Legislature(2019 - 2020)BUTROVICH 205
02/20/2019 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB7 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 7 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 7-MED. ASSISTANCE WORK REQUIREMENT
1:31:20 PM
CHAIR WILSON announced that the only order of business would be
SENATE BILL NO. 7, "An Act requiring the Department of Health
and Social Services to apply for a waiver to establish work
requirements for certain adults who are eligible for the state
medical assistance program."
1:32:30 PM
CRYSTAL BOURLAND, Executive Director, National Alliance of
Mental Illness (NAMI) Juneau, Juneau, spoke in opposition to SB
7. She said NAMI Juneau is a non-profit that focuses on
education and support for individuals affected by mental
illness. Medicaid is a lifeline for eligible low-income
Alaskans, pregnant women, children, friends and family with
disabilities, and the elderly. Medicaid eligibility conditional
on employment does not help low-income individuals improve their
circumstances, but providing supported employment, job training,
and comprehensive health care coverage does. Access to Medicaid
often supports an individual's ability to engage in work and
community. However, work requirements may have the opposite
effect and undermine an individual's employment and management
of health care needs.
She said that one serious concern for NAMI is the effect of this
bill on individuals who do not meet disability criteria. These
are the ones who live with medical conditions, mental illnesses,
or substance use disorders. These individuals may need to step
away from work due to periodic disability or illness, a decline
in mental health, or substance use treatment. While exemptions
"look good on paper," these requirements can place additional
stress on these individuals who also face health care coverage
losses while navigating a work requirement exemption. The
processing period for social security disability takes several
years, so Medicaid often provides a lifeline for those people
who await their social security disability determination.
Residents in rural communities face challenges with limited
work, job training, and volunteer opportunities, as well as
challenges of reporting subsistence activities in remote areas.
The bill does not address these unintended consequences, she
said.
1:34:52 PM
KATE FINN, representing self, Homer, spoke in opposition to SB
7. It requires a certain level of health and health care to have
a job, live a subsistence lifestyle, or participate in work
equivalents. The "catch 22" is that people need health care to
work but people also need work to receive health care. While she
appreciated the detailed exclusions in the bill, the exclusions
were insufficient since some disabilities are less obvious.
1:37:27 PM
DIANA CHADWELL, representing self, Delta Junction, spoke in
opposition to SB 7. She said disabled Alaskans who are on
disability cannot work because these disabled people will not
receive their social security disability if they earn income.
This law would discriminate against the disabled, special needs,
and the poor. She also suggested that changes should be made to
Medicaid.
1:39:50 PM
CHAIR WILSON said that members' packets contain written
testimony from people who were not able to testify at the last
meeting. After first determining no one else wished to testify,
he closed public testimony on SB 7.
CHAIR WILSON said the committee heard testimony with concerns
about exemptions regarding age, tribal membership, children
still in school at ages 18 or 19, students in university classes
or trade schools, and an increase in the age of dependents from
12 months to 60 months. He asked Senator Micciche for comments
on whether any of these ideas could be included in amendments.
1:41:20 PM
SENATOR PETER MICCICHE, Alaska State Legislature, Juneau,
Alaska, spoke as sponsor of SB 7. He said used a commonsense
approach when drafting SB 7. He said that his intention was to
create opportunities, but not be punitive when removing health
care. He said he is open to suggestions to improve the bill. He
has heard some comments in public testimony on issues that are
not affected by the bill. He characterized this bill as one that
will help Alaskans become as best as possible. He noted that the
Alaska State Hospital and Nursing Home Association (ASHNHA) had
some good suggestions to improve the bill. The bill must
recognize that Alaska has a seasonal workforce. Some people work
very hard for part of the year, and it's important that seasonal
workers do not lose their health care in the off season. The
committee might need to consider how to handle the first
instance when a recipient doesn't meet the work requirement. He
said he did not draw a line in the sand that separates one group
of people from others. "We're all Alaskans. We want to help them
to succeed," he said.
1:43:10 PM
SENATOR STEVENS asked about a comment in earlier testimony that
related it took years to qualify for exemptions.
CHAIR WILSON surmised that the comment might have been about
applying for the waiver.
SENATOR STEVENS agreed.
1:43:57 PM
SENATOR MICCICHE said the timeline for the federal Section 1115
waiver issued by Centers for Medicare and Medicaid Services
[CMS] for work requirements is not clear. The department can
apply for the 1115 waiver and the state could review other
states' records to gain efficiencies in the application. He said
that the other states' waivers are in various stages of
execution. It was difficult for him to give a hard timeline for
when the waiver process would be completed.
CHAIR WILSON added that the 1115 waivers don't have a specific
timeline for a federal response to states, unlike the "1332 and
1915 waivers".
SENATOR STEVENS asked for further explanation of the federal
1115 waiver.
