Legislature(2005 - 2006)CAPITOL 106
03/21/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB426 | |
| HB258 | |
| HB412 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 426 | TELECONFERENCED | |
| += | HB 258 | TELECONFERENCED | |
| += | HB 412 | TELECONFERENCED | |
| += | HB 356 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 426-MEDICAL ASSISTANCE FOR PERSONS UNDER 21 3:05:16 PM CHAIR WILSON announced that the first order of business would be HOUSE BILL NO. 426, "An Act relating to medical assistance eligibility and coverage for persons under 21 years of age." REPRESENTATIVE SEATON moved to adopt CSHB 426, Version 224- LS1602\I, Mischel, 3/14/06. There being no objection, Version I was before the committee. 3:05:55 PM REPRESENTATIVE JOHN COGHILL, Alaska Legislature, testified as sponsor of HB 426, and paraphrased from the following written statement [original punctuation provided]: In times when federal dollars are diminishing, the legislature will have to review policies for providing for the public health. To better provide medical assistance to the truly needy, some eligibility requirements need to be changed. As the department has put it, we are trying to address the "low hanging apples" that drain millions of dollars a year from a program that is growing in astounding increments. HB 426 puts best practices to use by increasing third- party reimbursement, reducing Medicaid abuse and fraud, setting home equity limits, and implementing new federal requirements on the State for asset transfers and treating annuities like a Miller's Trust. This bill also requires a person applying for medical assistance for a minor to be that person's parent or legal guardian, unless the parent or legal guardian is a minor. If a child is in state custody, an employee of the department can apply for coverage. Currently, the unmarried father's income and resources are not considered in determining the eligibility of a pregnant woman for Medicaid. In this bill, we would count the income and resources of the unmarried father of an unborn child when determining the eligibility of the pregnant woman. Neither the resources nor the income of the unmarried father can exceed $50,000 a year. Lastly, this bill directs the department to report back to the legislature no later than the first day of the Twenty-Fifth Legislature on ways to reduce medical assistance expenditures for services received in residential psychiatric treatment centers by enhancing parental financial responsibilities and maximizing third-party resources available. Under current law a child could be placed in residential treatment and qualify for medical assistance after being out of the family home for thirty days, even though one or both parents have medical insurance. 3:09:03 PM RYNNIEVA MOSS, Staff to Representative John Coghill, Alaska Legislature, explained that current law allows other public assistance can garnish the permanent fund dividend (PFD) for reimbursement. This bill provides language allowing the [Department of Health and Social Services (DHSS)] to garnish a PFD to reimburse for medical assistance. Ms. Moss, in response to a question, indicated that the PFD garnishment language is located in Section 5. 3:11:23 PM CHAIR WILSON inquired as to when the PFD garnishment would be applied. 3:11:27 PM KEVIN HENDERSON, Medical Assistant, Administrative Manager, Division of Public Assistance, Department of Health and Social Services (DHSS), explained that the current law allows the department to garnish the PFD of individuals who, as recipients of public assistance programs, owe money to the state for reasons provided in statute. This bill adds medical assistance to that statute. 3:12:40 PM CHAIR WILSON posed a scenario: I've had people come to me where ... maybe the ex- husband is making [support] payments and then something came up ... [and he] didn't make the payment ... so social services made the payment; ...[thus] he got behind on his payments [but] now he's making payments. I just want to make sure that this isn't added on to what he owes. 3:13:16 PM MR. HENDERSON responded that this is limited in scope for two reasons. Current regulations state that when a recipient of medical assistance abuses the program or is found guilty of fraud, they have an obligation to repay the state for those services. Also, a recipient awaiting a fair hearing for the previously indicated reason may request continued benefits while awaiting that hearing. However, if the recipient is not successful in his/her hearing, he/she is subject to repay the state for the cost of medical assistance paid during the extended benefits period. He said: Sometimes it's like getting blood out of a turnip. ... The PFD is really the most efficient way for the state to get reimbursement in those cases. We just want to add Medicaid to that list. 3:14:57 PM REPRESENTATIVE CISSNA asked whether a garnishment would apply to a parent's or a child's PFD. MR. HENDERSON responded that if a parent filed for a fair hearing on behalf of his/her child's case and lost the case, the department could seek from the parents any medical assistance paid to the child. 