NOTE: As provided in LFC policy, this report is
intended only for use by the standing finance committees of the
legislature. The Legislative Finance Committee does not assume
responsibility for the accuracy of the information in this report when used for
other purposes.
The most recent FIR
version (in HTML & Adobe PDF formats) is available on the Legislative
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SPONSOR: |
Feldman |
DATE TYPED: |
|
HB |
|
||
|
SHORT TITLE: |
Senior Citizen Prescription Drug Waiver |
SB |
391/aSFC |
||||
|
|
ANALYST: |
Weber |
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APPROPRIATION
|
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
||
|
FY03 |
FY04 |
FY03 |
FY04 |
|
|
|
|
|
|
$12,700.0 |
Recurring |
General
Fund |
|
|
|
|
|
|
|
(Parenthesis
( ) Indicate Expenditure Decreases)
REVENUE
|
Estimated Revenue |
Subsequent Years Impact |
Recurring or
Non-Rec |
Fund Affected |
|
|
FY03 |
FY04 |
|
|
|
|
$37,000.0 |
|
|
Recurring |
Federal
Funds |
|
|
|
|
|
|
(Parenthesis ( ) Indicate Revenue Decreases)
SB
391 is almost identical to HB 402.
Responses
Received From
Human
Services Department
Agency
on Aging
Health
policy commission
SUMMARY
Synopsis of SFC Amendment
The Senate Finance Committee amendment eliminates the $150,000
appropriation to HSD to develop the waiver and defray administrative
costs. In addition, the emergency clause
is omitted.
Synopsis
of Original Bill
Senate Bill 391
appropriates $150,000 from the state general fund for expenditure in fiscal
years 2003 and 2004 to the Human Services Department (HSD) to establish a
Medicaid Waiver program that would provide prescription drugs to seniors whose
incomes are less than one hundred eight-five percent of the federal poverty
level (FPL) and who are over the age of sixty-five or who have been determined
to be disabled under the criteria established under the federal Social Security
Administration’s disability determination rules. SB 391 also provides for cost-sharing
provisions, to the extent practicable, so as to minimize state general fund
expenditures.
SB 391 contains an
emergency clause.
Significant
Issues
The Center for Medicare and Medicaid Services (CMS)
has a model state demonstration template, “Pharmacy Plus,” which allows states,
through an 1115 Demonstration waiver, to expand Medicaid coverage prescription
drugs to Medicare beneficiaries and other individuals with incomes up to 200%
FPL. Individuals covered must not
otherwise be eligible for the full Medicaid package. The population addressed by the bill would
appear to be eligible for inclusion in such a waiver. However, HSD may not need to apply for a
waiver and may not use the specific type of waiver requested in the bill. An amendment to delete the waiver language
could be used to resolve this issue.
FISCAL IMPLICATIONS
The appropriation of
$150.0 contained in this bill is a non-recurring expense to the General Fund.
Any unexpended or unencumbered balance remaining at the end of Fiscal Year 2004
shall revert to the General Fund.
HSD states the
bill instructs the department to use cost-sharing to minimize state general
fund expenditures. The age 65 and over
Based on existing
blended utilization data for these populations, an average of five prescriptions
monthly at a cost of $40 each would be expected, or $50.4 million
annually. Under Medicaid federal
participation rates, the state’s share of this amount would be slightly more
than $12.7 million. If a $5 co-pay were
utilized the state share drops to $11.0 million. In the absence of a “crowd out” feature from
private insurance, there is no reason all of the eligible individuals would not
use prescriptions through the program with resultant higher costs.
MW/prr:yr