Legislature(2023 - 2024)ADAMS 519
04/20/2023 01:30 PM House FINANCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB58 | |
| HB59 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 58 | TELECONFERENCED | |
| += | HB 59 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
April 20, 2023
1:34 p.m.
1:34:10 PM
CALL TO ORDER
Co-Chair Foster called the House Finance Committee meeting
to order at 1:34 p.m.
MEMBERS PRESENT
Representative Bryce Edgmon, Co-Chair
Representative Neal Foster, Co-Chair
Representative DeLena Johnson, Co-Chair
Representative Julie Coulombe
Representative Mike Cronk
Representative Alyse Galvin
Representative Sara Hannan
Representative Andy Josephson
Representative Dan Ortiz
Representative Frank Tomaszewski
MEMBERS ABSENT
Representative Will Stapp
ALSO PRESENT
Tony Newman, Director, Division of Senior and Disabilities
Services, Department of Health; Renee Gayhart, Director,
Division of Health Care Services, Department of Health;
Emily Ricci, Deputy Commissioner, Department of Health.
PRESENT VIA TELECONFERENCE
Marge Stoneking, Advocacy Director, AARP Alaska, Anchorage;
Robert Tasso, Health and Social Services Planner,
Governor's Council on Disabilities and Special Education,
Anchorage; Brooke Ivy, Vice President, Policy and Advocacy,
Alaska Children's Trust (ACT), Anchorage; Jamie Morgan,
Government Relations Regional Lead, American Heart
Association (AHA), Sacramento, California.
SUMMARY
HB 58 ADULT HOME CARE; MED ASSISTANCE
HB 58 was HEARD and HELD in committee for further
consideration.
HB 59 MEDICAID ELIGIBILITY: POSTPARTUM MOTHERS
HB 59 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster reviewed the meeting agenda. He noted the
plan was to hold the bills and wait for the Senate version
to come to the committee the following week.
HOUSE BILL NO. 58
"An Act relating to medical assistance for recipients
of Medicaid waivers; establishing an adult care home
license and procedures; providing for the transition
of individuals from foster care to adult home care
settings; and providing for an effective date."
1:35:16 PM
Co-Chair Foster asked staff from the Department of Health
(DOH) to review the fiscal notes.
TONY NEWMAN, DIRECTOR, DIVISION OF SENIOR AND DISABILITIES
SERVICES, DEPARTMENT OF HEALTH, thanked the committee for
hearing the bill again. He briefly explained that the bill
would provide elderly Alaskans and adults with disabilities
enrolled in the Medicaid home and community based waivers
with a new living option called adult home care. The bill
established a new licensed residential setting type and a
new certified service that would be overseen by DOH. He
offered to take questions or provide an overview of the
fiscal notes.
Co-Chair Foster asked for a review of the fiscal notes.
Mr. Newman reviewed the first fiscal note, OMB component
number 2663, control code fpGii. The fiscal note primarily
funded one position to begin in FY 25, which would
implement and operationalize the adult home care service.
The work would entail developing the organizational
procedures around certifying and monitoring providers who
offer the service, in addition to certifying and monitoring
the providers. The position was new, and it would involve
setting up the program, providing training, and making it
clear to families and providers how the service was
different from existing service options. The note included
the salary of $119,100 for one health program manager II
with $2,300 for some minimal travel, $14,000 for services
(i.e., core service costs for an employee including IT,
lease costs, HR, and fiscal management services costs), and
$4,000 for commodities. The costs would be funded with 50
percent federal Medicaid funds and 50 percent state general
Medicaid funds.
1:38:28 PM
Mr. Newman reviewed the second fiscal note OMB component
number 3234, control code boKBB. The note was zero and had
been compiled by the department to demonstrate to the
legislature that it had considered what it would cost to
add a new service. The department had determined it would
have a net zero impact on the Medicaid Services budget. He
reminded the committee that the service was for people who
were already eligible for Medicaid home and community based
waiver services. He explained it would be a more expensive
service in some cases and a less expensive service in other
cases, leading to a net zero estimate.
