Legislature(2025 - 2026)DAVIS 106
04/01/2025 03:15 PM House HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| Presentation: the Impacts of Medicaid in Alaska | |
| 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
April 1, 2025
3:19 p.m.
MEMBERS PRESENT
Representative Genevieve Mina, Chair
Representative Andrew Gray
Representative Zack Fields
Representative Donna Mears
Representative Justin Ruffridge
Representative Rebecca Schwanke
MEMBERS ABSENT
Representative Mike Prax
COMMITTEE CALENDAR
PRESENTATION: THE IMPACTS OF MEDICAID IN ALASKA
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
MONIQUE MARTIN, Vice President
Alaska Native Tribal Health Consortium
Anchorage, Alaska
POSITION STATEMENT: Co-offered the Impacts of Medicaid in
Alaska presentation.
JOSHUA ARVIDSON, Chief Operating Officer
Alaska Behavioral Health
Anchorage, Alaska
POSITION STATEMENT: Co-offered the Impacts of Medicaid in
Alaska presentation.
CAROL AUSTERMAN, CEO
Kodiak Community Health Center
Kodiak, Alaska
POSITION STATEMENT: Co-offered the Impacts of Medicaid in
Alaska presentation.
ACTION NARRATIVE
3:19:56 PM
CHAIR GENEVIEVE MINA called the House Health and Social Services
Standing Committee meeting to order at 3:19 p.m.
Representatives Fields, Gray, Mears, Ruffridge, and Schwanke
were present at the call to order.
^PRESENTATION: The Impacts of Medicaid in Alaska
PRESENTATION: The Impacts of Medicaid in Alaska
3:20:34 PM
CHAIR MINA announced that the only order of business would be a
presentation of The Impacts of Medicaid in Alaska.
3:21:09 PM
MONIQUE MARTIN, Vice President, Alaska Native Tribal Health
Consortium, gave an introduction for the Impacts of Medicaid in
Alaska presentation. She began by stating that 264,000 Alaskans
are on Medicaid and offered other statistics on the Alaskans
receiving Medicaid. She emphasized that people experience
medical bills, regardless of their ability to pay them. She
said that Medicaid is very important for Alaska's economy, that
it drives down uncompensated care within the state, and that it
is also very important to tribal health. Ms. Martin described
the Alaska Tribal Health System, which is required to seek
third-party reimbursement, which includes Medicaid. Medicaid is
integral to the services provided by the Alaska Native Medical
Center (ANMC) and across the tribal health system. She related
that 40 percent of revenue at ANMC comes from Medicaid. She
emphasized that the tribal health system provides services to
many non-Native and rural Alaskans.
3:29:35 PM
REPRESENTATIVE SCHWANKE asked if the Indian Health Service (IHS)
or Medicaid pays first when an Alaska Native patient has a bill
submitted.
MS. MARTIN responded that the answer is a bit convoluted. She
explained the agreement made between IHS and the Alaska Native
Tribal Health Consortium.
3:30:52 PM
JOSHUA ARVIDSON, Chief Operating Officer, Alaska Behavioral
Health, as co-presenter of the Impacts of Medicaid in Alaska
presentation, began a PowerPoint, titled "Alaska Behavioral
Health Wellness for Everyone" [hard copy included in the
committee file]. He said that Alaska has the second highest
rate of suicide in the nation, emphasizing that untreated mental
illness is the principle causal factor. He explained the ways
that Alaska Behavioral Health is working to increase access to
mental health care to patients across the state. He said that
suicide is extremely rare in those who receive treatment because
treatment works. Mr. Arvidson added that 72 percent of Alaskans
the organization serves use Medicaid and "loss of adequate
Medicaid coverage will push Alaskans who depend on it for
outpatient care into emergency rooms," which has consequences on
every Alaskan. He offered an anecdote for the committee to
imagine the struggles of Alaskans losing Medicaid.
3:36:06 PM
REPRESENTATIVE RUFFRIDGE said that last year a piece of
legislation was passed that would add associate professional
counselors to the group of individuals who could provide
behavioral health services in a counseling capacity. He asked
if those associate professional counselors have been able to
accept Medicaid payments.
MR. ARVIDSON responded that licensed professional counselors
account for only half of the workforce at Alaska Behavioral
Health, and that increasing the workforce to include those on
the pathway to professional licensed counselors has been very
helpful.
3:37:21 PM
CHAIR MINA asked what the top services are on the "chopping
block" with potential cuts to Medicaid.
MR. ARVIDSON responded that it is hard to think about the
chopping block because all services his organization provides
are medically necessary. He added that the most common services
provided are psychotherapy, psychiatric evaluation and
medication management.
