HB 185-MEDICAL ASSISTANCE; FAMILY PLANNING  3:48:31 PM CO-CHAIR MINA announced that the next order of business would be HOUSE BILL NO. 185, "An Act relating to medical assistance eligibility for family planning services; and providing for an effective date." 3:49:02 PM REPRESENTATIVE CAROLYN HALL, Alaska State Legislature, as prime sponsor, gave the sponsor statement for HB 185 [included in the committee file], which read as follows [original punctuation provided]: House Bill 185 will create a Family Planning State Plan Amendment that expands Medicaid coverage to provide family planning services to Alaskans. Since 2001, Alaska has had the highest rate of infant mortality and rising preterm birth rates in the U.S.. Currently, Alaskans at or below 138% of the federal poverty level (FPL) qualify for full Medicaid coverage. To qualify for Medicaid pregnancy coverage, Alaskans must be at 200% FPL. This bill would expand the eligibility limits to 225% FPL. HB 185 will be a cost-effective investment for Alaska, the Federal Government pays 90% of Medicaid's family planning services, with a 10% match from the state. The state will save $7 for every one dollar it spends on family planning for unintended pregnancy costs and long-term social services costs under Medicaid expansion. The Family State Plan Amendment will improve birth outcomes, empower Alaskans to decide whether to grow their families, and reduce infant mortality and preterm birth rates. Additionally, with this expansion of Medicaid, preventive screenings for STIs, HIV, cervical, and breast cancers will be included. REPRESENTATIVE HALL moved to a PowerPoint presentation, titled, "House Bill 185: Medical Assistance Eligibility for Family Planning Services" [hard copy in the committee file]. She moved to slide 2, an introduction, which read as follows [original punctuation provided]: ? Federal Government pays 90% of Medicaid family planning services; 10% match from the state. ? State will save $7 for every one dollar spent on family planning. ? The SPA will: ? improve birth outcomes ? empower Alaskans to decide whether to grow their families ? reduce infant mortality and preterm birth rates. ? Additional services: preventive screenings for sexually transmitted infections, HIV, & cervical and breast cancers. REPRESENTATIVE HALL moved to slide 3, an overview of a state plan amendment, which read as follows [original punctuation provided]: ? An agreement between a state & the Federal government describing how the state administers its Medicaid and Children's Health Insurance Programs (CHIP). ? Assures a state will abide by Federal rules & may claim matching funds. ? The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state. REPRESENTATIVE HALL moved to slide 4, titled "Why do we need a Family Planning State Plan Amendment (SPA) in Alaska?" She read the bullet points from slide 4, which read as follows [original punctuation provided]: ? Highest rates of infant mortality in U.S. since 2001. ? Alaska's preterm birth rate is rising among Medicaid enrollees. ? Currently, eligible Medicaid families are at 138% of the Federal Poverty Level (FPL). REPRESENTATIVE HALL moved to slide 5, an overview of the federal poverty line, which read as follows [original punctuation provided]: ? Indicates the minimum amount of annual income that an individual / family needs to pay for essentials. ? Based on the size of a household and where someone lives. ? Alaska and Hawaii have higher Federal Poverty Levels due to the higher cost of living. To qualify for Medicaid pregnancy coverage Alaskans must meet 200% FPL. HB185 would expand eligibility limits to 225%. REPRESENTATIVE HALL moved to slide 6, titled "Where did the 225% come from?" She read the bullet points from slide 6, which read as follows [original punctuation provided]: ? Model language for the 225% FPL was inspired by 2023 legislation: HCS SB 58. ? HCS SB 58 extended postpartum Medicaid coverage for new mothers from 60 days to 12 months. Goal: lower and eliminate Alaska's high rate of infant mortality. REPRESENTATIVE HALL moved to slide 7 and drew committee members' attention to a line graph representative of preterm birth rates in Alaska and the United States from 2000 - 2023. She noted the increase in preterm births in Alaska since 2012, particularly for Alaska Natives. REPRESENTATIVE HALL moved to slide 8 and gave an overview of infant mortality rates in Alaska. Slide 8 read as follows [original punctuation provided]: ? Based on data from the Alaska Department of Health (DOH) Alaska's infant mortality rate is "43-83 deaths per year." ? The DOH reported that deaths within 27 days ("neonatal mortality rate") have been lower than the U.S. average and deaths from 28 days to 1 year ("postneonatal mortality rates") have been higher than the U.S. average. ? 