Please find below a summary of House budget hearing with the Department of Public Welfare as provided by PLS.

House Appropriations

House Appropriations Committee Budget Hearing with DPW (BH) 03/06/13, 9:30 a.m., Room 140, Main Capitol By Jason Gottesman

Reference Links: http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=HTM&sessYr=2011&sessInd=0&billBody=H&billTyp=B&billNbr=253 2&pn=3873 http://wallaby.telicon.com/pa/library/2013/20130306tz.pdf

At a Glance

Committee(s): House Appropriations

Meeting type: Budget hearing Subject: Department of Public Welfare Bills discussed: House Bill 2532 from 2012 Keyword(s): Medicaid, home care, disabilities Testimony: Bev Mackereth, Acting Secretary, Department of Public Welfare Dave Spishock, Budget Director, Department of Public Welfare Members Present: Chairman (R-Delaware), Minority Chairman Joe Markosek (D-Allegheny) and Representatives Mauree Gingrich (R-Lebanon), (D-Allegheny), Mike O'Brien (D-Philadelphia), (D-Allegheny), Matt Baker (R-Tioga), Cherelle Parker (D-Philadelphia), Matt Bradford (D-Montgomery), Deberah Kula (D-Fayette), Scott Conklin (D-Centre), John Sabatina (D-Philadelphia), Steve Santarsiero (D-Bucks), Mike Carroll (D-Luzerne), Steve Mentzer (R-Lancaster), Michele Brownlee (D-Philadelphia), Pam DeLissio (D-Philadelphia), Rick Saccone (R- Allegheny), (R-Erie), (R-Luzerne), Mark Mustio (R-Allegheny), Jim Christiana (R-Beaver), (R-Clarion), (R-York), Mike Peifer (R-Pike), Tom Killion (R-Delaware), (R- Cumberland), Jeff Pyle (R-Armstrong), Madeleine Dean (D-Montgomery), Dave Millard (R-Columbia), (R-Lycoming), (R-Bucks), Dave Maloney (R-Berks), (D-Luzerne), Kathy Watson (R-Bucks), Joe Hackett (R-Delaware), Brian Ellis (R-Butler), (R-Chester), (D-Cambria)

The committee held a budget hearing with the Department of Public Welfare (DPW).

Bev Mackereth, Acting Secretary, Department of Public Welfare and Dave Spishock, Budget Director, Department of Public Welfare represented the department.

Chairman Adolph detailed the background of Sec. Mackereth, including work in health and human services at the state and local level as well as a stint in the Pennsylvania General Assembly. He said Sec. Mackereth is a "hands on" individual and indicated her appointment came as no surprise to him to replace previous department secretary Gary Alexander.

Sec. Mackereth made an opening statement and discussed the department's budget. She said the department's budget is $28.4 billion including state and federal funds, with the state share making up $11 billion of that amount, including a $315 million, or three percent, increase over the prior fiscal year. She noted the job of the department is to help those that have the least, and stated while tough reforms and efficiencies have had to be found to deal with tough economic times, the current budget moves the department down the path of helping those most in need by getting people off waiting lists and giving the department the ability to provide services to the disabled, those with autism, and seniors. She indicated the department is trying to move people to home-based care and provide additional child care services so people can get to work. She noted continued investment in intervention, in early education, and ChildLine. Moving outside of the budget, Sec. Mackereth thanked the General Assembly for the Task Force on Child Protection, which she said did a great job in issuing a report that all will be looking at in order to help make Pennsylvania's children as safe as possible. Finally, discussing the Affordable Care Act, she said the department is working tirelessly to get information to the governor and stated while the governor wants all to have health coverage, there must be an understanding of what Pennsylvania uniquely needs and opined a mistake in this area cannot be made due to the large amount of dollars at stake. She also cautioned about comparing the state's Medical Assistance (MA) to other states since Pennsylvania spends more per capita than any other state except Missouri. She said if Medicaid expansion was chosen, there would be one in four people in Pennsylvania on MA with those on waiting lists still not covered. She also expressed concern about the future availability of federal funds to fund the expansion and pointed to other failed federal programs in this regard.

