Legislature(2015 - 2016)CAPITOL 106
03/17/2015 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Memory Care & Eden Philosophy | |
| Discussion: Medicaid Expansion | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 17, 2015
3:02 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Louise Stutes
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
Representative Neal Foster
COMMITTEE CALENDAR
PRESENTATION: MEMORY CARE & EDEN PHILOSOPHY
- HEARD
DISCUSSION: MEDICAID EXPANSION
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
VICKIE WILSON, Acting Director
Central Office
Division of Alaska Pioneer Homes
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Memory Care
& Eden Philosophy" during a presentation by the Alaska Pioneer
Homes.
GINA DEL ROSARIO, Administrator
Juneau Pioneer Home
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Spoke during the PowerPoint presentation by
the Alaska Pioneer Home.
CAITLIN TEASTER
Social Services Program Coordinator
Division of Alaska Pioneer Homes
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the presentation
by the Alaska Pioneer Homes.
ACTION NARRATIVE
3:02:25 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:02 p.m.
Representatives Seaton, Talerico, Stutes, Vazquez, and Wool were
present at the call to order. Representative Tarr arrived as
the meeting was in progress.
^Presentation: Memory Care & Eden Philosophy
Presentation: Memory Care & Eden Philosophy
3:02:51 PM
CHAIR SEATON announced that the first order of business would be
a presentation by the Alaska Pioneer Homes.
3:04:10 PM
VICKIE WILSON, Acting Director, Central Office, Division of
Alaska Pioneer Homes, Department of Health and Social Services,
reported that she had "been working in the field of aging for
the past 30 years," primarily working with individuals with some
form of dementia. She asked how many in the audience had a
family member with dementia, or had been a care giver.
MS. WILSON explained that Alzheimer's Disease was a progressive
disease that destroyed the memory and other important mental
functions, and that it was one of the more common causes of
dementia currently being diagnosed. She emphasized that this
was a degenerative disease that would result in death, although
it could go on for many years. She stated that almost 75
percent of the residents of the Alaska Pioneer Homes had some
form of memory impairment, at least 50 percent had Alzheimer's
Disease, and that, as most had previously been in their own
homes receiving community based care, they had a more advanced
stage of dementia. She directed attention to a PowerPoint
titled "Memory Care & Eden Philosophy," and spoke about slide 1,
"Alzheimer's and Dementia." She reported that these advanced
stages of the disease were often more aggressive, with more
wandering outside the home without knowing where they were,
hence the transition into the Pioneer Homes. She shared that
patients often perfected "cocktail conversations," superficial
conversations with no depth which masked the disease.
3:08:45 PM
MS. WILSON moved on to slide 2, "Transition to Memory Care," and
reported that the Alaska Pioneer Homes had begun this transition
to memory care in 1996. She explained that, although there was
a skilled nursing level in the facilities, there was not any
care for advanced cases of dementia so that people were sent to
facilities with no family or friends nearby. The Division of
Alaska Pioneer Homes changed its course to include care for
Alzheimer's Disease, and created specialized neighborhoods in
the Pioneer Homes which were more secure and cozy, creating a
sense of home. She reported that, as this specialization lead
to taking on higher risk individuals, the outer doors in all the
homes were then alarmed to provide protection to all the homes.
She detailed that activities were tailored to focus on their
abilities for success, which allowed individuals to more easily
reconnect with their family members. She said that some of the
traditional methods of memory care for patients had included the
use of anti-psychotic drugs as well as physical restraint,
declaring that "basically they were warehoused" with no programs
or activities for individuals. She directed attention to slide
3, "Alternative Methods of Memory Care," noting that shortly
after the Pioneer Homes accepted dementia care as part of its
mission, the Eden Philosophy was introduced into the Pioneer
Homes. She declared that, as Alaskans were more progressive in
their thoughts and ways in which things were handled, the focus
had already begun for person centered care and getting to know
the people. She relayed that the environments had been made
more stimulating and cozy, animals were moved in, and the
residents became a part of their own care. She declared that a
key factor was to "know who the person was," noting that the
homes had people from all walks of life. She reported that a
goal for the staff was to understand who the person was and what
was their history.
