Legislature(2003 - 2004)
03/03/2003 09:03 AM Senate FIN
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE BILL NO. 78
"An Act relating to an optional group of persons eligible for
medical assistance who require treatment for breast and
cervical cancer; relating to cost sharing by those recipients
under the medical assistance program; and providing for an
effective date."
This was the first hearing for this bill in the Senate Finance
Committee.
Co-Chair Wilken stated that this bill continues the optional breast
and cervical cancer Medicaid coverage due to terminate in June
2003. He stated that this bill would authorize the Department of
Health and Social Services to impose recipient cost sharing
procedures as allowed by federal regulations.
Co-Chair Green, the bill's sponsor, stated that the purpose of this
bill is to extend the termination date for this program. She
reminded the Committee that those individuals who have begun
treatment would continue to receive Medicaid coverage as previously
mandated by separate Legislation. Additionally, she noted, the bill
would allow the Department of Health and Social Services to impose
allowable cost sharing between the State and program recipients.
She furthered that the bill's language is consistent with language
of the Denali KidCare program. She noted that the bill would allow
the State the flexibility required to align with any upcoming
federal "re-workings" of the program. She noted that were the
existing legislation to include this flexibility, the State would
have been eligible for additional federal funding.
ELMER LINDSTROM, Special Assistant, Office of the Commissioner,
Department of Health and Social Services voiced the Department's
support of this legislation. He specified that the Office of the
Governor would welcome legislation that would make Medicaid
coverage of breast and cervical cancer treatment "permanent," and
he noted that the bill's fiscal note would be included in the
Governor's amended FY 04 budget. He affirmed that the bill's fiscal
note is consistent with the Department's projections as there has
been no unexpected growth in the program.
Senator Olson, a medical doctor, thanked the sponsor on behalf of
the individuals provided coverage by this bill. He questioned
whether the State is charging patients the maximum co-pay amount
allowable under federal law.
Mr. Lindstrom specified that, "the language in the proposal is
consistent with current practice relative to co-pays." He continued
that the issue of the co-payment amount "is something worth
reiterating" as this program provides coverage to people whose
income is "significantly" above the typical qualifying level. He
stated that the Murkowski Administration is committed to the
broader qualification coverage. Furthermore, he noted, the
Administration supports a co-payment "cost sharing" contribution by
the beneficiaries of the program. He noted that further expansion
of qualifications into the program would require changes in federal
regulations.
Senator Olson asked whether the State is charging participants the
maximum co-payment amount.
Mr. Lindstrom responded that the Department would collect the same
level of co-payments under the proposed legislation as collected
under the current legislation.
Senator Olson asked whether the State collects the maximum co-
payment amount allowed under federal law.
Mr. Lindstrom replied that is correct.
Senator Olson asked whether the proposed bill would change the
amount of money that the State would either pay or collect through
the program.
Co-Chair Green clarified that, rather than the State collecting the
co-payments, the co-payments would be paid to service providers.
She shared some the co-payment amounts. She reiterated that the
State's broadened "asset eligibility" requirements allow Medicaid
coverage for individuals earning significantly higher incomes than
normally allowed.
Senator Olson surmised that this legislation would not result in
cost savings to the State.
Mr. Lindstrom agreed.
SFC 03 # 13, Side A 10:41 AM
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Senator Hoffman asked the reason the legislation includes cost
sharing language if there is no related reduction in the cost to
the State.
Mr. Lindstrom responded that language is included in the proposed
legislation to allow the State to pursue higher cost-sharing co-
payment levels with program-eligible women in "significantly
higher" income brackets, provided that future changes in federal
regulations allow for that option.
Senator Hoffman asked whether the State has attempted to expand the
existing cost-sharing language in the Denali KidCare program, which
also provides benefits to those with incomes higher than the normal
qualifying amounts.
Mr. Lindstrom responded that, as a result of a State inquiry, the
federal government ruled against including additional cost sharing
language in the Denali KidCare program "barring some change in
federal law."
Senator Hoffman asked whether the Department anticipates a
different federal ruling pertaining to the additional cost sharing
language included in this breast and cervical cancer legislation.
Mr. Lindstrom responded that the Department does not currently
anticipate a different ruling; however, he reiterated, the language
is included in this legislation in anticipation of future federal
changes regarding cost-sharing allowances.
Co-Chair Wilken asked the testifier to clarify information in the
fiscal note regarding whether Alaska Native women, who receive 100
percent medical coverage through Indian Health Services, are
eligible for this program.
Mr. Lindstrom responded that the federal government has determined
that Native women could participate in this program. He stated,
however, that the reason for there being "fewer billings than
anticipated" for Native women is unclear.
Co-Chair Green informed the Committee that a financial arrangement
has been established whereby the Indian Health Services would
reimburse the State for the breast and cervical cancer treatment
provided to Native women. She continued that Native women could not
be denied this program.
Mr. Lindstom concurred with Co-chair Green's comments.
Senator Hoffman specified that, while many health providers
contract with the federal government to provide services, the
provider and the client have the option to determine whether or not
to bill Indian Health Services, an insurance company, or the State.
Co-Chair Wilken asked for further clarification regarding language
in the fiscal note regarding the expected growth rate; specifically
whether the growth rate would be five or ten percent.
Mr. Lindstrom clarified that, while there has been a five percent
increase in the number of program participants, there has been a
ten percent increase in program expenses due to the rising cost of
health care.
Co-Chair Wilken summarized that program expenditures are expected
to increase at twice the rate of the number of program recipients.
Mr. Lindstrom agreed.
Senator Taylor moved to report SB 78 from Committee with individual
recommendations and the accompanying fiscal note.
There being no objections, SB 78 reported from Committee with a
$970.0 fiscal note, dated February 24, 2003 from the Department of
Health and Social Services.
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