HOUSE BILL NO. 59 "An Act relating to Medicaid eligibility; expanding eligibility for postpartum mothers; conditioning the expansion of eligibility on approval by the United States Department of Health and Human Services; and providing for an effective date." 1:50:46 PM Co-Chair Foster requested a brief summary of the legislation and a review of the fiscal notes. EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH, explained that the bill would extend postpartum coverage from 60 days to 12 months. The department provided an overview and presentation of the bill to the committee the previous week. She reviewed the fiscal note OMB component number 3234, control code IgvwY. The fiscal note was based on an FY 25 starting date, which would provide the Department of Health (DOH) sufficient time to enact the regulatory and federal state plan amendment changes necessary to extend coverage from 60 days to 12 months. She remarked that the department would do the work faster if possible. The total estimated funds were around $9 million, which included anticipated claims costs contained on the Medicaid Services line with a combined funding source of $6.4 million in federal receipts and $2.6 million in UGF annually. She added the costs could change depending on the actual experience incurred by individuals over the next year to five years. The funding ratio reflected approximately 28 percent UGF match to 72 percent federal receipt authority. There were no positions requested in the fiscal note. Ms. Ricci reviewed an analysis of underlying the claims assumptions created by DOH. She relayed that the Division of Health Care Services looked back at 2018 through 2020 to identify the number of women who had a gap in coverage or lost coverage between the 60-day mark and the proposed 12- month period. There were a total of just over 3,600 beneficiaries who lost or experienced a gap in coverage during the time period. She detailed that just under 1,600 of the total lost coverage completely after the 60-day period and did not reenroll in the Medicaid program through another eligibility category. She explained that the individuals may have had other coverage, remained uninsured, or could have participated in the federal exchange. About 2,000 of the total experienced a gap in coverage between the 60-day period and 12-month period. She elaborated that perhaps individuals were disenrolled after that 60-day period but were reenrolled in another Medicaid eligibility category two to five months later (sometime between the 60 days and 12 months). Ms. Ricci continued to explain the methodology behind the numbers in the fiscal note. The department looked at the number of beneficiaries who had lost coverage or had a gap in coverage and had calculated what the estimated monthly cost would be without a gap or discontinuation of coverage for individuals during the time period [between 60 days and 12 months]. The cost was calculated to be approximately $566 per beneficiary per month. The department then applied the different federal match that would be available depending on the category of eligibility the individual may be covered under. For example, the typical match was 50 percent federal/50 percent state; however, tribal health members or beneficiaries received 100 percent federal match. Based on the information, the division estimated $9 million in additional claims with approximately 28 percent state match to 78 percent federal match. 1:55:51 PM Representative Josephson considered a scenario where the program coverage time could be extended more rapidly. He used a January 15 [2024] start date as an example. He asked if the department would bring it online and seek supplemental funding. He communicated eagerness to get going. Ms. Ricci answered that the department did not ever intend to seek to ask for supplemental funding; DOH tried to make sure its budget aligned with its estimated costs. She believed in the event the department was able to bring the extended coverage online earlier, DOH would work with its team managing federal receipt authority and general funds to ensure the additional costs could be covered. She highlighted the importance of estimating claims costs and building them into the foundational budget when extending coverage long-term. Representative Josephson stated that the presentation had made a real impression on the committee, which was the reason for his question. Representative Galvin requested follow up information from the department depicting the timeline for the implementation process. She offered to help in any way. 1:58:01 PM Co-Chair Foster OPENED public testimony. BROOKE IVY, VICE PRESIDENT, POLICY AND ADVOCACY, ALASKA CHILDREN'S TRUST (ACT), ANCHORAGE (via teleconference), relayed that ACT was the statewide lead agency on the prevention of child abuse and neglect in Alaska. The agency fully supported extending postpartum coverage to 12 months. She stated it was a perfect example of primary prevention and it could not align more with ACT's mission. She elaborated that extending the coverage would give new moms more time to deal with any post-birth health issues such as postpartum depression, which often did not occur until six months or more after a baby was born. She stated that 41 percent of the child abuse cases in Alaska involved children from birth to four years of age, with children from birth to one as the highest risk. Postpartum depression was associated with an array of negative outcomes including decreased child safety practices, decreased child checkups, and bonding difficulty between mother and child. The bill would reduce maternal mortality rates and would protect new parents from medical debt in the first year of their child's life. She relayed that th Alaska ranked 44 in the nation in health. The agency was excited to see Alaska join over 35 other states to make the extension permanent. She urged swift passage of the legislation. Co-Chair Foster stated the committee would return to Ms. Ivy after the next testifier. Co-Chair Foster noted that Representative Ortiz had joined the meeting. 2:00:56 PM JAMIE MORGAN, GOVERNMENT RELATIONS REGIONAL LEAD, AMERICAN HEART ASSOCIATION (AHA), SACRAMENTO, CALIFORNIA (via teleconference), testified in favor of the legislation. She relayed that maternal mortality rates had more than doubled in the United States. She detailed that instances in maternal morbidity had lasting health consequences and resulted in avoidable medical expenses. She stated action was needed to improve health outcomes for mothers and babies. The AHA recently released a policy statement call- to-action on maternal health and saving mothers. The statement set a new policy agenda to ensure healthy pregnancies, healthy births, and healthy moms. She relayed that extending postpartum Medicaid coverage was a key recommendation. The bill would ensure parents would have access to care during pregnancy and in the first full year after birth, providing parents and their babies the best possible start. The agency supported the bill and urged the committee's support. 2:02:51 PM Ms. Ivy continued her previous testimony. She relayed that postpartum depression was associated with an array of negative outcomes and the resulting bonding difficulty was a primary predictor of child abuse. The agency looked forward to seeing Alaska join more than 35 other states that had made the postpartum extension permanent. She urged swift passage of the bill due to the long implementation timeline. She thanked the governor for bringing the bill forward, the Senate for passing the bill to the House, and the committee for providing the opportunity to testify. Co-Chair Foster CLOSED public testimony. He reviewed the email address for public testimony. HB 59 was HEARD and HELD in committee for further consideration. Co-Chair Foster relayed the committee would await the Senate bills the following week. He reviewed the schedule for the following day.