3:17:01 PM
GINA DEL ROSARIO, Administrator, Juneau Pioneer Home, Department
of Health and Social Services, stated that the Eden Alternative
Philosophy had inspired all of the staff to transform the
environment for the elders and care partners, slide 4, in order
to promote a truly home like environment. She declared that
there were no more nursing stations, which had been replaced by
tables and chairs, dubbed the "hot spot plaza" for reading
newspapers and having coffee and donuts. She shared that the
staff stayed away from wearing uniforms to instead promote a
home like environment, with the ultimate goal for elimination of
the three main issues for elders: boredom, loneliness, and
helplessness.
MS. WILSON interjected that these issues were considered the
plagues of any nursing care.
MS. DEL ROSARIO explained that the transformation included
bringing plants, cats, dogs, and children into the Pioneer
Homes, as the purpose was to promote intergenerational contacts.
She emphasized that this also promoted respect for the elders,
reminding everyone that, first and foremost, they were
individuals with unique identities. She pointed out that, even
with dementia, many of the patients still had memories of those
happy days. She shared that the staff tried to get to know the
likes and dislikes of the patients, what were they most proud
of, what made them happy or mad, and what was their favorite
food, as those individualities allowed for a person centered
approach. She declared that the environment promoted continued
growth. She offered an anecdote of a resident who had arrived
only with thoughts of death, but had then realized how much life
there was within the Pioneer Home. She stated that the
residents were given autonomy for many of their decisions.
MS. WILSON reported that the residents of all the homes were
allowed to be out in the community, often sharing their own
insights for places to eat or visit. She said that it was
important to maintain interactions to slow the advancement of
the disease.
3:25:05 PM
MS. DEL ROSARIO emphasized the need for residents to have
choices, so they would feel freedom within the Pioneer Home, as
it was important for each individual to continue to explore.
She directed attention to slide 7, and stated that residents
needed a sense of security, to feel safe. She stressed that, no
matter the imparity of memory, the basic [needs] do not change:
respect, love, and genuine care.
MS. WILSON shared that, for many people who had been living on
the street, at the end of their lives, if they were given
respect it could change their whole life.
MS. DEL ROSARIO stated that the residents could feel whether the
care was genuine, regardless of the stage of dementia, as those
feelings could transcend. She noted that the staff worked to
provide opportunities for the residents to enjoy life, slide 8,
pointing out that the residents freely offered words of wisdom.
She declared that there were many ways to make a positive impact
to people with Alzheimer's Disease without resorting to
medication.
MS. WILSON shared a story about a truck stop with incredible
pies and milkshakes where the residents would visit, slide 9,
"Enjoying a Special Treat."
MS. DEL ROSARIO moved attention to slide 10, and emphasized that
the person centered approach had been practiced for many years,
as well as relationship building and continuing education for
care partners and families. She said that providing events and
activities to make life more enjoyable, to make people grow, and
to inspire the elders were all very important.
MS. WILSON said that each of the homes had different community
provided services, which included river tours, cruises, and a
variety of community involvement. She lauded the core of
thousands of volunteers that helped provide entertainment in the
homes.
MS. DEL ROSARIO shared slide 11, stating that two of the homes
had started using music to inspire and promote awareness. She
said that the staff would learn the residents' favorite music,
and record these on i-pods with headsets. She concluded with
slide 12, "Pioneers' Home Mission," and read: providing elder
Alaskans a home and community, celebrating life through its
final breath." She said that she could not over-emphasize their
gratefulness that the great State of Alaska continued to honor
its elders by continuing to provide this program of support to
the people who contributed so much to Alaska.
MS. WILSON said that it was a blessing.
MS. DEL ROSARIO shared that working at the Alaska Pioneer Home
was a great way for her to honor her dad, to give back and make
a difference. She added that her sister had also worked for the
past 10 years at the Pioneer Home in Ketchikan, Alaska.
