State health commissioner switched his story on Medicaid expansion within days

On April 13 at 2:11 p.m. during a legislative hearing, state health commissioner Adam Crum, 34, said this about his position on Medicaid expansion in Alaska, funded nearly entirely by the federal government: "We have done nothing in our budget phase to actually address anything when it comes to eligibility. It does bring in a great deal of federal dollars and the system has evolved around that.”

Asked by Rep. Tiffany Zulkosky if he would oppose federal spending on ideological grounds, he repeated his support: “We’ll continue to support that as we did through our phase one budget. We’re not touching eligibility at all. That level of federal match is very nice for the state.”

She asked again if he would continue to support Medicaid expansion. He said, “at this point in time,” nothing would change.

At this point in time, there are 49,088 Alaskans covered under the Medicaid expansion program. Since 2015, the federal government has paid more than $1 billion in medical claims for Alaskans who receieved care under Medicaid expansion. Eligibility standards are important to those 49,088 Alaskans, as well as to the financial stability of every health care institution in Alaska.

On April 16 at 4:08 p.m., the state’s chief health policy executive was back before the same committee. On April 15, the Dunleavy administration introduced a bill, House Bill 135, that would change eligibility standards for Medicaid so that the state would not be legally obligated to provide coverage.

Zulkosky asked why he had changed his position. As he did with almost every question in every hearing, Crum started off by thanking her for the question.

Then he said:

"So there is a lot to actually talk about on this side. So what this bill does what the intent is, this actually provides us tools to grow and provide for the expansion population so they can actually increase their economic prosperity, we can provide for them, so they don't have to face the fiscal cliff. Some of that concerning language right there, we've been talking with law, we'll actually have a statement for you guys. What the idea was behind this was open transparency to align with the Supreme Court decision, so that the Legislature understood where this stood on this process. So we can actually, I look forward to discussing this further throughout the subcommittee process as we look at this, but we have a statement that law is drawing up for you guys that explains further what that meant. But It is not the intent of this to cancel out the eligibility for the Medicaid expansion population."

Zulkosky said the bill would mean that the state would not be required to provide coverage.

"I'm trying to understand commissioner how you feel such a stark turn of position within a matter of days from your testimony on Saturday to the introduction of this bill yesterday can be rectified?"

Crum ducked the question:

"To clarify again, the intent of this bill is not to actually remove any care or treatment for the Medicaid expansion population. That particular line in which you referenced is a clarification option. It is a clarification to show that matches the Supreme Court as being an option. There’ll be some more, I recognize that this will be some more discussion …. to make sure there’s no legal issues or unintended consequences through this. Our main idea through this is to make sure that we have opportunities for these individuals. Currently as it stands, if they, personally in my previous life, having employees that would turn down a raise because if they got that raise they would then no longer qualify for benefits. So that is a rational economic thought for that individual to not want to do that.”

The “fiscal cliff” refers to the point at which a Medicaid recipient earns $1 too much to qualify for Medicaid and then has to decide whether to take a job that pays $1 more or keep Mediciad coverage. It’s an important topic and a real issue..

But that doesn’t explain why the state is proposing to add language to state law changing eligibility requirements. Crum is saying that while the bill would not require the state to provide coverage, the Dunleavy administration still plans to provide coverage.

The contradictory comments by Crum are significant because he is supposed to be in charge of health care policy and the largest proposed budget cuts announced by the Dunleavy administration are to Medicaid, with reductions of more than a half-billion dollars in the flow of state and federal dollars into the Alaska health care system.

The Dunleavy administration has yet to examine or explain the potential impact of its drastic proposed changes on the complicated economics of health care in Alaska. This alleged attempt at “transparency” makes it worse.