Chairman Adolph discussed the increase for the waiting list for intellectual disabilities particularly as it relates to children and the elderly. He asked how the formula works, especially since an additional $20 million will be appropriated. Sec. Mackereth said it is broken up to 1,080 persons who cannot be taken care of anymore and those leaving certain special education programs. Chairman Adolph asked what types of services will be available for the children. Spishock said the children will be moved into a program providing for family direct services and noted a significant difference in costs between the children and the adults. Chairman Adolph asked how the decision regarding the numbers breakdown was made. Spishock said the department took those who were leaving special education programs this year and chose to provide them services rather than have them on the waiting list. Chairman Adolph asked how many people are on this waiting list. Spishock said there are about 14,000 on the waiting list with 4,000 on the emergency list. He added those on the waiting list are getting some level of services. Chairman Adolph noted his experience meeting with some of the people on the waiting list in Philadelphia with the governor and said attacking the waiting list is one of the governor's priorities. He said the effort to get them off the waiting list needs to be continued and said the provision of services is something that is owed to the people that need assistance. Chairman Adolph said he rarely receives calls from constituents about not being able to get through to local welfare offices, but indicated this number has increased over the last two or three months. He said people that cannot get through to a person are struggling filling out their forms for benefits and stated it is wise to enlist in the labor forces at the local level. Sec. Mackereth noted the department is aware of the problem and asked Chairman Adolph and all members to let the department know about problems with constituents. She said the department is looking at streamlining its processes to better provide access to services. She further indicated a lot of turnover at the county assistance offices and stated it takes a lot of training to get someone ready for the position. She said the department needs good people to work at these offices that are committed to stay, and encouraged people that are eligible for the job to try for it.

Chairman Markosek commented on the Affordable Care Act and said all know this is a big issue in Pennsylvania and said if Medicaid expansion is not included in this budget, the state will miss out on a huge opportunity to provide health insurance to 500,000 Pennsylvanians with the federal government paying the cost for the first three years. He said a relatively small state investment means tens of billions of dollars coming into the state's economy. He said this will spur job creation in the health care sector and pointed to a report saying the expansion will support over 41,000 jobs across Pennsylvania's economy, which he opined will result in more revenues. He argued the governor's cost estimates are over-inflated and include costs the state will have to incur anyway, including already required administrative costs, and stated the governor's office is forgetting about a number of savings that the Affordable Care Act has and will continue to provide. "The more Pennsylvania drags its feet, the more Pennsylvania stands to lose," he said, and argued politics should not get in the way of doing what is right for Pennsylvania and makes financial sense. He indicated what should be looked at is the cost of doing nothing, particularly in terms of the human cost, the economic cost, and the budget costs for the Commonwealth and local governments. Finally, he said if Pennsylvania does not opt in, Pennsylvania tax dollars will go to improve health care in other states, but not Pennsylvania. Sec. Mackereth responded saying the governor did not say "no" to expansion, but rather said the state needs to talk to the federal government about flexibility and reform. She noted the state will be meeting with the federal government and said seeing what other states have been doing and getting will be helpful to Pennsylvania. Chairman Markosek asked Sec. Mackereth to urge the governor to adopt the expansion.

Chairman Adolph asked when the money from the federal government would start coming to the states. Sec. Mackereth said January 2014.

