Legislature(1997 - 1998)
04/15/1998 09:07 AM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
April 15, 1998
9:07 a.m.
MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice-Chairman
Senator Lyda Green
Senator Jerry Ward
Senator Johnny Ellis
MEMBERS ABSENT
None
COMMITTEE CALENDAR
SENATE BILL NO. 266
"An Act relating to Medicaid coverage for certain eligible children
and pregnant women; relating to primary care case management and
managed care services as optional services and to premiums and
cost-sharing contributions under the Medicaid program; establishing
the Healthy Families Alaska program; and providing for an effective
date."
HEARD AND HELD
CS FOR HOUSE BILL NO. 459(FIN) am
"An Act establishing new eligibility for medical assistance for
certain disabled persons and giving their eligibility for services
the highest priority among optional services and groups under the
medical assistance program; amending the definition of 'personal
care services in a recipient's home' as used in the medical
assistance program; moving midwife services from being the first to
being the 14th service eliminated under the medical assistance
program when there is insufficient funding; and adjusting the
priority of optional services and optional eligible groups under
the medical assistance program in order to reflect the new
priorities given to the newly-eligible disabled persons and to
midwife services but without otherwise changing the relative order
of the other optional services and optional groups."
PASSED CSHB 459(HES) FROM COMMITTEE
PREVIOUS SENATE COMMITTEE ACTION
SB 266 - See HESS minutes dated 4/8/98.
HB 459 - No previous Senate committee action.
WITNESS REGISTER
Jay Livey
Deputy Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Discussed and supports SB 266
Karen Pearson
Health Programs Manager
Division of Public Health
Department of Health and Social Services
P.O. Box 110610
Juneau, Alaska 99811-0610
POSITION STATEMENT: Discussed and supports SB 266
Margo Waring
Alaska Mental Health Trust Board
431 N. Franklin St.
Juneau, Alaska 99801
POSITION STATEMENT: Supports SB 266 and HB 459
Tana Bulkley
2753 John Street
Juneau, Alaska 99801
POSITION STATEMENT: Supports SB 266
Kim Champney
Division of Public Health
Department of Health and Social Services
P.O. Box 110610
Juneau, Alaska 99801-1610
POSITION STATEMENT: Supports SB 266
Representative Con Bunde
Alaska State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Sponsor of HB 459
Patti Swenson
Staff to Representative Con Bunde
Alaska State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Answered questions regarding HB 459
Robert Briggs
Disability Law Center
230 South Franklin, Suite 209
Juneau, Alaska 99801
POSITION STATEMENT: Discussed the proposed amendment and supports
HB 459
Ronnie Rosenburg
Arctic Alliance for People
448 Snow Owl Lane
Fairbanks, Alaska 99712
POSITION STATEMENT: Supports HB 459
ACTION NARRATIVE
TAPE 98-34, SIDE A
Number 001
CHAIRMAN WILKEN called the Senate Health, Education and Social
Services (HESS) Committee to order at 9:07 a.m. Present were
Senators Green, Leman, Ellis, and Chairman Wilken. The order of
business before the committee was the completion of the
presentation on SB 266, and then the presentation on HB 459.
SB 266 - MEDICAID COVER/HEALTHY FAMILIES AK PROGRAM
CHAIRMAN WILKEN asked Jay Livey to continue the presentation on SB
266, beginning with page 4, Chapter 19 (Section 9).
JAY LIVEY, Deputy Commissioner of the Department of Health and
Social Services (DHSS), asked Karen Pearson to address the section
on the Healthy Families Alaska Program.
KAREN PEARSON, Division of Public Health, DHSS, stated Chapter 19
contains two parts. The first part establishes the Healthy
Families Alaska Program in statute and describes the program's
operations.
SENATOR GREEN asked if the Healthy Families Alaska Program has been
a one year program in the past.
MS. PEARSON responded the program has existed through
appropriations.
