02/09/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB13 | |
| SB87 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 13 | TELECONFERENCED | |
| *+ | SB 87 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 9, 2009
1:34 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Johnny Ellis
Senator Joe Thomas
MEMBERS ABSENT
Senator Fred Dyson
COMMITTEE CALENDAR
SENATE BILL NO. 13
"An Act relating to eligibility requirements for medical
assistance for certain children and pregnant women; and
providing for an effective date."
MOVED SB 13 OUT OF COMMITTEE
SENATE BILL NO. 87
"An Act expanding medical assistance coverage for eligible
children and pregnant women; relating to cost sharing for
certain recipients of medical assistance; and providing for an
effective date."
MOVED SB 87 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 13
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY
SPONSOR(s): SENATOR(s) DAVIS
01/21/09 (S) PREFILE RELEASED 1/9/09
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, FIN
02/09/09 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 87
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY
SPONSOR(s): SENATOR(s) WIELECHOWSKI
01/28/09 (S) READ THE FIRST TIME - REFERRALS
01/28/09 (S) HSS, FIN
02/09/09 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
TOM OBERMEYER, aid
to Senator Bettye Davis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Introduced SB 13 for the sponsor.
GEORGE BROWN M.D., representing himself
Douglas AK
POSITION STATEMENT: Supported both SB 13 and SB 87.
ROD BETIT, President
Alaska State Hospital and Nursing Home Association (ASHNHA)
Juneau, AK
POSITION STATEMENT: Supported both SB 13 and SB 87.
NANCY ST. JOHN-SMITH
Peninsula Community Health Services
Kenai, AK
POSITION STATEMENT: Supported SB 13.
JODYNE BUTTO M.D., President
Alaska Chapter, American Academy of Pediatrics
Anchorage, AK
POSITION STATEMENT: Supported both SB 13 and SB 87.
DONNA GRAHAM
Anchorage Faith and Action Congregations Together (AFACT)
Anchorage, AK
POSITION STATEMENT: Supported both SB 13 and SB 87.
JORDEN NIGRO, Residential Director
Juneau Youth Services
President, Alaska Homes for Children (AHFC)
Juneau, AK
POSITION STATEMENT: Supported both SB 13 and SB 87.
LAVERNE DEMIENTIEFF, President
National Association of Social Workers (NASW), Alaska Chapter
Clinical Assistant Professor, University of Alaska Fairbanks
POSITION STATEMENT: Supported both SB 13 and SB 87.
JON SHERWOOD, Medical Assistant Administrator
Department of Health and Social Services (DHSS)
Juneau, AK
POSITION STATEMENT: Answered questions about the fiscal note for
SB 87.
SENATOR BILL WIELECHOWSKI
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SB 87.
MICHELLE SYDEMAN, aide
to Senator Bill Wielechowski
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Explained SB 87.
JERRY FULLER, Project Director
Medical Assistance Administration
Department of Health and Social Services
Anchorage, AK
POSITION STATEMENT: Answered questions about the
administration's position on SCHIP.
ELLIE FITJARRALD, Director
Division of Public Assistance
Department of Health and Social Services
POSITION STATEMENT: Answered questions about the fiscal note for
SB 87.
MARTHA KING, Group Director
National Conference of State Legislatures (NCSL)
Denver, CO
POSITION STATEMENT: Answered questions about what other states
are doing in this area.
JENNIFER SAUNDERS
National Conference of State Legislatures
Denver, CO
POSITION STATEMENT: Answered questions about what other states
are doing in this area.
ACTION NARRATIVE
1:34:46 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:34 p.m. Present at the
call to order were Senators Paskvan, Ellis, Thomas and Davis.
SB 13-MEDICAL ASSISTANCE ELIGIBILITY
CHAIR DAVIS announced consideration of SB 13.
1:35:57 PM
TOM OBERMEYER, aid to Senator Davis, introduced SB 13, saying it
increases and restores the qualifying income eligibility
standard for the Denali Kid Care program to the original levels
at 200 percent of the FPL guideline and makes health insurance
accessible to an estimated 1300 more uninsured children and 225
pregnant women in Alaska.