Rep. Baker, chairman of the House Health Committee, said it is a numbers game, with one-third of the state's budget tied up in welfare programs. He said he has serious concerns about the costs and proliferation of growing the welfare budget. He noted he testified in front of Congress regarding whether or not the federal government will pay for the expansion. He explained the first year costs for Medicaid expansion will be in the hundreds of millions of dollars and will continue to increase in the out years, particularly as the federal government reduces the amount it pays for. He also said if Medicaid expansion is chosen, one in four Pennsylvanians will be on welfare and indicated the woodwork effect of Medicaid will be 178,000 people. He again said he is concerned about the cost and the effect it would have on the state budget and noted a study showing if Pennsylvania accepts Medicaid expansion, it will cost Pennsylvania over a billion dollars in incremental costs. He asked if it is the opinion of the department that there will be 178,000 people eligible whether or not Pennsylvania moves ahead with expansion. Spishock said the department calculated $221 million in extra costs in this fiscal year for more people coming into the system. He said this would produce significant costs to the expansion going forward. Rep. Baker said if there is not maximum flexibility to sustain these costs, it will drain money from other programs in the commonwealth. Rep Baker asked what the growth rate is for Pennsylvania currently. Spishock noted expenditures are growing at a significant rate and will continue to do so under expansion. Rep. Baker said if there is not a way to reduce cost in the welfare system, the past efforts to control costs will be in vain. Rep. Wheatley said it is important for people to understand who and what is being talked about with Medicaid expansion. He asked how many of those accessing department services are able-bodied adults that are lazy and just want access to free money. Sec. Mackereth said the department does not know the answer to that. Rep. Wheatley said in order for a person to receive department dollars, they must be in need of the dollars for some reason. Sec. Mackereth noted there is the Temporary Assistance for Needy Families (TANF) population that requires a path to independence and work. Rep. Wheatley asked what the cost driver population is for the department. Spishock said it is either the disabled or elderly population that require more expensive services. Rep. Wheatley said discussions about controlling costs in the department affect the elderly and disabled in a negative way. Rep. Wheatley asked what the cost is for mental health drugs versus corrections or hospitalization costs that occur when patients with serious mental health problems do not have access to the medicine they need. Spishock said the department does not readily collect that information. Rep. Wheatley asked why the department does not collect that information. Spishock said it is not data that cannot be readily collected and would require working more with the individual to see what happened. Rep. Wheatley asked about the cost of having these prescribed medications coming off the list and said the only way to know the true cost is to follow the people who would be prescribed drugs that would be on the list and are now off the list. He said without this information, determinations as to cost cannot be made.

Rep. Grove said the contention that Medicaid expansion will put billions into the economy is unfair, especially due to the taxes that were implemented to pay for the expansion. He said if a free market economy is to be continued, people needs to be returned to the hands of the individuals and said anything else takes money out of the economy and does not allow the economy to grow and argued this will result in there being no large economic boom from the expansion. He asked what flexibility the other states are getting that chose expansion. Sec. Mackereth said a lot of the things other states are asking for, Pennsylvania already does, making it tough to compare Pennsylvania to other states. She said as the administration meets with the federal government, they will have better answers regarding the flexibility that will be provided to Pennsylvania. Rep. Grove asked what will happen with the growing elderly population. Sec. Mackereth said something needs to be done about this and the programs that are provided and said a continuum of care is needed. She said since the money from the lottery might not be there for community-based services, the department will continue to look at ways to try and fund the programs. Rep. Grove asked if the department is looking for flexibility from the federal government in the form of block grants. Sec. Mackereth explained the department is looking for consolidation of waivers, particularly if expansion is chosen.

Rep. Santarsiero asked about the costs of Medicaid expansion put forward by the administration and noted a number of the costs come from expanding eligibility for children between the ages of 6 and 19 to 133 percent of poverty, totaling $1.6 billion. He argued these are costs that would be incurred under Affordable Care Act anyway. Spishock said a lot of these costs will be incurred regardless of expansion. Rep. Santarsiero asked about woodwork costs under the Affordable Care Act where the administration estimates $2.38 billion over eight years and asked if these costs would be borne without expansion. Spishock said a lot of these people would not be coming in if expansion would not be chose and said many of these people would be able to get insurance off of the exchange. Rep. Santarsiero said if they are in the exchange, these people will be redirected to Medicaid under the Affordable Care Act. He said these are nearly $4 billion in additional costs that will be incurred by the Commonwealth regardless of the expansion and opined the cost is much lower over that time than is being portrayed by the administration and opined the "doom and gloom" is overstated by the administration, especially with these costs that will have to be borne anyway. Rep. Santarsiero argued there will be an economic boom for the economy if expansion is chosen and said some people are refusing to acknowledge the positive economic growth in the private sector that will happen as a result if expansion is chosen.