3:15:44 PM REPRESENTATIVE SEATON stated that [Version I] appears to encompass more than fair hearing situations. He asked whether it would provide for retroactive collection of funds when someone is reassessed and determined to no longer be waiver eligible. MR. HENDERSON said that the fair hearing situation is one example when the department could seek reimbursement. Program abuse or fraud would be other examples, he offered. 3:16:52 PM REPRESENTATIVE SEATON reiterated his concern that this bill language appears to cover any benefit considered an overpayment, including a recipient of medical assistance, who upon review, is found to be ineligible and determined to have been ineligible for some time prior to the reassessment, and has his/her PFD subject to garnishment. MR. HENDERSON offered the specific departmental regulations, 7 AAC 43.1800 and 7 AAC 43.1810, to clarify the criteria applied to seek reimbursement. He explained that the department does not seek reimbursement for services provided in good faith, only when the applicant has sought services inappropriately. 3:19:08 PM REPRESENTATIVE SEATON cautioned that in creating statute for reimbursement of benefit overpayment, the committee's obligation is to be clear regarding the scope of the bill versus relying on regulatory language for specifications. 3:19:39 PM MS. MOSS offered to present the bill sections individually and in numerical order. 3:20:45 PM DWAYNE PEEPLES, Director, Division of Health Care Services, Department of Health and Social Services (DHSS), explained that Sections 1-4 focus on support activities, which the Division of Health Care Services and DHSS are conducting to "tighten up and control and coordinate ... other third-party benefits, and reduce Medicaid expenditures." Under the Reimbursable Services Agreement, the Department of Law assigns attorney generals to DHSS to pursue subrogation and estate recoveries. Section 1 addresses eligibility and coordination of benefits, such that during the process of applying for Medicaid other potential third-party payers would be identified. Approximately 22 percent of people [receiving] Medicaid have other resources for health insurance. He noted that part of this is mandating 36 months during which the department can coordinate claims payments with other third-party payers, which meets federal statutes. Section 2 strengthens the department's ability to recover funds when there are legal actions on a subrogation. For instance, in an accident in which an insurance party will pay against a claim for settlement, the department has sometimes lost out on full recovery on its Medicaid payments for hospitalization physician services. 3:23:07 PM CHAIR WILSON surmised then that Section 2 makes it such that the department is one of the entities in line [to receive funds]. 3:23:14 PM STACIE KRALY, Chief Assistant Attorney General, Statewide Section Supervisor, Human Services Section, Civil Division (Juneau), Department of Law (DOL), confirmed that Sections 2-4 all enhance the department's ability to participate in third- party recoveries with Medicaid recipients when litigating through civil litigation or negotiating with insurance companies for payment for services that the state Medicaid program has paid. Therefore, Ms. Kraly specified that the language enhances the department's ability to gather information, coordinate services, and ensure that the department receives its third- party recovery to the fullest extent possible. CHAIR WILSON emphasized that such allows for more money to help someone else. 3:23:54 PM REPRESENTATIVE GARDNER turned attention to page 3, lines 26-27, and inquired as to how an attorney would know that he/she has a duty to notify the attorney general's office in such a case. MS. KRALY answered that the duty is a statutory duty requiring plaintiff and defense attorneys to understand the third-party recovery process. With regard to the general practice, Ms. Kraly said that if an individual seeks representation, there would be a duty to gather all of the information on the part of the attorney in order to determine whether the individual was a Medicaid recipient. The aforementioned duty exists now in a certain sense because the state has an ongoing subrogation and lien interest in these recoveries. Therefore, the aforementioned language further clarifies the attorney's responsibility so that as the attorney takes on representation of Medicaid clients, the department is aware of it and not left out during the negotiation process. 3:25:49 PM REPRESENTATIVE CISSNA inquired as to how many cases of this kind are performed every year. MS. KRALY answered that the attorney currently doing the subrogation cases has an open case load of almost 500 cases. Those are cases that have, through a review process, been determined to be meritorious to pursue in relation to the resources that are available, one attorney and one paralegal. Ms. Kraly opined that the department believes that with more resources more cases could be sought for recovery. Furthermore, [more resources] would address the state recovery issues mandated by federal law as well as the audit process required under AS 47.05.200. 