Legislature(2017 - 2018)CAPITOL 106
01/24/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Presentation: Fy2018 Department Overview | |
| Adjourn |
* first hearing in first committee of referral
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+ teleconferenced
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ALASKA STATE LEGISLATURE
JOINT MEETING
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
HOUSE FINANCE SUBCOMMITTEE ON HEALTH AND SOCIAL SERVICES
January 24, 2017
3:32 p.m.
MEMBERS PRESENT
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
HOUSE FINANCE SUBCOMMITTEE ON HEALTH AND SOCIAL SERVICES
Representative Les Gara, Chair
Representative Cathy Tilton
Representative Ivy Spohnholz
Representative Bryce Edgmon
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Jonathan Kreiss-Tomkins (alternate)
HOUSE FINANCE SUBCOMMITTEE ON HEALTH AND SOCIAL SERVICES
All Members Present
OTHER LEGISLATORS PRESENT
Representative Dan Saddler
COMMITTEE CALENDAR
OVERVIEW: FY2018 DEPARTMENT OF HEALTH & SOCIAL SERVICES BUDGET
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
VALERIE DAVIDSON, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint overview of the
Department of Health and Social Services.
SHAWNDA O'BRIEN, Acting Assistant Commissioner
Central Office
Finance and Management Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint overview of the
Department of Health and Social Services.
ACTION NARRATIVE
3:32:18 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:32 p.m.
Representatives Spohnholz, Gara, Kito, Tarr, Sullivan-Leonard,
Johnston, Tilton, and Eastman were present at the call to order.
Representative Edgmon arrived as the meeting was in progress.
Also in attendance was Representative Saddler.
^Presentation: FY2018 Department Overview
Presentation: FY2018 Department Overview
3:33:36 PM
CHAIR SPOHNHOLZ announced that the only order of business would
be an overview by the Department of Health and Social Services.
[Chair Spohnholz passed the gavel to Chair Gara]
3:33:47 PM
CHAIR GARA explained that a goal of the House Finance Sub-
committee on Health and Social Services was to present full
recommendations to the House Finance Committee, which could be
accepted or rejected. He expressed his intention to accept
amendments and to forward them whether or not they had passed or
failed. He declared that the focus would be on whole programs,
and whether there were programs that were not working, not
serving a purpose, not necessary, or could be working better.
He shared that one other goal of this sub-committee was to
assist the House Health and Social Services Standing Committee
to adopt statutory changes as needed. He described indirect
expenditures as revenue which the State of Alaska could have
generated, but did not. He offered as an example oil tax
credits, which he declared was revenue that could have been
generated for production taxes, but had been foregone. He
directed attention to a study of these expenditures,
commissioned by Representative Thompson, which listed the "money
that we're missing out on that maybe we shouldn't" through
Department of Health and Social Services.
3:36:47 PM
CHAIR GARA reiterated that amendments would be allowed at the
close out and that he would prepare a report summarizing the
work and the recommendations from the sub-committee. This
report would include all the proposed amendments, regardless of
whether each had passed.
REPRESENTATIVE JOHNSTON asked whether there would be a vote on
these amendments.
CHAIR GARA explained that each amendment would be voted on, and
those amendments which passed would be sent as recommendations
to the House Finance Committee. He clarified that any
amendments which did not pass would also be forwarded to the
House Finance Committee for review. He noted that there sub-
committee alternates from both the minority and the majority.
3:39:01 PM
VALERIE DAVIDSON, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), introduced
herself and other members of the Department of Health and Social
Services (DHSS) in attendance. She directed attention to a
PowerPoint presentation entitled "FY2018 Department Overview."
3:40:44 PM
CHAIR GARA introduced Amanda Ryder, Legislative Finance
Division, and declared that she was available for support to the
committee.
3:41:37 PM
COMMISSIONER DAVIDSON shared slide 2, "Health & Social
Services," and relayed that DHSS had been originally established
in 1919 as the [Alaska] Territorial Health Department, and then,
upon statehood in 1949, its responsibilities were expanded to
provide for "the promotion and protection of public health, as
well as public welfare." She pointed out that this was outlined
in Article 7 of the Constitution of the State of Alaska. She
described the links listed on slide 2, which included the
proposed FY18 department budget.
