Legislature(2023 - 2024)DAVIS 106
02/21/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB59 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 59 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 21, 2023
3:01 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick (via teleconference)
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 59
"An Act relating to Medicaid eligibility; expanding eligibility
for postpartum mothers; conditioning the expansion of
eligibility on approval by the United States Department of
Health and Human Services; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 59
SHORT TITLE: MEDICAID ELIGIBILITY: POSTPARTUM MOTHERS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/03/23 (H) READ THE FIRST TIME - REFERRALS
02/03/23 (H) HSS, FIN
02/21/23 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
ANNE ZINK, MD, Chief Medical Officer
Alaska Department of Health
Juneau, Alaksa
POSITION STATEMENT: Introduced HB 59 with a PowerPoint
presentation and answered questions.
EMILY RICCI, Deputy Commissioner
Alaska Department of Health
Juneau, Alaska
POSITION STATEMENT: Introduced HB 59 with a PowerPoint
presentation and answered questions.
REBEKAH MORISSE, Section Chief
Women's Children's and Family Health
Anchorage, Alaska
POSITION STATEMENT: Responded to questions pertaining to HB 59.
ACTION NARRATIVE
3:01:55 PM
CHAIR MIKE PRAX called the House Health and Social Services
Standing Committee meeting to order at 3:01 p.m.
Representatives McCormick (via teleconference), Ruffridge,
Sumner, Fields, and Prax were present at the call to order.
Representatives Saddler and Mina arrived as the meeting was in
progress.
HB 59-MEDICAID ELIGIBILITY: POSTPARTUM MOTHERS
3:03:14 PM
CHAIR PRAX announced that the only order of business would be
HOUSE BILL NO. 59, "An Act relating to Medicaid eligibility;
expanding eligibility for postpartum mothers; conditioning the
expansion of eligibility on approval by the United States
Department of Health and Human Services; and providing for an
effective date."
3:03:51 PM
ANNE ZINK, MD, Chief Medical Officer, Alaska Department of
Health, provided a PowerPoint presentation, titled "HB 59:
Postpartum Medicaid Extension." She began on slide 3,
describing HB 59 is intended to extend postpartum coverage of
Medicaid from 60 days to 12 months to help cover postpartum
medical and health concerns. She stated that HB 59 would help
support growing families, help improve Alaska's maternal and
child health future, simplify Medicaid coverage renewal, and
save long-term cost dollars.
3:05:15 PM
DR. ZINK continued to slide 4, titled "What Are the Stakes?" and
showed the higher maternal mortality rates of the United States
of America compared to other developed countries. She followed
with slide 5, which read as follows [original punctuation
provided]:
Pregnancy-related deaths occur well beyond the 60-day
postpartum period
29% of pregnancy-related deaths in the U.S. not
including those caused by accidents, homicides, and
suicides occur 43 to 365 days postpartum
For every pregnancy-related death, there are 70 to 80
cases of severe maternal illness and morbidity in the
postpartum period
Medicaid-enrolled women are especially vulnerable to
pregnancy-related death as they are more likely to
experience chronic conditions, pre-term or low-weight
births, and severe maternal morbidity
DR. ZINK added that 51 percent of all births in Alaska are
covered by Medicaid, but 71 percent of all maternal deaths - if
they have coverage - are covered by Medicaid.
3:06:35 PM
DR. ZINK outlined "Pregnancy-Associated Deaths in Alaska" on
slide 6, which read as follows [original punctuation provided]:
In 2021, Alaska's overall pregnancy-associated death
rate exceeded the previous 5-year average by 109%
Among deaths in 2015-2019: 73% occurred >6 weeks post-
delivery
Among deaths reviewed by Alaska's Maternal and Child
Death Review (MCDR) committee during 2016-2022, 88%
were potentially preventable, and 44% were associated
with barriers to health care access
DR. ZINK added that in rural regions the pregnancy-associated
death rate increased by 184 percent compared to 69 percent in
our urban regions.
