Legislature(2009 - 2010)CAPITOL 106

03/09/2010 03:00 PM HEALTH & SOCIAL SERVICES

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              SB 13-MEDICAL ASSISTANCE ELIGIBILITY                                                                          
3:05:49 PM                                                                                                                    
CO-CHAIR KELLER announced  that the first order  of business would                                                              
be  SENATE   BILL  NO.  13,   "An  Act  relating   to  eligibility                                                              
requirements  for  medical  assistance for  certain  children  and                                                              
pregnant women; and providing for an effective date."                                                                           
3:06:34 PM                                                                                                                    
SENATOR  BETTYE DAVIS,  Alaska State  Legislature,  said that  she                                                              
would not address  the two proposed amendments,  but would instead                                                              
just give a brief  statement.  She wanted to ensure  that a Denali                                                              
KidCare bill  was passed this session.   She announced  that SB 13                                                              
asked  for the  household  income  definition for  eligibility  to                                                              
benefits be  defined as 200 percent  of the federal  poverty line.                                                              
She pointed  out that  the two proposed  amendments would  require                                                              
that the  bill return to  the Senate, and  she offered  her belief                                                              
that  the bill  would  then  not have  enough  time  to be  passed                                                              
during  this  session.    She declared  that  SB  13  would  offer                                                              
medical care  benefits for  at least 1300  children.   She pointed                                                              
out that Department  of Health and Social Services  (DHSS) and the                                                              
governor's  office  both  supported   the  income  definition  for                                                              
benefits to be 200 percent of the federal poverty line.                                                                         
3:10:10 PM                                                                                                                    
CO-CHAIR  KELLER noted  that currently,  if the  income level  was                                                              
exceeded by  $1, then the  total care was  lost.  He  suggested an                                                              
amendment for  "a co-pay ramp" which  would allow for  an increase                                                              
to income  level without  a total  loss of  benefits.   He pointed                                                              
out that there  were federal requirements to the  allowable co-pay                                                              
3:11:59 PM                                                                                                                    
REPRESENTATIVE  CISSNA,  noting   that  childhood  obesity  was  a                                                              
problem  in   Alaska,  asked  if   the  increase  to   the  income                                                              
definition for eligibility would help this population.                                                                          
3:12:45 PM                                                                                                                    
SENATOR DAVIS  said that she did  not know of any study,  but that                                                              
Denali KidCare would cover children with medical problems.                                                                      
3:13:25 PM                                                                                                                    
REPRESENTATIVE T.  WILSON asked how  the estimate of help  to 1300                                                              
children was determined.                                                                                                        
3:13:41 PM                                                                                                                    
SENATOR DAVIS said that DHSS would explain the fiscal note.                                                                     
3:13:55 PM                                                                                                                    
CO-CHAIR KELLER  opened public  testimony.  He  stated that  SB 13                                                              
was not a discussion  of coverage for children, but  a question of                                                              
"who  pays  for it  and  at what  level."    He relayed  that  the                                                              
current qualifying  income was 175 percent of  the federal poverty                                                              
line (FPL).   He  equated this  to be  a $24/hour  job for  a 2000                                                              
hour  work year  for a  family of  four.   He  explained that  the                                                              
discussion  was to raise  this qualifying  income level  to become                                                              
200 percent  of the federal poverty  line, which he equated  to be                                                              
a $27.50/hour job  for a family of four.  He pointed  out that the                                                              
discussion  was  for the  criteria  for  payment, not  for  health                                                              
3:15:44 PM                                                                                                                    
SENATOR DAVIS,  in response  to Co-Chair  Keller, emphasized  that                                                              
the discussion  was for the cost to  cover a family of  four.  She                                                              
directed  attention  to  the  Executive   Summary  of  the  Kaiser                                                              
Commission  on  Medicaid  and  the   Uninsured  [Included  in  the                                                              
committee  packets.] and  specified that  Alaska was  one of  only                                                              
[four] states with  eligibility criteria of less  than 200 percent                                                              
of  FPL, which  she stated  was the  bottom.   She reflected  that                                                              
Alaska had  a criterion of 200 percent  of FPL in the  1990's, but                                                              
that this was  lowered to 175 percent  and then was eroded  to 156                                                              
percent.   She pointed out  that 70 percent  of the  funding comes                                                              
from the  federal government.   She offered  her belief  that 9000                                                              
children  were enrolled  under Medicaid  and  Denali KidCare,  and                                                              
she declared the  state capable of increasing the  FPL which would                                                              
increase  the   number  of  children   with  health  care.     She                                                              
reiterated that the  state only paid 30 percent of  the cost, with                                                              
