Legislature(2023 - 2024)BUTROVICH 205
02/09/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB45 | |
| SB58 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 58 | TELECONFERENCED | |
| += | SB 45 | TELECONFERENCED | |
SB 58-MEDICAID ELIGIBILITY: POSTPARTUM MOTHERS
3:53:57 PM
CHAIR WILSON announced the consideration of 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."
3:54:35 PM
DR. ANNE ZINK, Chief Medical Officer, Department of Health, said
SB 58 addresses a postpartum Medicaid coverage extension. She
stated the following were three highlights of SB 58:
• SB 58 simplifies Medicaid pregnancy coverage so that
an eligible mother has health insurance for one year
after giving birth, thereby eliminating the potential
loss of coverage when having to reapply after two
months.
• SB 58 takes a major step in addressing Alaska's rising
maternal mortality rates.
• SB 58 sets a trajectory for Alaska because its future
is its people, and there is no more critical cost-
effective time in life to invest in health than during
pregnancy and early childhood.
DR. ZINK defined postpartum as when "a physiological change in
pregnancy returns to the non-pregnant state." These changes
were thought to occur six to eight weeks after giving birth, so
Medicaid coverage ended at 60 days. However, most organizations,
including the American College of Obstetrics and Gynecology, now
define the period as the first year after birth. She said
Medicaid provides low-income Alaskans access to health care
through the state with support from federal matching funds.
Currently, Medicaid covers 51 percent of all births in Alaska.
SB 58 is an evidence-based bill supporting Alaskan families to
provide early care and improve maternal and child health
outcomes.
3:56:49 PM
DR. ZINK moved to slide 4 and said the United States is the only
developed country in the world where maternal mortality rates
are increasing far more than other countries. Other countries
have rates ranging from 1.7 to 8.7 per 100,000 live births. The
United States has 17.4 deaths per 100,000 live births. She
turned to slide 5 and provided the following facts:
[Original punctuation provided.]
• Pregnancy-related deaths occur well beyond the 60-day
postpartum period.
• 29% of pregnancy-related deaths in the U.S. not
including those caused by accidents, homicides, and
suicides occur 43 to 365 days postpartum.
• For every pregnancy-related death, there are 70 to 80
cases of severe maternal illness and morbidity in the
postpartum period.
• Medicaid-enrolled women are especially vulnerable to
pregnancy- related death as they are more likely to
experience chronic conditions, pre-term or low-weight
births, and severe maternal morbidity.
3:58:10 PM
DR. ZINK advanced to slide 6 and spoke to the following points
of pregnancy-associated deaths in Alaska:
[Original punctuation provided.]
• In 2021, Alaska's overall pregnancy associated death
rate exceeded the previous 5-year average by 109%
DR. ZINK noted that the rate of maternal mortality is 184
percent in rural areas of Alaska. In urban areas the rate is 64
percent, which shows that there are increasing discrepancies and
disparities between rural and urban healthcare.
• Among deaths in 2015-2019: 73% occurred >6 weeks post
delivery
• Among deaths reviewed by Alaska's Maternal and Child
Death Review (MCDR) committee during 2016-2022, 88%
were potentially preventable, and 44% were associated
with barriers to health care access
3:59:54 PM
CHAIR WILSON asked if Dr. Zink would talk more about minority
health disparity, especially in rural areas of Alaska.
4:00:21 PM
DR. ZINK replied that the department would provide more data to
the committee. She stated that maternal mortality has a large
racial, ethnic, and geographic discrepancy. African Americans,
Black Americans, and Alaskan Native people are at a much higher
risk of maternal mortality. She stated that the department
provided the committee with a summary of a maternal death
review.
4:01:00 PM
EMILY RICCI, Deputy Commissioner, Department of Health, Juneau,
Alaska, moved to slide 7 and said that Alaska is not the only
state noticing that the coverage provided by Medicaid is
insufficient. She said that in 2020 the American Rescue Plan Act
(ARPA) added the time-limited option for allowing states to
extend postpartum coverage from the required 60 days to 12
months for eligible beneficiaries through March 1, 2027.
