Legislature(2017 - 2018)CAPITOL 106
01/26/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Overview: Medicaid Redesign Implementation | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
JOINT MEETING
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
HOUSE FINANCE SUBCOMMITTEE ON HEALTH AND SOCIAL SERVICES
January 26, 2017
3:34 p.m.
MEMBERS PRESENT
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
HOUSE FINANCE SUBCOMMITTEE ON HEALTH AND SOCIAL SERVICES
Representative Les Gara, Chair
Representative Cathy Tilton
Representative Ivy Spohnholz
Representative Bryce Edgmon
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
Representative Jonathan Kreiss-Tomkins (alternate)
OTHER LEGISLATORS PRESENT
Representative Dan Saddler
COMMITTEE CALENDAR
OVERVIEW: MEDICAID REDESIGN IMPLEMENTATION
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
VALERIE DAVIDSON, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint overview titled
"Medicaid Redesign Implementation."
MONIQUE MARTIN, Health Care Policy Advisor
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint overview titled
"Medicaid Redesign Implementation."
ACTION NARRATIVE
3:34:51 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:34 p.m.
Representatives Spohnholz, Edgmon, Kito, Sullivan-Leonard,
Johnston, Eastman, Gara, and Tilton were present at the call to
order. Representative Tarr arrived as the meeting was in
progress. Also in attendance was Representative Saddler.
^Overview: Medicaid Redesign Implementation
Overview: Medicaid Redesign Implementation
3:35:50 PM
CHAIR SPOHNHOLZ announced that the only order of business would
be the overview on Medicaid redesign implementation.
[Chair Spohnholz passed the gavel to Chair Gara]
3:35:56 PM
CHAIR GARA declared that the Department of Health and Social
Services (DHSS) would address the large comprehensive issue of
Medicaid Reform and Medicaid Expansion, the results, and any
necessary actions. He reiterated his plan to forward all
amendments from this committee for review by the House Finance
Committee.
3:37:17 PM
VALERIE DAVIDSON, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), explained that
DHSS had worked with the Alaska State Legislature on
comprehensive Medicaid Reform which, she declared, went hand in
hand with Medicaid Expansion. She relayed that a comprehensive
Medicaid Reform bill had been passed during the 29th Alaska
State Legislature. She stated that it had "been an incredible
process working with Alaskans." She reported that there were 16
different groups working on this, and that DHSS was only the
lead on 12 of these groups. She lauded the collaboration with
stakeholders throughout Alaska to implement the necessary
programs.
3:39:40 PM
MONIQUE MARTIN, Health Care Policy Advisor, Office of the
Commissioner, Department of Health and Social Services, directed
attention to the PowerPoint titled "Medicaid Redesign
Implementation." She relayed that during the first efforts for
implementation of Senate Bill 74 there was an immediate
realization to the scope of the reforms and pointed to slide 3
which broke out the 16 initiatives of the bill.
MS. MARTIN moved on to slide 4, "Vision for Medicaid Redesign."
She listed many of the partner groups which came together,
including the Alaska Primary Care Association and the Alaska
State Hospital and Nursing Home Association, to help DHSS with
the Medicaid Redesign and Expansion Technical Assistance
Contract, and then to implement the aforementioned reforms
contained in Senate Bill 74. She discussed the guiding
principles of the vision for Medicaid redesign in Alaska, slide
4, as well as the graphic representation of the vision, which
showed a need for coordinated care both horizontally and
vertically to ensure this integration so that Alaskans would
receive the best health care possible.
3:42:50 PM
MS. MARTIN stated that she would review the 16 initiatives and
she directed attention to slide 5, "Primary Care Case Management
& Health Homes." She reported that it had been decided which
reforms needed to happen first and which reforms "teed up" other
reforms. She said that the coordinated care demonstration
project, one of the two biggest reforms in Senate Bill 74,
included primary care case management and the health homes
initiative and was important to have ramped up to serve
Alaskans. She added that there was also a desire to ramp up
some temporary case management services for Medicaid recipients.