MS. PEARSON explained the Healthy Families Alaska Program has one
main goal: to prevent child abuse and neglect. DHSS knows that
most families function at the level they can and nurture and care
for their children, but some families have certain stresses that
place them at risk for abuse and neglect. Healthy Families, in the
geographic areas that it serves, screens families for those risk
factors. If a family chooses to accept services from the Healthy
Families Program, a worker will discuss with the client the
stresses that can lead to abuse and neglect, such as substance
abuse, domestic violence in the home, a history of abuse of any
kind in the family, and/or financial stresses. If the family
chooses to enroll in the program, the family determines its goals
and what services and assistance it needs from Healthy Families.
Services available include assistance in getting substance abuse
treatment, counseling, access to housing services, or a number of
other things. Healthy Families Program workers simultaneously
teach families appropriate expectations for young children so that
parents use appropriate child rearing techniques. The program is
geared to the individual family's needs and to help the family
develop skills and abilities to deal with crises. The program is
available to pregnant women and parents of newborns (AS 47.19.030)
who can receive services for up to three to five years. Research
has shown that lasting outcomes do not occur when programs are
designed to help families deal with an immediate crisis. Families
need help dealing with several crises until they develop their own
coping mechanisms.
MS. PEARSON explained Section 47.19.040 describes the duties of
DHSS. It ensures that local agencies get the training and support
they need to run a good program. The program is based on service
delivery by paraprofessionals with the belief that people respond
better to a worker who has the same experiences and cultural
background. The most important characteristics of paraprofessionals
are empathy and support. The paraprofessionals do not provide
specialty counseling; they help the family access the professionals
they need. This section also requires DHSS to establish screening
and evaluation methods, and to ensure that all service providers
work together to prevent duplication of services, to deal with
problem resolution within the program, and to monitor and evaluate
services for the sake of accountability. Section 47.19.050
pertains to the individualized support plan in which the family
sets its own goals. The plan is reviewed and updated with the
family on an ongoing basis. Section 47.19.900 addresses
confidentiality and mandates that no records on any individual
family ever be released. The only types of data that would be
compiled by the program are aggregate numbers.
Number 167
SENATOR GREEN asked if any place already exists where a person can
receive the same services, in whole or in part, as those offered by
the Healthy Families Alaska Program.
MS. PEARSON replied some similar programs exist. The Head Start
Program is a home-visit based program that provides services to
children ages birth to three but its focus is on child development
and school readiness. Other programs exist but use a different
approach. The Healthy Families Alaska Program is specific to child
abuse and neglect prevention. Head Start provides services to
clients who are low income. The Healthy Families Program is not
income based.
SENATOR LEMAN asked whether the confidentiality section provisions
would preclude a court order to provide records.
MS. PEARSON said it would not.
SENATOR LEMAN asked if existing DHSS regulation provides for that
exception.
MS. PEARSON said it does.
Number 200
SENATOR GREEN asked if churches and synagogues are considered to be
culturally appropriate and community based, and could provide
services according to the language on page 5, lines 12 - 15.
MS. PEARSON stated if Senator Green was questioning whether DHSS
could give a grant to a church or synagogue to provide services,
she could not answer at this time. She pointed out that several
churches and synagogues have been involved because they are
partnered with local agencies.
DEPUTY COMMISSIONER LIVEY stated that DHSS does have the ability to
give grants to religiously affiliated organizations because it
already gives grants to Catholic Community Services in Juneau to
provide various kinds of social services.
SENATOR GREEN commented that churches were included, in the welfare
reform legislation, as entities to provide services in places where
no other agencies existed. She noted she would like to see
religious organizations included in this bill as well.
DEPUTY COMMISSIONER LIVEY responded that DHSS might be constrained
by the requirement that the organization receiving the grant must
be an organized, non-profit, social service organization.
SENATOR GREEN asked Mr. Livey to develop language to provide for
that ability.
Number 236
CHAIRMAN WILKEN asked for information about the Healthy Families
Programs in operation today.
MS. PEARSON informed committee members that eight local agencies
are operating in Alaska today. Seven of the programs are delivered
through local agencies, the Kenai program is operated by DHSS
staff. The Juneau program is administered through Catholic
Community Services; DHSS funds one staff person in the Southcentral
Foundation; there is a program in the Mountainview community of
Anchorage, the Mat-Su Valley, Fairbanks; a program in the Bristol
Bay area which combines funding with the ICWA program and provides
services in some of the villages; and a program in Bethel.
