Legislature(2009 - 2010)CAPITOL 106
03/09/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB13 | |
| HB284 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 13 | TELECONFERENCED | |
| *+ | HB 284 | TELECONFERENCED | |
| += | HB 309 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 13-MEDICAL ASSISTANCE ELIGIBILITY
3:05:49 PM
CO-CHAIR KELLER announced that the first order of business would
be SENATE BILL NO. 13, "An Act relating to eligibility
requirements for medical assistance for certain children and
pregnant women; and providing for an effective date."
3:06:34 PM
SENATOR BETTYE DAVIS, Alaska State Legislature, said that she
would not address the two proposed amendments, but would instead
just give a brief statement. She wanted to ensure that a Denali
KidCare bill was passed this session. She announced that SB 13
asked for the household income definition for eligibility to
benefits be defined as 200 percent of the federal poverty line.
She pointed out that the two proposed amendments would require
that the bill return to the Senate, and she offered her belief
that the bill would then not have enough time to be passed
during this session. She declared that SB 13 would offer
medical care benefits for at least 1300 children. She pointed
out that Department of Health and Social Services (DHSS) and the
governor's office both supported the income definition for
benefits to be 200 percent of the federal poverty line.
3:10:10 PM
CO-CHAIR KELLER noted that currently, if the income level was
exceeded by $1, then the total care was lost. He suggested an
amendment for "a co-pay ramp" which would allow for an increase
to income level without a total loss of benefits. He pointed
out that there were federal requirements to the allowable co-pay
amounts.
3:11:59 PM
REPRESENTATIVE CISSNA, noting that childhood obesity was a
problem in Alaska, asked if the increase to the income
definition for eligibility would help this population.
3:12:45 PM
SENATOR DAVIS said that she did not know of any study, but that
Denali KidCare would cover children with medical problems.
3:13:25 PM
REPRESENTATIVE T. WILSON asked how the estimate of help to 1300
children was determined.
3:13:41 PM
SENATOR DAVIS said that DHSS would explain the fiscal note.
3:13:55 PM
CO-CHAIR KELLER opened public testimony. He stated that SB 13
was not a discussion of coverage for children, but a question of
"who pays for it and at what level." He relayed that the
current qualifying income was 175 percent of the federal poverty
line (FPL). He equated this to be a $24/hour job for a 2000
hour work year for a family of four. He explained that the
discussion was to raise this qualifying income level to become
200 percent of the federal poverty line, which he equated to be
a $27.50/hour job for a family of four. He pointed out that the
discussion was for the criteria for payment, not for health
coverage.
3:15:44 PM
SENATOR DAVIS, in response to Co-Chair Keller, emphasized that
the discussion was for the cost to cover a family of four. She
directed attention to the Executive Summary of the Kaiser
Commission on Medicaid and the Uninsured [Included in the
committee packets.] and specified that Alaska was one of only
[four] states with eligibility criteria of less than 200 percent
of FPL, which she stated was the bottom. She reflected that
Alaska had a criterion of 200 percent of FPL in the 1990's, but
that this was lowered to 175 percent and then was eroded to 156
percent. She pointed out that 70 percent of the funding comes
from the federal government. She offered her belief that 9000
children were enrolled under Medicaid and Denali KidCare, and
she declared the state capable of increasing the FPL which would
increase the number of children with health care. She
reiterated that the state only paid 30 percent of the cost, with
the federal government paying the remaining 70 percent.
3:18:42 PM
CO-CHAIR KELLER replied that Department of Health and Social
Services (DHSS) would compare the Medicaid and Denali KidCare
services.
3:18:55 PM
REPRESENTATIVE T. WILSON asked if the eligibility requirement
for most states was income based.
3:19:24 PM
SENATOR DAVIS, in response to Representative T. Wilson, said
that there were a variety of state plans. She offered to
provide that information.