She reported that the Alaska Medicaid Coordinated Care
Initiative, also known as the super-utilizer program, was
expanded. She explained how the case management services to
those recipients and their family members receiving Medicaid had
been expanded to help with navigation of the health care
delivery system. She relayed that the other part of the case
management initiative was for health homes, a specific program
in the Patient Protection and Affordable Care Act, and was
intended to roll-out in 2018. She noted that this had been a
long process through the Centers for Medicare and Medicaid
Services (CMS) because it included an enhanced federal match for
those recipients. She noted that most federal matches in Alaska
were 50 percent, whereas the health home model allowed for a
higher federal match for its first eight quarters of
implementation. She said that there was a lot of flexibility in
how to rollout the health home initiative.
3:46:03 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if health homes were home
health care.
MS. MARTIN replied that health homes could be a primary care
setting, but could also be a behavioral health clinic which
provided services. She explained that it was designed to allow
flexibility for the health care needs of an individual and to
reduce health care costs.
CHAIR GARA asked for clarification that the health home project
was aimed at connecting emergency room over-users with medical
care that was cheaper and more appropriate.
MS. MARTIN expressed her agreement that this was one way to
implement health homes. She said that it could be proposed
through providers for behavioral health clients' health and
primary care needs, as it offered a lot of flexibility to set up
different programs. She pointed out that this program had an
enhanced federal match of 90 percent for its first eight
quarters.
3:48:56 PM
REPRESENTATIVE SADDLER asked if health home was also considered
a patient centered medical home.
MS. MARTIN replied that patient centered medical home was
another designation that did not come with the enhanced federal
match.
3:49:31 PM
MS. MARTIN directed attention to slide 6, and said that one of
the two biggest reforms in Senate Bill 74 was Behavioral Health
System Reform, which she described as "truly comprehensive
behavioral health reform, really looking at identifying the gap
in the continuum of care." She reported that there was an
important partnership with the Alaska Mental Health Trust
Authority, that the trustees had awarded almost $10 million for
the first three years of implementation of Senate Bill 74 to
include stakeholder engagement, actuarial consulting services
for Section 1115 waiver, and behavioral health. She said that
one of the biggest milestones for this reform was submitting a
Section 1115 waiver to the CMS, as it would provide flexibility
in the ways to provide and pay for Medicaid services. She
emphasized this was a shift to paying for value instead of
volume in the behavioral health system. She said that a waiver
concept paper had been recently submitted to CMS, the initial
step to the Section 1115 waiver. She declared that six public-
private teams were working on various aspects of the waiver
application. She shared that this application was a very
technical process with lots of CMS requirements, and included a
showing of budget neutrality.
CHAIR GARA asked for an explanation of the Section 1115 waiver.
3:53:07 PM
COMMISSIONER DAVIDSON explained that the Section 1115 waiver was
a waiver of certain requirements of the social security act.
She explained that, in this instance, as the waiver needed to
show budget neutrality, the department had negotiated terms with
the federal government for ways to provide health care
differently in Alaska. She shared that DHSS was reviewing ways
to improve outcome measures in five different areas, which
included expansion of treatment capacity and access to services
with better integration of care in different settings,
integration of social supports to aid with an individual's
success, cost and outcomes reform, provider payment and
accountability reform, and delivery system reform.
CHAIR GARA asked if this would allow for Medicaid funding at
larger facilities than was currently available.
COMMISSIONER DAVIDSON expressed her agreement. She explained
that CMS had a two-step process to waive the institutions for
mental disease limitation. She stated that a facility with more
than 16 beds could not bill Medicaid for treatment services, a
problem for Alaska as the state had a larger treatment facility
in order to maximize economy of scale and reduce costs. She
pointed out that, as Alaska was affected disproportionately by
this exclusion, the Section 1115 waiver would allow for a waiver
of the exclusion. She noted that these waivers were for a 5
year time period, and could be renewed.