the federal government paying the remaining 70 percent.                                                                         
3:18:42 PM                                                                                                                    
CO-CHAIR  KELLER  replied that  Department  of Health  and  Social                                                              
Services  (DHSS) would  compare  the Medicaid  and Denali  KidCare                                                              
3:18:55 PM                                                                                                                    
REPRESENTATIVE  T. WILSON  asked  if the  eligibility  requirement                                                              
for most states was income based.                                                                                               
3:19:24 PM                                                                                                                    
SENATOR  DAVIS,  in response  to  Representative  T. Wilson,  said                                                              
that  there  were a  variety  of  state  plans.   She  offered  to                                                              
provide that information.                                                                                                       
3:19:58 PM                                                                                                                    
DONNA GRAHAM  said that  her congregation  had heard  overwhelming                                                              
testimony from neighbors  and friends about the  lack of insurance                                                              
for children.   She  testified in  support of SB  13.   She agreed                                                              
that the  co-pay concept was  a good idea,  but she  stressed that                                                              
it was most necessary  to pass SB 13, which would  allow 1300 more                                                              
children  to   qualify  for  health   insurance.     She  directed                                                              
attention  to her  nursing background  and  shared that,  although                                                              
Alaska  was a wealthy  state, many  children  did not have  health                                                              
3:22:07 PM                                                                                                                    
MATTHEW TENNANT  suggested that doctor consultations  by telephone                                                              
would cut health care costs and save time.                                                                                      
3:23:53 PM                                                                                                                    
MICHAEL MARKOVICH  said that  he had been  working on this  for 11                                                              
months.   He stated  that he was  now a  disability advocate.   He                                                              
declared  that Representative  Tuck  would  sponsor an  amendment.                                                              
He shared  that his two children  were covered by  Denali KidCare.                                                              
He announced  that he was poor  and disabled, and did  not receive                                                              
any respect.   He  stated that  he did  not have  a platform,  but                                                              
that  he wanted  to  use SB  13  as a  platform  for his  proposed                                                              
amendments.   He said  there would  be a  continual struggle,  for                                                              
families similar to  his own, of "falling through  the system" and                                                              
that there would  be more crime and more homelessness.   He stated                                                              
that  he  wanted  fairness  in  the  system.    He  explained  his                                                              
personal family  situation.   He pointed out  that Alaska  did not                                                              
follow the  [federal] poverty  level.  He  stated his  support for                                                              
an increase  to 200 percent  of the FPL.   He referred to  his two                                                              
written testimonies  titled SB  13 Amendments.   [Included  in the                                                              
committee packets.]                                                                                                             
3:34:19 PM                                                                                                                    
LAURIE  MORRIS, United  Way Anchorage  Partner Agencies,  reported                                                              
that  she  spoke  for  28  Anchorage  United  Way  Agencies  which                                                              
represented  a  large spectrum  of  missions  and services.    She                                                              
stated that all  the partner agencies supported  the reinstatement                                                              
to 200 percent of  federal poverty level for Denali  KidCare.  She                                                              
confirmed  that   the  Anchorage   United  Way  partner   agencies                                                              
supported SB 13.                                                                                                                
3:35:20 PM                                                                                                                    
SHARON  SCOTT, Grant  Manager,  Mat-Su Health  Foundation,  stated                                                              
that  the  Foundation's  mission  was to  enhance  the  health  of                                                              
Alaskan's living  in the Matanuska-Susitna Borough.   Referring to                                                              
the 2006- 2008  census survey, she pointed out  that 10000 Alaskan                                                              
children, 18  years or younger, were  at or below the  200 percent                                                              
FPL and  were uninsured, which reflected  a 31 percent  decline in                                                              
children  covered  by  health  insurance.   She  noted  that  this                                                              
included  1530   children  in  Matanuska-Susitna  Borough.     She                                                              
pointed  to  an  increase  in the  statistics  of  these  children                                                              
missing school, and  not having a family doctor.   She stated that                                                              
an increase  to 200  percent FPL  would offer  health care  access                                                              
for more  families  and children.   She declared  that the  number                                                              
one goal for  the Mat-Su Health Foundation was  to reduce barriers                                                              
to health  care access.  She  directed attention to  the unanimous                                                              
resolution  supporting  Denali  KidCare    income  eligibility  to                                                              
increase  to 200 percent  FPL by  the Board  of Directors,  with a                                                              
cost  sharing option  for those  incomes of  200-300 percent  FPL.                                                              
