Legislature(2011 - 2012)HOUSE FINANCE 519
02/13/2012 09:00 AM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Medicaid 101 & the Affordable Care Act & Its Impacts on Alaska | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE FINANCE COMMITTEE
February 13, 2012
9:06 a.m.
9:06:02 AM
CALL TO ORDER
Co-Chair Thomas called the House Finance Committee meeting
to order at 9:06 a.m.
MEMBERS PRESENT
Representative Bill Stoltze, Co-Chair
Representative Bill Thomas Jr., Co-Chair
Representative Bryce Edgmon
Representative David Guttenberg
Representative Tammie Wilson
MEMBERS ABSENT
Representative Anna Fairclough, Vice-Chair
Representative Mia Costello
Representative Mike Doogan
Representative Les Gara
Representative Reggie Joule
Representative Mark Neuman
ALSO PRESENT
Representative Wes Keller; William Streur, Commissioner,
Department of Health and Social Services; Kimberli Poppe-
Smart, Deputy Commissioner For Medicaid And Health Care
Policy, Department Of Health And Social Services.
SUMMARY
PRESENTATION:
MEDICAID 101 & THE AFFORDABLE CARE ACT & ITS IMPACTS
ON ALASKA
9:07:43 AM
^PRESENTATION: MEDICAID 101 & THE AFFORDABLE CARE ACT & ITS
IMPACTS ON ALASKA
WILLIAM STREUR, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES, introduced staff and provided members with
a PowerPoint presentation: Partnerships, Medicaid Review
2012 (copy on file).
KIMBERLI POPPE-SMART, DEPUTY COMMISSIONER FOR MEDICAID AND
HEALTH CARE POLICY, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, observed that Medicaid was started in 1965 and
utilized state and federal funds. The program was managed
by states to provide care to low-income individuals; two-
thirds of the program coverage went to children and the
elderly. She shared that each state in the nation ran the
program differently; for example, some states had childless
adults in their coverage group. Medicaid provided health
insurance to approximately 60 million Americans and was 18
percent of the $3 trillion spent by the federal government
on healthcare. She said that the state's $1.5 billion
budget paid for the 92 percent of the nearly 146,000
Alaskans that were eligible for the program.
9:11:08 AM
Co-Chair Stoltze asked if the 146,000 represented single
applicants, or a whole line of dependents.
Ms. Poppe-Smart replied that 146,000 was the number of
eligible individuals.
Ms. Poppe-Smart continued. The program supported providers
and served as a safety net for individuals who would not
otherwise have healthcare coverage. Additionally, Medicaid
was the primary payer for long-term care services and
behavioral health services. She said that access through
Medicaid was comparable in many states to private health
insurance. In Alaska, healthcare expenditures in FY10 were
approximately $7.5 billion, Medicaid represented 18 percent
of those expenditures, as well as 32,000 jobs.
Ms. Poppe-Smart turned to Slide 4 titled, "National
Percentage Change in Total Medicaid Spending and Enrollment
FY 1998 - FY 2011," which reflected the rise and fall over
economic times in relation to Medicaid enrollment.
Ms. Poppe-Smart highlighted Slide 5 titled, "Percent Change
in Alaska's Total Medicaid Spending and Enrollment: FY 1998
- FY 2011." She stated that work had been done across the
states in order to eliminate, or reduce, barriers to
enrollment. She mentioned "express lane eligibility," which
was a national program that gave children that were
eligible for school lunch programs presumptive eligibility
for Medicaid. She furthered that the intention of the
express lane eligibility was to identify individuals,
primarily children, of low economic status that would not
otherwise be eligible for Medicaid.
9:13:49 AM
Representative Edgmon asked if the 32,000 jobs created by
Medicaid were in-state.
Ms. Poppe-Smart said yes.
Representative Edgmon asked if the growth in healthcare
jobs in the state could be attributed to Medicaid.
Ms. Poppe-Smart replied that the state represented 18
percent of Medicaid's expenditures, which could correlate
to the increase of jobs overtime that could be funded
because of Medicaid contributions.
Representative Edgmon thought that it would be interesting
to see the number of Alaskan jobs that were tied to
Medicaid.
Ms. Poppe-Smart said she would work to provide the
information to the committee.
9:15:01 AM
Ms. Poppe-Smart stated that Alaska's economic ebb and flow
paralleled the national economy, with a slight delay in
actual impacts. She said that Alaska's increasing elderly
population would cause rolls and expenditures to increase
over time. Nationally, dual eligibles accounted for 40
percent; the numbers were lower in the state, but it was
anticipated that they would increase.
