Legislature(2023 - 2024)ADAMS 519
04/26/2024 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB174 | |
| HB169 | |
| HB232 | |
| HB260 | |
| HB368 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 260 | TELECONFERENCED | |
| += | HB 368 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 174 | TELECONFERENCED | |
| += | HB 169 | TELECONFERENCED | |
| + | HB 232 | TELECONFERENCED | |
HOUSE BILL NO. 260
"An Act repealing programs for catastrophic illness
assistance and medical assistance for chronic and
acute medical conditions."
4:43:46 PM
AT EASE
4:44:30 PM
RECONVENED
Co-Chair Foster invited the bill sponsor and staff to come
to the table.
REPRESENTATIVE WILL STAPP, SPONSOR, introduced himself.
HONOUR MILLER-AUSTIN, STAFF, REPRESENTATIVE WILL STAPP,
introduced herself.
Representative Stapp explained that he had been going
through the operating budget book and in light of the SNAP
[Supplemental Nutrition Assistance Program] backlog he had
visited some of the Division of Public Assistance (DPA)
facilities in Fairbanks and across the state to try to
determine what kind of administration burden was plaguing
the Department of Health (DOH). In his conversations with
department staff, he had discovered the Catastrophic Acute
Medical Assistance (CAMA) program. He had been told by the
DPA office in Fairbanks that there was no one on the
program, yet the office still had to process applications.
He had discovered that in the past several years there had
only been one person in the program. In response, he had
asked the department a series of questions including the
number of applications it processed for CAMA in the
previous year. The department responded that it processed
6,226 applications and had approved no one. He thought it
seemed administratively wasteful and wondered how no one
qualified for the program.
Representative Stapp explained that the nucleus of the
program was effectively rendered outmoded when the
Affordable Care Act (ACA) passed, and Medicaid expansion
occurred. He explained that individuals enrolled in CAMA
basically fell off a cliff post-2015 in Alaska. He
elaborated that CAMA was designed for individuals who did
not qualify for Medicaid and could not get health insurance
on their own. There was a negative fiscal note associated
with the bill. He asked his staff to review the sectional
analysis.
4:47:42 PM
Ms. Miller-Austin reviewed the sectional analysis (copy on
file):
Section 1 Amends existing legislation to remove
references to programs for catastrophic illness
assistance and medical assistance for chronic and
acute conditions.
Section 2 Allows the issuance of subpoenas for
investigations related to medical assistance programs
removing references to repealed programs.
Section 3 Requires providers to grant access to
records for medical assistance recipients and allows
audits with adjustments for the repealed programs.
Section 4 Defines medical assistance fraud and
specifies offenses related to medical assistance
programs, updating references to the repealed
programs.
Section 5 Addresses exclusion from medical assistance
programs based on certain offenses with adjustments
for repealed programs.
Section 6 Updates the definition of medical assistance
program to exclude the repealed programs.
Section 7 Updates the definition of medical assistance
provider to include the repealed programs.
Section 8 Updates the definitions of services to
exclude the repealed programs.
Section 9 Adjusts regulations for civil history checks
to exclude references to the repealed programs.
Section 10 Repeals specific sections of existing law
related to the repealed programs.
Section 11 Specifies the applicability of amendments
to offenses committed after the effective date of the
act.
Section 12 Provides transition provisions for ongoing
investigations and access to records related to
services provided before the effective date of the
act.
4:49:20 PM
Representative Hannan asked how the state received
applications from 6,226 people for a program that no one
was eligible for. She was concerned that there was a group
of people that should have been walked through a different
program. She asked if the individuals got there on their
own.
Representative Stapp responded that statute required it to
be on the front page of the application. He elaborated that
when a person went to the DPA office to fill out an
application, there were "a bunch of boxes that people can
check." He detailed that often when individuals applied for
public assistance, many people checked all of the boxes on
the form. He expounded that when a person checked all of
the boxes on the form the department was required to
investigate whether or not an individual qualified for the
program. He explained it was the reason for the high number
of applications and so few approvals. The bill would repeal
the program because it was the only way he could get the
box for the [CAMA] program removed from the form.
Representative Josephson asked if the box individuals
checked "was their entrée to Medicaid expansion or the
Affordable Care Act."
Representative Stapp responded, "No." He explained that
there was a series of different boxes on a one-page form
including things like SNAP and Medicaid. He stated that one
box was for general relief and another was for CAMA. He
stated that there were individuals who checked all of the
boxes on the form that eligibility technicians referred to
as shotgun applications. He elaborated that the forms were
multiple pages with a lot of information the applicant
needed to fill out. He stated it was not really
unreasonable to think that when an individual reached the
"check the box portion" of the form that they checked all
of the boxes without giving that much thought to the
process.
Representative Josephson asked if the burden of telling
individuals they did not qualify for something (but they
would qualify for something else) was $154,000 per year.
