Legislature(1999 - 2000)
04/26/2000 04:17 PM Senate 207
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CONFERENCE COMMITTEE ON SB 207
April 26, 2000
4:17 p.m.
MEMBERS PRESENT
Senator Lyda Green, Co-Chair
Senator Robin Taylor
Senator Kim Elton
Representative Fred Dyson
Representative Jim Whitaker
Representative Tom Brice
MEMBERS ABSENT
None
OTHERS PRESENT
Representative Jack Coghill
COMMITTEE CALENDAR
HOUSE CS FOR SENATE BILL NO. 207(RLS)
"An Act relating to the establishment and enforcement of medical
support orders for children; amending Rule 90.3, Alaska Rules of
Civil Procedure; and providing for an effective date."
MOVED HCS SB 207(RLS) OUT OF COMMITTEE
PREVIOUS ACTION
Jrn-Date Jrn-Page Action
1/20/00 2016 (S) READ THE FIRST TIME - REFERRALS
1/20/00 2016 (S) HES, JUD, FIN
1/20/00 2016 (S) ZERO FISCAL NOTE (REV)
1/20/00 2016 (S) GOVERNOR'S TRANSMITTAL LETTER
3/22/00 Text (S) HES AT 1:30 PM BUTROVICH 205
3/22/00 Text (S) Moved Out of Committee
3/22/00 Text (S) MINUTE(HES)
3/23/00 2705 (S) HES RPT 2DP 2NR
3/23/00 2705 (S) DP: MILLER, ELTON; NR: PETE KELLY,
3/23/00 2705 (S) WILKEN
3/23/00 2705 (S) PREVIOUS ZERO FISCAL NOTE (REV)
4/12/00 Text (S) JUD AT 1:30 PM BELTZ 211
4/12/00 Text (S) Heard & Held
4/12/00 Text (S) MINUTE(JUD)
4/14/00 Text (S) JUD AT 1:00 PM BELTZ 211
4/14/00 Text (S) Heard & Held
4/14/00 Text (S) MINUTE(JUD)
4/14/00 3107 (S) JUD RPT 3DP
4/14/00 3107 (S) DP: TAYLOR, TORGERSON, ELLIS
4/14/00 3107 (S) PREVIOUS ZERO FISCAL NOTE (REV)
4/15/00 Text (S) FIN AT 9:00 AM SENATE FINANCE 532
4/15/00 Text (S) Moved Out of Committee
4/15/00 Text (S) MINUTE(FIN)
4/15/00 3128 (S) FIN RPT 2DP 7NR
4/15/00 3128 (S) DP: TORGERSON, ADAMS; NR: PARNELL,
4/15/00 3128 (S) PHILLIPS, GREEN, PETE KELLY,
4/15/00 3128 (S) LEMAN, WILKEN, DONLEY
4/15/00 3128 (S) PREVIOUS ZERO FISCAL NOTE (REV)
4/17/00 Text (S) RLS AT 1:30 PM FAHRENKAMP 203
4/17/00 Text (S) MINUTE(RLS)
4/17/00 3202 (S) RULES TO CALENDAR 4/17/00
4/17/00 3202 (S) READ THE SECOND TIME
4/17/00 3202 (S) ADVANCED TO THIRD READING UNAN CONSENT
4/17/00 3202 (S) READ THE THIRD TIME SB 207
4/17/00 3203 (S) PASSED Y17 N- A3
4/17/00 3203 (S) EFFECTIVE DATE(S) SAME AS PASSAGE
4/17/00 3205 (S) TRANSMITTED TO (H)
4/18/00 3256 (H) READ THE FIRST TIME - REFERRALS
4/18/00 3257 (H) FIN
4/19/00 Text (H) FIN AT 1:30 PM HOUSE FINANCE 519
4/19/00 Text (H) Moved Out of Committee
4/19/00 Text (H) MINUTE(FIN)
4/19/00 3328 (H) FIN RPT 7DP
4/19/00 3328 (H) DP: BUNDE, DAVIES, GRUSSENDORF, DAVIS,
4/19/00 3328 (H) WILLIAMS, PHILLIPS, FOSTER
4/19/00 3328 (H) SENATE ZERO FISCAL NOTE (REV) 1/20/00
4/20/00 3366 (H) RULES TO CALENDAR 4/20/00
4/20/00 3366 (H) RETURNED TO RLS COMMITTEE
4/24/00 Text (H) RLS AT 9:30 AM BUTROVICH 205
4/25/00 Text (H) RLS AT 9:30 AM BUTROVICH 205
4/25/00 Text (H) Moved HCS SB 207(RLS) Out of Committee
4/25/00 Text (H) MINUTE(RLS)
4/25/00 3486 (H) RLS RPT HCS(RLS) NT 3DP 2NR
4/25/00 3486 (H) ...TECHNICAL TITLE CHANGE
4/25/00 3487 (H) DP: COWDERY, KOTT, PORTER;
4/25/00 3487 (H) NR: PHILLIPS, BERKOWITZ
4/25/00 3487 (H) SENATE ZERO FISCAL NOTE (REV) 1/20/00
4/25/00 3491 (H) RULES TO CALENDAR 4/25/00
4/25/00 3491 (H) READ THE SECOND TIME
4/25/00 3491 (H) RLS HCS ADOPTED UNAN CONSENT
4/25/00 3492 (H) ...TECHNICAL TITLE CHANGE
4/25/00 3492 (H) ADVANCED TO THIRD READING UNAN CONSENT
4/25/00 3492 (H) READ THE THIRD TIME HCS SB 207(RLS)
4/25/00 3492 (H) PASSED Y38 N1 A1
4/25/00 3492 (H) EFFECTIVE DATE(S) SAME AS PASSAGE
