Legislature(2003 - 2004)
03/17/2003 01:50 PM FIN
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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.