Legislature(2009 - 2010)BUTROVICH 205

02/09/2009 01:30 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 13 MEDICAL ASSISTANCE ELIGIBILITY TELECONFERENCED
Moved SB 13 Out of Committee
*+ SB 87 MEDICAL ASSISTANCE ELIGIBILITY TELECONFERENCED
Moved SB 87 Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                        February 9, 2009                                                                                        
                           1:34 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Bettye Davis, Chair                                                                                                     
Senator Joe Paskvan, Vice Chair                                                                                                 
Senator Johnny Ellis                                                                                                            
Senator Joe Thomas                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Fred Dyson                                                                                                              
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 13                                                                                                              
"An Act relating to eligibility requirements for medical                                                                        
assistance for certain children and pregnant women; and                                                                         
providing for an effective date."                                                                                               
     MOVED SB 13 OUT OF COMMITTEE                                                                                               
                                                                                                                                
SENATE BILL NO. 87                                                                                                              
"An  Act  expanding  medical  assistance  coverage  for  eligible                                                               
children  and  pregnant  women;  relating  to  cost  sharing  for                                                               
certain recipients  of medical assistance;  and providing  for an                                                               
effective date."                                                                                                                
     MOVED SB 87 OUT OF COMMITTEE                                                                                               
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB  13                                                                                                                  
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY                                                                                     
SPONSOR(s): SENATOR(s) DAVIS                                                                                                    
                                                                                                                                
01/21/09       (S)       PREFILE RELEASED 1/9/09                                                                                
01/21/09       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/21/09       (S)       HSS, FIN                                                                                               
02/09/09       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB  87                                                                                                                  
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY                                                                                     
SPONSOR(s): SENATOR(s) WIELECHOWSKI                                                                                             
                                                                                                                                
01/28/09       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/28/09       (S)       HSS, FIN                                                                                               
02/09/09       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
TOM OBERMEYER, aid                                                                                                              
   to Senator Bettye Davis                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Introduced SB 13 for the sponsor.                                                                         
                                                                                                                                
GEORGE BROWN M.D., representing himself                                                                                         
Douglas AK                                                                                                                      
POSITION STATEMENT: Supported both SB 13 and SB 87.                                                                           
                                                                                                                                
ROD BETIT, President                                                                                                            
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Juneau, AK                                                                                                                      
POSITION STATEMENT: Supported both SB 13 and SB 87.                                                                           
                                                                                                                                
NANCY ST. JOHN-SMITH                                                                                                            
Peninsula Community Health Services                                                                                             
Kenai, AK                                                                                                                       
POSITION STATEMENT: Supported SB 13.                                                                                          
                                                                                                                                
JODYNE BUTTO M.D., President                                                                                                    
Alaska Chapter, American Academy of Pediatrics                                                                                  
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported both SB 13 and SB 87.                                                                           
                                                                                                                                
DONNA GRAHAM                                                                                                                    
Anchorage Faith and Action Congregations Together (AFACT)                                                                       
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported both SB 13 and SB 87.                                                                           
                                                                                                                                
JORDEN NIGRO, Residential Director                                                                                              
Juneau Youth Services                                                                                                           
President, Alaska Homes for Children (AHFC)                                                                                     
Juneau, AK                                                                                                                      
POSITION STATEMENT: Supported both SB 13 and SB 87.                                                                           
                                                                                                                                
LAVERNE DEMIENTIEFF, President                                                                                                  
National Association of Social Workers (NASW), Alaska Chapter                                                                   
Clinical Assistant Professor, University of Alaska Fairbanks                                                                    
POSITION STATEMENT: Supported both SB 13 and SB 87.                                                                           
                                                                                                                                
JON SHERWOOD, Medical Assistant Administrator                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions about the fiscal note for                                                              
SB 87.                                                                                                                          
                                                                                                                                
SENATOR BILL WIELECHOWSKI                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Sponsor of SB 87.                                                                                         
                                                                                                                                
MICHELLE SYDEMAN, aide                                                                                                          
   to Senator Bill Wielechowski                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Explained SB 87.                                                                                          
                                                                                                                                
JERRY FULLER, Project Director                                                                                                  
Medical Assistance Administration                                                                                               
Department of Health and Social Services                                                                                        
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Answered questions about the                                                                              
administration's position on SCHIP.                                                                                             
                                                                                                                                
ELLIE FITJARRALD, Director                                                                                                      
Division of Public Assistance                                                                                                   
Department of Health and Social Services                                                                                        
POSITION STATEMENT: Answered questions about the fiscal note for                                                              
SB 87.                                                                                                                          
                                                                                                                                
MARTHA KING, Group Director                                                                                                     
National Conference of State Legislatures (NCSL)                                                                                
Denver, CO                                                                                                                      
POSITION STATEMENT: Answered questions about what other states                                                                
are doing in this area.                                                                                                         
                                                                                                                                
JENNIFER SAUNDERS                                                                                                               
National Conference of State Legislatures                                                                                       
Denver, CO                                                                                                                      
POSITION STATEMENT: Answered questions about what other states                                                                
are doing in this area.                                                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:34:46 PM                                                                                                                    
CHAIR BETTYE DAVIS called the Senate Health and Social Services                                                               
Standing Committee meeting to order at 1:34 p.m. Present at the                                                                 
call to order were Senators Paskvan, Ellis, Thomas and Davis.                                                                   
                                                                                                                                
