Legislature(2017 - 2018)BUTROVICH 205
01/27/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Presentation: Update on Medicaid Reform | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 27, 2017
1:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Tom Begich
MEMBERS ABSENT
Senator Peter Micciche
COMMITTEE CALENDAR
PRESENTATION: UPDATE ON MEDICAID REFORM
- HEARD
WITNESS REGISTER
VALERIE DAVIDSON, Commissioner
Alaska Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Addressed Medicaid reform.
MONIQUE MARTIN, Health Care Policy Advisor
Alaska Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Addressed Medicaid reform.
RANDALL BURNS, Director
Division of Behavioral Health
Alaska Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Addressed Medicaid reform.
ACTION NARRATIVE
1:32:08 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Begich, Giessel, von Imhof, and
Chair Wilson.
^Presentation: Update on Medicaid Reform
PRESENTATION: Update on Medicaid Reform
1:32:48 PM
CHAIR WILSON announced that the committee will hear a
presentation on Medicaid reform from the Alaska Department of
Health and Social Services (DHSS).
1:33:29 PM
At ease.
1:35:05 PM
CHAIR WILSON called the committee back to order.
1:35:15 PM
VALERIE DAVIDSON, Commissioner, Alaska Department of Health and
Social Services, Juneau, Alaska, announced that DHSS will
address Medicaid redesign and implementation, the progress of SB
74, Medicaid expansion, and the "landscape" on the federal
level.
CHAIR WILSON welcomed the Alaska League of Women Voters and Ms.
Epstein and her class from the Dzantik'i Henni Middle School for
attending the meeting.
COMMISSIONER DAVIDSON exclaimed that one of the highlights of
last year's legislative session was the incredible work that
went into the bipartisan Medicaid reform bill, [SB 74]. She set
forth that workable timelines have been established to take
advantage of the impetus for change within the DHSS's and
provider community's limitations.
1:37:59 PM
MONIQUE MARTIN, Health Care Policy Advisor, Alaska Department of
Health and Social Services, Juneau, Alaska, explained that DHSS
broke down the reforms in SB 74 into 16 initiatives in order to
stay on time and achieve the savings stated in the bill's fiscal
notes. She divulged that DHSS gathered 25-different
organizations from across the state in 2015 for assistance with
Medicaid redesign and expansion. She pointed out that many of
the reforms in SB 74 were the result of the key-partners
process. She summarized that the DHSS's presentation is a way to
communicate to the public what is really in SB 74 and how
providers or Medicaid recipients might be affected by the
reforms in the bill. She referenced "Alaska Medicaid Redesign"
as follows:
· Delivery system reforms:
ƒPrimary care case management and Health Homes;
ƒBehavioral health system reform;
ƒCoordinated care demonstration project;
ƒ1915(i) and (k);
ƒCriminal justice reform (SB 91), led by the Department of
Corrections;
ƒEmergency department care improvement, led by the Alaska
State Hospital and Nursing Home Association (ASHNHA).
· Delivery system infrastructure:
ƒTelehealth;
ƒHealth information infrastructure plan;
ƒImplementation of tribal claiming policy;
ƒMedicaid reform program: quality and cost effectiveness
metrics, explanation of benefits;
ƒPrescription drug monitoring program (PDMP), led by the
Alaska Department of Commerce, Community and Economic
Development.
· Internal systems improvements:
ƒRegular progress reports to the Legislature and
stakeholders;
ƒMedicaid fraud and abuse prevention;
ƒEligibility verification system.
· Exploring options:
ƒPrivatization studies: Alaska Psychiatric Institute,
Division, Division of Juvenile Justice facilities,
Pioneer Home pharmacy;
ƒHealth care authority feasibility study, let by the
Alaska Department of Administration.