3:35:46 PM
REPRESENTATIVE STUTES commented that she was a recent past
president of the Pioneers of Alaska of Kodiak, and that she had
a lot of exposure to people with family in the Pioneer Home,
declaring that it was "a tremendous gift to the people of this
state."
MS. WILSON said that there had always been a strong involvement
with the pioneers in Fairbanks.
REPRESENTATIVE WOOL asked how many pioneer homes there were in
Alaska.
MS. WILSON replied that there were 6 homes, with about 499 beds.
CHAIR SEATON asked if there was a waiting list.
MS. WILSON replied that the beds varied as to the levels of
care, and that there were not enough beds to meet the needs for
the higher level of care. She reported that the Pioneer Homes
across the state were about 90 percent full, and that the wait
list varied per community. She said that there were more than
5,000 people on the inactive waiting list, each of whom were at
least 65 years of age with at least one year of residency in the
state. She said that the application date set each person's
time to be added. She relayed an anecdote about living in the
home you were managing.
MS. DEL ROSARIO added that collaboration and communication with
the families, volunteers, and staff was a very important factor
for successful care of the elders. She relayed that "it truly
takes a community to raise an elder." She encouraged everyone
to sign up for the Alaska Pioneer Homes when they reach 65 years
of age so they have their priority date set.
REPRESENTATIVE TARR reflected on the recent recognition of a
need to the higher level of care for aging populations. She
asked about early intervention services, specifically through
Medicaid Expansion, and if these were opportunities to assist in
a delay of the onset for the more severe symptoms.
MS. WILSON offered her belief that community based services,
including in-home and respite care, were growing. She pointed
out that the Medicaid waivers provided those services. She
declared that approximately 50 percent of the residents at the
Pioneer Homes were able to afford the care. She opined that
Medicaid Expansion would offer a waiver to allow diagnosis of
the disease, and then also qualify for eligibility to the
services waiver.
CHAIR SEATON asked about the active wait list, as opposed to the
inactive wait list.
MS. WILSON estimated that there were about 400 people on the
active wait list, although it varied from home to home. She
said that the shortest active wait list was 20 people at one
home; whereas, the longest active wait list was about 90 - 100.
She pointed out that this was most often for the highest level
of care, and that the beds at that level did not empty out very
quickly.
CHAIR SEATON asked for the probable length of time from the
active wait list to admission.
MS. WILSON replied that this depended on the date a person
signed up, noting that some people needed specialized care as
they were at risk for leaving the facility. She reported that
the current active wait list in Fairbanks and Juneau was 4 - 5
years.
MS. DEL ROSARIO shared that Sitka historically had shorter times
on the active wait list, adding that the vacancies were also
dependent on male or female, as opposite sexes were not allowed
to share a room, unless they were a couple.
CHAIR SEATON asked if the wait list was for a home in a specific
location.
MS. WILSON replied that the application included a list for home
placement by priority, as well as the option to be placed on all
five Pioneer Home waiting lists. She noted that many people did
not want to live that far from their home. She pointed out that
veterans were given a priority for 75 percent of the beds at the
Palmer Veterans Home.
CHAIR SEATON asked if the Mediset issue regarding individualized
prescription packaging had been resolved.
MS. WILSON replied that there had been a change which had
allowed for individual packaging. She relayed that this was
done by a pharmacy within the system.
REPRESENTATIVE TARR asked if the Palmer Pioneer Home model for
veteran preference was being looked at in other homes.
MS. WILSON explained that, as the Veterans Home did give
preference, any changes to the system on a larger scale would
require discussion for those limitations. She relayed that this
had been discussed a long time ago.
3:49:05 PM
CAITLIN TEASTER, Social Services Program Coordinator, Division
of Alaska Pioneer Homes, Department of Health and Social
Services, replied that it would require 75 percent veteran
occupancy to be included as a Veterans Home, which would cut off
a lot of Alaskan pioneers. She shared that there had been
discussion for changes to sections of each home, weaning toward
larger veterans occupancy, and thereby allowing access to
Veterans Administration funding.
