Legislature(2025 - 2026)DAVIS 106
05/06/2025 03:15 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HJR17 | |
| HB185 | |
| HB141 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HJR 17 | TELECONFERENCED | |
| *+ | HB 185 | TELECONFERENCED | |
| += | HB 141 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 185-MEDICAL ASSISTANCE; FAMILY PLANNING
3:48:31 PM
CO-CHAIR MINA announced that the next order of business would be
HOUSE BILL NO. 185, "An Act relating to medical assistance
eligibility for family planning services; and providing for an
effective date."
3:49:02 PM
REPRESENTATIVE CAROLYN HALL, Alaska State Legislature, as prime
sponsor, gave the sponsor statement for HB 185 [included in the
committee file], which read as follows [original punctuation
provided]:
House Bill 185 will create a Family Planning State
Plan Amendment that expands Medicaid coverage to
provide family planning services to Alaskans. Since
2001, Alaska has had the highest rate of infant
mortality and rising preterm birth rates in the U.S..
Currently, Alaskans at or below 138% of the federal
poverty level (FPL) qualify for full Medicaid
coverage. To qualify for Medicaid pregnancy coverage,
Alaskans must be at 200% FPL. This bill would expand
the eligibility limits to 225% FPL. HB 185 will be a
cost-effective investment for Alaska, the Federal
Government pays 90% of Medicaid's family planning
services, with a 10% match from the state. The state
will save $7 for every one dollar it spends on family
planning for unintended pregnancy costs and long-term
social services costs under Medicaid expansion. The
Family State Plan Amendment will improve birth
outcomes, empower Alaskans to decide whether to grow
their families, and reduce infant mortality and
preterm birth rates. Additionally, with this expansion
of Medicaid, preventive screenings for STIs, HIV,
cervical, and breast cancers will be included.
REPRESENTATIVE HALL moved to a PowerPoint presentation, titled,
"House Bill 185: Medical Assistance Eligibility for Family
Planning Services" [hard copy in the committee file]. She moved
to slide 2, an introduction, which read as follows [original
punctuation provided]:
? Federal Government pays 90% of
Medicaid family planning services;
10% match from the state.
? State will save $7 for every one dollar spent
on family planning.
? The SPA will:
? improve birth outcomes
? empower Alaskans to decide whether to grow
their families
? reduce infant mortality and preterm birth
rates.
? Additional services: preventive screenings for
sexually transmitted infections, HIV, & cervical and
breast cancers.
REPRESENTATIVE HALL moved to slide 3, an overview of a state
plan amendment, which read as follows [original punctuation
provided]:
? An agreement between a state & the Federal
government describing how the state administers its
Medicaid and Children's Health Insurance Programs
(CHIP).
? Assures a state will abide by Federal rules & may
claim matching funds.
? The state plan sets out groups of individuals to be
covered, services to be provided, methodologies for
providers to be reimbursed and the administrative
activities that are underway in the state.
REPRESENTATIVE HALL moved to slide 4, titled "Why do we need a
Family Planning State Plan Amendment (SPA) in Alaska?" She read
the bullet points from slide 4, which read as follows [original
punctuation provided]:
? Highest rates of infant mortality in U.S. since
2001.
? Alaska's preterm birth rate is rising among Medicaid
enrollees.
? Currently, eligible Medicaid families are at 138% of
the Federal Poverty Level (FPL).
REPRESENTATIVE HALL moved to slide 5, an overview of the federal
poverty line, which read as follows [original punctuation
provided]:
? Indicates the minimum amount of annual income that
an individual / family needs to pay for essentials.
? Based on the size of a household and where someone
lives.
? Alaska and Hawaii have higher Federal Poverty Levels
due to the higher cost of living. To qualify for
Medicaid pregnancy coverage Alaskans must meet 200%
FPL. HB185 would expand eligibility limits to 225%.
REPRESENTATIVE HALL moved to slide 6, titled "Where did the 225%
come from?" She read the bullet points from slide 6, which read
as follows [original punctuation provided]:
? Model language for the 225% FPL was inspired by 2023
legislation: HCS SB 58.
? HCS SB 58 extended postpartum Medicaid coverage for
new mothers from 60 days to 12 months.
Goal: lower and eliminate Alaska's high rate of infant
mortality.
REPRESENTATIVE HALL moved to slide 7 and drew committee members'
attention to a line graph representative of preterm birth rates
in Alaska and the United States from 2000 - 2023. She noted the
increase in preterm births in Alaska since 2012, particularly
for Alaska Natives.
