Legislature(2009 - 2010)CAPITOL 106
04/01/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SCR13 | |
| SB238 | |
| HB282 | |
| HB126 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SCR 13 | TELECONFERENCED | |
| + | SB 238 | TELECONFERENCED | |
| + | HB 282 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 126 | TELECONFERENCED | |
SB 238-MEDICAID FOR MEDICAL & INTERMEDIATE CARE
CO-CHAIR HERRON announced that the next order of business would
be SENATE BILL NO. 238, "An Act amending the eligibility
threshold for medical assistance for persons in a medical or
intermediate care facility."
3:29:07 PM
SENATOR BETTYE DAVIS, Alaska State Legislature, mentioned that
the members should all be able to identify with this bill.
3:29:36 PM
TOM OBERMEYER, Staff to Senator Davis, Alaska State Legislature,
read from the sponsor statement: [original punctuation
provided] [Included in the committee packets.]
This bill amends and restores the Medicaid income
eligibility threshold for individuals who reside in a
medical or intermediate care facility from a specified
monthly income limit to 300% of the Social Security
income benefit rate. This threshold is also used for
people who receive home and community-based waiver
services. In 2003 the Legislature froze the Medicaid
long-term services income eligibility limit for
persons in medical or intermediate care facilities at
$1,656 per month which was 300% Supplemental Security
Income (SSI) at that time. This change created an
income ceiling for waiver eligibility, effectively
freezing the eligibility limit for the last seven
years, rather than allowing the limit to adjust
annually in tandem with the SSI, the income equivalent
of which in 2009 was $2,022. The result was that
small Social Security cost of living adjustments have
disqualified many needy disabled people from the
program.
Alternatives for preserving eligibility, particularly
for those requiring lifetime or long-term care,
include creation of a Medicaid qualifying income
trust, also known as a Miller Trust. Trusts, however,
have procedural drawbacks, including numerous
responsibilities and restrictions, limited access to
income, assistance of an attorney, and a trustee to
manage trust assets.
As background, the Supplemental Security Income (SSI)
program is a federal needs-based disability program
for low income adults over age 65, blind, or disabled.
For an adult, the SSI disability requirement is based
on the ability to work. An adult is considered
disabled if the person cannot do the work that he/she
performed before the disability occurred or cannot do
alternate work because of a severe physical or mental
condition. For a child to be eligible, he/she must
suffer from serious physical and/or mental problems.
For both adults and children, the disability must
last, or be expected to last for at least a year.
Medicaid services are critical to the well-being of
Alaska's most vulnerable citizens. Supporting SB 238
will ensure that eligible Alaskans can continue to
receive nursing home care and in-home services. It
also will save the Legislature from amending statutes
every year or two as the Federal Poverty Level
guidelines and Supplemental Security Income levels
increase with the cost of living.
3:32:44 PM
CO-CHAIR HERRON asked if research had reflected the
justification for establishing the ceiling in 2003.
3:33:14 PM
MR. OBERMEYER explained that there had been a fiscal problem at
that time, and that both this and Denali KidCare were shifted to
fixed dollar amounts. He opined that the value of these fixed
amounts had been diluted as the cost of living had increased.
He pointed out that this affected Alaska's most vulnerable
citizens.
3:33:59 PM
CO-CHAIR HERRON asked why this would have happened.
3:34:22 PM
MR. OBERMEYER said that he did not know.
3:34:31 PM
SENATOR DAVIS, in response to Co-Chair Herron, explained that
the administration at that time had cut budgets, and that this
had not since been adjusted.
3:34:58 PM
REPRESENTATIVE T. WILSON asked how this could have a zero fiscal
note.
3:35:15 PM
SENATOR DAVIS replied that there was not a cost to the state.
3:35:27 PM
REPRESENTATIVE CISSNA pointed out that the people most affected
by SB 238 more often relied on emergency room visits, which were
more costly to the state.
3:35:47 PM
MR. OBERMEYER agreed, and he added that many of the affected
seniors would not receive any services. He pointed out the
savings to the state from assistance in home care services.
3:36:23 PM
REPRESENTATIVE CISSNA requested an analysis of the cost benefits
for these programs.
3:36:53 PM
KEN OZMENT stated his support of SB 238. He relayed that he had
been denied Medicaid a few years prior. He was able to procure
a supplemental health insurance policy. He pointed out the
difficulties to those on a fixed income.
3:38:33 PM
HOLLY HANDLER, Attorney, directed attention to the small cost of
living increases at the end of December, 2008, which would have
terminated 50 - 60 people in Juneau from Medicaid. She said
that the necessary legal steps to these individuals for
establishing a Medicaid qualifying income [Miller] trust were
very difficult. She opined that a very critical aspect was the
requirement that, in order to establish this trust, the Medicaid
recipient must release the power over their finances to a
separate trustee. She advocated support for SB 238, which would
allow income eligibility to be based on social security limits,
instead of the current fixed amount.
3:42:25 PM
MS. HANDLER, in response to Co-Chair Herron, said that the
Office of Public Advocacy dealt with issues of elder fraud and
exploitation.
REPRESENTATIVE T. WILSON asked about Medicaid eligibility with a
Miller Trust.
3:43:07 PM
MS. HANDLER explained that the Miller Trust allowed for a
special trust account which would distribute the Medicaid income
to the recipient, but that upon death, the remaining money in
the Miller Trust was returned to the state.