3:27:14 PM MR. PEEPLES pointed out that Sections 4 and 5 are tied together and would allow the Division of Health Care Services to pursue PFD recoveries in those cases of fraud, waste, et cetera. Section 4 specifies the order in which a PFD would be garnished following tax liens and settlement costs for attorneys. MS. KRALY interjected that [Section 4] further clarifies the statutory lien for subrogation rights in regard to the Medicaid lien. The language specifies the order of priority of the Medicaid lien, which allows [the state] to recovery before other entities. 3:29:12 PM REPRESENTATIVE SEATON, referring to Section 5, asked if statutory language to the effect that the benefit overpayment is collected where fraud, waste, and abuse were present is included or is that "our" interpretation. MR. PEEPLES specified that [the language] refers to a benefit overpayment that has been determined to have been used fraudulently. REPRESENTATIVE SEATON asked if the language, "where fraud, waste, or abuse has occurred" could be inserted without "troubling the statute." He mentioned that the question could be answered later. 3:30:31 PM MR. HENDERSON, referring to Sections 6-8, related that DHSS is supportive of the general effort, although it has concerns with regard to Section 6. 3:31:07 PM MS. MOSS, in response to Representative Gatto, explained that originally the intent [of Section 6] was to include the income of the stepfather in the household income. She related a case in Anchorage in which a physician at Providence Hospital is the stepfather of children who received Denali KidCare benefits. However, the language to make it work hasn't been developed and thus the compromise was to seek the unmarried father and make him personally responsible for some of the medical bills. Ms. Moss opined that part of the concern of the department is that the woman could lie about who the father is, which would result in paternity tests. She related that the sponsor feels strongly that if [the desire] is to preserve family units, they should be made personally responsible for the upbringing of their children. The aforementioned is the background of Section 6, which she characterized as a starting point. 3:33:17 PM REPRESENTATIVE GATTO then referred to page 7, lines 9-12, which refers to [the father's] household income and resources that don't exceed $50,000 annually. He asked if it would be possible for an individual to have an annual income of less than $50,000, but have $1 million worth of resources in a house. MS. MOSS said that's covered on page 8, line 9, which specifies that the equity in the house can't exceed $500,000. 3:34:22 PM REPRESENTATIVE GATTO posed a scenario in which the individual has an annual income of less than $50,000, but $1 million worth of resources in stocks and negotiable securities. MR. HENDERSON commented that Medicaid eligibility rules "get dicey." He related his understanding that the intent of the $50,000 was that it refers to income or resources. If that's not specified in the bill, then the department would consider [a change to remedy that]. In further response to Representative Gatto, he related his belief that the intent was to refer to either the income or resources in the amount that exceed $50,000. MS. MOSS agreed with Mr. Henderson that the intent was to refer to situations in which either the resources or the income of the individual exceed $50,000. 3:36:10 PM REPRESENTATIVE GATTO moved Conceptual Amendment 1, as follows: Page 7, line 10: Delete "each do" Insert "either does" 3:36:33 PM MS. MOSS opined that if the word "and" isn't replaced, then the individuals resources and income would be limited to $50,000. REPRESENTATIVE GATTO agreed, that on page 7, line 9, the word "and" should be replaced with "or". He characterized it as a friendly addition to Conceptual Amendment 1. Therefore, Conceptual Amendment 1, as amended, would read as follows: Page 7, line 9: Delete "and" Insert "or" Page 7, line 10: Delete "each do" Insert "either does" 3:37:43 PM CHAIR WILSON objected for discussion purposes. REPRESENTATIVE GARDNER asked if the intention is that the household income can't exceed $50,000 and the resources can't exceed $50,000 or rather that the household income and resources combined can't exceed $50,000. MS. MOSS clarified that the intent is that either the household income or the resources can't exceed $50,000. In further response to Representative Gardner, if the individual has household income of $25,000 and resources of $25,000, this provision wouldn't be triggered. 3:38:33 PM MR. HENDERSON, in response to Representative Cissna, specified that except for a provision later in the bill, a person's home is almost always an exempt resource and thus isn't included in this discussion. He specified that the term "resources" refers to additional property such as a [second property] or a mutual fund. 3:39:31 PM REPRESENTATIVE ANDERSON inquired as to what will ultimately be denied of the putative father. MR. HENDERSON answered that the pregnant women's Medicaid eligibility would be denied. The department has a reservation about [Section 6], he related. The intent has always been to have a liberal eligibility group to encourage pregnant women to obtain prenatal care such that healthy children are born, which in the long-term results in less expenditures for Medicaid or any health insurance. 