However, in December 2022, the Consolidated Appropriations Act
2023 (CAA-2023) revised ARPA to make state adoption of the
optional coverage extension permanent. Medicaid is a complicated
program to change because it is a shared state and federal
program with many different rules. The Consolidated
Appropriations Act was the federal government's way of making
adopting the change as easy as possible.
4:02:58 PM
MS. RICCI turned to slide 8 and said that a legislative bill is
needed to implement the change for the following reasons:
[Original punctuation provided.]
• The Legislature must approve all optional groups
for Medicaid coverage in statute AS 47.07.020
• Women who are eligible for Medicaid in Alaska
based on their pregnancy currently only receive
coverage for 60 days postpartum
• In Alaska, 51% of births are covered by Medicaid
4:03:54 PM
DR. ZINK stated that the Center for Medicare and Medicaid
Services (CMS) rarely offers options like CAA-2023 without
overwhelming evidence. She said the number of states adopting
the option increases continually. Currently, 35 states have
opted to extend postpartum coverage.
4:04:49 PM
DR. ZINK advanced to slide 9, Benefits to Alaskans, and spoke to
the following points:
[Original punctuation provided.]
• Improves maternal health outcomes
o Prevents gaps in health care coverage and
improves health care access
• Improves maternal mental health
o Mental health conditions contributed to 31% of
pregnancy-associated deaths in Alaska between
2014 and 2018
o 14% of Alaskan mothers who had a baby in 2020 had
symptoms of postpartum depression
• Addresses disparities in maternal health outcomes
o Medicaid plays a vital role in addressing
disparities in maternal mortality and morbidity
rates
• Improves child health outcomes
o Parental enrollment in Medicaid is associated
with a 29 % higher probability that a child will
receive an annual well-child visit
4:06:52 PM
DR. ZINK turned to slide 10, and spoke to cost savings:
[Original punctuation provided.]
• The costs for providing Medicaid coverage for new
mothers who would have otherwise lost or experienced a
gap in coverage have been estimated using historical
Medicaid claims data, but these costs do not take into
account potential savings and offsetting factors.
• Savings from averted severe maternal morbidity:
Medicaid-enrolled pregnant women with severe maternal
morbidity cost an average of $10,134 annually compared
to $6,894 for those without.
• Savings from prevention: Preventing gaps in coverage
ensures access to primary and preventive care,
including management of chronic conditions and
screening for mental health conditions, substance use,
and intimate partner violence.
4:07:54 PM
DR. ZINK moved to slide 11 and said the following organizations
support extending postpartum Medicaid coverage:
[Original punctuation provided.]
The American College of Obstetricians & Gynecologists
(ACOG)
The American Medical Association
The American Academy of Pediatrics
The Society for Maternal-Fetal Medicine
The American College of Physicians
The American Academy of Family Physicians
The American Hospital Association
The American Psychiatric Association
The American College of Cardiology
The American Osteopathic Association
The March of Dimes
4:08:03 PM
DR. ZINK said the postpartum extension fits the governor's
healthy families initiative, which has three pillars: healthy
beginnings, healthcare access, and healthy communities. She
mentioned a four-year statewide initiative the governor is
putting forward to make Alaska a better place to raise a family.
4:08:35 PM
MS. RICCI provided an overview of the sectional analysis for SB
58:
[Original punctuation provided.]
Section 1 Adds a new section (o) to AS 47.07.020,
authorizing the department to implement an extension
of postpartum Medicaid coverage up to the maximum
period authorized under federal law.
Section 2 Amends the uncodified law to add the
requirement for submission of a Medicaid state plan
amendment to allow Medicaid beneficiaries to receive
postpartum coverage for up to 12 months.
Section 3 Amends the uncodified law to establish the
requirement that the commissioner of health notifies
the revisor of statutes within 30 days of federal
approval of the state plan amendment.