Denali Kid Care is an enhanced reimbursement program with up to
70 percent matching funds under the federal government's State
Children's Health Insurance Program (SCHIP), which was created
in 1997. Congress reauthorized the SCHIP program for five years;
on February 4, 2009 President Obama signed a law expanding
coverage to four million more children.
Alaska is only one of five states that fund SCHIP below the 200
percent guideline.
The Kaiser Commission on Medicaid and the Uninsured provided the
following information in January of 2009: 44 states including
Washington D.C. cover children and families with incomes of 200
percent of the FPL or higher; 33 states cover children and
families with incomes between 200 and 250 percent of the FPL; 19
states including D.C. cover children and families with incomes
of 250 percent or higher and 10 of those states cover children
and families with incomes of 300 percent of FPL or higher; 35
states allow premiums, enrollment fees or co-payments on a
sliding scale for selected services in the SCHIP programs.
MR. OBERMEYER continued; Denali Kid Care serves an estimated
7900 Alaska Children and remains one of the least costly medical
assistance programs in the state at approximately $1700 per
child for full coverage including dental, which is about 20
percent of the cost of adult senior coverage. Early intervention
and preventive care under SB 13 will greatly increase the health
of Alaska's children and yield substantial savings to the state
in public and private sector hospital emergency rooms, which
must admit indigent and uninsured patients for non-emergency
treatment.
1:39:44 PM
It is estimated that uninsured children with a medical need are
five times as likely not to have a regular doctor as insured
children and four times as likely to use emergency rooms at a
much higher cost. There are still approximately 18,000 uninsured
children in Alaska, about nine percent of the children aged 18
and under. Private health care coverage for children has
declined over 30 percent in the last 10 years and the deepening
recession is pulling more children and families into the ranks
of the uninsured. The reauthorized SCHIP program and stimulus
package should help, but Alaska is encouraged to do its share
and take advantage of the federal matching funds by insuring its
low income children up to and including 200 percent FPL under SB
13.
1:40:30 PM
CHAIR DAVIS advised the committee that Jerry Fuller with the
Department of Health and Social Services (DHSS) was online and
available for questions.
1:41:39 PM
GEORGE BROWN M.D., Douglas AK, has practiced pediatric medicine
in Alaska since 1965. He said he is delighted that the federal
government has expanded coverage for SCHIP and that the state
has bills under consideration related to increasing coverage. He
and his pediatric colleagues in Juneau are very much in favor of
a 200 percent [qualification for] coverage for children without
a co-pay, and are pleased that this seems to be moving forward
with the governor's support.
DR. BROWN said he and his colleagues have also been discussing
the issue of higher levels [of coverage] with co-pays. Whether
or not co-pays really work is a difficult question. One of his
colleagues has seen a problem with co-pays in Washington;
families get behind in their co-pays and then are ineligible. On
the other hand, if the care is all free, some people seem to
think they don't need to keep appointments and become careless
of their responsibility as parents; perhaps a simple, uniform
co-pay of $10 or $15 per visit would provide the right
incentive. He stressed that there should be no punitive results
[for failure to keep or cancel appointments] however, because it
sometimes takes many years for families who have not had health
insurance before to realize they are welcome in a doctor's
office. As those families continue to come in and be treated
with respect, to see other families there who are being treated,
they become good users of the preventive medical system.
In closing, he said that the whole idea of SCHIP is ultimately
prevention; for every dollar we invest in prevention, we save
from six to ten dollars in the long-run.
1:45:22 PM
CHAIR DAVIS advised that Jennifer Saunders and Martha King of
the National Conference of State Legislatures (NCSL) are also
online and available to answer questions.
1:46:03 PM
ROD BETIT, President, Alaska State Hospital and Nursing Home
Association (ASHNHA), Juneau, AK, said he is very excited to see
this bill before the committee. ASHNHA represents 28 health care
providers throughout the state including tribal, military,
private and city owned organizations and all of them support
this legislation, which has been unanimously approved by
ASHNHA's legislative committee. He added that bringing [the
qualifying limit] to the 200 percent level is appropriate even
though the health care commission process hasn't started yet,
because he believes this is one of the first actions that
commission would recommend. This action was recommended by the
Health Care Strategies Planning Council last year.