CHAIRMAN WILKEN asked the amount of the program's funding.
MS. PEARSON replied the amount is $1.4 in grant monies, and about
$270,000 for running the Kenai program.
CHAIRMAN WILKEN asked if the program leverages any federal money.
MS. PEARSON responded it does, but not in terms of the local
agencies, except for the Southcentral Foundation. That foundation
has a federal grant from the Maternal Child Health Bureau.
Number 261
DEPUTY COMMISSIONER LIVEY made the following remarks about SB 266.
DHSS's major focus in SB 266 is to ensure that children have good
health care. The bill expands medicaid coverage for children whose
family's income is up to 200 percent of the poverty level, and
maintains the expansion for pregnant women at that same poverty
level. DHSS believes that expanding health care coverage to 200
percent of the poverty level will complement the welfare reform
program because a lot of welfare recipients returning to the work
force will not have health care coverage. DHSS does not want
people to quit jobs and apply for public assistance to get medicaid
coverage for their children. By providing this program through a
medicaid expansion, more federal money will be leveraged. SB 266
is a relatively inexpensive investment on behalf of the state in
order to receive a lot of federal money. That money will help to
build a health care infrastructure in rural Alaska. Deputy
Commissioner Livey reminded committee members that something needs
to be done this year or the state will lose its federal allotment
of $5.6 million. DHSS believes this program is a good investment
in terms of the benefits it will provide in the future.
SENATOR GREEN asked what amount 200 percent of the poverty level
equals.
DEPUTY COMMISSIONER LIVEY replied for a family of three, the level
of income would be about $33,000 per year, or about $16 per hour.
Number 297
SENATOR GREEN asked if any thought has been given to using the same
income guidelines in the eligibility requirements for all programs
so that children at age 17 would be eligible at the same income
level as children at age 7.
DEPUTY COMMISSIONER LIVEY stated that approach makes sense because
under the current guidelines, a 14 year in a family might not be
covered by medicaid while a younger sibling is. Those eligibility
requirements are complicated for the families and for program
staff. DHSS wants all programs to set the eligibility requirement
at 200 percent of the poverty level, regardless of the child's age.
SENATOR GREEN asked if DHSS has determined the number of people who
will be eligible at the 200 percent level, 175 percent level, 150
percent level, etc., and whether using the 200 percent income
guideline will increase the number of eligible applicants to the
point to where services cannot be provided to all.
DEPUTY COMMISSIONER LIVEY explained that at the 133 percent level,
DHSS could serve about 1600 additional children and no additional
pregnant women because that group is already being served at that
level. At the 200 percent level, DHSS could serve an additional
4,000 children and 781 pregnant women. At that level, DHSS
estimates that coverage could be provided at a cost of $4 million
in general funds which would leverage about $11 million in federal
funds.
Number 315
SENATOR GREEN questioned whether DHSS would eliminate some of its
current programs because they will no longer be necessary and
whether an overall reduction in costs might occur.
DEPUTY COMMISSIONER LIVEY said the different programs are really
parts of one program. The difference between them is the level of
coverage a person qualifies for depending on his/her income. DHSS
would wipe out the different income levels for eligibility
determination and use one level.
BOB LABBE, Division of Medical Assistance, DHSS, added that the
current levels are the federal required minimum levels that all
states must have. One of DHSS's goals is to have a common standard
which will require a statutory change. DHSS believes that the 200
percent level is the most advantageous to maximize federal funds
because Alaska's population is not that large. If any lower level
is used, the state will not be taking full advantage of the federal
block grant. He noted he provided an analysis of the numbers to
Senator Parnell.
Number 360
SENATOR GREEN questioned whether it is possible that this program
will provide a disincentive to employers to provide health care
coverage for employees.
