Legislature(2003 - 2004)

04/22/2003 03:27 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
SB 105-MEDICAID:CHILDREN/PREGNANT WOMEN/FACILITY                                                                              
                                                                                                                                
[Contains discussion of HB 172]                                                                                                 
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
CS FOR SENATE BILL NO. 105(HES)  am(efd fld), "An Act relating to                                                               
eligibility  requirements  for  medical  assistance  for  certain                                                               
children,   pregnant  women,   and  persons   in  a   medical  or                                                               
intermediate care facility."                                                                                                    
                                                                                                                                
Number 1794                                                                                                                     
                                                                                                                                
REPRESENTATIVE  COGHILL   moved  to  adopt  the   proposed  House                                                               
committee substitute  (HCS), Version 23-GS1128\H, as  the working                                                               
document.   There being  no objection, Version  H was  before the                                                               
committee.                                                                                                                      
                                                                                                                                
CHAIR WILSON  explained that CSSB  105(HES) am(efd fld)  uses 175                                                               
percent of  the poverty level,  while Version H uses  200 percent                                                               
of the poverty level,  which she said is the same  as HB 172 that                                                               
was previously reported from this committee.                                                                                    
                                                                                                                                
REPRESENTATIVE COGHILL  said although  he is  a proponent  of the                                                               
175 percent of  poverty level, he wouldn't object  to [Version H]                                                               
at this point.                                                                                                                  
                                                                                                                                
Number 1864                                                                                                                     
                                                                                                                                
JOHN RILEY,  Physician Assistant, informed the  committee that he                                                               
works in a  practice that serves the uninsured  and the medically                                                               
underserved.    Every day  he  said  he  deals with  barriers  to                                                               
appropriate treatment for patients who  cannot afford the cost of                                                               
ongoing [care].   There are over 90,000 uninsured  Alaskans.  Mr.                                                               
Riley pointed out  that Governor Murkowski was  fortunate to have                                                               
health coverage  when he suffered  from symptoms  that ultimately                                                               
led to  the discovery of  a blocked artery  in his heart,  and to                                                               
have it treated.  However, an  uninsured person would have had to                                                               
forgo this evaluation due to the possible cost of over $10,000.                                                                 
                                                                                                                                
MR. RILEY  highlighted the National  Republican Party  agenda and                                                               
President  George  W. Bush's  recognition  of  the necessity  for                                                               
health  care access  for Americans,  as  it is  essential to  the                                                               
well-being and  productivity of America's  workforce.   Mr. Riley                                                               
said it is well documented  that the uninsured have [poor] health                                                               
outcomes,  have increased  mortality  once  diagnosed with  major                                                               
illnesses,  and receive  emergency care  [instead of  going to  a                                                               
primary physician].   "Health care  is not a luxury,"  he stated.                                                               
This  legislation  is  a  "double hit"  to  those  who  currently                                                               
qualify for Denali  KidCare, and drops those  between 175 percent                                                               
and  200 percent  of the  poverty level.   By  fixing the  income                                                               
level, (indisc.) cut off by the level of inflation each year.                                                                   
                                                                                                                                
MR. RILEY said in the next  ten years he anticipates a 20 percent                                                               
reduction  in  the income  qualification  level,  with more  than                                                               
10,000 Alaskans losing eligibility over  the next five years.  He                                                               
said 71  percent of the cost  of Denali KidCare is  provided by a                                                               
federal match,  and any  decrease in  the coverage  will decrease                                                               
those federal dollars.                                                                                                          
                                                                                                                                
CHAIR  WILSON  surmised  that  Mr.  Riley  was  speaking  to  the                                                               
original  Senate bill,  but  said the  HCS  before the  committee                                                               
[Version  H] maintains  the existing  situation  and freezes  the                                                               
requirements in place now.                                                                                                      
                                                                                                                                
Number 1995                                                                                                                     
                                                                                                                                
REPRESENTATIVE CISSNA  related her  understanding that  Version H                                                               
is a change [from the  existing situation] because it removes the                                                               
300 percent rule and replaces it with a dollar figure.                                                                          
                                                                                                                                
CHAIR WILSON said in the long run it would be the same.                                                                         
                                                                                                                                
REPRESENTATIVE CISSNA directed  attention to page 2,  line 16, of                                                               
Version H.                                                                                                                      
                                                                                                                                
