03/11/2009 01:30 PM House FINANCE

HOUSE BILL NO. 26                                                                                                             
                                                                                                                                
     "An  Act  repealing  the   repeal  of  preventative  and                                                                   
     restorative  adult dental  services reimbursement  under                                                                   
     Medicaid; providing  for an effective date  by repealing                                                                   
     the  effective date  of sec.  3, ch. 52,  SLA 2006;  and                                                                   
     providing for an effective date."                                                                                          
                                                                                                                                
CO-CHAIR MIKE  HAWKER, SPONSOR,  explained the purpose  of HB
.   He described the bill  as continuing the  authorization                                                                   
established in 2006  for the Adult Dental program.   The bill                                                                   
is  an   Act  repealing  the   repeal  of  preventative   and                                                                   
restorative adult dental services  reimbursed under Medicaid.                                                                   
It would  create open-ended authority  for the  Department of                                                                   
Health   and  Social   Services   to  continue   to   provide                                                                   
preventative adult dental services.                                                                                             
                                                                                                                                
Co-Chair  Hawker related  how  the program  existed prior  to                                                                   
2006.   At that time, adults  on Medicaid could  only receive                                                                   
emergency care to  relieve pain and fight infection.   Due to                                                                   
budget  constraints,  there  were   concerns  that  expanding                                                                   
Medicaid services  would lead  to overspending.   Limitations                                                                   
were  set as  to  how  much could  be  spent on  one  patient                                                                   
annually.  It would  have taken two years to obtain  a set of                                                                   
dentures  under  those  limitations.   In  order  to  control                                                                   
costs, the  amount was kept in  a separate allocation  in the                                                                   
budget  so money  could  not be  moved  in or  out.   It  was                                                                   
estimated to cost  about $10 million a year.   In reality, it                                                                   
turned out to be around $6 to $7 million per year.                                                                              
                                                                                                                                
Co-Chair Hawker pointed out in  the fiscal note that there is                                                                   
very  moderate  growth  going  forward.    He  saw  it  as  a                                                                   
component  of Medicaid  in which  spending  has been  brought                                                                   
under control.                                                                                                                  
                                                                                                                                
Co-Chair Hawker  noted that  passing HB  26 would remove  the                                                                   
sunset  provision  and  make   the  Adult  Dental  program  a                                                                   
permanent part of the state Medicaid program.                                                                                   
                                                                                                                                
1:48:29 PM                                                                                                                    
                                                                                                                                
Vice-Chair   Thomas  inquired   if  there   is  a   residency                                                                   
requirement.  Co-Chair Hawker  observed that the requirements                                                                   
are  those  of  the  Medicaid   program.    He  thought  that                                                                   
residency was a requirement.                                                                                                    
                                                                                                                                
Representative  Kelly asked  if the Mental  Health Trust  was                                                                   
still involved.   Co-Chair Hawker replied that  the agreement                                                                   
with the Mental Health Trust was  that they would support the                                                                   
program   through  its   pilot  phase   and,  if  it   became                                                                   
successful, it would become part of the Medicaid program.                                                                       
                                                                                                                                
Representative  Kelly asked  how  success was  defined.   Co-                                                                   
Chair Hawker  replied that success  was determined by  if the                                                                   
program  was operated  within the intended  parameters.   Two                                                                   
hundred providers  have been developed, providing  service to                                                                   
about 6,000 patients annually.   Dental prevention has proven                                                                   
to  be  much  more  successful  than  the  previous  barbaric                                                                   
standard.                                                                                                                       
                                                                                                                                
Representative   Kelly    asked   if   federal    funds   are                                                                   
undiminished.    Co-Chair  Hawker  explained  that  the  FMAP                                                                   
percentage rate  is in play.   The program will  include FMAP                                                                   
no matter if the rate is up or down.                                                                                            
                                                                                                                                