REPRESENTATIVE TARR acknowledged that, as Alaska had an aging
population and the largest veterans population per capita, it
was good to have discussions regarding opportunities to provide
good care to elders.
CHAIR SEATON reiterated that, although no one was exempt from
Alzheimer's Disease, the primary focus of the House Health and
Social Services Standing Committee was for prevention of
disease. He directed attention to a series of eight different
peer reviewed scientific studies between 2013 - 2015 which
reviewed the delay of onset and the prevention by at least half
for the occurrence of dementia and Alzheimer's Disease. He
shared that the community should be made aware that there were
things that could be done to slow down the onset.
MS. WILSON replied that she was aware of several of the studies,
and that the Pioneer Homes did Vitamin D blood draws on its
residents, and that supplements were offered by the providers.
CHAIR SEATON said that there was a new study from Sweden for the
geographic distribution of Alzheimer's Disease, noting that the
rate of the disease increased the further north. He pointed out
that Sweden was at a similar latitude to Alaska. He said that
it was not being suggested that there was a single cause. He
expressed his support for nutritional sufficiency in the Pioneer
Homes.
3:53:46 PM
The committee took a brief at-ease.
^Discussion: Medicaid Expansion
Discussion: Medicaid Expansion
3:54:19 PM
CHAIR SEATON announced that the next order of business would be
continuation of earlier discussions on Medicaid Expansion. He
shared future plans for ongoing presentations and discussion.
REPRESENTATIVE TARR referenced a one page memo of suggestions,
which included, super utilizers and over utilization of the
emergency rooms. She offered her belief that this issue should
be focused upon as it offered the opportunity to discuss
successful reforms already started and how these reforms can be
built upon to bring more efficiency to the program and reduce
costs. She reported that the issue for super utilizers first
came to light during a presentation to the House Finance
Committee early last year, and she offered an example of an
individual super utilizer who added extra costs from these
emergency room visitations. She reminded the committee that the
presentation by Commissioner Davidson had discussed the early
success for this as one of the current reform measures, with a
goal for expansion to address more individuals that were super
utilizers. She said that this would accomplish several things,
citing "the right care, at the right time, for the right price."
She declared that this was a great opportunity to build this
component into the Alaska health care system. She suggested
that this could incorporate the patient centered medical home
model, a more holistic approach to overall health needs which
was the right type of care and less costly. She offered her
belief that several million dollars had already been saved, with
a future savings target of a few million dollars more. She
asked about a report that Chair Seaton had requested from
Legislative Research Services.
CHAIR SEATON offered his belief that many minds would need to
work together for a solution to super utilizers, to get these
super utilizers to understand that there was better health care
in a more appropriate environment. He reminded the committee
that signups for Medicaid would be voluntary, as it was not
mandated.
4:01:19 PM
REPRESENTATIVE TALERICO asked about the potential for Medicaid
payments to help people purchase private insurance.
CHAIR SEATON suggested that this question be submitted to
Department of Health and Social Services. He asked that any
articles be shared with the other committee members. He stated
that they were looking for a solution to fill the gap in
Medicaid coverage created by the U. S. Supreme Court.
REPRESENTATIVE TARR offered her belief that this was taking
place in some other states, possibly Arkansas, and that it was
possible to apply for a waiver. She mused that some states had
not negotiated the correct waiver, suggesting a discussion for
the metrics to the correct waiver for Alaska. She relayed that
the overall goal was to bring down the rates for private
insurance payers.
CHAIR SEATON noted that insurance for people who have not had
insurance was a high cost model, especially if there was not the
90, 95, and 100 percent reimbursement from the federal
government. He declared that expensive care in Alaska was a
problem and there needed to be a way to reduce the cost of care.
He questioned whether super utilizers were also found in Rural
Alaska.
REPRESENTATIVE TARR reflected on the aforementioned report on
super utilizers, stating that 25 percent of them lived in her
constituency neighborhoods. She relayed that a look at where
people live and where the bus route was could help determine
these neighborhoods, especially when a hospital was on the bus
route as it was the only form of transportation for many of the
super utilizers. She shared that there was a proposal to open a
primary health care clinic in one of her neighborhoods, but she
questioned whether Medicaid would pay for those individuals'
services.
