04/12/2008 12:40 PM House HES
| Audio | Topic |
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| Start | |
| SB212 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 12, 2008
12:40 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Wes Keller
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Anna Fairclough
COMMITTEE CALENDAR
SENATE BILL NO. 212
"An Act relating to eligibility requirements for medical
assistance for certain children and pregnant women; and
providing for an effective date."
- MOVED SB 212 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 212
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY
SPONSOR(s): SENATOR(s) DAVIS
01/16/08 (S) PREFILE RELEASED 1/4/08
01/16/08 (S) READ THE FIRST TIME - REFERRALS
01/16/08 (S) HES, L&C, FIN
01/23/08 (S) HES AT 1:30 PM BUTROVICH 205
01/23/08 (S) <Bill Held Over to 1/25/08>
01/25/08 (S) HES AT 1:30 PM BUTROVICH 205
01/25/08 (S) Moved SB 212 Out of Committee
01/25/08 (S) MINUTE(HES)
01/28/08 (S) HES RPT 3DP 1NR
01/28/08 (S) DP: DAVIS, ELTON, THOMAS
01/28/08 (S) NR: DYSON
01/30/08 (S) L&C REFERRAL WAIVED
04/08/08 (S) FIN RPT 2DP 3NR 1AM
04/08/08 (S) DP: ELTON, THOMAS
04/08/08 (S) NR: HOFFMAN, STEDMAN, OLSON
04/08/08 (S) AM: DYSON
04/08/08 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/08/08 (S) Moved SB 212 Out of Committee
04/08/08 (S) MINUTE(FIN)
04/11/08 (S) TRANSMITTED MR. OBERMEYER (H)
04/11/08 (S) VERSION: SB 212
04/11/08 (H) READ THE FIRST TIME - REFERRALS
04/11/08 (H) HES
04/12/08 (H) HES AT 10:30 AM CAPITOL 106
WITNESS REGISTER
TOM OBERMEYER, Staff
to Senator Bettye Davis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced SB 212 on behalf of Senator
Bettye Davis, sponsor.
JON SHERWOOD
Office of the Commissioner
Medicaid and Health Care Policy
Department of Health & Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
212.
ELLIE FITZJARRALD, Director
Division of Public Assistance
Department of Health & Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
212.
PAT HEFLEY, Director
Behavioral Health
Southeast Alaska Regional Health Consortium (SEARHC)
Sitka, Alaska
POSITION STATEMENT: Testified in support of HB 212.
BRENDA MOORE, Secretary
Alaska Mental Health Board
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 212.
CHRISTINA VAN CLEVE, Representative
Alaska School Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 212.
PATRICIA SENNER
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 212.
LORIE MORRIS, Representative
Alaska Human Services Coalition
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 212.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 12:40:33 PM.
Representatives Cissna, Gardner, Seaton, and Wilson were present
at the call to order. Representatives Roses and Keller arrived
as the meeting was in progress.
SB 212-MEDICAL ASSISTANCE ELIGIBILITY
12:40:33 PM
CHAIR WILSON announced that the first order business would be
SENATE BILL NO. 212 "An Act relating to eligibility requirements
for medical assistance for certain children and pregnant women;
and providing for an effective date."
12:41:32 PM
TOM OBERMEYER, Staff to Senator Bettye Davis, Alaska State
Legislature, introduced the bill on behalf of Senator Davis,
sponsor. He informed the committee that SB 212 is an act
relating to eligibility requirements for medical assistance for
certain children and pregnant women. The bill is called the
Denali Kid Care bill, following the State Children's Health
Insurance Program (SCHIP), which is a national program. He
informed the committee that Alaska is participating in SCHIP at
rate of 175 percent of federal poverty guidelines, which is a
lower rate than many other states. The original rate was set at
200 percent of poverty level; moreover, inflation drops the
effective rate to about 154 percent. Mr. Obermeyer advised that
the current bill would reinstate 1,277 children and 218 pregnant
women that were excluded by previous changes in the rate. At a
higher rate, Alaska would again be able to assist those children
who have no regular health care and no insurance. He urged the
committee to recognize that the federal government would
reimburse at the enhanced rate of two-thirds up to 70 percent.