She reported  that the Mat-Su  Health Foundation was  sponsoring a                                                              
Denali  KidCare   enrollment  initiative,   to  ensure   that  all                                                              
eligible   children   in  the   Matanuska-Susitna   Borough   were                                                              
3:37:54 PM                                                                                                                    
CO-CHAIR  KELLER asked  how many  of the  1500 children  currently                                                              
not covered by  health insurance in the Matanuska-Susitna  Borough                                                              
would be covered with an increase to 200 percent of FPL.                                                                        
3:38:17 PM                                                                                                                    
MS. SCOTT  replied that all of  these children were under  the 200                                                              
percent  FPL, but,  in response  to Co-Chair  Keller, she  did not                                                              
know how many were under the 175 percent FPL.                                                                                   
3:38:34 PM                                                                                                                    
JODYNE  BUTTO,  President,  Alaska  Chapter  American  Academy  of                                                              
Pediatrics,  shared   that  she   was  representing   the  Alaskan                                                              
pediatricians.    She  stated  that  the  academy  had  long  been                                                              
advocates for child  health care, and had been  working every year                                                              
to  bring  the  FPL  back  up to  200  percent  and  above.    She                                                              
supported co-pay  above the  200 percent FPL.   She  stressed that                                                              
Alaska had  the most  stringent qualifications  of any  state, and                                                              
that we needed to  take care of our children.   She stated support                                                              
for SB 13.                                                                                                                      
3:40:23 PM                                                                                                                    
REPRESENTATIVE  CISSNA  asked  if  this  would help  to  stem  the                                                              
obesity problem.                                                                                                                
3:41:04 PM                                                                                                                    
DR. BUTTO  replied that there was  a childhood obesity  task force                                                              
that  had made  some  recommendations  to  be offered  during  the                                                              
screening of children.   She said that children  could be referred                                                              
to a  nutritionist, which  was paid  for by  Denali KidCare.   She                                                              
said  that regular  access to  a  primary care  physician was  the                                                              
most important issue.                                                                                                           
3:42:30 PM                                                                                                                    
REPRESENTATIVE  T.  WILSON asked  how  Alaska was  more  stringent                                                              
than other states.                                                                                                              
3:42:44 PM                                                                                                                    
DR.  BUTTO, in  response to  Representative T.  Wilson, said  that                                                              
Alaska  included  asset  allocations  for  eligibility,  but  that                                                              
other states did not.                                                                                                           
3:42:55 PM                                                                                                                    
REPRESENTATIVE  T.   WILSON  replied  that  she   understood  that                                                              
neither  assests nor  the Permanent  Fund  Dividend were  included                                                              
for eligibility.                                                                                                                
3:43:05 PM                                                                                                                    
DR.  BUTTO pointed  out that  most states  had yearly  enrollment,                                                              
but  that Alaska  had  monthly  enrollment,  which often  lead  to                                                              
delays in processing and was a barrier to continual care.                                                                       
3:43:50 PM                                                                                                                    
ANGELA MORGAN, Aniak  Traditional Council, shared  that she worked                                                              
with struggling  families.  She  said that often in  the villages,                                                              
although  both parents  worked,  there was  not family  insurance.                                                              
She  reported  that  Denali  KidCare  ensured  that  children  had                                                              
health coverage.   She detailed how expensive it was  to leave the                                                              
village for doctor  visits, health checkups,  vision examinations,                                                              
and dental work,  all of which were available in  the city but not                                                              
in the village.  She stated support for SB 13.                                                                                  
3:47:02 PM                                                                                                                    
DAVE BOMALASKI,  Doctor, Alpine  Urology, stated  that he  was one                                                              
of the  few pediatric surgeons  in Alaska.   He shared a  story of                                                              
two infants  who, because of  their enrollment in  Denali KidCare,                                                              
were  able  to  have  a  surgery   at  Providence  which  was  not                                                              
available  at  Alaska  Native  Medical  Center.    He  stated  his                                                              
support for SB 13 and its impact to Alaskan children.                                                                           
3:49:02 PM                                                                                                                    
CO-CHAIR  KELLER  asked if  the  infants' eligibility  would  have                                                              
been affected by SB 13.                                                                                                         
3:49:19 PM                                                                                                                    
DR.  BOMALASKI declared  the  importance  of Denali  KidCare,  and                                                              