CHAIR WILSON specified that the "$1,656" is the 300 percent.                                                                
                                                                                                                                
REPRESENTATIVE  CISSNA  maintained  that   it  is  a  significant                                                               
difference because it doesn't allow for [inflation-proofing].                                                                   
                                                                                                                                
CHAIR WILSON agreed.                                                                                                            
                                                                                                                                
REPRESENTATIVE CISSNA  pointed out  that if ["$1,656"]  is placed                                                           
in statute, it is a change.                                                                                                     
                                                                                                                                
CHAIR WILSON  reiterated that the  Version H freezes  the current                                                               
criteria.                                                                                                                       
                                                                                                                                
Number 2068                                                                                                                     
                                                                                                                                
BOB  LABBE, Deputy  Commissioner, Department  of Health  & Social                                                               
Services (DHSS),  related his belief  that Version H  mirrors the                                                               
legislation that the governor  introduced, which uses essentially                                                               
the  same   language.    That  language   proposes  freezing  the                                                               
eligibility levels  at the 2002  income standards.   He clarified                                                               
that it was not only Denali  KidCare, but also the special income                                                               
standard for  nursing home and  community-based care.   He agreed                                                               
that there wouldn't be any inflation[proofing].                                                                                 
                                                                                                                                
REPRESENTATIVE SEATON turned attention to the fiscal note.                                                                      
                                                                                                                                
CHAIR WILSON said it reflects a slight change.                                                                                  
                                                                                                                                
MR.  LABBE offered  his belief  that Version  H is  basically the                                                               
same as  for HB 172  and that the fiscal  note would be  the same                                                               
for Version H [as for HB 172].                                                                                                  
                                                                                                                                
REPRESENTATIVE  COGHILL   remarked  that   the  fiscal   note  is                                                               
significantly different.                                                                                                        
                                                                                                                                
CHAIR WILSON clarified  that her comparison was  that [Version H]                                                               
wasn't  any different  from HB  172 when  it passed  out of  this                                                               
committee.                                                                                                                      
                                                                                                                                
Number 2185                                                                                                                     
                                                                                                                                
REPRESENTATIVE CISSNA directed  attention to page 5,  line 31, of                                                               
Version  H, which  specifies that  a  pregnant woman  alone in  a                                                               
household is  considered a  household of two  persons.   She said                                                               
she understood that to be a change and requested an explanation.                                                                
                                                                                                                                
MR. LABBE  explained that under  federal law when  eligibility is                                                               
determined for  a pregnant  woman, [a pregnant  woman alone  in a                                                               
household] is considered to be a  household of two persons.  Thus                                                               
a larger income level is used.                                                                                                  
                                                                                                                                
Number 2254                                                                                                                     
                                                                                                                                
REPRESENTATIVE WOLF  moved to  report HCS  CSSB 105,  Version 23-                                                               
GS1128\H, out  of committee  with individual  recommendations and                                                               
the accompanying fiscal notes.                                                                                                  
                                                                                                                                
REPRESENTATIVE  CISSNA  objected.   She  noted  that there  is  a                                                               
nationwide  crisis in  access  to  health care.    She said  most                                                               
states grappling  with this  have focused on  taking care  of the                                                               
children,  which  is why  Medicaid  made  this program  possible.                                                               
Alaska is  unique in that it's  a young state that  does not have                                                               
the infrastructure  that other states  have.  Families  in Alaska                                                               
face huge  problems.  Locking  this in  at a dollar  figure takes                                                               
away  that little  bit  that is  available,  which she  indicated                                                               
meant a lot  to the families.   In order to ensure  the safety of                                                               
Alaska's  children,   she  said,   the  300  percent   should  be                                                               
specified.                                                                                                                      
                                                                                                                                
A  roll  call  vote  was taken.    Representatives  Gatto,  Wolf,                                                               
Coghill,  Seaton, and  Wilson  voted in  favor  of reporting  the                                                               
bill,  Version  23-GS1128\H,   from  committee.    Representative                                                               
Cissna  voted  against it.    Therefore,  HCS CSSB  105(HES)  was                                                               
reported  from the  House Health,  Education and  Social Services                                                               
Standing Committee by a vote of 5-1.                                                                                            
                                                                                                                                

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