Legislature(2017 - 2018)CAPITOL 106

03/15/2018 03:00 PM EDUCATION

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03:03:06 PM Start
03:04:50 PM Presentation: Healthy Start & Strong Families
05:11:15 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Please Note Time Change --
Joint with House HSS
+ Presentation: Healthy Start & Strong Families TELECONFERENCED
+ Bills Previously Heard/Scheduled TELECONFERENCED
                     ALASKA STATE LEGISLATURE                                                                                 
                          JOINT MEETING                                                                                       
                HOUSE EDUCATION STANDING COMMITTEE                                                                            
       HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                          March 15, 2018                                                                                        
                            3:03 p.m.                                                                                           
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
HOUSE EDUCATION STANDING COMMITTEE                                                                                              
                                                                                                                                
 Representative Harriet Drummond, Chair                                                                                         
 Representative Justin Parish, Vice Chair                                                                                       
 Representative Tiffany Zulkosky                                                                                                
 Representative Ivy Spohnholz                                                                                                   
 Representative Jennifer Johnston                                                                                               
 Representative Chuck Kopp                                                                                                      
 Representative Geran Tarr (alternate)                                                                                          
                                                                                                                                
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                             
                                                                                                                                
 Representative Ivy Spohnholz, Chair                                                                                            
 Representative Tiffany Zulkosky, Vice Chair                                                                                    
 Representative Geran Tarr                                                                                                      
 Representative David Eastman                                                                                                   
 Representative Jennifer Johnston                                                                                               
 Representative Colleen Sullivan-Leonard                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
HOUSE EDUCATION STANDING COMMITTEE                                                                                              
                                                                                                                                
 Representative David Talerico                                                                                                  
 Representative Lora Reinbold (alternate)                                                                                       
                                                                                                                                
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                             
                                                                                                                                
 Representative Sam Kito                                                                                                        
 Representative Matt Claman (alternate)                                                                                         
 Representative Dan Saddler (alternate)                                                                                         
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: HEALTHY START & STRONG FAMILIES                                                                                   
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
MONICA WINDOM, Director                                                                                                         
Division for Public Assistance                                                                                                  
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided a presentation on Healthy Start                                                                 
and Strong Families.                                                                                                            
                                                                                                                                
BARBARA HALE, Manager                                                                                                           
Children's Health Insurance Program (CHIP)                                                                                      
Division of Healthcare Services                                                                                                 
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided a presentation on Providing health                                                              
coverage to Alaskans in need.                                                                                                   
                                                                                                                                
REBEKAH MORISSE, Section Chief                                                                                                  
Women's, Children's & Family Health                                                                                             
Division of Public Health                                                                                                       
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented on Public Health -Early Childhood                                                              
Health Programs.                                                                                                                
                                                                                                                                
TIM STRUNA, Section Chief                                                                                                       
Public Health Nursing                                                                                                           
Division of Public Health                                                                                                       
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented on Public Health Nurses.                                                                       
                                                                                                                                
DUANE MAYES, Director                                                                                                           
Division of Senior and Disability Services                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced the presentation on Senior and                                                                
Disability Services.                                                                                                            
                                                                                                                                
MAUREEN HARWOOD, Chief of Developmental Programs                                                                                
Senior and Disabilities Services                                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:     Presented   on  Senior   &  Disabilities                                                             
Services.                                                                                                                       
                                                                                                                                
BRITA BISHOP, Quality Assurance Section Administrator                                                                           
Division of Behavioral Health                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Presented  on  Partners Promoting  Healthy                                                             
Communities.                                                                                                                    
                                                                                                                                
CHRISTY LAWTON, Director                                                                                                        
Office of Children Services (OCS)                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented on Strengthening Families.                                                                     
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:06 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ called the  joint meeting of the House Health                                                             
and  Social  Services  Standing  Committee  and  House  Education                                                               
Standing Committee to order at  3:03 p.m. Representatives Parish,                                                               
Sullivan-Leonard,   Zulkosky,  Tarr,   Johnston,  Drummond,   and                                                               
Spohnholz were  present at  the call  to order.   Representatives                                                               
Kopp and Eastman arrived as the meeting was in progress.                                                                        
                                                                                                                                
CHAIR  SPOHNHOLZ reviewed  the  presentations  the committee  has                                                               
recently had  and how  the state  departments and  programs serve                                                               
children ages 0-7 and their families.                                                                                           
                                                                                                                                
3:04:50 PM                                                                                                                    
                                                                                                                                
^Presentation: Healthy Start & Strong Families                                                                                  
          Presentation: Healthy Start & Strong Families                                                                     
                                                                                                                              
