Legislature(2025 - 2026)ADAMS 519
03/03/2025 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Medicaid Enrollment and Spending Forecast (fy 25-fy 45) | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
March 3, 2025
1:33 p.m.
1:33:23 PM
CALL TO ORDER
Co-Chair Josephson called the House Finance Committee
meeting to order at 1:33 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Andy Josephson, Co-Chair
Representative Calvin Schrage, Co-Chair
Representative Jeremy Bynum
Representative Alyse Galvin
Representative Sara Hannan
Representative Nellie Unangiq Jimmie
Representative DeLena Johnson
Representative Will Stapp (via teleconference)
Representative Frank Tomaszewski
MEMBERS ABSENT
Representative Jamie Allard
ALSO PRESENT
Ted Helvoigt, President, Evergreen Economics; Courtney
Enright, Legislative Liaison, Department of Health.
SUMMARY
PRESENTATION: MEDICAID ENROLLMENT and SPENDING FORECAST (FY
25-FY 45)
Co-Chair Josephson reviewed the meeting agenda.
^PRESENTATION: MEDICAID ENROLLMENT and SPENDING FORECAST
(FY 25-FY 45)
1:34:43 PM
TED HELVOIGT, PRESIDENT, EVERGREEN ECONOMICS, provided a
PowerPoint presentation titled "MESA FY2025-FY2045: Long
Term Forecast of Medicaid Enrollment and Spending in
Alaska," dated March 3, 2025 (copy on file). He turned to
slide 2 titled "Long-Term Medicaid Forecast ('MESA')." He
relayed that he would discuss what had happened in the past
few years with Medicaid. He mentioned Covid-19, unwinding,
and how Alaska compared to other states as topics of
discussion. He relayed that his organization presented the
forecast first in 2006.
Mr. Helvoigt turned briefly to slide 3. He moved to slide 4
titled "Bending the Medicaid Cost Curve," which showed a
graph of actual and projected Medicaid spending. The green
line represented actual dollars spent, the dark blue line
depicted the original forecast presented in 2006, and the
blue dashed line represented the most current forecast.
Representative Galvin asked what cost containment methods
had been implemented by the state to result in lowered
costs below the expectations of 2006.
Mr. Helvoigt replied that he was not aware of all the
things the department had done. He described a "firewall"
between the department's actions and his work, in order to
have an uninfluenced forecast. He knew that at the time of
the original study in 2006, spending had increased by 15
percent to 16 percent per year without growth in
enrollment. He mentioned the biggest driver was personal
care attendant services. He knew that after the report
presentation, the department made a lot of changes in how
it was administered, which brought down spending growth.
From there forward, he was not as informed as the
department regarding what had been done over the years.
1:38:55 PM
Mr. Helvoigt continued with slide 4. He reiterated that at
the time of the original forecast in 2006, spending
continued increasing through 2003 through 2005. The
legislature had wanted to know what would happen if the
program stayed the same over the next 20 years, which was
depicted by the blue dotted line. The green line reflected
actual spending, which was much less due to actions taken
by the department. In 2025, spending was about $1.5 billion
lower than the original forecast. The blue dashed line that
depicted the most recent forecast showed spending going up.
He cited that reimbursement rates for providers, driven by
medical price inflation, would keep driving costs up.
Upcoming slides would address the topic. He summarized that
current spending was much lower than it would have been but
for actions taken by the department.
Representative Hannan appreciated that there was a firewall
that kept him from being too intimately involved in
decisions made with Department of Health (DOH). She
mentioned his comments about cost containment for personal
care attendants. She noted that on the continuum of care,
the cheapest thing if a person's health deteriorated would
be to keep them in their home with an attendant. She asked
if Mr. Helvoigt considered any of the variabilities such as
putting more people into different increased care.
Mr. Helvoigt answered yes and affirmed personal care
attendants were still a very important service within the
Medicaid program. He pondered the idea of cuts to personal
care attendants, which would result in services moving
toward nursing homes. He thought it was a relatively easy
analysis to do.
Representative Hannan asked if the analysis was included in
the presentation.
Mr. Helvoigt replied in the negative.