3:43:36 PM
VANCE SANDERS, Attorney, relayed that he was also the President
of Alaska Legal Services, which worked closely with seniors and
other disabled people. He noted that many people throughout
Alaska would be affected by SB 238, as the fixed income ceiling
had limited eligibility. He opined that the fixed income had
been introduced without an understanding of how the systems
worked together. He explained that as social security limits
increased, this increase to income affected the fixed
eligibility income levels. He explained the difficulties with
an irrevocable trust, which included the necessity for a
trustee, provisions to allow for change of living environment,
and registration with the court. He reported that only death or
a court order could terminate the trust. He reflected on the
difficulty of finding qualified, knowledgeable trustees. He
urged support for SB 238.
3:47:01 PM
AMY ONEY, Assisted Living, stated her support for SB 238. She
directed attention to the fiscal note, and opined that there
would be a cost savings from passage of SB 238, as the current
system was very costly to monitor and administer.
3:49:14 PM
MARIANNE MILLS, President, AgeNet, Alaska's Association of
Senior Service Provider Agencies, pointed out that SB 238 would
allow elder Alaskans access to cost effective home and community
based services. She explained the two requirements for
eligibility to the home and community based waiver program:
financial need and medical necessity for nursing home level of
care. She reflected that the annual cost of living increase to
social security benefits would often make a person ineligible
for the Medicaid waiver program. She pointed out that SB 238
would change the income eligibility relative to the cost of
living increases. She reported that this would allow older
Alaskans to remain longer in their own homes. She stated her
support for SB 238.
3:51:47 PM
MARIE DARLIN, AARP Capital City Task Force, stated support for
SB 238 as it would correct the current problems. She pointed
out the cost increases in the seven years since the change.
3:53:17 PM
SHERRY METTLER offered her support of SB 238. She stated her
belief that the Miller Trust was extremely complicated.
3:55:54 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
Department of Health and Social Services, said that the
commission became aware of this situation in December, 2008,
when the cost of living allowance was increased, and eligibility
for services was then threatened. She opined that every cost of
living increase would jeopardize more individual eligibilities.
She pointed out that managing personal finances was a matter of
personal dignity, and that when the Miller Trust removed this
control and gave it to a trustee, it became a humiliating
process for the senior.
3:58:55 PM
REPRESENTATIVE SEATON asked if the one time federal payment of
$250 would affect eligibility.
4:00:00 PM
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services,
discussed the impact of the bill. He stated that it would raise
the income standard for eligibility of people in nursing homes
or recipients of the home and community based waivers. He did
not anticipate that raising the eligibility limit would increase
the number of nursing home or waiver recipients. He explained
the cost of care calculation which called for a contribution of
income toward the cost of care. This was income that was in
excess of personal needs and other allowed deductions, and was a
separate calculation done after the eligibility determination.
He opined that the cost of care calculation would not change.
He clarified that the Miller Trust was still available for those
people who had income in excess of the maximum allowable income,
300 percent of SSI. He said that those people with income
between the current fixed amount and the proposed 300 percent of
SSI would not need to have a Miller Trust.
4:03:11 PM
CO-CHAIR KELLER asked to clarify that the zero fiscal note was
because of the Miller Trust.
4:03:31 PM
MR. SHERWOOD agreed. He directed attention to the large cost of
living increase in 2009, and noted that everyone was able to
retain Medicaid eligibility. He allowed that it was difficult
to set up a Miller Trust, especially on short notice.
4:04:06 PM
CO-CHAIR KELLER asked if the Miller Trust was a federal trust.
He inquired about any criteria or qualifications for the
trustees.
4:04:32 PM
MR. SHERWOOD said that there was a state statute regarding
compliance with the federal statute for Miller Trusts. He
explained that federal law dictated that states which operate
Medicaid programs have to recognize these trusts for determining
Medicaid eligibility. He reported that income entering the
trust was disregarded during the eligibility determination, but
was included in the cost of care calculation. He pointed out
that under ordinary circumstances most income trusts for people
with disabilities did not accrue much money, as the cost of care
calculation "cleans them out every month, if they are
administered correctly."
4:06:00 PM
CO-CHAIR HERRON asked if the new federal health reform law
contained any eligibility criteria.
4:06:30 PM
MR. SHERWOOD replied that he was still analyzing its effect on
Medicaid eligibility. He reported that the newly added
categories would use different income calculations than were
traditionally used for Medicaid populations. He noted that
there were exceptions to the existing Medicaid populations. He
shared that an analysis to the impact was still necessary.
4:07:19 PM
REPRESENTATIVE T. WILSON asked if the seniors would have more
money without the trusts.
MR. SHERWOOD said that was not the case. He explained that
after the eligibility determination there was a cost of care
calculation to determine the individual contribution. He
reiterated that the cost of care calculation was irrelevant to
the trust. He listed the cost of care to include prescriptions
not covered by Medicaid or Medicare, a personal needs allowance,
and non-covered dependent medical expenses.
4:08:35 PM
CO-CHAIR HERRON closed public testimony.
4:08:45 PM
REPRESENTATIVE SEATON shared that he had watched the burden on
recipients increase since the shift to the fixed dollar amount.
He noted that the intent had been to save money, but that time
had shown that it did not. He expressed support for SB 238.
4:09:59 PM
CO-CHAIR KELLER stated his support for maintaining the dignity
of the seniors. He reiterated that it may become necessary to
revisit this issue in the future when the federal health care
reform bill was better analyzed.
4:10:39 PM
REPRESENTATIVE T. WILSON moved to report SB 238 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, SB 238 was reported from the
House Health and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CS HB 282 support letter - Tom Laing 03.30.2010.doc |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| CS HB 282 support letter - Center for Natural Medicine 03.23.2010.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| CS HB 282 - 26-LS1208.W - for intro into (H) HSS.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| SCR 13 support letter - K. Turkington 03.15.2010.pdf |
HHSS 4/1/2010 3:00:00 PM |
|
| DCCED fiscal note for CS HB 282 - 26-LS1208.W.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |