03/11/2009 09:00 AM Senate FINANCE

SENATE BILL NO. 13                                                                                                            
                                                                                                                                
     "An Act relating to eligibility requirements for                                                                           
     medical assistance for certain children and pregnant                                                                       
     women; and providing for an effective date."                                                                               
                                                                                                                                
SENATOR BETTYE  DAVIS, SPONSOR,  introduced the bill  and her                                                                   
staff member.                                                                                                                   
                                                                                                                                
LYNNE  KORAL, INTERN,  SENATOR  BETTYE  DAVIS, discussed  the                                                                   
legislation,  which increases  eligibility limits for  Denali                                                                   
Kid  Care  (DKC) from  175  to  200 percent  of  the  federal                                                                   
poverty level  (FPL). She explained  that SB 13  restores the                                                                   
original level of the qualifying  income eligibility standard                                                                   
for the DKC program to 200 percent  of the FPL. She explained                                                                   
that  DKC is  considered  an enhanced  reimbursement  program                                                                   
with  up  to  70 percent  matching  funds  from  the  federal                                                                   
government's  State   Children's  Health  Insurance   Program                                                                   
(SCHIP), created in 1997.                                                                                                       
                                                                                                                                
Ms. Koral stated that uninsured  children with a medical need                                                                   
are four times  more likely to use emergency rooms  at a much                                                                   
higher  cost because  they tend  not to receive  care from  a                                                                   
regular care provider. Alaska  is one of five states who fund                                                                   
its  SCHIP program  below  200 percent  of  the FPL.  Private                                                                   
health  care  coverage  for children  has  declined  over  30                                                                   
percent in the  last 10 years and the deepening  recession is                                                                   
pulling more children and families  into the uninsured ranks.                                                                   
SB 13 makes insurance eligibility  accessible to an estimated                                                                   
1,277 additional  children and 225 additional  pregnant women                                                                   
in Alaska.                                                                                                                      
                                                                                                                                
9:36:34 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  commented  that  the  administration  does                                                                   
support CSSB 116.                                                                                                               
                                                                                                                                
Senator Huggins  asked if the administration  supports SB 13.                                                                   
Senator Bettye  Davis stated that  she had not  been informed                                                                   
about  a  lack  of  support  from   the  administration.  The                                                                   
department  stated that  they indeed  support an increase  in                                                                   
eligibility  limits to  200 percent  of the  FPL in the  last                                                                   
Senate Finance Committee meeting of 2/25/09.                                                                                    
                                                                                                                                
9:38:06 AM                                                                                                                    
                                                                                                                                
JON SHERWOOD, DIRECTOR, OFFICE  OF PROGRAM REVIEW, DEPARTMENT                                                                   
OF  HEALTH AND  SOCIAL SERVICES  (DHSS),  explained that  the                                                                   
Governor  publically supported  expanding income  eligibility                                                                   
levels  to 200  percent of  the FPL.  The Governor  expressed                                                                   
interest in provisions  such as premiums. He  stated that the                                                                   
administration does  not have a position in  opposition to SB
.                                                                                                                             
                                                                                                                                
Senator  Huggins asked  for the  contrast  between a  similar                                                                   
bill addressing  the increase of eligibility  limits for DKC.                                                                   
Mr.  Sherwood   answered  that  there  were   four  different                                                                   
proposals on the table to expand  the DKC program. Two of the                                                                   
bills expand beyond  200 percent of the FPL  with some degree                                                                   
of cost sharing  in the form of premiums and  or co-pays. One                                                                   
bill expands  from 175 to  250 percent  of the FPL  with cost                                                                   
sharing in the  form of premiums beginning at  175 percent of                                                                   
the FPL and expanding for children only.                                                                                        
                                                                                                                                
Senator  Huggins   assumed  that   the  specialists   in  the                                                                   
department  favor one  bill that best  supports children  and                                                                   
remains cost effective.                                                                                                         
                                                                                                                                
9:40:43 AM                                                                                                                    
                                                                                                                                
Mr.  Sherwood  stated  that  he  had  disclosed  all  of  the                                                                   
information that was  available to him. He did  not feel that                                                                   
he could answer the question further.                                                                                           
                                                                                                                                
Senator  Huggins encouraged  an  effective  means of  helping                                                                   
Alaskans   with   healthcare   costs   and   he   asked   the                                                                   
administration to come forward with a position.                                                                                 
                                                                                                                                
Senator  Bettye Davis  stated that  the cost  of the  various                                                                   
bills remains  the same,  however, SB  13 allows children  to                                                                   
obtain coverage as soon as possible.  She emphasized that the                                                                   
proper action was to bring as  many children onto DKC as soon                                                                   
as possible.  She maintained  that cost  sharing was  still a                                                                   
possibility  with   another  bill.  She  stressed   that  the                                                                   
solitary goal of SB 13 was raising  income eligibility limits                                                                   
to 200 percent of the FPL.                                                                                                      
                                                                                                                                
Senator  Huggins stated  that  he preferred  an omnibus  bill                                                                   
that combines the best methods within the available means.                                                                      
                                                                                                                                
9:43:33 AM                                                                                                                    
                                                                                                                                
Senator Bettye Davis stated that  SB 13 could pass while work                                                                   
occurs with the  other bills providing the  accomplishment of                                                                   
many good ideas.                                                                                                                
                                                                                                                                
Co-Chair   Stedman  asked   if   additional  employees   were                                                                   
necessary  to process  the paperwork.  Mr. Sherwood  answered                                                                   
that the program's caseload will  increase by 1500 additional                                                                   
individuals.  He informed  that  given the  current  caseload                                                                   
averages,  two additional employees  are necessary.  Co-Chair                                                                   
Stedman  asked   if  the   positions  were  eliminated   when                                                                   
eligibility was reduced in 2003.                                                                                                
                                                                                                                                
9:45:43 AM                                                                                                                    
                                                                                                                                
ELLIE FITZJARRALD,  DIRECTOR, DIVISION OF  PUBLIC ASSISTANCE,                                                                   
DEPARTMENT OF  HEALTH AND SOCIAL  SERVICES, commented  on the                                                                   
elimination  of positions  with  eligibility reductions.  The                                                                   
two  positions requested  for  SB 13  are due  to changes  in                                                                   
Medicaid  requirements surrounding  citizenship  verification                                                                   
and  the  emphasis   on  payment  accuracy  to   ensure  that                                                                   
applicants are  eligible for the program. When  income scales                                                                   
are increased,  more time  is needed  to ensure  eligibility.                                                                   
The  request for  additional employees  serves the  increased                                                                   
number of applicants.                                                                                                           
                                                                                                                                
9:47:58 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  spoke to the three fiscal  notes increasing                                                                   
the general  fund spending $861,000  in FY09 and  $940,000 in                                                                   
FY10.                                                                                                                           
                                                                                                                                
Senator Bettye Davis  stated that she wished for  the bill to                                                                   
pass out during the current hearing.                                                                                            
                                                                                                                                
Co-Chair Hoffman MOVED to report  SB 13 out of Committee with                                                                   
individual  recommendations   and  the  accompanying   fiscal                                                                   
notes. There being NO OBJECTION, it was so ordered.                                                                             
                                                                                                                                
SB 13 was REPORTED out of Committee  with "no recommendation"                                                                   
and  with a  new  fiscal impact  note  by the  Department  of                                                                   
Health and Social Services and  with two previously published                                                                   
fiscal impact notes: FN1 (DHS) and FN2 (DHS).