CHAIR SPOHNHOLZ announced  that the only order  of business would                                                               
be a presentation on Healthy Start and Strong Families.                                                                         
                                                                                                                                
3:05:48 PM                                                                                                                    
                                                                                                                                
MONICA   WINDOM,  Director,   Division  for   Public  Assistance,                                                               
Department  of  Health and  Social  Services  (DHSS), provided  a                                                               
presentation  on Healthy  Start and  Strong Families.   She  said                                                               
many  of the  programs  work across  state  departments and  with                                                               
federal agencies.                                                                                                               
                                                                                                                                
3:08:42 PM                                                                                                                    
                                                                                                                                
MS.  WINDOM  addressed  slide 4,  "AECC  Alaska  Early  Childhood                                                               
Coordinating Council."   She indicated  all programs  were needs-                                                               
based.  She explained how  the Division of Public Assistance fits                                                               
under the umbrella of the AECCC.                                                                                                
                                                                                                                                
3:11:31 PM                                                                                                                    
                                                                                                                                
MS.  WINDOM  spoke   to  slide  5,  "Healthy   Start  and  Strong                                                               
Families,"   which   read   as  follows   [original   punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
        • Denali KidCare                                                                                                        
      • Supplemental Nutrition Assistance Program (SNAP)                                                                        
        • Women, Infants and Children Program (WIC)                                                                             
          o Farmer's Market Nutrition Program (FMNP)                                                                            
         o Breastfeeding Peer Counseling Program (BFPC)                                                                         
        • Child Care Assistance Program (CCAP)                                                                                  
        • Alaska Temporary Assistance Program (ATAP)                                                                            
        • Heating Assistance                                                                                                    
                                                                                                                                
MS.  WINDOM   said  Denali   KidCare  covers   about  56,000                                                                    
children.    She said  the  household  income limit  is  203                                                                    
percent  of  federal  poverty  level  for  children  without                                                                    
insurance and  177 percent of  poverty level for  those with                                                                    
insurance.    She  informed that  the  SNAP  program  serves                                                                    
31,000 children under the age of eight.                                                                                         
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  how the  breakdown  with  Denali                                                               
KidCare relates to Indian Health Service.                                                                                       
                                                                                                                                
MS.  WINDOM answered  the participants  receive Medicaid  and the                                                               
department receives a 100 percent federal match.                                                                                
                                                                                                                                
REPRESENTATIVE JOHNSTON asked to receive the breakdown.                                                                         
                                                                                                                                
MS.  WINDOM added  the  average  benefit in  Alaska  is $180  per                                                               
person.  The  WIC  program  serves  17,000  women,  infants,  and                                                               
children. The  eligibility level  is 185  percent of  the federal                                                               
poverty level,  and the  program serves  women who  are pregnant,                                                               
breastfeeding,  postpartum, and  children up  to age  five.   She                                                               
stated the WIC program fosters parent success.                                                                                  
                                                                                                                                
REPRESENTATIVE  PARISH  asked  how  many  Alaska  children  would                                                               
likely have died without the program.                                                                                           
                                                                                                                                
MS. WINDOM answered she would attempt to get that figure.                                                                       
                                                                                                                                
CHAIR SPOHNHOLZ asked Ms. Windom  to recap the percent of poverty                                                               
level for Denali KidCare eligibility.                                                                                           
                                                                                                                                
MS. WINDOM answered  that for those without  insurance, the level                                                               
is 203 percent  of the federal poverty level, and  for those with                                                               
insurances the level is 177 percent.                                                                                            
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  for the  average  income                                                               
level of the families at the poverty level.                                                                                     
                                                                                                                                
MS. WINDOM answered  100 percent of the federal  poverty level is                                                               
is about $1,600 a month, or $19,200 annual income.                                                                              
                                                                                                                                
3:16:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  mentioned  the federal  poverty  level  and                                                               
suggested  if the  state could  return the  income levels  to 200                                                               
percent [of the federal poverty  level], the program would help a                                                               
lot more kids.                                                                                                                  
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  commented on Denali  KidCare and                                                               
the Affordable  Care Act (ACA).   She  said she would  rather see                                                               
the private sector be successful.                                                                                               
                                                                                                                                
CHAIR  SPOHNHOLZ  clarified  that  most  people  who  use  Denali                                                               
KidCare work in places that don't provide health insurance.                                                                     
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD clarified  she was  remarking on                                                               
the connection with the ACA.                                                                                                    
                                                                                                                                
3:19:39 PM                                                                                                                    
                                                                                                                                
MS. WINDOM described the farmers  market nutrition program (FMNP)                                                               
and  the Breastfeeding  Peer Counseling  Program which  makes 781                                                               
contacts per month to aid breastfeeding mothers.                                                                                
                                                                                                                                
