Legislature(1997 - 1998)
03/15/1997 11:07 AM House STA
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 153 - ALIENS AND ASSISTANCE PROGRAMS The next order of business to come before the House State Affairs Standing Committee was HB 153, "An Act relating to the eligibility of aliens for state public assistance and medical assistance programs affected by federal welfare reform legislation; and providing for an effective date." Number 2468 RICK TESSANDORE, Executive Director, Disability Law Center of Alaska, was the next person to testify via teleconference in Anchorage. TAPE 97-28, SIDE B Number 0001 MR. TESSANDORE stated that 1,850 folks were on Medicaid, of which, 800 were Supplemental Security Income (SSI) recipients. The center was working with Catholic Social Services, the Division of Public Assistance and the Mental Health Trust Authority to try to identify and to find the legal immigrants with disabilities who were at risk of losing federal and state benefits in the near future. The process of finding these individuals had been quite difficult due to language barriers, for example. Many of these folks had lived and worked in Alaska for many years but had never become naturalized U.S. citizens. There were waiver processes that were being used by the protection and advocacy system around the country to identify these folks and to get them through the process of naturalization. Thus, the center was concerned about the time frame involved. The bill could extend the time needed to identify and help these folks. He asked the committee members to support the bill and to give the center the time to complete its search and process to determine if these individuals would be eligible to maintain their benefits. Number 0105 SYLVIA CARVAJAL, Project Coordinator, Disability Law Center of Alaska, was the next person to testify via teleconference in Anchorage. She had conducted a research project for the Municipality of Anchorage and Catholic Social Services to determine the impact of the welfare reform law on lawful permanent residents mostly in Anchorage and Kodiak. The research indicated that many of the lawful and permanent residents were disabled and elderly. They had little or no income or other resources. They received social security assistance. They used the money to pay for their rent, their utilities, and their basics for survival. They consistently ranked social security as the benefit that would greatly affect them if they lost it. They also listed Medicaid and Food Stamps. Some of the reactions from the individuals who were interviewed were: crying, hopelessness, fear, desperation and pleading for help. The center supported the bill and encouraged its passage. Number 0176 MADELEINE GRANT, M.D., Co-Medical Director, Anchorage Neighborhood Health Center, was the next person to testify via teleconference in Anchorage. She was testifying today on a personal and a professional level. Personally, she thought it was morally reprehensible to deny services to those who immigrated to this country legally. She was not a Native American, therefore, her relatives had immigrated at some time to the country. Medically, she thought the denial of assistance led to problems in their personal lives and to a cost for the community. For example, prenatal and antenatal care could prevent premature babies who often had life-long disabilities. She cited several other examples of scenarios that preventative medicine could stop or prevent life- long disabilities. Hypertension was common in the immigrant population and treatment prevented major strokes that caused disabilities. She urged the committee members to support the bill. Number 0333 JAY LIVEY, Deputy Commissioner, Office of the Commissioner, Department of Health and Social Services, was the first to testify on behalf of the Governor on HB 153. The bill responded to the federal government's welfare reform bill. The federal government restricted services to legal aliens for all federally funded programs which included Food Stamps and Supplemental Security Income regardless of when they entered the country. Supplemental Security Income was a federal program for individuals who were blind and disabled. It was about $460 per month in cash. There was nothing that the state could do about this, however, because it was a federal law. The programs that were half-state and half- federal which included Medicaid and the Alaska Temporary Assistance Program (ATAP) were funded by the federal government and matched by the state. Therefore, the federal government said the states could choose what to do about them. Those individuals, as far as the state was concerned, would be barred from the services for five years. The third program affected was the Adult Public Assistance (APA) program. It was a state program that provided a cash supplement to those who were found to be disabled under SSI. The state could write the eligibility rules for that program. The Governor's bill said that if a person was on Medicaid, Alaska Temporary Assistance program, or Adult Public Assistance, the state would continue coverage as long as the person was in the country by August 22; otherwise, the state would bar that individual for five years. As a result, there was no additional cost to the state. The fiscal note showed a savings because currently there was a defined pool of those who were eligible as of August 22 and through normal attrition people would be leaving that pool. MR. LIVEY further stated that the issue involved legal aliens who had been told that they could be in the country from the federal government. There were 2,100 legal aliens currently on programs, of