HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

 

 

March 06, 2003†† Hearing Room 50

3:00 PM Tapes50 - 51

 

MEMBERS PRESENT:††††††††††† Rep. Ben Westlund, Chair

Rep. Steve March, Vice-Chair

Rep. Jeff Kruse

Rep. Jeff Merkley

Rep. Alan Bates

 

MEMBERS EXCUSED:††††††††††† Rep. Randy Miller

††††††††††††††††††††††† ††††††††††† ††††††††††† Rep. Susan Morgan, Vice Chair

 

 

GUEST MEMBERS:†† ††††††††††† Rep. Mitch Greenlick

††††††††††††††††††††††† ††††††††††† ††††††††††† Rep. Monnes Anderson

††††††††††††††††††††††† ††††††††††† ††††††††††† Rep. Carolyn Tomei

 

STAFF PRESENT:††††† ††††††††††† Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

 

ISSUES HEARD:†††††††† ††††††††††† Informational Meeting - Invited Testimony Only

††††††††††††††††††††††† ††††††††††† ††††††††††† Stakeholder Group Reports

††††††††††††††††††††††† ††††††††††† ††††††††††† Rep. Ben Westlund, Chair

††††††††††††††††††††††† ††††††††††† ††††††††††† Rep. Jeff Kruse

††††††††††††††††††††††† ††††††††††† ††††††††††† Rep. Alan Bates

 

 

 

These minutes are in compliance with Senate and House Rules.Only text enclosed in quotation marks reports a speakerís exact words.For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 50, A

001

Chair Westlund

Calls meeting to order, announces that the gentlemen invited to testify could not be here and he, Rep. Kruse and Rep. Bates will testify on their behalf as they chair the stakeholder meetings.Chair Westlund gives the gavel to Rep. March and he opens the informational meeting.

INFORMATIONAL MEETING

015

Rep. Westlund

Introduces himself and Rep. Kruse and Rep. Bates and talks about bringing the committee up to date on the workgroups on the Oregon Health Plan and Mental Health.Begins the presentation with the Oregon Health Plan and presents (EXHIBIT A).

 

Rep. Monnes Anderson

Asks for clarification on what the 145.9 is.

 

Chair Westlund

Comments that it is the difference between the Governorís balanced budget 992. and the 846, which leaves us 145.9.Continues presentation.

 

Rep. Bates

Gives clarification of where the figures came from.

 

Rep. Kruse

Gives a detailed explanation of the numbers from the Governorís budget where these figures came from.

 

Chair March

Questions the comments from Rep. Kruse.

 

Rep. Bates

In the 846 number is included the cost of not having a prescription drug benefit, which drives up the cost in other areas and elaborates about adding back the pharmacy benefit.

 

Chair March

Comments about loss of Federal funds as we are not putting as much state funds in.

 

Rep. Bates

Comments that they stuck with general funds because that is our universe.

 

Rep. Westlund

Discussion of the boxes in (EXHIBIT A).

 

Rep. Kruse

The only difference is that the middle box on this chart includes the numbers from Price Water House Coopers which is utilization and reimbursement and behavioral offset for prescriptions.

 

Chair March

Asks then does that number appear under the other funds category.

 

Rep. Westlund

Answers no, it just an offset in costs, if you do not have a pharmaceutical benefit your hospital costs are going up.

 

Chair March

We are assuming that a mandatory plan and a bare basic plan would include the four items in the lower box and the mandatory services, how much general fund do we need to do that.

 

Rep. Westlund

Comments that if you buy back all of those four benefits in the lower box, we will need 127 million.

 

Rep. Tomei

Asks if the 127 million is those buy backs in the third box.

 

Rep. Kruse

The 127 million is what we are short based on the governorís budget of funding everything that was in the second and third box.

 

Rep. Westlund

Including the 85 million positive gab away from that 200 million and come up with 127 million dollars additional to buy those four benefits back.

 

Rep. Greenlick

Comments that he thought the 145 stays there.

