Legislature(2005 - 2006)SENATE FINANCE 532
05/02/2006 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB318 | |
| HB380 | |
| HB105 | |
| HB16 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 318 | TELECONFERENCED | |
| + | HB 380 | TELECONFERENCED | |
| + | HB 105 | TELECONFERENCED | |
| + | HB 16 | TELECONFERENCED | |
| += | HB 218 | TELECONFERENCED | |
| + | TELECONFERENCED |
CS FOR HOUSE BILL NO. 105(FIN)
"An Act relating to coverage for adult dental services
under Medicaid; and providing for an effective date."
9:46:25 AM
This was the first hearing for this bill in the Senate Finance
Committee.
BILL HOGAN, Deputy Commissioner, Department of Health and Social
Services, informed the Committee this legislation would change
Medicaid coverage to allow adult recipients to receive up to
$1,150 annually in preventive and restorative dental care
services such as cleaning, exams, tooth restoration and both
upper and lower dentures. Adult dental care is currently limited
to emergency care for the immediate relief of pain or acute
infection. The most common outcome of the current care is the
extraction of teeth. This Medicaid expansion would benefit "the
most needy Alaskans: those with disabilities and seniors".
Approximately 16,000 of the adults currently enrolled in the
State's Medicaid program could benefit from this proposal.
Mr. Hogan noted this was one of the first Medicaid programs to
specify a maximum limit. In addition, the bill would include a
three-year termination date. "This will allow the Department and
the Legislature to evaluate the effectiveness of the program,"
to include participation levels "and the true cost and value of
the program". The Department is actively working with
stakeholders, particularly the Alaska Mental Health Trust
Authority (AMHTA), "who consider this a significant issue within
communities throughout Alaska". AMHTA would provide the State
match required by Medicaid for this program.
Mr. Hogan stated that between $700,000 and $800,000 of AMHTA
mini-grant program funds are spent annually on providing dental
care to AMHTA beneficiaries, particularly those with behavioral
health issues and developmental disabilities. Those funds could
be better utilized for other beneficiary needs were this program
implemented.
Mr. Hogan shared that the Division of Vocational Rehabilitation
in the Department of Labor and Workforce Development annually
expends $100,000 to help individuals in their program "obtain
dental care to increase the likelihood that they could be
employed".
9:49:53 AM
JANET CLARK, Assistant Commissioner, Finance and Management
Services, Department of Health and Social Services stated that
the Department's assumptions in the original fiscal note were
extensively reviewed during the bill's hearing before the House
Finance Committee. As a result, the fiscal note that reported
from House Finance was considerably less than the initial fiscal
note. Many of the assumptions were changed, including the
decision to reduce the number of recipients served by the
program in its initial two years due to access and start-up
issues. The original assumption that the program would serve 35
percent of eligible adults is reflected in the program's third
year of operation.
Ms. Clarke continued that, in addition, the Department's
emergency dental care expenses were reduced for year two and
three of the program, based on the assumption that the Medicaid
preventive care service would reduce the demand on emergency
dental care service.
Ms. Clarke stated that the Department's original fiscal note was
developed with the understanding that Federal Medical Assistance
Percentage (FMAP) funding would be reduced from 57 to 50
percent; however that reduction had not transpired. Therefore,
the fiscal note was revised to reflect the current 57.58 percent
FMAP level. Another "key" fiscal element was AMHTA's commitment
to provide their FY 07, FY 08 and FY 09 dental services budget
to the program. Thus, as reflected in Fiscal Note #2, dated May
4, 2006, AMHTA would contribute $425,000 in FY07, and $1,425,000
each for FY 08 and FY 09. The FY 07 fiscal note was also
reduced, as the program would not be anticipated to begin until
late in the fiscal year.
Ms. Clarke noted that the State's FY 08 general fund match
obligation would be $1,300,000. This, with the assistance of the
AMHTA funding, would leverage approximately $10.3 million in
services. The fiscal note also reflected the termination of the
program in FY 09. Efforts to refine the fiscal note assisted in
reducing the program's impact on the State's general fund.