3:07:32 PM
EMILY RICCI, Deputy Commissioner, Alaska Department of Health,
continued the PowerPoint, on slide 7, "What Can Alaska Do About
It?," which read as follows [original punctuation provided]:
Section 9812 of the American Rescue Plan Act (ARPA)
added the time-limited option for allowing states to
extend postpartum coverage from the required 60 days
to 12 months for eligible beneficiaries through March
1, 2027.
The Consolidated Appropriations Act of 2023 (CAA-2023)
revised ARPA to make the optional coverage extension
permanent.
3:09:19 PM
MS. RICCI outlined why the legislature should pass a bill, as
shown on slide 8, "Why a Bill?," which read as follows [original
punctuation provided]:
The Legislature must approve all optional groups for
Medicaid coverage in statute AS 47.07.020
Women who are eligible for Medicaid in Alaska based on
their pregnancy currently only receive coverage for 60
days postpartum
In Alaska, 51% of births are covered by Medicaid
3:09:42 PM
DR. ZINK continued to slide 9, "Benefits to Alaskans," adding
that that 41 states had already opted to take advantage of the
American Rescue Plan Act (ARPA). Slide 9 read as follows
[original punctuation provided]:
Improves maternal health outcomes
Prevents gaps in health care coverage and improves
health care access
Improves maternal mental health
Mental health conditions contributed to 31% of
pregnancy-associated deaths in Alaska between 2014 and
2018
14% of Alaskan mothers who had a baby in 2020 had
symptoms of postpartum depression
Addresses disparities in maternal health outcomes
Medicaid plays a vital role in addressing disparities
in maternal mortality and morbidity rates
Postpartum period is an especially vulnerable time for
parents recovering from substance use disorders
Extending postpartum coverage increases access to
screening and education about chronic diseases such as
diabetes and high blood pressure
3:11:28 PM
DR. ZINK followed with slide 10, by the same name, which read as
follows [original punctuation provided]:
Improves child health outcomes
Parental enrollment in Medicaid is associated with a
29% higher probability that a child will receive an
annual well-child visit
Maternal mental health matters not only because of
maternal mortality; it is intimately tied to the
health and development of the child
Maternal depression can lead to negative outcomes in
children including delayed cognition and social-
emotional/behavioral development
3:12:07 PM
DR. ZINK outlined "Cost Savings" of HB 59 on slide 11, which
read as follows [original punctuation provided]:
The Congressional Budget Office (CBO) estimates that
by 2024, about a quarter of postpartum beneficiaries
will live in states that elect the new option and that
extended Medicaid coverage will result in almost $6.1
billion in federal spending over the first ten years
and expected to grow over time
The CBO estimates that not only are their federal and
state cost savings, but this will decrease ACA subsidy
cost for private insurance
Savings from averted severe maternal morbidity:
Medicaid-enrolled pregnant women with severe maternal
morbidity cost an average of $10,134 annually compared
to $6,894 for those without
Savings from prevention: Preventing gaps in coverage
ensures access to primary and preventive care,
including management of chronic conditions and
screening for mental health conditions, substance use,
and intimate partner violence
3:13:26 PM
DR. ZINK displayed slide 12, "Mental Health," which contained an
infographic from Mathematica outlining the key takeaways of
perinatal mood and anxiety disorders, and the impact of the
mother and child is an estimated $14.2 billion. Slide 12
continued as such [original punctuation provided]:
Drug/alcohol use or substance use disorders were
documented in 72% of Alaskan pregnancy-associated
deaths reviewed by the MCDR Committee during 2016-2022
Increasing access to screening and treatment for
substance misuse during and after a pregnancy may
reduce costs for the index child as well as subsequent
pregnancies and births
Alaska Medicaid paid 3.9 times as much per infant for
those affected by Neonatal withdrawal compared to
nonaffected infants
3:14:25 PM
DR. ZINK continued to slide 13, "Alaska Supports HB 59," which
lists who supports extending postpartum Medicaid Coverage. The
list read as follows [original punctuation provided]:
The American College of Obstetricians & Gynecologists
(ACOG)
The American Medical Association
The American Academy of Pediatrics
The Society for Maternal-Fetal Medicine
The American College of Physicians
The American Academy of Family Physicians
The American Hospital Association
The American Psychiatric Association
The American College of Cardiology
The American Osteopathic Association
The March of Dimes
The Alaska Native Tribal Health Consortium
The American Heart Association
3:14:44 PM
MS. RICCI, in response to a question from Representative Saddler
about whether Alaska is under ARPA legislation, stated that
Alaska is not under ARPA legislation, but HB 59 would allow
Alaska to take advantage of the extension provided by ARPA. In
response to a follow-up question, she confirmed there was no
time limit to take advantage of the Consolidated Appropriations
Act of 2023 (CAA-2023).