1:39:36 PM
MS. MARTIN said DHSS reconvened the key partners to talk about
SB 74 implementation and the need for a vision in what to
achieve in Medicaid redesign. She referenced a visual-
representation document that summarized the "Vision for Medicaid
Redesign" regarding "principles and values" and "key features"
pertaining to a "system of whole person" and "high value care"
to achieve the desired outcome from SB 74.
She said when putting the initiatives together, the intent was
for the two biggest reforms: "behavioral health" and the
"coordinated care demonstration projects" to take the lead and
reshape Alaska's health-care delivery system. She noted that
implementation deadlines are a bit later to allow the "tip of
the spear" to proceed first in order to allow reforms to come in
line afterwards.
MS. MARTIN informed that Primary Care Case Management, and
Health Homes are the first initiatives. She said the intent for
Primary Care Case Management is to allow Behavioral Health
Reforms to go through its process and Coordinated Care
Demonstration Projects proposals to come forward to do something
for Medicaid recipients instead of waiting. She detailed that a
program was ramped-up to address super-utilizers that utilize
emergency rooms more than five times in a calendar year; that
program is called the Alaska Medicaid Coordinate Care Initiative
(AMCCI). DHSS sends 30,000 Medicaid-recipient names per month to
a contractor to ask individuals if they are interested in
participating in AMCCI to assist with navigating the Health Care
Delivery System. She revealed that AMCCI has been well received.
She summarized that as Coordinated Care Demonstration Projects
and behavioral health come on line, Medicaid recipients will
transition to the more appropriate program that is focused to
their specific health-care needs.
She detailed that Health Homes is the second part of the
initiative that allows providers to identify Medicaid recipients
in order to "wrap" added services; for example, a recipient that
has both a behavioral health and chronic health-care need. She
noted that the Affordable Care Act and Social Security Act have
specific sections for Health Homes: Section 2703 for the
Affordable Care Act and Section 1945 for the Social Security
Act. She detailed that DHSS goes through the Centers for
Medicare and Medicaid Services (CMS) to identify a health-home
project that results in an enhanced federal match. She specified
that depending on the program covered by Medicaid, the first 8-
quarter matches range from 50-50, 90-10 where the federal
government pays 90 percent, up to a 100 percent federal match.
She asserted that DHSS is conscientious in maximizing federal
matches when rolling out a Health Home in order for a ready-set-
go process when identifying a need and ramping up the program
with providers.
1:44:18 PM
CHAIR WILSON noted that DHSS rolled out a "patients in their
medical home" model in 2008 and asked if the Health Home program
was a continuation or a separate model.
MS. MARTIN answered that Health Homes require a patient to have
two or more healthcare needs for the model to exist.
CHAIR WILSON asked if the Health Homes model is based on
national or state-based models that are currently ongoing.
1:47:39 PM
MS. MARTIN explained that participants in the Medicaid redesign
process from the Alaska Primary Care Association see Health
Homes as the next step in the patient-centered medical home.
SENATOR BEGICH noted that Ms. Martin referenced federal matching
for Health Homes for the first eight-quarters and asked what
happens afterwards.
MS. MARTIN answered that the federal match would revert to an
individual's qualified Medicaid-match category.
She said one of the biggest concerns about DHSS's behavioral
health system was the gaps in the continuum-of-care. She
explained that the language in SB 74 allows DHSS the flexibility
to design a comprehensive behavioral-health system. She said SB
74 calls out that DHSS work specifically with the Alaska Mental
Health Trust Authority and noted that their trustees contributed
$10 million over next three years to help implement the reforms
in SB 74, funding that is critical to the success of
implementing the reforms.
She set forth that the biggest part of behavioral health reform
will be the Section 1115 Waiver. She detailed that DHSS
submitted a waiver-concept paper in January to CMS that
addressed the vision for the new health-care delivery system.
She added that DHSS will submit a waiver application to CMS in
July. She detailed that the 1115 Waiver must show budget
neutrality for the federal government that care can be provided
at no additional cost to the federal government. She added that
another part of SB 74 requires DHSS to contract with the
Administrative Services Organization (ASO) to support systems of
care. The Division of Behavioral Health manages the new system
of care and focuses on outcomes before there is a problem.