REPRESENTATIVE HALL moved to slide 8 and gave an overview of
infant mortality rates in Alaska. Slide 8 read as follows
[original punctuation provided]:
? Based on data from the Alaska Department of Health
(DOH) Alaska's infant mortality rate is "43-83 deaths
per year."
? The DOH reported that deaths within 27 days
("neonatal mortality rate") have been lower than the
U.S. average and deaths from 28 days to 1 year
("postneonatal mortality rates") have been higher than
the U.S. average.
? 2022: "Alaska's infant mortality rate per 1,000 live
births: 6.6 (35th nationally); U.S. average: 5.6."
? 2023: "Alaska's infant mortality rate per 1,000 live
births: 7.3 U.S.: 5.6"
3:58:55 PM
REPRESENTATIVE HALL, in response to a question from
Representative Prax, stated that the maximum income for
eligibility would be 225 percent of the federal poverty line
under HB 185.
3:59:57 PM
REPRESENTATIVE SCHWANKE asked, under HB 185, what mechanism
would reduce the number of preterm births.
REPRESENTATIVE HALL responded that the mechanism would be
increased family planning services, available in person or via
telehealth. She noted that HB 185 would particularly help those
living in rural Alaska, increasing their access to healthcare.
REPRESENTATIVE SCHWANKE noted that the opportunity for induced
births has increased in rural Alaska and that it is very common
for rural Alaskans to be asked to come into towns early to
prepare for birth. She asserted that preterm births could be
intentionally done.
4:01:53 PM
REPRESENTATIVE GRAY noted that the fiscal note is very large and
stated his confusion regarding it. He listed the costs of
several contraceptives. He asked where the high cost of HB 185
would come from.
REPRESENTATIVE HALL deferred to her staff to answer
Representative Gray's question.
4:03:24 PM
JAYLY JACKSON, Staff, Representative Carolyn Hall, on behalf of
Representative Hall, prime sponsor, noted that there are two
fiscal notes. He said that part of the cost is related to
administrative services and part is for the actual Medicaid
services. He deferred to the Department of Health (DOH) to
answer the remainder of Representative Gray's question.
4:04:24 PM
KRISTIN DELFINO, Division Operations Manager, Division of
Healthcare Services, Department of Health, explained that the
fiscal note was calculated by generating the range of
individuals [2,800 to 4,200] that may be eligible under the
proposed legislation. She said that the average of that range,
3,500, was multiplied by the average cost for the current
individuals eligible for family planning services, which is
about $600.
4:05:50 PM
REPRESENTATIVE FIELDS asked if the fiscal note covers only the
costs, not savings, of HB 185.
MS. DELFINO confirmed that is correct.
REPRESENTATIVE FIELDS responded that this is part of a
structural problem, which extends beyond HB 185.
4:06:24 PM
MS. DELFINO, in response to questions from Representative Gray,
explained that $600 is the current average annual cost per
Medicaid member for family planning services. She stated that
$600 was then used to calculate the fiscal note for HB 185. Ms.
Delfino stated that it was anticipated that the 3,500 would be
new individuals not currently covered by Medicaid. She added
that people on Medicaid already receive birth control and family
planning services.
4:09:56 PM
MS. DELFINO, in response to Representative Prax, stated that the
fiscal impact was calculated under the assumption that the 3,500
new individuals would be eligible only for family planning
services under Medicaid.
4:10:56 PM
CHAIR MINA announced invited testimony.
4:11:19 PM
CLAUDIA HAINES, CEO, stated that Kachemak Bay Family Planning
Clinic (KBFPC) provides reproductive healthcare, sexual health
education, and family planning services to individuals with low
incomes. She said that reproductive healthcare is vital to a
person's wellbeing. She stated that 66 percent of KBFPC clients
rely on KBFPC for their healthcare and have no other primary
care provider, 30 percent are covered by Medicaid, and 24
percent have no insurance coverage. She added that since last
July, over 100 women have enrolled in the Alaska Breast and
Cervical Screening Assistance Program and many more have
received cancer screenings and follow-up care because of the
program. Ms. Haines stated that Alaskans experience high
sexually transmitted infection (STI) rates and high infant
mortality rates, which are directly linked to lack of access to
family planning services. She said that addressing these
serious public health issues requires long-term solutions and
strong partnerships.
4:14:29 PM
ROBIN HOLMES, MD, Medical Director, Kachemak Bay Family Planning
Clinic, said that preterm births from induction are due to
pregnancy complications. She stated that clients at her clinic
come to the clinic because of the accessibility. She said that
even if family planning services are guaranteed under Medicaid,
many clients do not go to primary physicians for several
reasons, including long distances and a lack of sliding scale
services. She stated that her clinic provides STI screening,
cervical screening, contraceptives, and family planning. She
described her typical day at the KBFPC and the variety of
resources she may provide in just one day. She said she
believes it is important to eliminate as many barriers as
possible to family planning services.
