimized its investment  in this area                                                               
and said that  the federal government contributes  60 percent for                                                               
Medicaid,  but about  70 percent  for  DKC. That  means that  for                                                               
every  dollar that  is spent,  70  cents comes  from the  federal                                                               
government. This is because the  tribal children that are covered                                                               
have been  integrated into the  system. Native  American children                                                               
are  getting  the  care  they  are entitled  to  by  the  federal                                                               
government and  using DKC, but  the federal government  is paying                                                               
the whole bill. This is a very efficient system in this regard.                                                                 
9:40:21 AM                                                                                                                    
MS. PERDUE  said that  many states are  cutting back  on Medicaid                                                               
and it's  a very difficult  time for health providers  and people                                                               
planning  their  senior retirement,  but  virtually  no state  is                                                               
cutting  children's health  care.  They may  be cutting  provider                                                               
rates  or changing  utilization,  but they  are  not cutting  off                                                               
She said  ASHNHA has supported  DKC for  more than a  decade, but                                                               
hospitals and  nursing homes  are not  going to  get most  of the                                                               
benefit as a provider group. Most  of these kids are not going to                                                               
be in  hospitals; for  the most  part babies  are going  home and                                                               
getting  preventative  services  and  ASHNHA  sees  part  of  its                                                               
mission is to support the overall health of the State of Alaska.                                                                
MS. PERDUE  said the state has  reasons to decide on  this matter                                                               
once and  for all this  year. She  said there are  possibly other                                                               
times  when it  would be  advantageous  for Alaska  to have  this                                                               
expansion  in moving  toward more  block  granting approaches  or                                                               
blending the  match rate, but this  is a major window  for making                                                               
this kind of decision in the affirmative.                                                                                       
She said when DKC first  passed it was almost entirely bipartisan                                                               
and prior  to being vetoed  her records  show that it  passed the                                                               
Senate  by a  vote of  15 to  4 and  the House  by 37  to 3.  She                                                               
suggested that  it might be time  to establish a waiting  list so                                                               
they know what the true need  is and said there is always someone                                                               
outside of the level.                                                                                                           
9:44:44 AM                                                                                                                    
SARAH WEBER,  DKC recipient,  said she and  her husband  are both                                                               
born  and raised  Alaskans and  have  four children.  They are  a                                                               
working family and  have been on DKC mostly  for preventative and                                                               
prenatal care as  a supplement to their  primary health insurance                                                               
through  her husband's  employer.  Unfortunately,  it would  cost                                                               
almost 30 percent  of their take-home pay to insure  all of their                                                               
children with  a $5,000  deductible per  person. She  related how                                                               
her   first   four  children   have   had   the  normal   medical                                                               
expenditures, but the seemingly healthy  child that was born last                                                               
October was  diagnosed with stage four  of a rare form  of cancer                                                               
six months  ago. Infants don't  get treated for it  here. Because                                                               
they have  DKC treatment  that never stopped,  they were  able to                                                               
fly her  to Portland within 36  hours of her diagnosis  where she                                                               
received care from  a team of specialists  that work specifically                                                               
with this  type of cancer.  She is now  home and can  receive six                                                               
out of her eight chemotherapy treatments at Providence Hospital.                                                                
MS. WEBER said  her child's monthly medical needs  are on average                                                               
about  three  times  her  family's   earnings  and  without  this                                                               
coverage  her  child's  care  would have  been  delayed  and  she                                                               
probably would have died. She said  before her child was born her                                                               
family bounced around $150 a month from not qualifying.                                                                         
9:51:26 AM                                                                                                                    
SENATOR MEYER joined the committee.                                                                                             
9:51:35 AM                                                                                                                    
DAVID MESUO, former DKC employee, said  he is one of the original                                                               
DKC  technicians  that started  the  program  in 1998.  He  truly                                                               
believed it to  be one of the finest programs  that Alaska has to                                                               
offer  its children.  A pregnant  woman under  DKC is  seen right                                                               
away by a  physician and seen through her pregnancy  and the baby                                                               
is taken care  of at birth for one full  year. People might think                                                               
that's a lot of money, but  it's nothing compared to a mother who                                                               
has a  baby but has  never seen a doctor  until the very  day she                                                               
has her baby. Children  are covered up to the age  of 19 and then                                                               
DKC ends,  but by  that time they  are ready to  go out  into the                                                               
He  supported having  DKC at  the 200  percent level  whether the                                                               
parents  have  insurance  or  not.  It  doesn't  cost  that  much                                                               
compared to sending a child to  the emergency room because the he                                                               
has a cold.                                                                                                                     
9:59:03 AM                                                                                                                    
WALTER  MAJOROS,  Executive   Director,  Juneau  Youth  Services,                                                               
Juneau,  said  they provide  mental  health  and substance  abuse                                                               
services  to  kids  ages  3-21,  many  of  whom  are  victims  of                                                               
significant child  abuse and other  forms of trauma  and involved                                                               
in state custody.  They serve over 500 youth and  families a year                                                               
from  all over  the  state.  They are  very  supportive  of SB  5                                                               
increasing  the  eligibility for  DKC  from  175 percent  to  200                                                               
percent  of  the  federal  poverty  level,  the  level  that  was                                                               
established when the  program was first created in  1997. He said                                                               
Alaska is  now one  of only  four states in  the country  with an                                                               
eligibility level  that is below  200 percent and that  25 states                                                               
have set that bar at 250 percent or higher.                                                                                     
The latest data he has read  says there are over 24,000 uninsured                                                               
children in  Alaska and  raising the  eligibility to  200 percent                                                               
