Legislature(2003 - 2004)
04/22/2003 03:27 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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.