              SB 13-MEDICAL ASSISTANCE ELIGIBILITY                                                                          
                                                                                                                              
CHAIR DAVIS announced consideration of SB 13.                                                                                   
                                                                                                                                
1:35:57 PM                                                                                                                    
TOM OBERMEYER, aid to Senator  Davis, introduced SB 13, saying it                                                               
increases   and  restores   the  qualifying   income  eligibility                                                               
standard for the  Denali Kid Care program to  the original levels                                                               
at 200  percent of the  FPL guideline and makes  health insurance                                                               
accessible to an  estimated 1300 more uninsured  children and 225                                                               
pregnant women in Alaska.                                                                                                       
                                                                                                                                
Denali Kid Care  is an enhanced reimbursement program  with up to                                                               
70 percent  matching funds under  the federal  government's State                                                               
Children's Health  Insurance Program  (SCHIP), which  was created                                                               
in 1997. Congress reauthorized the  SCHIP program for five years;                                                               
on  February  4, 2009  President  Obama  signed a  law  expanding                                                               
coverage to four million more children.                                                                                         
                                                                                                                                
Alaska is only  one of five states that fund  SCHIP below the 200                                                               
percent guideline.                                                                                                              
                                                                                                                                
The Kaiser Commission on Medicaid  and the Uninsured provided the                                                               
following  information in  January of  2009: 44  states including                                                               
Washington D.C. cover  children and families with  incomes of 200                                                               
percent  of the  FPL  or  higher; 33  states  cover children  and                                                               
families with incomes between 200 and  250 percent of the FPL; 19                                                               
states including  D.C. cover children  and families  with incomes                                                               
of 250  percent or higher and  10 of those states  cover children                                                               
and families  with incomes of  300 percent  of FPL or  higher; 35                                                               
states  allow  premiums,  enrollment  fees or  co-payments  on  a                                                               
sliding scale for selected services in the SCHIP programs.                                                                      
                                                                                                                                
MR.  OBERMEYER continued;  Denali  Kid Care  serves an  estimated                                                               
7900 Alaska Children and remains  one of the least costly medical                                                               
assistance  programs  in the  state  at  approximately $1700  per                                                               
child  for full  coverage  including dental,  which  is about  20                                                               
percent of the cost of  adult senior coverage. Early intervention                                                               
and preventive care under SB  13 will greatly increase the health                                                               
of Alaska's children  and yield substantial savings  to the state                                                               
in  public and  private  sector hospital  emergency rooms,  which                                                               
must  admit indigent  and  uninsured  patients for  non-emergency                                                               
treatment.                                                                                                                      
                                                                                                                                
1:39:44 PM                                                                                                                    
It is estimated  that uninsured children with a  medical need are                                                               
five times  as likely  not to  have a  regular doctor  as insured                                                               
children and  four times as  likely to  use emergency rooms  at a                                                               
much higher cost. There are  still approximately 18,000 uninsured                                                               
children in  Alaska, about nine  percent of the children  aged 18                                                               
and  under.  Private  health  care   coverage  for  children  has                                                               
declined over 30  percent in the last 10 years  and the deepening                                                               
recession is  pulling more children  and families into  the ranks                                                               
of  the uninsured.  The reauthorized  SCHIP program  and stimulus                                                               
package should  help, but  Alaska is encouraged  to do  its share                                                               
and take advantage of the  federal matching funds by insuring its                                                               
low income children up to and  including 200 percent FPL under SB                                                               
13.                                                                                                                             
                                                                                                                                
1:40:30 PM                                                                                                                    
CHAIR  DAVIS advised  the committee  that Jerry  Fuller with  the                                                               
Department of  Health and Social  Services (DHSS) was  online and                                                               
available for questions.                                                                                                        
                                                                                                                                
1:41:39 PM                                                                                                                    
GEORGE BROWN  M.D., Douglas AK, has  practiced pediatric medicine                                                               
in Alaska  since 1965. He said  he is delighted that  the federal                                                               
government has  expanded coverage  for SCHIP  and that  the state                                                               
has bills under consideration related  to increasing coverage. He                                                               
and his pediatric colleagues in Juneau  are very much in favor of                                                               
a 200  percent [qualification for] coverage  for children without                                                               
a co-pay,  and are pleased that  this seems to be  moving forward                                                               
with the governor's support.                                                                                                    
                                                                                                                                
DR. BROWN  said he and  his colleagues have also  been discussing                                                               
the issue  of higher levels  [of coverage] with  co-pays. Whether                                                               
or not  co-pays really work is  a difficult question. One  of his                                                               
colleagues  has  seen  a  problem  with  co-pays  in  Washington;                                                               
families get behind in their  co-pays and then are ineligible. On                                                               
the other  hand, if  the care  is all free,  some people  seem to                                                               
think they  don't need to  keep appointments and  become careless                                                               
of  their responsibility  as parents;  perhaps a  simple, uniform                                                               
co-pay  of  $10  or  $15   per  visit  would  provide  the  right                                                               
incentive. He stressed  that there should be  no punitive results                                                               
[for failure to keep or  cancel appointments] however, because it                                                               
sometimes takes many  years for families who have  not had health                                                               
insurance  before  to realize  they  are  welcome in  a  doctor's                                                               
office.  As those  families continue  to come  in and  be treated                                                               
with respect, to see other  families there who are being treated,                                                               
they become good users of the preventive medical system.                                                                        
                                                                                                                                