4/25/00 3493 (H) COURT RULE(S) SAME AS PASSAGE
4/25/00 3521 (H) TRANSMITTED TO (S) AS AMENDED
4/26/00 Text (S) 207 AT 4:15 PM FAHRENKAMP 203
4/26/00 3516 (S) FAILED CONCUR (H) AM Y- N19 A1
4/26/00 3517 (S) CONFERENCE COMMITTEE APPOINTED
4/26/00 3517 (S) *GREEN, TAYLOR, ELTON
4/26/00 3529 (H) FAILED RECEDE (H) AM N35 E1 A4
4/26/00 3531 (H) CONFERENCE COMMITTEE APPOINTED
4/26/00 3531 (H) *DYSON, WHITAKER, BRICE
WITNESS REGISTER
Ms. Terri Lauterbach
Division of Legal Services
Legislative Affairs Agency
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Answered questions about HCS SB 207(RLS).
Ms. Shirley Dean
Child Support Enforcement Division
Department of Revenue
410 Willoughby Ste 107
Juneau, AK 99801-0400
POSITION STATEMENT: Answered questions about CSED's practices.
Kevin Henderson
Denali KidCare
Division of Medical Assistance
Department of Health and Social Services
PO Box 110660
Juneau, AK 99811-0660
POSITION STATEMENT: Answered questions about Denali KidCare.
ACTION NARRATIVE
TAPE 00-1, SIDE A
Number 000
SB 207-MEDICAL SUPPORT ORDERS FOR CHILDREN
CO-CHAIR LYDA GREEN called the Conference Committee on SB 207 to
order at 4:17 p.m. Present were Senators Taylor and Elton and
Representatives Whitaker and Brice and Co-Chair Dyson.
Representative Coghill was also present.
CO-CHAIR GREEN announced the committee would be considering HCS SB
207(RLS) because Senators felt it would be advantageous to make
changes to the bill in this forum rather than on the Senate floor.
She asked Senator Taylor to outline his concerns.
SENATOR TAYLOR stated that SB 207 was originally four or five
pages. HCS SB 207(RLS) was then lengthened to 13 pages by the
House yet the Senate has never heard any explanation of the
modifications.
CO-CHAIR DYSON explained that SB 207 was introduced at the request
of the Governor. When the House started to work on it, several
issues came up. First, the Governor's bill assumes that the only
way parents can meet their child's health needs is to have health
insurance. He felt that might be the practical answer but in cases
in which no support order has been issued, meaning the parents have
independently agreed on the financial aspects of child custody, a
non-custodial parent with a lot of financial resources may be able
to meet the child's medical needs without insurance. Second, the
House did not want CSED to be able to bypass a court decision using
an administrative procedure. The House wanted to keep the
obligation for the child's health care with the parents when
possible. The House directed Terri Lauterbach, the legislative
drafter, to make those changes. She advised them that those
changes would require incorporating a court rule into statute. Co-
Chair Dyson noted that the House amendments significantly improve
the bill and that the Child Support Enforcement Division (CSED)
agrees, but the changes make the bill longer.
CO-CHAIR GREEN asked Ms. Lauterbach to address the committee.
Number 073
MS. TERRI LAUTERBACH, an attorney with the Division of Legal and
Research Services, Legislative Affairs Agency, informed committee
members that she prepared the committee substitute (CS) for the
House. Had she done a CS for the Senate, she would have
recommended the same sections for review. Often, the Division of
Legal Services' first chance to have input and determine whether a
bill contains ambiguities occurs when a Governor's bill gets
changed in a committee.