Co-Chair Stoltze asked if the department was presenting
Medicaid as an economic engine.
Ms. Poppe-Smart replied in the affirmative.
Representative Wilson wondered how many Medicare recipients
in the state were also benefiting from Medicaid.
Ms. Poppe-Smart replied that there were 14,500 dual
eligibles in Alaska; individuals that became Medicare
eligible because of age were also eligible for Medicaid.
Representative Wilson asked how many people were dual
enrolled because their Social Security payments were not
enough to cover healthcare.
Ms. Poppe-Smart replied that there were a number of
individuals that became eligible because of health status.
9:17:36 AM
Ms. Poppe-Smart reviewed Slide 6, which was a map of the
Statutory Federal Medical Assistance Percentages (FMAP) FY
2012. She said that Alaska was at a 50 percent match rate
for general Medicaid. She stated that the last of the
American Recovery and Reinvestment Act (ARRA) dollars had
been distributed in June 2011. Those funds had translated
to an enhancement in the state's FMAP rate. She clarified
that if there was a Tribal Health beneficiary that was
receiving services from a Tribal Health provider the
reimbursement rate for the service itself was 100 percent.
She added that there were breast and cervical cancer, as
well as children health insurance programs that had
enhanced FMAP rates. She relayed that the formula that the
FMAP rates was based on considered unemployment rates,
general economy and number of participants. She furthered
that nationally, with the loss of the enhanced ARRA funding
federal match rates sank 10.8 percent; Alaska experienced
the decrease at 4 percent. She reported that Medicaid had
been growing at a slower rate per enrollee than national
health expenditures per capita and private health insurance
companies.
9:20:35 AM
Co-Chair Stoltze asked how much of the slower growth rate
could be attributed to the lower rate paid to Medicaid.
Ms. Poppe-Smart replied that in Alaska the rates were
comparable to private health insurance. She said that
across the nation the reimbursement for Medicaid was below
other payers, in some cases even below Medicare rates. She
thought it was possible that there was a lower
participation rate by providers, but she could not
speculate as to how much the smaller growth per enrollee
played a part.
Representative Wilson expressed disbelief that Medicaid
payments were comparable to private insurance.
Ms. Poppe-Smart assured the committee that comparisons
would be done during the presentation. She clarified that
Medicaid paid less than commercial insurance in Alaska, not
necessarily nationwide.
9:22:25 AM
Ms. Poppe-Smart discussed Slide 8 titled, "Controlling
Growth in Medicaid." She explained that there were four
ways to control growth in Medicaid growth:
· Eligibility
· Covered Services
· Rates
· Utilization Controls
Ms. Poppe-Smart stated that the list on the right hand side
of the slide highlighted other efforts being made to
control Medicaid spending:
· Compliance/Anti-Fraud
· Innovations in Service Delivery
· Technology
· Maximize Revenue
Ms. Poppe-Smart spoke to Slide 9, which involved a bar-type
chart detailing what different states were doing in
response to the economic climate. She said some states were
increasing payments, some were decreasing, some were
increasing and decreasing; some states had found that
dentists needed to be reimbursed at a higher rate to get
adequate dental coverage for recipients. She relayed that
some states were cutting provider rates in an attempt to
control the growth in Medicaid programs and subsequently
their state budget deficits. She said that eligibility had
increased nationwide and that some state-only funded
programs had appeared. She said that the home and community
bases service program in Alaska was strong, with less
institutional care provided. Alaska had approximately 708
nursing home beds.
9:25:41 AM
Ms. Poppe-Smart discussed controlling costs through
eligibility. She explained that when the state received
enhanced funding under ARRA, the maintenance of effort
requirement was imposed on the states. Under the
requirement the state could not eliminate or reduce
eligibility categories.
Co-Chair Stoltze asked if the long-term maintenance of
effort restrictions were a result of the short-term ARRA
funding.
Ms. Poppe-Smart replied yes, the restrictions were extended
through the Affordable Care Act through 2014. She said that
the maintenance of effort restrictions still applied to the
state, but with some possible exceptions.
Ms. Poppe-Smart discussed covered services. She said that
mandatory services generally included nursing homes,
hospitals and out-patient providers. She relayed that
optional benefits usually included home and community based
programs and pharmacy services. She said that elimination
of optional services would lead to more demand in mandatory
services. She referred to the scenario as the "shifting
bulge," and asserted that most optional services were not
really optional when looking at the big picture. She said
that examples of cuts due to budget deficits could be found
across the country.