Mr. Helvoigt advanced to slide 5 titled "Many More Alaskans
Receiving Medicaid Services." Enrollment had increased as
had recipients. He explained that an enrollee was anyone
enrolled in Medicaid and a recipient was a person enrolled
in Medicaid and receiving services. The takeaway was that
the department was covering far more Alaskans at present
than was projected for the future. He mentioned Medicaid
expansion in FY 2016, at which time enrollment and
recipients went up quite a bit. The number of enrollees and
recipients had gone down since the bump in 2005 from
continuous the enrollment requirement during the Covid-19
pandemic. The number of recipients would increase over the
next 20 years but slowly.
1:45:41 PM
Mr. Helvoigt moved to slide 6 titled "Spending per
Recipient is no Longer Growing Slowly." He mentioned the
cost containment efforts by the department after spending
growth in the early 2000's. He noted that spending was flat
until several years ago. He thought the increased
reimbursement rates to providers was a long time in coming.
He turned to slide 8 titled "Medicaid Enrollment and
Recipients Before and after COVID." He drew attention to
the multi-colored line at the top of the graph, which
depicted spending during periods of time such as the public
health disaster emergency declaration in 2020. He discussed
the federal requirement for continuous enrollment, which
was relaxed in April 2023. The continuous enrollment
required states not to remove anyone from the Medicaid
rolls during the Covid-19 pandemic unless the person
requested it or passed away. The number of people on
Medicaid increased rapidly by 40,000 people during the
period.
Mr. Helvoigt continued to address the graph on slide 8 and
addressed the beginning of unwinding. Enrollment declined
by 18,000 between April 2023 and December 2024. He noted
that recipient counts varied considerably month to month
but had averaged about 120,000 per month over the past
three years.
Representative Galvin asked about the change in policy
pertaining to zero-to-one-year olds. She thought Medicaid
had expanded to include children at one year rather than at
one month. She wondered if the increase would be balanced
out with the unwinding.
Mr. Helvoigt answered that there was really no impact. He
relayed that he would discuss the issue throughout the
presentation.
1:50:54 PM
Representative Galvin asked Mr. Helvoigt to touch on the
specific age group throughout the presentation.
Mr. Helvoigt answered that the information was too fine-
tuned and would not be seen in the data. He explained that
the impact on spending would be negligible.
Representative Galvin asked if the number would be expanded
(perhaps to six years old) if Mr. Helvoigt would think the
numbers would be relatively negligible.
Mr. Helvoigt replied that the issue would be to consider if
there was something special in the medical needs of the age
group rather than other Medicaid enrollees.
1:52:19 PM
Mr. Helvoigt continued with slide 8. He pointed out that
enrollment increased quite a bit during the Covid-19
pandemic and the continuous enrollment requirement, but
spending was not affected much. The number of recipients
did not go up much after the Covid-19 period. He moved to
slide 9 titled "Medicaid Spending has not Dropped," which
showed a period of spending on Medicaid services from July
2022 to December 2024. The graph looked at the issue of the
unwinding, or the end of continuous enrollment. The dotted
lines showed the linear trend and month to month variation
in spending. He observed that spending kept increasing
during the period. He moved to slide 10 and relayed that
General Fund (GF) spending on Medicaid claims continued to
grow during the same period as the previous slide. He noted
that the rate of spending growth was a little greater due
to returning to the regular federal financial participation
(FFP) rate, which had been lower during continuous
enrollment. There had been an additional 6.2 percent picked
up by the federal government, which disappeared during
unwinding and resulted in GF spending going up.
Representative Hannan asked about the term "unwinding." She
asked for verification that he was referring to the
unwinding of enrollment due to the COVID-19 pandemic.
Mr. Helvoigt agreed. He elaborated that the DOH for each
state was going through the same process regarding rules
how to start redetermining individuals that were left on
the Medicaid rules during continuous enrollment.
Representative Hannan asked for verification that the
unwinding period was finished for Alaska.
Mr. Helvoigt answered that he was not certain. He did
monthly updates for the department with respect to
unwinding, which he was still doing. He thought all states
were still going through the process, which was slower than
expected. He believed the process was still happening. He
was still looking at data on a monthly basis that was
related to the unwinding process.
Co-Chair Josephson believed it was called redetermination.
Mr. Helvoigt agreed.
1:56:48 PM
OURTNEY ENRIGHT, LEGISLATIVE LIAISON, DEPARTMENT OF HEALTH,
affirmed that redetermination was mostly done and believed
it would be done March 31, 2025.