The phrase "child support" or "child support payments" is referred
to in several places in statute. The phrase "child support" can
refer to financial support, medical support or both. The goal of
SB 207 was to make sure that CSED could issue a medical support
order without a financial support order, but that change would make
the phrase "child support" ambiguous in seven sections of statute,
which was not addressed in SB 207. Consequently, Sections 1-5, 18
and 19 of SB 207 needed to be changed.
MS. LAUTERBACH explained that Section 1 in the House CS is new. It
pertains to a criminal law about aiding a person in the nonpayment
of child support. Section 1 clarifies that a person can be in
violation of the statute not only for nonpayment of financial
support but also for not providing health coverage for their
children. She noted the policy call could go the other way but she
recommends the legislature decide whether the statute will cover
only child support payments or health care, otherwise the phrase
"child support" will be ambiguous in this statute.
CO-CHAIR GREEN asked if that is the "corporate stamp" for the
expansion.
MS. LAUTERBACH repeated that Sections 1-5, 18 and 19 fit that
explanation. When redrafting the bill, she also made changes to
Sections 8, 21, and 22 that she assumed the original drafter
missed. She pointed out the sectional analysis contains an
explanation of those changes.
CO-CHAIR GREEN asked Ms. Lauterbach if, essentially, she changed
the phrase "child support order" to "child support order or medical
support order."
MS. LAUTERBACH said that is pretty much true although the context
is slightly different in each of the sections. The goal was to
clean up all of the ambiguous statutes while maintaining the policy
that medical support could be separate from periodic payments.
SENATOR ELTON asked Ms. Lauterbach to explain the difference
between a court rule change and an indirect amendment on a court
rule.
MS. LAUTERBACH explained that a direct amendment of a court rule
happens when a court rule is referred to in a bill and amended. An
indirect amendment is made when a statute is simply changed in a
way that differs from how the court rule reads; it is done through
a statute instead of amending the rule directly.
CO-CHAIR GREEN asked which was done in SB 207.
MS. LAUTERBACH replied HCSSB 207(RLS) contains an indirect
amendment to a court rule.
CO-CHAIR GREEN asked if it is an indirect amendment because Ms.
Lauterbach changed the statutory language to include medical
support.
MS. LAUTERBACH answered the indirect court rule amendment clarifies
that a medical support order can be issued separately by a court,
as well as by CSED. Currently, Rule 90.3 does not address whether
medical support orders can be issued separately from child support
orders. It also places most of the sections of Rule 90.3 that
apply to health insurance and medical coverage in statute. HCS SB
207(RLS) differs a little. The court rule says that when medical
expenses are more than $5,000 in a calendar year, the cost will be
split between the parents based on their financial situations at
the time the expenses were incurred. HCS SB 207(RLS) says that all
costs not covered by health insurance should be split evenly unless
there is good cause to do otherwise.
CO-CHAIR GREEN asked if that provision in HCS SB 207(RLS) only
applies to health care expenses above the cost of insurance.
MS. LAUTERBACH replied it would apply to all out-of-pocket expenses
for health care. It does not create a separate category of costs
above $5,000.
Number 174
SENATOR ELTON asked, "I may have missed this Terri, so I just want
to bore in a little bit more on the indirect amendment. What
prevails? I mean, does a court rule that is directly - I mean do
the statutes prevail or does this force a change in the court
rules?"
MS. LAUTERBACH said the answer to that question, in the context of
SB 207 only, is that Rule 90.3, which applies to child support, was
specifically adopted by the Alaska Supreme Court under its
interpretive authority. A two-thirds vote of the Legislature is
not required to change it, unlike most other court rules. In this
situation, the statute will prevail.
SENATOR ELTON commented that Rule 90.3 was put in place because
there was no controlling statute.
MS. LAUTERBACH agreed, and added at the time the federal government
required states to have child support guidelines.
SENATOR TAYLOR asked an inaudible question.
MS. LAUTERBACH replied as part of a welfare reform bill, in about
1986 or 1988, the federal government required each state to adopt
child support guidelines in order to make child support awards more
uniform within the states. About two years later, the federal
government required states to enforce those guidelines. The
Legislature did not act so the Alaska Court System did.
SENATOR TAYLOR asked if part of HCS SB 207(RLS) is meant to resolve
that federal obligation.