would  allow  for  1,300  of these  uninsured  youth  to  receive                                                               
coverage. He  emphasized that  DKC is  one of  the main  ways for                                                               
children with mental health and  substance abuse issues to access                                                               
services.  Over   83  percent  who  receive   mental  health  and                                                               
substance  abuse services  at Juneau  Youth  Services are  funded                                                               
through DKC and other forms of Medicaid.                                                                                        
10:02:57 AM                                                                                                                   
MR.  MAJOROS said  the  important  message is  that  this is  the                                                               
primary way kids in the State  of Alaska access mental health and                                                               
substance  abuse  services and  the  earlier  these services  are                                                               
provided the greater the chance  of avoiding longer term problems                                                               
and  more  intensive  care.  Research  has  shown  that  children                                                               
without health  care coverage are  four times more liable  to use                                                               
expensive emergency  care. JYC wants  to provide  more efficient,                                                               
less intensive  community based services and  more prevention and                                                               
early intervention services so kids  don't need high end services                                                               
later on. He  said the DKC also makes  sense financially, because                                                               
approximately 70  percent of the  costs are paid  through federal                                                               
Medicaid matching funds.                                                                                                        
10:04:16 AM                                                                                                                   
JUNE SOBOCINSKI, Vice President,  Community Action, United Way of                                                               
Anchorage,  Anchorage,  said  they  have several  goals  and  the                                                               
potential  passage  of  this  increase  in  DKC  would  certainly                                                               
contribute to  all of them. The  first is that kids  enter school                                                               
ready  and that  they  go on  to graduate  from  high school  and                                                               
college career  ready, that families  are financially  stable and                                                               
that individuals in Anchorage have access to health care.                                                                       
MS. SOBOCINSKI said last year 100  percent of the 50 agencies she                                                               
works with  agreed to collaborate  to lobby on behalf  of passage                                                               
of this bill and pooled resources  to do so. This says something!                                                               
She urged the legislature to pass  SB 5 again, since it passed it                                                               
last year.  She related that  for a brief  time when she  and her                                                               
husband were transitioning  from homes and jobs, she  and her son                                                               
were uninsured  and she lived  with terrible anxiety  during that                                                               
time because  she knew  that any  serious accident  or unexpected                                                               
illness could have  been their complete financial ruin  - and she                                                               
cannot imagine not  responding to the health needs  of her child.                                                               
Yet this is exactly what they  have imposed on 1,300 children and                                                               
their families in failing to pass this last year.                                                                               
10:07:34 AM                                                                                                                   
She  related that  last year  the one  thing that  terminated the                                                               
possibility  of  health  insurance  for these  children  was  the                                                               
question  of abortion  and she  suggested that  they engage  that                                                               
question, but apart from this bill  "which is about the health of                                                               
children we  already have." Look  for the appropriate  context in                                                               
which to grapple  with that question and hold  harmless the 1,300                                                               
children and 300 pregnant women.                                                                                                
10:08:33 AM                                                                                                                   
At ease from 10:08:33 AM to 10:20:08 AM.                                                                                        
10:20:08 AM                                                                                                                   
CLOVER SIMON  said she  is a  Masters level  Social Worker  and a                                                               
board member  of National Association  of Social  Workers, Alaska                                                               
Chapter, and was  speaking on their behalf. They  work all across                                                               
the state and provide the  majority of its mental health services                                                               
and  work  in hospitals,  social  service  agencies, home  health                                                               
agencies,  court  and  schools   for  the  military  and  private                                                               
corporations.  She   said  "social  work"  by   definition  is  a                                                               
profession that  prides itself in  standing up for others  and to                                                               
that end they  support increasing the eligibility for  DKC to 200                                                               
percent of the federal poverty level.                                                                                           
She said simply that many  parents cannot afford health insurance                                                               
as  others have  testified,  but  basically uninsured  low-income                                                               
children  are also  four times  as  likely to  rely on  emergency                                                               
departments and have  no regular source of care.  This extends to                                                               
the mental health  and behavioral issues that  some children face                                                               
in the state.                                                                                                                   
The delay in seeking  care sends the kids who are  on the edge of                                                               
eligibility  that  would  benefit  from  routine  behavioral  and                                                               
mental  health screenings  to residential  care. These  costs are                                                               
huge and could  be avoided if these kids had  access to screening                                                               
prior to the crisis ensuing in their family.                                                                                    
10:22:10 AM                                                                                                                   
She said  a conference of  over 200  social workers was  going on                                                               
right now and  unfortunately they couldn't all be  here but asked                                                               
them to imagine her multiplied by 200 in support of DKC.                                                                        
10:22:36 AM                                                                                                                   
PAT LUBY,  Advocacy Director, AARP  Alaska, said they  support SB                                                               
5.  He  said   AARP  is  the  world's   largest  organization  of                                                               
grandparents   and   they    are   concerned   about   everyone's                                                               
grandchildren. Many  members over  65 have  the luxury  of having                                                               
health security  because they  are old enough  to be  on Medicare                                                               
and they think  Alaska's children and pregnant  women should have                                                               
the same health security.                                                                                                       
They believe a healthy future  for Alaska's children is something                                                               
that all should be able to  agree on. Mr. Luby said 5,500 Alaskan                                                               
grandparents are raising over 8,200  grandchildren; many of these                                                               
