Legislature(1997 - 1998)
03/10/1998 03:05 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
HB 459 - MEDICAID FOR LOW-INCOME DISABLED Number 0115 CHAIRMAN BUNDE announced the first bill on the agenda was HB 459, "An Act relating to medical assistance for certain disabled persons; relating to the priorities established for the medical assistance program." He asked Mr. Briggs to come forward to address the bill. Number 0140 BOB BRIGGS, Staff Attorney, Disability Law Center of Alaska, expressed his pleasure at being invited to testify on the subject of expanding the opportunities for employment of persons with disabilities. He handles a wide range of legal matters for persons with disabilities and in the course of his work, he has come to understand how frequently in a person's life, the event of becoming disabled is a radical change in their life and in the course of life's adventure, they focus on getting a job again. The biggest hurdle he hears from people in the disability community is being able to provide for their medical expenses. Medical costs are especially high for people with disabilities. For example, his client Dawn Pedersen, who is a driving force behind expanding the employment opportunities for persons with disabilities, lost her liver to lupus and received a liver transplant. To live today, Dawn takes autoimmune suppression drugs costing about $900 per month and has blood draws done and analyzed monthly. Number 0289 MR. BRIGGS stated the option presented in HB 459 is for the state to provide Medicaid buy-ins for people with disabilities who go back to work. He said the Disability Law Center endorses the concept in HB 459 because it accomplishes the goal of exercising the option. House Bill 459 won't solve all the problems of people with disabilities who are trying to get back to work; it won't benefit all people who are currently unemployed, disabled and on government benefits, but it's a good step in the right direction. He urged the committee to pass HB 459. CHAIRMAN BUNDE noted the committee needed to adopt the proposed committee substitute as the working document. Also, there was an amendment which needed to be addressed. Number 0363 REPRESENTATIVE BRIAN PORTER made a motion to adopt proposed committee substitute 0-LS1504\E, as a work draft. There being no objection, that version was before the committee. Number 0389 CHAIRMAN BUNDE asked Mr. Briggs to speak to the amendment. MR. BRIGGS explained the amendment was not specifically at his request, but he would endorse it. He explained the purpose of the amendment is that persons with disabilities, especially those with severe disabilities, can function and become contributing members of society with personal care attendant services. The amendment would expand the ability for people getting personal care attendant services to receive those services at the workplace and outside the home. The point is that the concept of receiving personal care attendants at the home is too restrictive and this amendment would provide more flexibility for people with disabilities to participate in the community, including the opportunity to work. Number 0487 REPRESENTATIVE TOM BRICE made a motion to adopt Amendment 1 which read: Page 1, line 1, following ";": Insert "relating to personal care services for recipients of medical assistance; and" Page 3, following line 24: Insert a new bill section to read: "*Sec. 3. AS 47.07.900(15) is amended to read: (15) "personal care services in a recipient's home" means services authorized under a service plan [PRESCRIBED BY A PHYSICIAN] in accordance with applicable federal and state law [THE RECIPIENT'S PLAN OF TREATMENT AND PROVIDED BY AN INDIVIDUAL WHO IS (A) QUALIFIED TO PROVIDE THE SERVICES; (B) SUPERVISED BY A REGISTERED NURSE; AND (C) NOT A MEMBER OF THE RECIPIENT'S FAMILY;] Renumber the following bill sections accordingly. CHAIRMAN BUNDE asked if there was any objection. Hearing none, Amendment 1 was adopted. Number 0502 REPRESENTATIVE BRICE referred to page 3, and said the option list refers to services, but line 24 addresses individuals. He asked Mr. Briggs to clarify that for the committee. MR. BRIGGS responded that Representative Brice was pointing out a problem with the draftsmanship of the committee substitute. Section 2 amends AS 47.07.035 which is a list of medical assisted services provided by the state and it sets a priority for when those services should be withdrawn during periods of budgetary shortfall. As Representative Brice pointed out, it's a list of services not a list of persons, but the amendment describes a class of persons whose Medicaid services would be withdrawn and it places those persons at the bottom of the list which creates a very high priority for those people. To solve the draftsmanship problem, he suggested the language be changed to read "individuals receiving services as described in AS 47.07.020(b)(1)" which