noted  that other  children  lived  in poverty  and  did not  have                                                              
access  to health  care,  so that  the program  was  vital to  the                                                              
3:49:53 PM                                                                                                                    
WALTER MAJORES,  Executive Director, Juneau Youth  Services (JYS),                                                              
Alaska Associations  of Homes for Children, explained  that Alaska                                                              
Associations of  Homes for  Children represented 18  organizations                                                              
across the  state that provided  services to kids  with emotional,                                                              
behavioral,  and  substance  abuse  problems.   He  voiced  strong                                                              
support  of  SB 13,  as  it would  allow  for  many more  kids  to                                                              
receive health  care services.   He affirmed that Alaska  was 49th                                                              
out  of 50  states  for its  eligibility  threshold, and  stressed                                                              
that  children's  health care  was  the  most important  piece  of                                                              
national  health care  reform.   He  stated that  the most  common                                                              
percent  of FPL  for eligibility  was  250-300 percent.   He  said                                                              
that  this  would  cost  about  $1300  per  child,  which  was  an                                                              
inexpensive form of prevention.                                                                                                 
3:52:30 PM                                                                                                                    
REPRESENTATIVE T. WILSON  asked how many children at  JYS were not                                                              
currently covered.                                                                                                              
3:52:43 PM                                                                                                                    
MR. MAJORES  replied that about  80 percent  of the JYS  kids were                                                              
covered through Denali KidCare.                                                                                                 
3:53:12 PM                                                                                                                    
CO-CHAIR KELLER  asked about the  criteria for coverage  by Denali                                                              
KidCare versus Medicaid.                                                                                                        
3:54:05 PM                                                                                                                    
MONICA GROSS, Doctor,  testified in support of SB 13.   She stated                                                              
that  this  bill   shifted  medical  care  from   crisis  care  to                                                              
preventative family  care.  In response to  Representative Cissna,                                                              
she declared  that obesity  was a crisis  in Alaska.   She pointed                                                              
out  that an  emergency room  visit  would not  measure body  mass                                                              
index,  but  would only  attend  to  the  crisis situation.    She                                                              
affirmed that  a Well-Child check  up at her office  would include                                                              
height,  weight, and  body mass  index.   She  announced that  all                                                              
family  doctors  were trained  to  recognize the  significance  of                                                              
overweight or  obesity.  She declared  that an emergency  room was                                                              
not oriented for preventative care.                                                                                             
3:56:01 PM                                                                                                                    
REPRESENTATIVE LYNN  asked why Alaskan children had  a higher rate                                                              
of obesity than in other states.                                                                                                
3:56:53 PM                                                                                                                    
DR.  GROSS  reported  that  three  factors  had  been  related  to                                                              
obesity in  children.  It  was lower in  families that  ate dinner                                                              
together, lower  when there  was less  television or screen  time,                                                              
and lower  with families  that exercised and  kept aware  of diet.                                                              
She stressed  that  these issues  would be addressed  by a  family                                                              
doctor, not in an emergency room.                                                                                               
3:57:48 PM                                                                                                                    
REPRESENTATIVE LYNN asked why this was different in Alaska.                                                                     
3:58:04 PM                                                                                                                    
DR. GROSS replied that the data was being reviewed.                                                                             
3:58:32 PM                                                                                                                    
REPRESENTATIVE  T. WILSON asked  Dr. Gross how  many of  her child                                                              
clients had private insurance.                                                                                                  
3:58:47 PM                                                                                                                    
DR.  GROSS replied  that  it was  about  50 percent  with  private                                                              
insurance and about 50 percent with Denali KidCare.                                                                             
3:58:59 PM                                                                                                                    
REPRESENTATIVE T.  WILSON asked if the private  insurance included                                                              
co-pay or deductibles.                                                                                                          
3:59:19 PM                                                                                                                    
DR. GROSS replied  that coverage varied.  She  emphatically stated                                                              
that  Denali  KidCare  included  Well-Child Care,  but  that  some                                                              
private  insurance did  not offer  this, and  as a result  "things                                                              
fall through  the cracks in  those families,  and it is  a serious                                                              
4:00:26 PM                                                                                                                    