CHAIR GARA asked if the addition of social supports to
transition people out of the system and back into the community
would also be covered by Medicaid through this waiver, and would
this be better than a 50 percent match.
COMMISSIONER DAVIDSON explained that the Section 1115 waiver
would allow Alaska to be reimbursed at the appropriate level per
the individual's eligibility. She acknowledged that this would
include coverage of the social supports.
3:57:16 PM
MS. MARTIN relayed that DHSS would also contract with an
administrative services organization as support for this new
system being developed with the Section 1115 waiver. She listed
the next big steps to include the release of a request for
information on an administrative services organization, which
would allow DHSS to gauge the interest for provision of these
services, and to ask questions to help flush out the requests
for proposals. She relayed that this would help the Division of
Behavioral Health Services to move from management of contracts
with grantees and providers toward analysis of data provided by
the administrative services organization identifying areas of
potential gaps as the new system of care was developed. This
would allow movement into policy development for the necessary
services for Alaskans.
3:58:50 PM
MS. MARTIN directed attention to slides 7 and 8, "Coordinated
Care Demonstration Projects." She stated that these would allow
DHSS to test a new delivery system and payment reform models for
the Medicaid program. She listed some of the specific measures
which the Coordinated Care Demonstration Projects had to
include, including the release of a request for information to
gauge interest. She stated that those responses had ranged from
regional accountable care models to statewide full risk managed
care, although none of these responses were required to submit a
proposal when the RFP (Request for Proposal) was released. She
relayed that DHSS had found some funding opportunities for
technical assistance, and had worked with the Pacific Health
Policy Group in a review of the current system of care and what
should be considered. She reported that the RFP had been
released on December 30, 2016, as required by Senate Bill 74,
and that the department anticipated an intensive proposal
evaluation during the extensive reply process.
CHAIR GARA asked what the project would do once it started.
MS. MARTIN expressed her agreement that the coordinated care
demonstration projects could do about anything someone may
propose for case management services to the more costly portions
of the Medicaid program, and that they had not yet started. She
said they could take on the delivery of any health care model to
all Medicaid recipients in a region of the state, or even
statewide, as determined by the regional providers.
COMMISSIONER DAVIDSON added that the department had broad reform
authority under Senate Bill 74, which allowed them to work with
communities and providers in the testing of new models of
delivery. She acknowledged that it had sometimes been
challenging for DHSS to pursue new models for delivery of health
care until they had been granted this authority. She reported
that many of the proposals had been very forthright with their
information and modeling. She pointed out that DHSS had not
done this type of work previously, so they brought in national
experts to share what was within the range of possibility which
was being done by other states. DHSS was encouraged to request
information from groups prior to refining the RFP process.
4:05:34 PM
CHAIR GARA asked to focus more on the adopted reforms and the
cost benefit savings that were currently happening with Medicaid
Expansion reform.
COMMISSIONER DAVIDSON offered an alternative for sharing the
appropriate timelines for expectations of progress.
CHAIR GARA expressed his agreement.
4:07:55 PM
MS. MARTIN moved on to slide 9 "1915(i) and (k) Options" and
addressed implementation of these options for home and community
based services which were designed to keep Alaskans in their
homes. She stated that these were offered as an alternative to
mandatory Medicaid services for nursing level of care, pointing
out that these were designed to keep people in their home at a
lower cost. She pointed out that this would allow for an
enhanced federal match, and clarified that DHSS would not
implement a program which would become mandatory. She said that
both the 1915(i) and (k) options were entitlement programs and
could not have wait lists to set caps and ensure DHSS was
staying within budget. One of the recommendations was to move
forward with the 1915(k) option only, at this point, to ensure
that DHSS could meet the requirements for savings as detailed in
Senate Bill 74. She relayed that more information would be
forthcoming, and there was a possibility for pursuit to a
different type of waiver.
CHAIR GARA asked for an example of a state paid institutional
level of care, which would qualify for federal matching funds if
the waiver was approved.
