Commissioner praises Medicaid expansion

WASILLA — Health care advocates cheered Alaska Gov. Bill Walker’s July decision to use federal funds to expand Medicaid in the state. The expansion was a boon to Alaskans, Alaska Health and Social Services Commissioner Valerie Davidson told a room packed with social service and health care providers Thursday afternoon.

She put the health care access on the first rung of an economic hierarchy of needs for the state.

“We know, we’ve said it repeatedly, that people can’t work,” she said. “People can’t hunt, they can’t fish, they can’t be as productive if they’re not healthy enough to do so. So all of the great economic opportunities that we have in the world that aren’t Medicaid expansion don’t become realized if Alaskans aren’t healthy enough to be able to take advantage of those work opportunities.”

The federally funded expansion extends Medicaid coverage to families and individuals earning less than 133 percent of the federally determined poverty level for the state. Many people at the meeting of the Mat Su Agency Partnership, an umbrella group of food banks, chambers of commerce, consultancies, health care organizations and government agencies, attended rallies or advocated for Medicaid expansion during the spring and summer of 2015.

However, a lot of work still remains, Davidson said. Officials had signed up 3,316 customers for the Medicaid expansion since enrollment began Sept. 1, Davidson said, and were working to boost participation.

Open enrollment for the Federal 2016 marketplace started Nov. 1 and ends Jan. 31, 2016. The deadline to apply for coverage by Jan. 1, 2016 is Dec. 15. Unlike federal marketplace plan enrollment, Medicaid enrollment is not limited to the open enrollment period, according to Medicaid.gov.

Officials estimate about 42,000 Alaskans are eligible for the expanded coverage, and the department is on track to hit the 20,000 mark by the end of the first full year of enrollment, Davidson said.

The administration’s decision to expand Medicaid came with a commitment to reform a system many critics charged was unsustainable. From Davidson’s perspective, that means leveraging state dollars to obtain the maximum amount of healthcare funds. It also means potentially redesigning the Medicaid payment system to create a greater level of federal reimbursement for some Medicaid services, Davidson said.

“We are really looking at what are the ways we can improve our efficiency,” she said. “What are the ways that we can increase other opportunities? Quite frankly, shamelessly bringing in other federal resources, whether it’s through Medicaid expansion, whether it’s through federal grants, whether it’s through private opportunities and partnerships. I have no problem smiling really big at people who have resources to try to bring them to Alaska so that we can help improve the health of Alaskans.”

The first processed payment via the state’s expanded Medicaid program was made on Sept. 2, and allowed an unidentified patient to buy prescription drugs they previously could not afford, according to Davidson.

Health and Social Services lost 21 positions from cuts to the 2016 budget, until the Mental Health Trust Authority stepped in to bridge the gap. When Davidson told state officials the expected cost reductions arising from Medicaid wouldn’t available for years, she said state officials told her to tough it out.

“The system isn’t going to be ready for us to be able to do that yet,” she said. “The response was ‘You’ll be fine.’”

Additional reductions are likely, Davidson said.

“We are looking at more cuts,” she said. “We’re trying to do that in ways that are least harmful as possible, but when we are the department that determines whether children are safe, whether families eat, whether families have resources, whether they have access to healthcare, any cuts we make we know will impact people. And that’s hard, it’s heartbreaking, it’s horrible.”

A lawsuit by the Alaska Legislature over the expansion further complicates the matter, Davidson said. While Alaska Superior Court and the Alaska Supreme Court both rejected an emergency injunction that would have prevented the start of Sept. 1 Medicaid enrollment, the lawsuit isn’t over. The most recent movement on the lawsuit allows the Walker administration’s four lawyers time to oppose a motion for summary judgment, according to court documents.

The $3-billion state revenue shortfall behind those cuts overshadows just about every discussion, Davidson said.

“Earlier, when I walked in, (Partnership Chair) Phillip (Licht) said ‘Well is there anything you need?’ and I said ‘Yeah. Solve that budget challenge for me, that’d be really great,’” Davidson joked. “He said ‘I probably can’t do that, but there are some sandwiches and things over there.’”

Contact reporter Brian O’Connor at 352-2270, brian.oconnor@frontiersman.com, or on Twitter @reporterbriano.