people are on Medicare themselves and  they have no way to insure                                                               
those  grandchildren unless  they  can get  them  onto DKC.  It's                                                               
critical simply for  that large number of people  who are raising                                                               
their grandkids.                                                                                                                
He also  mentioned that when  Dr. Farr testified about  how money                                                               
was taken  away from Medicare  to transfer into Medicaid  and the                                                               
children's health  insurance program, AARP supported  taking $500                                                               
million  out  of  the  Medicare   program.  That  money  was  all                                                               
earmarked for Medicare Advantage  and Medicare Advantage and none                                                               
of those  policies were  sold in  Alaska. Medicare  Advantage was                                                               
supported by the  regular Medicare beneficiaries and  it paid for                                                               
things  like eye  glasses, hearing  aids, some  preventive health                                                               
care, and  even gym memberships.  AARP did not think  that normal                                                               
regular  Medicare  beneficiaries  should have  to  support  those                                                               
advantages for other  people and supported taking  that away from                                                               
the federal program.                                                                                                            
10:25:42 AM                                                                                                                   
VALERIE  DAVIDSON, Senior  Director, Legal  and Intergovernmental                                                               
Affairs,  Alaska Native  Tribal Health  Consortium, Bethel,  said                                                               
they support SB  5. Alaska is one of the  few states that doesn't                                                               
use 200 percent of the  federal poverty level for eligibility for                                                               
DKC. She  underscored that we  all love our children  wherever we                                                               
live and Alaskan  Native families want what every  family wants -                                                               
their  children  to  be  healthy,  happy  and  to  live  in  safe                                                               
communities.  Alaska's children  deserve  the best  and with  the                                                               
resources we  have, Alaska  should be among  the best  states not                                                               
among the worst.                                                                                                                
For people living  in rural Alaska, DKC  provides travel benefits                                                               
that  really make  the  difference for  getting  basic access  to                                                               
health care  they wouldn't otherwise  have. She related  how milk                                                               
in  Bethel is  $9/gal  when  it's on  sale  and  heating oil  and                                                               
gasoline are over  $6/gal; a 40 minute plane ride  costs $300 for                                                               
a  round-trip ticket.  The average  village  size is  300 to  350                                                               
people. The tribal health system  is for all intents and purposes                                                               
the public  health system in  much of  Alaska. There is  no other                                                               
state presence in  the small communities whether  you are Alaskan                                                               
Native or not for basic or emergency health care.                                                                               
10:28:50 AM                                                                                                                   
MS. DAVIDSON  said many of the  services that are covered  by DKC                                                               
include dental  and vision services  and higher  skilled behavior                                                               
health services that are not available  in villages of 300 to 350                                                               
people. Those  services are available at  sub-regional clinics of                                                               
the  regional hospital  and most  families cannot  afford a  $300                                                               
plane  ticket  to  get  to the  next  community.  Without  roads,                                                               
driving isn't an option.                                                                                                        
She  said 25  percent of  Alaska Native  communities who  live in                                                               
rural  communities have  dental  carries. Most  kids have  dental                                                               
carries,  which means  25 percent  of those  kids have  untreated                                                               
cavities. So, they  started a dental health  aid therapy program,                                                               
a  mid-level dental  practice, and  20 certified  people are  now                                                               
providing care. With  about 200 villages more than  20 people are                                                               
needed. It's important  for the committee to  understand that for                                                               
people  in  rural  Alaska  it's  the  dental  and  optometry  and                                                               
behavioral health  services that  makes the difference.  It's the                                                               
same as  a person living  in Anchorage  needing to go  to Seattle                                                               
because those services aren't available there.                                                                                  
10:30:57 AM                                                                                                                   
MS. DAVIDSON said  it is important to remember  that federal CHIP                                                               
dollars are allocated by state and  if a state doesn't use theirs                                                               
it gets redistributed to other  states. If Alaska doesn't use its                                                               
allocation it  will go to other  states, which means we  would be                                                               
subsidizing children  in other  states when so  many of  ours are                                                               
not covered and deserve access to  care. She said she has learned                                                               
that it's never  too late to do  the right thing and  we all make                                                               
mistakes  which lowering  the  eligibility is,  but  we have  the                                                               
opportunity to  turn it around.  Sometimes doing the  right thing                                                               
is  hard, but  it  won't  get done  otherwise.  She concluded  by                                                               
urging them  to put  Alaska among the  best in  treating Alaska's                                                               
children, not the worst.                                                                                                        
10:33:22 AM                                                                                                                   
KIME MCCLINTOCK,  field organizer, Planned Parenthood,  said they                                                               
see the benefits  of preventative health care every  day. Many of                                                               
their  patients  are  uninsured  and   come  to  them  for  their                                                               
reproductive health care because they  can't be seen by a private                                                               
Planned Parenthood  in Alaska today is  advocating for increasing                                                               
DKC eligibility to  200 percent of the federal  poverty level and                                                               
said, "Our  children are our  future and  we need to  insure that                                                               
they are given every chance  to reach their full potential." This                                                               
means  giving pregnant  women access  to essential  prenatal care                                                               
and making  sure every child has  a doctor so they  can get basic                                                               
preventative care to avoid expensive emergency room visits.                                                                     
MS.  MCCLINTOCK  said in  this  economy  especially many  working                                                               
families  can't  afford  health insurance.  By  not  raising  the                                                               
eligibility level they are forcing  parents to choose between one                                                               
basic  necessity and  another.  Additionally, they  are tired  of                                                               
seeing Alaska's children falling behind  in our country; 44 other                                                               