COMMISSIONER DAVIDSON offered an example of home and community
based services which included assistance with activities of
daily living for which the state had a 50 percent match, and she
shared that with the 1915(k) waiver the state would now receive
an enhanced match of 56 percent. She reported that there was
still hope to move forward with a 1915(i) option that would
allow certain behavioral health services to be moved from 100
percent general fund payment to a 50 percent match, although it
did not appear to be feasible for the state at this time.
COMMISSIONER DAVIDSON stated that, as DHSS moved forward, it had
been very careful about making sure "that we drill down and get
the information, due the actuarial analysis, meet with those
national experts who can do a deep dive on what's happening in
Alaska" before making any adjustments and decisions for when to
move forward. She reiterated that the 1915(i) option was not
currently feasible for the state, so DHSS was looking at other
options to provide this service.
4:13:10 PM
MS. MARTIN addressed slide 10, "Criminal Justice Reform (SB 91
Integration)," and relayed that there was a workgroup related to
Senate Bill 91, implementation and integration with the ongoing
efforts for reform in Senate Bill 74. She said that DHSS had a
large role in conjunction with the Department of Corrections
(DOC), joining in a monthly work group which looked at
maximizing enrollment in Medicaid and other qualifying programs
for those about to be released from a correctional facility in
order to ensure success upon release.
4:14:07 PM
REPRESENTATIVE JOHNSTON asked if both the Section 1915(i) and
(k) programs were both longstanding.
COMMISSIONER DAVIDSON replied that Section 1915(k) was made
available with the passage of the Patient Protection and
Affordable Care Act, and that Section 1915(i) was through the
American Reinvestment and Recovery Act (ARRA), with enhancements
through the Patient Protection and Affordable Care Act.
COMMISSIONER DAVIDSON, in response to Representative Tarr, said
that most released prisoners were eligible for Medicaid
Expansion. She added that behavioral health appointments in the
first week of release, along with ongoing support had been shown
to be an effective recidivism reduction effort in other states,
and that DHSS was working with DOC to build healthy Alaskans.
4:17:17 PM
MS. MARTIN shared slide 11, "Emergency Dept. Care Improvement,"
and stated that this initiative called on the Alaska State
Hospital and Nursing Home Association (ASHNHA) as the lead
agency, adding that ASHNHA had identified a real time
information exchange to help those super-utilizers of emergency
rooms connect more appropriately with primary care services.
She relayed that the information exchange also identified those
seeking prescription drugs. There were new guidelines for
prescribing narcotics which were designed to reduce opioid
abuse, and these final guidelines had been distributed to
hospitals for sign-off. She pointed out that this would reduce
the number of Alaskans inappropriately using emergency rooms,
and connect them with more appropriate primary care, which could
reduce the costs.
REPRESENTATIVE SADDLER asked if the guidelines were binding.
COMMISSIONER DAVIDSON, in response, relayed that the governor
was interested in the pursuit of enhancements to the opioid
strategy based on the recommendations from the opioid policy
task force. She opined that some of these would require
legislative changes, while others could be implemented in other
ways.
CHAIR GARA, in response to Representative Saddler, said that
this would be discussed at a later meeting.
4:20:54 PM
REPRESENTATIVE JOHNSTON asked about emergency room usage, and
questioned whether there was a way to track usage in order to
see if the reforms were effective.
COMMISSIONER DAVIDSON replied that one requirement of the
public-private partnership was for tracking the change once the
program was implemented.
REPRESENTATIVE JOHNSTON asked for the statistics from last year
and this year.
COMMISSIONER DAVIDSON replied that this specific project in
partnership with Alaska State Hospital and Nursing Home
Association was still in the planning and implementation phase
and had not yet begun. However, a voluntary program looking at
super-utilizers and matching them with a care coordinator to
find a primary care appointment was being tracked. She offered
to provide the information as it became available.
REPRESENTATIVE TARR said that there had been a successful
decrease in super-utilizers in her district.