Representative Stapp answered that two things were
occurring. One was the appropriation on the grants and
benefits line. He noted that the budget book showed that
the actual for FY 23 was $1.00. The legislature
appropriated the money in the grants and benefit lines as
if people would qualify for the program, but because no one
did, the money lapsed or the department had authority to
move up to $10 million around; therefore, sometimes the
money was likely spent through the RSA [Reimbursable
Services Agreement] process. He relayed that the real cost
to the program was in the processing time of DPA
technicians. He had asked the department how long it took
to process one of the applications on average. The answer
was 90 minutes and was included in writing in members' bill
packets. He relayed that multiplying $6,226 times 90
minutes resulted in about 13,000 man hours. He expounded
that based on the average wage of a DPA technician, the
cost was around $400,000 in administrative time and payroll
as opposed to the grants and benefits line shown in the
fiscal note. He remarked that one of the fascinating things
about being on the House Finance Committee was that the
committee just saw the money allocated to the line item and
it did not see the cost of administering the program.
4:53:20 PM
Co-Chair Foster OPENED public testimony.
Co-Chair Foster CLOSED public testimony.
4:54:18 PM
Representative Galvin referenced the sponsor statement
(copy on file) and observed that two applicants had
qualified for the program in 2021 after ACA. She asked why
and what happened to the individuals.
Representative Stapp deferred the question to his staff.
Ms. Miller-Austin responded the individuals fell into the
window of the five-year waiting period where individuals
coming to the United States from another country could not
qualify for Medicaid during that time period.
Representative Galvin remarked that the U.S. had recently
seen quite a few people coming in from Ukraine, Somalia,
and other countries. She asked if rules had been changed
meaning there would never be a similar situation to the two
individuals who qualified [in 2021].
Representative Stapp responded that there was a very slim
window of individuals who could in theory still qualify for
CAMA; however, the individuals qualified for health
insurance through the ACA. He stated that having CAMA as
opposed to a policy through the ACA was more
disadvantageous for the individual, especially because it
was income based. He detailed that the [two] individuals
were eligible for CAMA because of certain standards, but
refugees were exempt from the five-year waiting period on
the Medicaid program. He explained that the situation
basically involved legal immigrants who had not been in the
state for five years. He relayed that those individuals
were also legally eligible for ACA. He stated that in terms
of the best interest of the individual, it was much more
advantageous for them to buy a policy through ACA.
Representative Galvin referred to the potential for new
leadership in the U.S. government later in the year and the
possibility of ACA going away. She asked if the scenario
would mean the state would look at going back to using
CAMA.
Representative Stapp responded that even if it were
possible, the program should not be designed like CAMA. He
considered a scenario where ACA was eliminated. He stated
it would then be necessary to unwind Medicaid expansion. He
suggested that under the scenario the state should create a
program similar to the old CHIP program the state used to
have. He stated that CAMA was an antiquated program. He
deferred to his staff to provide additional detail on the
program's history.
Ms. Miller-Austin responded that the program was designed
to help middle class recipients who were too young for
Medicare and with incomes too high to qualify for Medicaid
who were not covered by health insurance or whose insurance
was insufficient to withstand a catastrophic illness
episode without jeopardizing their financial resources,
livelihood, and essential assets. She added that CAMA was
established in 1986. She noted that since that time how
coverage was obtained had progressed.
4:58:58 PM
Representative Galvin understood that Medicaid expansion
and other things had helped fill the gap since then. She
referenced the 13,000 man hours Representative Stapp
discussed. She presumed that some of the applicants would
need some sort of referral and would still need to fill out
an application for a different program within DPS. She
wanted to ensure that Representative Stapp had consulted
with DPS on the topic.
Representative Stapp answered that the department did not
break out the programs individually, which he believed was
a mistake in how it tracked workflow. He remarked that he
had another bill addressing the issue. He stated that all
he could do was compare the answers from the department
with the number of applications. He suggested that the next
legislature consider mandating the department to track its
workflow in order for the legislature to better understand
how long and arduous the process was and to look for
efficiencies, especially with a department that had a lot
of trouble with administrative workload.
Representative Galvin asked if Representative Stapp
consulted with DPA and if the director agreed his
conclusions made sense.
Representative Stapp responded affirmatively.
Co-Chair Foster thanked the bill sponsor.
HB 260 was HEARD and HELD in committee for further
consideration.
5:02:04 PM
AT EASE
6:05:33 PM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB260 Additional Documents-January 2024 Dept of Health 01.31.2024.pdf |
HFIN 4/26/2024 1:30:00 PM |
HB 260 |
| HB260 Sectional Analysis 02.01.2024.pdf |
HFIN 4/26/2024 1:30:00 PM |
HB 260 |
| HB260 FY25 Gov Operating Budget for DOH 02.01.2024.pdf |
HFIN 4/26/2024 1:30:00 PM |
HB 260 |
| HB260 Sponsor Statement 02.01.2024.pdf |
HFIN 4/26/2024 1:30:00 PM |
HB 260 |
| HB 368 Legal Memo 042424.pdf |
HFIN 4/26/2024 1:30:00 PM |
HB 368 |