04/17/2010 05:22 PM House FIN

SENATE BILL NO. 238                                                                                                           
                                                                                                                                
     "An Act amending the eligibility threshold for medical                                                                     
     assistance for persons in a medical or intermediate                                                                        
     care facility."                                                                                                            
                                                                                                                                
6:54:58 PM                                                                                                                    
                                                                                                                                
THOMAS  OBERMEYER, STAFF,  SENATOR  BETTYE DAVIS,  explained                                                                    
that the  legislation would amend  and restore  the Medicaid                                                                    
eligibility   threshold    for   medical    assistance   for                                                                    
individuals in a medical or  intermediate care facility from                                                                    
a  specified monthly  income  limit to  300  percent of  the                                                                    
social security  income benefit rate. The  threshold is also                                                                    
used for people who  receive home and community-based waiver                                                                    
services. In 2003, the legislature  froze the Medicaid long-                                                                    
term services income eligibility  limit at $1,656 per month;                                                                    
at that time the amount  was 300 percent of the supplemental                                                                    
security income (SSI). The change  created an income ceiling                                                                    
for   waiver    eligibility,   effectively    freezing   the                                                                    
eligibility  limit  for the  past  seven  years rather  than                                                                    
allowing the  limit to  adjust annually  in tandem  with the                                                                    
SSI. In 2009,  the income equivalent was  $2,022. The result                                                                    
was  that small  social security  cost-of-living adjustments                                                                    
have  disqualified  many  needy, disabled  people  from  the                                                                    
program.    Alternatives    for   preserving    eligibility,                                                                    
particularly for those requiring  lifetime or long-term care                                                                    
include the  creation of a Medicaid  qualifying income trust                                                                    
known   as  the   Miller  Trust.   Trusts  have   procedural                                                                    
drawbacks,    including   numerous    responsibilities   and                                                                    
restrictions,  limited access  to income,  assistance of  an                                                                    
attorney, and a trustee to manage trust assets.                                                                                 
                                                                                                                                
Mr. Obermeyer  asserted that Medicaid services  are critical                                                                    
to the  well-being of Alaska's most  vulnerable citizens. He                                                                    
believed that  supporting SB 238 would  ensure that eligible                                                                    
Alaskans  would continue  to receive  nursing-home care  and                                                                    
in-home  services. In  addition, the  legislature would  not                                                                    
have  to amend  statutes every  year or  two as  the federal                                                                    
poverty  level guidelines  and supplemental  security income                                                                    
levels increase with the cost of living.                                                                                        
                                                                                                                                
Mr. Obermeyer  pointed out that  the bill had a  zero fiscal                                                                    
note; making the adjustment would  not increase costs to the                                                                    
state.                                                                                                                          
                                                                                                                                
Representative Gara commented that  when the legislation was                                                                    
presented by  the Commission  on Aging  as a  priority, they                                                                    
were not  sure if the  fiscal note  would be zero.  The same                                                                    
number  of people  would qualify  but they  need to  hire an                                                                    
attorney and create  a Miller Trust to move  their assets in                                                                    
order to qualify.  People would not have to  create a Miller                                                                    
Trust if the threshold is changed.                                                                                              
                                                                                                                                
Co-Chair Stoltze opened and closed public testimony.                                                                            
                                                                                                                                
Vice-Chair Thomas  MOVED to report  SB 238 out  of Committee                                                                    
with individual recommendations  and the accompanying fiscal                                                                    
note. There being NO OBJECTION, it was so ordered.                                                                              
                                                                                                                                
SB  238 was  REPORTED  out  of Committee  with  a "do  pass"                                                                    
recommendation  and   with  attached   previously  published                                                                    
fiscal note: FN1 (DHS).