Number 243
CO-CHAIR DYSON noted that the federal government requires that a
custodial parent who applies for Medicaid or government health care
services have a medical support order in place. Custodial parents
have to jump over many hoops to get Medicaid for their children in
Alaska because Rule 90.3 does not separate medical support orders
for children. CSED has been forced to establish somewhat phony
financial support orders for families that do not have one in place
so that the custodial parent can jump over that hoop to get Denali
KidCare. [Due to static, part of CO-CHAIR DYSON's testimony is
inaudible.] At the same time, the phony support order might have
an enforcement action which is absolutely bizarre. He believes
CSED wants to get out of the awkward situation of not being able to
satisfy the federal requirements for Denali KidCare because no
medical support order is available.
SENATOR TAYLOR said his concern is that this bill has nothing to do
with the subject at hand. It expands the Denali KidCare program
and will have a huge financial impact in the future, which is
primarily a policy call. Although he probably supports that
program, people should be aware that SB 207 is not just an
innocuous bill that will merely take care of some paperwork. He
cautioned that next session the Legislature will be looking at a
significant increase in the Denali KidCare budget if this bill
passes.
CO-CHAIR DYSON pointed out the Administration would claim that the
purpose of SB 207 is to meet the needs of those children because
the parents could go through all of the hoops anyway. This bill
makes the hoop more fair and direct. He added the Administration
has said that the cost to the State of the Denali KidCare program
is 28 cents for each federal dollar.
REPRESENTATIVE BRICE commented that he has received a lot of phone
calls from people who said they do not need child support but they
do need health insurance. He believes this bill gets to the heart
of the problem and he is comfortable with it. HCS SB 207(RLS) will
set up a system where divorced parents can cooperatively ensure
that their child gets medical coverage. He noted that medical
support orders appear to be exempted from Sections 18 and 19 so
that a parent cannot lose an occupational or driver's license if
they are at odds with the custodial parent. He asked Ms.
Lauterbach to address those sections.
MS. LAUTERBACH explained that Sections 18 and 19 make reference to
the payment of child support which, in this case, refers only to
the periodic payments. She clarified those sections for the House
committee because that definition seemed most consistent with what
had passed before. She noted that the sentence on page 10, lines
28-29, refers to arrearages and she interpreted that to apply only
to the monthly payment amount. She was not sure how to apply that
concept to medical support so she clarified it in the easiest way
possible for the committee to review at the time.
REPRESENTATIVE BRICE said the sections are specific to periodic
payments so that if CSED takes a person's driver's license or means
to make a living it must be for hard dollars. He pointed out that
quite often medical benefits are tied to a person's job.
SENATOR TAYLOR stated that he thinks the ongoing system assumes
everyone works for the State of Alaska and takes home a regular
check every month. He said this bill not only makes a person
criminally responsible for non-payment of child support, but for
non-payment of health care, and the bill adds a section [Section 1]
which contains draconian penalties. He stated when people are out
of work in his district, married or not, they cannot pay their
bills and their kids have no coverage. He surmised that the
fastest way to get health care coverage for kids is to get
divorced. Now, under this bill, CSED can throw the non-custodial
parent and that person's employer in jail if medical coverage is
not made available. He expressed concern that this policy creates
a significant disparity between married people with children and
those who are divorced. He thought the Legislature is going way
overboard in its attempt to make sure that all children are always
taken care of. He noted it is a great goal but in his district he
has a hard time getting "that blood out of that turnip."
MS. LAUTERBACH pointed out that Section 1 of the bill is not aimed
at the obligors; it is aimed at people who employ the obligors and
do not give information about whether they provide health insurance
or what the price is. This is not a new crime.
SENATOR TAYLOR stated there is a new section for obligors separate
from this one.
MS. LAUTERBACH replied it is not in the bill so it has not been
amended to do anything about medical payments.
CO-CHAIR GREEN asked if Section 1 is about the employer.
MS. LAUTERBACH said it is.
CO-CHAIR GREEN asked if that section is not new but that it is
being amended.
MS. LAUTERBACH explained the crime is not new but a new section had
to be added to the bill.
CO-CHAIR GREEN asked what CSED's procedure is when it asks for
information from an employer.
MS. SHIRLEY DEAN, CSED, explained that CSED sends a letter to
employers asking if a person is an employee and how much that
person earns.
CO-CHAIR GREEN asked if CSED will now supplement that request with
information about health care coverage.
MS. DEAN said CSED currently asks employers whether the employee is
offered health care coverage for children through the employer's
insurance plan. If health care coverage is not available, CSED
takes no action.
CO-CHAIR GREEN asked what CSED would do if an employer gave
incorrect or inadequate information.
MS. DEAN replied the case worker would turn the case over to the
investigative unit. To her knowledge, CSED has never prosecuted
any employer for failing to provide medical information.