would make the classes the same. He did not view the defect as anything that should slow the bill down if the committee's not inclined to amend it as suggested. REPRESENTATIVE BRICE commented that it had been a question in his mind and after discussing it with Legislative Legal Services, he wanted it brought before the committee. CHAIRMAN BUNDE viewed it as a technical adjustment that can be rewritten. He noted there were a number of individuals waiting to testify via teleconference. He asked Howard Hedges to present his comments at this time. Number 0728 HOWARD HEDGES testified via teleconference from Homer, stating his support for HB 459 as he was directly affected by the issue of benefits versus going back to work. He suffered a stroke in 1993 which left him disabled, but with the support of his employer and medical people, he went back to work in 1996 for one year and used the transitional benefits that were available. At the end of the year, he could not secure private health care insurance that would cover his medical needs; $1500 a month for medications in addition to physical therapy. In June 1997, he was let go from his job because he would have been a fiscal liability because no insurance coverage was available for him. This past December he had an internal defibrilator installed in his heart, which cost $8,000. Had he not quit his job and gone back on Medicaid benefits, he would have had no insurance coverage and he and his family would have suffered great hardship. Number 0835 MR. HEDGES noted there was something left out of HB 459 which is that persons who receive supplemental security income (SSI) can qualify for this under 1619(b) of the social security regulations. Persons like him who receive social security disability (SSD) insurance can't qualify because of the income level. He urged committee members to look into this issue, because there are a lot of disabled people who want to go back to work and would be able to under HB 459, but individuals like himself would be left out. CHAIRMAN BUNDE thanked Mr. Hedges for his testimony and asked Joyanna Geisler to testify. Number 0893 JOYANNA GEISLER testified via teleconference from Homer. She supported HB 459 in concept because it supports the idea that people with disabilities who are receiving SSI can return to work and contribute to the purchase of their Medicaid services. She believed that was important for a variety of reasons, a couple are that not only do a lot of persons with disabilities need the continued health care service, but they also need the ability to contribute to their own purchase of that insurance. She fully supports Amendment 1 to go along with the Medicaid buy-in option. She expressed caution that while this is a good first step, it has no impact on a number of individuals who do experience a disability and receive SSDI and not SSI. As Mr. Hedges pointed out, SSI recipients can currently qualify for the 1619(b) option allowing them to keep their benefits. CHAIRMAN BUNDE thanked Ms. Geisler for her comments and asked Jim Shine to come forward to present his testimony. Number 1034 JAMES M. SHINE, SR., Chairperson, Governor's Committee on Employment and Rehabilitation of People with Disabilities and Private Attorney, testified in support of HB 459 as amended. He noted there are a number of legislative bills working through the system - HB 348 is a companion bill, as is SB 253. He said, "And of these three bills, yours I think, most adequately addresses the needs of people experiencing disability; in particular because of the priority you have placed on people experiencing disabilities for those services to be removed when it's an optional service as well as the sliding scale which you have adopted by regulation rather than leaving it open to the possibility of a policy determination." Number 1106 REPRESENTATIVE FRED DYSON asked how well the state is doing at employing disabled people? MR. SHINE responded that efforts are being made. He said the Governor's Committee on Employment and Rehabilitation of People with Disabilities is fortunate to have Beverly Reaume, Director of the Division of Personnel, heading up the standing employment committee, and concerted efforts are being made to hire more people with disabilities. The committee is presently working with the Alaska Human Resource Investment Council to encourage employment of people with disabilities. He, along with others in the disabled community would certainly like to see more toward that regard. He discussed plans for a new program under consideration whereby the state Division of Vocational Rehabilitation loans money to an enterprise to acquire a capital asset in exchange for which that business agrees to hire for a period of five years a certain number of people with disabilities. In answer to Representative Dyson's question, he couldn't say exactly how many people with a disability are