Legislature(2017 - 2018)CAPITOL 106
05/04/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HJR20 | |
| HB234 | |
| HB236 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HJR 20 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 234 | TELECONFERENCED | |
| += | HB 236 | TELECONFERENCED | |
HJR 20-MEDICAID EXPANSION
3:08:49 PM
CHAIR SPOHNHOLZ announced that the first order of business would
be HOUSE JOINT RESOLUTION NO. 20, Urging the United States
Congress and the President of the United States to maintain
health insurance coverage for individuals currently covered by
Medicaid expansion.
3:09:04 PM
REPRESENTATIVE JUSTIN PARISH, Alaska State Legislature,
paraphrased from the Sponsor Statement for HJR 20, which read as
follows [original punctuation provided]:
This resolution urges our United States Congress and
the President of the United States to maintain the
Medicaid Expansion to cover individual health
insurance coverage. Health care is an essential
service for our residents.
Health care coverage also benefits employers as
healthy employees are more productive. Alaska has the
second highest rate of residents without health care
in the nation. This expansion has provided coverage to
more than 31,000 Alaskans who would otherwise not be
covered. As of March 31st, 2017, Alaska has received
$413 million total payments made under the expanded
program reducing the number of uninsured people
visiting emergency rooms and providing necessary
funding for behavioral health treatment and treatment
for substance abuse.
I would appreciate your support for this resolution to
maintain the federal funding for Medicaid Expansion.
REPRESENTATIVE PARISH pointed out that Alaska had the second
highest rate of residents without health care in the United
States.
3:11:55 PM
REPRESENTATIVE SULLIVAN-LEONARD asked how much money the State
of Alaska had paid in order to receive the federal funding for
Medicaid Expansion.
3:12:27 PM
LISA WORL, Staff, Representative Justin Parrish, Alaska State
Legislature, replied that the state match was five percent of
the total amount. She added that the Alaska Native population
had additional coverage through the Indian Health Service (IHS)
at 100 percent.
REPRESENTATIVE PARISH noted that for every $1 the state paid,
there was a federal match of $19.
3:13:07 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if the recent changes to
the Patient Protection and Affordable Care Act would have any
effect on Alaska.
REPRESENTATIVE PARISH offered his belief that Alaska may be
moving toward a per capita allocation of funds, which he deemed
as not good for Alaska given the disproportionate health care
costs and other systemic challenges in the state.
REPRESENTATIVE SULLIVAN-LEONARD asked for more explanation to
the per capita allocation.
REPRESENTATIVE PARISH explained that each state might be
allotted a certain amount of funds in proportion to its
population rather to than the actual economic and health needs
of the state.
3:14:35 PM
REPRESENTATIVE JOHNSTON directed attention to page 2, line 11,
of the proposed resolution, and read: "the state spends the
second lowest percentage of state funds on Medicaid." She asked
about the source of this information.
MS. WORL deferred to the representative from the Department of
Health and Social Services.
REPRESENTATIVE JOHNSTON asked about the reduction to
uncompensated care through Medicaid Expansion. She reported
that although the projection had been for Medicaid expansion to
reduce the expensive emergency room care and allow for more
preventative care, nationally and in Alaska emergency room care
had increased. She declared that the policy was not matching
the outcomes. She added that it was not just an increase to
emergency room usage but also to emergency room transport. She
expressed her concern with the statement on page 2, line 13.
3:16:28 PM
REPRESENTATIVE PARISH directed attention to page 2, line 13,
which read: "Whereas Medicaid expansion has reduced
uncompensated care provided by Alaska hospitals by tens of
millions of dollars, which helps reduce costs to all patents,"
and stated that this did not directly address the issue to which
Representative Johnston had referred. He opined that although
there was a higher overall use of emergency facilities,
previously people would have stayed home and "duct taped over
the injury." He stated that 31,000 more people, if an emergency
room visit was necessary, would now have some sort of funding
instead of receiving uncompensated care. He added that most
bankruptcies in the country were the result of medical debt.