Mr. Helvoigt looked at slide 11, which addressed Medicaid
recipients with claims from July 2022 to December 2024. He
discussed seasonal and random variations in the data. He
relayed that if he was not previously aware redetermination
was going on with respect to recipients and spending, he
would not know from the data.
Mr. Helvoigt advanced to slide 12 titled "Spending per
Recipient has Grown Rapidly." He observed that spending per
recipient was going up. There was month-to-month variation
with the average spend per recipient. The average spending
per month had increased by 18 percent per year, which was
as substantial increase relative to what had been happening
with Medicaid over the previous 15 years.
Co-Chair Josephson asked if the increase was due to
Medicaid enrollees accessing care more, or rather if it was
a result of inflation or rate re-basement.
Mr. Helvoigt answered that the increase was primarily due
to rate re-basement, or an increase in rates of providers.
He thought there was some increase in the utilization of
services, but most of the increase was due to the
increasing reimbursement rates to providers.
Representative Tomaszewski asked how to ensure claims were
legitimate. He asked if the presentation would address any
findings related to trends of fraud or waste in the
Medicaid system.
Mr. Helvoigt replied that he did not know. He was reliant
on data through the claims database, and he had no ability
to discern if a claim was for a legitimate service.
Co-Chair Josephson noted that the Department of Law had a
Medicaid fraud unit.
Representative Hannan wanted to understand if it was the
cost of services had increased or if the rebasing was the
answer.
Mr. Helvoigt relayed that subsequent slides would address
the issue.
2:01:44 PM
Mr. Helvoigt moved to slide 13 titled "Medicaid Spending,
Enrollment, and Recipients." The bars on the graph
represented spending, and the two lines represented people.
The green dashed line reflected enrollees, as an annual
unduplicated count. The dark green dotted line represented
recipients, which were those who services. There would
always be at least as many enrollees as recipients. He
noted that there was an expected 5 percent difference
because not everyone used the benefits. He mentioned
increased enrollment as a result of the Affordable Care Act
(ACA) and Medicaid expansion. He mentioned that the
increased enrollment had increased at a much greater rate
than recipients of Medicaid services. He observed a
divergence between enrollees and recipients, and currently
there was only 75 percent to 80 percent of enrollees
actually receiving services.
Mr. Helvoigt addressed the bars, which addressed state fund
spending and federal fund spending. He noted that the state
GF spending amount was fairly constant until 2024.
Proportionally the Medicaid program had become more
federalized in Alaska, and currently the federal spending
was about 75 percent.
Representative Hannan asked what FFP on the slide stood
for.
Mr. Helvoigt answered that it stood for Federal Financial
Participation (FFP) or Federal Medical Assistance
Percentage (FMAP).
2:05:20 PM
Mr. Helvoigt turned to slide 14 and a comparison of average
annual growth in Medicaid spending between FY 16 and FY 23
between Alaska and other states. The study looked at six
other states including Idaho, Montana, New Mexico, North
Dakota, South Dakota, and Wyoming. There were three sets of
bars on the graph that showed total spending, state
spending, and enrollees. The data was from Centers for
Medicare and Medicaid Services (CMS). Over the period all
of the state's spending increased, with Alaska as the
average. Alaska's state spending had decreased during FY 16
and FY 23 and was the only state to do so. The number of
enrollees increased for all states, with a substantial
increase for Alaska. State spending was related to a
combination of expansion. Many of the enrollees many were
Alaska Native or American Indian and had total FMAP. In
addition, there was Indian Health Service (IHS) reclaiming,
which had shifted dollars from state to federal spending.
Co-Chair Josephson was familiar with reclaiming. He asked
why an Alaska Native individual benefitted from being an
IHS enrollee and a Medicaid enrollee. He asked if one was
sufficient.
Mr. Helvoigt answered that the two enrollments were
connected and not connected. He mentioned IHS facilities.
He mentioned that IHS eligibility came with 100 percent
FMAP. The benefit was to the state. The individual could
get healthcare wherever they chose.
Representative Galvin surmised that North Dakota and New
Mexico both would have indigenous population that would do
similar things as Alaska with regard to IHS, yet the two
state's spending was much higher than Alaska. She thought
it looked like Alaska had negative growth and was spending
less between FY 16 and FY 23. She made note of a bigger
number for the other two states.