DEPUTY COMMISSIONER LIVEY replied that the question of how to
prevent employers who are currently providing coverage from
discontinuing that coverage has been considered by Congress and by
this Legislature. The Robert Wood Johnson Foundation has studied
other states who have established similar expansions. The
Foundation concluded that if the expansion deals primarily with
children then that kind of "crowd out" does not occur, nor does it
occur until eligibility includes people above the 200 percent of
poverty level. He noted DHSS has also looked at ways to put
barriers up to keep individuals from crossing over from employer
coverage to medicaid coverage.
CHAIRMAN WILKEN welcomed Senator Ward. He then informed committee
members that written testimony sent by people from Fairbanks had
been placed in committee packets.
Number 386
MARGO WARING, staff to the Alaska Mental Health Board, made the
following comments. The Board has spent a fair amount of time
discussing SB 266 and is very supportive of the expansion of
medicaid coverage for children and pregnant women. The Board hears
frequently, in discussions with parents, about the difficulty of
accessing mental health coverage for children, particularly for low
income families. The Board believes that access to early
intervention services provided through Medicaid could make
significant differences in the lives of children with emotional
disturbances. Whatever costs are incurred through medicaid will be
offset by preventing children from becoming involved with the state
juvenile justice and other systems later on. Regarding the Healthy
Families Program, the Board is cognizant of the importance of
identifying high risk families and providing them with needed
services. Reduction in the rates of abuse and neglect is essential
to any kind of prevention and early intervention strategy of
serious emotional disturbance in children later in their lives
because abuse and neglect are one of the strong environmental
factors that create serious emotional disturbances in children. SB
266 is a very cost effective intervention strategy because it
targets those at risk families. Intervention will occur at birth,
before children experience the traumas that can lead to later
psychiatric difficulties.
SENATOR GREEN asked whether the Alaska Mental Health Board has
given direct grants to the Healthy Families Program from the Mental
Health Trust.
MS. WARING stated she did not believe so but would defer to someone
else from the Trust for that answer.
Number 427
TANA BULKLEY, a Healthy Families Alaska Program client, gave the
following testimony. She is the mother of four children, ages 15,
13, 7, and a newborn. She was young when she had her first two
children and did not have much of a family support system. She
had a lot of trouble parenting at that young age, especially with
her daughter, who was neglected and has been in treatment for
several years. Ms. Bulkley was forced to do a lot of things on her
own with her first two children. She finished her GED and returned
to school in an attempt to succeed, but it was a struggle. She was
not aware of any help available until her children were four or
five years old. When her newborn was born, she was given a
questionnaire at the hospital that asked her whether she wanted
help through the Healthy Families Program. A worker comes to her
home, provides her with reading materials, and offers child
development tips. She emphasized the most important factor in the
success of the Healthy Families Program is that the worker comes to
the client's home, which is extremely important to mothers with
newborns and infants.
KIM CHAMPNEY stated she is completing her MSW by doing field work
with the Healthy Families Program in Juneau. She felt strongly
about coming to the hearing today because she has seen the impact
the program has had on families she has worked with. Ms. Bulkley
represents a group of parents who are not receiving home visiting
services because the program is full right now but her situation is
valuable to share because she has raised children with and without
aid from the Healthy Families Program. Had Ms. Bulkley received
services from the Healthy Families Program for her first two
children, she would have been matched with a home visitor who would
have helped her to identify her immediate needs such as adequate
housing, child care, job training or employment opportunities among
other things. Ms. Bulkley's daughter was involved in a serious
accident when she was 18 months old. Had a family support worker
been involved, the worker could have advocated for services such as
physical therapy or respite care. The family support worker would
have helped Ms. Bulkley learn effective parenting skills and the
support could have lasted until her children were five years old.
Her children entered the state system at about the age of five
which could have been avoided had Ms. Bulkley had help from a
family services worker. Ms. Bulkley's family is beating the odds
and pulling together which is what the program is about. Ms.
Champney stated it is important to establish the program in statute
so that it can be implemented statewide in a uniform manner and be
accountable to the public.
CHAIRMAN WILKEN noted no one else was present to testify on SB 266.