3:42:50 PM
SHAWNDA O'BRIEN, Acting Assistant Commissioner, Central Office,
Finance and Management Services, Department of Health and Social
Services, explained that slide 3 represented the total general
funds for DHSS, noting that general fund spending had increased
annually until 2015, when there had been a reduction in the
"overall UGF spending" of $190 million. She moved on to slide
4, which depicted the "fund sources for the entire department
spread across our lines of authority." She noted that the
majority of the spending was included on the line for grants and
benefits, pointing out on the timeline that, although the UGF
funding had declined, the service levels had been maintained
largely due "to the increase in federal authority." She moved
on to slide 5, which portrayed the UGF funding spread across the
departmental divisions.
CHAIR GARA asked for acknowledgement that all the members
understood UGF.
COMMISSIONER DAVIDSON noted that these slides were referred to
as a "10-year look back" in order "to show the progression for a
10-year time period," in this case the period from 2008 - 2018.
3:44:51 PM
MS. O'BRIEN continued with slide 5, and reported that
expenditures for Medicaid services comprised the majority of the
departmental budget, about 64 percent. She pointed out that,
although the UGF spending for Medicaid services had begun to dip
in 2010, there had been an increase of federal funding
opportunities through the American Recovery and Reinvestment Act
(ARRA). She reported that overall growth in the Medicaid
program was reflected in the large increase to expenditures in
FY2011. She noted that the UGF funding began to decline again
in FY2015 through the present year.
3:45:41 PM
MS. O'BRIEN explained slide 6 as a representation of all funds
spread across each of the DHSS divisions, reporting that
Medicaid services represented the largest expenditure. Although
the UGF spending had decreased, a maximization of federal
funding had allowed for the service levels to be maintained.
She pointed out that, since 2015, the Medicaid program had
reduced general fund spending by $112 million, while increasing
federal authority by $198 million. She moved on to slide 7, a
graph for total funding spread across the various funding
sources for DHSS. She pointed out that, although the general
funds had decreased, the services levels had been maintained
through the federal funding opportunities. She declared that
these services were critical safety net programs and had all
been maintained.
CHAIR GARA, addressing slide 5, surmised that the annual
increase to the Medicaid budget was due to an increase in the
number of people on Medicaid in "bad times," and that the State
of Alaska had the highest or second highest average annual
increase to medical costs nationwide.
COMMISSIONER DAVIDSON expressed her agreement, and in response,
explained that when state economies were doing well there were
fewer people unemployed, hence a lower number of people
eligible. However, when a state experienced an economic
downturn, there was a rise in people eligible for services. She
explained that, as Medicaid was a federal entitlement program,
if there was an eligible applicant, the person must be served.
She acknowledged that the cost of health care in Alaska was the
highest in the nation, noting that, as the state population
aged, the cost of health care increased as younger people did
not need as many acute services. She allowed that the one
exception, noting the 2009 dip on the slide, was reflective of
the financial boost from the federal government match.
REPRESENTATIVE SULLIVAN-LEONARD asked for more detail as to why
the State of Alaska had the highest dollar amount for Medicaid.
COMMISSIONER DAVIDSON, in response, explained that Medicaid
payment rates were set. She explained that the best payer for
reimbursement to medical costs was private health insurance,
with Medicaid most likely second best, and with Medicare being
the third best. She stated that private payment was generally
"written off to some percentage." She reported that, as
utilization impacted the medical budget, DHSS had reviewed this
over-utilization of services which occurred in inappropriate
places. She offered an example of emergency room use for health
services as it was required by federal law for every patient to
be stabilized prior to release or transfer. She described a
DHSS program which matched the over-utilizers with a plan for
more appropriate care to attempt to reduce this as a part of
Senate Bill 74. She referenced a private-public partnership
between the State of Alaska and the Alaska State Hospital and
Nursing Home Association (ASHNHA).
3:55:40 PM
REPRESENTATIVE TARR commented on experiences with super-
utilizers in her district. She asked for verification that
Alaska had the most expensive Medicaid program in the country.
COMMISSIONER DAVIDSON, in response, expressed her agreement that
the Medicaid expenditures were higher in many categories. She
pointed out that the state participated in many optional
services as part of the Medicaid program. She explained that
Medicaid was a federal program administered by both the federal
government and the states. Each state had a federal match, a
federal medical assistance percentage (FMAP), which was
determined by the average income of the citizens of that state.
The FMAP in Alaska was 50 percent, although there were
exceptions for children, pregnant women and Medicaid expansion.
Under the federal program, Medicaid required certain programs to
be mandatory, which included in-patient and out-patient visits.