In closing,  he said that the  whole idea of SCHIP  is ultimately                                                               
prevention; for  every dollar  we invest  in prevention,  we save                                                               
from six to ten dollars in the long-run.                                                                                        
                                                                                                                                
1:45:22 PM                                                                                                                    
CHAIR DAVIS  advised that  Jennifer Saunders  and Martha  King of                                                               
the  National Conference  of State  Legislatures (NCSL)  are also                                                               
online and available to answer questions.                                                                                       
                                                                                                                                
1:46:03 PM                                                                                                                    
ROD  BETIT, President,  Alaska State  Hospital  and Nursing  Home                                                               
Association (ASHNHA), Juneau, AK, said  he is very excited to see                                                               
this bill before the committee.  ASHNHA represents 28 health care                                                               
providers  throughout  the   state  including  tribal,  military,                                                               
private  and city  owned organizations  and all  of them  support                                                               
this  legislation,   which  has  been  unanimously   approved  by                                                               
ASHNHA's  legislative  committee.  He added  that  bringing  [the                                                               
qualifying limit]  to the 200  percent level is  appropriate even                                                               
though  the health  care commission  process hasn't  started yet,                                                               
because  he  believes this  is  one  of  the first  actions  that                                                               
commission would  recommend. This  action was recommended  by the                                                               
Health Care Strategies Planning Council last year.                                                                              
                                                                                                                                
1:47:33 PM                                                                                                                    
NANCY  ST.  JOHN-SMITH,   Peninsula  Community  Health  Services,                                                               
Kenai, AK,  said that  their community  health center,  which was                                                               
formerly  called  Central  Peninsula   Health  Center,  has  been                                                               
offering  medical and  dental care  to communities  on the  Kenai                                                               
Peninsula  since   2002.  They  merged  with   Central  Peninsula                                                               
Counseling Services  in October 2008 and  are offering behavioral                                                               
health care  under their new  name. She urged the  legislature to                                                               
pass  this  bill  increasing the  eligibility  guideline  to  200                                                               
percent  of FPL  because  with  Denali Kid  Care  they can  offer                                                               
preventive medical  and dental  care to  many children  who would                                                               
not  otherwise receive  it. For  example, she  said, many  people                                                               
they see on an emergency basis  have not received any dental care                                                               
as children;  by the time they  come to the clinic,  the tooth or                                                               
teeth have to be pulled,  which can affect their nutrition, heart                                                               
health and other future health  issues. She agreed with Dr. Brown                                                               
that the  ability to  offer preventive  services is  important to                                                               
improve the quality of life  and to teach people about prevention                                                               
so they  will raise  their children in  good health.  She thanked                                                               
the  committee  for  hearing  her   testimony  and  stressed  how                                                               
important this legislation is to people on the Kenai.                                                                           
                                                                                                                                
1:49:53 PM                                                                                                                    
JODYNE BUTTO  M.D., President,  Alaska Chapter,  American Academy                                                               
of  Pediatrics,  Anchorage,  AK,  said  SCHIP  has  made  a  huge                                                               
difference in  the health of  children across the  United States.                                                               
It is  important that  Alaska provide the  best care  possible to                                                               
its children;  that means  providing access to  care and  part of                                                               
that access  is insurance. She  agreed with prior  testimony that                                                               
the  program cost  is outweighed  by the  savings in  health care                                                               
costs represented by preventive care.                                                                                           
                                                                                                                                
MS. BUTTO  also stressed the  importance of health  to children's                                                               
school performance.  Although it  can't be easily  quantified, it                                                               
is well known  that children with good  health, particularly good                                                               
dental health,  perform better  in school,  miss fewer  days, are                                                               
better behaved and enjoy greater  academic success than those who                                                               
do not. She applauded the legislature for tackling this issue.                                                                  
                                                                                                                                
1:53:15 PM                                                                                                                    
DONNA GRAHAM,  Anchorage Faith and Action  Congregations Together                                                               
(AFACT), Anchorage, AK,  is a school nurse and  parish nurse. She                                                               
said AFACT  is thrilled  that Alaska is  finally getting  back to                                                               
the 200  percent [eligibility  level]. This is  the right  way to                                                               
go; Alaska is  a rich state and  can show it by not  being at the                                                               
bottom  of the  list  of states  that put  their  kids first.  In                                                               
summary, she said,  this is a great step forward!  Let's put more                                                               
kids  back  into  fitness  and   health  to  promote  energy  and                                                               
learning.                                                                                                                       
                                                                                                                                
1:55:30 PM                                                                                                                    
JORDEN  NIGRO,  Residential   Director,  Juneau  Youth  Services,                                                               
President,  Alaska Homes  for Children  (AHFC), Juneau,  AK, said                                                               
they are  really excited to see  all of the bills  coming forward                                                               
for Denali  Kid Care. The  only comment she  cared to add  to the                                                               
previous  testimony  was that,  if  a  sliding co-pay  goes  into                                                               
effect, she  hopes it won't affect  those at 200 percent  or less                                                               
of  the FPL.  Behavioral  health for  youth  is primarily  funded                                                               
through Denali Kid Care and many  kids and families are unable to                                                               
access the services because they  are on the cusp of eligibility;                                                               
Alaska  has a  high  number of  people  on the  cusp  due to  the                                                               
fishing and subsistence lifestyles that are prevalent here.                                                                     
                                                                                                                                