employed in the state of Alaska. REPRESENTATIVE DYSON inquired if he could logically infer that the state has not done as well in the past as is possible. MR. SHINE reiterated that efforts are being made, but the state is probably not employing as many people with disabilities as the disabled community would like to see. Number 1207 REPRESENTATIVE JOE GREEN asked if persons with disabilities are displacing nonhandicapped persons, or filling a niche that needs to be filled. MR. SHINE replied, "We always say that you are hiring ability; you are not hiring a disability." These are persons who are qualified to do the work who happen to experience a disability and generally do not displace people who are "temporarily able bodied". He said that a disability is probably the most indiscriminate thing that can happen to anyone. It is a pervasive condition of life in the twentieth century. CHAIRMAN BUNDE thanked Mr. Shine for his comments and asked Patrick Reinhart to come forward to testify. Number 1293 PATRICK REINHART, Executive Director, State Independent Living Council, thanked the committee for addressing this issue and expressed support for HB 459, particularly with the amendment. The Independent Living Council felt the personal care attendant was very important in terms of getting people with disabilities back to work. With respect to Representative Dyson's question regarding employment, he said he experiences a disability and has been helped over the years with college classes and with the purchase of a prostethic by the Division of Vocational Rehabilitation in Alaska and in Wisconsin. Those are the type of services provided by the vocational rehabilitation programs across the country. His personal opinion is that Alaska does a good job in getting people with disabilities the education and training needed to get back to work, but there are constant barriers or disincentives to work, such as the Medicaid issue, as well as being able to have personal care attendants come into the office place. These are issues every state is trying to address. Alaska is on the right track with this legislation but there is much more to be done. A lot of money is investment in training people with disabilities to get back to work, but the attitudes of society that people with disabilities can't do the job is the biggest barrier needing to be overcome. CHAIRMAN BUNDE thanked Mr. Reinhart for his remarks and asked Jon Sherwood to come forward. Number 1421 JON SHERWOOD, Division of Medical Assistance, Department of Health & Social Services, expressed the division's support of HB 459 and the amendment. He said, "This option for the working disabled can include people who receive social security disability benefits as long as their benefits are below the needs standard for the adult public assistance program, which is a little less than twice that of the SSI program. So, to the extent that these people would receive Medicaid anyway while receiving the disability benefits, they would be able to go back to work and continue to receive Medicaid." As has been pointed out, that won't address the problem for everybody but it will include a lot more people than are being reached now. CHAIRMAN BUNDE asked Mr. Sherwood to address the fiscal note. MR. SHERWOOD commented the division is of the opinion this will actually save money over time because as people go back to work, there will be less adult public assistance payments. In the short term, the division believes there are some people who currently are able to go back to work and would leave Medicaid and eventually, this option may allow them to continue Medicaid a little longer, so there's a small amount of short term Medicaid cost associated with it, combined with long term savings in the adult public assistance program. The net effect is that over time the division expects the savings will continue to grow as more people are able to go back to work. Number 1548 REPRESENTATIVE BRICE asked Mr. Sherwood if he could explain how the 250 percent federal poverty level relates to SSI and SSDI. MR. SHERWOOD replied that supplemental security payments are right now about $500 a month for an individual, which is about half of what the federal poverty level is for one person. The 250 percent of poverty for a household of four would be well in excess of $40,000 a year. REPRESENTATIVE BRICE said, "So this would cover everybody from $40,000 -- in excess of $40,000 on down with disabilities." MR. SHERWOOD said that was correct, to the extent the earnings were earned income, because earned income can be disallowed. If there were payments from other sources, there may still be some problems. Number 1600 REPRESENTATIVE GREEN asked if the disability had to be a certain degree in order to qualify. MR. SHERWOOD responded this category uses the social security definition of disability, which is the inability to work for at least one year. But