Other programs could be provided at each state's option. Alaska
had chosen to implement optional services that would save money
in the long term. She offered as an example that prescriptions
and pharmaceutical services were considered optional, not
mandatory, services. She stated that, as poor people did not
generally have the money to spend on pharmaceuticals out-of-
pocket, it did not take long for acute emergency care, a result
of failure to take medications, to cost more than the
medications. She offered another example for long term care and
support services, and explained that a nursing level of care was
a required, mandatory service with a very high cost; however,
home and community based services for chores, cooking, etc. were
an optional service offered by the state which allowed people to
live independently in their own homes. She reported that
eligibility for these home and community based waiver services
required the individual to meet the level of service necessary
for in-patient nursing level of care. If the optional home and
community based services were not offered, the state would have
to supply a residential, in-patient service which was more
expensive and in short supply in Alaska.
REPRESENTATIVE TILTON asked that a list of the optional programs
with the corresponding state funding be distributed to the
committee members.
4:02:48 PM
MS. O'BRIEN returned attention to slide 7 and pointed out that,
although there had been a decrease in state general fund
spending, there had been an increase in federal authority in
order to maintain historic service levels.
4:03:31 PM
COMMISSIONER DAVIDSON moved on to slide 8, explaining that the
next 12 slides included 99 rows of detail in 12 columns. She
explained the header for each column, which included the program
name/budget allocation, the funding, the number of employees in
that program, and the number of Alaskans served by the program.
4:05:59 PM
REPRESENTATIVE SULLIVAN-LEONARD, directing attention to the
column regarding rating of importance, asked how this system was
determined with a rate of effectiveness and importance.
COMMISSIONER DAVIDSON, in response, explained that the rating of
importance was prescribed by the House Finance Committee in its
budget memo and directions to the department. She explained
that the guidelines had been offered by the House Finance
Committee and the department then made an assessment for each
program as to how each best fit into the rating category.
CHAIR GARA added that a memo from Representative Seaton for what
was most important had been included.
REPRESENTATIVE JOHNSTON asked for clarification about the rating
of effectiveness.
COMMISSIONER DAVIDSON, in response, explained that this rating
was categorized as (1) getting the job done; (2) getting the job
done but with a substantial opportunity for improvement; or (3)
not getting the job done with limited opportunity for
improvement.
REPRESENTATIVE JOHNSTON asked if the performance measures were
used as criteria.
COMMISSIONER DAVIDSON expressed her agreement. She added that
this was the first use of the rating system matrix, which had
resulted "in exciting and vigorous debate within the department
about where that rating should land."
4:11:56 PM
COMMISSIONER DAVIDSON explained that the final three columns
outlined whether each program was a federal or state statutory
requirement, or a constitutional requirement. She explained
that a grey horizontal row indicated a summary with the detail
below, pointing out that not all of these boxes were filled.
She reported that, in recent budget years, DHSS had looked for
ways to maximize its federal participation through partnerships
and re-financing, in order to save state general funds.
4:14:47 PM
MS. O'BRIEN referenced the information about the Alaska Pioneer
Homes on slide 8. She reported that the majority of staffing in
the Pioneer Homes provided direct services, and that the Pioneer
Homes were 2.3 percent of DHSS budget.
COMMISSIONER DAVIDSON shared that, since FY15, the Alaska
Pioneer Homes budget had been reduced in UGF by 9.8 percent,
about $3.6 million, which included reductions of 23 full time
positions, about 4 percent.
4:16:03 PM
MS. O'BRIEN moved on to slide 9, which outlined the Division of
Behavioral Health. She shared that this division was 4.9
percent of the department budget, with the majority of its staff
working for the Alaska Psychiatric Institute and providing
direct services to the residents of the facility. She noted
that the largest amount of UGF was for treatment and recovery
grants, which were issued for direct services to grantees. She
shared that Medicaid Expansion now allowed client billing of
services to Medicaid, thereby decreasing the reliance on state
funding.
CHAIR GARA pointed out there would be separate hearings on
treatment services, Medicaid Expansion, privatizing the
pharmaceutical function at the Pioneer Homes, and [Office of]
Children's Services.
COMMISSIONER DAVIDSON reported that the Division of Behavioral
Health had been reduced by 24 percent, about $18.96 million
since FY2005, with a full time position reduction of 5
positions, about 1.4 percent.
REPRESENTATIVE SULLIVAN-LEONARD asked for clarification to the
reduction of positions.
COMMISSIONER DAVIDSON stated that these were elimination of
positions.