He informed committee members that a companion bill, HB 369, is
moving through the House and he planned to see how the committee
can help the efforts of that bill, or vice versa.
HB 459 - MEDICAID FOR LOW-INCOME DISABLED
REPRESENTATIVE CON BUNDE, sponsor of HB 459, stated he introduced
the measure in an effort to resolve a "catch-22" situation. HB 459
pertains to people with disabilities who want to go to work for
various reasons, but cannot because the jobs for which they are
skilled do not pay enough money in the first year or two of
reemployment to cover the costs of their medication nor do they
offer affordable health insurance. The only way the disabled
worker can get assistance to pay for medication is to quite working
to get public assistance and medicaid. HB 459 simply allows people
who want to transition back to work to buy into medicaid on a
sliding scale so that they have health care coverage until they
progress in their careers to a point to where they make enough
money to pay for their medications.
CHAIRMAN WILKEN asked Robert Briggs of the Disability Law Center to
join the committee members at the table. He noted the committee
previously heard SB 253, which is similar to HB 459. During that
hearing, Senator Leman brought up the issue of a sliding fee scale.
Tab number one, in committee packets, is a response to that issue.
and tab number two is a response to Senator Green's questions
regarding the definition of the word "disability."
Number 570
ROBERT BRIGGS, Disability Law Center attorney, stated four issues
were raised by committee members during the last hearing on the
working draft adopted in lieu of SB 253. The first was in regard
to whether a transition provision should be adopted. He urged
committee members to leave the language in the bill as is, because
the one year transition period will involve insignificant costs.
He believes DHSS should be given the discretion to establish a
transition provision by written policy; a policy that does not have
to go through the notice and comment rule making, but something
that DHSS will be required to adhere to. If the committee wants
DHSS to charge a premium during the transition period while DHSS is
adopting formal regulations, he prepared an amendment. He believed
the amendment is fair and will adequately address the committee's
concern that DHSS not provide a benefit without some contribution
from those who take advantage of it.
MR. BRIGGS said turning to the issue of the definition of
"disability," he believes it is adequately defined in the context
of the present bill which specifically makes this benefit available
only to those eligible for supplemental security benefits under 42
USC 1381-1383(c). "Disability" is further defined in two letters
from the Health Care Financing Administration, the agency
instrumental in the adoption of Section 4733 of the Balanced Budget
Act of 1997. That Act initially provided this Medicaid option to
the state. The two letters clearly define that a person, to be
eligible for this benefit, must meet the disability criteria to be
eligible for supplemental security income under present regulations
and statutes. The criteria require the person to have a physical
or mental impairment severe enough to meet a listing, or a
combination of impairments of equivalent severity under Appendix 1
of Subpart (p) of 20 CFR, Part 404, or he/she must have medical
limitations that prevent conduct of past relevant work under what
is familiarly known as the "grids" located at Appendix 2 of Subpart
(p) of 20 CFR, Part 404. Not only do they have to meet that
initial eligibility criterion, but their medical condition must
have a continuing limitation on their abilities over time. He
explained that the eligibility definition for benefits under the
supplemental security standard is different from, and more
restrictive than, the definition of "disability" under the
Americans with Disabilities Act.
TAPE 98-34, SIDE B
Number 561
SENATOR GREEN noted Mr. Briggs gave her an enlightening explanation
of the definition of "disability" prior to the meeting so she will
not be offering an amendment.
MR. BRIGGS explained the third issue raised by the committee was
the definition of personal care attendant services. The current
language accomplishes the goal of streamlining medicaid costs in
permitting PCA services delivered in the work place and other
settings that will expand the population of disabled people who are
able to return to work. The House considered this matter and urges
the Senate to maintain this provision.
MR. BRIGGS stated the fourth issue pertained to the adequacy of the
representation of program expenses in the fiscal note. In his
April 3 letter, he explained that the fiscal notes show cumulative
projected savings, but not cumulative projected expenses. He
believes the projections are based on appropriate assumptions but
felt DHSS should address the assumptions. He agreed with
Representative Bunde that a common refrain within the disability
community is that access to health care is one of the biggest
obstacles to reemployment, and that when people enter the
workforce, they often enter a track that eventually leads to a
better job with health care benefits. It is hoped that HB 459 will
provide a bridge for people with disabilities, people who want to
become self reliant.