it's sometimes referred to as a 100 percent disability standard. An individual can't be able to work, although it allows for a small amount of employment - less than $500 a month. CHAIRMAN BUNDE thanked Mr. Sherwood for testifying and asked Mr. Kreher to present his comments. Number 1645 RON KREHER, Special Assistant, Division of Public Assistance, Department of Health & Social Services, said the division supports HB 459. Any legislation that helps move people toward self- sufficiency and improves the quality of life is in the best interest of the division as well as the state. He volunteered to answer any questions regarding the division's fiscal note. CHAIRMAN BUNDE thanked Mr. Kreher for his comments and called on Millie Ryan to testify. Number 1682 MILLIE RYAN, Planner, Governor's Council on Disabilities and Special Education, said the council had just completed the three- year planning process and had heard from many people across the state wanting to work, but were running into a number of disincentives. She said the Division of Vocational Rehabilitation invests money in training and getting people to work, but when the time comes to look for a job, the disincentives discourage them from working. One of the biggest disincentives is the fear of losing medical coverage, because these people need the medical coverage in order to survive. She said HB 459 is a good beginning; it will help get some people to work. She said the council is reviewing some of the ways to address other disincentives, some of which can probably be addressed at the state level. She said it's important to remember that when people with severe disabilities go to work, often they have expenses that are unique to their disability. Those expenses will not go away just because they are able to work, so it's important to have a gradual reduction in services. Number 1760 REPRESENTATIVE GREEN reflected while working in the oil industry several years ago, there were a group of employees doing rather routine jobs. He recalls having an aide with a mental handicap who was one of the best employees because even though the work was boring, his mind didn't wander because it was a challenge for him and he felt he was making a contribution. He wondered if that same attitude applied to individuals with a physical handicap. MS. RYAN responded that most individuals want to work and are qualified to work. She works most closely with persons with developmental disabilities who may need a job coach to help with the training on the job. For the most part, people with disabilities want to work and that sort of an attitude makes a big difference in people's performance. CHAIRMAN BUNDE thanked Ms. Ryan for her comments and asked Walter Majoros to come forward to testify. Number 1834 WALTER MAJOROS, Executive Director, Alaska Mental Health Board, testified in strong support of HB 459. He reiterated there are a number of people with a mental illness that would like to work, but can't work because of various impediments; the lack of health insurance options has been identified as the biggest impediment to keeping people with mental illnesses being able to engage in employment. Oftentimes people with mental illness who are employed either do not have health insurance, or if they do, it's benefits for physical health issues with minimal mental health coverage or no mental health coverage whatsoever. Often, the high cost of a person's psychotropic medication alone prohibits them from maintaining a job and pay their expenses. He noted the Alaska Mental Health Board meets four times a year and takes testimony at two of the meetings at least, and the single issue heard most over the last several years, has been insurance coverage. House Bill 459 will remove some disincentives to employment for people with mental illnesses and will allow them to choose work over welfare and, to a greater degree, be contributing members of society. CHAIRMAN BUNDE asked Mr. Briggs if he had any closing remarks. Number 1924 MR. BRIGGS expressed his appreciation to the committee for addressing this issue and urged the committee to pass HB 459 and send it on to the Finance Committee. Number 1941 REPRESENTATIVE PORTER summarized that HB 459 purports to employ persons with disabilities or to keep them employed, allowing them to work toward self-sufficiency for a reasonably minor investment for the next two years which would be more than overcome by savings in the next three or four years. Number 1964 REPRESENTATIVE PORTER made a motion to move HB 459 as amended from committee with individual recommendations and attached fiscal notes. There being no objection, CSHB 459(HES) moved from the House Health, Education and Social Services Committee. REPRESENTATIVE DYSON encouraged individuals working with the disabilities community to find a staff person for him next year.
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