HB 151-MEDICAL ASSISTANCE: CHILDREN UNDER AGE 6  3:49:51 PM CHAIR MINA announced that the only order of business would be HOUSE BILL NO. 151, "An Act relating to continuous eligibility for medical assistance for children under six years of age; and providing for an effective date." 3:50:12 PM REPRESENTATIVE MEARS moved to adopt the proposed committee substitute (CS) for HB 151, Version 34-LS0571\N, A Radford, 3/29/25, as a working document. CHAIR MINA objected for the purpose of discussion. 3:50:50 PM ALYSE GALVIN, Alaska State Legislature, as prime sponsor, presented HB 151. She stated that HB 151 would mitigate unnecessary disruptions in access to care for children receiving Denali Kid Care. She said that HB 151 would guarantee continuous eligibility for children under the age of 6. She explained the difference between the original bill version and HB 151, Version N. She stated that the language in the original version of HB 151 incorporated federal laws, while Version N more accurately ensures that the state can use all tools available to it. 3:54:01 PM LACEY MATULA, Staff, Representative Alyse Galvin, Alaska State Legislature, on behalf of Representative Galvin, prime sponsor, presented the sectional analysis of HB 151 [hard copy included in the committee file], which read as follows [original punctuation provided]: Section 1-  This section will ensure that children under six do not lose their Medicaid Benefits due to re-evaluations or other administrative processes, providing continuous coverage for them until they reach six- years-old.   Section 2-  This section outlines the necessary permissions and approvals from the United States Department of Health and Human Services (HHS) to make the changes in Medicaid coverage happen. If the state does not get approval, the changes won't take effect.   Section 3-  This section will ensure that the new rule will only be implemented if the state gets approval from the federal government. It also sets a timeline for notifications, making sure that the change will only happen after federal approval is granted.   Section 4-  This section ensures that the change won't take effect until the federal government has officially approved it, which might take time. 3:58:15 PM CHAIR MINA removed her objection. There being no further objection, Version N was before the committee. 3:58:49 PM REPRESENTATIVE SCHWANKE asked what the process of reapplying for annual reauthorization would look like. 3:59:43 PM DEB ETHERIDGE, Director, Division of Public Assistance, Department of Health, described the difference between reapplication and recertification. She said that a recertification occurs when an individual has been receiving benefits, while a reapplication occurs when there has been a break in coverage. 4:00:26 PM REPRESENTATIVE SCHWANKE asked if an annual phone call was required for changes in coverage. MS. ETHERIDGE responded that DOH will do all possible to renew an individual's coverage for them, without having to send them a renewal form. She said that when needed, she will call families to complete a renewal form over the phone. 4:01:34 PM REPRESENTATIVE MEARS asked about how to reenroll families when it is difficult to contact them. MS. ETHERIDGE responded that during the pandemic individuals did not lose their Medicaid coverage because they were automatically reenrolled. However, that made it very difficult to reenroll many individuals as DOH did not have every individual's current contact information. REPRESENTATIVE MEARS noted that HB 151, Version N, would reduce those administrative burdens for children in Denali Kid Care moving forward. 4:04:03 PM REPRESENTATIVE GRAY thanked the sponsor for bringing forward a "common sense" bill. He asked how common it is for children between ages 0-6 to lose their Denali Kid Care and how many children would benefit under HB 151, Version N. MS. ETHERIDGE responded that children in foster care remain eligible for Denali Kid Care. She stated that 31,648 children ages 0-6 are currently covered. She said that she does not have the exact numbers right now to answer his questions. REPRESENTATIVE GRAY asked if HB 151, Version N, would benefit enough children so that the Division of Public Assistance would see a tangible impact. MS. ETHERIDGE responded that HB 151, Version N, would avoid a procedural closure for children who do still need Denali Kid Care, as they cannot self-advocate. 4:06:50 PM REPRESENTATIVE SCHWANKE asked if HB 151 would require parents to contact the state if their children no longer qualify for Denali Kid Care. MS. ETHERIDGE responded that DOH requires a notice of change for major changes to a family, which might affect their eligibility for coverage, and this also includes children covered by Denali Kid Care. 4:08:09 PM REPRESENTATIVE GALVIN asked about how to avoid situations where patients receive coverage from both their employer and Medicaid. MS. ETHERIDGE responded that Medicaid is the payer of last resort. She said that the primary payer would be the insurance company of the employer. 