Ms. Poppe-Smart stated that the Centers for Medicare and
Medicaid Services (CMS) would not approve changes to
programs that would impact access to necessary services.
She said that in May of 2011, CMS put forward a proposed
rule that would require the department to study access for
each service category for a year to demonstrate that access
would not be infringed upon. She stressed the CMS was
diligent about vetting any State Plan Amendments (SPA) to
make changes in services, including changes to rates,
services and eligibility.
Representative Wilson asked if the federal ARRA funding and
The Affordable Care Act (ACA) had caused the restrictions.
Ms. Poppe-Smart replied that the maintenance of effort
requirement originated with ARRA funding and was extended
through the ACA. She observed that the state did not take
the ARRA funding. She explained that by continuing to
participate in the Medicaid program the state must follow
the rules.
Representative Wilson asked if the restriction would still
exist if Medicaid was state funded.
Ms. Poppe-Smart responded that if the state had elected to
decline the $900 million in federal Medicaid funding, the
state could make its own rules but would lose federal
matching funds.
9:35:46 AM
Ms. Poppe-Smart turned to Slide 13, which listed mandatory
and optional services:
Mandatory
· Inpatient hospital
· Outpatient hospital
· Physicians
· Nurse midwives
· Lab and X-ray
· Advanced Nurse Practitioners
· Early Periodic Screening, Diagnosis, and Treatment
· Family planning services
· Pregnancy-related services
· Nursing facility (NF) services
· Home Health (NF qualified)
· Medical/surgical dental services
Optional
· MH Rehab/Stabilization
· Diagnostic/Screening/Preventive
· Therapies (OP,PT,SLP)
· Inpatient psychiatry<21 years
· Drugs
· Intermediate Care Facility/Mental Retardation
· Personal care
· Dental
· Other home health
· Other licensed Practitioners
· Transportation
· Targeted Case Management
Ms. Poppe-Smart stressed that optional services were not
always optional.
Co-Chair Stoltze took offense with the term "mental
retardation." He hoped a different term would be used in
the presentation into the future.
Ms. Poppe-Smart responded that a national change in
terminology to "intellectual disability" was under
discussion.
Ms. Poppe-Smart discussed rate control. She relayed that 39
states in the nation were looking to control rates by
freezing or reducing them. She observed that reducing rates
in one area may cause cost increases in another. She said
that some rate reductions had ended in litigation. She
noted CMS approval of an SPA was necessary and could impact
access and quality of care.
Co-Chair Stoltze emphasized the cost of not being able to
charge Medicaid for no-shows. He wondered if the issue had
been examined.
9:41:16 AM
Ms. Poppe-Smart noted that the department looked into no-
shows for dental providers. She observed that the no-show
rate was not higher among Medicaid users than for
commercial providers. She said that the problem existed
across the board. She asserted that covering no-shows would
put pressure on CMS and would pose the question of the
state covering the cost of no-shows.
Representative Wilson pointed out that self-payees were
responsible for their no-show costs whereas Medicaid
recipients were not.
Ms. Poppe-Smart understood that there was a financial
impact for no-show self-payees. She reiterated that the
rate of no-shows was not higher for Medicaid recipients
than self-pay patients or people covered by private plans.
Co-Chair Stoltze echoed Representative Wilson's concern.
Commissioner Streur acknowledged the issue. He pointed out
to the committee that the issue was not just a no-show
issue, but that it was a challenge for providers. He said
that the state was precluded under federal law from paying
for no-shows, unless general funds were used. He assured
the committee that solutions were under discussion.
9:45:13 AM
Co-Chair Stoltze asked if the no-show problem was worse
among Medicaid recipients than the rest of the population.
Commissioner Streur explained that a study performed by
dental providers showed that the numbers were not higher
for Medicaid patients than self-providers. He said that
dental providers did take issue with the inability to
charge the state for no-show patients covered by Medicaid.
Representative Guttenberg suggested that there could be a
division between other medical providers and dental
providers. He wondered if the no-show issue could stem from
the nature of the service being provided. He stressed that
many people had an aversion to dental care.
Ms. Poppe-Smart replied that she did not have any data on
no-shows regarding other medical providers.