1:47:33 PM
NANCY ST. JOHN-SMITH, Peninsula Community Health Services,
Kenai, AK, said that their community health center, which was
formerly called Central Peninsula Health Center, has been
offering medical and dental care to communities on the Kenai
Peninsula since 2002. They merged with Central Peninsula
Counseling Services in October 2008 and are offering behavioral
health care under their new name. She urged the legislature to
pass this bill increasing the eligibility guideline to 200
percent of FPL because with Denali Kid Care they can offer
preventive medical and dental care to many children who would
not otherwise receive it. For example, she said, many people
they see on an emergency basis have not received any dental care
as children; by the time they come to the clinic, the tooth or
teeth have to be pulled, which can affect their nutrition, heart
health and other future health issues. She agreed with Dr. Brown
that the ability to offer preventive services is important to
improve the quality of life and to teach people about prevention
so they will raise their children in good health. She thanked
the committee for hearing her testimony and stressed how
important this legislation is to people on the Kenai.
1:49:53 PM
JODYNE BUTTO M.D., President, Alaska Chapter, American Academy
of Pediatrics, Anchorage, AK, said SCHIP has made a huge
difference in the health of children across the United States.
It is important that Alaska provide the best care possible to
its children; that means providing access to care and part of
that access is insurance. She agreed with prior testimony that
the program cost is outweighed by the savings in health care
costs represented by preventive care.
MS. BUTTO also stressed the importance of health to children's
school performance. Although it can't be easily quantified, it
is well known that children with good health, particularly good
dental health, perform better in school, miss fewer days, are
better behaved and enjoy greater academic success than those who
do not. She applauded the legislature for tackling this issue.
1:53:15 PM
DONNA GRAHAM, Anchorage Faith and Action Congregations Together
(AFACT), Anchorage, AK, is a school nurse and parish nurse. She
said AFACT is thrilled that Alaska is finally getting back to
the 200 percent [eligibility level]. This is the right way to
go; Alaska is a rich state and can show it by not being at the
bottom of the list of states that put their kids first. In
summary, she said, this is a great step forward! Let's put more
kids back into fitness and health to promote energy and
learning.
1:55:30 PM
JORDEN NIGRO, Residential Director, Juneau Youth Services,
President, Alaska Homes for Children (AHFC), Juneau, AK, said
they are really excited to see all of the bills coming forward
for Denali Kid Care. The only comment she cared to add to the
previous testimony was that, if a sliding co-pay goes into
effect, she hopes it won't affect those at 200 percent or less
of the FPL. Behavioral health for youth is primarily funded
through Denali Kid Care and many kids and families are unable to
access the services because they are on the cusp of eligibility;
Alaska has a high number of people on the cusp due to the
fishing and subsistence lifestyles that are prevalent here.
1:57:17 PM
LAVERNE DEMIENTIEFF, President, National Association of Social
Workers (NASW), Alaska Chapter, Clinical Assistant Professor,
University of Alaska Fairbanks, Fairbanks, AK, said NASW
strongly supports the efforts of this committee to raise the
Denali Kid Care eligibility requirement to 300 percent of the
FPL. Alaska is one of only nine states with eligibility
requirements below 200 percent. This makes us the fourth least
responsive state to children who live in poverty. Raising
eligibility to 200 percent will restore vital health insurance
to 1300 children and 225 pregnant women; imagine what raising it
to 300 percent would achieve for Alaskan families.
MS. DEMIENTIEFF recognized that fiscal responsibility is
everyone's priority, but noted that Alaska won't shoulder the
majority of the cost associated with this program; with the
passing of SCHIP, the federal government will pay 70 to 75
percent of it. Finally, she said this is an important investment
Alaska and in the future of Alaska's children and families.
1:59:02 PM
CHAIR DAVIS announced that she was closing public testimony on
SB 13.
SENATOR THOMAS asked what the other referrals are for SB 13.
CHAIR DAVIS answered that it will go to Finance next.
SENATOR THOMAS asked if she intends to leave the explanation of
the fiscal note to Finance.
CHAIR DAVIS said they can discuss it if he wishes; but she had
not intended to get into it today.