SENATOR TAYLOR surmised that CSED never prosecuted anyone for
failure to give medical information because CSED only has the
authority to request information. This bill will create a new
area.
MS. DEAN remarked if CSED requested that information from an
employer and was given false information, CSED could prosecute the
employer under current law.
Number 364
CO-CHAIR GREEN expressed concern that the federal government will
eventually get out of the Denali KidCare program leaving the cost
of the entire program to the State. She asked whether any of the
language in HCS SB 207(RLS) creates a direct link to the Denali
KidCare program.
MS. DEAN replied not as far as she knows. The only link that CSED
has occurs when a parent applies for Denali KidCare. CSED is then
required to set up a child support order on behalf of the child.
CO-CHAIR GREEN asked if it is for the reason mentioned earlier.
MS. DEAN acknowledged that is part of it but some parents have
independently made financial agreements and get along fine but have
no insurance available. Those parents only want the medical
support order.
SENATOR TAYLOR surmised that in 99 per cent of those cases, if
either parent has insurance available, it covers the children.
MS. DEAN answered sometimes, but there are parents for which
everything is fine except the insurance.
SENATOR TAYLOR said he understands this will give CSED a huge
hammer to make them do it but he hates to see the Legislature
restructure all of the laws in this State to do something for the
federal government.
MS. DEAN pointed out that under current law, if a parent signs up
for Medicaid for the children, CSED must set up a child support
order. This bill will allow CSED to only set up a medical support
order only.
SENATOR TAYLOR said if an indirect amendment of court rules was
possible, he would have all kinds of legislation that would
indirectly affect a court rule.
MS. LAUTERBACH asked committee members to look at Section 25 of HCS
SB 207(RLS). She pointed out that the reason a two-thirds vote of
the Legislature is not required for this court rule change has
nothing to do with whether it directly or indirectly amends the
court rule. A two-thirds vote is not required because Rule 90.3,
by the Alaska Supreme Court's own admission, was adopted under its
interpretive authority under Article IV, sec. 1 of the Alaska
Constitution. It was not adopted under Article IV, sec. 15, which
pertains to rules of practice and procedure and rules of
administration. The Legislature must have a two-thirds vote to
amend a rule of practice and procedure.
SENATOR TAYLOR recalled that the Supreme Court asked the
Legislature to set policy in this area on three different occasions
but, having failed to do so, the Supreme Court exercised its
interpretive authority. The Supreme Court knew it was creating a
substantive law of whole cloth and asked the legislature to take it
up but no one has had the courage to do so. He tried several times
but each time his efforts were shot down. He does not believe it
was an appropriate thing for the court to do, but what frightens
him are the very words "notwithstanding Article IV, sec. 15,". He
found that language to be shocking.
MS. LAUTERBACH stated that Section 25 of the bill could have been
reworded to read something like, "Even though sec. 15 says a rule
of practice and procedure needs a two-thirds vote, this is not a
rule of practice and procedure so two-thirds is not required." She
emphasized that the word "Notwithstanding" does not mean the
Legislature knows it is doing something unconstitutional but
chooses to do so anyway. She pointed out that same provision is
included in any bill that refers to Rule 90.3.
CO-CHAIR GREEN asked if a two-thirds vote has never been required
of the Senate to change Rule 90.3.
SENATOR TAYLOR noted not much has been done with Rule 90.3.
MS. LAUTERBACH added it is a hard policy call.
SENATOR TAYLOR asked if Rule 90.3 has been amended by the
Legislature.
CO-CHAIR GREEN said the Legislature tried but nothing passed.
MS. LAUTERBACH clarified that one amendment to HCS SB 207(RLS) was
added to make sure that Indian Health Service (IHS) coverage is
considered. That was not included in Rule 90.3 but it was put in
statute so the court had to amend Rule 90.3. The second change is
in regard to payment of support to 18 year olds who are
emancipated.
SENATOR TAYLOR said he thought the Legislature passed a law but
left it up to the court to make the decision about changing the
court rule.
Number 461
CO-CHAIR DYSON said that one thing that helped him philosophically
with the changes made to the bill was the possibility that a very
wealthy non-custodial parent could self insure his or her own
medical care. If one of the children suddenly had a significant
medical emergency and the custodial parent went to Denali KidCare,
the non-custodial parent could never be held accountable for any
costs because that parent had no insurance, which is the only
standard that can be applied. HCS SB 207(RLS) now allows the non-
custodial parent to meet that obligation with means other than
insurance. He added that the House's experience with Governor's
bills is that they have been drafted very narrowly. The
legislative legal team takes a broader view and looks at the bill's
affect on other statutes.
