SENATE BILL NO. 58 "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." 2:24:17 PM EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH, relayed that Dr. Zink was currently in another committee meeting and would join as soon as she was able. Co-Chair Foster asked for a quick summary of the bill. Ms. Ricci replied that the bill would extend Medicaid coverage for postpartum mothers from 60 days to 12 months. Representative Stapp MOVED to ADOPT Amendment 1, 33- GS1583\A.1 (Dunmire, 4/25/23) (copy on file) [note: due to the amendment length it has not been included here. See copy on file for details]. Co-Chair Foster OBJECTED for discussion. Representative Stapp explained the amendment. The amendment would increase eligibility of postpartum coverage from 200 percent to 225 percent of the federal poverty line. He explained there was a certain population of individuals in between income requirements who did not quite make enough money to afford health insurance, but during the expansion of the postpartum coverage they may fall into a category with no health insurance coverage. He stated it was his goal to help make Alaska one of the most pro-family states in the union. He thought the best way to do so was to ensure certain coverage was extended to segments of the population who were unable to get quality healthcare because they effectively made $3 more an hour. The amendment would cover more of those women and would allow them to have quality healthcare. Co-Chair Foster asked what the impact to the fiscal note would be. Representative Stapp answered that so far the amendment would add an additional $1.5 million to the bill and would cover up to 450 more women. Co-Chair Foster observed that the federal portion was $6.4 million and the state portion was $2.6 million. He asked about the federal/state funding breakdown. Representative Stapp answered it was the state GF, which leveraged substantial federal funding through the Medicaid program. He detailed that the Federal Medical Assistance Percentage (FMAP) was 70 percent with 30 percent funded by the state. 2:28:54 PM Representative Galvin fully supported the amendment. She did not think it was possible to do enough given current data with regard to children and pregnant moms and rates of issues downstream. She asked about any assessment on the savings given upstream healthcare costs. DR. ANNE ZINK, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH, answered that savings would be hard to calculate for the bill. However, the department had submitted data showing the best return on investment for kids and moms would result in the first year of life. She highlighted the importance of supporting the mental and physical health of mothers, which in turn impacted adverse childhood experiences. She shared statistics indicating that 26 percent more children would receive their first well child checks if their mom had access to health insurance. There was evidence of dental care and immunizations being able to move upstream along those lines. She relayed that the national CBO [Congressional Budget Office] looked at the long-term savings and included the service as an option due to its importance moving forward as a country. She stated that it was challenging to calculate the savings for Alaska and therefore it was not included in the fiscal note. The fiscal note only included the cost associated with people using care. She noted the number of people using the care would be very small. 2:31:46 PM Ms. Ricci spoke to the proposed amendment. Initially the department had looked at the number of women between the ages of 15 and 45 in Alaska and based on the community population survey, the department determined there were about 7,000 women with an income between 200 and 220 percent of the federal poverty level. There were approximately 64.3 births per 1,000, resulting in approximately 450 births per year in the population. The department had then applied the $566 per mother per month to the 450 births per year that would be covered under the amendment. The calculation applied coverage to nine months of pregnancy and 12 months of postpartum coverage. The estimate was still being dialed in, but it was approximately $5.3 million. The state would be responsible for 20 percent, estimated at $1.5 million. Representative Galvin appreciated the responses, which were helpful for the committee to understand the full picture when thinking about how to expand and provide better services, particularly in light that the implementation could not take place for over a year. She considered the opportunity to provide additional coverage to 450 women and believed it would result in less emergency care. Additionally, she thought about the importance of early identification of learning issues with regard to the education system. She highlighted the downstream cost associated with remedial work within education and how the costs had been considered on a national level. She believed there may be some available numbers for national savings with regard to making the investment early. She looked forward to hearing how the program went and was interested in local Alaska data. She could not think of anything more important in terms of an investment. 2:34:46 PM Representative Hannan referred to Representative Stapp's explanation that Amendment 1 would move from 200 to 225 of the federal poverty line. She noted the brackets in the amendment specified the number 175. She presumed the figure reflected current statute. Representative Stapp replied that Alaska's effective statutes regarding many of the Medicaid rates were not accurate. Following the passage of Medicaid expansion, the Centers for Medicare and Medicaid Services (CMS) required the state to cover people at higher levels of poverty line. He explained that most of the statutes did not reflect the change. He deferred to the department for additional detail. Ms. Ricci responded that in 2014 there had been nationwide changes in the Medicaid program and income levels were calculated based on modified adjusted gross income (MAGI). States were required to adopt the change for certain Medicaid categories, resulting in an effective 200 percent rate of the federal poverty level. Representative Hannan highlighted the importance of ensuring babies' safety. She noted the increase [proposed in the amendment] was much smaller in reality than when compared to statute. She supported the amendment and the bill. 2:36:58 PM Representative Ortiz thanked Ms. Ricci for her explanation of how the department arrived at the 450 [births per year in Alaska within the particular population]. Representative Coulombe thanked Representative Stapp for proposing the amendment. She appreciated the detailed work to ensure the bill covered many women as possible. Representative Josephson referenced Ms. Ricci's statement that the department was still vetting the number included in its fiscal note. He asked for verification the number would be in the range of $1.5 million. Ms. Ricci replied that it was what the department believed based on the numbers. The department was currently working with its divisions to ensure it had contemplated any additional unintended cost. The department was also working actively with CMS to ensure it understood any changes that the federal agency may require. She confirmed that the department anticipated the cost would be approximately $5.3 million total cost including approximately $1.5 million in undesignated general funds. Representative Josephson asked for verification there was nothing under Title 42 (the U.S. code) or CMS that would prohibit going to the proposed rate. Ms. Ricci confirmed there was nothing she was aware of that would prohibit the change. She noted there were several other states that had implemented rates at the same level or higher. She noted it was a matter of clearly understanding the process CMS required in order for the state to make the changes. 2:38:57 PM Dr. Zink emphasized that the estimates looked at previous services a mother needed and used. She clarified it did not mean it was the amount that would be spent or had to be spent. There was a lot of work being done by the Department of Health to decrease the need in order to be able to move upstream to create preventative services outside of the specific area. Co-Chair Foster WITHDREW the OBJECTION. There being NO further OBJECTION, Amendment 1 was ADOPTED. Co-Chair Edgmon MOVED to REPORT HCS SB 58(FIN) out of committee with individual recommendations and the accompanying fiscal notes. There being NO OBJECTION, it was so ordered. HCS SB 58(FIN) was REPORTED out of committee with a "do pass" recommendation and with two new fiscal impact notes from the Department of Health.