SENATOR GREEN asked if the "crowd out" scenario, discussed in
relation to SB 266, might apply to HB 459.
MR. BRIGGS asked Senator Green what she meant by the phrase "crowd
out."
SENATOR GREEN stated a "crowd out" would occur if an employer stops
offering health care coverage to an employee because that employee
receives health care coverage under Medicaid.
MR. BRIGGS maintained he does not think HB 459 will provide a
disincentive because this bill applies to a population of people
who find it very difficult to get insurance through the private
sector.
Number 528
MS. RONNIE ROSENBURG, representing the Arctic Alliance for People,
a non-profit consortium of 45 non-profit agencies and individuals
who serve low-income people and people with disabilities, gave the
following testimony via teleconference from Fairbanks. The Arctic
Alliance submitted a resolution to interior delegation legislators
in support of HB 459. Because the committee substitute is similar
to the original bill she felt sure the Alliance membership would
support it. She urged the committee to retain the supplemental
security income definition of "disability" because a considerable
body of law and understanding exists among people in the field as
to what SSI disability is. Changing the definition will only cause
confusion and appeals. As the case management director of the
Fairbanks Resource Agency for over two years, she had to inform
many high functioning clients with development disabilities that
they would lose their Medicaid benefits if they became employed and
she had to advise them to decline the job offer. Some clients were
able to get full-time jobs with health benefits, but many clients
are not medically able to work a 40 hour work week. HB 459 will
enable those people to work to their maximum potential. The same
dilemma occurred for welfare recipients: if they went to work, they
often lost the only health care coverage available to them through
Medicaid. Ms. Rosenburg emphasized the need for this bill and
urged committee members to support HB 459.
CHAIRMAN WILKEN thanked Ms. Rosenburg for her work with Arctic
Alliance. He commented Arctic Alliance is a wonderful organization
that should be mirrored around the state. CHAIRMAN WILKEN noted
Mr. Sherwood and Mr. Kreher from DHSS were present and available to
answer any questions committee members may have.
Number 490
MARGO WARING, representing the Alaska Mental Health Board, stated
the Board strongly supports HB 459. Many people with mental
illnesses have discussed with the Board their desire to work and be
self-reliant, but their inability to do so because of a lack of
insurance options. A whole new generation of psychotropic
medications is available that enable people to function on much
higher levels than previously, however those medications are
extremely expensive. Many people find themselves capable of taking
on work, but are unable to do so because they will be unable to
afford the medications that enable them to work if they no longer
receive Medicaid. In addition, some people are working at jobs
that do not provide insurance so that when they become ill, they
are forced to quit to become eligible for Medicaid to get
medication. People who want to work and make a contribution should
be able to do so. HB 459 will allow that to happen.
CHAIRMAN WILKEN thanked Mr. Briggs for his letter and help on the
bill. He noted Senator Leman prepared a proposed amendment
regarding the sliding fee scale.
SENATOR LEMAN moved to adopt the proposed amendment and then
objected for the purpose of making a statement.
SENATOR LEMAN explained the amendment will provide for a small co-
payment to keep costs down. He stated he likes the formula, but
suggested DHSS might want to review and adjust the numbers,
especially at the upper income end, for the long term. He felt the
formula is a big step in the right direction for use during the
transition period. He thanked Mr. Briggs for working on the
concept. Senator Leman then removed his objection to the motion.
SENATOR ELLIS asked if the formula pertains to a sliding scale co-
pay.
SENATOR LEMAN said yes, and explained that the maximum co-pay
amount is ten percent. He noted he wanted the co-pay amount to be
small enough so as not to discourage the program from functioning,
but large enough to act as a deterrent to unnecessary services.