CHAIR SEATON pointed out that whereas hospitals were required to
offer charity care, primary clinics were not required to do so.
He shared that the hospital in Homer had bought two of the local
clinics.
REPRESENTATIVE TARR reflected on individuals trying to access
mental health care services through the hospital emergency rooms
and other facilities "not well situated to provide that kind of
care." She questioned whether this situation would change if
there was Medicaid Expansion to allow for access to other health
care services.
CHAIR SEATON opined that this was a big issue in Medicaid
Expansion, as it required parity for mental and physical health
treatment. He commented that, as there were a lot of Alaskans
with behavioral health issues, it would be interesting to see
how those services were brought up and running to serve the
needs of an expanded population.
4:10:09 PM
REPRESENTATIVE WOOL reported a result of the closure of mental
health facilities in many states was for a lot of the mental
health population ending up in jails, where there was not any
treatment, and which only incurred more state debt. He
expressed hope that there would be some relief of stress to the
prison system in Alaska if those incarcerated primarily for
mental health issues could be treated outside the system, with
Medicaid making the payments.
REPRESENTATIVE TARR pointed to potential savings in the
corrections budget, as incarceration was not the best treatment
for individuals with mental health issues. She declared that
she was passionate about showing a greater respect and care for
neighbors with these mental health challenges. She shared that
an individual without access to primary care and specifically
access to the services for medication, could not be well
regulated in their behaviors which often lead to confrontations
with the legal system, and then back into corrections. She
reflected on the cost to each of these systems while dealing
with this problem, suggesting that these dollars could be better
spent. She declared her passion to better meet the needs of
people for improving health outcomes, and allowing Alaskans to
live better lives. She relayed that it often took several times
for an individual to deal with breaking a serious addiction, and
that going to jail did not support this. She suggested that
outcomes would be much improved if there was earlier
intervention with "a good strong support network and social
safety net programs."
4:15:44 PM
CHAIR SEATON reported that he had met with the commissioner of
the Department of Corrections (DOC). He declared that there was
not any data regarding nutritional deficiency and an adequate
supplement for the hormone against depression which also
regulated the immune system, Vitamin D. He lauded the Alaska
Pioneer Homes for recognition to the necessity of Vitamin D. He
reported that there was currently data which looked at all the
worldwide randomized control trials on Vitamin D without any
biological flaws in the data. He stated that these trials found
that raised Vitamin D levels had the same overall effect to the
population as anti-depressant drugs. He pointed out that, as
these drugs were considered an adequate treatment, something
else that people could manufacture though their own skin should
be addressed. He declared the need to provide adequate
nutrition in the corrections system. He said that only one bad
interaction between an officer and an inmate, either suffering
from depression from inadequate Vitamin D, would cost more than
an entire budget to pay for Vitamin D for everyone. He said
that there was not any data that said that it was good for
people to be kept in a deficient state of Vitamin D. He
declared that he would bring this issue to discussions about
corrections and ways to keep the prison population lower.
4:19:45 PM
REPRESENTATIVE TARR read from a case that the U. S. Supreme
Court was considering: "if the Supreme Court rules against
subsidies, any exchange not operated by the state itself will
lose the ability to help people pay for their health insurance."
She stated that this would impact Alaska, as Alaska had chosen
not to do its own state exchange, but had, instead participated
in the federal exchange. She relayed that, in 2014, 88 percent
of the people who enrolled on the exchange received subsidies
and that should Medicaid Expansion not become a reality for
Alaska, it was not known what would happen to Alaskans if the U.
S. Supreme Court ruled against the subsidies. She declared that
it was necessary to understand the impacts of this court case on
those people who were already receiving subsidies.
CHAIR SEATON clarified that the subsidies for private insurance
was not the proposed Medicaid Expansion population. He stated
that if this was not worked out, it was unknown "how the system
might fall apart if all of those that are getting subsidies in
private insurance are no longer able to do that."