MS. WINDOM said the Child  Care Assistance Program in 2017 served                                                               
an  average 3,500  children and  2,000 families  per month.   She                                                               
listed the  eligibility criteria for  the program.  She  said the                                                               
Alaska Temporary Assistance Program  (ATAP) serves 6,500 children                                                               
under the age of 8.  She said  the amount of the benefit is based                                                               
on income and shelter expenses.   The average benefit is $263 per                                                               
person.                                                                                                                         
                                                                                                                                
REPRESENTATIVE JOHNSTON asked for the figures in writing.                                                                       
                                                                                                                                
MS. WINDOM  added that in order  to qualify for ATAP,  the parent                                                               
has to  cooperate with  child support.   She  said the  parent is                                                               
required   to  be   self-sufficient.     She  addressed   heating                                                               
assistance.  She said around  3,100 children benefit from heating                                                               
assistance.  She said  the income  limit  is 150  percent of  the                                                               
federal poverty level.   She shared her  personal experience with                                                               
the programs.                                                                                                                   
                                                                                                                                
3:25:46 PM                                                                                                                    
                                                                                                                                
MS. WINDOM  moved to  slide 6,  "Data and  other Collaborations,                                                                
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
        • Free school lunch program                                                                                             
        • Family Nutrition Program                                                                                              
        • Child Care Assistance Program                                                                                         
             o Office of Children's Services                                                                                    
             o Alaska Child Care and Development Fund                                                                           
               (CCDF) Tribal Grantees                                                                                           
        • thread                                                                                                                
          o Alaska Early Care and Learning Data Dashboard                                                                       
             Project                                                                                                            
          o Temporary link: bit.ly/alaskadashboard                                                                              
                                                                                                                                
3:28:54 PM                                                                                                                    
                                                                                                                                
MS. WINDOM addressed  slide 7, "Presenting the  Alaska Early Care                                                               
and  Learning Data  Dashboard,"  showing a  "sneak  peek" of  the                                                               
website for the dashboard.   The website presents statewide early                                                               
learning data.                                                                                                                  
                                                                                                                                
3:29:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ZULKOSKY  asked for the number  of Alaska children                                                               
who use SNAP.                                                                                                                   
                                                                                                                                
MS. WINDOM answered 31,304 children under 8 use the program.                                                                    
                                                                                                                                
REPRESENTATIVE  PARISH  asked  about  the  use  of  the  FMNP  in                                                               
Southeast Alaska.                                                                                                               
                                                                                                                                
MS. WINDOM said she would get the information.                                                                                  
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked  whether the  division works  with                                                               
the Child in Transition program  in the Anchorage, Alaska, school                                                               
district.                                                                                                                       
                                                                                                                                
MS. WINDOM answered, "Not that I know of."                                                                                      
                                                                                                                                
3:30:27 PM                                                                                                                    
                                                                                                                                
BARBARA  HALE,  Manager,   Children's  Health  Insurance  Program                                                               
(CHIP),  Division of  Healthcare Services,  Department of  Health                                                               
and   Social  Services   (DHSS),  provided   a  presentation   on                                                               
 Providing health coverage to Alaskans  in need."  She said CHIP,                                                               
known in Alaska as Denali  KidCare, had been implemented in March                                                               
1999.                                                                                                                           
                                                                                                                                
MS. HALE spoke  to slide 9, "Early  Periodic Screening Diagnostic                                                               
&  Treatment,"  which  read   as  follows  [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     For children and adolescents                                                                                               
        • Covered by Medicaid & CHIP                                                                                            
        • EPSDT program covers all medically necessary                                                                          
          services  regardless of  whether they  are in  the                                                                    
          State Plan:                                                                                                           
          Medical                                                                                                               
          Hearing                                                                                                               
          Developmental screening                                                                                               
          Vision                                                                                                                
          Immunizations                                                                                                         
          Dental                                                                                                                
          Behavioral health and substance misuse                                                                                
          Translation                                                                                                           
          Transportation                                                                                                        
                                                                                                                                
MS. HALE read from a  prepared statement, which reads as follows,                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
      • Medicaid and Denali KidCare offer comprehensive                                                                         
          health insurance coverage  for children and teens,                                                                    
          ages 0  up to the age  of 21 in Alaska  under what                                                                    
          is   known  as   the   Early  Periodic   Screening                                                                    
          Diagnostic    and   Treatment    (EPSDT)   service                                                                    
          provision, which falls under  Title XIX of the Act                                                                    
          or regular Medicaid                                                                                                   
     • The EPSDT service provision under Section 1905(a)                                                                        
          of the Act provides  for coverage of all medically                                                                    
          necessary   Medicaid   services  to   correct   or                                                                    
          ameliorate   a   child's    physical   or   mental                                                                    
          condition,  regardless  of whether  such  services                                                                    
          are covered  under a State's Medicaid  State Plan,                                                                    
          which is often a surprising revelation.                                                                               
        • The bulleted list in the slide outlines some of                                                                       
          the services  covered under  EPSDT and  you'll see                                                                    
          that the services are  very comprehensive and also                                                                    
          cover enabling  services to ensure access  such as                                                                    
          transportation  and translation,  for example.  In                                                                    
          addition,  EPSDT  has   a  requirement  to  inform                                                                    
          families  with children  about EPSDT  services and                                                                    
          the  regular  intervals  that  well  child  visits                                                                    
          should occur.                                                                                                         
        • DHSS has adopted by reference in the AAC the                                                                          
          AAP/BF   recommended   periodicity  schedule.   To                                                                    
          reference  the  0-8  early  childhood  age  group,                                                                    
          you'll note, when you have  a chance to review the                                                                    
          handout provided,  that there are a  minimum of 18                                                                    
          preventive health  care visits recommended  in the                                                                    
          first   8  years   of  life   to  cover   history,                                                                    
          measurements,   sensory  screenings   (vision  and                                                                    
          hearing),     developmental/behavioral     health,                                                                    
          physical  examination,  procedures  including  lab                                                                    
          tests, oral health  and anticipatory guidance. For                                                                    
          a  link to  the  CMS EPSDT  webpage  to read  more                                                                    
          detailed  information please  see the  handout. On                                                                    
          this  webpage,  a  link to  the  EPSDT  Guide  for                                                                    
          States  can  be  found.  The  EPSDT  handout  also                                                                    
          provides   a  link   to  the   AAP/BF  periodicity                                                                    
          schedule.                                                                                                             
        • Annual reporting requirements on EPSDT to CMS on                                                                      
          child  screening   and  participation   rates  are                                                                    
          required for all children  enrolled in Medicaid by                                                                    
          age and delivery system. The  report, known as the                                                                    
          EPSDT 416, is due each  April and covers the prior                                                                    
          FFY.                                                                                                                  
        • EPSDT also requires Medicaid agencies at 42 CFR                                                                       
          to  partner  with  their Public  Health,  Maternal                                                                    
          Child Health agency,  in AK known as  WCFH   Title                                                                    
          V,  to  ensure  child  and  adolescent  access  to                                                                    
          Medicaid services  and delivery of  quality health                                                                    
          care including  children with special  health care                                                                    
          needs,  which are  the  highest  cost children  to                                                                    
          serve in Medicaid.                                                                                                    
                                                                                                                                
MS. HALE added that EPSDT has a requirement to inform families                                                                  
of the availability of services.  She referenced a handout                                                                      
listing Early Periodic Screening Diagnostic & Treatment Services                                                                
[included in committee packet].                                                                                                 
                                                                                                                                
3:35:40 PM                                                                                                                    
                                                                                                                                
MS. HALE advanced to slide 10, "Leverage, Report, Strategize,"                                                                  
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
        • Partnerships to streamline efforts                                                                                    
          o Public Health, Women's Children & Family Health                                                                     
          o Pediatric Children's Quality Measures                                                                               
          o Chance to leverage funds                                                                                            
          o Enhanced rates                                                                                                      
          o For all children                                                                                                    
        • Medicaid/CHIP child participation rates                                                                               
          o Measuring in spirit of SB74                                                                                         
                                                                                                                                
MS. HALE continued to read from her prepared statement, as                                                                      
follows [original punctuation provided]:                                                                                        
                                                                                                                                