 

Rep. Westlund

Disagrees and elaborates.

 

Rep. Monnes Anderson

Asks if these figures are based on projected eligibles or eligibles we have now.

 

Rep. Kruse

Responds that they are based on the projected eligibles half way through the next biennium.

 

Rep. March

To sum up the conversation for clarification, if we wish to continue the Oregon Health Plan as it is somewhat constructed now, with our waiver structure, asks if we are going back to basic Medicaid.

 

Rep. Westlund

Explains in more detail

 

Rep. Kruse

comments the reality is under the current waiver, we could do what we are proposing here, because what would happen is what is already happening and the plans are dropping standard and all those people are still eligible and become fee for service and donít get service, but under the current waiver we could not afford in the budget we current have to do the match necessary to cover the population with the four categories there, right now if we did absolutely nothing we would go back to a basic Medicaid with a little bit of RX because that is all that is in the budget.

319

Rep. Tomei

Asks what four categories Rep. Kruse is referring to.

324

Rep. Kruse

Responds with the page number 2, drugs and durable medical.

 

Rep. Kruse

Comments that technically, theoretically we may be able to get away with it under the current waiver, but what we are looking at is that we need to craft something that going to allow us to go past what the current waiver allows and be sustainable and expandable.

332

Rep. Bates

Discusses how we got the waivers, why we have the waiver and why the waiver is in jeopardy at this point.

375

Rep. Tomei

Would like to discuss what she thinks she just heard.

393

Rep. Kruse

Gives additional information to make this part of the process more clear.

423

Rep. Greenlick

Comments that it would go back to basic Medicaid.

TAPE 51, A

016

Rep. Westlund

Makes additional comments for clarification and that this is where we are with existing resources.

031

Chair March

Comments about where we are still short with the budget.

039

Rep. Westlund

Comments that this is the mandatory minimum package and is reasonable by Federal standards and we will exceed that.

043

Rep. Greenlick

Asks if there is any other State that does this at the moment as minimum as that.

045

Rep. Westlund

Comments that he knows of no state that does not have a pharmaceutical benefit.

047

Rep. Kruse

The state of New Mexico does not have hospitalization in their Medicaid program, they got a waiver that allowed them to drop hospitalization.

049

Rep. Bates

Comments that Utah has a waiver that covers primary care only, no sub specialty care and no hospitalization and does cover pharmaceutical, they were thinking of putting money into primary care and keeping people out of hospitals as much as possible and out of sub specialists.

060

Rep. Merkley

Asks if we go back to the OHP plus, with these numbers put in front of us today are we only going to the income levels absolutely required..

077

Rep. Kruse

Responds to the numbers put in from of them.

079

Rep. Bates

Agrees with Rep. Kruse and elaborates.

087

Rep. Westlund

Comment that this is bare bones as you can get, we started from the basic and are still short and elaborates.

150

Rep. Kruse

Makes comments about Lynn Readís paper. (EXHIBIT B) and (EXHIBIT C)

 

Rep. Bates

Comments that if we are successful in this process, we will be only successful in recreating a bare bones Medicaid product, no SCHIP, no standard and the cost shift to the commercial market is significant.

170

Rep. Monnes Anderson

Asks with the cost shift, she could easily see hospitals closing down, have hospitals been on the table in this.

178

Rep. Bates

Makes comments about the hospitals stability.

197

Rep. Westlund

Makes comments about hospitals verses commercial markets.

217

Rep. Merkley

Comments about ideas that have not been discussed, are they a smaller piece of this big picture.

240

Rep. Bates

Comments that all the details have been discussed and will be discussed in the next couple meetings.

264

Rep. Greenlick

Asks questions about the figures on the charts shared. (EXHIBIT A)

281

Rep. Kruse

Comments that we are not a ways and means committee and this is a very logical place to start.

298

Rep. Westlund

Comments that this is a very logical place to start unless you donít want to seek Federal match dollars then you start your zero base is the minimum you can do to receive the Federal match and that is where we started.