REPRESENTATIVE STUTES asked for a definition of the exchange.
REPRESENTATIVE TARR explained that it was the federal market
place, as the State of Alaska had not created its own exchange.
She pointed out that Alaskans buying health insurance as a
result of the Patient Protection and Affordable Care Act was
usually done through this federal exchange. She directed
attention to those people eligible for a subsidy with an income
that was 100 - 400 percent of the federal poverty level, whereas
anyone below 100 percent were not eligible. She acknowledged
Chair Seaton's definition that Medicaid Expansion would cover
people below 138 percent of the federal poverty level. She
asked about people in the 100 - 138 percent of the federal
poverty level who were eligible for a subsidy through the
exchange, but could not afford to purchase health insurance if
the subsidy was discontinued.
CHAIR SEATON said that this should be answered at the upcoming
discussion on Medicaid as he was also unsure of the answer.
4:23:29 PM
REPRESENTATIVE WOOL acknowledged that he had bought health
insurance through the federal exchange and that it was
subsidized so what would otherwise be expensive insurance was
more affordable. He shared that losing the subsidy would affect
those with lower income, offering his belief that "it would
really turn the health care world on its head. They'd have to
redo the whole thing."
CHAIR SEATON pointed out that this was not the Medicaid
population, except for the possibility of those in the window
between 100 - 138 percent of the federal poverty level.
REPRESENTATIVE TARR asked whether an individual who had
purchased health care would return to being a super utilizer if
there was not any Medicaid Expansion and no health exchange
subsidy. She questioned this cost to the system.
CHAIR SEATON said that it was a known cost prior to the Patient
Protection and Affordable Care Act, so that, even with repeal of
the exchange, an expansion of Medicaid would still cover that
lower income population.
REPRESENTATIVE WOOL shared discussions he had heard that
Medicaid Expansion could create a disincentive for increased
employment, as this could remove eligibility for Medicaid, even
though the federal subsidy [through the Patient Protection and
Affordable Care Act] would still keep health insurance
affordable. He allowed that there could be some truth to this
dependent upon the outcome of King v. Burwell.
4:28:53 PM
REPRESENTATIVE TARR declared that Alaska was an aging state,
with a "silver tsunami" heading in its direction, as Alaska had
the fastest growing senior population [in the country]. She
expressed her agreement that there must be a focus on prevention
and early intervention. She noted that preventative care was
required under the Patient Protection and Affordable Care Act,
pointing out that this was much less expensive, especially for
home and community based services, and she expressed her desire
that the state policies reflect the commitment to elders. She
offered her belief that the state had previously not done a good
job for low cost services.
CHAIR SEATON reflected on discussions of prevention and studies
regarding delay in the risk of occurrence and the rate of
Alzheimer's Disease.
REPRESENTATIVE VAZQUEZ said that [Medicaid] expansion only
provided Medicaid for those aged 18 - 65 years, and that, as
anyone younger than 65 years was not elderly, she was unclear
for the statement regarding Medicaid providing more services to
seniors. She declared that seniors were covered by Medicare.
She expressed her serious concern for the costs and equities
with a possible expansion. She relayed that the current group
of eligible individuals were funded with a federal match of 50
percent and that the expansion population would include a
younger population funded at much higher levels, which would be
progressively reduced to a 90 percent federal match. She
declared that there would be a temptation to cut back on the
first eligible population, the elderly and disabled, as they
were only funded at 50 percent federal match. She stated that
there would also be pressure as there was a shortage of
providers, especially for Medicare patients. She opined that,
as Anchorage had a shortage of providers, it would take months
for an elder on Medicare to get care. She stated that there
were equity issues with expansion, as the veterans' and the
elderly would have less benefit.
CHAIR SEATON suggested that it would be best to take each of
these issues one at a time. He noted that Medicaid Expansion
would create a population that was healthier when it reached
eligibility for Medicare, as they would have had health care.
He clarified that it had not been proposed for Medicaid to take
over Medicare.