4:18:34 PM
REPRESENTATIVE RUFFRIDGE noted that there is administrative code
that defines a family planning service. He asked how that term
would be defined under HB 185.
4:19:44 PM
MS. DELFINO replied that she would get back to the committee.
4:20:06 PM
REPRESENTATIVE RUFFRIDGE requested a definition of child-bearing
age. He stated that he was under the impression that the
proposed legislation would only apply to women and asked if it
would also cover men.
REPRESENTATIVE HALL responded yes.
REPRESENTATIVE RUFFRIDGE asked what the [reproductive age range]
is for men.
REPRESENTATIVE HALL responded that she does not know but that is
a very good question.
4:22:20 PM
DR. HOLMES replied that under Title X, there are federal
definitions. She noted that men are [in reproductive range] for
a long time. She said that if a man could get an individual
pregnant or pass on an STI, then he is deserving of her clinic's
services. She emphasized that it is important for men to also
have access to family planning services.
4:24:04 PM
REPRESENTATIVE RUFFRIDGE referenced a bill from the Thirty-Third
Alaska State Legislature regarding increasing the upper limit
for receiving family planning coverage to 225 percent of the
federal poverty line. He said that legislation expanded
coverage to people who are pregnant. He asked what the goal is
of providing care to people before they become pregnant.
REPRESENTATIVE HALL responded that the goal of HB 185 is to
provide preventative care. She emphasized that STIs, cervical
and breast cancer screenings are all important services for an
individual to access before having a family.
REPRESENTATIVE RUFFRIDGE asked for clarification that the
proposed legislation is not expansion for all Medicaid services,
just family planning services.
4:26:35 PM
MS. DELFINO replied that that is correct and the fiscal note was
calculated based on that assumption.
4:27:02 PM
REPRESENTATIVE SCHWANKE noted that Alaska has a lower-than-
average infant mortality rate for infants under 28 days old, but
higher for infants between 28 days and 12 months old. She asked
what might be causing that.
4:28:03 PM
DR. HOLMES replied that she was unsure. She noted that there
are a lot of babies born prematurely and spend more time in
hospitals and, upon returning home, they have less access to
resources.
4:29:00 PM
REPRESENTATIVE GRAY said that this conversation is analogous to
the baby box conversation. He stated that it makes sense to
expand care for pre-pregnant women and that it is important to
have established care before becoming pregnant.
4:30:03 PM
REPRESENTATIVE HALL, in response to Representative Prax, stated
that other screenings could include STI screenings, breast and
cervical cancer screenings. She further deferred to Dr. Holmes.
DR. HOLMES responded that most of the evidence for lowering
infant mortality rates involves improving birth conditions and
reducing preterm births. She said that while birth control is
one important aspect of healthy family planning, it is not the
only. She said other services include STI screenings and
cervical/breast cancer screenings. She noted that Alaska has
very high rates of STIs compared to the rest of country,
including gonorrhea and syphilis.
4:32:41 PM
REPRESENTATIVE HALL, in response to a series of questions from
Representative Prax, stated that Senate Bill 58 from the 33rd
Legislature covered expansion of services for pregnant people.
She said that requiring insurance to cover birth control would
be a different concept. She noted that the proposed legislation
would expand only Medicaid family planning services.
Representative Hall added that HB 185 would expand services to
people who are not covered by insurance and that approximately
3,500 Alaskans would have greater access to healthcare, which
would address the high infant mortality rates.
4:36:52 PM
CHAIR MINA noted there was a public health notice put out last
year encouraging people of child-bearing age to get tested for
STIs, given that Alaska has some of the highest rates of
syphilis in particular.
[HB 185 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HJR 17 Sponsor Statement Version A.pdf |
HHSS 5/6/2025 3:15:00 PM |
HJR 17 |
| HJR 17 Version A.pdf |
HHSS 5/6/2025 3:15:00 PM |
HJR 17 |
| HB 185 Sponsor Statement.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |
| HB0185A.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |
| HB 185 Sectional Analysis.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |
| HB 185 Supporting Documents.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |
| HB 141 Draft CS Version N 05.05.25.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 141 |
| HB 185 Presentation.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |
| HB185-DOH-PAFS-5-2-25.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |
| HB185-DOH-MS-05-2-25.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |
| HB 185 Combined Bill Packet 05.05.25.pdf |
HHSS 5/6/2025 3:15:00 PM |
HB 185 |