Legislature(2023 - 2024)ADAMS 519
04/26/2023 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Governor's Appointments: Brett Huber, Alaska Oil and Gas Conservation Commission; Robert Doyle, Regulatory Commission of Alaska | |
| SB57 | |
| SB58 | |
| HB28 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 58 | TELECONFERENCED | |
| + | SB 57 | TELECONFERENCED | |
| + | SB 58 | TELECONFERENCED | |
| + | HB 28 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 58
"An Act relating to Medicaid eligibility; expanding
eligibility for postpartum mothers; conditioning the
expansion of eligibility on approval by the United
States Department of Health and Human Services; and
providing for an effective date."
2:24:17 PM
EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH,
relayed that Dr. Zink was currently in another committee
meeting and would join as soon as she was able.
Co-Chair Foster asked for a quick summary of the bill.
Ms. Ricci replied that the bill would extend Medicaid
coverage for postpartum mothers from 60 days to 12 months.
Representative Stapp MOVED to ADOPT Amendment 1, 33-
GS1583\A.1 (Dunmire, 4/25/23) (copy on file) [note: due to
the amendment length it has not been included here. See
copy on file for details].
Co-Chair Foster OBJECTED for discussion.
Representative Stapp explained the amendment. The amendment
would increase eligibility of postpartum coverage from 200
percent to 225 percent of the federal poverty line. He
explained there was a certain population of individuals in
between income requirements who did not quite make enough
money to afford health insurance, but during the expansion
of the postpartum coverage they may fall into a category
with no health insurance coverage. He stated it was his
goal to help make Alaska one of the most pro-family states
in the union. He thought the best way to do so was to
ensure certain coverage was extended to segments of the
population who were unable to get quality healthcare
because they effectively made $3 more an hour. The
amendment would cover more of those women and would allow
them to have quality healthcare.
Co-Chair Foster asked what the impact to the fiscal note
would be.
Representative Stapp answered that so far the amendment
would add an additional $1.5 million to the bill and would
cover up to 450 more women.
Co-Chair Foster observed that the federal portion was $6.4
million and the state portion was $2.6 million. He asked
about the federal/state funding breakdown.
Representative Stapp answered it was the state GF, which
leveraged substantial federal funding through the Medicaid
program. He detailed that the Federal Medical Assistance
Percentage (FMAP) was 70 percent with 30 percent funded by
the state.
2:28:54 PM
Representative Galvin fully supported the amendment. She
did not think it was possible to do enough given current
data with regard to children and pregnant moms and rates of
issues downstream. She asked about any assessment on the
savings given upstream healthcare costs.
DR. ANNE ZINK, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH,
answered that savings would be hard to calculate for the
bill. However, the department had submitted data showing
the best return on investment for kids and moms would
result in the first year of life. She highlighted the
importance of supporting the mental and physical health of
mothers, which in turn impacted adverse childhood
experiences. She shared statistics indicating that 26
percent more children would receive their first well child
checks if their mom had access to health insurance. There
was evidence of dental care and immunizations being able to
move upstream along those lines. She relayed that the
national CBO [Congressional Budget Office] looked at the
long-term savings and included the service as an option due
to its importance moving forward as a country. She stated
that it was challenging to calculate the savings for Alaska
and therefore it was not included in the fiscal note. The
fiscal note only included the cost associated with people
using care. She noted the number of people using the care
would be very small.
2:31:46 PM
Ms. Ricci spoke to the proposed amendment. Initially the
department had looked at the number of women between the
ages of 15 and 45 in Alaska and based on the community
population survey, the department determined there were
about 7,000 women with an income between 200 and 220
percent of the federal poverty level. There were
approximately 64.3 births per 1,000, resulting in
approximately 450 births per year in the population. The
department had then applied the $566 per mother per month
to the 450 births per year that would be covered under the
amendment. The calculation applied coverage to nine months
of pregnancy and 12 months of postpartum coverage. The
estimate was still being dialed in, but it was
approximately $5.3 million. The state would be responsible
for 20 percent, estimated at $1.5 million.
Representative Galvin appreciated the responses, which were
helpful for the committee to understand the full picture
when thinking about how to expand and provide better
services, particularly in light that the implementation
could not take place for over a year. She considered the
opportunity to provide additional coverage to 450 women and
believed it would result in less emergency care.
Additionally, she thought about the importance of early
identification of learning issues with regard to the
education system. She highlighted the downstream cost
associated with remedial work within education and how the
costs had been considered on a national level. She believed
there may be some available numbers for national savings
with regard to making the investment early. She looked
forward to hearing how the program went and was interested
in local Alaska data. She could not think of anything more
important in terms of an investment.
2:34:46 PM
Representative Hannan referred to Representative Stapp's
explanation that Amendment 1 would move from 200 to 225 of
the federal poverty line. She noted the brackets in the
amendment specified the number 175. She presumed the figure
reflected current statute.
Representative Stapp replied that Alaska's effective
statutes regarding many of the Medicaid rates were not
accurate. Following the passage of Medicaid expansion, the
Centers for Medicare and Medicaid Services (CMS) required
the state to cover people at higher levels of poverty line.
He explained that most of the statutes did not reflect the
change. He deferred to the department for additional
detail.
Ms. Ricci responded that in 2014 there had been nationwide
changes in the Medicaid program and income levels were
calculated based on modified adjusted gross income (MAGI).
States were required to adopt the change for certain
Medicaid categories, resulting in an effective 200 percent
rate of the federal poverty level.
Representative Hannan highlighted the importance of
ensuring babies' safety. She noted the increase [proposed
in the amendment] was much smaller in reality than when
compared to statute. She supported the amendment and the
bill.
2:36:58 PM
Representative Ortiz thanked Ms. Ricci for her explanation
of how the department arrived at the 450 [births per year
in Alaska within the particular population].
Representative Coulombe thanked Representative Stapp for
proposing the amendment. She appreciated the detailed work
to ensure the bill covered many women as possible.
Representative Josephson referenced Ms. Ricci's statement
that the department was still vetting the number included
in its fiscal note. He asked for verification the number
would be in the range of $1.5 million.
Ms. Ricci replied that it was what the department believed
based on the numbers. The department was currently working
with its divisions to ensure it had contemplated any
additional unintended cost. The department was also working
actively with CMS to ensure it understood any changes that
the federal agency may require. She confirmed that the
department anticipated the cost would be approximately $5.3
million total cost including approximately $1.5 million in
undesignated general funds.
Representative Josephson asked for verification there was
nothing under Title 42 (the U.S. code) or CMS that would
prohibit going to the proposed rate.
Ms. Ricci confirmed there was nothing she was aware of that
would prohibit the change. She noted there were several
other states that had implemented rates at the same level
or higher. She noted it was a matter of clearly
understanding the process CMS required in order for the
state to make the changes.
2:38:57 PM
Dr. Zink emphasized that the estimates looked at previous
services a mother needed and used. She clarified it did not
mean it was the amount that would be spent or had to be
spent. There was a lot of work being done by the Department
of Health to decrease the need in order to be able to move
upstream to create preventative services outside of the
specific area.
Co-Chair Foster WITHDREW the OBJECTION.
There being NO further OBJECTION, Amendment 1 was ADOPTED.
Co-Chair Edgmon MOVED to REPORT HCS SB 58(FIN) out of
committee with individual recommendations and the
accompanying fiscal notes.
There being NO OBJECTION, it was so ordered.
HCS SB 58(FIN) was REPORTED out of committee with a "do
pass" recommendation and with two new fiscal impact notes
from the Department of Health.