Legislature(2015 - 2016)BUTROVICH 205
04/01/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| SB78 | |
| SB74 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 74 | TELECONFERENCED | |
| += | SB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 1, 2015
1:35 p.m.
MEMBERS PRESENT
Senator Bert Stedman, Chair
Senator Cathy Giessel, Vice Chair
Senator Bill Stoltze
MEMBERS ABSENT
Senator Pete Kelly
Senator Johnny Ellis
COMMITTEE CALENDAR
SENATE BILL NO. 78
"An Act relating to medical assistance reform measures; relating
to eligibility for medical assistance coverage; relating to
medical assistance cost containment measures by the Department
of Health and Social Services; and providing for an effective
date."
- HEARD & HELD
SENATE BILL NO. 74
"An Act relating to permanent fund dividends; relating to a
medical assistance reform program; establishing a personal
health savings account program for medical assistance
recipients; relating to the duties of the Department of Health
and Social Services; establishing medical assistance
demonstration projects; and relating to a study by the
Department of Health and Social Services."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 78
SHORT TITLE: MEDICAL ASSISTANCE COVERAGE; REFORM
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/18/15 (S) READ THE FIRST TIME - REFERRALS
03/18/15 (S) HSS, FIN
03/30/15 (S) HSS AT 1:30 PM BUTROVICH 205
03/30/15 (S) Heard & Held
03/30/15 (S) MINUTE(HSS)
04/01/15 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 74
SHORT TITLE: MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES
SPONSOR(s): KELLY
03/13/15 (S) READ THE FIRST TIME - REFERRALS
03/13/15 (S) HSS, STA, FIN
03/13/15 (S) HSS AT 1:30 PM BUTROVICH 205
03/13/15 (S) -- MEETING CANCELED --
03/23/15 (S) HSS AT 1:30 PM BUTROVICH 205
03/23/15 (S) Heard & Held
03/23/15 (S) MINUTE(HSS)
04/01/15 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
AMANDA RYDER, Fiscal Analyst
Legislative Finance Division
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Presented information on SB 78.
JON SHERWOOD, Deputy Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented information on SB 78.
ROSS BEILING, CEO
Medical Bidline, LLC
Anchorage, Alaska
POSITION STATEMENT: Testified on SB 74.
BECKY HULTBERG, President/CEO
Alaska State Hospital and Nursing Home Association
Juneau, Alaska
POSITION STATEMENT: Testified in favor of reform and expansion
concepts in SB 78.
JEFF JESSEE, CEO
Alaska Mental Health Trust Authority (AMHTA)
Anchorage, Alaska
POSITION STATEMENT: Testified in favor of Medicaid reform and
expansion in SB 78.
FRANK MCQUERY, representing himself
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to the expansion of
Medicaid.
JEREMY PRICE, State Director
Americans for Prosperity
Anchorage, Alaska
POSITION STATEMENT: Testified against further implementation of
the Affordable Care Act in Alaska.
ACTION NARRATIVE
1:35:07 PM
CHAIR BERT STEDMAN called the Senate Health and Social Services
Standing Committee meeting to order at 1:35 p.m. Present at the
call to order were Senators Stoltz, Giessel, and Chair Stedman.
SB 78-MEDICAL ASSISTANCE COVERAGE; REFORM
1:36:01 PM
CHAIR STEDMAN announced the consideration of SB 78 and noted
that Legislative Finance would give a presentation.
1:36:56 PM
AMANDA RYDER, Fiscal Analyst, Legislative Finance Division,
Legislative Affairs Agency, presented information on SB 78. She
said she is responding to the request by the committee to
produce graphs related to Medicaid history, growth rate, and
inflation impacts. She showed graphs comparing the fiscal impact
of the Governor's amended budget and SB 74 and SB 78 on state
general funding and on state and federal total spend.
1:39:40 PM
MS. RYDER turned to two graphs that show the budget history of
Medicaid, for general funds and for total funds, as well as cost
per recipient.
She showed graphs depicting inflation-adjusted numbers for
Anchorage and for Anchorage health care.
1:42:44 PM
MS. RYDER discussed a graph of Alaska's population growth and
Medicaid enrollee growth.
She turned to graphs of historical Medicaid growth adjusted for
Anchorage inflation and cost per enrollee.
1:46:09 PM
She showed graphs of historical and projected Medicaid
appropriations adjusted for medical inflation and cost per
recipient.
1:48:11 PM
She highlighted graphs of the projected Medicaid growth rates
for general funds and for all funds from 2006 to 2016, and from
2012 to 2016.