1:51:53 PM
SENATOR GIESSEL pointed out that part of the 1115 Waiver was to
increase the latitude of qualified health-care providers to
provide mental-health services. She noted that there were
regulations in place that constrained service opportunities. She
asked if increasing the latitude of health-care providers was
addressed in the DHSS's concept paper and if the concept paper
was available for legislative review.
MS. MARTIN answered that the concept paper along with additional
initiative information are available online for review. She
asked that the Division of Behavioral Health address Senator
Giessel's question regarding the 1115 Waiver and the removal of
the grantee requirements.
1:53:57 PM
At ease.
1:54:36 PM
CHAIR WILSON called the committee back to order.
1:57:34 PM
RANDALL BURNS, Director, Division of Behavioral Health, Alaska
Department of Health and Social Services, Juneau, Alaska,
explained that the legislative impact on grantees was fairly
dramatic, but not on individual providers. He specified that the
Legislature would have to amend the statute to list licensed
professional counselors and marriage-and-family therapists as
possible Medicaid billers. He said the division is addressing
the scope of practices and the cost of the Medicaid system to
broaden the ability of mental health and behavioral health
professions to join in the work. He set forth that the focus is
on the changes that will bring the most access to the
individuals who really need the services. He noted that the
attorney general's office believes that the regulation needs to
be amended. He admitted that the situation with individual
therapists is extraordinarily complex.
2:01:15 PM
SENATOR GIESSEL noted her frustration because qualified non-drug
prescribing people are available to provide services. She
explained that not everyone needs drugs and that is what a
psychiatrist does. She said there are psych-mental nurse
practitioners that are equally qualified to provide supervision
and do not charge the high fees that psychiatrist charge, and
are more numerous and assessable in many situations. She noted
that her comments are based on testimony from the previous year
by a psych-mental nurse practitioner. She opined that state
government is "glacial" and often antiquated, a frustrating
situation when there are people that can benefit from qualified
mental health and family therapist services.
MR. BURNS answered that he agreed. He noted that DHSS tries to
balance the Legislature's concern while also maintaining cost
neutrality.
2:03:39 PM
SENATOR BEGICH noted that a number of his constituents brought
up the supervision issue. He pointed out that Mr. Burns stated
that the division is going through a supervision change process
and asked if there is a timeline for the change. He stated that
he shared Senator Giessel's access concern.
MR. BURNS explained that there is pressure during the 1115
Waiver process to deal with individual systems rather than
looking at the whole. He remarked that given the attorney
general office's opinion on the physician's clinic, the division
is going to move forward and seek a change.
SENATOR BEGICH asked Mr. Burns how long the process might take
and if a recommendation will be given to the Legislature to add
statutory classes for billing.
MR. BURNS replied that the timing on most regulation projects is
six months. He added the Legislature could amend the statute to
include professions, but the division would have to prepare a
fiscal note and gauging the cost to the Medicaid system would be
a best-guess; the division wants to do that as part of the 1115
Waiver process due to concerns regarding the cost neutrality of
future Medicaid.
2:07:40 PM
MS. MARTIN said the second of DHSS's two biggest reforms is the
Coordinated Care Demonstration Projects, which allows DHSS to
test new delivery system and payment models. DHSS issued a
request for information in September 2016 with 12 responses
received that ranged from a regional accountable-care
organization type model to full-risk-statewide managed care, the
result allowed DHSS to draft a request for proposal (RFP) that
was released in December 2016. She said DHSS anticipates an
intensive proposal evaluation process throughout 2017. She noted
that Senator Giessel was selected to participate in the
proposal-review committee. She noted that the proposal-review
committee's time process is extensive due to: possible approval
from CMS, waivers, state-plan amendments, or regulations. She
summarized that the intent is to have process requirements
clarified for both the RFP proposal and the state.