MS. O'BRIEN moved on to slide 10 regarding the Office of
Children's Services, which was 5.6 percent of the department
budget. She pointed out that the majority of staff funding was
for front line social workers providing direct services to
children and their families. She reported that the majority of
UGF dollars was spent on formula programs, including foster care
and adoption and guardianship payments.
COMMISSIONER DAVIDSON stated that, since FY2015, the Office of
Children's Services had been reduced by 7.3 percent, $6.8
million, although the job positions had increased by 24, about
4.7 percent, largely due to the number of children in out-of-
home placement.
CHAIR GARA asked if the number of youth in foster care had
increased from 1800 youth to about 3000 youth in the last six
years.
COMMISSIONER DAVIDSON expressed her agreement.
CHAIR GARA asked if the staffing had also increased commensurate
to the caseload.
COMMISSIONER DAVIDSON assessed that the number of staff had not
increased commensurate to the increase in case load.
4:21:42 PM
MS. O'BRIEN reported on slide 11, the Division of Health Care
Services. She relayed that this division accounted for 0.8
percent of the overall departmental budget, and its staff
administered the Medicaid claims payment programs and for the
Medicaid redesign work. Moving on to the next program listed,
she reported that the Catastrophic and Chronic Illness
Assistance program had previously served more than 400 people,
but since Medicaid Expansion and subsequent reform efforts, the
majority of the recipients were now eligible for Medicaid
Expansion and the program now served fewer than 10 people.
4:22:38 PM
REPRESENTATIVE JOHNSTON asked if there would be a specific
hearing relative to the report from Senate Bill 74, in order to
determine what has been accomplished and what could be
accomplished in the upcoming FY2018 budget.
CHAIR GARA asked for clarification.
REPRESENTATIVE JOHNSTON explained that she wanted more
information relative to the current status of the reform efforts
in Senate Bill 74 and the possible impact to decisions for the
FY2018 budget.
COMMISSIONER DAVIDSON expressed her agreement that Senate Bill
74 was "a comprehensive Medicaid redesign bill" and that reform
and expansion should move "hand in hand." She declared that
DHSS had met all of its statutory requirements for timelines and
the department would provide more budget detail. She lauded the
extensive bi-partisan work to this point.
CHAIR GARA, in response to Representative Johnson, shared that
this would be the topic of the next committee meeting.
COMMISSIONER DAVIDSON returned attention to the Division of
Health Care Services and reported that, since FY2005, there had
been a 17.5 percent reduction, about $1.7 million. She added
that there had been a reduction of 3 positions since 2015, about
2.4 percent. She pointed out that these positions were handling
the analysis and available opportunities in Senate Bill 74.
4:25:17 PM
MS. O'BRIEN moved on to slide 12, and reported that the Division
of Juvenile Justice accounted for 2.1 percent of the
departmental budget. She relayed that it was important to note
that the department had recently closed the Ketchikan [Youth]
Facility and that the Nome Youth Facility was scheduled to close
in FY2018 due to the loss of one time funding.
REPRESENTATIVE TARR asked for more information about the closure
of the Nome Youth facility.
COMMISSIONER DAVIDSON replied that the Division of Juvenile
Justice privatization study would soon be released, and that
more detail could then be provided. She added that Senate Bill
74 had required privatization studies for the Alaska Pioneer
Homes and its pharmaceutical services, as well as the Alaska
Psychiatric Institute. She stated that these reports would all
be released shortly.
REPRESENTATIVE TARR expressed her concern for kids being placed
so far away from their home communities and those corresponding
nearby support networks. She asked where the kids would now be
placed.
COMMISSIONER DAVIDSON explained that the current budget
proposals were released prior to completion of the feasibility
studies. She reported that, as the Nome Youth Facility had only
received a one year funding, DHSS did not include the facility
in its recommendations to the governor during discussion of the
proposed budget cuts. She noted that DHSS would also be
reviewing the privatization studies.
COMMISSIONER DAVIDSON relayed that, since FY2015, the Division
of Juvenile Justice had sustained a 7 percent budget cut, about
$4 million, as well as 38 full time position reductions, 7.9
percent.
REPRESENTATIVE SULLIVAN-LEONARD asked for a summary of the
reductions and its effect on DHSS.
COMMISSIONER DAVIDSON asked whether this was a request for the
dollar reductions and the percent reductions, as well as the
staff reductions and those percentages.
REPRESENTATIVE SULLIVAN-LEONARD expressed her agreement.