3:19:58 PM
DONNA GRAHAM said that her congregation had heard overwhelming
testimony from neighbors and friends about the lack of insurance
for children. She testified in support of SB 13. She agreed
that the co-pay concept was a good idea, but she stressed that
it was most necessary to pass SB 13, which would allow 1300 more
children to qualify for health insurance. She directed
attention to her nursing background and shared that, although
Alaska was a wealthy state, many children did not have health
care.
3:22:07 PM
MATTHEW TENNANT suggested that doctor consultations by telephone
would cut health care costs and save time.
3:23:53 PM
MICHAEL MARKOVICH said that he had been working on this for 11
months. He stated that he was now a disability advocate. He
declared that Representative Tuck would sponsor an amendment.
He shared that his two children were covered by Denali KidCare.
He announced that he was poor and disabled, and did not receive
any respect. He stated that he did not have a platform, but
that he wanted to use SB 13 as a platform for his proposed
amendments. He said there would be a continual struggle, for
families similar to his own, of "falling through the system" and
that there would be more crime and more homelessness. He stated
that he wanted fairness in the system. He explained his
personal family situation. He pointed out that Alaska did not
follow the [federal] poverty level. He stated his support for
an increase to 200 percent of the FPL. He referred to his two
written testimonies titled SB 13 Amendments. [Included in the
committee packets.]
3:34:19 PM
LAURIE MORRIS, United Way Anchorage Partner Agencies, reported
that she spoke for 28 Anchorage United Way Agencies which
represented a large spectrum of missions and services. She
stated that all the partner agencies supported the reinstatement
to 200 percent of federal poverty level for Denali KidCare. She
confirmed that the Anchorage United Way partner agencies
supported SB 13.
3:35:20 PM
SHARON SCOTT, Grant Manager, Mat-Su Health Foundation, stated
that the Foundation's mission was to enhance the health of
Alaskan's living in the Matanuska-Susitna Borough. Referring to
the 2006- 2008 census survey, she pointed out that 10000 Alaskan
children, 18 years or younger, were at or below the 200 percent
FPL and were uninsured, which reflected a 31 percent decline in
children covered by health insurance. She noted that this
included 1530 children in Matanuska-Susitna Borough. She
pointed to an increase in the statistics of these children
missing school, and not having a family doctor. She stated that
an increase to 200 percent FPL would offer health care access
for more families and children. She declared that the number
one goal for the Mat-Su Health Foundation was to reduce barriers
to health care access. She directed attention to the unanimous
resolution supporting Denali KidCare income eligibility to
increase to 200 percent FPL by the Board of Directors, with a
cost sharing option for those incomes of 200-300 percent FPL.
She reported that the Mat-Su Health Foundation was sponsoring a
Denali KidCare enrollment initiative, to ensure that all
eligible children in the Matanuska-Susitna Borough were
enrolled.
3:37:54 PM
CO-CHAIR KELLER asked how many of the 1500 children currently
not covered by health insurance in the Matanuska-Susitna Borough
would be covered with an increase to 200 percent of FPL.
3:38:17 PM
MS. SCOTT replied that all of these children were under the 200
percent FPL, but, in response to Co-Chair Keller, she did not
know how many were under the 175 percent FPL.
3:38:34 PM
JODYNE BUTTO, President, Alaska Chapter American Academy of
Pediatrics, shared that she was representing the Alaskan
pediatricians. She stated that the academy had long been
advocates for child health care, and had been working every year
to bring the FPL back up to 200 percent and above. She
supported co-pay above the 200 percent FPL. She stressed that
Alaska had the most stringent qualifications of any state, and
that we needed to take care of our children. She stated support
for SB 13.
3:40:23 PM
REPRESENTATIVE CISSNA asked if this would help to stem the
obesity problem.
3:41:04 PM
DR. BUTTO replied that there was a childhood obesity task force
that had made some recommendations to be offered during the
screening of children. She said that children could be referred
to a nutritionist, which was paid for by Denali KidCare. She
said that regular access to a primary care physician was the
most important issue.
3:42:30 PM
REPRESENTATIVE T. WILSON asked how Alaska was more stringent
than other states.
3:42:44 PM
DR. BUTTO, in response to Representative T. Wilson, said that
Alaska included asset allocations for eligibility, but that
other states did not.