1:45:26 PM
SHAWNDA O'BRIEN, Director, Division of Public Assistance,
Department of Health and Social Services (DHSS), Juneau, said
this bill would require DHSS to file for a Section 1115 waiver,
which will take some time for approval. She said the division
would review other states' applications and mirror what other
states have done in order to make their process more efficient.
CHAIR WILSON asked her to define an 1115 waiver.
MS. O'BRIEN offered to respond in writing to outline the
different waivers and to identify the requirements.
SENATOR STEVENS clarified that a waiver is requested through the
department and is submitted to the federal government. He
acknowledged that it would be frustrating if it takes years to
process.
MS. O'BRIEN reiterated that the department might gain some
efficiencies and streamlining of the process by reviewing what
other states who have applied for waivers have done.
1:46:59 PM
SENATOR GIESSEL drew the committee's attention to a National
Academy for State Health Policy document in members' packets
which she said partially summarized the waiver. She read, "New
policy allowing states to implement work and community
engagement requirements. States must seek federal approval to
require nonelderly, nonpregnant, and nondisabled adults to meet
these requirements to qualify for a full or partial Medicaid
coverage."
CHAIR WILSON offered to provide members with the department's
explanation of the waivers, which is a very complicated system.
1:48:04 PM
SENATOR BEGICH said that last year former Senator Kelly
introduced this bill and SB 7 seems substantially the same. He
said he reviewed the prior bill's fiscal notes to find
efficiencies. He noticed that the figures have changed in the
fiscal notes for SB 7. The original assumption was that 10.5
percent of recipients would be moved off public assistance,
which has been increased to 25 percent in the fiscal note for SB
7. He asked for explanation of the substantial difference in the
fiscal notes.
MS. O'BRIEN responded that assumptions last year [for former
Senator Kelly's bill] were based on enrollment. This year the
division based some of its assumptions on the existing TANF
(Temporary Assistance for Needy Families) work requirement
programs. The division has not seen as much growth in the
Medicaid program as it did initially, she said.
1:50:18 PM
SENATOR BEGICH pointed out that this represented a 150 percent
difference, so the increase in the figure is rather substantial.
MS. O'BRIEN said the division based the assumptions on
anticipated program success that envisions that more people
would be off assistance and back in the workforce.
SENATOR BEGICH said if the bill were to pass, that the state
already has an 1115 waiver in progress. He asked how many
waivers a state can have and if the state would need to amend
its waiver.
MS. O'BRIEN answered that the department would request a new
waiver separate from the one that is in progress.
1:51:18 PM
SENATOR BEGICH asked for a general timeline on the waiver if the
bill is signed into law this year.
MS. O'BRIEN replied that the fiscal notes are based on a start
date of December 31, 2019 to allow time for the waiver approval
process and to update its regulations. She said that the program
would begin on July 1, 2019. The staff training and the
notification to those affected by the bill would occur
concurrently during the approval process and adoption of new
regulations.
1:52:54 PM
SENATOR GIESSEL said that other states have implemented work
requirement programs. She noted that many states have a work
requirement of 80 hours per month. She asked Senator Micciche if
he had any data that indicated the success or outcome of these
programs. She noted that members' packets contain materials from
Arkansas.
SENATOR MICCICHE pointed out that the program has been in
existence for about 13 months. The National Academy for State
Health Policy document developed a spreadsheet that identifies
which states have applied, the stage of implementation, and the
work requirement hours. He agreed that the requirement for 20
hours [per week] is something of a standard. He preferred to
have a monthly total instead of a weekly average to capture
volunteer opportunities in places where employment might be
limited.
1:55:16 PM
EDRA MORLEDGE, Staff, Senator Peter Micciche, Alaska State
Legislator, Juneau, said that Legislative Research Services is
in the process of gathering that data. However, the agency has
not yet found any definitive studies. Implementation by some
states has been held up by lawsuits and other programs have not
been operational long enough to acquire data, he said.
SENATOR GIESSEL directed attention to a report in members'
packets from January 2018 about Arkansas [Work Requirements Are
Working in Arkansas: How commonsense welfare reform is improving
Arkansans' lives]. She said that the report is positive, that
Arkansas saw incomes more than triple for people who left
welfare and found work, which also resulted in savings to the
state. She expressed an interest in the impact Alaska's program
might have on the self-esteem and independence people from
employment, and the example it would set for their children. She
recalled that the report from Kansas was also quite positive,
that participants significantly increased their income, far
offsetting the benefits these recipients received from TANF and
other aspects of Medicaid. She said she looked forward to
receiving research from Legislative Legal Research Services.