3:41:06 PM CHAIR WILSON related her understanding that 50 percent of all children born in the state are paid for by the state. 3:41:17 PM MR. HENDERSON opined that [Section 6] adds a layer of bureaucracy. Furthermore, the legislation refers to the "putative father", although there is no proviso for a paternity test to uphold this aspect. However, he suggested that federal law would result in the state's inability to enforce the provision unless the individual was the documented and tested father of the child. For some of the special Medicaid only groups such as Denali KidCare and this pregnant woman eligibility group, the income and resources of someone can't be counted when determining eligibility unless he/she is the spouse or the child. He related that the state will have to obtain a state plan amendment to implement this provision. He further related that the department is fairly certain that the federal government wouldn't approve it in its current state. 3:43:00 PM REPRESENTATIVE ANDERSON expressed concern with the lack of a paternity test in determining the father and the amalgamation of the father's resources to determine the mother's eligibility for Medicaid. He inquired as to when the mother would receive coverage. MR. HENDERSON posed a situation in which a putative father, after being identified as the father, refuses to cooperate with verifying his income and resources. In such a situation, the department can't do anything to the uncooperative father. Mr. Henderson specified that the only action available to the department is to deny eligibility for the pregnant woman. REPRESENTATIVE ANDERSON opined that the aforementioned is the case 50 percent of the time and thus the woman pays the penalty. CHAIR WILSON said she, too, is concerned with the aforementioned. She related that one of her constituents took a paternity test and was found not to be the father. However, he was still asked to pay. Chair Wilson opined that there needs to be a way to be sure that the right person is held responsible. 3:46:05 PM MS. MOSS interjected that she didn't want this provision to slow the progress of this legislation because the sponsor acknowledges that the legislation isn't exactly where it should be. Therefore, if the committee chooses to delete [Section 6], the sponsor can continue to work on this aspect. In response to Chair Wilson, Ms. Moss said that the next committee of referral for HB 426 is the House Finance Committee. 3:46:36 PM CHAIR WILSON said that she liked [Section 6] if there was a determination as to the identity of the father. MS. MOSS suggested that Chair Wilson could request a referral to the House Judiciary Standing Committee in order that it address [Section 6]. REPRESENTATIVE ANDERSON agreed with the need to determine who is the father. He then expressed the need to address a situation in which the father refuses to pay and the mother is left ineligible during the years it takes to garnish the father. CHAIR WILSON said that she would like to have a House Judiciary Standing Committee referral added before the House Finance Committee referral. MS. MOSS said that the sponsor wouldn't have a problem with that because he wants the legislation to be correct when it makes it to the floor. 3:47:22 PM REPRESENTATIVE SEATON related his preference to delete [Section 6] and have it reinserted in the House Judiciary Standing Committee if determined [to be appropriate]. From this committee's standpoint, the child is not going to receive prenatal care because there's an identified person who might have resources that may not pay the bills. 3:48:13 PM CHAIR WILSON reminded the committee that it has a motion before it. She then removed her objection to Conceptual Amendment 1, as amended. There being no further objection, Conceptual Amendment 1, as amended, was adopted. 3:48:46 PM REPRESENTATIVE SEATON moved Amendment 2, as follows: Page 7, lines 7-12: Delete all material. REPRESENTATIVE GARDNER objected for discussion purposes. She then inquired from where these income figures come. MS. MOSS responded that the income figures already exist in statute. 3:49:30 PM REPRESENTATIVE SEATON said that he doesn't object to the concept [of the language being deleted by Amendment 2]. However, he opined that this provision needs more work and he preferred having the work done in the House Judiciary Standing Committee. 3:50:03 PM REPRESENTATIVE GARDNER agreed with Representative Seaton, and opined that one of the large problems in society is that fathers are undervalued. She said that valuing fathers includes holding them responsible for their paternity, although not to the extent of denying or limiting medical care to a pregnant woman. 3:50:56 PM CHAIR WILSON announced that she will request that HB 426 be referred to the House Judiciary Standing Committee in order to address this provision. 3:51:34 PM REPRESENTATIVE GARDNER removed her objection to Amendment 2. There being no further objection, Amendment 2 was adopted. 