2:11:54 PM
MS. MARTIN said another reform is the 1915 (i) and (k) options
that is related to home and community-based services currently
provided through the Division of Senior and Disabilities
Services. DHSS contracts with Health Management Associates (HMA)
to analyze service opportunities to maximize savings and make
sure Alaskans are getting the needed service in their homes. She
disclosed that a lot of the home and community based services
are optional, but the services are in lieu of more costly
nursing-level of care where people can stay in their homes or
communities.
She detailed that the 1915 (i) and (k) option is an entitlement
program that DHSS must provide if an Alaskan qualifies. She
pointed out that the current home and community-based services
allows DHSS to control the budget by capping the dollar amount
or the number of participants. She noted that HMA has assisted
DHSS in deciding whether the 1915 (i) and (k) options are good
for Alaskans and their potential budget impact. She revealed
that HMA suggested moving forward with the 1915 (i) and (k)
options with specific recommendations for Alaskans with
intellectual and developmental disabilities versus Alaskans with
traumatic and acquired brain injury. She disclosed that HMA
recommended that the 1915 (i) option may not be the best choice
and the state should look at other waiver opportunities such as
the 1915 (c) option. She pointed out that savings from the 1915
(i) and (k) options were attached to SB 74, but DHSS is
confident that the same savings can also be realized from the
1915 (c) option. She revealed that some of the services are
currently provided at 100-percent cost to the state, some are a
50-50 split with the federal government; however, by
implementing the 1915 (c) option the state would gain 6-percent
for a 44-56 split with the federal government.
2:15:06 PM
She said though not specifically called out in SB 74, DHSS felt
it needed to work in conjunction with the criminal justice
reforms that were enacted from SB 91. She said integrating
criminal justice reforms is one of four reform efforts that is
really led by another agency, but DHSS plays a critical role.
She revealed that the "SB 74/SB 91 integration work group" meets
monthly with other agencies and boards on getting Alaskans about
to be released from correctional facilities ready by enrolling
them in Medicaid and needed programs for a successful community
transition on day-one.
CHAIR WILSON asked to address Medicaid enrollment for inmates
that may need enrollment and behavioral health. He pointed out
that Medicaid expansion has not seen increased numbers on the
behavioral health side of the sector. He noted that Ms. Martin
mentioned that granting agencies have decreased in hopes of
making that back on the Medicaid billing side. He inquired how
DHSS plans to remedy the situations he described without
increased numbers.
MS. MARTIN noted that DHSS publishes a monthly "Medicaid
dashboard" that tracks enrollment in Medicaid expansion.
2:17:30 PM
COMMISSIONER DAVIDSON noted that additional information on the
dollar amount of claims that have been paid will be provided
later in the presentation.
MS. MARTIN disclosed that one of the other reforms that DHSS is
not the lead on is the Emergency Department Care Improvement
Initiative, which is led by the ASHNHA in conjunction with the
Alaska Chapter of the American College of Emergency Physicians.
She detailed that program is designed on Washington state's "ER
is for Emergencies" program. She detailed that the working group
has selected a real-time information exchange called the
Emergency Department Information Exchange (EDIE). She disclosed
that EDIE is scheduled to go "live" in the Providence system,
[Anchorage, Kodiak, Valdez and Seward], in February; other
hospitals will review the EDIE system in February 2017 as well.
She specified that EDIE is designed to provide emergency room
providers real-time information access; for example, people who
repeatedly use an emergency room can be identified, and opioid
or narcotics abuse can be singled out in the emergency room as
well. She noted that the working group also put together some
uniformed narcotic prescription guidelines for hospitals,
emphasizing that the guidelines are not requirements. She added
that consultants from Milliman, Inc. are assisting with a
shared-savings model to assist physicians and providers with
reducing costs for emergency department care.