which, 801 were on the Adult Public Assistance, 818 were on the Alaska Temporary Assistance Program, and 1,900 were on the Medicaid program. MR. LIVEY further stated that they were eligible for these programs essentially because they had met all of the eligibility criteria, not because they were legal aliens. Therefore, those who were on the SSI and Adult Public Assistance were disabled or blind and could not work. MR. LIVEY referred the committee members to a handout titled, "Legal Aliens," a comparison of the current law and the proposed change under the Governor's bill for the five affected programs. Food Stamps and SSI were federal programs so the legal alien was no longer eligible under the current law and the proposed change. Medicaid and the Alaska Temporary Assistance Program were state- federal programs, of which, the federal government barred coverage and the proposed change would bar the legal alien for five years for those who entered the country after August 22, 1996. The Adult Public Assistance program was a state-only program so it could do anything it wanted to it. MR. LIVEY referred the committee members to a handout title, "FY 97 Budgeted Expenditures," showing the benefit packages. Before the passage of the federal law, a blind or disabled individual received $70 in Food Stamps, $484 in SSI, $362 in APA and they were eligible for Medicaid. After the federal law and under current state law, the blind or disabled individual would lose Food Stamps, SSI, and Medicaid while retaining APA. Under the Governor's proposed bill, the blind or disabled individual who arrived in the country prior to August 22, 1996, received only $362 in APA and was eligible for Medicaid. Number 0775 REPRESENTATIVE DYSON asked Mr. Livey what would be the fiscal note if the bill was not passed? The question did not indicate how he was going to vote. Number 0785 MR. LIVEY replied if no bill was passed then the state would have to continue to cover APA recipients for those that were here as of August 22, 1996; as-well-as, any new aliens coming into the country who were eligible for the program. There was nothing in the state law to restrict that eligibility. It would be the same for the ATAP program. The only difference was that because of the federal welfare reform all of the services would be from state funds for those that arrived after August 22, 1996 because the federal government said the state could not use federal funds for five years. It was different for Medicaid because an individual had to be listed to be eligible. Legal aliens were not listed specifically. Therefore, if no bill passed then legal immigrants would lose their eligibility for Medicaid. MR. LIVEY further explained that the legislature could craft its own response to the federal law. If it did craft its own response then there would be a difference in the combinations of eligibility. Number 0912 REPRESENTATIVE DYSON asked Mr. Livey if the state did nothing would it still be paying its component of the Medicaid program? MR. LIVEY replied, "No." REPRESENTATIVE DYSON asked Mr. Livey if the state did nothing would there be a savings in the Medicaid component? MR. LIVEY replied, "Yes." REPRESENTATIVE DYSON asked Mr. Livey what would be the magnitude of the savings? MR. LIVEY asked that Mr. Sherwood, Division of Medical Assistance, come forward and explain the Medicaid fiscal note. JOHN SHERWOOD, Medical Assistance Administrator, Division of Medical Assistance, Department of Health and Social Services, was the next person to testify on behalf of the Governor. He explained there were two fiscal notes - facility and non-facility - which was how the budget was broken up. Both were zero fiscal notes and on page 2 of each one showed the scenario if the legislature did not pass the bill. Under the federal law the state still had to provide emergency medical services to legal immigrants who did not qualify for regular Medicaid. And the General Relief Medical (GRM) program would provide coverage for certain services such as maintenance drugs for certain chronic conditions. There would be a shift, therefore, of the cost from the regular Medicaid program to the Medicaid emergency medical coverage and for the GRM program. The division estimated that on an annual basis there would be a reduction in total spending of about $2.4 million if the bill did not pass. That would only be a general fund reduction, however, of approximately $750,000 because of the five year ban and the division would continue to receive bills from those that were eligible from providers. Number 1056 CHAIR JAMES stated if the state did nothing it would not continue to give Medicaid assistance, except in emergencies. The Medicaid program was a matching program; therefore, she wondered if the federal government did not give any money, would the state have to match. Was that why the state did not have to fix the Medicaid part? she asked. Number 1090 MR. SHERWOOD replied, "Yes." Under state law, Medicaid services could not be provided to individuals unless they were listed in state law as being eligible. Once the federal government gave the option to provide eligibility, there was no listing of this group. Therefore, even under state law, the state could not continue to provide that benefit. Number 1115 CHAIR JAMES commented on the certification process of the SSI program. She asked Mr. Livey who paid for the qualification now and who would paid for it if the law changed? Number 1164 MR. LIVEY replied the federal government paid for the recertification. CHAIR JAMES replied but now that the federal government did not allow for the SSI program, it would not