MS. RICCI, in response to a question from Representative Saddler
about why the state did not take advantage of this opportunity
earlier, stated that the focus was primarily on the pandemic,
cyber-attack, and other items, and the department is taking
advantage of this offer as early as it can.
3:17:29 PM
DR. ZINK, in response to a question from Representative
Ruffridge about the original temporary coverage extension to
postpartum eligibility that preceded CAA-2023, said that it was
during 2022, and that it was supposed to expire in 2027.
REPRESENTATIVE RUFFRIDGE stated that if it was presented as an
option in 2022, then it may have not been available to the
legislature in its entirety.
DR. ZINK said she did not know its exact date and was not able
to confirm Representative Ruffridge's statement. She added that
many other states are implementing Section 9812 of ARPA right
now.
3:19:34 PM
DR. ZINK moved to slide 15, "Healthy Family Initiative," which
read as follows [original punctuation provided]:
Strong families are the foundation of a healthy
society and a vibrant economy.
4-year statewide investments in the health and well-
being of Alaskan families
Governor Dunleavy proposed $9.5M (UGF) in FY 24
operating budget for Healthy Families activities
within DOH:
Postpartum Medicaid extension
Office of Health Savings
TB and congenital syphilis mitigation
DR. ZINK added that under the Healthy Families Initiative that
the Governor has put forward, the three major pillars were
healthy beginnings, access to health care and healthy
communities.
3:20:23 PM
MS. RICCI listed the four sections of HB 59 on one slide each,
starting on slide 17 and ending on slide 20, which read as
follows [original punctuation provided]:
MS. RICCI explained what HB 59 does, as shown on slides 17-20,
which read as follows [original punctuation provided]:
Section 1
Adds a new section (o) to AS 47.07.020, authorizing
the department to implement an extension of postpartum
Medicaid coverage up to the maximum period authorized
under federal law.
Section 2
Amends the uncodified law to add the requirement for
submission of a Medicaid state plan amendment to allow
Medicaid beneficiaries to receive postpartum coverage
for up to 12 months.
Section 3
Amends the uncodified law to establish the requirement
that the commissioner of health notifies the revisor
of statutes within 30 days of federal approval of the
state plan amendment.
Section 4
Establishes that the postpartum extension takes effect
on the day after the date the commissioner notifies
the revisor of statutes as described above.
3:21:39 PM
DR. ZINK clarified that April 1, 2022, was the first time that
this legislation would come about as part of ARPA. She followed
with a story about a patient that she had seen who had lost
health care access after pregnancy and was struggling with
alcohol use. The patient was able to re-enroll into Medicaid,
which allowed her to get clean and sober.
3:22:50 PM
REPRESENTATIVE MINA asked how many individuals are uninsured and
go into private insurance after losing Medicaid coverage after
the current 60 days.
3:23:31 PM
MS. RICCI was not able to provide specific data on the question.