9:47:44 AM
Ms. Poppe-Smart looked to Slide 14, which provided payment
comparisons from the Milliman Client Report: Physician
Payment Rates in Alaska and Comparison States prepared for
the Alaska Health Care Commission in 2011. The slide
reflected two different categories of service: Office Visit
and Obstetrical Care; and the payment methods; Alaska
Medicare, Alaska Medicaid, Alaska Commercial Mean,
Washington Medicaid, Washington Commercial Mean, North
Dakota Medicaid and Idaho Medicaid. She shared that Alaska
paid a higher rate than most states for Medicaid and higher
than some commercial providers.
Representative Wilson queried the consequence of paying
higher Medicaid rates than other states in the country. She
expressed concern that people would move to Alaska to
benefit from the higher rate Medicaid coverage.
Ms. Poppe-Smart responded that she did not have data to
validate that assumption. She acknowledged that some
patients came to the state to be cared for by family
residing in Alaska.
Representative Wilson believed that there was a correlation
between people moving in-state and the higher Medicaid
benefits. She suggested that Alaska should lower coverage
in order to stay in the same realm as other states.
Co-Chair Stoltze interjected that the correlation would be
hard to determine.
9:50:46 AM
Ms. Poppe-Smart reminded Representative Wilson that the
rates were paid to providers and not recipients, which
should result in more providers moving to the state and not
recipients. She observed that rural areas were addressed
differently. She said that the department did not receive
complaints that people found it difficult to access
services in the program. She stressed that people in other
states had complained of the difficulty in finding a doctor
that would take their Medicaid rate.
Representative Wilson pointed out the difference between
Medicaid and commercial rates. She maintained that Medicaid
did not offset the additional cost of paperwork. She said
that she thought that the system was "pretty poor."
Ms. Poppe-Smart rebutted that Health Care Commission
studies had reflected a higher cost of health care in
Alaska in general, but had not yet identified the cause.
9:52:51 AM
Ms. Poppe-Smart continued to Slide 15, which highlighted
utilization controls:
· States may impose utilization controls to ensure
appropriateness of treatment being funded
· Wide range of controls and screens
o Prior Authorization
o Post payment reviews
o Hard or soft edits
o Bundling, unbundling, and order of billing
o New Edits and audits for FFS (fee-for-service)
9:54:54 AM
Ms. Poppe-Smart looked to Slide 16, which discussed
compliance and anti-fraud:
· In some states may be an untapped area for savings
· Fraud in Medicaid is a reality
· Numerous methods and vendors
· Fraud undermines the entire program
· Politically popular reduction
Ms. Poppe-Smith explained that the federal government was
concerned $22.5 billion in improper payments that were made
to Medicaid in FY10. She noted that Alaska had a relatively
small provider population.
Representative Guttenberg asked if there was a breakdown
available to separate intentional fraud and simple
miscoding mistakes.
Ms. Poppe-Smart replied that fraud cases in Alaska were
handled by the Medicaid Control Unit under the Department
of Law. She said that few cases in the state resulted in
prosecution, as compare to the national numbers. She added
that fraud had proven a problem in larger urban areas of
the country. She shared that there was an active
surveillance and utilization system that tracked patterns
of practice and payments in the attempt to identify any
problems.
9:58:14 AM
Co-Chair Stoltze questioned if there was a quantifiable
fraud percentage.
Ms. Poppe-Smart responded that there was not a quantifiable
percentage available. She said that the Division of Public
Assistance had a unit dedicated to examining fraud
concerns. She explained that the department examined the
statutory required audits. She stressed the department had
programs already in place to look for, and prevent fraud,
and did not believe that it was a rampant problem in
Alaska.
10:00:38 AM
Representative Wes Keller probed the efforts taken by the
department to control fraud.
Ms. Poppe-Smart stated that the process began with the
enrollment of a provider; inspector general records were
examined to determine any history of fraudulent activity or
exclusion in other state programs. She furthered that a
surveillance and review team looked to claims payment
systems for any suspicious patterns. She added that the
department sometimes received reports from individuals;
explanation of benefit reports helped individuals review
their claims. She furthered that the department had a
program integrity team that worked with audits. She shared
that the error rate in Alaska for 2008-2009 was one of the
lowest in the nation. She stated that statutorily mandated
audits occurred on a regular basis and any fraudulent
activities were referred to the federal government. She
noted the existing compliance efforts in Alaska:
· Surveillance Utilization Review (SUR)
· Audits required by AS 47.05.200
· Credit Balance Audits
· Focused reviews
· CMS Medicaid Integrity Program
· Payment Error Rate Measurement
· "Cluster Audits"
· Medicaid Recovery Audit Contractors
· Medicaid Fraud Control Unit (MFCU)
· Provider, referrer, prescriber, renderer enrollment
· Medicaid Recovery Audit Contractor
Co-Chair Stoltze asked if it could be determined were fraud
existed.