2:09:40 PM
Mr. Helvoigt answered that Alaska had done a very good job
over the past several years, and he suspected it had done
better than other states. He pointed out that there were
more Alaska Natives in the Alaska population than there
were Native Americans in North Dakota and New Mexico. He
relayed that Alaska Natives were a growing population
compared to non-IHS-eligible people.
Representative Galvin asked for clarification on what he
meant by Alaska was doing a good job.
Mr. Helvoigt answered that he was talking about the state
budget and the efforts to ensure IHS facilities were
collocated where needed. He mentioned contracts with non-
His facilities where the Medicaid program could get the IHS
rate.
Representative Galvin thought it sounded as though the
partnerships, which were taking place in rural Alaska, were
advantageous with regard to overall spending.
Mr. Helvoigt did not want to generalize but thought that
clearly partnerships with tribal organizations had
benefitted the state, members, and the whole community.
Co-Chair Josephson pointed out that all of the legislatures
were in session around the country at present and pondered
that some other states could be asking how Alaska was doing
so great.
Mr. Helvoigt found it amazing that other states did not
look at long-term data. He had experience with the states
of Oregon and Washington.
2:12:42 PM
Mr. Helvoigt turned to a comparison to private insurance in
Alaska on slide 15. The bar graph depicted annual
enrollment and per-enrollee spending for Medicaid and
private insurance in Alaska from FY 05 to FY 24. He noted
that the green bars showed private insurance enrollment.
The blue bars represented Medicaid enrollees, and the lines
depicted spending per enrollee for the two groups. The
spending did not include long-term care. He noted that the
data on private insurance was only available through 2020
and the remaining was a projection. He observed that
private insurance had been pretty flat, with about 50
percent of Alaskans on private insurance, while Medicaid
had gone up quite a bit. The spending per enrollee in 2005
was greater for Medicaid, but the difference had been
erased in the previous five to six years and the spending
for Medicaid now looked a lot like private insurance.
Co-Chair Josephson asked if the spending was in reference
to premiums, spending on the plan, or reimbursement to the
provider.
Mr. Helvoigt replied that spending was total spending by
the individual including premiums, deductibles, and co-
pays.
Co-Chair Josephson asked if where the dashed lines merged
reflected the providers getting virtually the same amount
for the same service.
Mr. Helvoigt saw the logic in Co-chair's Josephson's
question but found it hard to believe the two amounts would
be the same.
Representative Hannan was interested in where the lines on
the graph merged and what it did or did not indicate. She
pondered that sometimes people said Medicaid was abused,
but thought the graph reflected about the same amount of
care from the two systems.
Mr. Helvoigt clarified that the graph data was on an
enrollee basis not recipient basis. For Medicaid, a lot of
enrollees were not recipients. With respect to private
insurance versus Medicaid, he could not speak to whether a
person was getting services that were not needed. He
pondered that private insurance enrollees were more likely
to be recipients.
2:18:28 PM
Representative Hannan asked what the graph indicated to Mr.
Helvoigt.
Mr. Helvoigt relayed that his takeaway was that private
insurance had been flat in Alaska, and Medicaid enrollment
had gone up quite a bit. He furthered that the cost of
spending per enrollee of Medicaid was about the same as
what was occurring in the private insurance marketplace. He
offered the caveat that not all enrollees were recipients.
He restated that spending per covered individual was
roughly the same. He mentioned that the issue of chronic
conditions was worrisome but was not only a Medicaid issue.
Mr. Helvoigt moved to slide 17 titled "Alaska's Population
is Aging and Shrinking." He relayed that there would be
three themes in projection. He noted that the Alaska
Department of Labor and Workforce Development (DOL) had a
state demographer who projected that the state population
was expected to decline over the next 20 years, which he
found worrisome. The decline would be larger for children
and mostly flat for working-aged people. The increase in
population was in the senior category, who paid less taxes
and tended to have higher healthcare costs.
2:23:00 PM
Representative Stapp asked about slide 15 and recipients
versus utilizers. He asked if there was a way to break down
the utilization of the Medicaid program into population
types. He thought Mr. Helvoigt was aware that there were
higher rates for tribal reimbursement under the fee for
service Medicaid plan. He thought it would be helpful to
break out population groups to see rates of reimbursement.