3:52:27 PM REPRESENTATIVE ANDERSON turned the committee's attention to Section 8 on page 7, lines 24-26. He posed a situation in which a 17-year-old woman has a one-year-old, and related his understanding that the woman would be able to apply per this language. MS. MOSS related her understanding that once a child is born, the parent is considered the legal guardian of that child. 3:53:19 PM REPRESENTATIVE SEATON agreed with Ms. Moss, but pointed out that the language in Section 8 specifies that the individual must be an adult and the legal guardian or parent. MS. MOSS said that could be changed. REPRESENTATIVE ANDERSON said that [on page 7, line 26, the "and"] should be replaced with "or". 3:53:38 PM CHAIR WILSON announced that the aforementioned is Amendment 3. MS. MOSS interjected that the committee may want a different amendment because Amendment 3 may give any adult permission to apply for the child. 3:54:02 PM CHAIR WILSON asked if the language could merely refer to "the parent or legal guardian of the child". Therefore, New Amendment 3 would read as follows: Page 7, line 26: Delete "an adult and" 3:54:52 PM REPRESENTATIVE GARDNER said that she's trying to determine what problem is being addressed with this section. She surmised that under this legislation, if a 15-year-old runaway lives with a friend's family, the friend's family can't obtain Medicaid for the runaway 15-year-old. MS. MOSS said that is correct. She related that the sponsor believes that the parents of an unemancipated child that's under 18 years of age should have a voice in that child's life, regardless of whether the child has runaway or not. If the child is in the state's custody, the department would have the authority to apply for Medicaid. Further, if the child is living with a relative, the adult caretaker who is the relative would be able to apply for Medicaid. 3:56:15 PM REPRESENTATIVE GARDNER asked if, under current law, adults housing a runaway child can obtain [medical] care. MS. MOSS answered that under current law, anyone 18 years of age or older can apply for a child under 18 years of age to have Medicaid. REPRESENTATIVE GARDNER posed a situation in which a child is a runaway living at Covenant House with his/her parents living out of state and uninvolved, and asked how such a child would obtain medical care. MS. MOSS related her assumption that the child would have to apply for a legal guardian with the assistance of the Office of Children's Services. MR. HENDERSON highlighted that under current law there isn't anything that prevents a person from applying for themselves. He related his understanding that [Section 8] attempts to address the situation when someone applies on behalf of someone else. 3:58:03 PM REPRESENTATIVE GARDNER asked whether the state would seek reimbursement from the parent of the 17-year-old in the aforementioned situation. MS. MOSS replied, yes. She then related an example of a teenager in Utah receiving residential treatment. Although both parents worked for the state and had state insurance, because the child hadn't lived in the home for 30 days the child qualified for Medicaid. Section 11 addresses this issue, which is a complicated matter. She informed the committee that the [department] has been asked to prepare a report with possible legislation that would clarify parental financial responsibility and maximize any third-party payers. 4:00:09 PM REPRESENTATIVE SEATON asked if the addition of the new subsection would mean that a 17-year-old could not apply for him/herself. MR. HENDERSON related his understanding that it's not intended to do so. MS. MOSS said she didn't believe that the sponsor has a problem with an individual filing for Medicaid. However, the sponsor does have a problem with a runaway who gets an adult to sign up him/her for Medicaid without the parent's knowledge. Again, the sponsor believes that the parents of a runaway should be involved with decisions for their child under 18 years of age. 4:01:23 PM REPRESENTATIVE SEATON expressed his desire to word subsection (j) on page 7, lines 24-25, such that it captures the sponsor's intent. MS. MOSS said that the opportune language is "for a child", which means that a person is applying for Medicaid for a child. 4:02:29 PM MS. KRALY stated that Ms. Moss is correct, but stated that [subsection (j)] would be less ambiguous if language "on behalf of a child" was included. She then pointed out the statutory provision in AS 18.25 that deals with the ability of an unemancipated minor who is estranged from his/her family that allows him/her to obtain medical care on his/her own behalf. She said that the aforementioned needs to play into this determination also. Again, it's important not to penalize a child for an estranged relationship with his/her family. REPRESENTATIVE GARDNER said that at the same time if the parent is expected to pay for something, the parent should have some input. Therefore, if a minor child can obtain his/her own medical care and that child wants to do something that the parent disapproves of, the parent shouldn't be held responsible, she opined. MS. KRALY clarified that she highlighted the conflicting statutory authority in order to be sure that there is no inherent conflict between the ability to apply for Medicaid and the services for minors as opposed to the ability of a minor, under that express statutory grant, to