Rep. Gingrich asked about the payment of direct home care attendants under PPL after the transition as mandated by CMS. Sec. Mackereth said there are about 17,000 workers affected and said those that have submitted accurate time sheets have been paid, but noted a lot of issues during the transition, which she couched as "not smooth." Rep. Gingrich asked if the consolidation of the payroll services will save money. Spishock said while this was not started as a money saving measure, it will save some money. Sec. Mackereth said the most important part is ensuring people get the services and the home care workers will get saved. She added an audit that will be conducted by the Office of Auditor General will elucidate why the process was not smooth.

Rep. Brownlee said policy makers do not always look at outcomes and asked about the elimination of the general assistance cash program. She wanted to know how much was saved from the elimination. Spishock said there was savings of $150 million last year, but noted those receiving Medical assistance were able to retain their coverage or were moved from the Healthy Horizons category until SSI benefits could be obtained. Sec. Mackereth noted those eliminated from the program did get other benefits including SNAP, MA, Social Security, or TANF. Rep. Brownlee asked if there were any steps taken to ensure people with specific mental health problems would not lose coverage. Sec. Mackereth said nobody lost coverage and indicated the move was more administrative in nature. Rep. Brownlee asked how many on the program got jobs, were arrested, put into a mental hospital, or became homeless. Sec. Mackereth noted many of those in the program continued with another benefit, but she does not know their final outcome. She explained the people on the program were given information on other programs they could find and said since the money was all state funds, it is incumbent upon the community to step up and help people who are in need. She said the department has not heard of any numbers spiking as a result of ending the program and opined there is no way to follow people forever. Rep. Brownlee said any policy needs to be found out how it affects people. She then asked how many people will be cut off in this year's budget. Spishock said the $70 million in savings in this budget is just an annualization of the savings from last year.

Rep. Boback asked about the home and community-based waiver program. Spishock said there are twelve of these waiver programs. Rep. Boback asked if all of the programs are driven financially. Spishock said they are and the person needs to be clinically eligible for nursing home care. Rep. Boback asked if this is paid for out of the department. Spishock said either DPW or the Department of Aging pays, depending on how the person is classified. Rep. Boback asked if the home care equates to savings for the department. Spishock confirmed there are saving for taxpayers through the department. Rep. Boback asked if the program is being paid for out of the Lottery Fund. Spishock confirmed it is.

Rep. Parker asked about domestic violence in Pennsylvania and opined there has been a dramatic increase in this area and a resulting request for services. She indicated there are 1.5 million cases of domestic violence in Philadelphia with 84,000 requests for assistance denied. She noted fees from marriage and divorce pay for some of these services and asked if the department has any opinion on increasing these fees so the line item can remain fully funded. Sec. Mackereth said she feels the same way about the issue and noted the department would have to take a better look at the funding streams and detailed private contractors that help provide services. She said anything that the members want the department to look at they will look at. Rep. Parker said it makes her skin cringe when people try to rebrand the term "welfare" and make it extremely polarizing. She said it is important to put a face on those being serviced by the department and asked if the department can provide a map to the committee showing where TANF and Medicaid recipients reside in the commonwealth. Finally, Rep. Parker asked about the Affordable Care Act and noted while the governor has not said no to the expansion, but said Pennsylvania has already opted out of the exchange and asked if Pennsylvania could have an exchange in the future. Sec. Mackereth noted Pennsylvania would have people go into the federal exchange and said the state can have its own exchange in the future and pointed out if people in the federal exchange are eligible for MA, they will be rereferred to the state. Rep. Parker said insuring all individuals should be the priority of all in government.