1:57:17 PM                                                                                                                    
                                                                                                                                
LAVERNE  DEMIENTIEFF, President,  National Association  of Social                                                               
Workers  (NASW), Alaska  Chapter,  Clinical Assistant  Professor,                                                               
University  of   Alaska  Fairbanks,  Fairbanks,  AK,   said  NASW                                                               
strongly  supports the  efforts of  this committee  to raise  the                                                               
Denali Kid  Care eligibility  requirement to  300 percent  of the                                                               
FPL.  Alaska  is  one  of   only  nine  states  with  eligibility                                                               
requirements below  200 percent. This  makes us the  fourth least                                                               
responsive  state  to  children  who  live  in  poverty.  Raising                                                               
eligibility to  200 percent will  restore vital  health insurance                                                               
to 1300 children and 225  pregnant women; imagine what raising it                                                               
to 300 percent would achieve for Alaskan families.                                                                              
                                                                                                                                
MS.   DEMIENTIEFF  recognized   that  fiscal   responsibility  is                                                               
everyone's  priority, but  noted that  Alaska won't  shoulder the                                                               
majority  of the  cost  associated with  this  program; with  the                                                               
passing  of SCHIP,  the  federal  government will  pay  70 to  75                                                               
percent of it. Finally, she  said this is an important investment                                                               
Alaska and in the future of Alaska's children and families.                                                                     
                                                                                                                                
1:59:02 PM                                                                                                                    
CHAIR DAVIS  announced that she  was closing public  testimony on                                                               
SB 13.                                                                                                                          
                                                                                                                                
SENATOR THOMAS asked what the other referrals are for SB 13.                                                                    
                                                                                                                                
CHAIR DAVIS answered that it will go to Finance next.                                                                           
                                                                                                                                
SENATOR THOMAS asked  if she intends to leave  the explanation of                                                               
the fiscal note to Finance.                                                                                                     
                                                                                                                                
CHAIR DAVIS  said they can discuss  it if he wishes;  but she had                                                               
not intended to get into it today.                                                                                              
                                                                                                                                
SENATOR  THOMAS said  he wondered  whether the  savings that  are                                                               
expected to  accrue from intervention  and prevention  were taken                                                               
into consideration when preparing the fiscal note.                                                                              
                                                                                                                                
2:01:55 PM                                                                                                                    
JON  SHERWOOD,  Medical  Assistant Administrator,  Department  of                                                               
Health  and Social  Services (DHSS),  Juneau, AK,  explained that                                                               
their assumptions  on the fiscal  note did not  specifically take                                                               
those  preventive  aspects into  account,  but  they based  their                                                               
costs on the cost of care  for children in the next lowest income                                                               
group,  which is  covered [by  Denali Kid  Care]. Those  children                                                               
experience  the same  preventive  effects from  being covered  by                                                               
Denali  Kid   Care  and  they   assumed  the  impacts   would  be                                                               
comparable.                                                                                                                     
                                                                                                                                
              SB 87-MEDICAL ASSISTANCE ELIGIBILITY                                                                          
                                                                                                                                
CHAIR DAVIS announced consideration of SB 87.                                                                                   
                                                                                                                                
2:02:48 PM                                                                                                                    
SENATOR BILL WIELECHOWSKI, sponsor of  SB 87, explained that this                                                               
is  a bill  he  first introduced  two years  ago,  which was  not                                                               
passed. He  decided to introduce it  again this year due  in part                                                               
to the opportunity  represented by the increase  in federal funds                                                               
to Alaska from about $10 million to over $22 million.                                                                           
                                                                                                                                
This bill increases  the base eligibility for Denali  Kid Care to                                                               
200 percent  of the  federal poverty level  and allows  people to                                                               
buy in  up to  the level of  300 percent of  FPL. What  he thinks                                                               
this  will do  is to  make  health insurance  available to  every                                                               
child in the  state of Alaska. People at or  under 200 percent of                                                               
FPL will get  it [for free] and the federal  government will pick                                                               
up 65 to  66 percent of the cost; people  over 300 percent should                                                               
probably  be able  to afford  health care;  so it  is the  people                                                               
between  200  and 300  percent  of  FPL  whom this  expansion  is                                                               
intended to help.                                                                                                               
                                                                                                                                
SENATOR WIELECHOWSKI added that the  fiscal note they received is                                                               
very questionable.  When he  filed this bill  two years  ago, the                                                               
fiscal  note said  it would  require  the addition  of another  7                                                               
[DHSS] staff  members; now  for some  strange reason,  the number                                                               
has increased  to 17. In addition,  SB 13, which adds  about 1300                                                               
people [to  Denali Kid  Care], requires the  addition of  2 staff                                                               
members;  this bill,  which adds  2000 to  2500 people,  requires                                                               
another 15 staff. A fiscal  note like this greatly undermines the                                                               
credibility of the department.                                                                                                  
                                                                                                                                
2:06:11 PM                                                                                                                    
SENATOR ELLIS asked  how this legislation would  comport with the                                                               
bill just signed by President Obama.                                                                                            
                                                                                                                                
SENATOR  WIELECHOWSKI  turned  the   question  over  to  Michelle                                                               
Sydeman.                                                                                                                        
                                                                                                                                