3:38:40 PM
CAROL AUSTERMAN, CEO, Kodiak Community Health Center, as co-
presenter of the Impacts of Medicaid in Alaska presentation,
began a PowerPoint, titled "Protecting Medicaid: A Lifeline for
Rural Alaska" [hard copy included in the committee file]. She
provided an overview of the Kodiak Community Health Center,
including the services it provides and the demographics of those
it serves, emphasizing that its payer mix is 28 percent
Medicaid. She then described the challenges Kodiak faces in
accessing medical services. She said that cuts to Medicaid
would leave Kodiak patients stranded from the care that they
need to receive outside of Kodiak. She said that without
Medicaid, many Alaskans would avoid primary and preventative
care, leading them to costly emergency room and hospital visits.
She offered examples of patients whose lives would change due to
Medicaid cuts. She summarized that Medicaid cuts have great
economic and community impacts.
3:45:00 PM
REPRESENTATIVE FIELDS shared a personal anecdote to describe the
life-saving services that Medicaid provides. He added that
states that have not expanded Medicaid have shut down many
hospitals in rural areas. He asked how Medicaid cuts would
impact hospitals in Alaska.
MS. MARTIN responded that there has been a swell of support for
Medicaid, across political parties, as rural providers have
spoken up about their need for Medicaid to function. She
emphasized the "fragility of the healthcare delivery system",
especially in rural communities.
3:49:18 PM
REPRESENTATIVE GRAY asked if federally qualified health centers
(FQHCs) are at risk, beyond general Medicaid cuts.
MS. AUSTERMAN responded that FQHCs are funded federally for only
two years at a time, so they are essentially always at risk [of
losing] their federal funding. She said that there are no other
specific targets to FQHCs.
REPRESENTATIVE GRAY expressed his fear that patients will seek
out care at an FQHC after losing care through a private provider
due to Medicaid cuts.
MS. AUSTERMAN responded that Kodiak Community Health Center
offers a sliding fee to all of its patients and it does not
matter what their insurance coverage is. She said that its
uninsured numbers dropped after Medicaid was expanded, but in
many areas the FQHC would be the only option for the uninsured
to receive care.
REPRESENTATIVE GRAY said that he is seen at ANMC, as a non-
native in Anchorage.
3:54:06 PM
CHAIR MINA asked about the cascading impacts of uncompensated
care and how that uncompensated care leads to a higher cost for
Alaskans.
MR. ARVIDSON responded that when Alaskans do not have adequate
insurance coverage, they delay seeking healthcare, leading to
more intense and more expensive treatment when they eventually
do seek healthcare. He also said that uncompensated care
ultimately gets paid for somewhere and has consequences for the
entire health system. In response to an earlier question from
Representative Fields regarding rural hospital closures, Mr.
Arvidson added that when families must relocate to seek care, it
is extremely disruptive financially and socially.
3:56:40 PM
MS. MARTIN responded that as Alaskans lose coverage, more will
turn to the emergency department, entering the healthcare system
at the most expensive place to receive care. She said the state
will also see a decrease in the number of Alaskans able to
receive preventative care.
4:00:19 PM
MS. AUSTERMAN responded that FQHCs have not seen an increase in
federal funding, while costs of healthcare have increased
greatly over recent years. She said that many have searched for
other funding sources to keep their doors open. She emphasized
that if Medicaid goes away entirely, many FQHCs will not be able
to stay open, including the Kodiak Community Health Center.
4:04:55 PM
REPRESENTATIVE FIELDS asked about the cascading effects to air
service, Medicaid being just one part of that in rural Alaska.
MS. MARTEN replied that the Alaska Native Tribal Health
Consortium has become a "tribal travel broker," making
arrangements for Alaskans to travel to either hub communities or
to Anchorage to receive care. She emphasized that this process
is critical for Alaskans to receive care. Decreasing flights to
these hub communities since the pandemic have already added
challenges to accessing timely care.
REPRESENTATIVE FIELDS asked how Medicaid cuts will increase the
rates of drug addiction, overdose, and crime driven by
addiction.
MR. ARVIDSON responded that untreated behavioral health
conditions are progressive and often fatal. Without the access
to adequate mental health treatment that Medicaid provides, the
state will see more Alaskans unemployed, homeless, and
committing crime.
4:08:57 PM
REPRESENTATIVE GRAY said the expectation of a regular annual
exam is unnecessary, as healthy people may take up spots that
could be used by other patients. He also said that patients
receiving therapy weekly may also take spots from other patients
who may truly need it.
MR. ARVIDSON agreed with the importance of evidence-based mental
health treatment that is goal-oriented.
4:13:05 PM
REPRESENTATIVE MEARS said that any opportunity for early-
intervention and preventative care before issues become more
expensive for our communities is very important.
4:14:33 PM
REPRESENTATIVE SCHWANKE offered an anecdote about rural health
care in her community and how its costs have greatly increased.