Rep. Millard read an email from his local Area Agency on Aging (AAA) that he said shares insight into the difficulties the AAAs face with the waiver program. Sec. Mackereth noted her long history with AAAs and said the work they do keeps people in their homes and communities instead of institutionalized care. She said she has learned since she took office that there are no regulations for AAAs and said regulations will provide for accountability and give direction about what can be done and not done. She said the department is meeting with AAA representatives each month and are listening to them. Sec. Mackereth reported two rates have already been increased that will help the AAAs, but noted comprehensive change takes time, despite wanting to keep the AAAs viable.

Rep. Dean asked about House Bill 2532 from 2012 which would deal with the renaming of the department to the Department of Human Services. She said she supports the legislation because "words matter" and the use of the word "welfare" can be polarizing. Sec. Mackereth said the department has spent six to eight months looking at the cost and said their main concern is the cost. She said if the name-change did not cost anything, it would be great. Sec. Mackereth said she will get the cost information to the department. Rep. Dean indicated any cost for changing the name might come back to the department. Rep. Dean asked about the general assistance program as it relates to the cash benefit and said it was the final safety net for many people. She wanted to know if there is any chance of restoring this benefit to those in recovery for drug and alcohol abuse. Sec. Mackereth said those seeking these services should still be able to get treatment since the medical insurance did not start and said any reinstatement would need authorization by the General Assembly. She said she would likely not support any move in this regard and argued the communities should step up and help these people and said it will be impossible for everyone to be reached unless the community steps up and helps people. Rep. Dean said there are a number of organizations that are stepping up and noted the $200 difference from cash assistance made the difference with some people keeping their homes. Sec. Mackereth asked for additional efforts to help getting communities together to help those that might be in need or financial or other services.

Rep. Oberlander asked about child welfare and the documentation required by the department for the contractors. She asked if there is a third of the 200 contractors that are waiting for payment and do not have signed contracts. Sec. Mackereth said for FY 2011-2012 there were 206 provider packets brought to the department with 205 of those finalized. She said for FY 2012-2013 around 60 percent of the provider packets have been finalized and noted the unique nature of the contracting with these providers. She said oversight checks with the packets takes additional time and indicated there are workgroups instituting reforms to streamline the contracting process. Rep. Oberlander asked about other contractors waiting for their rate-setting. Sec. Mackereth asked if there are any specific groups of providers being talked about and said she has heard of issues, especially with regard to child welfare where reforms were made to help the process. She asked for specifics so the department can address the problem. Rep. Oberlander asked about the transportation program and said there are over 11 million trips per year and asked why people need t he transportation. Sec. Mackereth explained this area was one of her biggest areas of question when she was at York County. She said the department will continue to look at this issue and work with the Department of Transportation at what needs to be done and what changes need to be made.

Rep. Bradford said using terms like "welfare" and "socialism" do a disservice to what is being done by the department and noted the importance of the programs offered by the department. He asked about Medicaid expansion and the impact of the woodwork effect, particularly if there would be no woodwork effect without Medicaid expansion. Sec. Mackereth said that is not what is being said and noted there are people eligible for MA that are not in the system today. Rep. Bradford asked if the woodwork people are pregnant women and poor families. Sec. Mackereth said it is for anyone not on Medicaid that is eligible and said they could not be on the program for any number of reasons. Rep. Bradford said it must be noted that this woodwork effect will be had whether or not the expansion is done and asked if the costs are budgeted into the budget. Spishock said the amount is not put into the request and said if people are eligible for MA, they still might not come into MA despite being eligible. Rep. Bradford said this should be appropriated for. Spishock said there might not be that big of a push into the program, he also added it is not entirely clear whether or not Pennsylvania would qualify for the 100 percent federal match funds. Sec. Mackereth said the governor wants to ensure Pennsylvanians have affordable, quality health care, but said the administration is still trying to get information so they can properly inform members. Rep. Bradford asked this is a concern of the "expansion state" issue. Sec. Mackereth said the department is concerned about this and said based upon the questions asked, it is an unknown whether or not Pennsylvania would be getting the 100 percent or not. Rep. Bradford noted New Jersey Gov. Chris Christie has chosen expansion and said his reason was the funds were going to be spent and thought they should be spent in his state. He said he would like to see Pennsylvania money be spent in Pennsylvania.