2:06:40 PM                                                                                                                    
MICHELLE SYDEMAN,  legislative aid  to Senator  Wielechowski said                                                               
the  current federal  bill would  provide funding  to get  Alaska                                                               
easily up to 200 percent of  FPL; they have also heard assurances                                                               
from Speaker of the House Nancy  Pelosi and others that it is the                                                               
intent of  Congress to  provide sufficient  funding to  cover all                                                               
states' efforts to ensure that  children are insured. The funding                                                               
Alaska  has received  so far  gets them  up to  200 percent,  but                                                               
there  are indications  that they  can go  higher. Alaska  simply                                                               
needs to  revise its  plan and its  allotment should  increase as                                                               
well.                                                                                                                           
                                                                                                                                
2:07:27 PM                                                                                                                    
CHAIR DAVIS  advised that  there is someone  in the  audience who                                                               
can  speak to  Senator Wielechowski's  concerns about  the fiscal                                                               
note.                                                                                                                           
                                                                                                                                
SENATOR WIELECHOWSKI  said he  would be curious  to find  out why                                                               
the  number of  employees  they think  the  department needs  has                                                               
increased by  ten in the  past year,  when the bill  has remained                                                               
the same  and why  they think  they need  15 more  employees than                                                               
they need for SB 13.                                                                                                            
                                                                                                                                
2:08:17 PM                                                                                                                    
JERRY    FULLER,    Project    Director,    Medical    Assistance                                                               
Administration,  Department   of  Health  and   Social  Services,                                                               
Anchorage, AK, said Ellie Fitjarrald  might have more information                                                               
on that.                                                                                                                        
                                                                                                                                
2:08:32 PM                                                                                                                    
ELLIE  FITJARRALD,  Director,   Division  of  Public  Assistance,                                                               
Department of Health and Social  Services, said they are treading                                                               
new ground.  The workload  that goes  into calculating  costs and                                                               
premiums for families  up to 300 percent of FPL  is something the                                                               
department  has not  done before.  The states  that have  done it                                                               
have  found that  it is  very  labor intensive.  She asked  Chair                                                               
Davis if  she would like to  go through the fiscal  note today or                                                               
wait until the bill gets to Finance.                                                                                            
                                                                                                                                
CHAIR DAVIS answered that not  all of the committee members serve                                                               
on  Finance, so  it  would  be helpful  if  she  would walk  them                                                               
through it today.                                                                                                               
                                                                                                                                
MS.  FITZJARRALD  said  she  can cover  the  Division  of  Public                                                               
Assistance  and  Jon  Sherwood can  cover  the  other  divisions,                                                               
because  Medicaid touches  most  divisions of  the Department  of                                                               
Health  and  Social  Services. She  continued;  the  Division  of                                                               
Public Assistance estimated a need  for 13 positions working with                                                               
an  assumption of  what  is  adequate to  serve  the nearly  3000                                                               
eligible  children  and  the increase  in  pregnant  women.  That                                                               
number  represents children  who  will be  eligible  and not  the                                                               
entire number  who will  apply for services.  At any  given time,                                                               
about  30 percent  of applications  are  denied; so  they see  an                                                               
average  of 4000  kids  applying for  services.  With the  higher                                                               
income groups, they will have  to verify the families' incomes to                                                               
be  sure they  qualify, calculate  their premiums  per child  and                                                               
monitor their  premiums as their incomes  change. This represents                                                               
a  lot  of  accounting,  not just  during  the  determination  of                                                               
eligibility but on an ongoing basis.                                                                                            
                                                                                                                                
She  accepted that  the previous  fiscal note  showed a  need for                                                               
fewer  staff; but  as they  become more  familiar with  what this                                                               
work  will entail,  they think  more  staff will  be needed  than                                                               
previously  estimated. She  also noted  that on  page two  of the                                                               
fiscal  note, where  there is  a  breakdown of  the 13  positions                                                               
required in the eligibility field,  they have included four lead-                                                               
worker  positions that  would  provide  statewide outreach.  They                                                               
would contact health providers and  clinics in the communities to                                                               
make sure  they know about the  program and how it  works: how to                                                               
apply;   how  premiums   are  calculated;   and   as  there   are                                                               
interruptions in  coverage when  people are  unable to  pay their                                                               
premiums and benefits are suspended, how to get them reinstated.                                                                
                                                                                                                                
MS.  FITJARRALD   asserted  that  it  is   like  running  another                                                               
insurance program  and this is  the department's  best estimation                                                               
of the work it will take. They have requested:                                                                                  
   · 2 Administrative Support Staff                                                                                             
   · 5 Eligibility Technicians                                                                                                  
   · 4 Lead Eligibility Technicians to provide community                                                                        
     outreach and quality assurance                                                                                             
   · 1 Eligibility Supervisor                                                                                                   
   · 1 Public Assistance Analyst to oversee interpretation of                                                                   
     the rules, develop policy, make system changes and provide                                                                 
     technical support                                                                                                          
                                                                                                                                
These  13 positions  represent about  $350,000  from the  General                                                               
Fund and $350,000 from the federal government.                                                                                  
                                                                                                                                
2:12:29 PM                                                                                                                    
CHAIR DAVIS  asked if the four  lead-eligibility worker positions                                                               
were included in the fiscal note last year.                                                                                     
                                                                                                                                
MS. FITJARRALD  did not believe they  were but was not  sure. She                                                               
said she  would check  and get  back to  the committee  with that                                                               
information.                                                                                                                    
                                                                                                                                
2:13:01 PM                                                                                                                    
SENATOR  THOMAS asked  if  the amount  of  $15,000 per  telephone                                                               
shown under contractual services is  typical of what the state is                                                               
now paying across the board.                                                                                                    
                                                                                                                                