       • As a segue to the last slide, the CHIP, under                                                                          
          Title  XXI   of  the  Act  also   includes  annual                                                                    
          reporting requirements  on children's  health care                                                                    
          quality,   utilizing  standardized   measures  for                                                                    
          children  funded  under  both Medicaid  and  CHIP,                                                                    
          including  a  CAHPS  patient  experience  of  care                                                                    
          survey.  CHIP  has  also  incentivized  children's                                                                    
          quality  improvement. AK,  OR and  WV participated                                                                    
          in  a $15  million children's  quality improvement                                                                    
          demonstration between 2010    2015 where the focus                                                                    
          of our  work was  on children's  quality measures,                                                                    
          improving  models of  care via  (PCMH), which  are                                                                    
          important  to   ensure  continuity  of   care  for                                                                    
          children, while incorporating the  use of HIT. The                                                                    
          3 states  partnered closely with our  MCH agencies                                                                    
          to  leverage   resources  and   population  health                                                                    
          expertise on  C&YSHCNs and health  provider models                                                                    
          of care and systems.                                                                                                  
      • There are opportunities available under the CHIP                                                                        
          for  health services  initiative proposals,  which                                                                    
          are approved  by CMS and provide  enhanced funding                                                                    
          up  to  a  capped  limit  for  not  only  children                                                                    
          enrolled  in  ME/DKC,  but  also  the  population,                                                                    
          which is  the focus  of work  in WCFH.  Medicaid &                                                                    
          Denali  KidCare   are  partnering  to   develop  a                                                                    
          proposal for  Department leadership with  our WCFH                                                                    
          and  other PH  section counterparts  to strengthen                                                                    
          the work  that is  priority to their  PH sections,                                                                    
          while leveraging  CHIP health  services initiative                                                                    
          funding  to improve  the quality  of the  CQM data                                                                    
          reported  by Medicaid/CHIP,  and  could assist  in                                                                    
          the SB  74 Quality and Cost  measurement work that                                                                    
          includes   a  number   of  the   CMS  standardized                                                                    
          measures for  evaluation of the  Medicaid program.                                                                    
          These standardized measures could  also be used in                                                                    
          some of the  SB 74 demonstration work  to serve as                                                                    
          basis for  comparison at  the state,  provider and                                                                    
          national  levels.   An  example  of  one   of  the                                                                    
          commonly  reported  child  measures by  states  is                                                                    
          Access  to Primary  Care and  is  provided in  the                                                                    
          handouts. You will see the  data reported for 2014                                                                    
          as compared to other states.                                                                                          
        • Under the CHIPRA 2009, AK DHSS was awarded $18.5                                                                      
          million     in     performance     bonuses     for                                                                    
          simplifying/streamlining       enrollment      and                                                                    
          eligibility from  2009    2013, which  enjoins the                                                                    
          partnership that the Medicaid  and CHIPs have with                                                                    
          the DPA,  which is  the gatekeeper  for children's                                                                    
          and adult enrollment in  AK. Accordingly, the DHSS                                                                    
          monitors the  data reported through the  US Census                                                                    
          Bureau  surveys   through  the  ACS  and   CPS  on                                                                    
          uninsurance   and    corresponding   participation                                                                    
          rates. The  data show  that from  2013    2015, AK                                                                    
          had  a  child  PR  of 87.6%  as  compared  to  the                                                                    
          national average  of 93.1%,  so there is  room for                                                                    
          improvement  in   providing  access   and  working                                                                    
          collaboratively with the DPA.                                                                                         
        • To fold this presentation back into the data                                                                          
          presented by  Pat Sidmore yesterday,  Medicaid has                                                                    
          added questions  in our annual  patient experience                                                                    
          of care  survey to parents about  whether Medicaid                                                                    
          enrolled providers are  proactively asking parents                                                                    
          ACE  questions  related   to  abuse,  neglect  and                                                                    
          family dysfunction  in addition to  questions from                                                                    
          the  NSCH  on positive  health/thriving/resilience                                                                    
          to  assess  parental  response  on  whether  their                                                                    
          children and adolescents  are flourishing. Lastly,                                                                    
          as  Trevor Storrs  mentioned  in his  presentation                                                                    
          yesterday, many Alaskan families  are living at or                                                                    
          below the  FPG level. AK's upper  income limit for                                                                    
          children enrolled in  ME & DKC is  203%. Under the                                                                    
          CHIP, a  targeted low-income  child is  defined as                                                                    
          living  in a  family earning  < or  equal to  200%                                                                    
          FPG,  meaning that  this  income level  represents                                                                    
          what it  takes to  cover the basic  necessities of                                                                    
          food, clothing and shelter. It  is important to be                                                                    
          mindful that AK's upper  income limit for children                                                                    
          enrolled  in Medicaid  and  Denali  KidCare, as  a                                                                    
          percentage  of  the FPG,  was  ranked  as the  9th                                                                    
          lowest  in the  nation to  qualify for  children's                                                                    
          health   insurance  and   this  is   important  to                                                                    
          remember as health insurance  is very difficult to                                                                    
          afford at  these income  levels. Often  child only                                                                    
          coverage in  the HIM or  individual market  is too                                                                    
          expensive and  dependent coverage, if a  parent is                                                                    
          fortunate  to have  ESI,  is  also not  affordable                                                                    
          according to the research.                                                                                            
                                                                                                                                
MS. HALE pointed  to the handout on 2014 data  for access to                                                                    
primary  care,  "AK   Medicaid/CHIP  Child  Quality  Measure                                                                    
Compared  to Other  States:  Percentage  Visiting a  Primary                                                                    
Care  Provider,  by  Age    2014*"  [included  in  committee                                                                    
packet].                                                                                                                        
                                                                                                                                
