00 SENATE BILL NO. 150 01 "An Act relating to eligibility for medical assistance coverage; and providing for an 02 effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04  * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 05 to read: 06 MEDICAL ASSISTANCE ELIGIBILITY EXPANSION; LEGISLATIVE 07 FINDINGS. The legislature finds that 08 (1) an estimated 41,500 uninsured Alaska residents with incomes under 138 09 percent of the federal poverty line are eligible for Medicaid comprehensive health insurance 10 coverage as of January 2014; 11 (2) the federal government will cover 100 percent of the expansion costs in the 12 first three years, 2014 - 2016, between 90 and 100 percent of the expansion costs for the years 13 2017 - 2019, and 90 percent of the expansion costs in 2020 and subsequent years, which are 14 far higher than under the state's Medicaid program today; 01 (3) the expansion would decrease delays in care, increase the quality of care, 02 and improve the health of many Alaskans, particularly the most vulnerable Alaskans; 03 (4) according to research findings, if Alaska participates in the expansion, 04 scores of lives of Alaskans could be saved; 05 (5) full-time workers earning up to $9 an hour or up to $18.75 an hour for the 06 head of a household of four would gain access to Medicaid coverage, creating a healthier 07 workforce and relieving employers of health insurance costs; 08 (6) expanding Medicaid coverage would create approximately 4,000 new jobs 09 by 2020, with $1,200,000,000 more in wages and salaries paid to Alaskans annually; 10 (7) for every dollar in funding from the state, an additional $12 in new federal 11 dollars would flow to the state over the initial seven years of the expansion; 12 (8) cumulatively, from 2014 - 2020, the state would spend a projected 13 $91,000,000 on the expansion, an increase of only 1.9 percent, while receiving 14 $1,100,000,000 in new federal funds; 15 (9) direct state spending for the expansion would be significantly if not 16 completely offset by savings of at least $67,000,000 made possible elsewhere in the state 17 budget; 18 (10) without considering those offsets, a Medicaid expansion would increase 19 state spending by not more than two percent, yet would increase the number of Alaskans 20 covered by Medicaid by an estimated 33 percent; 21 (11) under the expansion, the percentage of uninsured Alaskans would 22 decrease by more than half, from 21 percent to 10 percent, and uncompensated care costs and 23 bad debt would decline dramatically; 24 (12) under the expansion, substantial new resources for health care services 25 would be available to serve residents in regions throughout the state; in 2020 alone 26 $56,400,000 in additional resources would be available to serve residents of the Anchorage 27 region, $57,900,000 to serve residents of the Kenai Peninsula Borough and Matanuska- 28 Susitna Borough, and $50,600,000 to serve residents of the Aleutians, Bethel, Nome, Kodiak, 29 and Fort Yukon; 30 (13) expanding health insurance coverage, thereby increasing the number of 31 low-income patients able to compensate providers for services, would 01 (A) increase the ability of providers to expand and operate in areas 02 previously considered uneconomic; and 03 (B) decrease private health insurance premiums paid by individuals in 04 Alaska by an estimated $257 annually; 05 (14) the expansion of Medicaid in Alaska under this Act is important but 06 should be limited to the availability of federal funding of 90 percent or more of the cost of 07 expansion. 08  * Sec. 2. AS 47.07.020(b) is amended to read: 09 (b) In addition to the persons specified in (a) of this section, the following 10 optional groups of persons for whom the state may claim federal financial 11 participation are eligible for medical assistance: 12 (1) persons eligible for but not receiving assistance under any plan of 13 the state approved under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act, 14 Supplemental Security Income) or a federal program designated as the successor to the 15 aid to families with dependent children program; 16 (2) persons in a general hospital, skilled nursing facility, or 17 intermediate care facility, who, if they left the facility, would be eligible for assistance 18 under one of the federal programs specified in (1) of this subsection; 19 (3) persons under 21 years of age who are under supervision of the 20 department, for whom maintenance is being paid in whole or in part from public 21 funds, and who are in foster homes or private child-care institutions; 22 (4) aged, blind, or disabled persons, who, because they do not meet 23 income and resources requirements, do not receive supplemental security income 24 under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act), and who do not 25 receive a mandatory state supplement, but who are eligible, or would be eligible if 26 they were not in a skilled nursing facility or intermediate care facility to receive an 27 optional state supplementary payment; 28 (5) persons under 21 years of age who are in an institution designated 29 as an intermediate care facility for persons with intellectual and developmental 30 disabilities and who are financially eligible as determined by the standards of the 31 federal program designated as the