REPRESENTATIVE VAZQUEZ replied that many issues were being
researched regarding Medicaid and Medicaid Expansion. She said
that some studies were counter intuitive, that the Medicaid
population, even though they have access to care, "may not do
better overall in health."
CHAIR SEATON asked that this information be shared with the
committee. He suggested addressing whether Medicaid Expansion
would influence the population which currently received a 50
percent reimbursement. He opined that it was not being proposed
to expand coverage into that program. He questioned how this
program would influence Medicare for its adequacy of care.
REPRESENTATIVE WOOL offered his belief that people over 65 years
of age could still get Medicaid, dependent on their financial
situation. He opined that there was also an asset, as well as
an income, parameter.
CHAIR SEATON stated that the Department of Health and Social
Services would discuss the integration of Medicaid and Medicare
in an upcoming committee meeting.
4:39:44 PM
REPRESENTATIVE TARR stated that an advantage of Medicaid
Expansion was that more people had more access for a longer
period of their life, and she spoke about the benefits for
preventative services and the continuum of care. She offered an
example of adult onset diabetes, that the corresponding issues
were less problematic and less costly if addressed earlier.
REPRESENTATIVE VAZQUEZ said that people with no income or low
income were able to go the Anchorage Neighborhood Clinic, and
were charged on a sliding scale based on income. She stated
that there was some health care available, and she acknowledged
that it could be made better.
REPRESENTATIVE VAZQUEZ expressed her concern for the projected
cost to Medicaid Expansion, stating that it was the biggest
driver in the state budget.
CHAIR SEATON asked if she was referencing the chart, "The Bottom
Line:" [Included in members' packets] put together by the Lewin
Report.
REPRESENTATIVE VAZQUEZ explained that she was addressing the
projected costs by the Lewin Group, Evergreen Economics, and the
projected state savings by the Department of Health and Social
Services. She offered her belief that the cost to the state was
unknown, and that it was necessary to be "extremely careful."
She suggested that, from the experience of other states, a
change and flexibility to the program was not necessarily
allowed. She cited some examples.
CHAIR SEATON offered his understanding that there was a letter
to the State of Alaska which itemized the repayment schedule and
the ramp down procedure should the state decide to withdraw from
Medicaid Expansion. He offered his belief that the state would
be able to opt out if it supplied a transitional plan.
REPRESENTATIVE TARR referenced the history of eligibility for
Denali Kid Care with its original basis on 200 percent of the
federal poverty level, which was subsequently lowered to 175
percent of the federal poverty level, then had its income levels
frozen, which were later unfrozen, although the attempt to move
the basis back to 200 percent of the federal poverty level was
defeated. She reported that over the life of this program the
state had been able to make modifications, and that this had
been done openly to the public, so that, if necessary, changes
could be made to the Medicaid Expansion program should they be
necessary.
4:47:34 PM
CHAIR SEATON noted that there was the question of cost or
savings to the State of Alaska. He pointed out that the Alaska
Mental Health Trust Authority had volunteered to pay $1.5
million of administrative costs for the first year. He stated
that those hospitals currently offering charity care with no
reimbursement, which would then shift to 100 percent
reimbursement, should voluntarily contribute back into the
program as the state was absorbing all the risk for converting
charity care to reimbursable care. He clarified that this
contribution could not be mandatory or a tax, as this was
illegal under federal law, although nothing prevented a
voluntary contribution to the state. He asked for any other
ideas of money to help pay for expansion, which was estimated to
bring in about $145 million to the private providers in the
state during the first year, should the program include an
estimated 50 percent of the eligible participants. He pointed
out that more than $300 million would be spent in the private
economy of the state should all the eligible recipients enroll
in the program. He noted that it was necessary to balance these
private jobs with the potential risk to the state should the
savings not be as much as projected, and the state was actually
having to expend money. He questioned whether the private
industry was willing to voluntarily offset some of the risk. He
offered his hope that there could be a secure mechanism for
offsetting some of the state risk.