1:57:59 PM
SENATOR MICCICHE said that the Arkansas report is related to its
welfare reform. The report was issued before the Centers for
Medicare and Medicaid Section 1115 Medicaid waiver for work
requirements. This program was one of the reasons for his
interest in developing the bill. He said that the number of
able-bodied, childless adult food stamp enrollment dropped by 70
percent. Their recipients had incomes more than triple within
two years of leaving public assistance, which offset their lost
food stamp benefits. Taxpayers in Arkansas saved more than $28
million a year. He said that Arkansas also had relative success
in reductions to its Supplemental Nutrition Assistance Program
(SNAP) and TANF.
SENATOR MICCICHE said that SB 7 relates to Medicaid work
requirements by creating opportunities for Alaskans. He directed
attention to other studies in members' packets, including the
Economic Research Center at the Buckeye Institute study that
estimated women could earn an additional $212,000 and men an
additional $323,000 over the course of their careers while still
receiving Medicaid work requirements. Under SB 7, the program
would encourage education, job training, social interaction and
community participation. It would also ensure accountability for
able bodied persons on public assistance by using a regular,
structured process to help them improve their social-economic
conditions rather than living a life of dependency. This bill
would still provide health care benefits for those willing to
work or volunteer. At some point people would likely obtain
private insurance, he said.
He said that he is trying to separate this discussion from the
arguments against this program from those who directly benefit
from public assistance or the providers of these programs. He
emphasized that the work requirement program would provide
opportunities for individuals currently receiving public
assistance to succeed.
2:01:06 PM
SENATOR GIESSEL pointed out that Alaska Housing Finance
Corporation (AHFC) has seen positive impacts in its program,
once participants were provided support and low-income housing.
She said that the work requirement program will provide a safety
net for people, but not a permanent solution. She asked whether
the committee could obtain information on the AHFC program.
CHAIR WILSON said his office has requested information from AHFC
about the Step Program, which is a five-year plan for housing
vouchers. He offered to share that report with the committee.
2:02:02 PM
SENATOR BEGICH asked if Senator Micciche's office provided the
Arkansas report in members' packets.
MS. MORLEDGE answered that the sponsor provided the Arkansas
report for the purpose of showing that work requirements are
working in other states.
SENATOR BEGICH said Arkansas did not have its CMS Section 1115
waiver until March 2018. He clarified that Arkansas now has a
lawsuit about work requirements.
2:03:08 PM
MS. MORLEDGE said Arkansas has a lawsuit, but its waiver was
granted.
SENATOR BEGICH responded that Arkansas's waiver was granted in
August of 2018, but three months later a lawsuit challenged it.
However, the improvements in Arkansas were related to
requirements in Arkansas and not this waiver since the waiver
has not been in existence long enough to obtain the data.
MS. MORLEDGE agreed that was true.
SENATOR BEGICH asked how many of lawsuits were pending in the
Lower 48. He expressed concern that Alaska could potentially
risk a lawsuit if this bill were to pass.
MS. MORLEDGE answered that Legislative Legal Services is
researching this issue.
2:04:27 PM
SENATOR MICCICHE said the state has no way of predicting whether
it will be sued on any piece of legislation. He cannot stop
working to improve the lives of Alaskans worrying about
lawsuits.
SENATOR STEVENS said the report highlighted the wonderful
success in Arkansas in terms of reducing public assistance. He
asked for clarification on the difference between the Arkansas
program and the program proposed in SB 7.
SENATOR MICCICHE replied that he provided the Arkansas report as
a model to show what can occur when people are encouraged to
take advantage of temporary support programs to become self-
sufficient and independent. He offered his belief that this
program has a direct correlation to Medicaid.
He said that SB 7 would allow people to retain Medicaid
benefits, but require able bodied recipients to start advancing
and developing their potential, so that one day these recipients
will likely not require Medicaid.
He said that other states found the 1115 waiver practices were
proven to be successful with a subset of the Medicaid and public
assistance populations. He acknowledged that the work
requirement program will not work for everyone. The goal is not
to take away needed health care, but to lessen dependency on
state and federal programs such as Medicaid and public
assistance.
2:06:51 PM
SENATOR STEVENS said he was unsure if the program in SB 7 is
exactly like the Arkansas program.
CHAIR WILSON said the first state to go through [the 1115
waiver] process is Kentucky. He was unsure if it has prevailed
in a lawsuit on work requirements.
SENATOR BEGICH responded that a follow-up lawsuit was initiated
in Kentucky last month. He reported that Governor Bevin
initiated the waiver process early in 2017 and it was approved
in January 2018.
2:08:26 PM
CHAIR WILSON said he would hold SB 7 and consider amendments at
the next hearing.
SENATOR BEGICH asked whether anyone was working with the Alaska
State Hospital and Nursing Home Association (ASHNHA) regarding
their suggestions for SB 7.
SENATOR MICCICHE noted the ASHNHA letter in members' packets and
said he does not support all their ideas, but he wants this to
work for Alaskans that depend on Medicaid for their health care.
He said he looks forward to working with the committee to
develop the best bill to help Alaskans move forward.
[SB 7 was held in committee.]