states provide  coverage at 200 percent  or above and 19  of them                                                               
provide coverage  at 300 percent or  above. Alaska is one  of the                                                               
four  states that  cover pregnant  women and  children under  200                                                               
percent of the federal poverty level.                                                                                           
She added that increasing the  proportion of pregnancies that are                                                               
wanted and  welcomed by both  parents helps reduce  child poverty                                                               
and income  disparities, improves over-all family  well-being and                                                               
reduces  taxpayer  costs.  Until  comprehensive  family  planning                                                               
services are affordable  to all women, abortion  will continue to                                                               
be  a legal  option for  women facing  an unplanned  and unwanted                                                               
pregnancy. In Alaska, that right extends to poor women, as well.                                                                
10:37:36 AM                                                                                                                   
MARY  SULLIVAN, Alaska  Primary  Care  Association, said  because                                                               
health insurance  coverage is a  key component related  to health                                                               
care  access,  the  Association   supports  SB  5  and  extending                                                               
eligibility for DKC to 200  percent of the federal poverty level.                                                               
It would benefit not only their  members, but all the children of                                                               
Alaska. The need  for care is rising as evidenced  by over 24,000                                                               
children 18  years old or younger  in 2009 that are  uninsured in                                                               
Alaska, 12  percent of our  0-18 population. Nation-wide  only 10                                                               
percent of this demographic is  uninsured; so this makes Alaska a                                                               
leader of uninsured children.                                                                                                   
She explained that children from  low income families do not have                                                               
appropriate health  care access due  to lack of coverage  and the                                                               
cost  of premiums  in relation  to family  budget. Although  most                                                               
uninsured  children  live in  a  family  that  has at  least  one                                                               
working parent,  the average total  cost of family coverage  in a                                                               
private group health insurance plan  is now approximately $12,000                                                               
to $15,000 a  year. This means for a family  with moderate income                                                               
whose employer  contributes less than a  very substantial portion                                                               
of  their cost  of  insurance  coverage may  be  well beyond  the                                                               
family's reach even though they  are working very hard. A $12,000                                                               
premium would  consume more than  one-fourth of the  total annual                                                               
income  of a  family  of  three at  250  percent  of the  federal                                                               
poverty  level.  Additionally,  parents working  for  firms  that                                                               
don't  offer  family  coverage  or   who  are  not  eligible  for                                                               
employer-based  coverage or  who are  self-employed face  similar                                                               
challenges in providing coverage to their children.                                                                             
MS.  SULLIVAN  said  even though  DKC  upper  income  eligibility                                                               
guidelines is  at 175 percent  of the federal poverty  level, the                                                               
fact that  46 percent of Alaska's  children live at or  below 200                                                               
percent of the federal poverty  level as compared to 40.6 percent                                                               
nation-wide  and  39 percent  in  Health  Resources and  Services                                                               
Administration's (HRSA)  regional 10. This indicates  that Alaska                                                               
has  more children  in the  175  to 200  percent federal  poverty                                                               
range per capita than most  other states. Covering these children                                                               
not  only benefits  hard-working,  low-income  families but  also                                                               
society at large.                                                                                                               
She stated  that having  access to  health care  is not  just for                                                               
primary  care,  but for  behavioral  health  care services,  too.                                                               
Alaska  has seen  a 31  percent decline  in the  total number  of                                                               
children covered by  private health insurance in  the past decade                                                               
and the  cost of caring  for uninsured  children is passed  on to                                                               
other Alaskans, to businesses  raising premiums and out-of-pocket                                                               
expenses for everyone.  This cost to society can  be captured not                                                               
just in  transferred out-of-pocket  of expenses  but also  in the                                                               
decreased public health overall.  For example, uninsured children                                                               
are nine times  less likely to have a regular  doctor, four times                                                               
more likely  to be taken to  emergency rooms and 25  percent more                                                               
likely  to miss  school  than uninsured  children.  This lack  of                                                               
access to primary care puts  these children at increased risk for                                                               
other social  challenges such as  educational attainment  and may                                                               
further exacerbate existing behavioral  health challenges or be a                                                               
factor  in   developing  behavioral   health  problems   such  as                                                               
increased risk for suicide, depression,  substance abuse or later                                                               
criminal activities.                                                                                                            
MS.  SULLIVAN  said  the  long-term   impacts  and  risk  factors                                                               
associated with  lack of access  to health care for  children are                                                               
too  costly for  our society.  The uninsured  are also  much less                                                               
likely  to receive  preventive services  including immunizations,                                                               
dental and vision care. Saving the  lives of children is the most                                                               
pro-life thing they can do and that's what this bill does.                                                                      
10:45:16 AM                                                                                                                   
REPRESENTATIVE TUCK said it's obvious  that the money spent today                                                               
on  prenatal  health care  and  early  lives of  children  really                                                               
benefits the State of Alaska down  the road. It's probably one of                                                               
the best investments they can continue making.                                                                                  
10:46:25 AM                                                                                                                   
RAY WARD,  representing himself, said he  represents newcomers to                                                               
Alaska primarily Laotian, Hmong,  Vietnamese, Thai, Cambodian and                                                               
Malaysian; many are new to this  culture and new to the language.                                                               
Many  families are  low income  and have  many children;  most of                                                               
those who do have jobs make  a minimum wage and don't qualify for                                                               
insurance. He said  SB 5 would help many families  qualify to get                                                               
adequate medical care for themselves and their children.                                                                        
MR.  WARD related  that he  is on  social security  disability at                                                               
$1500  a month;  that makes  him $67  dollars over  the limit  of                                                               