Senator Dyson inquired to the income and asset levels a non-
AMHTA recipient, "non-disabled, non-elderly adult" must have to
qualify for the program.
Ms. Clark responded that a 21 through 64-year-old person, who
was not in one the aforementioned categories and who did not
have children, would not typically qualify for Medicaid.
Senator Dyson acknowledged.
9:54:04 AM
Co-Chair Wilken asked regarding the Department's efforts "to
work with the Alaska Dental Association to get them to allow
temporary dental licenses for those dentists from outside
Alaska" who wish to provide basic dental services in rural areas
of the State during the summer.
Mr. Hogan deferred to the Department's Dentist, Dr. Brad
Whistler.
9:54:46 AM
DR. BRAD WHISTLER, Dentist, Department of Health and Social
Services, testified via teleconference from an offnet site.
Community health centers and tribal dental programs have
discussed this issue with the Alaska Dental Board. The Board is
considering issuing courtesy licenses, which are different than
temporary licenses. The Department deferred to the community and
tribal dental programs to further this issue with the Alaska
Dental Board.
Co-Chair Wilken identified his interest to be with the issuance
of temporary licenses rather than courtesy licenses. Continuing,
he asked the status of Board action regarding the issuance of
temporary licenses "to people that want to come and help
Alaskans".
Mr. Whistler had not been personally involved in the actions of
the Dental Board. However, he understood that "the only issue
that is being addressed by the Dental Board at this time is the
courtesy license issue".
Co-Chair Wilken asked whether Dr. Whistler planned on asking the
Dental Board to consider "granting temporary licenses that could
take care of some of our more indigent people by what amounts to
volunteers".
Mr. Whistler, speaking on behalf of the Department, stated he
would "be happy to" advance that subject. He explained that a
temporary license could be issued to a dentist desiring to
practice in Alaska, provided they held a license in another
state. This license would suffice until the time the Dental
Board could meet and "do licensure by credentials". A courtesy
license could be issued to a dentist who planned on providing
volunteer services, as a person holding a courtesy license could
not charge a fee for their service. A courtesy license would not
be appropriate for the needs of a community health center or
tribal program, as their desire is to employ dentists.
9:56:34 AM
Co-Chair Wilken asked Dr. Whistler to provide his office a
letter detailing the efforts being taken by the Department "to
enable temporary licenses" in the State. The letter should
include such things as the feasibility of the licensure, the
steps that would be required to further the effort, and the
benefits that would be anticipated. He also requested a copy of
any correspondence between the Department and the Dental Board
relating to this issue.
Co-Chair Green supported Co-Chair Wilken's request.
Co-Chair Wilken shared his concern about the proposed dental
program by repeating the "old saying that those that forget
history are doomed to repeat it. And here we go again." He
recalled discussions that occurred when the Denali Kid Care
program was proposed. While that program "was presented with a
firm number of expenditure", the cost associated with that
program "has far exceeded" what had been anticipated for a
variety of reasons. The Power Cost Equalization program is
another program whose expenses dramatically increased. Its
expenses increased from eight million dollars a year to $80
million dollars in six years.
Co-Chair Wilken questioned the true fiscal impact of the bill,
as, while he appreciated the inclusion of the $1,150 per person
annual dental service limit, the number of program recipients is
unknown. Therefore, to gain his support, he suggested an annual
maximum expenditure level be specified for the program. The
intent would be to terminate the program once the limit was
reached. This would provide the Legislature with "a hard
indication of just the demand" on the program.
Co-Chair Wilken asked that the bill be held in Committee to
further discuss how to incorporate such language.
Co-Chair Green acknowledged.
9:58:31 AM
Senator Olson asked the Department's and the Alaska Dental
Board's "views" on licensing dental hygienists who received
training in countries other than the United States.
