Legislature(2003 - 2004)
04/30/2003 03:15 PM House FIN
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
CS FOR SENATE BILL NO. 105(HES) am(efd fld)
An Act relating to eligibility requirements for medical
assistance for certain children, pregnant women, and
persons in a medical or intermediate care facility.
JOEL GILBERTSON, COMMISSIONER, DEPARTMENT OF HEALTH & SOCIAL
SERVICES, spoke to the HES version (H) of the bill, which
would lower and freeze income levels for eligibility for the
Denali Kid Care Program and would also freeze income levels
for Medicaid under the special income limit for nursing
homes and home and community based waiver services.
Under current law, income standards for these eligibility
categories increase every year by the amount of cost-of-
living adjustments to the Supplemental Security Income (SSI)
program or the federal poverty guidelines for Alaska. The
bill would eliminate the annual cost-of-living adjustments
and put in statute fixed dollar income levels for those
programs based on the SSI standard that became effective on
January 1, 2003 or the federal poverty guideline for Alaska,
which became effective on April 1, 2002.
Commissioner Gilbertson noted that the Senate had reduced
the fixed income levels for the Denali Kid Care Program at
175% of the federal poverty guideline and the House HES
Committee amended the bill back to the Governor's original
proposal. The HES version before the House Finance
Committee keeps the Denali Kid Care income eligibility at
200%. Setting the program income standard at 200% would
allow the Department to maintain current Medicaid benefits
to over 26,000 beneficiaries while fixing levels to realize
significant cost savings in subsequent years.
Commissioner Gilbertson added that pregnant women who
establish eligibility before June 30, 2003 would remain
eligible for nine months notwithstanding the passage of the
bill. Likewise, children who establish eligibility before
June 30, 2003 would be protected for a period of six months
under existing continuous eligibility rules.
Representative Croft referenced Pages 4 and 5, which lists
the household income amounts and asked if those numbers
represented the 200% freeze. Commissioner Gilbertson
reiterated that the dollar levels for the Denali Kid Care
Program and the Medicaid program would be locked in at the
200% poverty level and that the legislation would remove the
inflation adjustments.
Representative Croft asked if the 200% federal poverty
guideline had already been incorporated at the 25% level for
Alaska. Commissioner Gilbertson responded that the federal
poverty level had been uniquely calculated for the State of
Alaska. It is adjusted to reflect a 25% increase and
parallels the cost-of-living adjustment that is received by
federal employees because of the higher cost-of-living in
Alaska. The Alaska Permanent Fund is not included in the
calculation.
Co-Chair Harris pointed out that the bill had originated in
the Senate. He observed that at one time, eligibility had
been lowered to 175% of poverty level. Commissioner
Gilbertson reiterated that the Governor had introduced the
legislation at the 200% and that the Senate HES Committee
reduced it from 200% to 175%. Additionally, that Committee
did not reflect the special income standards for long-term
care. They elected to lower it from 200% to 175%.
Co-Chair Harris asked where those figures were located.
Commissioner Gilbertson responded on Page 4, Section 13.
Co-Chair Harris asked how he could make the adjustment back
to a 175% poverty level. Commissioner Gilbertson explained
that the numbers listed are calculated at the 200% level.
In order to indicate that reduction, each of the numbers
would need to be adjusted. He added that the low-end
monthly difference would be approximately $300-$400 dollars
per month.
Co-Chair Harris inquired the amount of general fund savings
using the 175% figure. Commissioner Gilbertson responded
that the fiscal note passed from the Senate would be a
general fund savings in 2004 in the amount of $2.1 million
dollars with total funds saved of $7.1 million dollars. He
added that the State does receive enhanced federal medical
funds and that the State would lose approximately $5 million
in federal dollars by that reduction. The State receives
funding for some optional categories, the Enhanced Federal
Medical Assistance percentage. The program generates a 71%
federal share.
Co-Chair Harris questioned the number of Alaskans that would
be affected at the 175% level versus the 200% level.
Commissioner Gilbertson responded that for FY04, in the
Denali Kid Care Program that 123 pregnant women and 1,214
children would be affected. He pointed out the impact in
FY04 would be minimized by some extent by the fact that
women that are currently eligible, would loose their
coverage under the adjustment but that they would be able to
retain their coverage throughout their pregnancy under
federal law. Children in the Denali Kid Care Program would
continue their eligibility. He reiterated that the impact
in the first year would be reduced by the fact that pregnant
women in that first year would not loose their coverage
during the pregnancy. However, in the out years, 200
individuals will be affected.
Co-Chair Harris noted that the savings in the out-years were
significant given the proposed benefit cap. Commissioner
Gilbertson responded it would save approximately $12 million
dollars. In the far-out years, the projected savings would
amount to twice what the Governor's proposal recommends at
the 175% level. He commented that at the 200% scenario, in
FY09, there would be a total fund savings of roughly $10
million dollars, $3.5 of that would be general fund savings.
Under the 175% scenario, there would be a total savings in
FY09 of $22 million dollars.