being able to qualify for food  stamps, Medicaid or for any other                                                               
10:49:38 AM                                                                                                                   
ELISABETH RIPLEY,  Executive Director, Mat-Su  Health Foundation,                                                               
Wasilla,  said  their  mission  is  to  improve  the  health  and                                                               
wellness of  Alaskans living in  Mat-Su. Their goal is  to become                                                               
the healthiest borough  in the state and have  four strategies to                                                               
reach it. One  is to reduce barriers to health  care access. Lack                                                               
of health  insurance is one  of those  barriers. In 2007,  of the                                                               
22,991  children in  Mat-Su, approximately  6.5 percent  or 1,499                                                               
were uninsured.  However, 650  of these  children fell  below 200                                                               
percent of  the federal poverty  level. Ironically, the  rate for                                                               
uninsured children is  higher the closer they get  to the federal                                                               
poverty level. Whereas the overall  uninsured rate of children in                                                               
Mat-Su was  6.5 percent, the  rate for  children at or  below the                                                               
200 percent federal poverty level was 20.4 percent in 2007.                                                                     
Since Alaska has  decreased the eligibility for DKC,  the rate of                                                               
uninsured  children within  or  close to  the  poverty level  has                                                               
grown each year  by 1 or 2 percentage points  and Alaska has seen                                                               
a  31  percent decline  in  the  number  of children  covered  by                                                               
private  insurance in  the past  decade. The  cost of  caring for                                                               
uninsured children  is passed  on to other  Alaskans if  they use                                                               
other federal programs.                                                                                                         
MS.  RIPLEY said  it's  not just  the cost,  but  the facts  that                                                               
uninsured children are  nine times less likely to  have a regular                                                               
doctor, four  times more  likely to be  taken to  emergency rooms                                                               
and 25 percent more likely  to miss school than insured children.                                                               
They  are not  as healthy  as children  who have  regular access.                                                               
Without insurance, their parents often  delay going to the doctor                                                               
until  the situation  becomes  emergent.  And one  way  to get  a                                                               
handle on  rising Medicare  costs is  to address  chronic disease                                                               
and other  drivers at  the primary  care level -  to stay  on top                                                               
with  prevention and  maintenance of  health. These  children who                                                               
are uninsured  don't have  this opportunity  and cost  the system                                                               
much more on the other end.                                                                                                     
She said the  state is looking at some level  of managed care for                                                               
the  Medicaid program  and  is  going to  issue  an  RFP for  the                                                               
development of four medical homes  to make sure that patient care                                                               
is coordinated to  address chronic disease and  prevention and to                                                               
keep cost  drivers down and  if this  can't be done  for children                                                               
now, it  will be  paid for  downstream. In  issuing this  RFP the                                                               
state is recognizing  it must go upstream and find  new models of                                                               
providing care.                                                                                                                 
MS.  RIPLEY  said that  increasing  DKC  eligibility levels  will                                                               
result  in improved  public health  and  overall health  outcomes                                                               
throughout  the state  for Alaskan  children and  that the  state                                                               
should explore every  other means to make  sure eligible children                                                               
are enrolled.  Other states  are doing  this with  great success.                                                               
She  encouraged them  to  increase eligibility  to  at least  200                                                               
percent of poverty level.                                                                                                       
10:56:00 AM                                                                                                                   
CHAIR DAVIS invited Mr. Sherwood back.                                                                                          
MR. SHERWOOD said he had no  further comments, but would be happy                                                               
to address questions.                                                                                                           
MS. JOHNSON thanked the committee for having this hearing.                                                                      
10:58:13 AM                                                                                                                   
Recess from 10:58 to 1:25 PM.                                                                                                   
1:25:24 PM 1:18:47                                                                                                            
DAHNA  GRAHAM, representing  herself, Anchorage,  said she  is an                                                               
unashamed  advocate for  the wellness  and  wholeness of  growing                                                               
Alaskans. She  said she is also  a member of Anchorage  Faith and                                                               
Actions  Together that  is working  toward restoring  the state's                                                               
health insurance  coverage to  children who  used to  be covered.                                                               
These are  children of working  families and  well-deserving. She                                                               
knows the  Governor vetoed the  same language last year  and it's                                                               
their expectation that  the legislature work with him  to reach a                                                               
mutually agreeable position  that will insure children  up to 200                                                               
percent of poverty level.                                                                                                       
She  said it  would be  hard to  find anyone  who would  say that                                                               
children's  access  to  health   insurance  and  health  care  is                                                               
controversial.  Putting  these  members  in  office  demonstrates                                                               
their  trust that  legislators will  all have  the understanding,                                                               
the  expert  resources,  the factual  information  and  skill  to                                                               
design  legislation that  can be  passed by  the legislature  and                                                               
signed into law by the governor. Alaska has the money.                                                                          
CHAIR  DAVIS  said she  also  was  anxious  to reach  a  mutually                                                               
acceptable bill with the governor  and was willing to do whatever                                                               
she could to compromise and work with him.                                                                                      
ADELE PERSON-GRONING,  representing herself, Homer, said  hers is                                                               
a young family; she works part-time  at a gallery and her husband                                                               
is self-employed  doing fishing  and construction. His  wages are                                                               
good when he  is working in the summer, but  it is not year-round                                                               
employment. They have two children, 6  years and 2 years old, who                                                               
are currently  covered by  DKC; they usually  fall very  close to                                                               
the 175 percent  mark and it's terrifying to think  of losing the                                                               
measure of security. She related that  she had a cesarean for her                                                               
first  daughter   who  was  diagnosed  with   hip  dysplasia  and                                                               