3:18:28 PM
TOM CHARD, Executive Director, Alaska Behavioral Health
Association, explained that the Alaska Behavioral Health
Association was a group of leaders from about 60 mental health
and drug and alcohol treatment centers across the state. He
shared his experience from both before and after Medicaid
expansion in Alaska. He said that prior to September 2015, and
Medicaid expansion in Alaska, in order to qualify for Medicaid
an individual had to fall into one of several different
categories, which included: had a child or dependent; or, was
deemed to be disabled, which was often a designation through the
social security administration. He explained that for people
with mental illness, it was necessary to present paperwork to
the social security administration to initiate the process to be
deemed disabled in order to qualify for Medicaid. For
individuals with substance abuse disorders, as the social
security administration did not consider this a qualifying
disability, it did not make any difference whether a person was
poor or disabled. Consequently, there were many people who
could not access care, even as the grant system attempted to
"put a patch on that" with the use of unrestricted general
funds. He pointed out that the effects of untreated behavioral
health disorders were "really pressing our system." He
explained that Medicaid expansion offered some resources to
these individuals to allow access to treatment and care and that
although the system was gearing up to provide that access to
treatment, it was a heavy lift to transition a system which was
financed by grants to a system which was reimbursed by Medicaid.
He declared that his group was very supportive of Medicaid
expansion because the people who had needed treatment all along
could now get access to the necessary treatment. He added that
this was keeping families together and keeping people out of the
public safety and criminal justice system. He moved on to
discuss the national vote regarding the Patient Protection and
Affordable Care Act and discussed the opioid crisis and the
pandemic problems in the state with alcohol, drugs, and
untreated mental illness. He emphasized that there was a "very
high degree of uncertainty hanging out there right now." He
explained that many individuals had not had access to treatment
for years, and now that they had access, it was unknown for
whether there would be continued access. He acknowledged that
there were things in the Patient Protection and Affordable Care
Act that were not working and suggested to fix those things and
keep the things that were working. He emphasized that Medicaid
expansion was working phenomenally well, especially in Alaska,
and he expressed hope that people would receive the care and
treatment needed. He stated support for the proposed
resolution.
3:25:28 PM
REPRESENTATIVE JOHNSTON asked if, once someone received a social
security disability, they could return to work.
3:25:34 PM
MR. CHARD spoke about a program that attempted to get
individuals the necessary benefits counseling, so they could
return to work. He said there were therapeutic benefits to
work.
REPRESENTATIVE JOHNSTON asked about the outcomes for behavioral
health in those states that began Medicaid expansion before
Alaska. She declared that the problems with behavioral health
and homelessness were expanding nationally and asked if any
states were "doing it well."
MR. CHARD offered his belief that Department of Health and
Social Services had done an amazing amount of work on reform of
the behavioral health system to meet some of the gaps. He
declared that Medicaid expansion was a huge support. He
reported that some states were ahead, and that Alaska was
studying the health care service delivery systems of other
states.
REPRESENTATIVE JOHNSTON asked if Alaska was reviewing both
states with and without Medicaid expansion in its search for
best practices.
3:28:11 PM
MR. CHARD said that his group was conferring with associations
in the other states, always asking for what could be done with
the available resources. He stated that Medicaid expansion
offered more available resources. In reference to an earlier
question from Representative Sullivan-Leonard, he pointed out
that the essential health benefits included in the Patient
Protection and Affordable Care Act specifically called for
access to mental health and substance abuse treatment. He said
that current amendments to the Patient Protection and Affordable
Care Act would allow states to option out of or define as they
desire the essential health benefits. He asked that everyone
consider the impacts on access to mental health and substance
abuse treatment services, and what that essential health benefit
does for the people in the state.
3:30:07 PM
CHAIR SPOHNHOLZ shared her background while working with the
Salvation Army programs, and the difficulty for expanding when
necessary. She stated that Medicaid expansion met the needs and
asked what it could mean to those who need these services if the
program was cut back.
3:31:04 PM
MR. CHARD stated that as substance abuse was a grant-based
treatment system, it had been realized early on that significant
federal resource to pay for the same services would help the
state with budget problems by reducing the use of unrestricted
general funds. He declared that should Medicaid expansion
vanish, there would again be a reliance on the grant-based
system, currently reduced because of the new resource. He said
that the grant reduction had necessitated a need to identify
priority populations and that even some of the providers had to
limit their referral sources.
3:33:04 PM
CHAIR SPOHNHOLZ mused that a contraction of Medicaid expansion
would necessitate an increase of the unrestricted general funds
contribution.