Mr. Helvoigt answered that it was possible. He relayed that
he would get the information to Ms. Enright or someone at
the department.
2:24:27 PM
Representative Stapp asked about slide 17 related to
utilization. He asked if it was strictly the senior
population that was a growth driver, or if there were other
factors such as federal FMAP and increase in cost for
coverage.
Mr. Helvoigt asked if Representative Stapp was referencing
slide 15.
Representative Stapp could not see the slides so was
referencing all of the above.
Mr. Helvoigt replied that population was not a cost driver
because it was flat, but the changing demographic of the
population would be a cost driver. He discussed the revenue
side and the workers and economy to pay for the cost in the
future. He moved to slide 18 related to Medicaid
reimbursement rates. He mentioned that the department had
done a great job keeping costs low. He mentioned not
increasing reimbursement rates to providers. He addressed
the medical price inflation on slide 18. The green bars
reflected the growth in medical price inflation in Alaska
and the gray dotted bars reflected growth in Alaska
Medicaid reimbursement rates.
Mr. Helvoigt continued that medical price inflation grew
much faster than reimbursement rates from FY 17 to FY 20.
The cost to individuals on private insurance went up a lot
in 2017 through 2020. On average over the four years,
medical price inflation grew by 3.6 percent faster each
year than Medicaid reimbursement rates. He thought there
was a similar phenomenon in 2013 to 2016. In 2021 and
through 2024, Medicaid reimbursement rates increased a
little faster than medical price inflation. The increases
were sizable after being flat for more than a decade. He
assumed that over the next 20 years Medicaid reimbursement
rates would be only slightly slower than medical price
inflation. He did not see providers being able to operate
without the increase in rates over time.
Co-Chair Josephson asked what decade were the numbers flat.
2:29:39 PM
Mr. Helvoigt replied that the numbers were flat in the
period of 2010 to 2020.
Co-Chair Josephson read the chart to mean that providers in
the last seven years had been disincentivized to some
degree to have the popoulation of patients, but in the
three years from 2021 to 2023 they were perhaps
incentivized.
Mr. Helvoigt agreed.
Representative Johnson asked how often federal
reimbursement rates had changed.
Mr. Helvoigt did not know the full process for changing
reimbursement rates.
Representative Johnson asked if it was not automatic.
Mr. Helvoigt did not know.
Representative Johnson wondered if private insurance was
compensating for not having medical rates increased by the
federal government and was having to pay the difference.
Mr. Helvoigt answered that most people studying healthcare
economics would say it was a well-known secret that private
insurance had subsidized public insurance for a long time.
He thought it was one reason workplace insurance premiums
had gone up by nine percent or ten percent per year.
Representative Stapp asked about reimbursement rates and
medical inflation. He referenced Mr. Helvoigt's work with
Oregon and Washington and thought most states utilized a
Medicaid provider tax scheme to ensure doctors and
hospitals could be compensated when they raised rates. He
asked how much Mr. Helvoigt knew about how Oregon and
Washington might address the matter.
Mr. Helvoigt answered that he was not sure about Oregon and
Washington. He knew that healthcare providers were taxed,
which went towards helping to pay for Medicaid. He offered
to look into the matter to see the range across states and
get back to Representative Stapp with the information.
2:33:56 PM
Mr. Helvoigt advanced to slide 19 titled "Faster Forecasted
Growth in Spending." He noted that last year's forecast was
for an average annual growth of 4.4 percent. The average
annual growth for state GF was 4.5 percent, and the average
for federal spending growth was 4.8 percent for the same
period. He mentioned continuous enrollment unwinding and
the increased FFP for regular Medicaid that was now gone.
There was expectation with a population that would be
increasingly IHS-eligible. In the current year, Medicaid
services would be about $3 billion in Alaska and were
projected to grow to $7.4 billion by 2045.
Co-Chair Josephson mentioned his experience teaching
constitutional law and referenced the Indian Commerce
Clause. He asked if there was anything guaranteed requiring
the federal government to pay 100 percent of IHS claims.
Mr. Helvoigt did not know the answer.
Co-Chair Josephson mentioned the bullet on slide 19,
"Continued shift toward IHS FFP rate," and asked if it was
because the indigenous popoulation was growing faster than
the other population.