eventually had  surgery in  Anchorage. Had  those costs  not been                                                               
covered by DKC,  they may have not been encouraged  to go for the                                                               
1:26:03 PM                                                                                                                    
SARAH  LEONARD,  staff person,  thread  Child  Care Resource  and                                                               
Referral  Network, Anchorage,  supported SB  5. She  said working                                                               
with  over 7,500  families annually,  thread  sees how  important                                                               
health  care resources  are for  children's healthy  development.                                                               
Recent  brain research  shows that  supporting children  in their                                                               
youngest years is the most critical time.                                                                                       
1:27:28 PM                                                                                                                    
PAGE HOBSON, representing  herself, Anchorage, said she  is a mom                                                               
and a  domestic violence advocate.  She has a  small organization                                                               
called Alaska Moms  for Custodial Justice, a group  of women that                                                               
have custody challenges from abusive  fathers and are trying very                                                               
hard to get  back on their feet after  exiting relationships. New                                                               
crime  victimization studies  from UAA  show that  50 percent  of                                                               
women in  Anchorage have been  victimized at some point  in their                                                               
life.  She  mentioned  the link  between  manipulation  of  birth                                                               
control and  high incidence of additional  domestic violence when                                                               
women are pregnant;  younger children are at higher  risk as well                                                               
in those  situations. So, as many  people as possible need  to be                                                               
covered for  preventative care.  She urged them  to not  be short                                                               
sighted  about  trying  to  save  money here  and  there  or  let                                                               
ideology get  in the  way of really  protecting families  and the                                                               
most vulnerable populations.                                                                                                    
1:29:51 PM                                                                                                                    
KALEEM NEURIDEEN,  representing himself, Alaska, said  he is both                                                               
a father and a person  who works professionally with a non-profit                                                               
organization  that offers  direct services  to many  citizens who                                                               
are  being  left  out  of  appropriate health  care.  And  as  an                                                               
outreach minister for the Alaska  Center for Spiritual Living, he                                                               
also  represents a  spiritual  and  moral level.  He  said he  is                                                               
absolutely in  support of increasing the  levels of participation                                                               
of  Alaskan citizens  in DKC  for the  quality of  life that  all                                                               
citizens deserve to have.                                                                                                       
1:32:22 PM                                                                                                                    
JANE  LANDSTROM, representing  herself, supported  DKC. She  said                                                               
she is not a parent but  has known through her church and friends                                                               
how much DKC means to young  families. She urged them to increase                                                               
eligibility at a level that is as high as possible.                                                                             
1:33:04 PM                                                                                                                    
ROBERT   BOYLE,   Superintendent,  Ketchikan   School   District,                                                               
Ketchikan,  said  he  supported   DKC.  He  explained  that  NCLB                                                               
requires   all   students    to   be   academically   successful.                                                               
Economically  disadvantaged  kids  are  the  single  target  area                                                               
within  his district  that they  are  unable to  reach well  with                                                               
their programs. They  don't have a strong lobby and  are first to                                                               
get cut in communities across the state.                                                                                        
1:35:41 PM                                                                                                                    
NICK MOE,  representing himself, said  he supported SB 5.  It's a                                                               
very important program. His mom  used this program in Nebraska to                                                               
help raise  his two  sisters; she  works 12 to  14 hour  days and                                                               
still  needs  food stamps.  A  family  shouldn't have  to  decide                                                               
between health care  and food or between rent and  health care or                                                               
worry  about being  bankrupt because  of  their children  getting                                                               
1:37:07 PM                                                                                                                    
DEBBIE THOMPSON,  Executive Director, Alaska  Nurses Association,                                                               
said they support  SB 5. It's important to take  care of the most                                                               
vulnerable population  - their ability  to learn and  continue on                                                               
to become  productive citizens.  She urged  them to  increase the                                                               
eligibility level to more than the 175 percent if possible.                                                                     
1:38:12 PM                                                                                                                    
MR. SHERWOOD came forward again.                                                                                                
CHAIR DAVIS  asked Mr. Sherwood  to come forward again  and asked                                                               
him if abortion  related services have to be provided  as part of                                                               
the DKC pregnancy services, and if so, how many are paid for.                                                                   
MR. SHERWOOD  replied that  their figures  include the  number of                                                               
recipients   receiving  abortion   related  services,   but  that                                                               
excludes  other   kinds  of  terminations  of   pregnancies  like                                                               
miscarriage and stillbirth.  He didn't have the  actual number of                                                               
abortions with him right now  because claims for services come in                                                               
over time and providers have up to a year to bill.                                                                              
CHAIR DAVIS asked if all abortions  (100 percent) are paid by the                                                               
state  even though  the federal  government could  be billed  for                                                               
three recognized categories.                                                                                                    
MR.  SHERWOOD   replied  that  currently   to  be   eligible  for                                                               
reimbursement  from  the  federal   government  there  are  three                                                               
exceptions to the prohibition against  funding abortion: cases of                                                               
rape, incest and  the life of the mother.  Documentation from the                                                               
physicians performing  the services  must be  received to  file a                                                               
claim and that  documentation has not been received  in the past.                                                               
The state is required to pay either way under Alaska case law.                                                                  
CHAIR DAVIS asked if the department provides the claim form.                                                                    
MR. SHERWOOD answered yes.                                                                                                      
CHAIR DAVIS asked why the  department doesn't provide them to the                                                               
MR.  SHERWOOD   replied  that  the  department   makes  the  form                                                               
available; the question  may be if an  affirmative statement that                                                               