1:51:03 PM                                                                                                                    
                                                                                                                                
Representative Gara asked what  the income limitations are in                                                                   
order  to qualify  for Medicaid  services.   Co-Chair  Hawker                                                                   
deferred to the  Department of Health and Social  Services to                                                                   
answer.                                                                                                                         
                                                                                                                                
Representative Gara  inquired about the relationship  between                                                                   
Medicaid  coverage  and  Denali  KidCare.    Co-Chair  Hawker                                                                   
deferred to the Department of Health and Social Services.                                                                       
                                                                                                                                
1:52:37 PM                                                                                                                    
                                                                                                                                
JON SHERWOOD, DIRECTOR, OFFICE  OF PROGRAM REVIEW, DEPARTMENT                                                                   
OF HEALTH AND SOCIAL SERVICES,  spoke in support of extending                                                                   
the  Medicaid  Adult  Dental program,  which  has  been  very                                                                   
successful.   There  is also  an  Administrative proposal  to                                                                   
extend  the program  another five  years in  order to  better                                                                   
prove  cost savings  claims.    He spoke  in  support of  the                                                                   
program.                                                                                                                        
                                                                                                                                
Mr. Sherwood observed  that there is a  residency requirement                                                                   
to  qualify   for  Medicaid.     He   discussed  the   income                                                                   
requirements  to qualify  for this program.   These  services                                                                   
apply to adults.  The income limits  for the disabled and the                                                                   
aged  are approximately  about  110  percent  of the  federal                                                                   
poverty  level.   For parents  of dependant  children in  low                                                                   
income families, the income limit  is closer to 75 percent of                                                                   
the federal poverty level.  Comprehensive  dental coverage is                                                                   
already  included the  Medicaid program  for children  so the                                                                   
Denali KidCare population would not be directly affected.                                                                       
                                                                                                                                
Co-Chair  Stoltze asked  about  the developmentally  disabled                                                                   
community  as it  relates to  the program.   Co-Chair  Hawker                                                                   
replied  that   the  disabled  community,  such   as  ARC  of                                                                   
Anchorage and the Key Coalition, benefits from the program.                                                                     
                                                                                                                                
Co-Chair Stoltze  pointed out  that Hope Community  Resources                                                                   
recognized Co-Chair Hawker as Legislator of the Year.                                                                           
                                                                                                                                
1:56:42 PM                                                                                                                    
                                                                                                                                
BRAD  WHISTLER,  DIVISION  OF PUBLIC  HEALTH,  DEPARTMENT  OF                                                                   
HEALTH AND SOCIAL  SERVICES, described the  programs provided                                                                   
by the program: preventive and  routine dental exams, routine                                                                   
restorative,  root canal  therapy, and  denture services.  He                                                                   
maintained that good oral health  is a quality-of-life issue.                                                                   
He  provided  examples.   He  spoke  of how  dental  problems                                                                   
relate to job opportunities and  food choices.  He shared the                                                                   
advantages   of  preventative   care.     He  described   the                                                                   
relationship   between   good   dental   care   and   disease                                                                   
prevention.   He  shared  information about  children's  oral                                                                   
health.                                                                                                                         
                                                                                                                                
1:59:42 PM                                                                                                                    
                                                                                                                                
Co-Chair  Stoltze wondered  how  the issue  of missed  dental                                                                   
visits  resulting  in lost  fees  could  be addressed.    Mr.                                                                   
Whistler  shared that  the Department's  positions is  that a                                                                   
missed appointment  is not a Medicaid service.   Dentists may                                                                   
charge  for   missed  appointments.     He  added   that  the                                                                   
Department  tries to  educate patients  in the importance  of                                                                   
keeping appointments.   He suggested a potential  fix for the                                                                   
problem by tracking missed appointments  in order to identify                                                                   
the extent of the problem.                                                                                                      
                                                                                                                                