Mr. Hogan deferred to Dr. Whistler.
9:58:46 AM
Dr. Whistler clarified that the Department is not involved with
the Alaska Dental Board and the issuance of licenses. The
Department, in this process, has focused on "Medicaid financing
and reimbursement for those providers that are practicing under
general supervision of dental staff". The Department has
participated in "expanding private capacity" and has been
supportive of the program encouraging "tribal expansion and
provision of care to Indian Health Service (IHS) beneficiaries
in the State".
Senator Olson asked whether he would be correct in communicating
to his constituents in the IHS program that Dr. Whistler and the
Department were supportive of the program.
Dr. Whistler stated that the Department has been and would
continue to support IHS activities. As a dental officer of the
State, he is aware that this model has been successful in New
Zealand, Australia, Great Britain and other countries. The
dental access issue is widespread in the United States, and this
concept and others have been discussed. The American Dental
Hygiene Association has proposed "an expanded dental hygiene
model to address some of these same issues." Numerous
discussions between private dentistry and public health dentists
have occurred on the issue of how to meet the needs of "the
underserved". Personally, he believed this program was worthy of
consideration and could work. It has been successfully
implemented in other areas of the world. He agreed that the
program should be evaluated to ensure that it would be "an
appropriate model for the State".
10:01:49 AM
ANDY POPE, a senior citizen, testified in Juneau in support of
the bill. Senior citizens, particularly low-income seniors, "are
probably the only class [of citizens] in this State excluded
from the dental health care". Native health corporations provide
dental care to Natives and employed people have access to
employer insurance plans. Seniors cannot purchase private
insurance, and if it were available, the cost would exceed
senior's financial capacity. "There are programs for alcoholics
and narcotics, but not low-income seniors." This is "an overdue
benefit" for seniors. The bill is "well constructed" and the
$1,150 per person annual limit would provide "a safety cap",
which, by requiring people to participate for expenses above the
limit, would curtail excessive expenses. However, people might
have a problem finding a dentist "that would let you get
something done for a down payment". He doubted the program would
escalate out of control. "All individuals would be treated the
same". The $1,150 per person limit "is reasonable", and the
termination date would control the parameters of the program. He
urged the Committee to adopt this "long overdue" legislation.
10:04:25 AM
DR. KATHINKA WHITE, Representative, Alaska Primary Care
Association, Inc., spoke in support of the bill. The Association
"represents 24 health care organizations operating 115 non-
profit community health centers and other safety net providers"
that offer health and dental care to "the uninsured,
underinsured, underserved populations in the State". Her
testimony was as follows.
I am speaking to you on behalf of Alaskans that remain
untreated victims of our nation's silent epidemic, oral
disease. Dental carries and periodontal disease are
infectious diseases caused by the transmission of bacteria
from the parent to child or from partner to partner. In the
year 2000, in the publication "Oral Health in America" the
Surgeon General released a milestone report that provided
overwhelming evidence of this epidemic. It emphasized that
the mouth is a point of entry for infection, which can
spread to other parts of the body and pointed to emerging
associations between oral diseases and other physical
ailments such as diabetes, heart disease, strokes, adverse
pregnancy outcomes including low birth weight babies. The
report makes it clear that oral health is integral to
overall health. Oral health care represents the most
frequently reported unmet health need among low-income
persons.
The inability to access proper dental health resources has
had devastating personal consequences for many Alaskans,
including severe oral facial pain, infection, impaired
ability to eat, poor diet, nutritional status, speech
difficulties, lost work days, and unnecessary tooth loss.
Currently dental services for adults are limited to the
relief of pain and infection only. These services do not
include root canals resulting in the extraction of most
teeth. Many individuals would rather live in continuous
pain than have their teeth extracted because the social
consequences of oral disfigurement diminishes their self-
image and sense of self worth. Adults without adequate
dental care resources express a feeling that their lack of
dental coverage and resulting inability to get appropriate
dental care reflects society's lack of recognition of them
as people with intrinsic value.