2022: "Alaska's infant mortality rate per 1,000 live births: 6.6 (35th nationally); U.S. average: 5.6." ? 2023: "Alaska's infant mortality rate per 1,000 live births: 7.3 U.S.: 5.6" 3:58:55 PM REPRESENTATIVE HALL, in response to a question from Representative Prax, stated that the maximum income for eligibility would be 225 percent of the federal poverty line under HB 185. 3:59:57 PM REPRESENTATIVE SCHWANKE asked, under HB 185, what mechanism would reduce the number of preterm births. REPRESENTATIVE HALL responded that the mechanism would be increased family planning services, available in person or via telehealth. She noted that HB 185 would particularly help those living in rural Alaska, increasing their access to healthcare. REPRESENTATIVE SCHWANKE noted that the opportunity for induced births has increased in rural Alaska and that it is very common for rural Alaskans to be asked to come into towns early to prepare for birth. She asserted that preterm births could be intentionally done. 4:01:53 PM REPRESENTATIVE GRAY noted that the fiscal note is very large and stated his confusion regarding it. He listed the costs of several contraceptives. He asked where the high cost of HB 185 would come from. REPRESENTATIVE HALL deferred to her staff to answer Representative Gray's question. 4:03:24 PM JAYLY JACKSON, Staff, Representative Carolyn Hall, on behalf of Representative Hall, prime sponsor, noted that there are two fiscal notes. He said that part of the cost is related to administrative services and part is for the actual Medicaid services. He deferred to the Department of Health (DOH) to answer the remainder of Representative Gray's question. 4:04:24 PM KRISTIN DELFINO, Division Operations Manager, Division of Healthcare Services, Department of Health, explained that the fiscal note was calculated by generating the range of individuals [2,800 to 4,200] that may be eligible under the proposed legislation. She said that the average of that range, 3,500, was multiplied by the average cost for the current individuals eligible for family planning services, which is about $600. 4:05:50 PM REPRESENTATIVE FIELDS asked if the fiscal note covers only the costs, not savings, of HB 185. MS. DELFINO confirmed that is correct. REPRESENTATIVE FIELDS responded that this is part of a structural problem, which extends beyond HB 185. 4:06:24 PM MS. DELFINO, in response to questions from Representative Gray, explained that $600 is the current average annual cost per Medicaid member for family planning services. She stated that $600 was then used to calculate the fiscal note for HB 185. Ms. Delfino stated that it was anticipated that the 3,500 would be new individuals not currently covered by Medicaid. She added that people on Medicaid already receive birth control and family planning services. 4:09:56 PM MS. DELFINO, in response to Representative Prax, stated that the fiscal impact was calculated under the assumption that the 3,500 new individuals would be eligible only for family planning services under Medicaid. 4:10:56 PM CHAIR MINA announced invited testimony. 4:11:19 PM CLAUDIA HAINES, CEO, stated that Kachemak Bay Family Planning Clinic (KBFPC) provides reproductive healthcare, sexual health education, and family planning services to individuals with low incomes. She said that reproductive healthcare is vital to a person's wellbeing. She stated that 66 percent of KBFPC clients rely on KBFPC for their healthcare and have no other primary care provider, 30 percent are covered by Medicaid, and 24 percent have no insurance coverage. She added that since last July, over 100 women have enrolled in the Alaska Breast and Cervical Screening Assistance Program and many more have received cancer screenings and follow-up care because of the program. Ms. Haines stated that Alaskans experience high sexually transmitted infection (STI) rates and high infant mortality rates, which are directly linked to lack of access to family planning services. She said that addressing these serious public health issues requires long-term solutions and strong partnerships. 