Section 4 Establishes that the postpartum extension
takes effect on the day after the date the
commissioner notifies the revisor of statutes as
described above.
4:10:11 PM
DR. ZINK shared an anecdotal story of a mother with postpartum
depression and how providing services was essential to the well-
being of the mother and baby. Families are the foundation that
society needs to invest in to build a strong future.
4:11:47 PM
SENATOR KAUFMAN asked how the department determined the
estimated base of 1,596 women for the fiscal note.
4:12:22 PM
MS. RICCI stated that the department established the base of the
fiscal note using data from 2018, which determined that 3,600
postpartum women either lost or experienced a gap in coverage
following the 60 days of coverage. An estimated 1,600 women
experienced a total loss of coverage, and 2,000 experienced a
coverage gap between 60 days and one year. The average monthly
cost per beneficiary during the ten months following the 60 days
of Medicaid coverage was $566. The federal government provides a
56.2 percent match.
4:13:49 PM
SENATOR DUNBAR asked what has driven the five-year trend that
has increased Alaska's maternal mortality and morbidity rates.
4:14:20 PM
DR. ZINK said the reasons are multifactorial. In Alaska's death
categorization data from 2015 to 2019, there are many deaths of
despair, such as suicides, drug overdose, and homicides. Eighty-
eight percent were considered preventable. Seventy-two percent
involved substance abuse disorders. Seventy-one percent of the
deceased were victims of interpersonal violence. Forty-four
percent were associated with barriers to healthcare access.
Seventeen were pregnant at the time of death. Six occurred
within seven days of postpartum delivery. Four occurred between
eight and 42 days of delivery. Seventy-three percent occurred
greater than 42 days after postpartum delivery.
4:15:57 PM
REBEKAH MORISSE, Section Chief, Women's Children's and Family
Health, Division of Public Health, Department of Health,
Anchorage, Alaska, added that Alaska had seen an increase in
chronic diseases, substance abuse, mental illness, and intimate
partner violence. She stated that the department could provide
the committee with a fact sheet.
4:16:46 PM
SENATOR DUNBAR said the fact sheet describes the deaths, but it
does not address why there is an increase in substance abuse and
mental illness. He opined that SB 58 is a necessary piece of
legislation.
4:17:33 PM
SENATOR GIESSEL asked what the timeframe is for the
implementation of SB 58.
4:17:57 PM
MS. RICCI replied that after SB 58 passes, it would take at
least 12 months to implement since it will go through a Service
Provision Assessment (SPA) and a public process. She said the
department must also promulgate regulations to support SB 58.
4:19:28 PM
CHAIR WILSON opened public testimony on SB 58.
4:19:50 PM
BROOKE IVY, Vice President, Policy and Advocacy, Alaska
Children's Trust (ACT), Juneau, Alaska, testified in support of
SB 58. She stated that SB 58 aligns with the purpose of ACT. SB
58 addresses primary prevention and is paramount to resolving
Alaska's child abuse and neglect cases. SB 58 would give mothers
time to deal with post-birth health complications, which
research shows are associated with an array of adverse outcomes
such as reduced safety practices and mother-child bonding.
Reduced mother-child bonding is a primary predictor of child
abuse. Forty-one percent of child neglect cases are children
aged birth to four, with the highest at-risk age being birth to
one. SB 58 also helps protect new parents from medical debt
during the baby's first year, which reduces financial stress.
Alaska ranks 44th in health according to the National Kids Count
program. ACT supports improving health outcomes for families and
is excited to join the other thirty-four states that passed the
extension of postpartum coverage.
4:22:14 PM
MORGAN LIM, Lobbyist, Planned Parenthood Alliance Advocates
(PPAA), Juneau, Alaska, testified in support of SB 58. Economic
inequality, structural racism, and public health failures have
collided, resulting in dire maternal health outcomes for Black
and indigenous people in the US. He said the southwest region
has the highest maternal mortality rates within Alaska. American
Indians and Native Alaskans are twice as likely to die of
pregnancy-related causes compared to white women. Black women
are three times more likely to die from pregnancy-related causes
than white women. Ensuring continuous care that addresses the
leading causes of complications is essential to reducing
maternal mortality rates in Alaska. He stated that 60 percent of
all pregnancy-related deaths are preventable, and therefore
expanding care could significantly reduce the maternal mortality
rate. SB 58 takes a step towards improving maternal health
outcomes and addressing disparities.