MS. FITJARRALD said  that is the cost associated  with the phones                                                               
and some of the IT usage  for their computer systems now that the                                                               
phones are integrated.                                                                                                          
                                                                                                                                
2:13:47 PM                                                                                                                    
CHAIR DAVIS invited Senator Wielechowski to follow up.                                                                          
                                                                                                                                
SENATOR ELLIS asked  Ms. Fitzjarrald if she  had actually checked                                                               
with other  states that  have a  track record  with this  type of                                                               
program, to find out what their experience has been.                                                                            
                                                                                                                                
MS. FITJARRALD  admitted that  they have  not checked  with other                                                               
states; it is  what they have heard  nationally on state-to-state                                                               
call chats.  Their analysis is really  based on the work  as they                                                               
know it here in Alaska.                                                                                                         
                                                                                                                                
SENATOR ELLIS  concluded there is  not any  particular experience                                                               
elsewhere informing their fiscal note.                                                                                          
                                                                                                                                
MS. FITJARRALD answered "No, not specifically."                                                                                 
                                                                                                                                
2:15:12 PM                                                                                                                    
MR. SHERWOOD  asked if  the committee would  like him  to discuss                                                               
the Medical Assistance Administration fiscal note.                                                                              
                                                                                                                                
CHAIR DAVIS  asked the  committee if  that is  a concern  at this                                                               
time.                                                                                                                           
                                                                                                                                
2:15:33 PM                                                                                                                    
SENATOR  WIELECHOWSKI answered  that his  biggest concern  is the                                                               
fact that,  to go from [eligibility  of] 175 to 200  adds roughly                                                               
1,400 people  and the  department is  adding only  two additional                                                               
staff. To go  from 200 to 300, adds another  roughly 2,000 people                                                               
to the roles...                                                                                                                 
                                                                                                                                
MR. SHERWOOD corrected that it adds approximately 1,700 people.                                                                 
                                                                                                                                
SENATOR WIELECHOWSKI  continued; so  to go from  200 to  300 adds                                                               
roughly the  same number of  people and yet the  department needs                                                               
15 additional  staff. "Is  that what you're  trying to  tell this                                                               
committee?" he asked.                                                                                                           
                                                                                                                                
MR.  SHERWOOD agreed  that is  what  their fiscal  notes say.  He                                                               
thinks a big  part of that is around the  issue of premiums; both                                                               
premium   collection  and,   because  people's   incomes  change,                                                               
modification  of premiums.  With  the increase  from  175 to  200                                                               
percent of FPL and with  continuous eligibility for children, the                                                               
department works the  case once until the next  review period and                                                               
does  not  have to  make  additional  adjustments; therefore  the                                                               
workload per case is significantly different.                                                                                   
                                                                                                                                
2:17:13 PM                                                                                                                    
SENATOR WIELECHOWSKI asked if the administration supports SB 87.                                                                
                                                                                                                                
MR.   SHERWOOD  answered   that  several   proposals  are   under                                                               
discussion  and  the  Governor has  supported  expansion  to  200                                                               
percent of FPL.  In looking at the  proposals, the administration                                                               
has a preference  for cost-sharing through premiums  and an asset                                                               
test, but  does not  have a  position on the  bill to  share with                                                               
him.                                                                                                                            
                                                                                                                                
SENATOR WIELECHOWSKI opined that  they do support the fundamental                                                               
philosophy  of what  SB  87 is  attempting to  do  with the  cost                                                               
sharing component.                                                                                                              
                                                                                                                                
MR. SHERWOOD agreed.                                                                                                            
                                                                                                                                
SENATOR WIELECHOWSKI  asked if the  administration worked  on any                                                               
amendments  at  the  congressional  level  to  stop  the  federal                                                               
increase above 200 percent.                                                                                                     
                                                                                                                                
MR. SHERWOOD  could not  answer Senator  Wielechowski's question.                                                               
He  said he  knows  the department  responded  to questions  from                                                               
their  congressional delegation  about  different proposals,  but                                                               
that he did  not have as much communication with  them as did Mr.                                                               
Fuller.                                                                                                                         
                                                                                                                                
MR. FULLER answered  that he responded to  questions and comments                                                               
from the senatorial  delegation as they were  working through the                                                               
SCHIP reauthorization;  so the  answer to  Senator Wielechowski's                                                               
question is "yes."                                                                                                              
                                                                                                                                
CHAIR  DAVIS  advised Senator  Wielechowski  that  there are  two                                                               
people from NCSL online for questions.                                                                                          
                                                                                                                                
2:19:47 PM                                                                                                                    
SENATOR WIELECHOWSKI  said his  understanding was  that requiring                                                               
premiums  or  enrollment  fees as  a  cost-sharing  provision  is                                                               
fairly  common and  asked  the NCSL  representatives  if that  is                                                               
correct.                                                                                                                        
                                                                                                                                
MARTHA  KING,  Group  Director,   National  Conference  of  State                                                               
Legislatures  (NCSL),  Denver,  CO,   referred  the  question  to                                                               
Jennifer Saunders.                                                                                                              
                                                                                                                                
JENNIFER  SAUNDERS, National  Conference  of State  Legislatures,                                                               
Denver, CO, said 24 states  charge co-payments and 35 states have                                                               
premiums or enrollment fees.                                                                                                    
                                                                                                                                
CHAIR DAVIS asked if that includes asset tests.                                                                                 
                                                                                                                                