Ms. Poppe-Smart replied that there was a small number of
fraud on both the provider and the recipient end. She
stated that she did not have the figures at hand.
10:05:11 AM
Representative Wilson asked how much the state was paying
to handle fraud cases versus how much was recouped from
prosecution.
Ms. Poppe-Smart responded that the department would work to
would provide data. She believed that due to low the
incidences of fraud the department paid more in
administrative cost than was recovered.
Representative Keller shared that federal measurements of
error rates involved insuring that recipients received the
maximum benefits allowed by law.
10:07:50 AM
Ms. Poppe-Smart continued to Slide 17 which showed where
recoveries had been, she noted that the numbers were not an
identification of fraud but audits where an overpayment had
been made, usually in an instance where there had not been
documentation in provider's records to support the payment
that was made through the claims system.
Ms. Poppe-Smart turned to Slide 19, which listed
innovations in service delivery and payment:
· Medical Home
· Tribal Health - exemplar of alternative provider types
· Bundled services
· Integrated Bills previously Heard or
Scheduled./Primary care services
· More
Ms. Poppe-Smart said that medical homes worked because they
provided case managers that helped patients manage chronic
medical conditions and stay on top of care needs;
additionally, it had lowered the rate of emergency room
visits for those patients. She shared that some of the
medical home programs that had started across the country
had witnessed a 10 percent savings in Medicaid costs.
Co-Chair Stoltze spoke to the Tribal Health Consortium. He
had been told that the top three priorities for the
consortium were entities in The Copper River Valley, the
Mat-Su, and one to be built in Kenai.
10:11:23 AM
Commissioner Streur shared that the Mat-Su effort was
largely driven by the South-central Foundation. He said
both Kenai and the Copper River Native Association had
approached the state for funding for their respective
facilities. He added that if the facilities are built they
will have 20 years of operation costs paid for by the
federal government.
Co-Chair Stoltze wondered whether savings would be realized
because of the higher reimbursement rate for tribal health
entities.
Commissioner Streur replied that every patient, and every
service that was diverted for an Alaska Native into a
native facility, received double reimbursement from the
federal government.
Co-Chair Stoltze wondered whether the numbers could be
quantified.
Commissioner Streur explained that currently 40 percent of
native services were reimbursed at 100 percent. He said
that the goal was to substantially increase those services.
He believed the state could double the amount of native
services.
Ms. Poppe-Smart interjected that the native services
reimbursement amount was $208 million.
Ms. Poppe-Smart addressed the second bullet on Slide 19.
She stated that 1 in 5 Alaskans was covered by Medicaid, 40
percent of which were Tribal Health beneficiaries, and 40
percent of that received their care within the Tribal
Health system. She believed this left a lot of opportunity
to enhance the Tribal Health participation. She stated that
the she had attended the Alaska Native Tribal Health
Consortium where she learned that the federal government,
through Indian Health Services (IHS) funding covered 50
percent of health costs. She said that Medicaid was the
partner that could help to make up the other 50 percent.
She stressed that there was significant dialogue between
the department and IHS. She explained that Tribal Health
beneficiaries, like Medicaid beneficiaries, continued to
maintain a choice on where they received their health care.
She said that the department supported ongoing efforts to
provide choices in rural areas.
10:16:14 AM
Ms. Poppe-Smart said innovations in the area of long-term
managed care had been seem in other states, as well as
changes in dual eligibility. She said that because of
Alaska's small Medicaid population the department could
observe changes made in other states and then only
incorporate the best ideas. She stated that many stats were
moving toward the deinstitutionalization of long-term care
residents; community based care was already a trademark of
the Alaska Health Care Delivery System.
Ms. Poppe-Smart noted Slide 20 which addressed technology:
operational efficiencies and care delivery implications.
She noted that more efficiencies lead to higher enrollment.
She said that the department was working on the claims
payment system with the expectation of enhanced
efficiencies by spring 2012, as well as the incorporation
of additional metrics to allow for better management and
observation of overall quality. She said that there were a
number of technology initiatives across the country that
looked into increased compliance efforts and searches for
fraud using software. She relayed that the department hoped
to be able to manage health care through technology systems
that allowed for access to real-time health information
across systems.