MR. CHARD expressed his agreement. Without a rebalancing of
resources, even when pulling out the high-risk pool, there would
be increased pressure in the emergency departments, prisons, and
other places where unrestricted general funds were spent.
3:34:21 PM
VALERIE DAVIDSON, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), relayed that
the proposed resolution encouraged the continuation of the
Medicaid expansion program, and she shared more details about
the program and the experience with it in Alaska. She reported
that there were 32,958 Alaskans covered under Medicaid
expansion, about 4.48 percent of the state population. She
stated that about $445 million in claims had been paid for
services in the following areas: $126.4 million for inpatient
hospital services; $81.4 million for outpatient hospital
services; $109.7 million in professional and clinic services
such as specialists; and $30 million in behavioral health
services, which included mental health and substance use
disorder treatment services. She declared that behavioral
health coverage was critical to the criminal justice reform
efforts. She added that the claims also included $45.6 million
in prescriptions and $20 million in medically necessary travel,
which ensured that Alaskans without access to a specialist in
their community could be cared for in the next closest
community.
COMMISSIONER DAVIDSON spoke about the match rate for Medicaid
expansion and explained that states which had expanded beginning
on January 1, 2014, enjoyed three full calendar years at 100
percent federal match. Beginning in calendar year 2017, the
federal match was 95 percent, and the state paid 5 percent. In
calendar year 2018, the federal match was 94 percent; in
calendar year 2019, the federal match was 93 percent; and in
calendar year 2020, the federal match would become 90 percent.
She stated that for 2017, although the federal match was 95
percent, the effective state match rate was 3.26 percent because
for Indian Health Service (IHS) beneficiaries who were also
Medicaid beneficiaries and received services through an IHS
facility, the federal match was 100 percent. She reminded the
committee that Governor Walker had negotiated an agreement to
change the tribal claiming policy and allow 100 percent for
travel policy and services which began in an IHS facility but
were referred to a non-tribal facility to extend that level of
care. She reported that in the current fiscal year, the general
fund savings for Alaska had been about $32 million.
3:39:51 PM
REPRESENTATIVE SULLIVAN-LEONARD asked about the Medicaid
rewrite, and mused that the overall savings would be about $400
million. She noted that as there would be a decrease in federal
funding, there would be an increase in state funding.
3:40:36 PM
COMMISSIONER DAVIDSON asked to continue speaking about Medicaid
expansion and then come back to this question.
3:40:53 PM
CHAIR SPOHNHOLZ asked if the committee could hold its questions.
3:41:08 PM
COMMISSIONER DAVIDSON added that Medicaid expansion had infused
a significant amount of cash into the Alaska economy, almost
$445 million most of which was federal dollars. She noted that
this had a significant economic impact with a benefit to every
community in which health care was provided. She relayed that
the biggest beneficiaries of this economic boost were Anchorage
and the Matanuska-Susitna area. She reported that the current
administration had declared that Medicaid expansion and reform
move forward hand in hand, as the additional federal resources
from Medicaid expansion provided a cushion for providers to do
things more creatively. She shared that currently there were
significant gaps in the behavioral health care system, and that
over the past year, Department of Health and Social Services had
been engaged with providers and stakeholders to develop a new
way to provide behavioral health services in Alaska. She stated
that more flexibility was desired, as some of the current rules
did not provide the flexibility which Alaska needed. She
reported that Department of Health and Social Services was
negotiating for a 1115 waiver with the Centers for Medicare and
Medicaid Services, which would provide this flexibility. She
stated that Alaska had been challenged by a rule called the
Institutions for Mental Disease exclusion. This federal rule
stated that a facility with more than 16 treatment beds could
not bill for Medicaid. There had recently been an effort to
serve people in a homelike, less restrictive setting, which
meant that substance use treatment facilities in Alaska were
often too large. She reported that the Centers for Medicare and
Medicaid Services had indicated a willingness to amend the
existing 1115 Behavioral Health waivers to waive the
Institutions for Mental Disease exclusion. She spoke about
other reforms included in Senate Bill 74 which provided broad
authority for the Department of Health and Social Services to
look at new reform opportunities being made available and would
allow them to move forward quickly. She stated that there was
also provision to address the over-utilization of Medicaid
beneficiaries. She explained a voluntary program which would
reach out to Medicaid beneficiaries who over-utilized emergency
room services to help them find a primary care provider. She
shared that beneficiaries love having a primary care provider,
and that the department would follow up with these beneficiaries
to remind them of appointments, help with transportation, and
other issues. She shared that there was another mandatory
program for individuals with acute conditions which increased
contact; whereas another program pursued by the Alaska State
Hospital and Nursing Home Association was a public-private
partnership working with emergency departments. She relayed
that there was a coordinated care demonstration project looking
for interested parties for better care coordination services for
Medicaid beneficiaries in Alaska. She stated that the
department recognized the opportunity to get people treatment
with early intervention and to "build healthier Alaskans." She
pointed out that with early intervention for access to health
care services upon release from incarceration there was a much
better outcome for reduced recidivism. She declared that
Medicaid expansion was a critical component of criminal justice
reform.