it  doesn't meet  the criteria  is required.  At this  point they                                                               
don't, but they are considering changing regulations to do so.                                                                  
1:42:26 PM                                                                                                                    
CHAIR  DAVIS  asked if  abortions  cost  the  state less  than  1                                                               
percent of the DKC budget.                                                                                                      
MR. SHERWOOD replied that it would  be less than 1 percent of the                                                               
total DKC budget in calendar year 2010.                                                                                         
CHAIR DAVIS asked how much that is in dollars.                                                                                  
MR. SHERWOOD answered $343,000.                                                                                                 
CHAIR DAVIS  asked if 300  pregnant women and 1,300  children are                                                               
brought into the program at this time, how much that would cost.                                                                
MR. SHERWOOD  answered their technique doesn't  estimate abortion                                                               
expenditures.  They look  at total  spending and  average federal                                                               
match  and  apply that  to  the  expected number  of  individuals                                                               
coming on.                                                                                                                      
CHAIR DAVIS  asked the total  budget for  the DKC portion  of the                                                               
provided services.                                                                                                              
MR.  SHERWOOD replied  in  2010, $238  million  for DKC  enrolled                                                               
1:45:20 PM                                                                                                                    
CHAIR  DAVIS asked  if  those that  qualify  for abortions  under                                                               
Medicaid are being transferred to the DKC budget for abortions.                                                                 
MR. SHERWOOD  replied DKC isn't  budgeted separately. If  a woman                                                               
is on  Medicaid and pregnant  and seeks abortion services  and is                                                               
not in one  of the DKC categories, the state  doesn't do anything                                                               
to her eligibility that would move her into DKC.                                                                                
1:47:50 PM                                                                                                                    
CHAIR  DAVIS  asked what  other  services  are included  in  that                                                               
MR. SHERWOOD answered  that he wasn't a clinician,  but there may                                                               
be preliminary  visits, lab tests,  follow up work and  so forth.                                                               
Sometimes medical  records are requested to  determine whether or                                                               
not  the  situation is  abortion  related  and therefore  federal                                                               
funds should  not be  claimed. Multiple  procedure codes  may get                                                               
billed as part of that service.                                                                                                 
CHAIR DAVIS  asked if abortions are  being paid for out  of state                                                               
general funds.                                                                                                                  
MR. SHERWOOD replied yes, out of general fund money.                                                                            
SENATOR  ELLIS  said he  was  in  the legislature  when  Governor                                                               
Murkowski  cut  back on  DKC  and  asked  if the  department  had                                                               
tracked  or quantified  in any  way  the health  outcomes of  the                                                               
people who lost service at that time.                                                                                           
MR.  SHERWOOD  replied that  he  didn't  recall any  tracking  of                                                               
health  outcomes  for  those  individuals,  but  the  approximate                                                               
number  of people  lost is  reflected  in their  estimate of  the                                                               
number of people expected to come back on if SB 5 passes.                                                                       
SENATOR ELLIS  asked how  people found  out they  were eliminated                                                               
from eligibility.                                                                                                               
MR.  SHERWOOD   replied  that  he   didn't  recall  all   of  the                                                               
"informational  activities"  they  did, but  generally  when  the                                                               
period of eligibility comes up, a  standard notice is sent if you                                                               
are   re-determined  to   no  longer   meet  income   eligibility                                                               
requirements. The letter  is generated by the  Division of Public                                                               
Assistance and explains the reason and provides appeal rights.                                                                  
SENATOR  ELLIS remarked  that  governors' names  are  on our  PFD                                                               
checks,  but   they  probably  weren't  on   the  termination  of                                                               
eligibility letters for DKC.                                                                                                    
MR. SHERWOOD replied that he  didn't remember the letter exactly,                                                               
but the  standard letter  is signed  by the  case worker  not the                                                               
SENATOR ELLIS remarked  that some of the people  who were dropped                                                               
from DKC after the action  occurred might have become eligible in                                                               
the future -  probably because their health costs  caught up with                                                               
them and  they became poor enough  to then qualify under  the 175                                                               
percent  level. Is  that reasonable  to think  that happened  for                                                               
some people?                                                                                                                    
MR. SHERWOOD  replied that  is a possibility  if you  lack health                                                               
care  and it  impacts your  ability to  work as  much. Generally,                                                               
their experience with  people with incomes at this  level is that                                                               
there are significant  variables in terms of the  hours they work                                                               
and job changes.                                                                                                                
1:55:12 PM                                                                                                                    
SENATOR ELLIS  asked if  today he  was saying  that approximately                                                               
the same number of people who  dropped off the program during the                                                               
Murkowski  days is  the  same  number that  would  come into  the                                                               
program if  SB 5  passed and  signed into law  at 200  percent of                                                               
MR. SHERWOOD replied that his  recommendation when they developed                                                               
the projection  for SB  5 was  to look  at the  impact of  the 25                                                               
percent reduction.                                                                                                              
1:58:45 PM                                                                                                                    
HEATHER MCCAUSLAND,  representing herself, Wasilla, said  she had                                                               
been on unemployment  for nine months before getting  a part time                                                               
job for 1,000 hours a year and  when she applied for DKC she made                                                               
$150 too much to qualify. She  urged them to fund this program at                                                               
the 200 percent level like 45 other states do.                                                                                  
2:00:10 PM                                                                                                                    
CHAIR  DAVIS  asked  Mr.  Sherwood   for  closing  statements  on                                                               
possible areas of compromise.                                                                                                   
MR. SHERWOOD replied  that he would continue  to evaluate various                                                               