4:14:29 PM ROBIN HOLMES, MD, Medical Director, Kachemak Bay Family Planning Clinic, said that preterm births from induction are due to pregnancy complications. She stated that clients at her clinic come to the clinic because of the accessibility. She said that even if family planning services are guaranteed under Medicaid, many clients do not go to primary physicians for several reasons, including long distances and a lack of sliding scale services. She stated that her clinic provides STI screening, cervical screening, contraceptives, and family planning. She described her typical day at the KBFPC and the variety of resources she may provide in just one day. She said she believes it is important to eliminate as many barriers as possible to family planning services. 4:18:34 PM REPRESENTATIVE RUFFRIDGE noted that there is administrative code that defines a family planning service. He asked how that term would be defined under HB 185. 4:19:44 PM MS. DELFINO replied that she would get back to the committee. 4:20:06 PM REPRESENTATIVE RUFFRIDGE requested a definition of child-bearing age. He stated that he was under the impression that the proposed legislation would only apply to women and asked if it would also cover men. REPRESENTATIVE HALL responded yes. REPRESENTATIVE RUFFRIDGE asked what the [reproductive age range] is for men. REPRESENTATIVE HALL responded that she does not know but that is a very good question. 4:22:20 PM DR. HOLMES replied that under Title X, there are federal definitions. She noted that men are [in reproductive range] for a long time. She said that if a man could get an individual pregnant or pass on an STI, then he is deserving of her clinic's services. She emphasized that it is important for men to also have access to family planning services. 4:24:04 PM REPRESENTATIVE RUFFRIDGE referenced a bill from the Thirty-Third Alaska State Legislature regarding increasing the upper limit for receiving family planning coverage to 225 percent of the federal poverty line. He said that legislation expanded coverage to people who are pregnant. He asked what the goal is of providing care to people before they become pregnant. REPRESENTATIVE HALL responded that the goal of HB 185 is to provide preventative care. She emphasized that STIs, cervical and breast cancer screenings are all important services for an individual to access before having a family. REPRESENTATIVE RUFFRIDGE asked for clarification that the proposed legislation is not expansion for all Medicaid services, just family planning services. 4:26:35 PM MS. DELFINO replied that that is correct and the fiscal note was calculated based on that assumption. 4:27:02 PM REPRESENTATIVE SCHWANKE noted that Alaska has a lower-than- average infant mortality rate for infants under 28 days old, but higher for infants between 28 days and 12 months old. She asked what might be causing that. 4:28:03 PM DR. HOLMES replied that she was unsure. She noted that there are a lot of babies born prematurely and spend more time in hospitals and, upon returning home, they have less access to resources. 4:29:00 PM REPRESENTATIVE GRAY said that this conversation is analogous to the baby box conversation. He stated that it makes sense to expand care for pre-pregnant women and that it is important to have established care before becoming pregnant. 4:30:03 PM REPRESENTATIVE HALL, in response to Representative Prax, stated that other screenings could include STI screenings, breast and cervical cancer screenings. She further deferred to Dr. Holmes. DR. HOLMES responded that most of the evidence for lowering infant mortality rates involves improving birth conditions and reducing preterm births. She said that while birth control is one important aspect of healthy family planning, it is not the only. She said other services include STI screenings and cervical/breast cancer screenings. She noted that Alaska has very high rates of STIs compared to the rest of country, including gonorrhea and syphilis. 4:32:41 PM REPRESENTATIVE HALL, in response to a series of questions from Representative Prax, stated that Senate Bill 58 from the 33rd Legislature covered expansion of services for pregnant people. She said that requiring insurance to cover birth control would be a different concept. She noted that the proposed legislation would expand only Medicaid family planning services. Representative Hall added that HB 185 would expand services to people who are not covered by insurance and that approximately 3,500 Alaskans would have greater access to healthcare, which would address the high infant mortality rates. 4:36:52 PM CHAIR MINA noted there was a public health notice put out last year encouraging people of child-bearing age to get tested for STIs, given that Alaska has some of the highest rates of syphilis in particular. [HB 185 was held over.]