SENATOR TAYLOR asked if the bill contains an exemption for parents
of certain religious beliefs, such as a Christian Scientist.
CO-CHAIR GREEN noted that issue was brought up in a hearing about
long term care.
MS. LAUTERBACH thought that issue would arise when a child needs
health care, regardless of whether child support is involved. If
the health care is provided, an expense is incurred and both
parents are obligated to pay that expense. If the health care is
not provided because of a religious objection, then no expense will
be incurred. She asked why an exception should be included in HCS
SB 207(RLS).
SENATOR TAYLOR said he was thinking of a case in which one parent
is a Christian Scientist and the custodial parent is not.
MS. LAUTERBACH stated both parents are responsible for the child's
expenses.
SENATOR TAYLOR noted that even before an expense is incurred, a
court order will be issued and CSED will have all kinds of
authority including lien authority, withholding of wages authority,
etc.
MS. LAUTERBACH said she was confused to the extent that this is a
conference committee talking about two versions of a bill and the
issue of religious beliefs is outside of either bill.
SENATOR TAYLOR said a free conference committee just met that
morning and incorporated an issue outside of a bill.
CO-CHAIR GREEN asked if the subject of religious beliefs would be
part of the divorce decree.
SENATOR TAYLOR said it may but it may not. He thought it is
possible that one parent may insist on medical coverage while the
other does not believe in it.
MS. LAUTERBACH thought in that situation the parents would probably
go back to court and one parent would get custody because if the
parents cannot agree, the court will not award joint custody. She
added that once custody is imposed on one parent or the other, both
share the expenses.
SENATOR TAYLOR pointed out that this bill does not address who has
custody. It states that both parents are obligors. He thought if
the Legislature is going to impose this bill, it should contain an
escape valve for parents in that situation. He recounted the story
of a man from Wrangell who became frustrated because his union was
deducting money from his wages to be used for various purposes,
some of which violated his religious beliefs. He took that case to
the U.S. Supreme Court and the union was found to be in violation.
The court ruled that the employer was to deduct the same amount of
money but it was to be donated to the employee's church or another
charity. He thought this issue to be significant because the bill
could impose obligations that conflict with a person's religious
beliefs.
CO-CHAIR DYSON said, considering the late date in the session, if
this legislation does not pass, the same bad things will happen
with the added complications of the bogus financial support orders.
He assumes that when a court issues a medical support order or a
financial support order, a parent would make a case before the
court at that time if the order conflicts with the parent's
religious beliefs. If, indeed, a parent finds out later that his
or her money is being used to pay for medical services that the
parent is uncomfortable with, the parent would go back to court to
reconcile the issue.
SENATOR TAYLOR said CO-CHAIR DYSON is assuming the parent has the
money to go to court. He noted that 90 percent of these cases will
be handled administratively by CSED.
CO-CHAIR DYSON said the House strengthened SB 207 so that CSED,
through administrative procedures, can go beyond the court's
ruling.
SENATOR TAYLOR noted that the bill on long term care was amended to
provide for a very narrow exception for patients who do not want to
have certain treatments. He suggested the exception would be used
by very few people but an exception should be considered.
Number 564
CO-CHAIR GREEN suggested amending line 13 on page 7 (Section 7) so
that a parent could establish religious beliefs as good cause. She
said she believes there is a compelling reason to have everyone
involved in the rearing of a child involved in their general care.
She asked Ms. Lauterbach if the phrase "good cause" allows room for
an argument about religious beliefs. She also noted that just
because a parent has an objection to hospitalizing a child for
religious reasons, that parent could pay for other expenses
incurred.
SENATOR ELTON thought Senator Green was making a good argument. He
asked Ms. Lauterbach if she believes that a religious objection
could be adjudicated under the phrase, "unless there is good cause
to allocate the costs unequally."
MS. LAUTERBACH replied she believes this is an avenue that could be
used both with CSED or in court. She pointed out it goes both ways
because the other parent may have to pay charges for a Christian
Scientist practitioner.
TAPE 00-1, SIDE B
SENATOR TAYLOR said he is not certain that the previously mentioned
language is sufficient but he hopes it is. He added that he thinks
it is a good discussion to have on the record.
CO-CHAIR GREEN agreed.
CO-CHAIR DYSON asked if the conference committee has the authority
to amend HCS SB 207(RLS).
SENATOR TAYLOR answered not at this point.
CO-CHAIR DYSON noted the House HESS Committee was relatively
pleased with the work it did on SB 207 and believed it improved the
bill. He encouraged Senators to concur with those changes. He
stated if the Senators find a solution to the question of religious
beliefs and amend the bill on the Senate floor, he will encourage
House members to support that change.