4:30:37 PM
MS. O'BRIEN moved on to slides 13 and 14, the Division of Public
Assistance budget. She reported that the division entailed 11.2
percent of the departmental budget, and that the majority of its
staff were responsible for determining eligibility and assisting
recipients with the benefit process. She explained that the
Adult Public Assistance program was "responsible for satisfying
the maintenance of effort requirement for the Medicaid program
in the State of Alaska."
COMMISSIONER DAVIDSON reported that there had been a 15.7
percent reduction within the Division of Public Assistance since
FY2015, about $25.3 million. The full time staff reductions had
been about 1.6 percent although, she surmised, this seemed to be
low. She relayed that the department had received calls from
legislators and concerned Alaskans that there were unduly long
wait times for the process of applications to eligibility. She
pointed out that during the first year of Medicaid Expansion,
the Alaska Mental Health Trust Authority had made $1.3 million
available to the Department of Health and Social Services for
positions within the Division of Public Assistance to assist
with the additional 22,000 Alaskans projected to apply for
Medicaid Expansion. She relayed that, unfortunately, during
this same budget year, the Division of Public Assistance budget
for positions to process the applications was reduced by $1.5
million, between 23 - 26 positions. She declared that, as this
would be a recurring reduction, the department would remain
short of staff to process applications. She allowed that there
were some fast tracks for immediate assistance in processing,
including for pregnant women.
4:34:42 PM
MS. O'BRIEN explained that slides 15 and 16 referenced the
Division of Public Health which comprised 4.3 percent of the
departmental budget, and that the majority of its staffing was
in nursing which provided direct services. She added that the
general funds for the community health grant program had been
reduced through refinancing opportunities under the Medicaid
program.
COMMISSIONER DAVIDSON pointed out this refinancing had been with
a 100 percent federal match. She added that, since FY2015, this
division had a 22.9 percent reduction, about $12.79 million.
She shared that there had been a reduction of 57 positions,
about 11.9 percent.
REPRESENTATIVE TARR asked for clarification that these numbers
were from FY2015 until the present.
COMMISSIONER DAVIDSON expressed her agreement.
REPRESENTATIVE JOHNSTON asked if the community health grants
were for community centers or rural health centers.
COMMISSIONER DAVIDSON explained that these grants were pass
through funds which were shared with the communities, and were
not through rural health centers. She offered that some funds
went to the Municipality of Anchorage, and that these funds had
also experienced some reductions during the budget process.
REPRESENTATIVE JOHNSTON asked to clarify that there had been
some savings due to additional federal funding.
COMMISSIONER DAVIDSON explained that in this category there were
both community health grants as well as community health aide
training grants. She stated that the training grant funding had
been zeroed out of the UGF budget, but were recouped through 100
percent federal match funding from the Centers for Medicare and
Medicaid Services (CMS) to the tribal facilities which trained
these community health aides.
REPRESENTATIVE JOHNSTON asked if the UGF cuts were mainly for
the community health center grants.
COMMISSIONER DAVIDSON expressed her agreement.
4:38:35 PM
MS. O'BRIEN directed attention to slide 17, outlining the
Division of Senior and Disabilities Services. This division
comprised 2.5 percent of the departmental budget and the
majority of the staff provided direct services through the
administrative services. She addressed the community based
grants programs which provided low cost, in-home services to
seniors in order to help maximize independence and allow seniors
to remain in their homes longer.
COMMISSIONER DAVIDSON reported that this division had sustained
a $208,000 reduction, about 0.5 percent, since FY2015. There
had been an increase of 3 full time positions, about 1.8
percent. She explained that, in FY2016, the $8.9 million
Independent Living program had been transferred into this
program from the Department of Labor & Workforce Development,
and the Early Intervention Infant Learning Program had been
transferred from the Office of Children's Services.
4:41:02 PM
MS. O'BRIEN directed attention to slide 18 and addressed the
Department Support Services. She relayed that the majority of
this staff were information technology and that the IT manager
would be transferred to the Shared Services as part of the
centralized information office in the FY2018 budget.
COMMISSIONER DAVIDSON shared that, since FY2015, this department
had a 31.8 percent reduction, about $7.8 million, with a
reduction of 22 full time positions, about 8.5 percent.
4:41:59 PM
MS. O'BRIEN moved on to slide 19 which addressed the Medicaid
Services budget. She pointed to the various programs and the
number of Alaskans each program served. She noted that the
adult preventive dental component did not represent the entire
body of expenditures for the dental program, but only detailed
some of the services provided through adult dental.
4:42:50 PM
REPRESENTATIVE JOHNSTON asked about the transfer of the
Children's Medicaid Services.