2:20:45 PM
She revealed that the Telehealth Workgroup was formed to
identify opportunities or barriers to expand telehealth in
Alaska. She noted that the workgroup's membership is a cross
section of Alaskans across the state. She noted that the
workgroup's final report will be included in the annual Medicaid
Reform Report that is annually provided to the Legislature in
November.
MS. MARTIN revealed that the key-partner process emphasized the
real need to enhance the state's health information
infrastructure. She detailed that HealthTech Solutions was
brought on to assist with designing the Health Information
Infrastructure Plan and the programs have an opportunity to get
some enhanced funding that is 90 percent reimbursed by the
federal government.
2:23:03 PM
COMMISSIONER DAVIDSON revealed that DHSS is working with CMA to
make improvements to their tribal-claiming policy. She noted
that three things must come together for the state to get a 100-
percent federal match:
1. Individual must be an Alaskan native or American Indian;
2. Individual must be a Medicaid beneficiary;
3. Care must be received through an Indian Health Service
(IHS) facility.
She disclosed that DHSS is negotiating with CMS for 100 percent
federal match for additional tribal-claiming considerations as
follows:
· Travel expenses to be considered medically necessary for
care access.
· Federal responsibility should continue for referrals that
start in IHS facilities and transferred to a non-tribal
facility.
She noted that DHSS has been acting as a matchmaker for referral
agreements between tribal and non-tribal organizations to ensure
CMS claim terms have been satisfied. DHSS believes that
extending the level of care available to Alaskans avoids
services duplication and provides savings.
2:30:27 PM
MS. MARTIN explained that the Medicaid Reform Program calls out
11-specific reforms for DHSS to undertake, including Electronic
Distribution of Explanation of Benefits (EOB) for recipients to
understand the cost of the care being received as well as
helping DHSS to identify fraud. She added that the Medicaid
Reform Program includes an annual report to the Legislature that
addresses reform measures, benchmarks and specifically requested
data.
SENATOR BEGICH asked if an IHS person could be posted at a
juvenile justice facility for referring Alaskan native youth for
Medicaid reimbursement eligibility.
2:32:06 PM
COMMISSIONER DAVIDSON pointed out that there are Medicaid
eligibility limitations for individuals within facilities. She
set forth that DHSS is working to align all the reform packages
to yield better results and maximize general fund savings.
MS. MARTIN revealed that the other work group DHSS has is the
Quality and Cost Effectiveness Workgroup that is called out by
the Medicaid reform program in SB 74; their report and
recommendations will be included in the November 2017 report to
the Legislature.
She said the Prescription Drug Monitoring Program (PDMP) had
significant language included from SB 74 due to recommendations
by the Controlled Substances Advisory Committee, including the
change in requiring data submission on a weekly rather than a
monthly basis. She asserted that the more timely information
will help address the opioid epidemic and provide Medicaid
pharmacists with data access. She noted that the Internal
Systems Improvements Reporting Requirements workgroup makes sure
that annual, one-time and time-limited reports are created and
posted online.
2:34:49 PM
She explained that SB 74 also created the Alaska Medicaid False
Claim and Reporting Act:
· AK Health Reform has a webinar about reporting false claims
and ASHNA brought in experts to provide education.
· DHSS assesses interest and penalties on any identified
over-payments.
· Providers are required to conduct self-audits every two
years.
· The Fraud, Abuse, Waste, Payment and Eligibility Errors
Report was transmitted in November 2016 to the Legislature
and is accessible online.
2:35:51 PM
SENATOR VON IMHOF asked if Ms. Martin knows what type of savings
the state might see once the previously described efforts are
implemented.
MS. MARTIN replied that savings are identified in the fiscal
notes and additional information will be provided to committee
members.