Rep. Grell asked about the population of people in Pennsylvania eligible for Medicaid and Medicare, a number he said could be as high as 400,000. He wanted to know what is being done better address this population so their care can be better managed. Spishock said there are number of proposals to deal with this and said if expansion is chosen, this might be an area where CMS help is requested. Rep. Grell asked if any of these options include going to the private sector. Spishock said he is not sure about that. Rep. Grell asked about the appropriation for the LIFE program. Spishock said there is money for the continuation and growth of the program where there is funding for two additional providers. Rep. Grell asked if there is any idea of those who would be affected by the expansion. Sec. Mackereth said she can get back to the committee on that.

Rep. Conklin commented on the financial management of the home care attendants and noted he has many people in his district who are not getting paid and said there are elderly people he knows of that cannot fill out their paperwork due to lack of help and access. Rep. Conklin then asked about the Affordable Care Act and asked if expansion is chosen if the "university community" would be able to be insured. Sec. Mackereth said everybody is going to be asked to go to the exchange and said if the exchange determines the person is MA eligible, they will be rereferred to the state. She added with the exchange, people will get tax credits and said if they are currently eligible for MA, they will get MA. Rep. Conklin asked if these people will qualify for MA outside of Medicaid expansion. Sec. Mackereth said she will get back to the committee on this. Rep. Conklin asked if minimum wage individuals will be able to get health insurance without the expansion. Sec. Mackereth agreed it hinges on if there is participation and whether it costs or not to be insured. Rep. Conklin commented there are many people living below the poverty line across the commonwealth that will not accept government benefits due to the stigma attached.

Rep. Sonney asked about the payment of home care attendants and noted the previous contracts are sitting on a large amount of money that is frozen. Spishock said there are negotiations trying to get the state share of the money and opined the federal money must be returned, but could not provide a timetable.

Rep. Kula noted Pennsylvania ranks tenth according to CMS for the amount spent by the department, which is different than previously stated by the department. Sec. Mackereth said the department can share the study and noted that study was based off of the entire budget. Spishock said the number previously mentioned was on Medicaid spent. Rep. Kula then asked about the balancing incentive program, which she said could provide for an additional $40-$50 million for home and community based services. Spishock said this is an option under the Affordable Care Act and indicated in order for Pennsylvania to receive this money, the number of people receiving home and community based services would have to increase. Rep. Kula asked if this would not be able to be received if the governor chose not to have Medicaid expansion. Spishock said this is an area that the governor will be asking about to see if Pennsylvania should choose Medicaid expansion.

Rep. Petri said he will be submitting his questions in writing and noted his office receives visits from people that have to resubmit their eligibility forms and shared that doing this resubmission is important to determine if a person can qualify for other programs that gets them off of the state rolls or if their circumstances have changed.

Rep. O'Brien noted the Commonwealth Court decision yesterday to reinstate adultBasic and asked for preliminary thoughts on the decision. Spishock said this would impact the Insurance Department more than DPW. Rep. O'Brien noted it is the Speaker's intent to appeal this decision and for thoughts on the decision to appeal. Sec. Mackereth said she has not yet seen the decision yet, but noted she has heard it will not have an impact on the department.