obtain medical care on his/her behalf in certain circumstances. Ms. Kraly said that she didn't disagree with Representative Gardner's point, but the language needs to be reviewed and cleaned up. 4:05:03 PM REPRESENTATIVE CISSNA opined that often a large problem is obtaining medical help for teenagers who are not at home and whose parents cannot be found. She then stressed the importance of getting teenagers medical help. 4:05:55 PM CHAIR WILSON inquired as to the language that would be utilized in a paragraph (4) relating that there had been attempts to contact the parents. MS. KRALY indicated that such language would probably specify that the department has exhausted all attempts to contact the parents. She referred to such a provision as a notice provision. CHAIR WILSON opined that she would feel better knowing that is part of the process. 4:07:29 PM REPRESENTATIVE SEATON related his understanding that [Section 8] restricts who can apply for medical assistance on behalf of someone else. CHAIR WILSON opined that one wouldn't want the child to apply for such unless the parents had been contacted. 4:08:00 PM MS. MOSS asked if a child under age 18 who is estranged from his/her parents and the location of the parents isn't known would be considered a child in need of aid (CINA). MS. KRALY said that she wasn't sure she could answer that as an absolute, but it would be a question that would require review. 4:08:33 PM REPRESENTATIVE GARDNER related her practical experience in which the division is hesitant to take children into custody against their will when of an age to be noncompliant or resistant to a placement. Once the child is in state custody, then the state is responsible for where the child lives. However, if a 16- year-old says that she is going to live with her older boyfriend, there isn't much point in resources being spent on the state. Still, one would want that 16-year-old to have access to health care. 4:09:13 PM CHAIR WILSON suggested that the committee bring up all the questions during this hearing and the legislation could be heard again in this committee or referred on to the House Judiciary Standing Committee. 4:09:55 PM REPRESENTATIVE SEATON moved an amendment to New Amendment 3, as follows: Page 7, line 24, following "coverage": Delete "for" Insert "on behalf of" 4:10:25 PM There being no objection, the amendment to New Amendment 3 was adopted. CHAIR WILSON, upon determining there was no objection to New Amendment 3, as amended, announced that New Amendment 3, as amended, was adopted. 4:11:09 PM MS. MOSS, addressing Chair Wilson's concern with regard to contacting parents, related her understanding that under CINA the department has to make reasonable efforts to locate relatives. Therefore, Ms. Moss suggested inserting a paragraph (4) specifying that the department has made a reasonable effort to contact the parent or legal guardian. 4:12:16 PM REPRESENTATIVE CISSNA related that in her work with teenage females, it was common for sexual abuse to be the reason they ran away from home. In cases such as that, she opined that it may not be appropriate for the parent to know exactly what is occurring. MS. MOSS relayed that the sponsor believes that in such a case, the state should pursue sexual abuse charges. However, under CINA a civil court controls a criminal act and thus the sponsor is attempting to find ways in which to ensure that more criminal acts are treated as such. REPRESENTATIVE GARDNER noted that a child who left home due to sexual abuse may have vulnerable siblings at home and not taking action gives the perpetrator free license. REPRESENTATIVE CISSNA highlighted that the court system as well as other systems are really backed up such that services are not getting to children in time. MS. MOSS reminded the committee that a child under 18 years of age who has been sexually abused and left home, could apply for Denali KidCare him/herself. 4:15:01 PM REPRESENTATIVE SEATON said that rather than inserting the language specifying that the department has made a reasonable effort to contact the parent or legal guardian in a new paragraph in Section 8, it should be inserted as part of paragraph (3) because it's not to be in place of the caregiver, relative, or parent or legal guardian. 4:15:37 PM REPRESENTATIVE SEATON moved Conceptual Amendment 4, as follows: Page 7, line 30, following "department": Insert "and has made reasonable efforts to contact the parents" CHAIR WILSON objected for discussion, and pointed out that Section 8(3) refers to a child in the custody of the department. MS. MOSS explained that paragraph (3) would need to be renumbered as paragraph (4) and the aforementioned language would be the new paragraph (3). MS. KRALY opined that placing this language in Section 8 is confusing, and therefore she suggested tabling that issue and allowing the House Judiciary Standing Committee address it. She further opined that placing the language in Section 8 mandates a duty on the department to make reasonable efforts to locate parents for individuals who are applying for Medicaid, which is a completely different concept than the CINA provisions. She mentioned that the language may need to be inserted elsewhere within the Medicaid eligibility provisions. 