REPRESENTATIVE  T.  WILSON asked  if  private insurance  could  be                                                              
used in  conjunction with  Denali KidCare,  or was  it one  or the                                                              
DR. GROSS,  in response, clarified that  it was one or  the other.                                                              
She  explained that  families  without  Well-Child  care were  not                                                              
getting  the necessary  routine  care.   She  stressed that  every                                                              
study  pointed to the  long term  financial savings  from  a Well-                                                              
Child care program.                                                                                                             
4:01:52 PM                                                                                                                    
CO-CHAIR  KELLER  observed  that  the  question  was  not  to  the                                                              
validity of Well-Child care.                                                                                                    
DR.  GROSS,  in  response  to a  question  from  Co-Chair  Keller,                                                              
stated that there were six pediatricians in Juneau.                                                                             
CO-CHAIR  KELLER observed  that  a family  with private  insurance                                                              
would  qualify for  Denali KidCare  if  its income  was below  150                                                              
percent of FPL.                                                                                                                 
4:03:44 PM                                                                                                                    
DR.  GROSS assessed  that it  would  then be  possible for  Denali                                                              
KidCare to supersede private insurance.                                                                                         
4:04:34 PM                                                                                                                    
MARIE DARLIN,  AARP Capital  City Task  Force, stated  support for                                                              
SB 13  and encouraged  adjustment to  eligibility for  200 percent                                                              
FPL.  She read  in part from a March 8, 2010 letter  which she had                                                              
submitted to the committee: [Included in the committee packets.]                                                                
     AARP   is   the   world's    largest   organization   of                                                                   
     grandparents.   We are concerned about  health insurance                                                                   
     for  everyone's grandchildren.    In  addition, we  have                                                                   
     many   retired  grandparents   who  are  raising   their                                                                   
     grandchildren.     Currently,   there  are  over   5,500                                                                   
     grandparents  responsible for  raising over 8,200  young                                                                   
     Alaskan  grandchildren.  Very  often these  grandparents                                                                   
     are retired  and dependent on Medicare for  their health                                                                   
     coverage.   Denali KidCare, in  many cases, is  the only                                                                   
     health   insurance    they   can   secure    for   their                                                                   
     grandchildren.   If these grandparents  are not  able to                                                                   
     secure  insurance  coverage   for  their  grandchildren,                                                                   
     some  of the  children will  have to  leave this  caring                                                                   
     family environment  and become wards  of the state.   We                                                                   
     hope you  realize how important Denali  KidCare coverage                                                                   
     is  to  these extended  families  that  are now  in  one                                                                   
     household.   These  grandparents are  trying to  provide                                                                   
     the  best  care  for their  grandchildren.    They  need                                                                   
     Denali KidCare.                                                                                                            
4:07:07 PM                                                                                                                    
MS. DARLIN, in  response to Representative Cissna,  said that 5500                                                              
grandparents were in charge of 8200 grandkids.                                                                                  
4:07:41 PM                                                                                                                    
KEVIN  HENDERSON  encouraged  support  for  SB  13,  as  it  would                                                              
"improve the  chances of  a healthy and  productive start  for our                                                              
children."   He stated  that it makes  economic sense,  as healthy                                                              
children  would  impose  less  of  a demand  on  the  health  care                                                              
system, and would  perform better in school.  He  pointed out that                                                              
these same  children will pay off  as contributors to  society and                                                              
will become  the new decision  makers.   He offered a  story about                                                              
his grandson, noting  that his grandson no longer  had health care                                                              
coverage because his  mother was $7.56 over the income  limit.  He                                                              
pointed out  that she  was working  a full time  job, with  a part                                                              
time job  on the weekends,  and was  taking classes  at University                                                              
of Alaska.   He stated  that private insurance  would cost  her 25                                                              
percent  of  her  paycheck,  and  have a  $4000  deductible.    He                                                              
declared that  she and  his grandson were  one accident  away from                                                              
financial  ruin, and  he opined  that this  was a  story told  all                                                              
over Alaska.   He endorsed  Denali KidCare  to be the  only viable                                                              
option.   He urged  the committee  "to  do the right  thing."   He                                                              
suggested that  the discussion about  co-pay options be held  at a                                                              
later time.   In  response to  Co-Chair Keller,  he agreed  that a                                                              
co-pay system after  the 200 percent FPL was  worth consideration.                                                              
In response  to Representative  Wilson, he said  that there  was a                                                              