She added that, from the fiscal note, about 1,500 women
indicated that they would lose coverage after the 60 days, and
additionally there were about 2.300 women who experienced gaps
in health care over the following 10 months after postpartum
coverage. She concluded that under the current coverage of
Medicaid "it is not streamlined, it is not simplified, and it is
... very dependent on an individual's economic status."
MS. RICCI, in response to a follow up from Representative Mina
about how the ending of eligibility is notified to the
individuals, specified that generally a notice is received
through the mail some time before their enrollment ends.
3:25:47 PM
DR. ZINK clarified her previous story following Representative
Saddler's question, stating that the Medicaid coverage the
patient was able to re-enroll in was able to support the
patient's sobriety.
DR. ZINK, in response to a question from Representative Saddler
about the reasoning of the 60-day postpartum coverage, said that
it was originally established from Centers for Medicare and
Medicaid Services (CMS) in 1986, and there has been a lot of
research since that time that provides increasing evidence to
extend coverage to the first year postpartum.
3:27:54 PM
DR. ZINK, in response to Representative Saddler, clarified that
the extended coverage is focused on both physiological and
psychological aspects of care.
DR. ZINK, in response to a follow up from Representative Saddler
asking why only 12 months, said that it was what is offered to
them, as well as having coverage end for the mother and child at
the same period.
3:29:38 PM
MS. RICCI added to Dr. Zink's response with emphasis on the
simplicity of the current offer through CMS.
3:30:30 PM
REPRESENTATIVE RUFFRIDGE asked for more information about the
non-injury related deaths.
3:31:19 PM
REBEKAH MORISSE, Section Chief, Women's Children's and Family
Health, said she didn't have the exact causes on hand, but
offered to provide them later.
3:31:54 PM
REPRESENTATIVE SADDLER asked for clarification on whether
postpartum coverage is for all services, or just those
pertaining to postpartum care.
MS. RICCI confirmed it was for all services.
3:32:21 PM
DR. ZINK, in response to a question from Chair Prax about how
individuals lost coverage of Medicaid, stated that it is because
they do not renew coverage during the 60-day period.
3:33:23 PM
MS. RICCI, in response to a follow-up question from Chair Prax,
clarified that Medicaid does not have pre-existing conditions
exclusions, and few private insurance plans maintain pre-
existing exclusions.
3:34:23 PM
REPRESENTATIVE SADDLER asked if there is a limit to how far
Medicaid expansion will go and whether every Alaskan would
eventually be covered under Medicaid.
MS. RICCI assured that HB 59 is "specific, targeted, and
narrow," and only extends pre-existing coverage without creating
a new eligibility group. She expanded that Medicaid is intended
to take an upfront cost but provide long term savings, as seen
in Texas.
3:36:09 PM
REPRESENTATIVE SADDLER said he wished to see hard evidence of
the savings provided by Medicaid. He also asked Ms. Ricci to
provide an example of what an unnecessary expansion of Medicaid
would be.
MS. RICCI replied that she hesitated to speculate on what
expansions would be unnecessary.
3:37:04 PM
MS. RICCI, in response to a question from Chair Prax asking to
clarify that the individual Medicaid costs would decrease over
the long term, said that it is very difficult to quantify what
different variables affect what. She added that there has been
work in Texas that is able to demonstrate cost-savings.
3:38:50 PM
DR. ZINK added to Ms. Ricci's response and provided the examples
that the first states to take advantage of this opportunity were
non-expansion states. They determined that the most targeted
intervention that they could implement with the longest-term
benefit was expanding postpartum care. She further expanded on
Texas, clarifying that it was looking at a managed care program
that expanded coverage to 12 months and that the state was able
to see a decrease in high-risk pregnancies, the highest causes
of death were less influenced by pregnancies, and there was a
decrease in chronic conditions.
3:39:57 PM
DR. ZINK, in response to Representative Saddler, clarified that
although Texas used a managed care program, Alaska would likely
see similar results.
3:40:42 PM
REPRESENTATIVE RUFFRIDGE opined that although cost-saving is
important, the committee should consider that saving a life
should be thought of as well. He expressed that he would rather
save a life if given the opportunity.