SENATOR THOMAS said he wondered whether the savings that are
expected to accrue from intervention and prevention were taken
into consideration when preparing the fiscal note.
2:01:55 PM
JON SHERWOOD, Medical Assistant Administrator, Department of
Health and Social Services (DHSS), Juneau, AK, explained that
their assumptions on the fiscal note did not specifically take
those preventive aspects into account, but they based their
costs on the cost of care for children in the next lowest income
group, which is covered [by Denali Kid Care]. Those children
experience the same preventive effects from being covered by
Denali Kid Care and they assumed the impacts would be
comparable.
SB 87-MEDICAL ASSISTANCE ELIGIBILITY
CHAIR DAVIS announced consideration of SB 87.
2:02:48 PM
SENATOR BILL WIELECHOWSKI, sponsor of SB 87, explained that this
is a bill he first introduced two years ago, which was not
passed. He decided to introduce it again this year due in part
to the opportunity represented by the increase in federal funds
to Alaska from about $10 million to over $22 million.
This bill increases the base eligibility for Denali Kid Care to
200 percent of the federal poverty level and allows people to
buy in up to the level of 300 percent of FPL. What he thinks
this will do is to make health insurance available to every
child in the state of Alaska. People at or under 200 percent of
FPL will get it [for free] and the federal government will pick
up 65 to 66 percent of the cost; people over 300 percent should
probably be able to afford health care; so it is the people
between 200 and 300 percent of FPL whom this expansion is
intended to help.
SENATOR WIELECHOWSKI added that the fiscal note they received is
very questionable. When he filed this bill two years ago, the
fiscal note said it would require the addition of another 7
[DHSS] staff members; now for some strange reason, the number
has increased to 17. In addition, SB 13, which adds about 1300
people [to Denali Kid Care], requires the addition of 2 staff
members; this bill, which adds 2000 to 2500 people, requires
another 15 staff. A fiscal note like this greatly undermines the
credibility of the department.
2:06:11 PM
SENATOR ELLIS asked how this legislation would comport with the
bill just signed by President Obama.
SENATOR WIELECHOWSKI turned the question over to Michelle
Sydeman.
2:06:40 PM
MICHELLE SYDEMAN, legislative aid to Senator Wielechowski said
the current federal bill would provide funding to get Alaska
easily up to 200 percent of FPL; they have also heard assurances
from Speaker of the House Nancy Pelosi and others that it is the
intent of Congress to provide sufficient funding to cover all
states' efforts to ensure that children are insured. The funding
Alaska has received so far gets them up to 200 percent, but
there are indications that they can go higher. Alaska simply
needs to revise its plan and its allotment should increase as
well.
2:07:27 PM
CHAIR DAVIS advised that there is someone in the audience who
can speak to Senator Wielechowski's concerns about the fiscal
note.
SENATOR WIELECHOWSKI said he would be curious to find out why
the number of employees they think the department needs has
increased by ten in the past year, when the bill has remained
the same and why they think they need 15 more employees than
they need for SB 13.
2:08:17 PM
JERRY FULLER, Project Director, Medical Assistance
Administration, Department of Health and Social Services,
Anchorage, AK, said Ellie Fitjarrald might have more information
on that.
2:08:32 PM
ELLIE FITJARRALD, Director, Division of Public Assistance,
Department of Health and Social Services, said they are treading
new ground. The workload that goes into calculating costs and
premiums for families up to 300 percent of FPL is something the
department has not done before. The states that have done it
have found that it is very labor intensive. She asked Chair
Davis if she would like to go through the fiscal note today or
wait until the bill gets to Finance.
CHAIR DAVIS answered that not all of the committee members serve
on Finance, so it would be helpful if she would walk them
through it today.
MS. FITZJARRALD said she can cover the Division of Public
Assistance and Jon Sherwood can cover the other divisions,
because Medicaid touches most divisions of the Department of
Health and Social Services. She continued; the Division of
Public Assistance estimated a need for 13 positions working with
an assumption of what is adequate to serve the nearly 3000
eligible children and the increase in pregnant women. That
number represents children who will be eligible and not the
entire number who will apply for services. At any given time,
about 30 percent of applications are denied; so they see an
average of 4000 kids applying for services. With the higher
income groups, they will have to verify the families' incomes to
be sure they qualify, calculate their premiums per child and
monitor their premiums as their incomes change. This represents
a lot of accounting, not just during the determination of
eligibility but on an ongoing basis.