1:49:11 PM
CHAIR STEDMAN commented that it is not as scary when inflation
and population growth is considered, but state revenue is not
tied to those, unfortunately.
1:49:41 PM
JON SHERWOOD, Deputy Commissioner, Department of Health and
Social Services (DHSS), presented information on SB 78. He began
by answering a previous question from Senator Stoltz about the
PFD hold harmless provision, a complicated piece of the bill. He
provided background about changes in the Affordable Care Act
(ACA) that dealt with old Aid to Families with Dependent
Children rules. Under ACA, rules were changed from income rules
to those based on modified adjusted gross income, as well as who
is considered in the household. One difference is that the old
rules would take a gross income amount and apply income
"disregards," like child care expenses and other deductions.
Alaska applied for the disregard of the PFD and it also provided
for a hold harmless provision that says if a person is required
to count the PFD and it makes them ineligible for a program,
they can continue to receive benefits at state expense, but it
is paid out of the dividend account, not general funds. The
person can continue to receive benefits for up to four months if
the "disregard" makes them ineligible.
Under the old rules income was considered at "point of time."
Under the new modified gross income rules, income is annualized.
That is significant so people can move back and forth smoothly
between the exchange and Medicaid as their income changes, and
not lose eligibility. States were required to raise income
standards to reflect the loss of the "disregards.
Because the expansion group was not an existing category, there
is no provision for making such a conversion. Income for the
expansion group is annualized and the PFD hold harmless no
longer provides protection. There was no easy solution to this
problem. If members of the expansion group received a PFD that
made them ineligible for Medicaid, they would be eligible to
receive subsidized insurance coverage through the exchange with
minimal premiums or cost-sharing. It would be a relative minor
loss of benefits and it would solve a difficult administrative
problem.
MR. SHERWOOD summarized that the most practical solution was to
exempt these individuals from the hold harmless provision and
they would receive subsidized coverage from the exchange. All
existing beneficiaries would not be impacted; the expansion
group would be the only one this applies to.
1:58:46 PM
SENATOR STOLTZE clarified that the hold harmless provision is
such that, "We pay up to four months of benefits so people on
welfare can continue to receive the dividend. That comes out of
every other Alaskan's dividend." He asked Mr. Sherwood if he
would like to extend that benefit to the potentially new 42,000
beneficiaries.
MR. SHERWOOD said state law would compel them to do it, so they
proposed the exemption to satisfy the requirement.
SENATOR STOLTZE asked if the first approach was to try to
continue the hold harmless provision.
MR. SHERWOOD said yes.
SENATOR STOLTZE asked if the exemption would apply to all
dividend recipients in a family. He wondered if there was an
option for declining a PFD.
MR. SHERWOOD explained that in the Medicaid application there is
a requirement for a person to apply for income they are eligible
for, which would include one's PFD.
SENATOR STOLTZE asked if families can decline to apply for
minor's PFD's, which they then can collect when they reach 18.
MR. SHERWOOD said he would have to look into that. It generally
does not happen. Expansion cases are primarily adults without
children.
2:02:50 PM
SENATOR STOLTZE asked if a dependent's dividend is calculated as
part of the family's income.
MR. SHERWOOD said for the Medicaid population all income is
included. There are some exceptions. Those who do not have to
file tax returns, their incomes don't count.
SENATOR STOLTZE requested a written explanation.
CHAIR STEDMAN asked the department to prepare that information
for the committee.
SB 78 was held in committee.
SB 74-MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES
2:05:10 PM
CHAIR STEDMAN announced the consideration of SB 74. He opened
public testimony.
ROSS BEILING, CEO, Medical Bidline, LLC, testified on SB 74. He
provided information about his business. He discussed reform
efforts in light of the economic situation. He listed what
services his company provides. He suggested looking at cost
reforms in health care. He said there has not been competition
in health care and it has led to expensive equipment. He said we
cannot afford not to get Medicaid expansion right.
2:10:33 PM
CHAIR STEDMAN asked Mr. Beiling if he is requesting the state to
lower its costs by using used or reconditioned equipment. He
asked what his bottom line is.
MR. BEILING stated that the state should engage in competitive
bidding because it levels the playing field.
CHAIR STEDMAN asked for clarification.
MR. BEILING said it should be for new and used medical
equipment.
2:13:03 PM
BECKY HULTBERG, President/CEO, Alaska State Hospital and Nursing
Home Association (ASHNHA), testified in favor of reform and
expansion concepts in SB 78. She said ASHNHA supports many of
the reform concepts in both bills. She opined that expansion is
necessary as part of improving Medicaid. She pointed out that
hospitals support Medicaid expansion due to the potential for
reduction in costs of uncompensated care and to provide fiscal
and economic benefits. Reforms are also necessary to improve the
Medicaid system.