3:42:55 PM
REPRESENTATIVE T. WILSON replied that she understood that
neither assests nor the Permanent Fund Dividend were included
for eligibility.
3:43:05 PM
DR. BUTTO pointed out that most states had yearly enrollment,
but that Alaska had monthly enrollment, which often lead to
delays in processing and was a barrier to continual care.
3:43:50 PM
ANGELA MORGAN, Aniak Traditional Council, shared that she worked
with struggling families. She said that often in the villages,
although both parents worked, there was not family insurance.
She reported that Denali KidCare ensured that children had
health coverage. She detailed how expensive it was to leave the
village for doctor visits, health checkups, vision examinations,
and dental work, all of which were available in the city but not
in the village. She stated support for SB 13.
3:47:02 PM
DAVE BOMALASKI, Doctor, Alpine Urology, stated that he was one
of the few pediatric surgeons in Alaska. He shared a story of
two infants who, because of their enrollment in Denali KidCare,
were able to have a surgery at Providence which was not
available at Alaska Native Medical Center. He stated his
support for SB 13 and its impact to Alaskan children.
3:49:02 PM
CO-CHAIR KELLER asked if the infants' eligibility would have
been affected by SB 13.
3:49:19 PM
DR. BOMALASKI declared the importance of Denali KidCare, and
noted that other children lived in poverty and did not have
access to health care, so that the program was vital to the
state.
3:49:53 PM
WALTER MAJORES, Executive Director, Juneau Youth Services (JYS),
Alaska Associations of Homes for Children, explained that Alaska
Associations of Homes for Children represented 18 organizations
across the state that provided services to kids with emotional,
behavioral, and substance abuse problems. He voiced strong
support of SB 13, as it would allow for many more kids to
receive health care services. He affirmed that Alaska was 49th
out of 50 states for its eligibility threshold, and stressed
that children's health care was the most important piece of
national health care reform. He stated that the most common
percent of FPL for eligibility was 250-300 percent. He said
that this would cost about $1300 per child, which was an
inexpensive form of prevention.
3:52:30 PM
REPRESENTATIVE T. WILSON asked how many children at JYS were not
currently covered.
3:52:43 PM
MR. MAJORES replied that about 80 percent of the JYS kids were
covered through Denali KidCare.
3:53:12 PM
CO-CHAIR KELLER asked about the criteria for coverage by Denali
KidCare versus Medicaid.
3:54:05 PM
MONICA GROSS, Doctor, testified in support of SB 13. She stated
that this bill shifted medical care from crisis care to
preventative family care. In response to Representative Cissna,
she declared that obesity was a crisis in Alaska. She pointed
out that an emergency room visit would not measure body mass
index, but would only attend to the crisis situation. She
affirmed that a Well-Child check up at her office would include
height, weight, and body mass index. She announced that all
family doctors were trained to recognize the significance of
overweight or obesity. She declared that an emergency room was
not oriented for preventative care.
3:56:01 PM
REPRESENTATIVE LYNN asked why Alaskan children had a higher rate
of obesity than in other states.
3:56:53 PM
DR. GROSS reported that three factors had been related to
obesity in children. It was lower in families that ate dinner
together, lower when there was less television or screen time,
and lower with families that exercised and kept aware of diet.
She stressed that these issues would be addressed by a family
doctor, not in an emergency room.
3:57:48 PM
REPRESENTATIVE LYNN asked why this was different in Alaska.
3:58:04 PM
DR. GROSS replied that the data was being reviewed.
3:58:32 PM
REPRESENTATIVE T. WILSON asked Dr. Gross how many of her child
clients had private insurance.
3:58:47 PM
DR. GROSS replied that it was about 50 percent with private
insurance and about 50 percent with Denali KidCare.
3:58:59 PM
REPRESENTATIVE T. WILSON asked if the private insurance included
co-pay or deductibles.