Furthermore, if costs exceed the SCHIP funds, the claims are
reimbursed at the Medicaid rate. Mr. Obermeyer pointed out that
the fiscal notes are very good; in fact, the federal receipts
are about two-thirds of the cost in each case.
12:44:23 PM
CHAIR WILSON asked about the financial consequences to the state
if the federal government decides not to fund SCHIP.
12:44:59 PM
MR. OBERMEYER said that the Medicaid rate was about 50 percent
as compared to the 70 percent reimbursement through SCHIP. He
understood that a reduction in funding would be based on
population and would adversely affect all of the states.
12:45:29 PM
REPRESENTATIVE CISSNA asked for the number of children that were
left without insurance coverage by the state reductions.
12:45:57 PM
MR. OBERMEYER referred to the fiscal notes that indicate that
there was a substantial loss of about 2,500 to 3,000 children.
He suggested that the Department of Health & Social Services
(DHSS) may have more information. He stressed the importance of
the numbers and pointed out that the Alaska State Hospital and
Nursing Home Association (ASHNHA) supports this increase in
order to prevent additional expenses later in life and expensive
visits to emergency rooms.
12:48:20 PM
JON SHERWOOD, Office of the Commissioner, Medicaid and Health
Care Policy, Department of Health & Social Services, indicated
that his office could not report an exact number because of
other activities in addition to the eligibility action;
however, the DHSS anticipates that the bill would add 1,300 kids
and 200 pregnant women to the program.
12:49:16 PM
REPRESENTATIVE CISSNA observed that, after the loss of programs
like this, along with the increased cost of health care, there
has been an increase in homeless families in her community.
Further, the most frequent cause of bankruptcy is the high cost
of health care. She asked whether the DHSS studies issues such
as these to determine the cause of problems in communities.
12:50:26 PM
ELLIE FITZJARRALD, Director, Division of Public Assistance,
Department of Health & Social Services, clarified that the
passage of last year's bill restored eligibility to about 1,277
children and 1,100 have re-enrolled. However, pregnant women
are not enrolling at the rate anticipated.
12:51:53 PM
REPRESENTATIVE CISSNA also asked whether the legislation would
cover more people, such as those who are in institutions.
12:52:49 PM
MR. SHERWOOD answered that the legislation reproduces the entire
list of all those presently eligible for Medicaid under optional
categories. The only change to eligibility occurs by the change
in the percentage of the poverty line for children and pregnant
women; in fact, the other categories are listed for drafting
conventions.
12:53:30 PM
REPRESENTATIVE CISSNA further asked whether the bill would allow
coverage for those with impairments.
12:53:59 PM
MR. SHERWOOD explained that Medicaid is a categorical
eligibility and there are different standards for different
categories. A number of the categories do not involve children
or pregnant women; thus most of the categories are not affected
by these changes.
12:54:32 PM
REPRESENTATIVE ROSES recalled recommendations that state SCHIP
eligibility should not be increased until federal funding levels
were authorized. He asked for projections of the federal
funding levels.
12:55:28 PM
MR. SHERWOOD said that the federal funding was uncertain.
Congress extended the SCHIP through March of 2009, but without
re-authorization of the program. Alaska's SCHIP is a Medicaid
expansion; therefore, without SCHIP funding, reimbursement
defaults to Medicaid at a 50 percent rate.
12:56:20 PM
REPRESENTATIVE ROSES further asked whether the extension was
authorized at the same funding level.
12:56:46 PM
MR. SHERWOOD responded that the extension was at the same level
of funding; however, Alaska receives supplemental funding and
there is a potential for shortfall. In further response, Mr.
Sherwood said that the percentage of the shortfall is unclear.
The federal reimbursement would default to the Medicaid rate of
50 percent with the exception of Indian Health Service (INH)
beneficiaries which are reimbursed at 100 percent.
12:58:38 PM
REPRESENTATIVE ROSES estimated that the decrease in federal
funding was about six to eight percent.
12:59:09 PM
MR. SHERWOOD re-stated the uncertainty of the SCHIP funding. He
opined that the question would likely be resolved by the new
administration and Congress.
12:59:46 PM
REPRESENTATIVE ROSES summarized that the National Conference of
State Legislatures warned states about expanding eligibility
when federal support is uncertain. He drew a comparison to the
Alaska budget that may not be sustainable in the future.