CHAIR GARA reminded the committee to ask any budget questions.
COMMISSIONER DAVIDSON relayed that DHSS had tried to ensure that
the changes within different departments was integrated to
ensure success.
4:25:15 PM
CHAIR GARA asked about services and federal funding now being
provided that had not been offered prior to Medicaid Expansion.
COMMISSIONER DAVIDSON stated that there was a telehealth
workgroup for some of the already mentioned programs, although
with a focus on telehealth, slide 12, "Telehealth Workgroup."
She pointed to the members on slide 13, "Telehealth Workgroup
Members." She acknowledged some gaps in the health information
infrastructure, stating that a company had been engaged to "get
where we need to be so that we can make better data informed
decisions, to make better health policy decisions as a state,"
slide 14, "Health Information Infrastructure Plan. She added
that these were funded with a 90 percent match.
4:26:57 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if there had been an
increase in users during development of telehealth.
COMMISSIONER DAVIDSON said that, in tribal health, there had
been a significant increase in the utilization of telehealth as
the equipment and technology became more available; although,
there was not the same level of growth in the non-tribal system,
noting that there were some limitations in state law that did
not allow tele-health to exist at the extent desired in Alaska.
She pointed out that tele-health allowed an extended level of
care with a limited number of providers and specialists and
without an increase to the travel costs. She said that the
tribal health system had tracked the number of encounters which
resulted in reduced travel and an overall reduction in
expenditures.
4:28:58 PM
COMMISSIONER DAVIDSON addressed slide 15, "Tribal Claiming
Policy," and explained that CMS had extended services through
tribal and non-tribal partnerships under circumstance when
certain requirements were met. She relayed that negotiations
for care coordination agreements and for state plan amendments
were ongoing.
CHAIR GARA asked whether the entities not yet approved as
recipients had not completed negotiations.
COMMISSIONER DAVIDSON expressed her agreement. She explained
that during this first year most of the effort had been focused
on travel. She reported that both emergency travel and non-
emergency, medically necessary travel was covered at 100
percent. She said that ancillary travel and accommodation
services were still under discussion, and that care coordination
agreements had to be in place with each provider. She opined
that this could possibly present a violation of Health Insurance
Portability and Accountability Act (HIPAA). She explained that
the projected savings in travel had not yet been recognized.
She shared that currently the department was reviewing high
dollar, low volume services, although it was not an easy data
match for Indian Health Services and Medicaid requirements.
4:32:45 PM
REPRESENTATIVE TARR asked about travel costs related to
cancelled appointments and what was this frequency.
COMMISSIONER DAVIDSON explained that Alaska weather was the
predominant reason for missed appointments. She relayed that a
benefit of the tribal claiming policy was that a number of
tribal health organizations had expressed interest in taking
over this travel piece.
CHAIR GARA asked for more information on Medicaid Expansion, the
costs and the achievements.
4:36:02 PM
MS. MARTIN jumped ahead to slide 20, "Fraud & Abuse Prevention."
She reported that Senate Bill 74 had created the "Alaska
Medicaid False Claim and Reporting Act," which allowed the
department to assess interest and penalties on identified
overpayments, as well as requiring self-audits every two years
which allowed the provider to report any errors for overpayments
with no penalty. She stated that the first errors report to the
legislature was made on November 15, 2016, and the first set of
regulations related to audit and provider record keeping were
nearing completion. She shared that the privatization reports
were due to be released to the legislature the next day.
4:38:02 PM
COMMISSIONER DAVIDSON directed attention to slide 23, "Health
Care Authority," and noted that the Department of Administration
was the lead agency for this study on the feasibility of
creating a Heath Care Authority and that the preliminary report
would be released in February 2017.
COMMISSIONER DAVIDSON moved on to slide 25, "Medicaid in
Alaska," and relayed that this latest monthly report was through
December 28, 2016 and that it could be found via a link on the
DHSS website. She explained that the report showed that 27,415
Alaskans were currently enrolled in Medicaid Expansion. She
noted that the top bar reflected the enrollees by age category
and sex.