need  for all  children to  have Well  Child health  care, and  he                                                              
reported that his  daughter's insurance premiums were  going to be                                                              
$150 each  month, and  adding his  grandson could  increase  it to                                                              
more than $300  per month.  He  emphasized that this was  only for                                                              
major medical  coverage,  and would not  cover dental,  Well-Child                                                              
care, or visual examinations.                                                                                                   
4:16:01 PM                                                                                                                    
JOY LYON, Director,  Southeast Chapter for Alaska  Association for                                                              
the Education  of Young Children  (AEYC), stated that AEYC  was in                                                              
support  of an  immediate  eligibility change  to  200 percent  of                                                              
FPL, with future  consideration of co-pay for incomes  beyond this                                                              
eligibility  level.   She  shared that  the  Southeast Chapter  of                                                              
AEYC  had  just  completed  a  needs   assessment  with  its  Best                                                              
Beginnings partners.   She  reported that 25  percent of  women in                                                              
Juneau with  babies did  not get proper  pre-natal care,  and that                                                              
this  was now  a  top  priority. She  extolled  the  value of  the                                                              
doctor - patient  relationship, and affirmed how  important it was                                                              
to get  mothers and kids  to see the  doctor.  She  confirmed that                                                              
Denali KidCare was  critical for health and education,  as the two                                                              
were so  dependent on  each other.   She  reminded that  the state                                                              
only  pays 30 cents  on the  dollar for  the health  care for  its                                                              
children.   She  urged passage  of SB  13, so  that 1300  children                                                              
would not go another year without health care.                                                                                  
4:19:31 PM                                                                                                                    
CO-CHAIR  KELLER  asked  what  percentage   of  the  Juneau  women                                                              
without proper pre-natal care would be affected by SB 13.                                                                       
4:20:16 PM                                                                                                                    
MS.  LYON agreed  that SB  13 would  not cover  everyone, but  the                                                              
more children  covered by Denali  KidCare meant a  greater savings                                                              
from emergency care for Alaska.                                                                                                 
4:20:54 PM                                                                                                                    
REPRESENTATIVE CISSNA  asked for a  cost analysis to  decide where                                                              
to spend  money.  She reflected  on the economic value  for having                                                              
healthy children.                                                                                                               
4:22:01 PM                                                                                                                    
MS. LYON replied  that there was a $12-$17 return  on every dollar                                                              
invested in high quality children's health care.                                                                                
4:22:31 PM                                                                                                                    
JON   SHERWOOD,  Medicaid   Special   Projects,   Office  of   the                                                              
Commissioner,  Department of  Health and  Social Services,  stated                                                              
that the  administration  did support an  increase of  eligibility                                                              
to 200  percent of FPL,  without any cost  sharing.   He estimated                                                              
that the  bill would  serve 1300  children and  over 200  pregnant                                                              
women, which was  based on the earlier decline of  case loads when                                                              
the  eligibility  had been  changed.    He  pointed to  the  three                                                              
fiscal notes  for behavioral health,  primary and acute  care, and                                                              
public assistance  and administrative costs.  He  stated that most                                                              
children in  long term residential  treatment would  be considered                                                              
eligible  under Medicaid.   He said  that they  could be  eligible                                                              
under Denali KidCare upon their entry to treatment.                                                                             
4:25:51 PM                                                                                                                    
CO-CHAIR  HERRON asked  if  the DHSS  had  reviewed any  copayment                                                              
4:26:30 PM                                                                                                                    
MR. SHERWOOD  explained that  there were  federal rules  regarding                                                              
copayment  for Medicaid,  which included  some significant  limits                                                              
that were  administratively cumbersome.   He identified  that DHSS                                                              
was waiting  for the new federal  regulations.  He said  that DHSS                                                              
was willing to  evaluate cost sharing proposals  to ensure federal                                                              
4:27:43 PM                                                                                                                    
CO-CHAIR KELLER  said that  co-pay could not  exceed 5  percent of                                                              
total income.                                                                                                                   
4:28:10 PM                                                                                                                    
REPRESENTATIVE T. WILSON  asked how hard it would be  to add a co-                                                              
pay after the bill was passed.                                                                                                  
4:28:25 PM                                                                                                                    
MR.  SHERWOOD  said  that  it would  be  the  same  administrative                                                              
effort either  sooner or later.   He said  that the  education for                                                              