3:59:19 PM
DR. GROSS replied that coverage varied. She emphatically stated
that Denali KidCare included Well-Child Care, but that some
private insurance did not offer this, and as a result "things
fall through the cracks in those families, and it is a serious
issue."
4:00:26 PM
REPRESENTATIVE T. WILSON asked if private insurance could be
used in conjunction with Denali KidCare, or was it one or the
other.
DR. GROSS, in response, clarified that it was one or the other.
She explained that families without Well-Child care were not
getting the necessary routine care. She stressed that every
study pointed to the long term financial savings from a Well-
Child care program.
4:01:52 PM
CO-CHAIR KELLER observed that the question was not to the
validity of Well-Child care.
DR. GROSS, in response to a question from Co-Chair Keller,
stated that there were six pediatricians in Juneau.
CO-CHAIR KELLER observed that a family with private insurance
would qualify for Denali KidCare if its income was below 150
percent of FPL.
4:03:44 PM
DR. GROSS assessed that it would then be possible for Denali
KidCare to supersede private insurance.
4:04:34 PM
MARIE DARLIN, AARP Capital City Task Force, stated support for
SB 13 and encouraged adjustment to eligibility for 200 percent
FPL. She read in part from a March 8, 2010 letter which she had
submitted to the committee: [Included in the committee packets.]
AARP is the world's largest organization of
grandparents. We are concerned about health insurance
for everyone's grandchildren. In addition, we have
many retired grandparents who are raising their
grandchildren. Currently, there are over 5,500
grandparents responsible for raising over 8,200 young
Alaskan grandchildren. Very often these grandparents
are retired and dependent on Medicare for their health
coverage. Denali KidCare, in many cases, is the only
health insurance they can secure for their
grandchildren. If these grandparents are not able to
secure insurance coverage for their grandchildren,
some of the children will have to leave this caring
family environment and become wards of the state. We
hope you realize how important Denali KidCare coverage
is to these extended families that are now in one
household. These grandparents are trying to provide
the best care for their grandchildren. They need
Denali KidCare.
4:07:07 PM
MS. DARLIN, in response to Representative Cissna, said that 5500
grandparents were in charge of 8200 grandkids.
4:07:41 PM
KEVIN HENDERSON encouraged support for SB 13, as it would
"improve the chances of a healthy and productive start for our
children." He stated that it makes economic sense, as healthy
children would impose less of a demand on the health care
system, and would perform better in school. He pointed out that
these same children will pay off as contributors to society and
will become the new decision makers. He offered a story about
his grandson, noting that his grandson no longer had health care
coverage because his mother was $7.56 over the income limit. He
pointed out that she was working a full time job, with a part
time job on the weekends, and was taking classes at University
of Alaska. He stated that private insurance would cost her 25
percent of her paycheck, and have a $4000 deductible. He
declared that she and his grandson were one accident away from
financial ruin, and he opined that this was a story told all
over Alaska. He endorsed Denali KidCare to be the only viable
option. He urged the committee "to do the right thing." He
suggested that the discussion about co-pay options be held at a
later time. In response to Co-Chair Keller, he agreed that a
co-pay system after the 200 percent FPL was worth consideration.
In response to Representative Wilson, he said that there was a
need for all children to have Well Child health care, and he
reported that his daughter's insurance premiums were going to be
$150 each month, and adding his grandson could increase it to
more than $300 per month. He emphasized that this was only for
major medical coverage, and would not cover dental, Well-Child
care, or visual examinations.
4:16:01 PM
JOY LYON, Director, Southeast Chapter for Alaska Association for
the Education of Young Children (AEYC), stated that AEYC was in
support of an immediate eligibility change to 200 percent of
FPL, with future consideration of co-pay for incomes beyond this
eligibility level. She shared that the Southeast Chapter of
AEYC had just completed a needs assessment with its Best
Beginnings partners. She reported that 25 percent of women in
Juneau with babies did not get proper pre-natal care, and that
this was now a top priority. She extolled the value of the
doctor - patient relationship, and affirmed how important it was
to get mothers and kids to see the doctor. She confirmed that
Denali KidCare was critical for health and education, as the two
were so dependent on each other. She reminded that the state
only pays 30 cents on the dollar for the health care for its
children. She urged passage of SB 13, so that 1300 children
would not go another year without health care.