4:24:47 PM
JEANIE MONK, Senior Vice President, Alaska State Hospital and
Nursing Home Association (ASHNHA), Juneau, Alaska, testified in
support of SB 58. She stated that ASHNHA works to reduce
maternal mortality and morbidity. ASHNHA is involved with the
review process for maternal and child deaths. Access to care is
a critical area for reducing death rates. She stated that she
agreed with the statements made by others. From 2016 - 2022
almost half of the maternal deaths were associated with barriers
to healthcare access.
4:26:54 PM
KC CASORT, representing self, Fairbanks, Alaska, testified in
support of SB 58. She said Alaska's mortality rate is increasing
and passing SB 58 would help reduce the rate. She encourages the
House and Senate to pass SB 58.
4:27:45 PM
RENE O'HARA-JOLLEY, representing self, Anchorage, Alaska,
testified in support of SB 58. She said SB 58 would save lives
and shared an anecdotal story about the anxiety of having a
newborn. She stated that everyone should have access to care and
coverage to ensure people can raise happy and healthy children.
4:29:21 PM
JAMIE MORGAN, Government Relations Regional Lead, American Heart
Association, Sacramento, California, testified in support of SB
58. She stated that the American Heart Association recognizes
the importance of postpartum care, especially for women with
heart disease.
4:30:04 PM
CHAIR WILSON closed public testimony on SB 58.
4:30:20 PM
SENATOR GISSEL suggested reporting SB 58 to avoid holding up its
implementation.
4:30:51 PM
At ease.
4:31:30 PM
CHAIR WILSON reconvened the meeting.
CHAIR WILSON stated that while he agrees with Senator Giessel,
SB 58 is an important piece of legislation, and members should
have time to look at it before reporting it from committee.
4:32:22 PM
SENATOR GIESSEL asked if amending SB 58 would change the program
and questioned holding it in committee.
4:32:38 PM
CHAIR WILSON replied that members might have comments or issues
they want to include or discuss.
4:32:42 PM
CHAIR WILSON held SB 58 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 58 v A.PDF |
SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB 58 Sponsor Statement.pdf |
SFIN 3/7/2023 9:00:00 AM SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB 58 Sectional Analysis Version A.pdf |
SFIN 3/7/2023 9:00:00 AM SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB 58 Research Maternal Mortality 12.1.2022 .pdf |
SFIN 3/7/2023 9:00:00 AM SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB 58 Fiscal Note Version A.PDF |
SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB 58 Postpartum Medicaid Extension Presentation 2.6.2023.pdf |
SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB58 Letter of Support_Redacted Gorba 2.8.23.pdf |
SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB 45 Sectional Analysis v. S 2.1.23.pdf |
SHSS 2/7/2023 3:30:00 PM SHSS 2/9/2023 3:30:00 PM |
SB 45 |
| SB 45 v S.PDF |
SHSS 2/7/2023 3:30:00 PM SHSS 2/9/2023 3:30:00 PM |
SB 45 |
| SB 45 Sponsor Statement 2.1.2023.pdf |
SHSS 2/7/2023 3:30:00 PM SHSS 2/9/2023 3:30:00 PM |
SB 45 |
| SB 45 v S Fiscal Note.pdf |
SHSS 2/7/2023 3:30:00 PM SHSS 2/9/2023 3:30:00 PM |
SB 45 |
| SB 58 Letters of Support 2.8.23_Redacted.pdf |
SHSS 2/9/2023 3:30:00 PM |
SB 58 |
| SB 58 Letters of Support 2.9.23_Redacted.pdf |
SHSS 2/9/2023 3:30:00 PM |
SB 58 |