1:39:32 PM
RENEE GAYHART, DIRECTOR, DIVISION OF HEALTH CARE SERVICES,
DEPARTMENT OF HEALTH, reviewed the last fiscal note, OMB
component number 245, control code Pvlvr. The department
was requesting one PCN [position control number] beginning
in FY 25 for $105,000 with $10,000 in travel, $14,000 in
services, and $1,000 in commodities. The department was
looking at licensing approximately 40 new homes in the
first year and the position would be responsible for
regulations drafting, policies and procedures, training,
and outreach to the new provider types. The department was
requesting an additional PCN in FY 29 to reflect doubled
cost. She explained there was an uptick any time a new
license provider type came on board and the department
assumed it would continue to see additional facilities
wanting to be licensed under the program; therefore, the
department was projecting 40 new homes in the first year
and a similar amount in the outyears. The department would
also have to do recertifications or relicensing in the
fifth year. She explained the original licensed providers
would be relicensed as new licenses were coming on board as
well. She relayed that if the funding was approved, the
department would be able to submit a path for the position
in FY 29 and attach the approval of HB 58. The department
would still have to go through the budget and the Office of
Management and Budget (OMB) to get a PCN through
classification.
1:41:55 PM
Co-Chair Foster OPENED public testimony.
MARGE STONEKING, ADVOCACY DIRECTOR, AARP ALASKA, ANCHORAGE
(via teleconference), read from prepared remarks:
AARP strongly supports continued expansion and
improvement of home and community based waiver
services to better serve our fast growing senior
population, including offering a range of residential
settings. The vast majority of us want to remain in
our own homes and communities as we age and prefer a
home setting over a nursing home or other
institutional settings. Of course, as you know, home
and community based services (HCBS) cost a fraction of
what otherwise required nursing home care would cost.
In the home care workforce crisis combined with our
rapidly aging population, its threatening access to
HCBS for private pay and state pay alike and that is
already driving people into assisted living
facilities. This could additionally drive elders into
institutional care and because few can afford nursing
home care, could ultimately increase the Medicaid
rolls. That's why we need to use all tools in the
toolbox to expand home and community based service
options using proven service models from across the
nation to offer choices to appeal to waiver
participants and perspective workers alike.
Adult home care is one such solution and AARP welcomes
the administration proposing adult home care as an
additional service option and adult care homes as a
new residential setting for [inaudible] residents. It
is our understanding that HB 58 will provide a pathway
to creating a lower administrative burden for
operators than group assisted living homes and the
intent is to offer elders and others the option of
more homelike settings with lower level services and
fewer residents. For these reasons, AARP supports HB
58 and looks forward to working with the department on
regulations required in the bill. We also urge the
Department of Health, with the support of the
legislature, to stand up additional initiatives that
directly support the aging in place component of the
governor's Healthy Families Initiative, including
participant directed care. Aging in place is what the
vast majority of older Alaskans want to do and home
care services and support cost the state a fraction of
what institutional care does.
Co-Chair Foster noted that Representative Coulombe had
joined the meeting.
1:45:52 PM
ROBERT TASSO, HEALTH AND SOCIAL SERVICES PLANNER,
GOVERNOR'S COUNCIL ON DISABILITIES AND SPECIAL EDUCATION,
ANCHORAGE (via teleconference), spoke in support of the
legislation and the companion bill SB 57. The legislation
would expand home and community based services and
establish a new residential setting category for adult home
care. The bill would establish several main goals for
stakeholders, particularly allowing legally responsible
individuals including family members to care for seniors
and individuals with disabilities and to receive financial
support for the service. The bill would also allow for
continuity of care for individuals to provide the necessary
support for the family providing care and would lower cost
and decrease the administrative burden normally required
for an adult assisted living home. The bill provided an
opportunity for enhanced support for caregivers of
individuals with disabilities or individuals aging out of
the foster care system. He highlighted the current
workforce crisis and relayed that the bill would help
address the issue that many providers had been struggling
with. The governor's council supported the passage of the
bill.