REPRESENTATIVE COGHILL informed Senators that House members started
from the absurd and worked their way through the problem of having
medical support orders when needed. Through the discussion, it
came out that the IHS is the last payer of resort, Denali KidCare
or Medicaid is the next payer, and the first payer is the parent
obligor. The House tried to broaden the bill to get as close as it
could to requiring that private insurance be applied when there is
a need. House members were satisfied that this bill goes in that
direction. He questioned how Section 2(b)(2) on page 2, lines 21
and 22, applies to the employer.
MS. LAUTERBACH replied that Section 2 provides a defense to a
person who is being prosecuted under Section 1(a) and it contains
two defenses: paragraphs (1) and (2). The defendant could prove
that he or she did not intend to assist in the nonpayment of
support.
CO-CHAIR GREEN asked if the word "defendant" could be replaced by
the word "employer."
MS. LAUTERBACH thought that relates more to Section 1(a)(2)(C),
which pertains to an arrangement with the obligor to sell something
at less than fair market value. The defense would be that the
obligor might have sold something at less than fair market value
but did not intend to avoid paying child support by doing so.
REPRESENTATIVE COGHILL asked if a person could be held criminally
negligent if he or she did not have health care coverage.
CO-CHAIR GREEN asked if he is implying one is able to pay.
MS. LAUTERBACH clarified that nothing in the bill requires anyone
to have insurance that is not available to them through their
employer.
REPRESENTATIVE COGHILL said the scenario of a person who is
independently wealthy but has no health insurance came up in the
House HESS Committee.
MS. LAUTERBACH said subsection (C) on page 2, lines 6-14, talks
about selling things for less than fair market value, not about a
general situation of not paying. It is specific to a scheme to get
out of paying child support. She added if a person did sell
something at less than fair market value and still paid child
support and health care coverage, no criminal charges would apply.
SENATOR TAYLOR referred to a previous statement about first, second
and third payers of choice and asked for clarification.
CO-CHAIR GREEN said she did not think anything was set up in this
bill to that affect, she thought that is just the way it is.
Number 524
SENATOR TAYLOR cautioned that this bill may be moving a lot of
people on to Denali KidCare or on to Medicaid so they will no
longer qualify for IHS benefits.
MS. LAUTERBACH explained that language on page 6, Section 7, lines
29-31, speaks to that issue and reads, "The court or agency shall
consider whether the child is eligible for services through Indian
Health Service or other insurance before ordering either parent to
provide health coverage through insurance or other means."
REPRESENTATIVE COGHILL noted that House HESS Committee members were
told that IHS is the payer of last resort when it comes to
Medicaid.
REPRESENTATIVE BRICE pointed out that IHS is only available to
Natives. He understood that the State would look at IHS as being
the primary payer of resort and Medicaid the last.
CO-CHAIR GREEN asked a representative of Denali KidCare to explain
the rank of the payers.
MR. KEVIN HENDERSON, Division of Medical Assistance, DHSS,
explained that under federal law, Medicaid is the payer of last
resort with the exception of IHS. But, in all regular Medicaid
claims, Medicaid requires private insurance carriers to pay first.
CO-CHAIR GREEN asked if he is using the term "Medicaid"
interchangeably with Denali KidCare.
MR. HENDERSON said yes. He clarified that Denali KidCare is a new
coat on a Medicaid expansion that was authorized under federal law
and the State receives enhanced federal matching funds. While
Denali KidCare was an impetus behind HCS SB 207(RLS), the bill
applies to all Medicaid recipients.
REPRESENTATIVE COGHILL said that point needs clarification because
there was some confusion in the House HESS Committee about whether
the parent was initially expected to pay first or whether Medicaid
was expected to pay first.
CO-CHAIR GREEN asked Mr. Henderson to give the committee the
"pecking order" of how medical obligations are fulfilled.
MR. HENDERSON explained that if a child receives medical care and
is Medicaid eligible, Medicaid will not pay on the claim if private
health insurance is available.
CO-CHAIR GREEN asked Representative Coghill to repeat his question.
REPRESENTATIVE COGHILL read the following from page 6, lines 29
through 31, "The court or agency shall consider whether the child
is eligible for services through the Indian Health Service or other
insurance coverage," and said he was questioning whether the "other
insurance coverage" means first the parent and then Medicaid if
there is indigence or whether it is the other way around.
MR. HENDERSON replied it is not Medicaid. He thought where this
bill refers to the IHS and other insurance, it is talking about
establishing a medical support order which is different. When a
medical support order is established, CSED will look at whether IHS
coverage is available or whether private health insurance coverage
is available. If either is available, CSED is probably not going
to pursue a medical support order.