CHAIR GARA asked if the $316 million of services provided were
covered at the Medicaid Expansion rate.
COMMISSIONER DAVIDSON replied that these claims had been paid at
100 percent federal match, pointing out that these were new
federal revenues into the Alaska economy. She expressed her
appreciation that these Medicaid Expansion revenue benefits had
been dispersed throughout the state into every community which
provided health care.
CHAIR GARA asked for the parameters to Medicaid expansion.
COMMISSIONER DAVIDSON explained that Medicaid Expansion covered
adults between the ages of 19 - 64 without dependent children
with incomes of about $20,000 for a single Alaskan. Those
people over 64 were covered by Medicare and were not eligible
for Medicaid Expansion. People under 19 years of age were also
not eligible. She reported that Medicaid Expansion was
reimbursed through the Patient Protection and Affordable Care
Act, and for the first three hard calendar years, 2014 - 2016,
there was a 100 percent federal match. She clarified that these
were not rolling calendar years. Starting in calendar year
2017, the federal match was 95 percent; in calendar year 2018,
the federal match was 94 percent; in calendar year 2019, the
federal match was 93 percent; and in calendar year 2020 and
beyond, the federal match was 90 percent.
4:44:59 PM
REPRESENTATIVE SULLIVAN-LEONARD referenced slide 18, and asked
for a quick overview of the prescription drug monitoring
program.
COMMISSIONER DAVIDSON explained that the prescription drug
monitoring program was managed by the Board of Pharmacy, in the
Department of Commerce, Community & Economic Development. She
said that it required providers to submit data that documented
and tracked certain prescription drugs, including prescription
opioids. Providers had previously only been required to report
monthly, but with the passage of Senate Bill 74, the time period
was changed to reporting on a weekly basis. She allowed that
there were some exemptions, including hospice and end of life
care.
CHAIR GARA noted that this was not part of Medicaid Expansion.
REPRESENTATIVE SADDLER asked about the benefit from Medicaid
Expansion to boost the economy, and its effect on the recession
in the state.
CHAIR GARA clarified that there had been almost 7,000 jobs lost
in the state, and the budget had been cut by more than $2
billion. He asked what had been added to the economy through
Medicaid Expansion with relation to jobs.
COMMISSIONER DAVIDSON replied that she would get back to the
committee with the exact numbers, and referencing the recent
economic report from the Department of Labor & Workforce
Development, she pointed out that health care was the bright
spot in the Alaska economy.
COMMISSIONER DAVIDSON returned attention to the pie chart on
slide 25, which showed the percentage of Medicaid enrollees by
category, including children and children with disabilities,
parent caretakers, adults with disabilities, and seniors. She
relayed that the map on the page showed the geographic
representation for both Medicaid Expansion enrollees and all
enrollees.
CHAIR GARA asked about the impact of behavioral health parity
under Medicaid Expansion.
COMMISSIONER DAVIDSON said that one of biggest benefits that
Medicaid Expansion had provided in Alaska was another payer for
behavioral health services. She offered her belief that the
number of paid behavioral health claims was about $19 million.
She explained that behavioral health providers needed to operate
as a business, and could "only provide a certain amount of
charity care," as many people were receiving these services
although not being able to pay. She declared that the state was
not even close to providing the level of necessary behavioral
health services, noting that the Section 1115 waiver was a
comprehensive way "to better meet our needs."
4:52:33 PM
COMMISSIONER DAVIDSON directed attention to slide 26, "ACA
Repeal and Replace Impacts."
CHAIR GARA asked if the 100 percent paid by Medicaid Expansion
for behavioral health treatment displaced any money which the
state had paid for those services, or did it add services.