4:18:11 PM CHAIR WILSON announced that she would take questions on HB 426, but would ultimately hold it for further work. 4:18:34 PM REPRESENTATIVE SEATON withdrew Conceptual Amendment 4. REPRESENTATIVE ANDERSON recommended that committee members thoroughly review HB 426, have questions answered in advance, and not have lengthy dialogue [at the next meeting]. 4:19:01 PM REPRESENTATIVE CISSNA expressed her desire to contact those in the field with regard to the ramifications of these substantial changes encompassed in HB 426. CHAIR WILSON stated that she had already made the decision to "go ahead" because the committee has other legislation to address. 4:19:34 PM REPRESENTATIVE GATTO, referring to a February 22, 2006, memorandum from Kevin Henderson, DHSS, pointed out that there is the belief that an individual with $500,000 in equity should be counted in that individual's assets. However, the legislation allows for the individual to reduce the equity value in the home by selling it or by taking out a loan that affects the equity. He inquired as to why the aforementioned is the case. MR. HENDERSON explained that the origin of this $500,000 provision came from the federal Deficit Reduction Act, which applied only to those [seeking] long-term care. This legislation would apply it to everyone else, except family recipients. The federal law also includes the provisions allowing a reverse mortgage or [selling of the house]. Mr. Henderson emphasized that generally a house was totally exempt and thus this language merely places a threshold for eligibility. In further response to Representative Gatto, Mr. Henderson clarified that whatever money was available as a result of taking out a reverse mortgage would be factored in as part of the eligibility calculation as income or resources. 4:21:57 PM REPRESENTATIVE GARDNER related her understanding, as per the sectional analysis, that Section 9 is a repealor. She inquired as to what is being repealed. MR. PEEPLES explained that currently the department has the authority to provide a settlement waiver for medical costs on a subrogation settlement. He then posed a situation of a personal injury settlement in which a Medicaid beneficiary is injured and the state has been paying for medical care. If the attorneys settle between the insurance company and the recipient, the department wants to pick up the cost of that medical claim to reimburse the expenditure out of an insurance settlement. Therefore, the client or whomever else is in the legal action wouldn't reimburse the department for medical services. Section 9 repeals that authority. 4:23:44 PM REPRESENTATIVE GARDNER inquired as to why anyone would support the department's ability to waiver efforts to collect. MR. PEEPLES said he wasn't too sure with regard to the history on that. He informed the committee that during the last two- and-a-half years the department did one waiver [on a subrogation] settlement. By removing it from the authority of the department, it places the onus on the personal injury attorney not to discount the cost of medical services paid for by state and federal funds in that settlement. 4:24:31 PM MS. MOSS, in response to Representative Seaton, stated that the department doesn't prepare fiscal notes until committee substitutes (CS) are adopted. However, the department wanted to provide the committee with an idea, without knowing whether the CS would be adopted, of its fiscal impacts. 4:25:17 PM JANET CLARKE, Assistant Commissioner, Finance and Management Services, Department of Health and Social Services (DHSS), confirmed that the department hasn't done the fiscal notes. Since the legislation is complicated and fluid, the department has attempted to set out the construct based on assumptions so that the department can try to calculate the fiscal impact by trying to isolate the population that would be impacted. She said that the department knows that it will have to establish some regulations to implement this, and therefore the report specifies full-year costs although for fiscal year 2007 only half-year costs may occur. Ms. Clarke offered to, at the next committee hearing on HB 426, go through each section of the legislation and identify the assumptions. 4:26:28 PM REPRESENTATIVE SEATON noted his interest in information regarding Section 11 and the reports required for the psychiatric treatment facilities and parental financial responsibilities. MS. CLARKE said that the department could provide that information, but she pointed out that HB 426 wouldn't provide any savings or change but would merely allow the department to report what that might be in the future. Therefore, the department hasn't attempted to cost-out any savings related to a change in that provision. She related that the area in which the most savings are seen has to do with requiring enrollment in dual eligibles in Medicare. 4:27:35 PM MS. MOSS, in response to Representative Seaton, related that the sponsor doesn't have a problem waiting until the next meeting to address and adopt the amendment he provided to the committee. CHAIR WILSON announced that HB 426 would be held over.
| Document Name | Date/Time | Subjects |
|---|