The Surgeon General's report also noted this relationship
between oral facial disfigurement due to oral disease and
the associated social stigma, low esteem, and anxiety
experienced which in turn limits their educational, career,
and marriage opportunities. Among adults seeking jobs those
with visual carries and missing teeth were less employable
than those with healthy smiles, resulting in increased
numbers of adults on state funding ATAP [Alaska Temporary
Assistance Program], unemployment, and food stamp programs.
In closing, oral health means much more than healthy teeth.
Oral health is integral to the general health and well
being of all Alaskans. Not allowing dental care benefits
that include prevention and routine dental care knowingly
puts our most vulnerable citizens at a greater health risk.
Alaska cannot afford these long-term financial and human
welfare costs. Alaska Primary Care Association and the
Municipality of Anchorage support HB 105 and believe its
time for the dental Medicaid program to be restructured to
include preventative and restorative services. Thank you.
10:08:14 AM
Co-Chair Wilken asked whether the Primary Care Association (PCA)
had contacted the Alaska Dental Board in support of issuing
temporary dental licenses. The issuing of these licenses would
assist in serving some of the people she had spoken of.
Dr. White was unsure. She was aware, however, that the Alaska
Dental Board had not taken any action in that regard. PCA has
taken a position in support of the dental health aide program.
She also supported that program as she had personally worked in
many remote Bush villages and could attest to the skills,
knowledge, and empathy of the people involved in the program.
Co-Chair Wilken thought that the PCA's "voice would be very
powerful" in bringing the temporary license issue to the
attention of the Alaska Dental Board. Their participation could
advance the efforts included in this legislation. Therefore, he
urged her organization to investigate how other states'
experiences with temporary dental licenses could assist in
allowing "dentists to come and serve some of the less abled of
our society".
Dr. White responded positively to Co-Chair Wilken's suggestion.
The Association would support this endeavor, as many of its
member "community health centers are under-served. That's a big
problem for us." She was currently involved in an effort to
create an Alaska oral health care partnership to provide "more
dental care and better retention in the State".
Co-Chair Wilken appreciated Dr. White's comments.
Senator Olson asked the number of dentists employed by PCA.
Dr. White stated she was the sole PCA dentist. PCA is advancing
the aforementioned oral health network to improve access to
dental care "by establishing a more cohesive structure with the
community health center dental clinics", furthering a shared
provider program to improve dental care access, and advancing
other aspects to improve dental care opportunities through the
organization.
10:11:24 AM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority, thanked the Committee for considering this bill.
AMHTA is interested "in this bill and dental services in general
because" many of AMHTA's "beneficiaries have tremendous dental
needs". AMHTA annually funds a mini-grant program that "provides
grants of up to $3,000 directly to individual beneficiaries for
a wide range of things" such as laptop computers, a car to
transport them to work, or other expenses that would improve
their quality of life. AMHTA "was stunned" to find that
approximately 70 to 80 percent of the mini-grant funding was
used for dental services. Spending one's mini-grant funds on
dental care would not be expected to be "way up on people's list
of things they want to do in their spare time or with any
additional dollars they might have".
Mr. Jessee noted AMHTA worked closely with the Department to
construct a bill with cost containment provisions such as the
individual dental service limit and the termination date. In
addition to working on this "very important bill", AMHTA is
working on a program through which dentists could donate dental
service and be compensated for their out of pocket expenses.
Another effort being advanced by AMHTA is the development of
partnerships with community health centers "to get them up and
running on providing more comprehensive dental care".
Nonetheless, the funding mechanism proposed in this bill "is
critical" to these endeavors and to meeting the dental needs of
AMHTA beneficiaries.
10:13:54 AM
There being no further testimony, Co-Chair Green ordered the
bill HELD in Committee in order to develop language addressing
Co-Chair Wilken's concern.
10:14:22 AM
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