MS.  SAUNDERS  answered  that  46  states  and  the  District  of                                                               
Columbia do not require an asset test.                                                                                          
                                                                                                                                
2:21:12 PM                                                                                                                    
SENATOR PASKVAN asked at what level the other states require co-                                                                
payments or premiums.                                                                                                           
                                                                                                                                
MS. SAUNDERS  said that nine  states impose premiums  on children                                                               
and  families  with incomes  below  150  percent of  the  federal                                                               
poverty guidelines; 26 states charge  premiums at an income level                                                               
over 150  percent; 24 states  charge premiums at 200  percent; 18                                                               
states charge at 250 percent of the federal poverty guidelines.                                                                 
                                                                                                                                
MS. KING added that there is  a difference in the states' ability                                                               
to charge co-pays  depending on whether the state  has a Medicaid                                                               
expansion for its  SCHIP program as Alaska does, or  has a stand-                                                               
alone insurance-like SCHIP program.                                                                                             
                                                                                                                                
CHAIR DAVIS  thanked Ms. King  for that information and  asked if                                                               
that means Alaska cannot go down to 150 percent.                                                                                
                                                                                                                                
MS.  SAUNDERS  answered  that  below  150  percent,  cost-sharing                                                               
requirements are  very restrictive under Medicaid  rules; but she                                                               
does not have the exact requirements.                                                                                           
                                                                                                                                
CHAIR  DAVIS requested  that she  provide further  information on                                                               
that at a later time.                                                                                                           
                                                                                                                                
2:23:14 PM                                                                                                                    
SENATOR THOMAS asked  if, in NCSL's experience,  some states have                                                               
developed  a  particular  formula  to use  when  calculating  the                                                               
change  in the  amount of  reimbursement of  the federal  poverty                                                               
level.                                                                                                                          
                                                                                                                                
MS. SAUNDERS  told Senator Thomas  that she  is not aware  of any                                                               
but will try to find out.                                                                                                       
                                                                                                                                
2:23:53 PM                                                                                                                    
SENATOR ELLIS asked Ms. Fitzjarrald  and Mr. Sherwood if they are                                                               
saying  that,  of the  15  new  employees and  related  equipment                                                               
reflected in the fiscal note,  100 percent of their activity will                                                               
be dedicated to this program.                                                                                                   
                                                                                                                                
MS. FITJARRALD said that is  correct; determining eligibility for                                                               
the higher  income groups is  the work  they would be  doing. She                                                               
added that,  because Medicaid is  so large, if applicants  do not                                                               
qualify for this  program, the eligibility workers  would look to                                                               
see if they  qualify for other types of coverage;  but their work                                                               
will be related primarily to Denali Kid Care.                                                                                   
                                                                                                                                
2:25:13 PM                                                                                                                    
SENATOR WIELECHOWSKI  stated that  Alaska can  go to  300 percent                                                               
eligibility and  provide insurance  for most  of the  children in                                                               
the  state  for  an  additional $1.3  million  according  to  the                                                               
department's estimate, which he believes  to be over generous. He                                                               
added that, to  say it will require 2 additional  staff to handle                                                               
an  increase of  1,500 to  1,600 kids  and pregnant  mothers, but                                                               
adding 1,500  more with the increase  from 200 to 300  percent (a                                                               
position  they  know the  administration  fought  against at  the                                                               
congressional  level) will  require another  15 staff,  stretches                                                               
the imagination. However, he continued,  even if that is accurate                                                               
the amount is more than reasonable  for the outcome. He urged the                                                               
committee's support.                                                                                                            
                                                                                                                                
CHAIR DAVIS thanked the sponsor  and announced that the committee                                                               
would take public testimony for SB 87.                                                                                          
                                                                                                                                
2:26:47 PM                                                                                                                    
JORDEN  NIGRO,   President*  Alaska  Association  of   Homes  for                                                               
Children* Anchorage,  AK* said she  supports this bill  and urged                                                               
the committee to pass it out.                                                                                                   
                                                                                                                                
2:27:44 PM                                                                                                                    
LAVERNE  DEMIENTIEFF, President,  National Association  of Social                                                               
Workers  (NASW),   Alaska  Chapter,   Fairbanks,  AK,   said  her                                                               
Association also supports SB 87.                                                                                                
                                                                                                                                
2:28:06 PM                                                                                                                    
ROD  BETIT, President,  Alaska State  Hospital  and Nursing  Home                                                               
Association (ASHNHA),  Juneau, AK, said  he also supports  SB 87.                                                               
Having   been  a   state  health   worker,  he   understands  the                                                               
difficulties of  going forward with  this proposal,  but ASHNHA's                                                               
membership really  wants to  see the  state get  [eligibility] to                                                               
200 percent and  he believes this is a  well-constructed piece of                                                               
legislation. First, there  is no cost sharing  below 200 percent,                                                               
which  he believes  is important.  Second,  there is  significant                                                               
cost sharing above 200 percent. It  isn't a "give away," so there                                                               
is a  real attempt to  promote individual responsibility  in this                                                               
program;  above  250  percent,  co-payments  of  20  percent  are                                                               
required.  Third, it  contains a  strong anti-crowd  out measure,                                                               
which is  a very  important component of  the bill.  He explained                                                               
that  "crowd out"  refers to  public  programs shifting  patients                                                               
away from  the private programs,  which shifts who pays  for care                                                               
rather than who is covered.                                                                                                     
                                                                                                                                