                                  th                                                                                            
MS. HALE added that Alaska ranks 9 lowest in the nation to                                                                      
qualify for health insurance.                                                                                                   
                                                                                                                                
3:40:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PARISH asked for  confirmation that the percentage                                                               
of the federal  poverty guideline in Alaska is 9th  lowest in the                                                               
nation.                                                                                                                         
                                                                                                                                
MS. HALE answered in the affirmative.                                                                                           
                                                                                                                                
REPRESENTATIVE PARISH asked  whether, if the cost  of living were                                                               
accounted for, the state would be worst in the nation.                                                                          
                                                                                                                                
MS.  HALE  answered it  would  not,  as  Alaska and  Hawaii  have                                                               
different income standards due to cost of living.                                                                               
                                                                                                                                
CHAIR SPOHNHOLZ noted  that the families of  children who qualify                                                               
for  Denali  KidCare  are  the  working poor.    She  shared  her                                                               
personal experience with the program.                                                                                           
                                                                                                                                
REPRESENTATIVE PARISH asked whether  the legislature could reduce                                                               
the state percentage to second or  third lowest in the nation and                                                               
what the fiscal impact would be.                                                                                                
                                                                                                                                
MS. HALE answered  the states have the  responsibility of setting                                                               
Medicaid   and  children's   health   insurance  program   income                                                               
guidelines.   She said  that the  department would  have to  do a                                                               
fiscal analysis in order to set a different income level.                                                                       
                                                                                                                                
3:44:28 PM                                                                                                                    
                                                                                                                                
REBEKAH  MORISSE, Section  Chief,  Women's,  Children's &  Family                                                               
Health,  Division  of Public  Health,  Department  of Health  and                                                               
Social  Services  (DHSS),  presented  on Public  Health  -  Early                                                               
Childhood Health Programs.                                                                                                      
                                                                                                                                
MS. MORISSE spoke  to slide 11, "Public Health  - Early Childhood                                                               
Health  Programs," which  read as  follows [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
        • Women's, Children's & Family Health (WCFH)                                                                            
        Programs for pregnant women and their children                                                                          
        • Public Health Nursing                                                                                                 
        A local presence throughout Alaska; protects and                                                                        
        improves the health of young Alaskans                                                                                   
        • Chronic Disease Prevention and Health Promotion                                                                       
        Programs to help Alaskans live longer healthier                                                                         
        lives, like the Quitline                                                                                                
        • Epidemiology                                                                                                          
        Keeps young Alaskans safe from communicable                                                                             
        diseases, injuries and other health hazards                                                                             
                                                                                                                                
MS. MORISSE progressed to slide  12, "Division of Public Health,                                                                
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
        • Obesity Prevention                                                                                                    
      • Maternal, Infant & Early Childhood Home Visiting                                                                        
        • Parents as Teachers                                                                                                   
        • Early Childhood Comprehensive Systems (ECCS)                                                                          
        • Newborn Screening                                                                                                     
        • Immunizations                                                                                                         
        • Lead screenings                                                                                                       
        • Safe Sleep                                                                                                            
        • Targeted outreach to high-risk families                                                                               
                                                                                                                                
MS. MORISSE continued to slide 13, "Alaska Obesity                                                                              
Prevention and Control Program," which read as follows                                                                          
[original punctuation provided]:                                                                                                
                                                                                                                                
     Works with early care and education programs to help                                                                       
     Alaska's young children grow up to be a healthy weight                                                                     
     and be ready to learn                                                                                                      
     • Training and resources for Early Care & Education                                                                        
          (ECE) providers                                                                                                       
        • Obesity Prevention-ECE Work Group -                                                                                   
          DPH, Obesity Prevention and Control Program                                                                           
          Child Care Program Office (CCPO)                                                                                      
          Child and Adult Care Food Program (CACFP)                                                                             
          Women, Infants, and Children (WIC)                                                                                    
          Head Start                                                                                                            
          Thread                                                                                                                
          Municipality of Anchorage                                                                                             
          UAA/UAF                                                                                                               
                                                                                                                                
3:48:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD  asked   about  the   trend  in                                                               
childhood obesity.                                                                                                              
                                                                                                                                
MS. MORISSE  answered that she  thinks there is a  combination of                                                               
factors  and the  programs  aim to  educate  providers and  early                                                               
childhood educators about healthy choices.                                                                                      
                                                                                                                                
REPRESENTATIVE  JOHNSTON spoke  to Indian  Health Services  (IHS)                                                               
and mentioned a  large grant for obesity.  She  asked whether the                                                               
group is included in the partnership.                                                                                           
                                                                                                                                