4:09:12 PM REPRESENTATIVE RUFFRIDGE asked approximately how many children aged 0-6 are currently on Denali Kid Care. MS. ETHERIDGE responded that 31,648 children aged 0-6 are currently covered. REPRESENTATIVE RUFFRIDGE asked how many children aged 0-6 are in the State of Alaska. MS. ETHERIDGE responded that she does not have that information currently available. REPRESENTATIVE GALVIN said that approximately 10,000 children are born each year in the state. REPRESENTATIVE RUFFRIDGE asked if the number of children on Denali Kid Care typically fluctuates much. MS. ETHERIDGE responded that she would need to gather that information. 4:11:02 PM REPRESENTATIVE GRAY said that parents typically self-disclose if they have insurance other than Medicaid. He said that there is no benefit to not disclosing that information. 4:11:57 PM REPRESENTATIVE SCHWANKE asked how many children on Denali Kid Care are receiving Medicaid benefits as a primary or third-party insurance. 4:13:06 PM TRICIA SKITT, Operations Manager, Division of Health Care Services, Department of Health, responded that she could look into gathering that data, but she can share data from fiscal year 24 regarding the percentage of Medicaid costs being utilized. 4:14:05 PM REPRESENTATIVE RUFFRIDGE asked when the last state plan amendment approval was for authorizing continuous eligibility and what that process looks like. MS. ETHERIDGE responded that it is a long process. She said there are a few state plan amendments DOH must make to accommodate a change in an application. REPRESENTATIVE GALVIN responded that she does not know how long this process has taken in other states. MS. ETHERIDGE responded that the change in continuous eligibility from 0-12 was a state plan amendment and that process can take anywhere from 180 days to one year. REPRESENTATIVE RUFFRIDGE asked if 1115 waivers expire. MS. ETHERIDGE responded that they typically expire after five years. REPRESENTATIVE RUFFRIDGE asked further about the expiration of 1115 waivers. MS. ETHERIDGE responded that generally those waivers continue as needed and are renewed every five years. REPRESENTATIVE RUFFRIDGE asked if the extension of coverage to individuals post-partum was under an 1115 waiver or a state plan amendment. MS. ETHERIDGE responded that the extension was under a state plan amendment. REPRESENTATIVE RUFFRIDGE asked why DOH would employ an 1115 waiver in this scenario, rather than a state plan amendment. MS. ETHERIDGE responded that that is a question for the federal government. 4:19:00 PM REPRESENTATIVE GRAY said that sometimes receiving 1115 waivers from the federal government is expedient. MS. ETHERIDGE responded that some state plan amendments can happen rather quickly, but some things take longer than others. 4:20:06 PM CHAIR MINA announced invited testimony on HB 151, Version N. 4:20:15 PM TREVOR STORRS, President & CEO, Alaska Children's Trust, testified in support of HB 151, Version N. He said that the bill would ensure that children aged 0-6 have access to the resources they need to thrive. He explained that HB 151, Version N, would benefit children, families, and the state by investing in its youth. He emphasized that coming on and off Medicaid creates an unnecessary burden to the state, and unnecessary barriers to the individual patient. 4:24:33 PM TAMAR BEN-YOSEF, Executive Director, All Alaska Pediatric Partnership, testified in support of HB 151, Version N. She said that more than half of children in Alaska are covered by Medicaid, and any gap in coverage can have negative impacts on children. She emphasized that health issues that are treated later rather than earlier cost more for Medicaid and that early intervention is vital. She also highlighted the reality of many seasonal workers, whose income may increase and decrease throughout the year, whose children would benefit from continuous coverage. She also noted that many other states have already enacted similar legislation to HB 151 and that Alaska should follow suit. 4:28:33 PM JACOLINE BERGSTROM, Executive Director, Health Services, Tanana Chiefs Conference, testified in support of HB 151. She provided an overview of the work Tanana Chiefs Conference and other tribal health services engage in and the communities they serve. She said that in her region, 57 percent of all children qualify for Medicaid, while even higher percentages of children qualify in more rural communities. She said that Alaska Native populations have health disparities compared to the general population. Ms. Bergstrom stated that other states that have implemented continuous Medicaid coverage for children have experienced a decrease in administrative burdens, and Alaska could expect these same results under HB 151. 4:36:03 PM CHAIR MINA asked about the cost-savings related to continuous eligibility that other states have experienced. MS. MATULA responded that she can find and provide information on those savings for the committee. [HB 151, Version N, was held over.]