Finally,  he  said  if  there   are  federal  and  state  dollars                                                               
available, this  is a good next  step after going to  200 percent                                                               
and he would really urge the committee to consider it.                                                                          
                                                                                                                                
2:30:44 PM                                                                                                                    
SENATOR ELLIS  thanked Mr. Betit  for his testimony.  Coming from                                                               
someone  who  watches the  bottom  line,  he  said, it  is  great                                                               
testimony to carry through the process.                                                                                         
                                                                                                                                
2:31:11 PM                                                                                                                    
SENATOR   PASKVAN   thanked   him   again  and   asked   if   the                                                               
administration would be  more efficient for the  hospitals with a                                                               
flat fee charge rather than a percentage of income.                                                                             
                                                                                                                                
MR.   BETIT  answered   that  typically   those  fees   would  be                                                               
predetermined  during  the  eligibility   process  and  would  be                                                               
provided to the providers when  the patient comes in for service;                                                               
the  hospitals   and  physicians  would   not  have  to   do  the                                                               
calculation.                                                                                                                    
                                                                                                                                
2:32:04 PM                                                                                                                    
SENATOR  THOMAS   asked  if,  as  a   humanitarian  gesture,  the                                                               
hospitals  would  be  interested  in support  of  an  incremental                                                               
discount for  every $50  increment in  the federal  poverty level                                                               
increase as it is applied.                                                                                                      
                                                                                                                                
MR. BETIT asked  if Senator Thomas means  an incremental discount                                                               
in what the family is charged.                                                                                                  
                                                                                                                                
SENATOR THOMAS replied yes.                                                                                                     
                                                                                                                                
MR.  BETIT explained  that the  hospitals are  giving significant                                                               
discounts already,  because Medicaid  and other  federal programs                                                               
are  well  below  the  going  rate. They  would  come  under  the                                                               
protection of  the Medicaid rules,  which say that once  a person                                                               
has been billed  as a Medicaid patient, that is  all the provider                                                               
can charge.                                                                                                                     
                                                                                                                                
2:33:22 PM                                                                                                                    
DONNA GRAHAM,  representing herself,  Anchorage, AK,  agrees that                                                               
SB 13  is very important;  the state must  get to 200  percent of                                                               
FPL.  But   SB  87  is   a  wonderful  bill  and   very  fiscally                                                               
responsible, as she  reads it. Wellness and  prevention make much                                                               
more sense than waiting to treat problems.                                                                                      
                                                                                                                                
2:34:23 PM                                                                                                                    
JODYNE   BUTTO  MD,   American  Academy   of  Pediatrics   (AAP),                                                               
Anchorage, AK, asked  if anyone has considered  thinking a little                                                               
outside the box  and to find solutions that would  not require 15                                                               
positions. She  said it seems  as if there  ought to be  a better                                                               
way  to quantify  eligibility  for  a longer  period  of time  to                                                               
reduce  the  amount of  work  required  by  the patient  and  the                                                               
department. She  encouraged some "brainstorming" to  find ways to                                                               
streamline the process.                                                                                                         
                                                                                                                                
CHAIR DAVIS thanked  her for her suggestion and  commented that a                                                               
lot of the work Dr. Butto  referred to will take place in Finance                                                               
rather  than in  the Health  and Social  Services Committee.  She                                                               
also pointed  out that there  are other  bills in the  works this                                                               
session that don't  come up to this mark and,  if Alaska is going                                                               
to have  health care for all  of the children, this  is the piece                                                               
of legislation she would like to see passed.                                                                                    
                                                                                                                                
TOM OBERMEYER, aid to Senator  Davis, pointed out that the packet                                                               
that  was handed  out  to  members of  the  committee includes  a                                                               
report from the Kaiser Commission  on Medicaid and the Uninsured.                                                               
Page 10 of that report indicates  that 11 states have taken steps                                                               
to reduce procedural  barriers to coverage for  children; this is                                                               
a cost-saving  arrangement he  thinks the  state should  look at.                                                               
These states were able to  eliminate the requirement for families                                                               
to  participate  in  face-to-face  interviews  to  obtain  health                                                               
coverage   for   children.    Colorado   adopted   administrative                                                               
verification  and  renewal,  meaning  that the  state  no  longer                                                               
requires families to provide paper  documentation of their income                                                               
and  eligibility workers  obtain that  information from  existing                                                               
databases. So  things have been  done in other states  that could                                                               
help to reduce the numbers that were presented for SB 87.                                                                       
                                                                                                                                
CHAIR DAVIS thanked  Mr. Obermeyer for bringing  that forward and                                                               
mentioned that the administration  is working on some regulations                                                               
to  extend the  time  between personal  interviews. She  admitted                                                               
that there  is a  lot of  work to  be done  but repeated  that it                                                               
won't all be done in this  committee. She expressed her desire to                                                               
move both bills out today and asked the will of the committee.                                                                  
                                                                                                                                
2:38:40 PM                                                                                                                    
                                                                                                                                
                                                                                                                                
SENATOR PASKVAN moved to report SB 13 from committee with                                                                       
individual recommendations and attached fiscal note(s). There                                                                   
being no objection, the motion carried.                                                                                         
SENATOR PASKVAN moved to report SB 87 from committee with                                                                       
individual recommendations and attached fiscal note(s). There                                                                   
being no objection, the motion carried.                                                                                         
                                                                                                                                
2:39:39 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Senator Davis adjourned the meeting at 2:39 p.m.                                                                                
                                                                                                                                

Document Name Date/Time Subjects