Co-Chair Foster CLOSED public testimony.
Representative Galvin asked if the fiscal notes included
receipts for licenses. She wondered if it was not a part of
the overall consideration.
Ms. Gayhart replied that it would not be taken into
consideration until DOH drafted the regulations. Currently
the license fee was quite low at about $25 per bed. The
department had not factored it into account because it did
not yet know how many beds would come online. She explained
it would be included in the outyears. She stated there
would be limited receipts, but not to begin with.
Representative Galvin wondered if it was common to have a
placeholder in future years for accounting purposes. She
suggested making note of the issue in the drafting.
HB 58 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster noted he intended to schedule the bill the
following week. His staff would work with committee members
regarding an amendment deadline.
HOUSE BILL NO. 59
"An Act relating to Medicaid eligibility; expanding
eligibility for postpartum mothers; conditioning the
expansion of eligibility on approval by the United
States Department of Health and Human Services; and
providing for an effective date."
1:50:46 PM
Co-Chair Foster requested a brief summary of the
legislation and a review of the fiscal notes.
EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH,
explained that the bill would extend postpartum coverage
from 60 days to 12 months. The department provided an
overview and presentation of the bill to the committee the
previous week. She reviewed the fiscal note OMB component
number 3234, control code IgvwY. The fiscal note was based
on an FY 25 starting date, which would provide the
Department of Health (DOH) sufficient time to enact the
regulatory and federal state plan amendment changes
necessary to extend coverage from 60 days to 12 months. She
remarked that the department would do the work faster if
possible. The total estimated funds were around $9 million,
which included anticipated claims costs contained on the
Medicaid Services line with a combined funding source of
$6.4 million in federal receipts and $2.6 million in UGF
annually. She added the costs could change depending on the
actual experience incurred by individuals over the next
year to five years. The funding ratio reflected
approximately 28 percent UGF match to 72 percent federal
receipt authority. There were no positions requested in the
fiscal note.
Ms. Ricci reviewed an analysis of underlying the claims
assumptions created by DOH. She relayed that the Division
of Health Care Services looked back at 2018 through 2020 to
identify the number of women who had a gap in coverage or
lost coverage between the 60-day mark and the proposed 12-
month period. There were a total of just over 3,600
beneficiaries who lost or experienced a gap in coverage
during the time period. She detailed that just under 1,600
of the total lost coverage completely after the 60-day
period and did not reenroll in the Medicaid program through
another eligibility category. She explained that the
individuals may have had other coverage, remained
uninsured, or could have participated in the federal
exchange. About 2,000 of the total experienced a gap in
coverage between the 60-day period and 12-month period. She
elaborated that perhaps individuals were disenrolled after
that 60-day period but were reenrolled in another Medicaid
eligibility category two to five months later (sometime
between the 60 days and 12 months).
Ms. Ricci continued to explain the methodology behind the
numbers in the fiscal note. The department looked at the
number of beneficiaries who had lost coverage or had a gap
in coverage and had calculated what the estimated monthly
cost would be without a gap or discontinuation of coverage
for individuals during the time period [between 60 days and
12 months]. The cost was calculated to be approximately
$566 per beneficiary per month. The department then applied
the different federal match that would be available
depending on the category of eligibility the individual may
be covered under. For example, the typical match was 50
percent federal/50 percent state; however, tribal health
members or beneficiaries received 100 percent federal
match. Based on the information, the division estimated $9
million in additional claims with approximately 28 percent
state match to 78 percent federal match.
1:55:51 PM
Representative Josephson considered a scenario where the
program coverage time could be extended more rapidly. He
used a January 15 [2024] start date as an example. He asked
if the department would bring it online and seek
supplemental funding. He communicated eagerness to get
going.