3:41:58 PM
CHAIR PRAX said he appreciated the concern but reminded the
committee members that they must look at the comparative cost of
the state's budget. He mentioned that HB 17 also has a similar
question, adding costs for pregnancy prevention that have
economic consequences down the road.
3:43:03 PM
REPRESENTATIVE FIELDS added that expanding coverage reduces
cost, as the cost of churn [individuals disenrolling and re-
enrolling] is more expensive than being covered for 12 months.
3:43:31 PM
DR. ZINK expressed that she would be happy to provide more
information on churn in the Medicaid system. She added that
there is additional work being done by Medicaid Enrollment and
Spending in Alaska (MESA) looking at how Medicaid can manage
medical costs long term, and she acknowledged that it is
difficult to see the cost savings of these individual bills.
3:44:28 PM
REPRESENTATIVE FIELDS added that since expanding postpartum
coverage would reduce child abuse, it would then reduce costs in
other departments such as the Office of Children's Services
(OCS).
3:44:54 PM
DR. ZINK continued to add the Alaska Department of Health has
the Alaska Longitudinal Child Abuse and Neglect Linkage Project
(ALCANLink) that looks at the return on investment of reducing
adverse child experiences and increasing protective factors and
showing the long term economic and health benefits. She
referenced the previous information from the Mathematica
infographic and how the $14.2 [billion] cost is so big as it
includes many other sources of cost to the state.
3:46:35 PM
REPRESENTATIVE SADDLER asked if there is any part of the CMS
system that balances the cost of medical care with saving a
life.
DR. ZINK responded by assuring that she must balance the budget
on a policy level, which can conflict with what she wants as a
parent or what she wants as a physician. She added that the
Center for Disease Control and Prevention's (CDC's) Health
Impact in 5 Years (HI-5) project can show what up-front
investments are able to provide the largest long-term health
benefits, and that expanding postpartum care is one of the most
important places to implement cost-effective and health-
effective care.
3:49:35 PM
REPRESENTATIVE FIELDS requested to move back to slide 4 and
discuss how much the U.S. spends per capita on maternal care
compared to the other countries that have a [10] times lower
death rate.
DR. ZINK said that is depends on how maternal care costs are
calculated, but the U.S. usually spends more per individual on
health care costs. She added that the health of an individual
is about 80 percent determined by factors outside of the health
care system. She emphasized that putting up-front costs into
targeted policies can reduce long-term costs and provide better
health outcomes.
3:52:04 PM
REPRESENTATIVE SADDLER asked if there is any evidence that
helping fathers will also provide benefits.
DR. ZINK agreed firmly that helping fathers would also provide
similar benefits, but highlighted the legislature is taking
advantage of an opportunity provided by CMS.
3:52:54 PM
CHAIR PRAX announced that HB 59 was held over.
3:53:05 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 3:53 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 59 Research Maternal Mortality 12.1.2022 .pdf |
HHSS 2/21/2023 3:00:00 PM |
HB 59 |
| HB 59 Sectional Analysis Version A.pdf |
HHSS 2/21/2023 3:00:00 PM |
HB 59 |
| HB 59 Sponsor Statement.pdf |
HHSS 2/21/2023 3:00:00 PM |
HB 59 |
| HB 59 Summary Version A.pdf |
HHSS 2/21/2023 3:00:00 PM |
HB 59 |
| HB 59 Version A.PDF |
HHSS 2/21/2023 3:00:00 PM |
HB 59 |
| HB 59 Dept. of Health Presentation 2.17.2023.pdf |
HHSS 2/21/2023 3:00:00 PM |
HB 59 |
| HB 59-SB 58 American Heart Association Letter of Support.pdf |
HHSS 2/21/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 59 SB 58 |
| AHHA Letter of Support for HB59 Postpartum Medicaid 2-9-23.pdf |
HHSS 2/21/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 59 |