COMMISSIONER DAVIDSON replied that the state had saved on
catastrophic coverage for more than 450 Alaskans, previously
paid through the general fund, but which was now paid through
Medicaid Expansion at 100 percent federal match. She explained
that, although an inmate in corrections was not eligible for
Medicaid, for health care provided on a contract basis with an
overnight stay, the inmate was now eligible under Medicaid
Expansion.
CHAIR GARA asked if Medicaid Expansion displaced any state
expenditures on behavioral health.
COMMISSIONER DAVIDSON opined that she could "answer that
question about 100 different ways." She asked if she could
provide the committee with a variety of answers at a later time,
as there were significant improvements.
REPRESENTATIVE SADDLER asked how the number of enrollees and
cost per claim under Medicaid Expansion were currently comparing
to the projections, and if those projections could change in the
future.
COMMISSIONER DAVIDSON replied that in FY2016 it was anticipated
that Department of Health and Social Services would need $145.4
million, yet its expenses in FY16 were $149.5 million. In
FY2017, the projected Medicaid enrollment had been 23,000, but
the actual enrollment was 27,415. She opined that this was an
indication of a decline in the economy, as more people were now
eligible for Medicaid Expansion than had been anticipated. She
relayed that the projected expenditures in FY2017 would be
higher than anticipated, some due to pent-up demand and some due
to the utilization by those who have not had prior coverage.
She shared that this had been the experience with other states,
noting that eventually it would level off.
4:58:01 PM
COMMISSIONER DAVIDSON returned attention to slide 26, and
reported that general discussions had included a repeal of
Medicaid Expansion, although 31 states had expanded Medicaid and
those governors were asking what would replace it. She shared
that there was potential for elimination of the requirement for
the individual mandate for marketplace plans. She stated that
50,000 Alaskans had coverage through either Medicaid or
marketplace plans, and she asked what would happen to those
individuals and what would be the economic impact for the loss
of those resources. She pointed out that some specific
provisions in the Patient Protection and Affordable Care Act
impacted the work on health reform, including health homes and
the Section 1332 Waiver through the Division of Insurance which
allowed Alaska to better help the high-risk pool in order to
stabilize the individual market. She emphasized that private
insurance market place plans and Medicaid went "hand in hand" as
better health insurance coverage meant fewer people needing
Medicaid. She expressed concern with Medicaid block grants
becoming the way to shift an annual allocation to the states,
and then shifting the federal responsibility to the states. She
described states that did well with Medicaid block grants:
large population, large concentration in large urban settings,
care is provided the same, travel is not an access to care
issue, no tribal populations, stable economy, and low cost of
care. She declared that Alaska did not fit into any of these
categories, although if geography was a factor, "we'd be set."
She pointed out that health care was provided to meet the needs
of Alaskans in their settings, noting that the provision of care
by tribes in a small community was very different than the means
for provision of care in a large urban setting. She emphasized
that Indian Health Service beneficiaries, Alaska Natives or
American Indians, were already covered at 100 percent federal,
and therefore, should not be included in a block grant
allocation. She stated that, unless this was considered, states
similar to Alaska with a large tribal population were at a
disadvantage. She reported that states with a higher cost for
providing health care did not do as well. She shared that, as
the allocations were determined early in the calendar year and
did not include offsets throughout the year, any downward trend
during the year created a greater problem.
5:04:17 PM
CHAIR GARA commented that this would be the nightmare redesign
should the law be changed.
5:04:58 PM
COMMISSIONER DAVIDSON added that a group of Alaskans, including
providers, in a recent conversation with the Alaska
congressional delegation had stated that the "kinds of savings
that we are trying to achieve in Medicaid Reform through Senate
Bill 74 will be significantly compromised if Medicaid Expansion
goes away." She declared that Medicaid Expansion provided the
resources to task the programmatic changes, and that expansion
and reform went hand in hand.
[Chair Gara returned the gavel to Chair Spohnholz]
5:05:54 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:05 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS presentation on Medicaid Redesign Implementation.pdf |
HHSS 1/26/2017 3:00:00 PM |
Medicaid Redesign |