the public  and the providers might  be a bit more  difficult with                                                              
a later change.                                                                                                                 
4:29:10 PM                                                                                                                    
REPRESENTATIVE T.  WILSON asked if it  would be better  to add the                                                              
co-pay now, so that the public would understand what to expect.                                                                 
4:29:30 PM                                                                                                                    
MR. SHERWOOD  replied that  the administration  supported  a clean                                                              
expansion to 200 percent of FPL.                                                                                                
4:29:45 PM                                                                                                                    
REPRESENTATIVE  T. WILSON offered  an example  of two  people with                                                              
the same  income, but only one  had private insurance.   She asked                                                              
for a justification that only would receive the "free care."                                                                    
4:30:56 PM                                                                                                                    
MR. SHERWOOD  agreed that it was  an inequity of the  federal law.                                                              
He  allowed that  lower income  children were  still eligible  for                                                              
Medicaid,  but that  higher income,  uninsured  children were  not                                                              
4:31:24 PM                                                                                                                    
REPRESENTATIVE CISSNA  said that,  although the concept  of co-pay                                                              
was widely  accepted, the paperwork  for co-pay made it  so costly                                                              
that money  was lost.   She  asked to hear  more of  why it  was a                                                              
good economic  investment.   She pointed  out that these  children                                                              
were going to be the future workforce.                                                                                          
4:33:00 PM                                                                                                                    
MR. SHERWOOD replied  that he did not have statistics  of the long                                                              
term benefit  for providing health  care to children, but  that he                                                              
would inquire for national statistics.                                                                                          
4:33:35 PM                                                                                                                    
REPRESENTATIVE  SEATON  asked  if  the co-pay  would  reflect  the                                                              
federal equation  of 70 percent  - 30 percent,  so that  the state                                                              
savings would only be 30 percent of the co-pay.                                                                                 
4:34:11 PM                                                                                                                    
MR. SHERWOOD agreed that the ratio would be the same.                                                                           
4:35:23 PM                                                                                                                    
REPRESENTATIVE SEATON  pointed out that  the state also  picked up                                                              
an administrative  burden with the co-pay, but  would only receive                                                              
a minimal income.                                                                                                               
4:35:54 PM                                                                                                                    
REPRESENTATIVE  SEATON asked for  an estimate  of how  many people                                                              
in  the 175-200  percent of  FPL were  uninsured.   He noted  that                                                              
should the uninsured  estimate be high, then the  state was paying                                                              
for 100 percent of any emergency room visitations.                                                                              
4:36:54 PM                                                                                                                    
MR. SHERWOOD offered to provide the estimate.                                                                                   
4:37:19 PM                                                                                                                    
CO-CHAIR  KELLER  asked  about the  DHSS  $1  million  performance                                                              
bonus as an  incentive for enrollments in State  Children's Health                                                              
Insurance Program (SCHIP).                                                                                                      
4:38:43 PM                                                                                                                    
MR.  SHERWOOD  clarified   that  the  bonus  was   $788,505.    He                                                              
explained  that  there  were  target  enrollment  levels,  and  to                                                              
qualify  a  state  must  meet 5  of  8  criteria  for  eligibility                                                              
simplification.     He  listed  some   of  the  criteria   to  be:                                                              
continuous eligibility  for one  year in Medicaid;  liberalization                                                              
of the asset  requirement; elimination of the  in person interview                                                              
process for benefits;  use of the same application  for renewal in                                                              
Medicaid   and  SCHIP;   automatic   or  administrative   renewal;                                                              
presumptive  eligibility; express  lane  eligibility; and  premium                                                              
assistance subsidies.                                                                                                           
4:43:08 PM                                                                                                                    
REPRESENTATIVE T.  WILSON asked why Alaska did  not include assets                                                              
for eligibility determination.                                                                                                  
4:43:26 PM                                                                                                                    
MR. SHERWOOD  replied that the  asset requirement was  included in                                                              
a  number of  federal  and state  assistance  programs.   For  the                                                              
pregnant  women   and  children  categories  of   Medicaid,  often                                                              
referred  to   as  the  "poverty   level  categories,"   an  asset                                                              