successor to the aid to families with dependent 01 children program; 02 (6) persons in a medical or intermediate care facility whose income 03 while in the facility does not exceed 300 percent of the supplemental security income 04 benefit rate under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act) but who 05 would not be eligible for an optional state supplementary payment if they left the 06 hospital or other facility; 07 (7) persons under 21 years of age who are receiving active treatment in 08 a psychiatric hospital and who are financially eligible as determined by the standards 09 of the federal program designated as the successor to the aid to families with 10 dependent children program; 11 (8) persons under 21 years of age and not covered under (a) of this 12 section, who would be eligible for benefits under the federal program designated as 13 the successor to the aid to families with dependent children program, except that they 14 have the care and support of both their natural and adoptive parents; 15 (9) pregnant women not covered under (a) of this section and who 16 meet the income and resource requirements of the federal program designated as the 17 successor to the aid to families with dependent children program; 18 (10) persons under 21 years of age not covered under (a) of this section 19 who the department has determined cannot be placed for adoption without medical 20 assistance because of a special need for medical or rehabilitative care and who the 21 department has determined are hard-to-place children eligible for subsidy under 22 AS 25.23.190 - 25.23.210; 23 (11) persons who can be considered under 42 U.S.C. 1396a(e)(3) (Title 24 XIX, Social Security Act, Medical Assistance) to be individuals with respect to whom 25 a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c (Title 26 XVI, Social Security Act) because they meet all of the following criteria: 27 (A) they are 18 years of age or younger and qualify as disabled 28 individuals under 42 U.S.C. 1382c(a) (Title XVI, Social Security Act); 29 (B) the department has determined that 30 (i) they require a level of care provided in a hospital, 31 nursing facility, or intermediate care facility for persons with 01 intellectual and developmental disabilities; 02 (ii) it is appropriate to provide their care outside of an 03 institution; and 04 (iii) the estimated amount that would be spent for 05 medical assistance for their individual care outside an institution is not 06 greater than the estimated amount that would otherwise be expended 07 individually for medical assistance within an appropriate institution; 08 (C) if they were in a medical institution, they would be eligible 09 for medical assistance under other provisions of this chapter; and 10 (D) home and community-based services under a waiver 11 approved by the federal government are either not available to them under this 12 chapter or would be inappropriate for them; 13 (12) disabled persons, as described in 42 U.S.C. 14 1396a(a)(10)(A)(ii)(XIII), who are in families whose income, as determined under 15 applicable federal regulations or guidelines, is less than 250 percent of the official 16 poverty line applicable to a family of that size according to the United States 17 Department of Health and Human Services, and who, but for earnings in excess of the 18 limit established under 42 U.S.C. 1396d(q)(2)(B), would be considered to be 19 individuals with respect to whom a supplemental security income is being paid under 20 42 U.S.C. 1381 - 1383c; a person eligible for assistance under this paragraph who is 21 not eligible under another provision of this section shall pay a premium or other cost- 22 sharing charges according to a sliding fee scale that is based on income as established 23 by the department in regulations; 24 (13) persons under 19 years of age who are not covered under (a) of 25 this section and whose household income does not exceed 175 percent of the federal 26 poverty line as defined by the United States Department of Health and Human 27 Services and revised under 42 U.S.C. 9902(2); 28 (14) pregnant women who are not covered under (a) of this section and 29 whose household income does not exceed 175 percent of the federal poverty line as 30 defined by the United States Department of Health and Human Services and revised 31 under 42 U.S.C. 9902(2); 01 (15) persons who have been diagnosed with breast or cervical cancer 02 and who are eligible for coverage under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII);  03 (16) persons who are under 65 years of age, who are not pregnant,  04 whose income does not exceed 138 percent of the federal poverty line as defined  05 by the United States Department of Health and Human Services and revised  06 under 42 U.S.C. 9902(2), and who are eligible under 42 U.S.C.  07 1396a(a)(10)(A)(ii)(VIII), if the federal medical assistance percentage paid to the  08 state for the coverage is not less than 90 percent. 09  * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 10 read: 11 MEDICAID STATE PLAN; INSTRUCTIONS. The Department of Health and Social 12 Services shall immediately amend and submit for approval the state plan for medical 13 assistance coverage consistent with this Act. 14  * Sec. 4. This Act takes effect immediately under AS 01.10.070(c).