MR. BRIGGS clarified the initial idea was to use a sliding scale
based on a percentage of income. The maximum premium cost would be
ten percent of income at the maximum eligibility level of 250
percent of the poverty line, and the minimum premium would be zero
when a person's income is at 100 percent of the family line. The
premium only buys coverage for the disabled person so a disabled
person in a family of four will not pay significantly more than a
disabled person living alone. This formula is a function of family
size and family income however the premium should not encourage
people to expand their definition of family to get the benefit at
a lower cost. Mr. Briggs felt his best effort at achieving that
goal in the formula is incomplete, and that DHSS's final
regulations should address Senator Leman's concerns more
thoroughly. He stated he appreciates the generosity of the
committee in accepting the formula in its imperfection, and he
believes most people do want to contribute and that this co-pay
formula will cost buyers a lot less than paying their own medical
expenses.
Number 411
SENATOR LEMAN said he thinks the formula is a good first shot, but
at the upper end the premium starts going the other way which is
something that should be looked at later. He noted it is unlikely
that many families of seven or eight members will be affected.
SENATOR ELLIS questioned the ramifications of adopting into statute
this first shot at the formula. He stated he supports the concept
but asked if the language is specific to the mathematical formula
and not more general language to allow DHSS to take a second shot
at the formula.
SENATOR LEMAN replied that DHSS will work on the formula and that
this amendment only applies to the transition period.
SENATOR ELLIS asked for clarification.
SENATOR LEMAN clarified the formula will apply until regulations
are adopted by DHSS, which should occur within one to two years.
Without the amendment, the co-payment would be zero.
SENATOR ELLIS asked where that specific language is contained in
the bill.
SENATOR LEMAN answered on page 4, lines 14-18.
Number 387
SENATOR ELLIS asked if this mathematical formula for sliding scale
co-pays would be in use for a few years only.
SENATOR LEMAN clarified it would be used temporarily.
SENATOR ELLIS asked how serious the effect would be on disabled
people in larger family groups.
MR. BRIGGS referred to his April 3 letter and clarified that the
initial proposal was to have a sliding fee scale with a single line
which did not take into consideration family size. That meant any
individual eligible for this benefit would pay a fixed percentage
depending on his/her income. Paying ten percent of the income of
a person in a family of four would be a lot more difficult for that
family than it would be for a single person paying ten percent of
his/her income.
SENATOR ELLIS asked Mr. Briggs about his comment that the formula
does not completely adjust for family size.
MR. BRIGGS stated the defect in the formula is that the lines are
parallel on the graph. Ideally, the lines should all converge on
a single point at 100, which is something DHSS can work out if it
adopts this formula as a permanent approach. DHSS has a July 1,
1999 deadline to establish regulations. Mr. Briggs said if this
temporary formula does not work in practice because it is too
restrictive or does not provide enough income to the program, DHSS
will have the discretion to adjust the sliding fee scale
appropriately. He noted he is advocating this formula if it is the
will of the committee to adopt some sliding fee scale for the
transition period. He indicated he does not think the formula is
as generous as having no sliding fee scale at all during the
transition period, which is how the bill reads now.
SENATOR ELLIS asked Mr. Briggs if the proposed amendment accurately
reflects his proposal.
MR. BRIGGS indicated he drafted an amendment that he included with
his letter of April 3. He stated he has not read the amendment
proposed by Senator Leman, but if it is the same as the one he
submitted on April 3, he supports it. His amendment basically
required that the premium be calculated as a percentage of net
income of the person's family according to the mathematical
formula.
CHAIRMAN WILKEN noted the proposed amendment is a verbatim copy of
Mr. Briggs' suggested language.
SENATOR ELLIS maintained he agrees with the concept of the proposed
amendment but plans to vote against it because it is too
speculative at this time.
The motion to adopt the proposed amendment carried with Senators
Leman, Green, and Wilken voting for its adoption, and Senator Ellis
voting against it.
SENATOR LEMAN moved SCSHB 459(HES) to its next committee of
referral with individual recommendations and accompanying fiscal
notes. There being no objection, the motion carried.
There being no further business to come before the committee,
CHAIRMAN WILKEN adjourned the meeting at 10:15 a.m.
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