Ms. Ricci answered that the department did not ever intend
to seek to ask for supplemental funding; DOH tried to make
sure its budget aligned with its estimated costs. She
believed in the event the department was able to bring the
extended coverage online earlier, DOH would work with its
team managing federal receipt authority and general funds
to ensure the additional costs could be covered. She
highlighted the importance of estimating claims costs and
building them into the foundational budget when extending
coverage long-term.
Representative Josephson stated that the presentation had
made a real impression on the committee, which was the
reason for his question.
Representative Galvin requested follow up information from
the department depicting the timeline for the
implementation process. She offered to help in any way.
1:58:01 PM
Co-Chair Foster OPENED public testimony.
BROOKE IVY, VICE PRESIDENT, POLICY AND ADVOCACY, ALASKA
CHILDREN'S TRUST (ACT), ANCHORAGE (via teleconference),
relayed that ACT was the statewide lead agency on the
prevention of child abuse and neglect in Alaska. The agency
fully supported extending postpartum coverage to 12 months.
She stated it was a perfect example of primary prevention
and it could not align more with ACT's mission. She
elaborated that extending the coverage would give new moms
more time to deal with any post-birth health issues such as
postpartum depression, which often did not occur until six
months or more after a baby was born. She stated that 41
percent of the child abuse cases in Alaska involved
children from birth to four years of age, with children
from birth to one as the highest risk. Postpartum
depression was associated with an array of negative
outcomes including decreased child safety practices,
decreased child checkups, and bonding difficulty between
mother and child. The bill would reduce maternal mortality
rates and would protect new parents from medical debt in
the first year of their child's life. She relayed that
th
Alaska ranked 44 in the nation in health. The agency was
excited to see Alaska join over 35 other states to make the
extension permanent. She urged swift passage of the
legislation.
Co-Chair Foster stated the committee would return to Ms.
Ivy after the next testifier.
Co-Chair Foster noted that Representative Ortiz had joined
the meeting.
2:00:56 PM
JAMIE MORGAN, GOVERNMENT RELATIONS REGIONAL LEAD, AMERICAN
HEART ASSOCIATION (AHA), SACRAMENTO, CALIFORNIA (via
teleconference), testified in favor of the legislation. She
relayed that maternal mortality rates had more than doubled
in the United States. She detailed that instances in
maternal morbidity had lasting health consequences and
resulted in avoidable medical expenses. She stated action
was needed to improve health outcomes for mothers and
babies. The AHA recently released a policy statement call-
to-action on maternal health and saving mothers. The
statement set a new policy agenda to ensure healthy
pregnancies, healthy births, and healthy moms. She relayed
that extending postpartum Medicaid coverage was a key
recommendation. The bill would ensure parents would have
access to care during pregnancy and in the first full year
after birth, providing parents and their babies the best
possible start. The agency supported the bill and urged the
committee's support.
2:02:51 PM
Ms. Ivy continued her previous testimony. She relayed that
postpartum depression was associated with an array of
negative outcomes and the resulting bonding difficulty was
a primary predictor of child abuse. The agency looked
forward to seeing Alaska join more than 35 other states
that had made the postpartum extension permanent. She urged
swift passage of the bill due to the long implementation
timeline. She thanked the governor for bringing the bill
forward, the Senate for passing the bill to the House, and
the committee for providing the opportunity to testify.
Co-Chair Foster CLOSED public testimony. He reviewed the
email address for public testimony.
HB 59 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster relayed the committee would await the
Senate bills the following week. He reviewed the schedule
for the following day.
ADJOURNMENT
2:05:08 PM
The meeting was adjourned at 2:05 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 59 Public Testimony Rec'd by 4-17-23.pdf |
HFIN 4/20/2023 1:30:00 PM |
HB 59 |
| HB 59 HFIN Response questions 041823.pdf |
HFIN 4/20/2023 1:30:00 PM |
HB 59 |