With time winding down in the scheduled 90-day legislative session, questions remain about whether agreement can be reached on Gov. Bill Walker's proposal to expand and reform Medicaid.
House Finance Committee co-chairman Steve Thompson, whose committee has been hearing Walker's bill this week, said he is concerned with whether thousands of people can be added to a system that he calls broken.
Senate Health and Social Services Committee Chairman Bert Stedman (R-Sitka) said he thinks it works financially in the best interests of the state to go ahead with expansion and efforts to reduce and contain costs within the current Medicaid program.
"I'd hate to see one go without the other," he said.
If expansion doesn't pass, some believe that Walker, by law, could seek authority from the Legislative Budget and Audit Committee to accept and spend federal money tied to expansion and that even if the committee disapproves, he could move forward.
Walker spokeswoman Grace Jang said by email that the administration is focused on working with lawmakers to reform and expand Medicaid. "Working with the legislature has been and continues to be the administration's preferred route," she wrote.
Senate President Kevin Meyer (R-Anchorage) told reporters Friday he believes the majority of his GOP-led caucus would want to undertake changes to Medicaid and see how those work before moving toward expansion. But he didn't close the door on the possibility of members supporting expansion if, between now and the scheduled end of session April 19, they felt comfortable enough that the proposed reform efforts would work.
The administration sees expansion as going hand in hand with efforts to change what is widely seen as an unsustainable program. Medicaid comprises about 60 percent of the health department budget and is a driver of the state operating budget.
"Reform is going to happen. The question is, at what pace and with what resources to be able to drive that kind of change," health commissioner Valerie Davidson said Friday. "Are we willing to invest 100 percent federal dollars to be able to invest into a system to allow that reform to happen or are we going to wait and limp along with resources that we don't have, which means that that kind of reform is going to necessarily take longer because facilities are simply not going to be able to take on that business risk."
For states opting for expansion, the federal government is to pay 100% of the healthcare costs of newly eligible recipients through calendar year 2016, stepping down to 90% by 2020. The federal match for the existing Medicaid program is about 50%.
Concerns raised by lawmakers include the status of the state's Medicaid provider payment system, which had been beleaguered by problems after going live in 2013.
Becky Hultberg, president and CEO of the Alaska State Hospital and Nursing Home Association, told the House Finance Committee on Friday that her group does not have concerns with the ability of the system to handle additional enrollees.
Margaret Brodie, director of health care services for the health department, has said the majority of new claims through the system are processing correctly, and that the known remaining defects in the system are expected to be corrected this month. She said there is a backlog of claims that had processed correctly before that will take a couple of months to get through.