She said that rural Alaska is not getting healthier and many
people in her community use Medevac flights for a free trip to
Anchorage. She said she is curious about how to reduce the very
high costs of healthcare to the state.
4:18:59 PM
MS. MARTIN responded that healthcare provided to Alaska Native
and American Indian people is not free; it predates the United
States of America and treaties with American Indian people. She
said that last fiscal year tribal health entities saved the
State of Alaska $138 million through care coordination
agreements. She also emphasized the need for children to have
adult medical escorts in certain situations. She emphasized
that the unique nature of tribal health and how they help reduce
the cost of the state's Medicaid program.
REPRESENTATIVE SCHWANKE said that humans who receive free
services tend to utilize those services more. She said that the
huge healthcare infrastructure that has been created now places
a lot of pressure on the Medicaid system and the State. She
asked how the Supplemental Nutrition Assistance Program (SNAP)
can be modified to improve the health of low-income individuals.
She also asked if the expansion of medical infrastructure and
the increasing access to preventative care have had real
impacts.
MS. MARTIN responded that she would defer to the Department of
Health (DOH) regarding questions about SNAP. She clarified that
when a beneficiary of the Tribal Health System receives care at
a tribal health facility, the cost is 100 percent reimbursed by
the federal government.
MS. AUSTERMAN responded that in rural Alaska, many providers try
to treat their patients without the need to put them on an
airplane, including the use of telehealth. The goal of Kodiak
Community Health Center is to treat its patients in Kodiak.
4:32:14 PM
REPRESENTATIVE GRAY said that the current medical model in
Alaska incentivizes providing more expensive care, even when it
is not the best care, such that providers and clinics can be
reimbursed the most amount of money. He said that it is wrong
to blame sick people who are cogs in the system that makes money
off of keeping them sick. He said that FQHCs are not part of
the system as they are incentivized to not employ high-cost
care. He said that reducing poverty now will reduce costs to
Alaskans in the future.
4:35:53 PM
REPRESENTATIVE FIELDS said that the growth rate of healthcare
costs slowed significantly with Medicaid expansion. He said
that reducing uncompensated care costs saves money for the
Alaska Care system. Medicaid has made for a much more efficient
and humane system.
4:37:08 PM
MS. MARTIN said that Medicaid is a safety net program. She said
that 10 percent of Medicaid recipients receive services totaling
about 67 percent of the total Medicaid spend and that 60 percent
of recipients total about 10 percent of the spend. Therefore,
Medicaid cares for the most vulnerable Alaskans with the most
complex health conditions.
4:39:19 PM
REPRESENTATIVE RUFFRIDGE said that rebates, which Medicaid
participates in, contribute to the high cost of medications. He
said that rebates are dollars that simply should not have been
paid, that the Unites States is the only country to allow
rebates, and the United Health Group made $22 billion in profit
last year. He said that the high costs of medications are not
just a problem caused by the pharmaceutical industry. He
emphasized that there is no real reason to be uninsured, but
people remain uninsured due to stigma regarding the cost of
insurance.
4:45:07 PM
CHAIR MINA asked which populations would be affected by
introducing a work requirement to Medicaid.
4:46:25 PM
MS. AUSTERMAN responded that many Medicaid patients are already
employed. She explained that fishery and cannery workers in
Kodiak have very inconsistent income, making it difficult to
appropriately answer questions regarding their income on
healthcare.gov and Medicaid, leading them to be denied due to
their income in the past 30 days. She said that introducing a
work requirement to Medicaid will most likely not lead to
efficiencies within the program.
4:50:25 PM
MR. ARVIDSON described the differences in medical models that
focus on profits versus outcomes. He agreed that a work
requirement for Medicaid would not be the most effective way to
manage costs.
CHAIR MINA commented that there are a stigma and unawareness
regarding the marketplace.
4:54:03 PM
REPRESENTATIVE FIELDS said that through Medicaid expansion, the
State of Alaska saved $60 million, not adjusted for inflation.
He agreed that work requirements do not save money but do
increase costs and increase mortality rates.
4:55:21 PM
REPRESENTATIVE GRAY said that even the clinics that operate
differently from the current healthcare system must still
compete within the system that keeps costs so high.
4:56:42 PM
REPRESENTATIVE RUFFRIDGE said he is very grateful for the
statistics Representative Fields brought forward. He added that
the federal government has taken on some healthcare costs that
for which the State of Alaska once paid.
4:58:42 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:58 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Kodiak Community Health Center 04.01.25.pdf |
HHSS 4/1/2025 3:15:00 PM |
|
| Alaska Behavorial Health Presentation 04.01.25.pdf |
HHSS 4/1/2025 3:15:00 PM |