She accepted that the previous fiscal note showed a need for
fewer staff; but as they become more familiar with what this
work will entail, they think more staff will be needed than
previously estimated. She also noted that on page two of the
fiscal note, where there is a breakdown of the 13 positions
required in the eligibility field, they have included four lead-
worker positions that would provide statewide outreach. They
would contact health providers and clinics in the communities to
make sure they know about the program and how it works: how to
apply; how premiums are calculated; and as there are
interruptions in coverage when people are unable to pay their
premiums and benefits are suspended, how to get them reinstated.
MS. FITJARRALD asserted that it is like running another
insurance program and this is the department's best estimation
of the work it will take. They have requested:
· 2 Administrative Support Staff
· 5 Eligibility Technicians
· 4 Lead Eligibility Technicians to provide community
outreach and quality assurance
· 1 Eligibility Supervisor
· 1 Public Assistance Analyst to oversee interpretation of
the rules, develop policy, make system changes and provide
technical support
These 13 positions represent about $350,000 from the General
Fund and $350,000 from the federal government.
2:12:29 PM
CHAIR DAVIS asked if the four lead-eligibility worker positions
were included in the fiscal note last year.
MS. FITJARRALD did not believe they were but was not sure. She
said she would check and get back to the committee with that
information.
2:13:01 PM
SENATOR THOMAS asked if the amount of $15,000 per telephone
shown under contractual services is typical of what the state is
now paying across the board.
MS. FITJARRALD said that is the cost associated with the phones
and some of the IT usage for their computer systems now that the
phones are integrated.
2:13:47 PM
CHAIR DAVIS invited Senator Wielechowski to follow up.
SENATOR ELLIS asked Ms. Fitzjarrald if she had actually checked
with other states that have a track record with this type of
program, to find out what their experience has been.
MS. FITJARRALD admitted that they have not checked with other
states; it is what they have heard nationally on state-to-state
call chats. Their analysis is really based on the work as they
know it here in Alaska.
SENATOR ELLIS concluded there is not any particular experience
elsewhere informing their fiscal note.
MS. FITJARRALD answered "No, not specifically."
2:15:12 PM
MR. SHERWOOD asked if the committee would like him to discuss
the Medical Assistance Administration fiscal note.
CHAIR DAVIS asked the committee if that is a concern at this
time.
2:15:33 PM
SENATOR WIELECHOWSKI answered that his biggest concern is the
fact that, to go from [eligibility of] 175 to 200 adds roughly
1,400 people and the department is adding only two additional
staff. To go from 200 to 300, adds another roughly 2,000 people
to the roles...
MR. SHERWOOD corrected that it adds approximately 1,700 people.
SENATOR WIELECHOWSKI continued; so to go from 200 to 300 adds
roughly the same number of people and yet the department needs
15 additional staff. "Is that what you're trying to tell this
committee?" he asked.
MR. SHERWOOD agreed that is what their fiscal notes say. He
thinks a big part of that is around the issue of premiums; both
premium collection and, because people's incomes change,
modification of premiums. With the increase from 175 to 200
percent of FPL and with continuous eligibility for children, the
department works the case once until the next review period and
does not have to make additional adjustments; therefore the
workload per case is significantly different.
2:17:13 PM
SENATOR WIELECHOWSKI asked if the administration supports SB 87.
MR. SHERWOOD answered that several proposals are under
discussion and the Governor has supported expansion to 200
percent of FPL. In looking at the proposals, the administration
has a preference for cost-sharing through premiums and an asset
test, but does not have a position on the bill to share with
him.
SENATOR WIELECHOWSKI opined that they do support the fundamental
philosophy of what SB 87 is attempting to do with the cost
sharing component.
MR. SHERWOOD agreed.
SENATOR WIELECHOWSKI asked if the administration worked on any
amendments at the congressional level to stop the federal
increase above 200 percent.