2:15:05 PM
MS. HULTBERG pointed out that the department has already been
involved in reform. She stressed the importance of "paying for
value." She gave two examples of payment reform, one in
Ketchikan and the other in Central Peninsula Hospital.
She disagreed with the idea that reform should come before
expansion. Reform is an on-going process. She maintained that
Medicaid must evolve at the same pace as reform. She disagreed
that innovation and change require resources. Providers are
going to have to take risk and innovate to create new models of
care. She suggested capital for change can come from reduction
in uncompensated care.
She concluded that reform is achievable and expansion is key to
achieving reform.
2:19:04 PM
SENATOR STOLTZE requested Ms. Hultberg to comment on the
previous speaker's ideas.
MS. HULTBERG said she is not familiar with the details of Mr.
Beiling's proposals. She agreed competition is a positive
principle.
SENATOR STOLTZE questioned the role of competition in hospitals.
2:20:33 PM
JEFF JESSEE, CEO, Alaska Mental Health Trust Authority (AMHTA),
testified in favor of Medicaid reform and expansion in SB 78. He
explained that the reform elements in both bills are vital in
order to protect AMHTA beneficiaries in the long run. He stated
that expansion is critically important to beneficiaries because
there are many beneficiaries that do not have any health care.
Reform ideas in both bills would go a long way to stabilize
Medicaid and would be a positive fiscal move.
He said expansion should be looked at because other parts of the
state budget could also be brought under the same kind of cost
control. He used Corrections as an example of a department in
need of sustainability. Recidivism is prevented by providing
support for recovery and health care. There is now an
opportunity to have 90 percent coverage by the federal
government of support for recovery in the Corrections
population. He stressed that when the Corrections budget is
controlled, then other departments' budgets are affected; Public
Defender, Department of Law, Court System, the troopers and the
police.
He concluded that the Trust is supportive of reform efforts in
both bills, and the expansion in SB 78.
2:26:38 PM
FRANK MCQUERY, representing himself, testified in opposition to
the expansion of Medicaid. He said the bigger the system, the
more difficult it is to be controlled. He gave an example of a
problem with checking financial eligibility for Medicaid. He
said reform is needed before expansion. He maintained that the
system will not work for the neediest beneficiaries. He did not
believe expansion would work.
2:31:10 PM
JEREMY PRICE, State Director, Americans for Prosperity,
testified against further implementation of the Affordable Care
Act in Alaska. He noted a portion of Alaska's financial report,
noting defects in Medicaid's accounting system. He said he
agrees with the reform ideas in SB 74.
2:35:11 PM
SENATOR STOLTZE asked Mr. Price what outreach he has received
from DHSS.
MR. PRICE said none.
SB 74 was held in committee.
2:36:09 PM
There being nothing further to come before the committee,
Chair Stedman adjourned the Senate Health and Social Services
Standing Committee at 2:36 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 74 Supporting Documents - Legislative Finance Graphs.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Sponsor Statement.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Supporting Documents - NPR HSAs for Medicaid.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Ver H.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Bill Hearing Request SHSS.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| Fiscal Note 17.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| Fiscal note narrative 031715.doc |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| Governor Walker Medicaid Expansion and Reform - House Bill.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| Governor Walker Medicaid Expansion and Reform - Senate Bill.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| Hearing Request from Governor Walker.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| SB 74 Supporting Documents - LRS Report 15.284.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| Medicaid expansion and reform fact sheet.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| SB 74 Sectional Analysis.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB078 S HSS hearing request.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| Fiscal Note SB 23.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 23 |
| SB 78 S-HSS.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| SB 74 Fiscal Notes 233.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 242.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| Walker_Medicaid_Fiscal_Note_Overview.PDF |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
|
| SB 74 Fiscal Notes 317.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 354.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 2077.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 2660.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 78 Sectional.docx |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| SB 74 Fiscal Notes 2662.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 2663.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 2696.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 2787.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 2880.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 3099.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Congregation Sukkat Shalom.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| SB 74 Fiscal Notes 309.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| Supporters of Medicaid Reform.docx |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |
| SB 74 Supporting Document - Aetna Letter 3.27.15.pdf |
SHSS 3/23/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 |
| 3-30-15 Medicaid History and Projection PPT (SB74 and SB78).pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 74 SB 78 |
| APRN Info page.pdf |
SHSS 3/30/2015 1:30:00 PM SHSS 4/1/2015 1:30:00 PM |
SB 78 |