requirement was not  included as it was rare that  people with low                                                              
incomes  had  significant  assets,  and  it  was  administratively                                                              
burdensome to identify and verify assets.                                                                                       
4:45:21 PM                                                                                                                    
ELLIE  FITZJARRALD,  Director,   Division  of  Public  Assistance,                                                              
Department of  Health and Social  Services (DHSS),  explained that                                                              
the  initial focus  of  Denali KidCare  was  to  create access  to                                                              
health care  for children without  insurance.  She  explained that                                                              
the performance  bonus did not  entail many departmental  changes,                                                              
but  that  DHSS   tried  to  stabilize  enrollment   for  eligible                                                              
children  who  were  "lost  in the  administrative  trap."    This                                                              
resulted   in   the  12   month   qualification   for   continuous                                                              
eligibility and  stabilized care.   She pointed out that  DHSS was                                                              
working with the  tribal organizations to guarantee  that eligible                                                              
children were enrolled  in both Indian Health Services  and Denali                                                              
KidCare, as  it resulted  in higher  reimbursement for  the state.                                                              
She  noted that  there  were guidelines  for  spending the  bonus.                                                              
She shared  that 47  states did  not have  asset requirements  for                                                              
children's  health  care  programs,  and that  Alaska  focused  on                                                              
ensuring access  to children's  health care.   She mentioned  that                                                              
DHSS  had   considered  co-pay   and  premiums,  but   were  still                                                              
reviewing federal regulations.                                                                                                  
4:48:30 PM                                                                                                                    
REPRESENTATIVE  T. WILSON  offered  an example  that  a family  of                                                              
four, with  the Permanent Fund  Dividend (PFD), would  be eligible                                                              
to qualify  for Denali  KidCare with  an income  of $60,000.   She                                                              
said that,  without an asset test,  a family could be  living with                                                              
their parents, and qualify.                                                                                                     
4:49:30 PM                                                                                                                    
MS. FITZJARRALD,  in response  to Representative  T. Wilson,  said                                                              
that  the poverty  standard  for  a family  of  four  was a  gross                                                              
income of $55,140.                                                                                                              
4:49:57 PM                                                                                                                    
REPRESENTATIVE  T.  WILSON  replied   that  this  income  did  not                                                              
include the Permanent  Fund Dividend, and she questioned  how this                                                              
could be a poverty level.                                                                                                       
4:50:18 PM                                                                                                                    
MS.  FITZJARRALD  agreed  that inclusion  of  the  Permanent  Fund                                                              
Dividend  had  been  discussed.   She  directed  attention  to  an                                                              
earlier  statute which  stated that  the  PFD would  not count  in                                                              
determination  of eligibility  for  public assistance.   She  also                                                              
noted  that a  significant percentage  of the  adults in  families                                                              
receiving public  assistance did  not receive  the PFD, as  it was                                                              
often garnished  to pay  outstanding debts.   She said  that there                                                              
were a lot  of factors to be  decided when determining  a level of                                                              
4:52:28 PM                                                                                                                    
MR.  SHERWOOD,  in response  to  Co-Chair  Keller, said  that  the                                                              
reimbursement  level for  SCHIP was  66 percent  and for  Medicaid                                                              
was 62 percent.  He said that this would decline to 50 percent.                                                                 
CO-CHAIR  KELLER asked  if Denali  KidCare  would be  cut to  meet                                                              
future budget constraints.                                                                                                      
4:53:53 PM                                                                                                                    
MR.  SHERWOOD replied  that currently  there  were maintenance  of                                                              
effort  requirements  which  would  prevent  cuts  in  eligibility                                                              
without jeopardizing  funding.  He reported that  Medicaid, Denali                                                              
KidCare, and  SCHIPS were  all optional  programs, but  that there                                                              
were  mandatory   services  and   eligibility  for   coverage,  if                                                              
4:55:18 PM                                                                                                                    
REPRESENTATIVE  SEATON directed  attention to  the decisions  made                                                              
in  2003, which  had changed  the  eligibility to  175 percent  of                                                              
FPL.   He pointed  out that  the legislature  could make  a future                                                              
change, if necessary.                                                                                                           
4:55:59 PM                                                                                                                    
REPRESENTATIVE  CISSNA opined  that  cost  analysis was  important                                                              
because parents were  learning how to raise children  in a healthy                                                              
[SB 13 was held over.]                                                                                                          

Document Name Date/Time Subjects
SB13pckt.PDF HHSS 3/9/2010 3:00:00 PM
SB 13
HB284pckt.PDF HHSS 3/9/2010 3:00:00 PM
HB 284