MS. MORISSE  answered she would  find out.   She said there  is a                                                               
lot of collaboration with Tribal Health.                                                                                        
                                                                                                                                
REPRESENTATIVE  TARR asked  whether  the  population of  children                                                               
receiving assistance  through the  programs is  the same  that is                                                               
overweight.                                                                                                                     
                                                                                                                                
3:51:53 PM                                                                                                                    
                                                                                                                                
MS. MORISSE answered she would find out.                                                                                        
                                                                                                                                
CHAIR SPOHNHOLZ mentioned  the nutrition programs.   She spoke to                                                               
the free  and reduced lunch  program.   She related that  she did                                                               
not  let  her daughter  eat  the  free  lunch as  they  contained                                                               
reconstituted,  frozen,  or  fried  foods. There  has  been  some                                                               
research  that shows  there  is an  overlap  between poverty  and                                                               
obesity  due  to  "misinformed  execution  of  federal  nutrition                                                               
guidelines."                                                                                                                    
                                                                                                                                
MS.  MORISSE  addressed  slide  14,  "Maternal,  Infant  &  Early                                                               
Childhood  Home  Visiting,"  which   read  as  follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
        • Federally-funded, voluntary program                                                                                   
          o Provides comprehensive services to at-risk                                                                          
             families                                                                                                           
          o Strengthens and improves maternal and newborn                                                                       
             health outcomes                                                                                                    
        • Uses evidence-based practices:                                                                                        
          o the Nurse-Family Partnership model (RNs)                                                                            
          o Proven return on investment: $1 saves up to $5.70                                                                   
                                                                                                                                
MS.  MORISSE  added that  research  on  the effects  of  the                                                                    
program  noted  increases  in family  education,  employment                                                                    
levels,  and  savings in  governmental  costs.   She  listed                                                                    
eligibility  requirements.  She  said AECCC  serves  as  the                                                                    
advisory body for the program.                                                                                                  
                                                                                                                                
3:57:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked what  goes into the  calculation of                                                               
the $5.70 savings and who the savings benefit.                                                                                  
                                                                                                                                
MS. MORISSE answered the saving  is related to governmental cost.                                                               
She said she would follow up with more information on the study.                                                                
                                                                                                                                
REPRESENTATIVE  TARR shared  her understanding  that funding  for                                                               
the program that has been reduced.                                                                                              
                                                                                                                                
MS. MORISSE answered  the federal funding has  just been approved                                                               
for  another  five years.  In  the  past,  there was  some  state                                                               
funding for home visiting but not for this program.                                                                             
                                                                                                                                
REPRESENTATIVE TARR  asked how many  families could be  served if                                                               
there were no limitations to the program.                                                                                       
                                                                                                                                
MS.  MORISSE  remarked there  is  a  relatively small  amount  of                                                               
federal funding due to the small state population.                                                                              
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD commented  on the  work done  by                                                               
public  health nurses  and thanked  them  for their  work in  the                                                               
communities.                                                                                                                    
                                                                                                                                
REPRESENTATIVE PARISH seconded Representative Sullivan-Leonard's                                                                
remarks and  asked whether there  is other funding the  state can                                                               
pursue.                                                                                                                         
                                                                                                                                
MS. MORISSE answered she did  not anticipate other federal funds,                                                               
given the  recent 5-year  approval.    She informed  the division                                                               
was  constantly looking  for more  opportunities to  expand their                                                               
ability to serve the target population.                                                                                         
                                                                                                                                
4:02:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked about any other  partnerships such                                                               
as  non-profit organizations  that are  not part  of the  federal                                                               
program.                                                                                                                        
                                                                                                                                
MS.  MORISSE  answered  there is  a  tribal  health  nurse-family                                                               
partnership serving  the tribal  health beneficiaries.   She said                                                               
the  state program  and  the tribal  health  organization have  a                                                               
memorandum  of  understanding  with  each  other  and  coordinate                                                               
referrals.  She underlined they serve two different populations.                                                                
                                                                                                                                
REPRESENTATIVE JOHNSTON  said she wanted  to highlight it  is not                                                               
the only program in the state.                                                                                                  
                                                                                                                                
MS.  MORISSE listed  other home  visiting programs  such as  Cook                                                               
Inlet  Tribal Council's  Parents as  Teachers which  are "in  the                                                               
works."                                                                                                                         
                                                                                                                                
4:05:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND  asked  how  many  children  are  served                                                               
through "Parents as Teachers.                                                                                                   
                                                                                                                                
MS. MORISSE  said she would  find the  numbers and report  to the                                                               
committee.                                                                                                                      
                                                                                                                                
MS.  MORISSE addressed  slide 15,  "Parents  as Teachers,"  which                                                               
read as follows [original punctuation provided]:                                                                                
                                                                                                                                