CO-CHAIR DYSON noted that nothing in the bill occurs unless someone
applies for Medicaid - that is the triggering event. If a person
does apply, DHSS cannot offer Denali KidCare without a medical
support order. When CSED does the medical support order, it will
first see if the applicant qualifies for IHS and, if not, it will
determine whether private insurance is available. If the bill
passes, CSED will also determine whether either parent is capable
of paying the cost out of pocket. The House HESS Committee
inserted language so that before a child qualifies for Medicaid,
CSED must see whether a parent is capable of paying the medical
costs out of pocket.
MR. HENDERSON said that is generally accurate but, when CSED is
deciding whether to establish a medical support order, it will look
at whether the child is already covered by private health
insurance. If so, CSED will not bother with a medical support
order.
SENATOR TAYLOR pointed out that lines 25 and 26 on page 6 read,
"Regardless of whether a support order for periodic payments is
issued, the court or agency shall issue a medical support order."
He noted this is not only triggered when a person applies for
Medicaid.
MS. LAUTERBACH stated that Section 7 applies to any child, whether
on Medicaid or not. Section 7 allows any child to have either a
medical support order or a periodic financial payment support
order, or both. It allows CSED and the court to split those two
concepts for any child, not just one on welfare.
SENATOR TAYLOR remarked Section 7 applies to every court proceeding
involving divorce and custody.
MS. LAUTERBACH added, "Where the support of a minor child is at
issue."
SENATOR TAYLOR stated that this bill will require the court or
agency to establish a medical support order for every child in
every divorce or dissolution case, regardless of whether a
financial support order is issued.
MS. LAUTERBACH pointed out that current law requires the court to
issue a medical support order. The whole purpose of SB 207 is to
allow a medical support order to be issued separately from a
financial support order.
SENATOR TAYLOR stated the court will be required to consider
whether services are available through IHS. He said he can
guarantee that there are a lot of children eligible for IHS whose
parents choose to use Denali KidCare instead.
MR. HENDERSON agreed and said federal rules allow a person the
freedom of choice of providers. The person can choose to use a
private provider and have Denali KidCare or Medicaid cover the
cost.
SENATOR TAYLOR said he has a problem with a person choosing State
coverage, which the State has to pay for, when the person has IHS
coverage, which is covered by the federal government.
CO-CHAIR GREEN asked if the Legislature has the ability to change
that since it is a federal provision.
REPRESENTATIVE BRICE said his understanding is that the IHS does
not have a program similar to Denali KidCare. He thought, however,
the State was reimbursed by IHS for providing services to IHS
eligible patients.
MR. HENDERSON said he believes that is true but he is not an expert
in that area.
SENATOR TAYLOR asked how one would know. He asked if the Medicaid
application asks for a racial designation so that a determination
can be made.
MR. HENDERSON replied the applicants are only asked if they are IHS
eligible.
SENATOR TAYLOR asked if once applicants say they are IHS qualified,
all of their bills are sent to IHS. He pointed out he finds this
significant because HCS SB 207(RLS) will allow support orders to
demand parents to provide coverage through their workplace and
meanwhile the whole family might be covered by IHS.
MS. DEAN emphasized that CSED requires parents to take medical
insurance if it is available at a reasonable cost. That is what
this bill would do. There is also a place on the DR 300 where
parents can check whether they have other health coverage, such as
IHS, when getting a divorce. If a parent has IHS coverage, CSED
considers the DR 300 to be the medical support order.
CO-CHAIR GREEN asked if a person gave false information about being
IHS eligible, whether CSED would consider that fraud.
MS. DEAN thought that would be turned over to CSED investigators.
She pointed out that CSED only gets involved when a parent applies
for CSED services or when a child receives Medicaid.
SENATOR TAYLOR said his only thought is that each time a divorce
proceeding occurs, judges now have to be attuned to the Supreme
Court decision on which tribe is turned to regarding which person
the judge can grant custody to. He noted he always worked with
Tlingit and Haida and never had any problems because they always
did what was best for the child but he does not think that is long
lived.
MS. DEAN replied CSED would consider IHS as medical coverage or a
parent could provide double coverage.
The committee took a brief at-ease from 5:30 to 5:31 p.m.
SENATOR TAYLOR recommended that HCS SB 207(RLS) be moved back to
the Senate floor for action. There being no objection, it was so
ordered.
There being no further business to come before the committee, CO-
CHAIR GREEN adjourned the meeting at 5:32 p.m.
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