REPRESENTATIVE JOHNSTON asked why the cost for uncompensated
care in the hospitals had already started to drop prior to
Medicaid expansion.
COMMISSIONER DAVIDSON said that this information had been
provided by the Alaska State Hospital and Nursing Home
Association.
CHAIR SPOHNHOLZ suggested that Alaska State Hospital and Nursing
Home Association be available for questions at the next House
Health and Social Services Standing Committee meeting.
3:54:04 PM
REPRESENTATIVE JOHNSTON asked if the Indian Health Services
(IHS) was fully responsible for the health care for those
qualified individuals.
3:54:29 PM
COMMISSIONER DAVIDSON explained that the IHS covered its
beneficiaries, Alaska Natives or American Indians, and that
federal law required IHS and tribally operated health facilities
to pursue third party reimbursement from private insurance,
Medicaid, Medicare, or any other source. She declared that IHS
was considered the payor of last resort under federal law. She
explained that the tribal health organizations in Alaska were
only funded at about 50 percent of their level of need based on
the federal assessment of necessary funding. In response to
Representative Johnston, she explained that the federal
government reimbursed at 100 percent for IHS beneficiaries who
were also Medicaid beneficiaries receiving their care through an
IHS facility, in recognition of the federal trust responsibility
to tribes and tribal members.
3:57:02 PM
REPRESENTATIVE SULLIVAN-LEONARD reflected on the increase of
state match for Medicaid expansion and asked how the projected
savings of $400 million would be accomplished.
COMMISSIONER DAVIDSON explained that the trends in Alaska since
2015 for the Medicaid program showed reduction in the amount of
general fund spending with increased federal participation
because of Medicaid expansion and the new tribal claiming
policy. She said that those referenced savings were over a six-
year period with the implementation of the reform opportunities,
which had reduced the general funds and increased the federal
match.
3:58:59 PM
REPRESENTATIVE TARR offered her belief that Medicaid expansion
would provide behavioral health services to many who would not
have had access to those services. She asked if there was any
tracking regarding these outcomes.
COMMISSIONER DAVIDSON stated that many people in Alaska had not
ever had access to health care. She reiterated that many
behavioral health providers offered what they could with the
resources they had. She reported that since September 1, 2015,
$30 million in behavioral health services had been provided to
Alaskans enrolled in Medicaid expansion. She relayed that many
of the providers were nonprofit, grass roots organizations,
which provided services to the best of their ability. She
pointed out that as there was a limit to the amount of charity
care offered while still being able to meet expenses, the
federal dollars from Medicaid expansion had allowed many
organizations to continue to provide services to Alaskans who
needed access to care.
4:01:38 PM
COMMISSIONER DAVIDSON shared that the department had received
letters "that just make you cry from people whose lives have
been saved." Without Medicaid expansion, many of these people
would not have been able to get the necessary services. She
declared that she was excited about the opportunity offered,
stating that "people can't work, they can't hunt, and they can't
fish, if they're not well enough to do so." She stated that it
was necessary to have Alaskans healthy enough to do the work in
any resource, and now, for the first time, 32,000 Alaskans had
access to health care which they did not have before.
4:03:13 PM
CHAIR SPOHNHOLZ offered her belief that health care was what
stands between many people and independence, self-sufficiency
and a vibrant quality of life. She acknowledged that although
there was a care for dollars, the reason was for people to
realize their full potential.