4:19:31 PM
CO-CHAIR KELLER asked what percentage of the Juneau women
without proper pre-natal care would be affected by SB 13.
4:20:16 PM
MS. LYON agreed that SB 13 would not cover everyone, but the
more children covered by Denali KidCare meant a greater savings
from emergency care for Alaska.
4:20:54 PM
REPRESENTATIVE CISSNA asked for a cost analysis to decide where
to spend money. She reflected on the economic value for having
healthy children.
4:22:01 PM
MS. LYON replied that there was a $12-$17 return on every dollar
invested in high quality children's health care.
4:22:31 PM
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services, stated
that the administration did support an increase of eligibility
to 200 percent of FPL, without any cost sharing. He estimated
that the bill would serve 1300 children and over 200 pregnant
women, which was based on the earlier decline of case loads when
the eligibility had been changed. He pointed to the three
fiscal notes for behavioral health, primary and acute care, and
public assistance and administrative costs. He stated that most
children in long term residential treatment would be considered
eligible under Medicaid. He said that they could be eligible
under Denali KidCare upon their entry to treatment.
4:25:51 PM
CO-CHAIR HERRON asked if the DHSS had reviewed any copayment
schedules.
4:26:30 PM
MR. SHERWOOD explained that there were federal rules regarding
copayment for Medicaid, which included some significant limits
that were administratively cumbersome. He identified that DHSS
was waiting for the new federal regulations. He said that DHSS
was willing to evaluate cost sharing proposals to ensure federal
compliance.
4:27:43 PM
CO-CHAIR KELLER said that co-pay could not exceed 5 percent of
total income.
4:28:10 PM
REPRESENTATIVE T. WILSON asked how hard it would be to add a co-
pay after the bill was passed.
4:28:25 PM
MR. SHERWOOD said that it would be the same administrative
effort either sooner or later. He said that the education for
the public and the providers might be a bit more difficult with
a later change.
4:29:10 PM
REPRESENTATIVE T. WILSON asked if it would be better to add the
co-pay now, so that the public would understand what to expect.
4:29:30 PM
MR. SHERWOOD replied that the administration supported a clean
expansion to 200 percent of FPL.
4:29:45 PM
REPRESENTATIVE T. WILSON offered an example of two people with
the same income, but only one had private insurance. She asked
for a justification that only would receive the "free care."
4:30:56 PM
MR. SHERWOOD agreed that it was an inequity of the federal law.
He allowed that lower income children were still eligible for
Medicaid, but that higher income, uninsured children were not
eligible.
4:31:24 PM
REPRESENTATIVE CISSNA said that, although the concept of co-pay
was widely accepted, the paperwork for co-pay made it so costly
that money was lost. She asked to hear more of why it was a
good economic investment. She pointed out that these children
were going to be the future workforce.
4:33:00 PM
MR. SHERWOOD replied that he did not have statistics of the long
term benefit for providing health care to children, but that he
would inquire for national statistics.
4:33:35 PM
REPRESENTATIVE SEATON asked if the co-pay would reflect the
federal equation of 70 percent - 30 percent, so that the state
savings would only be 30 percent of the co-pay.
4:34:11 PM
MR. SHERWOOD agreed that the ratio would be the same.
4:35:23 PM
REPRESENTATIVE SEATON pointed out that the state also picked up
an administrative burden with the co-pay, but would only receive
a minimal income.
4:35:54 PM
REPRESENTATIVE SEATON asked for an estimate of how many people
in the 175-200 percent of FPL were uninsured. He noted that
should the uninsured estimate be high, then the state was paying
for 100 percent of any emergency room visitations.
4:36:54 PM
MR. SHERWOOD offered to provide the estimate.
4:37:19 PM
CO-CHAIR KELLER asked about the DHSS $1 million performance
bonus as an incentive for enrollments in State Children's Health
Insurance Program (SCHIP).