Mr. Helvoigt explained that fewer people were moving to
Alaska, more people were moving out of Alaska, and Alaska
Natives were more likely to stay in the state. He added
that of Alaska Natives that had IHS, there was continued
movement toward making sure the state got a 100 FFP rate.
Representative Galvin asked about whether it would make any
difference for Alaska to change to another sort of
insurance plan. She thought Oregon or another state had got
to Health Maintenance Organizations (HMOs). She asked if it
was a cost savings.
2:37:52 PM
Mr. Helvoigt answered that in general HMOs needed a big
central population. He mentioned fee-for-service states
such as Idaho, Montana, and Wyoming. He thought it was
possible that it may work to have an HMO in Anchorage or
Mat-Su but thought it would be difficult elsewhere. He
turned to slide 20 and addressed a graph depicting
projected spending on Medicaid services by component of
growth. He noted that growth in reimbursement rates would
drive spending growth. The green rectangle represented the
status quo. The grey showed the growth in recipients over
time. The dark blue thin band showed growth in utilization
of services. He described using more and more services on
Medicaid programs longer, which was a relatively small
increase into the future. He summarized that pretty much
all growth in spending would be in reimbursement rates for
providers. He pondered that if overall medical price
inflation was more in check, the growth would be at a rate
of 4.7 percent per year.
Mr. Helvoigt moved to slide 21 and addressed a bar graph
depicting the impact of allowing reimbursement rates to
grow at the same rate as medical price inflation. In 2045
there was about $800 million less in spending than if it
was growing at the same projected pace as medical price
inflation.
Co-Chair Josephson asked about the $800 million more in
spending, and thought under current law and investment by
Congress (which was currently morphing). He asked if the
amount was Alaska's share.
Mr. Helvoigt answered that about a third of the amount
would be state GF spending.
2:42:17 PM
Mr. Helvoigt advanced to slide 23 titled "Medicaid Spending
is Driven by a Relatively Small Proportion of Recipients."
He relayed that the information was a new area of inquiry
for the forecast at the request of the department. He cited
that for 2024, 1 percent of recipients accounted for 22
percent of all Medicaid spending; 10 percent of recipients
accounted for just over two-thirds of all spending; and the
50 percent of recipients with the lowest spending accounted
for only 4 percent of spending. He thought the information
got back to the issue that simply reducing the number of
people on Medicaid would not drive down costs, and there
was a relatively small number of individuals that were
driving the spending. He noted that if the slide showed the
U.S. overall, it would look very similar.
Mr. Helvoigt moved to slide 24 titled "Chronic Conditions
and Age, FY2024." The forecast looked at 64 chronic
conditions. He explained that he was referencing
information from CMS's Chronic Condition Index Warehouse.
An individual was defined as having a chronic condition
after receiving two diagnoses for the condition during FY
24. The number of recipients diagnosed with one or more
chronic conditions had remained stable since FY 19. He
noted that the horizontal axis of the bar graph on the
slide denoted age. He pointed out that there were a lot
more recipients under 15 than between 55 and 64. The
proportion of people with a diagnosed chronic condition
went up with age. He noted that age itself did not mean
spending would be high, but probability of getting one or
more chronic conditions increased with age.
2:46:08 PM
He turned to slide 25 and addressed chronic condition
diagnoses driving Medicaid spending. He thought the bar
graph was complex. The graph showed individuals with zero
chronic conditions on the left of the horizontal axis, with
the number of conditions increasing as one moved to the
right. There were two vertical axes. The left showed
spending per recipient, and the right showed total spending
for the group. The first bar with no chronic conditions
showed an average spending in 2024 of $4,500; with total
spending a little under $500,000. Moving to the right
showed individuals with one chronic condition with average
spending of over $17,000 and total spending of nearly
$700,000 for the group. As the graph went across the
spending went up and up.
Representative Johnson asked if the results on slide 25
were over a life span.
Mr. Helvoigt answered that the graph looked at FY 24.
Mr. Helvoigt addressed high-cost recipients and chronic
conditions. The slide considered eight chronic conditions.
The green bar on the graph showed 10 percent of Medicaid
recipients with the highest costs, and the grey bar
represented all other recipients. He summarized that
regardless of the chronic condition, the proportion was
much higher amongst high-cost recipients. He mentioned
tobacco use, obesity, and mental health conditions. He
noted that mental health conditions had been an increasing
cost driver in Medicaid spending in the state and country.