MR. SHERWOOD could not answer Senator Wielechowski's question.
He said he knows the department responded to questions from
their congressional delegation about different proposals, but
that he did not have as much communication with them as did Mr.
Fuller.
MR. FULLER answered that he responded to questions and comments
from the senatorial delegation as they were working through the
SCHIP reauthorization; so the answer to Senator Wielechowski's
question is "yes."
CHAIR DAVIS advised Senator Wielechowski that there are two
people from NCSL online for questions.
2:19:47 PM
SENATOR WIELECHOWSKI said his understanding was that requiring
premiums or enrollment fees as a cost-sharing provision is
fairly common and asked the NCSL representatives if that is
correct.
MARTHA KING, Group Director, National Conference of State
Legislatures (NCSL), Denver, CO, referred the question to
Jennifer Saunders.
JENNIFER SAUNDERS, National Conference of State Legislatures,
Denver, CO, said 24 states charge co-payments and 35 states have
premiums or enrollment fees.
CHAIR DAVIS asked if that includes asset tests.
MS. SAUNDERS answered that 46 states and the District of
Columbia do not require an asset test.
2:21:12 PM
SENATOR PASKVAN asked at what level the other states require co-
payments or premiums.
MS. SAUNDERS said that nine states impose premiums on children
and families with incomes below 150 percent of the federal
poverty guidelines; 26 states charge premiums at an income level
over 150 percent; 24 states charge premiums at 200 percent; 18
states charge at 250 percent of the federal poverty guidelines.
MS. KING added that there is a difference in the states' ability
to charge co-pays depending on whether the state has a Medicaid
expansion for its SCHIP program as Alaska does, or has a stand-
alone insurance-like SCHIP program.
CHAIR DAVIS thanked Ms. King for that information and asked if
that means Alaska cannot go down to 150 percent.
MS. SAUNDERS answered that below 150 percent, cost-sharing
requirements are very restrictive under Medicaid rules; but she
does not have the exact requirements.
CHAIR DAVIS requested that she provide further information on
that at a later time.
2:23:14 PM
SENATOR THOMAS asked if, in NCSL's experience, some states have
developed a particular formula to use when calculating the
change in the amount of reimbursement of the federal poverty
level.
MS. SAUNDERS told Senator Thomas that she is not aware of any
but will try to find out.
2:23:53 PM
SENATOR ELLIS asked Ms. Fitzjarrald and Mr. Sherwood if they are
saying that, of the 15 new employees and related equipment
reflected in the fiscal note, 100 percent of their activity will
be dedicated to this program.
MS. FITJARRALD said that is correct; determining eligibility for
the higher income groups is the work they would be doing. She
added that, because Medicaid is so large, if applicants do not
qualify for this program, the eligibility workers would look to
see if they qualify for other types of coverage; but their work
will be related primarily to Denali Kid Care.
2:25:13 PM
SENATOR WIELECHOWSKI stated that Alaska can go to 300 percent
eligibility and provide insurance for most of the children in
the state for an additional $1.3 million according to the
department's estimate, which he believes to be over generous. He
added that, to say it will require 2 additional staff to handle
an increase of 1,500 to 1,600 kids and pregnant mothers, but
adding 1,500 more with the increase from 200 to 300 percent (a
position they know the administration fought against at the
congressional level) will require another 15 staff, stretches
the imagination. However, he continued, even if that is accurate
the amount is more than reasonable for the outcome. He urged the
committee's support.
CHAIR DAVIS thanked the sponsor and announced that the committee
would take public testimony for SB 87.
2:26:47 PM
JORDEN NIGRO, President* Alaska Association of Homes for
Children* Anchorage, AK* said she supports this bill and urged
the committee to pass it out.
2:27:44 PM
LAVERNE DEMIENTIEFF, President, National Association of Social
Workers (NASW), Alaska Chapter, Fairbanks, AK, said her
Association also supports SB 87.
2:28:06 PM
ROD BETIT, President, Alaska State Hospital and Nursing Home
Association (ASHNHA), Juneau, AK, said he also supports SB 87.