Representative Roses stated that SB 212 was a far reaching bill
that was hard to review in a limited period of time, and he
asked whether the bill was also referred to the House Finance
Committee.
1:01:47 PM
CHAIR WILSON said no.
1:02:00 PM
REPRESENTATIVE SEATON asked whether the bill was an addition to
the budget.
1:02:19 PM
MS. FITZJARRALD understood that there was an amendment to the
operating budget in the expectation that this bill would pass.
1:02:47 PM
REPRESENTATIVE KELLER asked for the eligibility income level.
1:02:58 PM
MR. SHERWOOD answered that, for a family of one, 200 percent of
the federal poverty level is an annual gross income of $26,000;
for a family of two, it is $35,000; for a family of three, it is
$44,000; for a family of four, it is $53,000.
1:03:30 PM
REPRESENTATIVE GARDNER observed that a family of one would not
be affected by this bill.
1:04:00 PM
MR. SHERWOOD clarified that there are cases of a child whose
caregiver's income is not considered; that child would be a
family of one. Also, pregnant women count as a family of two.
1:04:40 PM
REPRESENTATIVE CISSNA encouraged the committee to hear testimony
from physicians who could speak to the benefits of a year-long,
strong, preventive program. She referred to research indicating
that the most effective action for long term benefits is
preventative care.
1:06:26 PM
REPRESENTATIVE ROSES pointed out that this was not a one-year
funding mechanism, but a permanent change in statute.
1:07:05 PM
REPRESENTATIVE KELLER recalled an attempt to reduce the funding
to Denali Kid Care and the negative impact on families that
depended on this entitlement. He re-stated the need for
additional time to study this issue.
1:08:09 PM
REPRESENTATIVE GARDNER stressed that the root of good health is
prevention, starting with pregnant women and children. She
stressed that 50 percent to 70 percent of the cost would be
matched by federal funds and that Alaska is a wealthy state that
ranks 41st in the nation in the amount of care provided for
children of the working poor. She informed the committee that
hospital write-offs in Alaska increased by 55 percent in the
last year, compared to 14 percent nationally, which is a result
of uncompensated emergency care. Representative Gardner further
noted that 41 states allow participation by families who earn
200 percent of the poverty level and some states allow
participation at the 300 percent level. She opined that support
for this effort should be obvious for House Health, Education
and Social Services Standing Committee members.
1:10:09 PM
CHAIR WILSON recessed to the call of the chair.
7:54:44 PM
CHAIR WILSON reconvened the House Health, Education and Social
Services Standing Committee back to order at 7:55:00 PM.
Representatives Wilson, Seaton, Gardner and Cissna were present
at the call to order.
7:55:35 PM
REPRESENTATIVE SEATON stated his interest in forwarding the
bill.
7:55:59 PM
CHAIR WILSON called for public testimony.
7:56:17 PM
PAT HEFLEY, Director, Behavioral Health, Southeast Alaska
Regional Health Consortium (SEARHC), agreed that the uncertainty
[of federal funding] is a concern. However, as a student of
health care financing, he pointed out the future cost of not
funding this bill. He opined that the question to be considered
is whether money for housing, court action, police work, and
emergency room visits is saved. Mr. Hefley assured the
committee that $1 spent by the passage of this legislation would
save $6 to $7 in future cost elsewhere in the budget.
7:57:49 PM
BRENDA MOORE, Secretary, Alaska Mental Health Board, expressed
her wish for the bill to be moved out of committee.
7:58:04 PM
CHRISTINA VAN CLEVE, Representative, Alaska School Nurses
Association, urged the committee to pass the bill. As a school
nurse, she knows children of hard-working parents who receive
essential medical care through Denali Kid Care.
7:58:54 PM
REPRESENTATIVE SEATON asked whether there were any witnesses who
would be testifying in opposition to the passage of SB 212.
7:59:10 PM
PATRICIA SENNER, Alaska Nurses Association, encouraged the
committee to pass the bill.
7:59:16 PM
LORIE MORRIS, Representative, Alaska Human Services Coalition,
encouraged passage of the bill to the House floor.
7:59:30 PM
CHAIR WILSON closed public testimony.
7:59:39 PM
REPRESENTATIVE GARDNER moved to report SB 212 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, SB 212 was reported from the
House Health, Education and Social Services Standing Committee.
7:59:52 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 8:00 p.m.
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