4:04:15 PM
REPRESENTATIVE TARR reflected on the Medicaid expansion effort
and the testimony regarding a pent-up demand from people who had
not had access to health care. She offered her belief that
there had been an expectation for an early on increase in costs
due to initial access and a need to "catch up on all their
health care needs." She asked if there was any way to follow
that trend.
4:05:23 PM
COMMISSIONER DAVIDSON expressed agreement that this had been the
experience of Alaska and other states. She pointed out that
Alaska had more people eligible for Medicaid expansion than
initially anticipated. She noted that also, because the Alaska
"economy unfortunately continues to tank," there were more
Alaskans eligible for regular Medicaid services. She reported
that a significant part of the spending was for inpatient
hospital care, as people had been putting off their health care
because they could not afford to go. This had included a lot of
lifesaving operations. She added that the cost of
pharmaceuticals was higher than expected, including treatments
for high blood pressure and diabetes. She noted that there was
also a high utilization for travel, as it was medically
necessary to access specialists who were not in the small
villages.
4:07:43 PM
CHAIR SPOHNHOLZ announced that HJR 20 would be held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HJR 20 Supporting Document - Medicaid-Expansion-Just-the-Facts-April-2016 5.1.2017.pdf |
HHSS 5/4/2017 3:00:00 PM HHSS 5/16/2017 3:00:00 PM |
HJR 20 |
| HJR 20 Supporting Document - State Savings From Medicaid OMB 5.1.2017.pdf |
HHSS 5/4/2017 3:00:00 PM HHSS 5/16/2017 3:00:00 PM |
HJR 20 |
| HJR 20 Supporting Document - Uncompensated care 5.1.2017.pdf |
HHSS 5/4/2017 3:00:00 PM HHSS 5/16/2017 3:00:00 PM |
HJR 20 |
| HJR 20 ver J 5.1.2017.PDF |
HHSS 5/4/2017 3:00:00 PM HHSS 5/16/2017 3:00:00 PM |
HJR 20 |
| HJR 20 Sponsor Statement 5.1.2017.pdf |
HHSS 5/4/2017 3:00:00 PM HHSS 5/16/2017 3:00:00 PM |
HJR 20 |
| HJR 20 Supporting Document - Medicaid Dashboard 5.1.2017.pdf |
HHSS 5/4/2017 3:00:00 PM HHSS 5/16/2017 3:00:00 PM |
HJR 20 |
| HB234 Supporting Document Chapter 18.09 Health Care Commission Statute.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB234 Supporting Document-AHCC Annual Report 2014.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB234 Supporting Document-AHCC-Audit 2013.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB234 Supporting Document-AHCC-Final-Report-Audit 2017.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB 234 ver A 4.17.17.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB234 Sponsor Statement 4.17.17.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB234 Fiscal Note DHSS--DSS 4.25.17.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB234 Supporting Document-Support Letter 4.24.17.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB234 Supporting Document Office of the Governor_ Administrative Order 246.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM |
HB 234 |
| HB 236 ver A.PDF |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM HHSS 9/28/2017 2:00:00 PM HHSS 2/6/2018 3:00:00 PM |
HB 236 |
| HB236 Sponsor Statement.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM HHSS 2/6/2018 3:00:00 PM |
HB 236 |
| HB236 Supporting Documents AARP Letter Support.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM HHSS 9/28/2017 2:00:00 PM HHSS 2/6/2018 3:00:00 PM |
HB 236 |
| HB236 Supporting Documents Alaska Commission on Aging.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM HHSS 9/28/2017 2:00:00 PM HHSS 2/6/2018 3:00:00 PM |
HB 236 |
| HB236 Supporting Documents Arneson Support Letter.pdf |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM HHSS 9/28/2017 2:00:00 PM HHSS 2/6/2018 3:00:00 PM |
HB 236 |
| HB236 Supporting Documents Senior Benefits Program Fact Sheet.PDF |
HHSS 4/25/2017 3:00:00 PM HHSS 4/27/2017 3:00:00 PM HHSS 5/4/2017 3:00:00 PM HHSS 2/6/2018 3:00:00 PM |
HB 236 |