continue to pay for recertification. Thus, would the state have to pay for it, or would the state let the program go on without recertification? MR. SHERWOOD replied the state had a contract with the Division of Vocational Rehabilitation that provided recertification for the Social Security Administration and for the state programs. Number 1207 CHAIR JAMES wondered if the state had been taking advantage of the designation with SSI. She knew a lot of people who had to qualify for SSI before the state would do anything for them at all. There was a piggyback approach. Correct? she asked. Number 1227 MR. LIVEY replied, "Yes. That's right." CHAIR JAMES stated then there would not be anything kicked in until the five years had gone by for the new aliens, except for recertification. Therefore, the state would have to do more now then when the feds were doing the recertification. Number 1251 CHAIR JAMES asked Mr. Livey why negative income was tied to the bill because the state would not get any of that income? Number 1267 MR. LIVEY replied the two negative fiscal notes were tied to the ATAP and APA programs. The notes represented time because there would not be any new people coming into the programs because it barred eligibility for five years. The fiscal notes really represented the pool of eligible people now. Some, over the next several years would leave that pool decreasing the General Fund contribution. The notes were actually dollar cost savings. Number 1309 CHAIR JAMES replied that really did not have anything to do with the bill. MR. LIVEY replied it had to do with the bill because it allowed the state to not put new people onto the program. CHAIR JAMES explained she had a real problem assigning a negative fiscal note to the bill because it appeared it was the result of the federal welfare reform as opposed to HB 153. "It seems to me like were being defensive here as opposed to being aggressive." She understood what Mr. Lively was saying, however. If the bill was not passed, the statute said that the state had to deal with legal aliens and the federal government would not give to the state any more money. Therefore, the money that it would not give the state would be a negative fiscal note. If the bill was not passed the state would also have a positive expense. "It's confusing." It seemed that there should be a notation indicating the savings and the costs, if the bill was not passed. It appeared that the notes only indicated the negative federal funds that the state would get. Number 1458 MR. LIVEY replied the notes did not indicate what the cost would be if the bill did not pass. CHAIR JAMES stated there was a negative cost as well as the income. There was also a negative fiscal note in the expense-line for introducing the bill. Number 1481 MR. LIVEY replied the APA fiscal note of $156,000 indicated that the state would save that amount in fiscal year 98. It was a combination of people coming off of the program and new people not coming onto the program. The net effect was that the program would not have to pay out $156,000 creating a savings to the General Fund. CHAIR JAMES stated that the figure was under grants and claims. Therefore, if the fiscal note was true, the legislature could reduce the department's budget by that much. MR. LIVEY replied if the bill was to pass, "Yes." MR. LIVEY further asked the committee members to keep in mind that these were folks who did have a disability and who did have a need for this type of support, or they would not have been on the program in the first place. The federal government had already taken a lot of that support away. This was a way for the state to maintain support for those individuals while at the same time changing the rules for those who entered the country after August 22, 1996. Number 1597 CHAIR JAMES asked Mr. Livey what did the state plan to do to address the additional needs that the aliens would have? She did not think the $362 from the state would cover their concerns. Number 1642 MR. LIVEY replied that was a difficult question. The federal welfare reform changes created a cost-shift from the federal government to the state government and frankly some of that cost would go down to the municipal government. The department did not have any other items in its budget to make up for the cash portion that the recipients would be loosing. The department had been working with the Municipality of Anchorage and Catholic Social Services to determine how programs and services could be absorbed at the local level. "Your question is a very, very good one. It's going to be very difficult." Number 1683 CHAIR JAMES stated that the department knew who these people were. She asked Mr. Livey if the department had done anything to notify the local governments and/or United Way, besides Catholic Social Services, to let them know where the need would be for a response? Number 1704 MR. LIVEY replied the department had a contract with the Municipality of Anchorage to work with the population of immigrants. The municipality worked directly with Catholic Social Services that had an immigration assistance program. The department was also working with the Disability Law Center of Alaska to find these folks and to help them become a naturalized citizen. It was probably not enough, however. CHAIR JAMES called for a motion to move the bill out of the committee. Number 1756 REPRESENTATIVE DYSON moved that HB 153 move from the committee with individual recommendations and the attached fiscal note(s). There was no objection, HB 153 was so moved from the House State Affairs Standing Committee.
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