Legislature(2003 - 2004)
03/17/2003 01:50 PM House FIN
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* first hearing in first committee of referral
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+ 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."
JAQUELINE TUPOU, STAFF, SENATOR LYDA GREEN, SPONSOR, spoke
in support of the bill. She explained that the bill removes
the sunset provision of the 2001 legislation and ensures
continued treatment for women who have been participating in
the Breast and Cervical Cancer Care program. She also noted
that the bill creates future certainty to those persons who
may be diagnosed with these ailments in the future.
Ms. Tupou continued to summarize that the bill gives
authority to the Department of Health and Social Services
(DHSS) to allow maximum cost sharing as per the federal law.
She noted that currently Alaska was imposing the maximum
cost sharing. She pointed out that statute contains the
word "lesser", and the current legislation states future
authority, allowing submission of an amended state program
should the federal government raise the level of cost
sharing.
Ms. Tupou referred to a handout (copy on file) regarding
poverty guidelines pertaining to a specific category of the
Medicaid program, allowing for 250 percent of the poverty
level. The guideline for a family of three is $46,950, and
for a family of four, $56,575.
Co-Chair Harris referred to the HESS fiscal note with a cost
of $282 thousand of general funds, to match $680 of federal
funds. He also pointed out that in FY 2009, the cost would
be nearly double, projected at $544 thousand. He asked if
the program was optional under Medicaid.
Ms. Tupou contended that the program was not optional. She
added that the program was initially a screening program,
but that when women were diagnosed, the program was extended
to close the loop between diagnosis and treatment. She
concluded that the program is currently required through
that legislation. She read from Public Law 106-354, enacted
th
by the 106 Congress, speculating that it was predicated
upon participation in the diagnosis program. She maintained
that because the State participates in the diagnosis portion
of the program, the treatment portion is also required.
Co-Chair Harris asked whether the federal government
required participation in the diagnosis portion of the
program.
ELMER LINDSTROM, SPECIAL ASSISTANT, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES spoke in support of the bill. He clarified
that the state's participation in the program was optional.
Co-Chair Harris referred to the fiscal note in relation to
the DHSS budget and the matching of federal dollars. He
asked if the estimate for FY 09 of $544 thousand was a
realistic figure, and what was driving the increase.
Mr. Lindstrom stated that the fiscal note was well within
initial projections. He referred to page 2 of the fiscal
note, which indicated two reasons for the increase in costs:
1) a five percent annual increase in total recipients and 2)
an assumption that expenditures in this category would grow
at a rate of 10 percent per year, similar to the national
average growth for Medicaid spending.
Responding to a comment by Co-Chair Harris, Mr. Lindstrom
referred to the package of bills introduced last week at the
request of the Governor directed at Medicaid cost
containment. He also expressed the Governor's enthusiastic
support of SB 78.
Representative Croft MOVED to ADOPT Amendment #1:
23-LS0592\A.1
Lauterbach
A M E N D M E N T
OFFERED IN THE SENATE
TO: SB 78
Page 1, lines 2 - 3:
Delete "relating to cost sharing by those
recipients under the medical assistance program;"
Page 1, line 8, through page 2, line 3:
Delete all material.
Renumber the following bill sections accordingly.
Page 2, lines 22 - 28:
Delete all material.
Renumber the following bill section accordingly.
Co-Chair Harris OBJECTED.
Representative Croft explained that the amendment deleted
cost sharing language. He noted his discomfort with
specific cost sharing language, suggesting that it was not
appropriate, and possibly not legally allowable. He
maintained that the language sent a "mixed message", as it
pertained to only a portion of the population.
Ms. Tupou reiterated that the category was at 250 percent of
poverty level, and added that the category contained no
asset test. She maintained that the category was therefore
a special category.
Representative Stoltze asked about the fiscal impact of the
amendment. Mr. Lindstrom stated that the amendment would
not impact the current fiscal note.
Ms. Tupou suggested that if in the future the federal
government allowed more cost sharing, the amendment might
have an impact.
Responding to a question by Co-Chair Williams, Ms. Tupou
maintained that the amount of the co-payment was minimal: $2
for prescription drugs, and a maximum $200 for hospital
stay.
Representative Croft asked if the fiscal note was not
impacted by the amendment since it could not be implemented
currently.
Mr. Lindstrom observed that the language in SB 78 was
similar to that authorizing the Denali Kid Care Program. He
pointed out the similarity in that, under current federal
law, additional cost sharing provisions were not possible.
He noted that, in the case of Denali Kid Care, the state
submitted a failed petition to the federal government for
the authority to add cost sharing. He confirmed that, in
this program, the income eligibility is significantly
greater than in typical Medicaid programs.
Mr. Lindstrom also indicated that the legislature might want
to reiterate the idea that in the case when income
eligibility was relatively high, with federal permission,
the State policy might be to increase co-payments.
Co-Chair Williams asked if federal changes were anticipated.
Mr. Lindstrom stated that he was unaware of any pending
changes, but noted that changes could occur quickly.
Ms. Tupou noted that the bill did give authority to the
Department to increase amounts if federal law changes.
Representative Stoltze asked about the Administration's
position on the issue.
Mr. Lindstrom stated that they deferred to the legislature.
TAPE HFC 03 - 34, Side B
Representative Croft suggested that the federal government
rejected the Denali Kid Care waiver because it targeted a
particular population. He maintained that a cost-sharing
request for the proposed program would also be rejected for
the same reason. He also summarized that the bill gave the
Department of Health and Social Services permission to
charge an uncertain amount at an uncertain time to affected
persons. He suggested that cost sharing be examined when
and if federal guidelines in fact changed. He expressed a
preference to send a clear message with the legislation.
A roll call vote was taken on the motion to adopt Amendment
#1.
IN FAVOR: Croft, Foster, Williams
OPPOSED: Hawker, Meyer, Stoltze, Chenault, Harris
Representatives Joule, Moses, and Whitaker were not present
for the vote.
The motion FAILED on a vote of 3 to 5.
Representative Foster MOVED to report SB 78 out of Committee
with the accompanying fiscal note. There being no OBJECTION
it was so ordered.
SB 78 was REPORTED out of Committee with "no recommendation"
and with a previously published fiscal impact note: HSS #1.
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