Representative Joule asked if the fund source indicated in
the fiscal note represented federal savings. Commissioner
Gilbertson noted that the amount shows a federal savings;
the federal government pays roughly 71% of the cost of the
Denali Kid Care Program and as a result, most of the savings
are federal dollars. He added that these are formula
programs and that any reductions in the Medicaid Program,
federal funds would be lost.
In response to an observation made by Representative Joule,
Commissioner Gilbertson stated that the reference was to
language passed in the Senate, which was amended in the HES
Committee. The bill before the Committee uses the original
language proposed by the Governor at the 200% level and
under that scenario, a $10 million dollars savings is
indicated.
Representative Joule asked if the program continued as is,
would the federal government participate at a higher level.
Commissioner Gilbertson responded that the legislation was
intended to contribute to a limited general funds savings.
However, no one currently in the program will loose
coverage. In addition, individuals in the program do not
have equal stratification of incomes. Those persons with
the higher level of income will be affected by the
legislation.
In response to a query by Representative Joule, Commissioner
Gilbertson reiterated that the Governor did not support the
Senate HES version of the legislation.
TAPE HFC 03 - 72, Side A
MARIE LAVIGNE, (TESTIFIED VIA TELECONFERENCE), EXECUTIVE
DIRECTOR, ALASKA PUBLIC HEALTH ASSOCIATION, ANCHORAGE, noted
that the Alaska Public Health Association applauds the
success of Denali Kid Care Program in improving the health
of pregnant women and children in Alaska and urges the
Committee to continue eligibility for this program at the
fullest level possible.
Public health research on the health impact of uninsured
children is noteworthy:
· Uninsured children who need medical and surgical
care are 4 times more likely to go without the care
they need than insured children with the same health
needs. When they do receive the care, they are
sicker and more likely to be seen in the emergency
room.
· Uninsured children are 4% times more likely to do
without needed prescriptions and eye glasses, and 5
times more likely to be unable to receive needed
dental care.
· Uninsured children are 1.5 times more likely to
arrive to kindergarten without their required
immunizations. They are 8 times more likely to not
have had a well child check up.
· Uninsured pregnant women are less likely to receive
prenatal care, placing them at risk to deliver
early, low-birth weight babies and at the greatest
risk for fetal and/or maternal death.
Ms. Lavigne stated that the Governor's transmittal letter
accompanying SB 105 states "While the cost savings
associated with this bill are modest in the short-term, this
measure will significantly reduce future year costs." From
a public health perspective, any short-term savings does not
compare to the greater long term costs to the health and
well being of pregnant women and children.
She added that to succeed in lowering the enrollment in the
Medical assistance programs, the Legislature should consider
the issue from a different perspective. SB 105 seeks to
lower the enrollment in medical assistance programs by
reducing eligibility for pregnant women and children who
qualify at the upper levels of the income eligibility, up to
200% of poverty level. The most effective approach the
Legislature could take would be to assist employers and
working families to get affordable health insurance,
reducing the number of pregnant women and children needing
coverage by Denali Kid Care.
Ms. Lavigne noted that while there are many factors
contributing to 1 in 5 Alaskans lacking health insurance
coverage, one of the greatest barriers is access to
affordable health insurance. A study by the Anchorage
Access to Health Care Coalition released this fall indicates
of the 16,000 adults in Anchorage who are uninsured, 71% are
working adults, the majority in business with less than 10
employees. The Legislature needs to join with businesses in
addressing the issue of affordable health care insurance.
In the meantime, she urged members to keep the eligibility
for the medical assistance programs at the full 200% of
federal poverty level to maximize the health of pregnant
women and children.
PATRICIA ZIMMERMAN, DOUGLAS ADVISORY BOARD, JUNEAU,
testified against the proposed legislation. She provided
her employment history in the pharmaceutical industry. She
pointed out that the difference between the countries where
there is poor health care and good health care has state
involvement. She spoke in support for universal health care
throughout the United States. Ms. Zimmerman recommended
taxing the oil and gas companies to help provide for these
insurances. She questioned why the State of Alaska is
considering taxing the poorest Alaskans to decrease
services. The companies that extract the State's resources
should be the ones taxed. Ms. Zimmerman recommended a
review of who takes the money out of Alaska.
MARIE DARLIN, ALASKA ASSOCIATION OF RETIRED PERSONS (AARP),
JUNEAU, voiced support for the Denali Kid Care Program
noting that AARP is the world's largest organization of
grandparents. She emphasized that AARP supports the 200%
poverty level for that program. Ms. Darlin questioned
putting the levels in statute, as that would bind future
legislators.
Representative Foster MOVED to report HCS CS SB 105 (HES)
out of Committee with individual recommendations and with
the accompanying fiscal note.
Representative Joule OBJECTED.
Following a brief at-ease, Representative Joule WITHDREW his
OBJECTION. There being NO further OBJECTIONS, it was so
ordered.
HCS CS SB 105 (HES)am(efd fld) was reported out of Committee
with a "do pass" recommendation and with a new fiscal note
by the Department of Health & Social Services.
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