Legislature(2003 - 2004)
02/26/2003 01:35 PM Senate HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 78-MEDICAID FOR BREAST & CERVICAL CANCER
CHAIR FRED DYSON announced SB 78 to be up for consideration and
noted that another bill on the same subject, sponsored by
Senator Davis, was referred to the Senate HESS Committee. That
bill is scheduled for a hearing next week.
SENATOR LYDA GREEN, sponsor, said SB 78 removes the sunset
provision of the 2001 legislation to allow women who have been
participating the program to continue treatment and to provide
treatment for women who will be diagnosed in the future. This
bill gives DHSS the authority to impose allowable cost sharing
under federal authority for the breast and cervical cancer
category. The state would then be able to submit an amended
state plan to the federal government that would also provide for
the implementation of a system by which these funds would be
collected. The language in the bill is the same as the language
that was used for the original Denali Kid Care program.
SENATOR GRETCHEN GUESS asked her to describe how other Medicaid
programs are dealt with and how many have the cost sharing
contribution language in section (e).
SENATOR GREEN explained that the more established Medicaid
programs have very high standards, meaning participants must
have low levels of income and very limited asset ownership to
qualify. The more recent programs have a general reference to an
income limit, but not to an asset limit. She suggested that at
some future time a co-pay requirement or client participation in
rates might allow the program to be extended to other people who
might qualify without creating a great expense to the state or
the federal government.
SENATOR GUESS asked what co-pays are in effect and would remain
in effect if this bill passes.
MR. LINDSTROM said the governor strongly supports this
legislation. He explained the current co-pay is $50 per day up
to a maximum of $200 for discharge of inpatient hospital
services, 5% of allowable charges for outpatient hospital
services, $3 per day for physicians services and $2 per day for
each prescription and [indisc.].
SENATOR GUESS asked if the language on page 1, line 11, is
problematic because it says, "to the maximum extent allowed by
federal law," but then later indicates a sliding scale by
household income.
MR. LINDSTROM replied that he didn't think so by virtue of the
permissive language on line 10, which says, "may require
premiums...."
CHAIR DYSON commented the co-pay limits are ridiculously low and
asked if federal law requires them.
MR. LINDSTROM replied that is correct and said he was speaking
to the maximum that DHSS would be allowed to implement at this
point according to federal law.
CHAIR DYSON said he understood the sponsor's comments to mean
that to qualify for this benefit a person will have to be at
200% of poverty level, the same as Denali Kid Care.
MR. LINDSTROM replied for this program, Medicaid eligibility is
tied directly to eligibility for the screening program and that
is 250 percent of the federal poverty level.
CHAIR DYSON said he understood this administration was going to
recommend altering some of the qualifying levels and asked Mr.
Lindstrom if he was saying those two will not be altered.
MR. LINDSTROM replied the administration supports the bill as
drafted and he is unaware of any suggestion to alter the federal
poverty level for this program. The point that Senator Green
made is why it's important to have this discussion about what
the committee might want to consider relative to cost sharing.
He pointed out:
It's been a long-standing desire of this
administration that if and when we are allowed to do
so by the federal government, it is perfectly fair and
very appropriate for individuals who are in these
relatively higher income categories to support the
medical costs to the extent they are able to do so in
a reasonable manner. This is language that we are very
comfortable with.
CHAIR DYSON asked how much 250 percent of annual income at the
federal poverty level amounts to.
AN UNIDENTIFIED SPEAKER said he thought the poverty level in
Alaska is about $11,000 per year, so 250 percent would be about
$25,000 for a single person.
MS. ANNE GORE, Program Director, Breast and Cervical Health
Check, said she thought the amount is about $23,000 per year for
a single individual.
CHAIR DYSON said he understood that there are no asset
limitations to qualify.
MS. GORE responded that to be eligible for the screening
program, a woman must have an income below the poverty level, be
between the ages of 18 - 64 and she may or may not have medical
insurance. She may have medical insurance that would preclude
her from receiving those screening services (i.e. if the
insurance wouldn't pay for preventative health care, such as an
annual exam or a mammogram). If she is below the income level,
has insurance and the physician submits proof that the insurance
carrier denied her claim because those services are not covered,
she is eligible to have her screening and diagnostic services
paid for. Once she undergoes treatment, even if she has an unmet
deductible of $5,000, she is considered to have creditable
coverage and is not eligible to receive treatment under
Medicaid.
