04/30/1994 01:50 PM House FIN

  SB 366    An Act  relating to medical support  for children;                 
            allowing  a  member  of the  teachers'  retirement                 
            system or the public  employees' retirement system                 
            to  assign  to  a  Medicaid-qualifying  trust  the                 
            member's right to receive a  monetary benefit from                 
            the   system;  relating   to  the   effect   of  a                 
            Medicaid-qualifying trust on the eligibility of  a                 
            person for  Medicaid; relating to the  recovery of                 
            certain Medicaid payments from estates and trusts;                 
            requiring persons who receive Medicaid services to                 
            be  liable  for  sharing  in  the  cost  of  those                 
            services to the  extent allowed under federal  law                 
            and regulations;  and providing  for an  effective                 
            date.                                                              
                                                                               
                                                                               
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            CS SB 366 (FIN)  am (efd fld) was reported  out of                 
            Committee with a "do pass" recommendation and with                 
            fiscal  notes  by  the Department  of  Health  and                 
            Social  Services  and a  zero  fiscal note  by the                 
            Department  of  Commerce and  Economic Development                 
            dated 4/12/94.                                                     
  SENATE BILL 366                                                              
                                                                               
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       "An  Act  relating  to  medical  support for  children;                 
       allowing a member of the teachers' retirement system or                 
       the public employees' retirement system  to assign to a                 
       Medicaid-qualifying trust the member's right to receive                 
       a monetary  benefit from  the system;  relating to  the                 
       effect   of   a   Medicaid-qualifying   trust  on   the                 
       eligibility of a  person for Medicaid; relating  to the                 
       recovery of certain Medicaid payments from  estates and                 
       trusts; requiring persons who receive Medicaid services                 
       to be liable for sharing in  the cost of those services                 
       to   the  extent   allowed   under   federal  law   and                 
       regulations; and providing for an effective date."                      
                                                                               
  DAVE WILLIAMS, DIVISION OF MEDICAL ASSISTANCE, DEPARTMENT OF                 
  HEALTH AND SOCIAL SERVICES, explained that under the federal                 
  Omnibus Budget Reconciliation  Act of 1993 (OBRA  93), State                 
  Medicaid programs  must implement provisions  to obtain  and                 
  enforce medical  support orders for noncustodial  parents on                 
  behalf of Medicaid-eligible children and to recover Medicaid                 
  expenditures on long term care  and related expenditures for                 
  Medicaid  recipients  age 55  or  older.   He  stressed that                 
  implementation of these provisions are necessary in order to                 
  avoid loss of federal financial  participation in the Alaska                 
  Medicaid program.                                                            
                                                                               
  SB  366 would  require the  Medicaid  program to  impose co-                 
  payments for Medicaid-funded services, to the maximum extent                 
  possible.   The provision would reduce Medicaid expenditures                 
  and shift costs to Medicaid recipients and providers.                        
                                                                               
  Discussion  followed regarding  the  implementation of  "co-                 
  payments" nominal  fees.   Mr. Williams  disclosed that  the                 
  fees  would provide  reduced Medicaid payments  for services                 
  provided.                                                                    
                                                                               
  Mr. Williams emphasized that "co-payments" would  not effect                 
  service delivery.   Representative Brown  asked if the  "co-                 
  payments" would provide  a medical  order to cover  Medicaid                 
  services.                                                                    
                                                                               
  JOHN SHERWOOD, DIVISION OF MEDICAL ASSISTANCE, DEPARTMENT OF                 
  HEALTH AND SOCIAL SERVICES, informed  the Committee that the                 
  medical support  provisions  would  parallel  other  support                 
  provisions already existing for AFDC clients extending those                 
  provisions  to  clients who  only  receive Medicaid.   Child                 
  Support Enforcement would  then be directed to  seek medical                 
  support  orders from non-custodial parents.  The legislation                 
  provides tools to enforce those orders.                                      
                                                                               
  Representative   Brown  noted   concern   for  the   already                 
  overburdened Child Support  Enforcement Agency pointing  out                 
                                                                               
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  the current year budget cuts.   She stressed that the agency                 
  would not be able to assume any additional obligations.                      
                                                                               
  PHIL PETRIE, OPERATIONS  MANAGER, CHILD SUPPORT  ENFORCEMENT                 
  AGENCY,  DEPARTMENT   OF   REVENUE,   responded   that   the                 
  legislation  would  place the  agency  into compliance  with                 
  federal requirements written in 1985.  He added at this time                 
  the agency completes orders  for Medicaid clients,  although                 
  recently  there  has  been  a  hearing   officer's  decision                 
  indicating  no  authority  for   that  concern  under  state                 
  statute.     Mr.   Petrie   concluded  that   Child  Support                 
  Enforcement will absorb the costs  as part of their  regular                 
  medical support.                                                             
                                                                               
  Co-Chair MacLean MOVED to report CS SB 366 (FIN) am(efd fld)                 
  out  of Committee with  individual recommendations  and with                 
  the accompanying fiscal notes.                                               
                                                                               
  Representative Brown addressed the Letter of Intent provided                 
  by the Senate Finance Committee.   The letter would override                 
  the  current  law   by  providing  the  Department   minimal                 
  flexibility in order  to waiver  the application of  policy.                 
  Mr. Williams  explained  that the  maximum extent  allowable                 
  would  cost  more  to  collect than  that  to  be  received.                 
  Representative Brown  warned that the  intent language would                 
  provide a clause  stating that it  would not cost more  than                 
  the amount anticipated to receive.                                           
                                                                               
  There being NO OBJECTION to  moving the bill from Committee,                 
  it was so ordered.                                                           
                                                                               
  There was NO MOTION TO ADOPT the Letter of Intent.                           
                                                                               
  CS SB 366  (FIN) am(efd fld)  was reported out of  Committee                 
  with "do pass" recommendation and with three fiscal notes by                 
  the  Department of  Health and  Social  Services and  a zero                 
  fiscal  note  by  the Department  of  Commerce  and Economic                 
  Development dated 4/412/94.