She said another reform in SB 74 is the Eligibility Verification
System where a third-party vendor verifies incomes, assets and
identities for Alaskans receiving programs through DHSS. She
specified that the legislation requires annual savings to exceed
the system implementation cost; its intent is to eliminate
payment duplication, fraud, waste and abuse in public-assistance
programs. She added that DHSS is moving to version-two of the
Alaska's Resource for Integrated Enrollment System where a
third-party will start performing the work once additional
eligibility is moved into the new system.
2:37:44 PM
CHAIR WILSON asked if the public-assistance "hiccups" that were
mentioned in the previous committee meeting will be relieved
through the version-two implementation or are the issues related
to waiting for assistance-eligibility enrollment.
COMMISSIONER DAVIDSON answered that moving into phase two will
result in eligibility-processing-time improvements; however, the
Eligibility Verification System differs by looking at fraud
prevention. She revealed that DHSS faces a significant backlog
challenge with phase two due to not having the bodies for
providing eligibility processing.
2:39:44 PM
MS. MARTIN reiterated that three privatization studies were
identified in SB 74 and the studies were transmitted to the
Legislature.
She said DHSS is partnering with the Department of
Administration on the Health Care Authority Feasibility Study to
look at creating a health-care authority like those found in
Washington state or Oregon for coordinating and consolidating
the state's health-care purchasing. She added that the PRM
Consulting Group is assisting with the feasibility study. She
revealed that the first round has been completed with a report
due out in February 2017. State and local employees and retirees
were surveyed to see what health-care benefits are provided and
at what cost. She informed that the second part of the report
will look at other Medicaid opportunities as well as the state's
health-care purchases for retirees and employees. She divulged
that the second-part report will be released in July 2017.
2:41:19 PM
MS. MARTIN set forth that DHSS informs the public on signing up
regarding Medicaid redesign and detailed as follows:
· Sign-up emails for the Medicaid Redesign List-Serv update
are sent out.
· DHSS fields Medicaid redesign e-mail questions.
· Public Notices for meetings are announced online.
· Reports, webinars and documents for the Medicaid Redesign
Planning Process (2015) can be accessed online.
COMMISSIONER DAVIDSON noted that Medicaid is a significant
portion of the state's budget and in the interest of
transparency, DHSS publishes a monthly point-in-time Medicaid
"dashboard" on the DHSS website.
She detailed the information that is presented on the Medicaid
dashboard and referenced data that was dated from December 28,
2016 as follows:
· Cumulative number of enrollees since Medicaid expansion
starting on September 1, 2015: 27,415 enrollees.
· Includes age group and sex demographics.
· $316.3 million in claims paid.
· Approximately $19 million in mental-health claims paid.
· Approximately 50 percent of all Medicaid beneficiaries are
children, 16 percent are covered through expansion; 5-
percent seniors; 20-percent parent-caretakers; 9-percent
adults with disabilities; 1-percent children with
disabilities.
· Includes regional enrollee information.
· 169,999 total enrollees, including the 27,415 covered by
Medicaid expansion.
She noted that Medicaid expansion covers Alaskans who are
without dependent children. A single Alaskan can be eligible if
the individual earns less than $20,000 year.
2:44:07 PM
SENATOR VON IMHOF pointed out that the dashboard lists 169,999
enrollees as being totally covered by Medicaid, approximately 15
to 20 percent of Alaska's total population. She asked how
Alaska's Medicaid participation compares with other states.
COMMISSIONER DAVIDSON replied that the number of Medicaid
eligible Alaskans is a little bit higher than in other states,
especially in areas of high unemployment.
SENATOR VON IMHOF asked how many of the 169,999 Medicaid
enrollees have secondary federally-covered insurance.
COMMISSIONER DAVIDSON answered that Medicaid is the secondary
payer for individuals with private insurance with an employer or
other ways.