2:00:46 PM                                                                                                                    
GERAN  TARR, representing  herself,  said she  wanted to  clarify                                                               
some of  Mr. Sherwood's statements.  When the program  was rolled                                                               
back to 175  percent, income levels were, in fact,  frozen at the                                                               
2003 levels. So  individuals were lost each year  up until income                                                               
levels were  unfrozen in  2007. His estimate  that the  number of                                                               
individuals that would  be covered under 200 percent  is the same                                                               
as the number of individuals  that were lost. She remembered from                                                               
working  in the  legislature at  that  time that  the number  was                                                               
almost  double when  the  change was  made to  roll  back to  175                                                               
percent  and  freeze   incomes  at  2003  levels.   A  number  of                                                               
individuals  lost coverage  immediately,  but in  2004 they  lost                                                               
coverage  because income  levels  were froze  in  2005, 2006  and                                                               
2:02:16 PM                                                                                                                    
CHAIR DAVIS  said she would  give Mr.  Sherwood some time  to get                                                               
accurate figures for them.                                                                                                      
2:02:33 PM                                                                                                                    
MS. THOMPSON stepped  back to testify on a  personal issue saying                                                               
her miscarriage was counted as  an abortion because of the coding                                                               
and  medical  terms.  She  asked Mr.  Sherwood  if  coding  would                                                               
actually  say   if  a   procedure  was   elective  or   it  would                                                               
automatically call a procedure an  abortion because of the number                                                               
of  weeks along  a woman  is. Can  those still  be mixed  in with                                                               
abortion figures?                                                                                                               
MR. SHERWOOD  responded that  he is not  a clinician  and doesn't                                                               
work  in  the  codes,  but  he has  had  conversations  with  the                                                               
clinicians and  understands that  they look  at a  combination of                                                               
procedure  and  diagnosis  codes.  When in  doubt,  they  request                                                               
medical  records.  He added  that  it's  possible that  something                                                               
could be incorrectly coded, but  clinicians feel comfortable that                                                               
they  are  not  including  other  non-voluntary  terminations  of                                                               
pregnancy and  that their process  for evaluating those  codes is                                                               
2:05:54 PM                                                                                                                    
CHAIR DAVIS  wanted to  know if abortion  services could  be paid                                                               
for out of another "pot of money."                                                                                              
MR. SHERWOOD  replied, "For budget  purposes it's all one  pot of                                                               
money." There is a single  appropriation for the Medicaid program                                                               
and it  doesn't distinguish between  whether someone  is eligible                                                               
through one  of the DKC categories  or one of the  other Medicaid                                                               
categories; the bills  are paid. He said it might  be possible to                                                               
set up  other budget structures,  but that is a  budget structure                                                               
question.  Practically,  if  someone is  eligible  for  pregnancy                                                               
services  through the  Medicaid program,  case law  dictates that                                                               
they are offer coverage of the  abortion services. So you can put                                                               
the money someplace  else, but you're not going  to be addressing                                                               
the access to service issue.                                                                                                    
CHAIR DAVIS said she wasn't  concerned about access, but that DKC                                                               
has  the stigma  of paying  for abortions  and asked  if they  be                                                               
shifted to the regular Medicaid program.                                                                                        
MR.  SHERWOOD replied  they don't  have  an abortion  allocation.                                                               
When  they  provide  numbers  on   DKC  expenditures,  they  look                                                               
retrospectively at how  much turned out to be somebody  who is on                                                               
DKC. He  explained that before  1998, the General  Relief Medical                                                               
Program  paid  for  all  the   abortions,  but  that  went  away.                                                               
Regardless of how  the budget is structured he  couldn't think of                                                               
how  that  would  really  change   the  outcome  since  it's  not                                                               
accounted for separately now.                                                                                                   
2:09:06 PM                                                                                                                    
MS.THOMPSON related  that her  personal insurance  denied payment                                                               
when she miscarried  a set of triplets because  the diagnosis was                                                               
an "AB" and not  a "missed AB" and she was too  far along and she                                                               
finally got  an attorney to  satisfy the  bill. She still  had "a                                                               
little  bit of  angst"  that the  medical  definitions and  codes                                                               
weren't adequate.                                                                                                               
2:10:21 PM                                                                                                                    
ADRIAN LECORNU, Alaska Federation  of Natives, simply stated they                                                               
support SB 5.                                                                                                                   
2:11:42 PM                                                                                                                    
HOLLY  RYAN,  representing  herself,  Anchorage, said  she  is  a                                                               
Pacific  University  student  and has  heard  many  heartbreaking                                                               
stories from women  and families who don't  have coverage because                                                               
of  small amounts  of income.  She  wholeheartedly supported  the                                                               
increase  to 200  percent  and  urged them  to  raise  it to  250                                                               
CHAIR  DAVIS  thanked  everyone   for  telling  their  compelling                                                               
stories and supporting this bill.                                                                                               
2:12:38 PM                                                                                                                    
SENATOR ELLIS  expressed appreciation to Chair  Davis for holding                                                               
this  hearing. He  suggested that  any DKC  advocates around  the                                                               
state  will have  to get  involved  if they  want SB  5 to  pass.                                                               
People who  want to  kill it  are very active  - they  make phone                                                               
calls, send emails  and lobby the governor  and legislators. More                                                               
people will have  to speak out for this bill  to pass, he stated.                                                               
A  shocking number  of people  want to  kill it  or keep  it from                                                               
2:15:26 PM                                                                                                                    
Finding no further business to come before the committee, Chair                                                                 
Davis adjourned the meeting at 2:15 PM.                                                                                         

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