Rep. Mustio asked about the additional $3 million for the Rising STARS program and asked if this is under the child care line item. Sec. Mackereth said it is and said she will get the full number for the appropriation to the committee. Rep. Mustio asked about how this program works with the Department of Education. Sec. Mackereth said this program has a dual deputate and noted the program is based upon quality with the assurance money is being spent the best way it can. She said the money for Rising STARS is an incentive for child care centers to increase quality to where they might be able to be a Keystone STARS facility.

Rep. Carroll asked if the meeting with the federal government has been scheduled regarding Medicaid expansion. Sec. Mackereth said it has been, for either the end of March or early April. Rep. Carroll then asked if a state can opt out of the expansion when it wants. Sec. Mackereth said that is her understanding. Rep. Carroll asked about the drug rebate program. Spishock said there is about $200 million for that program. Rep. Carroll asked what measure of revenue might accrue to the Commonwealth for reimbursement of the tax. Spishock said the assumption that CMS would pay the gross receipts tax has been assumed in the budget. Rep. Carroll asked if the department has contemplated the amount of revenue that can be accrued in the first three years of expansion. Spishock said the department has done this calculation. Rep. Carroll said there is unbelievable irony in the decision to end adultBasic might be the reason the state does not get the 100 percent reimbursement. Spishock said he agrees. Rep. Carroll asked if the administration has plans for the uninsured without expansion. Sec. Mackereth said the department is taking a look at what expansion means for Pennsylvania so the right decision can be made. Rep. Carroll said Pennsylvania would have a gap in coverage if expansion is not chose and said this equates to creating another waiting list.

Rep. Watson, chairman of the House Children and Youth Committee, asked about the Task Force on Child Protection's report and the various proposals that have come from the report, but opined the state cannot do nothing and still protect children. She asked if the department has any cost concerns about the expansion of the definition of child abuse. Sec. Mackereth said the department has done a matrix laying out many of the initiatives where there are dollar amounts for the particular proposals and promised to get that to the various committees concerned with the proposals. She also noted the report did not take into account any cost considerations and said the recommendations are all great things that will be helpful. Rep. Watson noted a difference between child abuse and child protection, the latter which she said everyone has a responsibility to curb and report. She asked if there should be training for the average person to spot and report matters that should be reported. Sec. Mackereth noted the department has two contract providers that have mandatory reporter training and added all 67 counties share the responsibility to get the word out about child abuse and how to report. Rep. Watson said members should be the point for distribution of this information. Sec. Mackereth said this is a great idea, especially with how many people state representatives interact with on a daily basis.

Rep. Bradford asked about nursing home and managed care providers receiving an increase. Spishock said these rates have been determined by actuaries and the two percent estimate was thought to be sound. He noted those on a fee schedule are not getting an increase until there is an increase across the board. Rep. Bradford if there would need to be funds appropriated in the budget if expansion is to be chosen this fiscal year. Spishock said money would need to be appropriated, but he is not sure if a state plan is required.

Rep. Santarsiero asked about the first three years of Medicaid expansion and said if expansion is not chosen there will be a lot of savings and money lost coming into the Commonwealth. He asked why the administration would not agree to expansion in the first three years given this. Spishock said he is not sure how backing the woodworkers out of that equation would change things. Sec. Mackereth also said questions about the CHiP participants remains and pointed out there are so many nuances to the expansion that it requires the department to take time to be responsible. Rep. Santarsiero said regardless of these factors, the state will come out ahead of the game and noted other states choosing expansion said they would take advantage of the expansion for the first three years. Spishock noted not all additional costs are known and said there are pluses and minuses in the expansion.

Rep. Parker asked about the children losing Medicaid coverage in August 2011 and noted the department entered into an agreement regarding this issue and then noted the expansion of Medicaid includes various sate flexibilities that the governor is seeking. Sec. Mackereth said the department is keeping this in mind and noted a backlog regarding the children on Medicaid and indicated the department sent eligibility letters to those who might be eligible, with only three percent being deemed to be eligible. She said all anybody who is eligible for a benefit needs to do is apply for the benefit.