CHAIR DYSON asked about the asset requirements.
MS. GORE replied there is no asset test for the screening and
diagnostic program or for the treatment program.
CHAIR DYSON asked if a person would qualify who had a home worth
$1 million that was paid for but had just lost his job and
medical coverage.
MS. GORE said technically that person could, but she thought one
would have enough assets if one owned a million dollar home to
pay for screening.
CHAIR DYSON asked Mr. Lindstrom if the preceding administration
had moved away from having an asset qualification.
MR. LINDSTROM said this program is peculiar because eligibility
is tied to the screening program. Historically, the cash
assistance programs have always had an asset test attached.
MR. KEVIN HENDERSON, Eligibility Program Officer, Division of
Medical Assistance, DHSS, said some Medicaid programs have been
around for 10-12 years that do not have an asset test. However,
most of the traditional categories do have asset tests.
CHAIR DYSON said he understood that asset requirements have been
on the books, but they have largely been ignored.
MR. HENDERSON replied:
Medicaid is pretty complicated and as you get into the
law, there are 30 some different categories of
eligibility - all of those authorized under some
federal law - some are mandatory, some are
optional....
He explained that the Denali Kid Care program and the Breast and
Cervical Program don't have an asset test under the federal
provisions. Many of the traditional Medicaid categories that
have been around a long time have always had an asset test
requirement.
CHAIR DYSON asked if federal law precludes the state from having
an asset test.
MR. HENDERSON replied it does in the breast and cervical cancer
category. He added:
It ties eligibility directly to whether they have been
screened by the Breast and Cervical Screening Program
and that program, I believe by federal law, does not
have an asset test attached to it. Adding an asset
test to it is not, to my knowledge, an option for the
state.
SENATOR BETTYE DAVIS asked if the division had been denied a
waiver once for Denali Kid Care and under what circumstances
that happened.
MR. LINDSTROM explained that DHSS petitioned the federal
government and asked for the ability to do more in the way of
co-payments and cost sharing but were told no.
SENATOR DAVIS said according to the bill, the state is already
drawing the maximum amount of money it can get based upon the
guidelines.
MR. LINDSTROM agreed.
SENATOR DAVIS thought Section 2 was redundant and asked why it
is needed.
MR. LINDSTROM replied the governor and commissioner think it is
worthwhile to reiterate the notion that with these programs,
particularly when someone is above the typical income level for
Medicaid, the state be allowed to implement a reasonable cost
sharing mechanism.
SENATOR DAVIS said she thought that language should be
clarified.
MR. LINDSTROM responded that he thought the language made that
clear and he didn't think it was inconsistent with other
language.
SENATOR DAVIS asked if Mr. Lindstrom was preparing a new plan or
waiting for the federal government to give out new guidelines.
MR. LINDSTROM said he thought allowing the state to go further
would require a change in federal law.
CHAIR DYSON said the state could change the 250% of the federal
poverty level amount if it wanted to.
MR. LINDSTROM replied that is correct, although it wouldn't be
in the context of the Medicaid program; it would refer back to
the screening program.
2:04 p.m.
MS. CAREN ROBINSON, Alaska Women's Lobby, supported SB 78.
MS. CARLA WILLIAMS, President of Alaska Breast Cancer Advocacy
and the state field coordinator for the National Breast Cancer
Coalition said that both organizations support SB 78.
CHAIR DYSON thanked her for her efforts on behalf of all
Alaskans, particularly people suffering from these devastating
maladies.
MS. EMILY NENON, American Cancer Society, stated support for SB
78 and told members, "It is unconscionable to look a woman in
the face and tell them they have cancer when you know they don't
have the means to get treatment." She said Congress recognized
this and created the 70 percent federal match to state dollars
spent on this program. This month President Bush requested a $10
million line-item increase for the screening and diagnostic side
of the program.
She also has questions about the future implications of setting
up cost sharing provisions and expressed concern about placing
an undue burden on cancer patients now or in the future. The
American Cancer Society is flatly opposed to changing the
current eligibility requirements for the treatment program. It
has to match the eligibility for the screening program otherwise
they haven't gotten around the issue of screening uninsured low-
income women, knowing that they have no means to get treatment.
SENATOR GREEN moved to pass SB 78 from committee with individual
recommendations and the accompanying fiscal note. There were no
objections and it was so ordered.
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