2:01:36 PM                                                                                                                    
                                                                                                                                
JEFF JESSEE,  CHIEF EXECUTIVE  OFFICER, ALASKA MENTAL  HEALTH                                                                   
TRUST AUTHORITY, spoke  in support of the bill.   He spoke of                                                                   
the successes  of the program  and the attempt to  reduce the                                                                   
legislature's  risk  by  implementing  cost  containment  and                                                                   
efficiency  into   the  programs.     He  thought   that  the                                                                   
Department had done an excellent job with the program.                                                                          
                                                                                                                                
Mr. Jessee responded  to a question by  Representative Kelly.                                                                   
Although the  Mental Health  Trust is  no longer a  financial                                                                   
partner,   the   mini-grant  program   continues   to   spend                                                                   
considerable money to supplement Medicaid dental services.                                                                      
                                                                                                                                
Co-Chair  Stoltze commented  that the  Mental Health  Trust's                                                                   
involvement was clearly defined as a short-term commitment.                                                                     
                                                                                                                                
2:03:27 PM                                                                                                                    
                                                                                                                                
SEVERVINE BASHAM, ALASKA PRIMARY  CARE ASSOCIATION, testified                                                                   
in favor of HB 26.  She reported  that there are currently 26                                                                   
community health  centers and 141 sites serving  about 80,000                                                                   
persons.   Primary  care  includes behavioral  health,  basic                                                                   
medical,   and  basic   dental.     Early  intervention   and                                                                   
prevention are the keys to good  dental health.  She spoke of                                                                   
the importance of the bill.                                                                                                     
                                                                                                                                
Representative Gara  asked what would  not be covered  if the                                                                   
bill  does not  pass.   Ms.  Basham thought  that  preventive                                                                   
medicine was covered by the bill.                                                                                               
                                                                                                                                
2:05:23 PM                                                                                                                    
                                                                                                                                
MARIE DARLIN,  AARP, spoke in favor  of HB 26.   She referred                                                                   
to  a  letter   included  in  the  members'   packets.    She                                                                   
paraphrased  from the letter.   Dental  care is essential  to                                                                   
quality  health care.    Funding for  dental  care should  be                                                                   
considered   sensible   prevention   with   the   long   term                                                                   
possibility of  saving Medicaid funds.   Of the  7,600 adults                                                                   
who  benefited  from  this program,  about  1,800  are  older                                                                   
Alaskans, including  900 who received dentures.   The average                                                                   
cost of care provided to a senior Alaskan was $855.                                                                             
                                                                                                                                
Ms. Darlin voiced  a concern about the annual  cap of $1,150.                                                                   
The fee for an upper or lower  set of dentures is now between                                                                   
$1,700  and $1,800, and  some of  the Medicaid  beneficiaries                                                                   
have  more  significant  oral  health problems  that  may  go                                                                   
considerably beyond the cap.   She suggested raising the cap.                                                                   
                                                                                                                                
2:08:27 PM                                                                                                                    
                                                                                                                                
Co-Chair  Hawker  pointed  out  that  the  fiscal  note  from                                                                   
2/20/09 contains  anticipated steady growth.   The amount for                                                                   
FY10 is  already in the budget  and is for about  $6 million.                                                                   
He  maintained   that  the  expense   was  reasonable.     He                                                                   
acknowledged the  federal match,  noting that there  would be                                                                   
FMAP rate changes.                                                                                                              
                                                                                                                                
Representative Gara noted that the state match is about $2.5                                                                    
million a year.  He suggested that there are many needs of                                                                      
equal import to be funded.                                                                                                      
                                                                                                                                
2:10:56 PM                                                                                                                    
                                                                                                                                
Representative Austerman MOVED to REPORT HB 26 out of                                                                           
committee   with    individual   recommendations    and   the                                                                   
accompanying fiscal note.                                                                                                       
                                                                                                                                
HB 26 was REPORTED out of Committee with a "do pass"                                                                            
recommendation and with fiscal note #1 by the Department of                                                                     
Health and Social Services.