Representative Johnson asked if the spending on mental
health conditions reflected into private insurance as well.
She wondered if the rates were similar.
Mr. Helvoigt answered that he did not know and explained
that the data was not available.
Representative Johnson mentioned drug and alcohol abuse as
a separate condition and wondered how much it was related
to mental health conditions.
Mr. Helvoigt answered that many Medicaid recipients had
multiple chronic conditions. He explained that mental
health and drug and alcohol abuse were definitely
interrelated.
2:51:47 PM
Mr. Helvoigt addressed slide 27 "Chronic Conditions drive
Growth in Medicaid Spending," which showed a bar graph of
projected spending of Medicaid services through FY 45. The
forecast expected about $7.4 billion in spending in 2045.
Each bar represented the spending divided between those
with diagnosed chronic conditions and without. He cited
that currently about 81 percent of Medicaid spending was on
individuals with one or more diagnosed chronic conditions.
It was forecast that not only would the total spending on
the individuals increase, proportionally there would be
more individuals with diagnosed chronic conditions. He
relayed that the projected increase was based on the
projection of fewer children and more seniors, who tended
to have more chronic conditions.
Co-Chair Josephson asked if slide 26 indicated that persons
on Medicaid with cancer were not terribly likely to have a
second chronic condition.
Mr. Helvoigt replied in the negative. He explained that an
individual could be represented in more than one bar. The
graph showed recipients that had diagnoses independent of
other diagnoses and were not unduplicated counts.
Co-Chair Josephson noted that the federal government was
paying about $2 billion per year for Medicaid in Alaska,
and the state was paying about $700 million per year. He
asked about Mr. Helvoigt's understanding of what was being
considered by Congress to decrease the spending by $880
billion.
Mr. Helvoigt agreed that it was a very large number of many
billions.
Co-Chair Josephson stated that one thing he had heard was a
potential decrease to the expansion population, which would
be an amendment to the Affordable Care Act (ACA). He asked
what Mr. Helvoigt was advising sister states if there was a
cut to federal Medicaid dollars.
Mr. Helvoigt answered that he made no recommendations for
the legislature. He suggested to focus on the expansion
population. He explained that generally when talking about
the expansion population, consider those not IHS eligible.
He reminded that the IHS-eligible Medicaid population was
100 percent federally matched. For 2025, the Medicaid
expansion population that was not IHS-eligible would be
about $460 million. Every percentage point decrease in the
FFP for expansion was worth $4.6 million. He had no feel
for the likelihood of it happening versus moving to a
system based on per capita. He relayed that there were lots
of ideas being discussed.
2:57:46 PM
Co-Chair Josephson asked if Mr. Helvoigt was following the
national scene as the issue developed.
Mr. Helvoigt answered that the company was following a lot
of different federal issues including health care,
resources, and energy. He was following the issue, but it
did not impact his work day-to-day. He explained that
something would happen and he could provide information
about the impact of any proposed change. He considered the
biggest risk to each state's Medicaid program to be
expansion. He thought it would be a big lift to change the
funding formula overall, but he thought the expansion was a
risk. He did not have any inside knowledge about anything
happening.
Representative Josephson asked if the $880 billion targeted
for a cut was for expansion only or for regular Medicaid in
general.
Mr. Helvoigt answered that he did not know but a number
that large would exceed expansion.
Co-Chair Josephson thanked Mr. Helvoigt for his testimony.
Mr. Helvoigt thanked the committee.
Co-Chair Josephson reviewed the schedule for the following
day.
ADJOURNMENT
3:00:21 PM
The meeting was adjourned at 3:00 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Long-term Forecast MESA Evergreen Forecast FY2025-FY2045.pdf |
HFIN 3/3/2025 1:30:00 PM |
|
| DOH - HFIN Presentation MESA - 022125.pdf |
HFIN 3/3/2025 1:30:00 PM |
|
| DOH - HFIN Response Annual Medicaid Reform Report FY2024 (1).pdf |
HFIN 3/3/2025 1:30:00 PM |
|
| DOH HFIN Response MESA Log 13211 Response.pdf |
HFIN 3/3/2025 1:30:00 PM |
|
| DOH HFIN Response MESA Joint Legislative Fraud, Waste, and Abuse.pdf |
HFIN 3/3/2025 1:30:00 PM |