REPRESENTATIVE VAZQUEZ said that uncompensated care by hospitals
was paid for by Medicaid and Medicare through the
disproportionate payments.
CHAIR SEATON relayed his understanding from DHSS that almost 100
percent of those payments went to API, and the hospitals
themselves did not get the reimbursement.
REPRESENTATIVE VAZQUEZ stated that the hospitals had offered
figures for their net income in 2013, and not for the requested
information regarding their receipts for disproportionate share
payments resulting from uncompensated care.
CHAIR SEATON said that it would be necessary to separate the
monies for "who receives what." He suggested that, as the state
received the money and distributed it, it should be possible to
find the exact distribution.
4:54:49 PM
REPRESENTATIVE TARR suggested that the Anchorage Neighborhood
Health Center could answer questions at the upcoming discussion.
CHAIR SEATON offered his agreement, and pondered if there was
any other organization in Juneau that would like to participate
in this discussion.
REPRESENTATIVE WOOL referenced the various reports for the
projected costs, if any, to the state, which he declared to be
the crux of the issue. He stated that the validity of the
numbers seemed to be in question. He pointed to the report by
the Lewin Group, noting that they were a subsidiary of United
Health, the largest private health insurance company in the
country. He suggested that this group could have an interest in
whether someone purchased public or private health insurance,
and that there had been a lot of speculation for a possible
conflict of interest.
CHAIR SEATON pointed out that the other issue of disparity in
the reports was for the reimbursement rates by the federal
government.
REPRESENTATIVE VAZQUEZ added that DHSS had previously used the
Lewin group for studies and reports. She stated that the
difference in estimates by the reports was dramatic, with the
Lewin Report estimating a cumulative cost between 2016 and 2020
of $210 million, whereas Evergreen estimated a cumulative cost
during this time period of $48 million, and DHSS estimated a
cost savings of $35 million. She declared that this "needs to
be sorted out."
CHAIR SEATON said that it was a valid question which the
committee would pose to DHSS. He expressed the need of an
explanation from the department for the difference between the
estimates, and what was the basis for each.
5:01:16 PM
REPRESENTATIVE TARR suggested that a deeper discussion about
Indian Health Service (IHS) beneficiaries and its limitations
would be valuable. She stated that IHS beneficiaries were not
covered 100 percent.
CHAIR SEATON noted that there should also be discussion about
the intermediate levels of care in Rural Alaska. He offered his
belief that many mental health issues were a result of
isolation, and he declared his desire to further these
discussions. He questioned whether Medicaid had a village
model, suggesting that a system for Alaska could be very
different than a system in California. He pointed out that he
represented 16 different communities that were not
municipalities, but had the same Department of Commerce,
Community & Economic Development (DCEED) definition as a
village. He suggested the development of a model which
integrated training to get to the intermediate level of care for
these villages, which could move toward a level of prevention.
REPRESENTATIVE VAZQUEZ expressed her concern with the broken
DHSS payment system, formerly known as MMIS, as it was
absolutely critical for the identification of over utilization,
duplication of services and billing, and overlapping of provider
billings. She noted that the department had not had a
surveillance utilization review database software program which
would flag the above issues. She added that the eligibility
system was also not fully functional, which made it difficult to
determine true eligibility.
CHAIR SEATON pointed out that July 1 would be the rollout for
the new coding system, although it might need to be held back a
month if there was Medicaid Expansion, to ensure that there were
not any coding problems as a result of the expansion.
REPRESENTATIVE WOOL stated that a software system was secondary
to having health care for people who were worried about how they
would pay for health care. He expressed agreement that the
neighborhood health clinics did offer services on a sliding
scale; however, as there was an expectation for a cash payment
up front, this was an issue for some people. He declared that
there were people who would greatly benefit from expansion.
5:08:14 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:08 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Alaska Pioneer Home-3.17.2015.pdf |
HHSS 3/17/2015 3:00:00 PM |
Presentations by DHSS |
| Brief Summary - Memory Care- pioneer homes.pdf |
HHSS 3/17/2015 3:00:00 PM |
DHSS |