MS. O'BRIEN explained that Children's Medicaid Services had been
transferred to the Behavioral Health component of Medicaid
Services as most of its services were behavioral health related.
CHAIR GARA asked about the elimination of a dental services
program in the prior year.
4:43:56 PM
COMMISSIONER DAVIDSON explained that there had been a reduction
to the optional dental services, but not an elimination.
CHAIR GARA asked which dental services were now provided through
Medicaid.
COMMISSIONER DAVIDSON explained that some of these services were
included under health care Medicaid services. When these
optional adult preventive dental Medicaid services were first
offered, the Alaska State Legislature asked that they be
accounted for separately. She pointed out that this service was
most often for dentures, as it enhanced the possibility for job
placement.
CHAIR GARA asked if the program had remained intact.
COMMISSIONER DAVIDSON explained that there had been reductions
in utilization.
4:45:19 PM
MS. O'BRIEN shared that, although there had been $112 million in
general fund reductions to the Medicaid services, there had been
an increase of $198 million in federal authorization. She
shared that service levels had been maintained while there had
been success in reducing the UGF.
CHAIR SPOHNHOLZ asked how much the UGF had been decreased.
MS. O'BRIEN, in response, reiterated that UGF had been decreased
by $112 million, a reduction of 8 percent.
4:46:41 PM
REPRESENTATIVE JOHNSTON asked about any cost and any savings
through Medicaid Expansion which had been applied to tribal
health.
COMMISSIONER DAVIDSON asked for further clarification.
REPRESENTATIVE JOHNSTON asked if any Medicaid expansion funds
had gone to tribal health organizations, and, if so, had this
resulted in any savings to the state.
COMMISSIONER DAVIDSON explained that any Medicaid provider
enrollee who had supplied a medically necessary service under
Medicaid, whether through Medicaid or Medicaid Expansion, could
seek reimbursement from the Medicaid program for those services.
She stated that this could include both tribal health and non-
tribal health programs. She offered background to the extensive
negotiations between tribal and non-tribal organizations since
Centers for Medicare and Medicaid Services (CMS) had provided
new guidance for the tribal claiming policy. She explained that
previously the federal government had required tribal health
organizations to seek third party reimbursement, such as private
insurance, Medicaid, or Medicare. However, the federal
government had now implemented a rule that offered 100 percent
federal reimbursement if a person was an Indian Health Service
(IHS) beneficiary, as well as a Medicaid beneficiary, and the
care was received through an IHS facility, which included
tribally operated facilities in Alaska. The interpretation had
now been expanded to include both medically necessary travel, as
this was an access-to-care issue, and care started in an IHS
facility but referred to a non-tribal facility because of a lack
of capacity for specific care; hence, these were now offered for
100 percent federal reimbursement. She offered an example,
citing an expansion of care available to Alaskans without a
duplication of services, and a savings of general fund dollars.
She relayed that these negotiations for expansion were on-going.
4:53:17 PM
REPRESENTATIVE KITO asked what would happen if there were a cut
to the larger programs such as Medicaid, as the 50 percent
reimbursable rate generated a cost of about $600 million. He
asked if service would then only be offered for a portion of a
year, or were there other mechanisms to decrease this level of
service to beneficiaries.
COMMISSIONER DAVIDSON replied that there were some options
through utilization management. She offered an example of home
and community based waiver services, and suggested that there
could be limitations on the number of hours or units of service
for which Medicaid would pay. She pointed out that a reduction
to this service could also limit the amount of time that people
were allowed to stay in their own home, instead requiring a move
to a facility, and thereby increasing the cost of care. She
reported that DHSS was scrutinizing travel, as Medicaid only
paid for medically necessary travel for care which was not
available in the patient's location. She pointed out that many
of the benefits from Medicaid, such as pre-natal care and child
immunizations, saved money in the long run.
REPRESENTATIVE KITO asked if a reduction of Medicaid funding for
expected services would lead to Alaskans without care.
COMMISSIONER DAVIDSON explained that changes to the Medicaid
program could be reductions in eligibility, reduction of
reimbursement rates to providers, or reductions in utilization
as previously explained. She pointed out that there had been an
aggressive movement for the leveraging of federal resources and
working with the tribal and non-tribal health organizations to
develop partnerships to continue the level of service.
CHAIR GARA lauded the tribal health waivers and other
initiatives DHSS had launched.
5:00:41 PM
[Chair Gara returned the gavel to Chair Spohnholz]
5:01:18 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:01 p.m.
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