Ms. Poppe-Smart pointed to Slide 21 related to the
maximization match, collections and refinancing
opportunities. She said that the plan was to replace state
funding with federal funding where allowable and to seek
out Tribal Partner opportunities.
Representative Keller requested that the department be
watchful for other health care facilities. He expressed
concern that the supply of care could negatively impact
other health care providers.
Ms. Poppe-Smart agreed that the conversation was important
for all parties involved.
10:22:38 AM
Ms. Poppe-Smart moved to "Accounting and Recovery
Collections" on Slide 22. She stated that the department
collected third party liability if a Medicaid recipient
also had access to insurance.
Ms. Poppe-Smart continued to Slide 23, which highlighted
the Medicaid Task Force. She relayed that the request for
proposal for the Medical Home had been responded to and
that the department was in the process of evaluating the
responses. She said that four pilot sites had been
estimated. She shared that the initial estimates had been
pretty slim with a savings of approximately $165,000 per
1,000 lives. She estimated that the numbers would rise as
the program matured.
Ms. Poppe-Smart discussed the Care Management Program on
Slide 24:
· Care Management Program - expanded element of medical
home with focus on recipients at highest risk who
offer the greatest potential for improvements in both
health outcomes and enhanced funding/cost avoidance.
o Estimated cost of avoidance: Enhanced FMAP for 8
quarters for each participant. Conservative
savings estimate of $1,040,000 for 7,500
participants.
Ms. Poppe-Smart addressed Slide 25 which discussed Pharmacy
Initiatives:
· Increased substitution to generic medications
o Phase 1: Q2 $1,250,000 cost avoidance annualized
at $5,000,000
· Increased Generic Medication through edits/PA
o Phase 1: 6 months $1,405,938 cost avoidance
annualized at $2,810,000
· State Maximum Allowable Cost
o Fully implemented: $500,000 cost avoidance
annualized at $5.5-$6 million
· Enhanced preferred Drug List - not implemented
o Estimate cost avoidance analysis underway.
· Psychiatric Medication Policy - not implemented
o Estimate of cost avoidance $182,000 - right care.
· Pharmacy initiative cost avoidance through Q2:
$4,655,938 annualized to $13,310,000 - $13,810,000
Ms. Poppe-Smart stated work was being done on the enhanced
preferred drug list. She stated that the list had not been
implemented but that discussions alone had resulted in cost
avoidance. She shared that appropriate psychiatric
medication administration for children in state custody had
been under discussion in light of concerns about metabolic
dysfunction that occurred when multiple psychiatric
medications were administered.
10:27:30 AM
Co-Chair Stoltze discussed the estimate of cost avoidance
on slide 26. He thought that it could be dangerous to limit
access to needed psychotropic drugs.
10:28:49 AM
Ms. Poppe-Smart responded that the initiatives were about
providing the right care to patients and not about limiting
care to anyone. She stressed that the plan was to provide a
consultant to help with the administration of sometimes 5
to 7 different psychotropic drugs at a time.
Commissioner Streur explained that the issue had been
delayed due to the emotion surrounding the issue.
10:31:01 AM
Ms. Poppe-Smart concluded with Slide 27:
· Community First Choice - home and community based
personal care services. Consultant engaged, design
discussions and viability analysis underway.
o Estimate of cost avoidance: Enhanced FMAP of 6%.
Ms. Poppe-Smart shared that the Affordable Care Act
estimations could not be calculated until the United States
Supreme Court ruled on the constitutionality of the act.
Commissioner Streur emphasized that the Supreme Court
ruling would provide some answers as to how ACA would
affect Medicare/Medicaid in the state.
Co-Chair Stoltze asked if the department could hypothesize,
independent of a Supreme Court rule, how ACA would affect
the Medicaid budget.
Commissioner Streur replied that he could not separate the
two. He stressed that absent the ruling the department did
not know the impact of the expanded Medicaid coverage.
10:33:47 AM
Co-Chair Stoltze thought that the department would have had
concerns about ACA, given that Governor Parnell was
litigating the legislation.
ADJOURNMENT
10:35:17 AM
The meeting was adjourned at 10:35 AM.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Medicaid 101 HFIN 2-13-12.pdf |
HFIN 2/13/2012 9:00:00 AM |