4:38:43 PM
MR. SHERWOOD clarified that the bonus was $788,505. He
explained that there were target enrollment levels, and to
qualify a state must meet 5 of 8 criteria for eligibility
simplification. He listed some of the criteria to be:
continuous eligibility for one year in Medicaid; liberalization
of the asset requirement; elimination of the in person interview
process for benefits; use of the same application for renewal in
Medicaid and SCHIP; automatic or administrative renewal;
presumptive eligibility; express lane eligibility; and premium
assistance subsidies.
4:43:08 PM
REPRESENTATIVE T. WILSON asked why Alaska did not include assets
for eligibility determination.
4:43:26 PM
MR. SHERWOOD replied that the asset requirement was included in
a number of federal and state assistance programs. For the
pregnant women and children categories of Medicaid, often
referred to as the "poverty level categories," an asset
requirement was not included as it was rare that people with low
incomes had significant assets, and it was administratively
burdensome to identify and verify assets.
4:45:21 PM
ELLIE FITZJARRALD, Director, Division of Public Assistance,
Department of Health and Social Services (DHSS), explained that
the initial focus of Denali KidCare was to create access to
health care for children without insurance. She explained that
the performance bonus did not entail many departmental changes,
but that DHSS tried to stabilize enrollment for eligible
children who were "lost in the administrative trap." This
resulted in the 12 month qualification for continuous
eligibility and stabilized care. She pointed out that DHSS was
working with the tribal organizations to guarantee that eligible
children were enrolled in both Indian Health Services and Denali
KidCare, as it resulted in higher reimbursement for the state.
She noted that there were guidelines for spending the bonus.
She shared that 47 states did not have asset requirements for
children's health care programs, and that Alaska focused on
ensuring access to children's health care. She mentioned that
DHSS had considered co-pay and premiums, but were still
reviewing federal regulations.
4:48:30 PM
REPRESENTATIVE T. WILSON offered an example that a family of
four, with the Permanent Fund Dividend (PFD), would be eligible
to qualify for Denali KidCare with an income of $60,000. She
said that, without an asset test, a family could be living with
their parents, and qualify.
4:49:30 PM
MS. FITZJARRALD, in response to Representative T. Wilson, said
that the poverty standard for a family of four was a gross
income of $55,140.
4:49:57 PM
REPRESENTATIVE T. WILSON replied that this income did not
include the Permanent Fund Dividend, and she questioned how this
could be a poverty level.
4:50:18 PM
MS. FITZJARRALD agreed that inclusion of the Permanent Fund
Dividend had been discussed. She directed attention to an
earlier statute which stated that the PFD would not count in
determination of eligibility for public assistance. She also
noted that a significant percentage of the adults in families
receiving public assistance did not receive the PFD, as it was
often garnished to pay outstanding debts. She said that there
were a lot of factors to be decided when determining a level of
need.
4:52:28 PM
MR. SHERWOOD, in response to Co-Chair Keller, said that the
reimbursement level for SCHIP was 66 percent and for Medicaid
was 62 percent. He said that this would decline to 50 percent.
CO-CHAIR KELLER asked if Denali KidCare would be cut to meet
future budget constraints.
4:53:53 PM
MR. SHERWOOD replied that currently there were maintenance of
effort requirements which would prevent cuts in eligibility
without jeopardizing funding. He reported that Medicaid, Denali
KidCare, and SCHIPS were all optional programs, but that there
were mandatory services and eligibility for coverage, if
offered.
4:55:18 PM
REPRESENTATIVE SEATON directed attention to the decisions made
in 2003, which had changed the eligibility to 175 percent of
FPL. He pointed out that the legislature could make a future
change, if necessary.
4:55:59 PM
REPRESENTATIVE CISSNA opined that cost analysis was important
because parents were learning how to raise children in a healthy
way.
[SB 13 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB13pckt.PDF |
HHSS 3/9/2010 3:00:00 PM |
SB 13 |
| HB284pckt.PDF |
HHSS 3/9/2010 3:00:00 PM |
HB 284 |