2:47:32 PM
She said DHSS has received inquiries on what is happening
nationally and its impact on Alaskans in terms of health-care
coverage, Medicaid, and Medicaid expansion. She said private
insurance, marketplace plans, and Medicaid go hand-in-hand. What
impacts one is going to impact the other. She opined that it
really is a matter of time before individuals qualify for
Medicaid when changes are made that limit insurance
availability. She said when looking at marketplace plans, and
Medicaid expansion combined, about 50,000 Alaskans are covered
through one of the programs. She referenced a meeting where
providers and insurance companies all said losing Medicaid
expansion would eliminate a cushion that will impact their
ability to participate in reform opportunities and to creatively
do things.
2:50:00 PM
SENATOR BEGICH remarked that the previous year's work by DHSS,
Senator Giessel and the Legislature in getting SB 74 passed had
a profound impact that resulted in Commissioner Davidson getting
"a seat at the table" in being able to define where the policy
goes in the future. He asked if his assertion is true.
COMMISSIONER DAVIDSON concurred and noted that the result was
due to DHSS being aggressive and progressive as well as its
partnership with the Legislature on reform efforts. She added
that Alaska benefits from its political position with Senator
Murkowski being on the Health, Education, Labor and Pensions
(HELP) Committee. She added that Alaska also benefited from the
Affordable Care Act through Section 1945 to demonstration
programs like Health Homes, 1915 (k) and (c) options, in
addition to the authorities and resources made available to DHSS
and its partners to do a better job of community-health
surveillance and emergency preparedness. She added that DHSS's
instate partner, the Division of Insurance, is pursuing a 1332
Waiver with CMS to allow for high-risk pools, and the
Legislature's passage of critical legislation that allowed DHSS
to stabilize insurance plans. She summarized that DHSS
recognizes that some change is going to happen, and the
department is committed to being at the table to move forward
and get the best deal possible for Alaska.
2:52:40 PM
COMMISSIONER DAVIDSON said DHSS is concerned about Medicaid
block grants for states. She noted that typical comments in
favor of block grants claim the following:
· Great deal for states,
· Flexibility to tailor programs to meet needs,
· Payment based on a per capita rate.
She remarked that the favorable comments may sound great, but
DHSS sees block grants as a mechanism to shift federal
responsibility to states. She said DHSS has seen Medicaid block-
grant proposals that do not favor Alaska and favor states with
the following attributes:
· High population,
· Concentrated in a relatively small number of urban centers,
· Travel or access to care is not an issue,
· Health care is provided pretty much the same,
· No large tribal population,
· Relatively stable economy.
She addressed block-grant allocation concerns as follows:
· Alaska's small population dispersed throughout a large
geography will always make travel a consideration. Alaska
is going to lose under a realm that does not take travel
into consideration.
· 20 percent of Alaska's population are IHS beneficiaries and
part of the federal trust responsibility should be paid at
100-percent match and not counted against the state's grant
allocation.
· Alaska's creative health-care delivery through community-
health aides, behavioral-health aides, or dental health
aides in small communities, all the way up to advanced-
hospital care; those are two very different things.
· Allocations for Medicaid enrollees are made at the
beginning of the year and Alaska cannot catch up to
increasing enrollees during a continued economic downturn
until the following year.
· Considerations made for high-cost states versus low-cost
states.
COMMISSIONER DAVIDSON summarized that Medicaid changes
continuously occur.
2:56:34 PM
CHAIR WILSON asked if DHSS has come up with contingency plans.
COMMISSIONER DAVIDSON answered that DHSS is working on
contingency plans, but there are several possibilities. She
noted that there are three versions of the bill with 400
different possibilities. She said DHSS has asked Alaska's
delegation to review all allocations over a five-year period.
She opined that block grants will look great for the first year,
but allocations for the second through fifth years will
diminish.
2:59:06 PM
CHAIR WILSON thanked Commissioner Davidson and reviewed the
committee's agenda for future meetings.
2:59:37 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Committee at 2:59 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 20170127_Senate HSS.pdf |
SHSS 1/27/2017 1:30:00 PM |
DHSS presentation on Medicaid Reform |