309

Rep. Kruse

Comments that they came up with what the minimum is to fund Medicaid with these buy backs and that is weighed off against the Governorís budget.

314

Rep. Bates

Inquires if he is saying that he wanted to see zero based budget build from the ground up.

318

Rep. Greenlick

Comments about zero based budgeting.

347

Rep. Westlund

Comments that you go to the 100 percent of the poverty line and you donít qualify for Federal minimum Medicaid anymore.

350

Rep. Greenlick

Understands, but the 100 percent minimum is what he thought could be one option.

358

Rep. Bates

Comments that we need to be pragmatic here we know fairly realistically what the amount of money is for the entire budget for the next two years is, but we have to go with something and what we decided was to take the Governorís budget and before the latest shortfall and already decreased it.

382

Rep. Merkley

Comments that if we keep a plan that looks more like today, asks what number does that drive us to.Comments that he is a little uncomfortable with the notion of starting with the assumption that all we have available is enough to cover the minimum and elaborates.

TAPE 50, B

011

Rep. Westlund

Makes comments to Rep. Merkley about his concerns.

055

Rep. Bates

Gives two perspectives on this process.

083

Chair March

Elaborates his opinion, once we have created the leanest meanest machine we can, we would like to price out what are currently the Oregon optional populations, which include the individuals and families up to 100 percent of the poverty level.

108

Chair Westlund

Elaborates on the future of this process.

133

Rep. Greenlick

He wants to point out that he endorses what has been said, what I was pushing at before was the looking at the balancing of three things and elaborates.

179

Rep. Westlund

Comments that we are working within available resources.

187

Rep. Greenlick

Made comments about the former Governorís plan.

196

Rep. Westlund

Comments that he cannot argue with someone who was there.

198

Rep. Bates

Comments what a bare absolute minimum would look like, and the surprise of how bad the numbers look.

236

Rep. Merkley

Has had folks coming into his office with these issues and their medical costs will cost more that the income they have coming in and he really feels that this is not ok.

274

Rep. Bates

Comments that he knows this is not ok and elaborates.

282

Rep. Westlund

Comments that we have gone way past just a report of the stakeholders group and comments on the challenges ahead.

318

Chair March

Asks the members to begin their testimony on the mental health stakeholders group.

320

Rep. Westlund

Begins the presentation on the mental health stakeholders group.

383

Rep. Bates

Makes additional comments regarding the group.

TAPE 51, B

017

Chair March

Makes comments about in sufficient room at the Oregon State Hospital and no place to send these people, asks if we are looking at that part of the problem.

034

Rep. Westlund

Responds to in sufficient room at the Oregon State Hospital.

040

Rep. Kruse

Talks about the risks of people that leave the Oregon State Hospital, and elaborates with more details.

059

Chair March

Makes comments about those in the hospital and those in the jails that should not be there.

066

Rep. Kruse

Talks about the new model they would like to create to keep those people out of the system in the first place.

070

Rep. Greenlick

Says this all sounds very familiar and it has failed are we going to make the same mistakes again.

077

Rep. Bates

Comments that he understands the concern, but this program has been done in several counties and works well, he elaborates about how he feels the new system will work.

103

Chair March

Comments that he shares the same concern with Rep. Greenlick we always tend to find the community solution idea because it is a cost saver, only when we donít have the money.

108

Rep. Kruse

Sees this as another problem that presents an opportunity and it allows us to get to some best management practices.

123

Rep. Westlund

Makes his closing comments.

 

Chair March

Calls meeting to a close and adjourns 4:55 PM

 

 

EXHIBIT SUMMARY

 

A Ė Informational, Mandatory Services for Mandatory Eligibles in 03/05, DHS, 1p

B Ė Informational, Oregon mandatory Populations, Lynn Read, 1 p

C Ė Informational, Possible Cost Containment Actions for 03/05, Lynn Read, 7 pp