Having been a state health worker, he understands the
difficulties of going forward with this proposal, but ASHNHA's
membership really wants to see the state get [eligibility] to
200 percent and he believes this is a well-constructed piece of
legislation. First, there is no cost sharing below 200 percent,
which he believes is important. Second, there is significant
cost sharing above 200 percent. It isn't a "give away," so there
is a real attempt to promote individual responsibility in this
program; above 250 percent, co-payments of 20 percent are
required. Third, it contains a strong anti-crowd out measure,
which is a very important component of the bill. He explained
that "crowd out" refers to public programs shifting patients
away from the private programs, which shifts who pays for care
rather than who is covered.
Finally, he said if there are federal and state dollars
available, this is a good next step after going to 200 percent
and he would really urge the committee to consider it.
2:30:44 PM
SENATOR ELLIS thanked Mr. Betit for his testimony. Coming from
someone who watches the bottom line, he said, it is great
testimony to carry through the process.
2:31:11 PM
SENATOR PASKVAN thanked him again and asked if the
administration would be more efficient for the hospitals with a
flat fee charge rather than a percentage of income.
MR. BETIT answered that typically those fees would be
predetermined during the eligibility process and would be
provided to the providers when the patient comes in for service;
the hospitals and physicians would not have to do the
calculation.
2:32:04 PM
SENATOR THOMAS asked if, as a humanitarian gesture, the
hospitals would be interested in support of an incremental
discount for every $50 increment in the federal poverty level
increase as it is applied.
MR. BETIT asked if Senator Thomas means an incremental discount
in what the family is charged.
SENATOR THOMAS replied yes.
MR. BETIT explained that the hospitals are giving significant
discounts already, because Medicaid and other federal programs
are well below the going rate. They would come under the
protection of the Medicaid rules, which say that once a person
has been billed as a Medicaid patient, that is all the provider
can charge.
2:33:22 PM
DONNA GRAHAM, representing herself, Anchorage, AK, agrees that
SB 13 is very important; the state must get to 200 percent of
FPL. But SB 87 is a wonderful bill and very fiscally
responsible, as she reads it. Wellness and prevention make much
more sense than waiting to treat problems.
2:34:23 PM
JODYNE BUTTO MD, American Academy of Pediatrics (AAP),
Anchorage, AK, asked if anyone has considered thinking a little
outside the box and to find solutions that would not require 15
positions. She said it seems as if there ought to be a better
way to quantify eligibility for a longer period of time to
reduce the amount of work required by the patient and the
department. She encouraged some "brainstorming" to find ways to
streamline the process.
CHAIR DAVIS thanked her for her suggestion and commented that a
lot of the work Dr. Butto referred to will take place in Finance
rather than in the Health and Social Services Committee. She
also pointed out that there are other bills in the works this
session that don't come up to this mark and, if Alaska is going
to have health care for all of the children, this is the piece
of legislation she would like to see passed.
TOM OBERMEYER, aid to Senator Davis, pointed out that the packet
that was handed out to members of the committee includes a
report from the Kaiser Commission on Medicaid and the Uninsured.
Page 10 of that report indicates that 11 states have taken steps
to reduce procedural barriers to coverage for children; this is
a cost-saving arrangement he thinks the state should look at.
These states were able to eliminate the requirement for families
to participate in face-to-face interviews to obtain health
coverage for children. Colorado adopted administrative
verification and renewal, meaning that the state no longer
requires families to provide paper documentation of their income
and eligibility workers obtain that information from existing
databases. So things have been done in other states that could
help to reduce the numbers that were presented for SB 87.
CHAIR DAVIS thanked Mr. Obermeyer for bringing that forward and
mentioned that the administration is working on some regulations
to extend the time between personal interviews. She admitted
that there is a lot of work to be done but repeated that it
won't all be done in this committee. She expressed her desire to
move both bills out today and asked the will of the committee.
2:38:40 PM
SENATOR PASKVAN moved to report SB 13 from committee with
individual recommendations and attached fiscal note(s). There
being no objection, the motion carried.
SENATOR PASKVAN moved to report SB 87 from committee with
individual recommendations and attached fiscal note(s). There
being no objection, the motion carried.
2:39:39 PM
There being no further business to come before the committee,
Senator Davis adjourned the meeting at 2:39 p.m.
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