      • Family education & parent support home visiting                                                                         
          program to:                                                                                                           
          o Increase parent knowledge of early childhood                                                                        
             development and improve parenting                                                                                  
          o Detect developmental problems early on in                                                                           
             development                                                                                                        
          o Prevent child abuse and neglect                                                                                     
          o Increase school readiness                                                                                           
        • Collaboration with DEED                                                                                               
          o Currently funds 4 federally funded grantees                                                                         
          o Serves Anchorage, Juneau, Hoonah, Haines,                                                                           
             Kodiak, Kake, and others                                                                                           
                                                                                                                                
MS. MORISSE advanced to slide 16, "Early Childhood Comprehensive                                                                
Systems (ECCS), which read as follows [original punctuation                                                                     
provided]:                                                                                                                      
                                                                                                                                
        • ECCS goals are to:                                                                                                    
          o Enhance                                                                                                             
          o Improve outcomes in children's developmental                                                                        
             health and family well-being                                                                                       
        • Focus is to increase evidence-based developmental                                                                     
          screening                                                                                                             
        • Communities Kodiak, Mat-Su, and Nome                                                                                  
        • Partnership with Help Me Grow Alaska                                                                                  
        • Federally funded                                                                                                      
                                                                                                                                
4:09:55 PM                                                                                                                    
                                                                                                                                
MS. MORISSE advances to slide 17, "Screening Services," which                                                                   
read as follows [original punctuation provided]:                                                                                
                                                                                                                                
        • Newborn screening (required by State statute;                                                                         
          funded by federal grants and fees)                                                                                    
             o Bloodspot Screening                                                                                              
               for conditions that can cause serious health                                                                     
               complications or death if not identified and                                                                     
               treated early                                                                                                    
             o Hearing Screening                                                                                                
               by one month of age; diagnosis by 3 months;                                                                      
               early intervention services by 6 months                                                                          
        • Pediatric Specialty Clinics                                                                                           
             o Autism/Neurodevelopmental    screening    and                                                                    
               diagnosis                                                                                                        
             o Metabolic Clinic for metabolic genetic                                                                           
               disorders                                                                                                        
             o Services not available elsewhere                                                                                 
             o Funding: federal and mental health general                                                                       
               funds                                                                                                            
                                                                                                                                
MS. MORISSE advanced to slide 18, "Maternal and child health                                                                    
data collection and analysis," which read as follows [original                                                                  
punctuation provided]:                                                                                                          
                                                                                                                                
        • Pregnancy Risk Assessment Monitoring System                                                                           
          (PRAMS) & Childhood Understanding Behaviors                                                                           
          Survey (CUBS)                                                                                                         
        • Alaska Birth Defects Registry (ABDR)                                                                                  
        • Maternal Child Death Review                                                                                           
       • Alaska Surveillance of Child Abuse and Neglect                                                                         
          (SCAN)                                                                                                                
          o Focus on data over many years gives clearer                                                                         
             picture:                                                                                                           
             1 in 3 children born in Alaska reported to OCS                                                                     
             before age 8 years                                                                                                 
                                                                                                                                
4:14:39 PM                                                                                                                    
                                                                                                                                
TIM  STRUNA, Section  Chief, Public  Health Nursing,  Division of                                                               
Public  Health,  Juneau,  Alaska,   presented  on  public  health                                                               
nurses.   He spoke to  itinerant public health nurses  who target                                                               
high  risk families  and children.     He said  that cuts  to the                                                               
section had  reduced the workforce by  20 percent.  He  shared an                                                               
example of a referral that had  been shared by one of the nurses.                                                               
He  underlined that  the nurses  are making  high-risk encounters                                                               
across  the  state.    He spoke  to  self-regulatory  skills  and                                                               
protective factors.  He said  nurses ensure that families get the                                                               
resources they need for those protective  factors.   He added the                                                               
group  is committee  to community  interventions to  look at  and                                                               
address local  issues.  He said  they work to bring  data sources                                                               
into  communities.    He  spoke to  bring  awareness  of  adverse                                                               
childhood experience.                                                                                                           
                                                                                                                                
4:19:11 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked about the term "expansion" on slide 21.                                                                   
                                                                                                                                
MR.  STRUNA  answered   it  should  be  a   contraction,  not  an                                                               
expansion.                                                                                                                      
                                                                                                                                
CHAIR SPOHNHOLZ commented that public  health resources have been                                                               
significantly reduced in recent years.                                                                                          
                                                                                                                                
MR. STRUNA  said the efforts  have seen  some progress.   He said                                                               
there  was also  progress  in raising  awareness about  substance                                                               
misuse.                                                                                                                         
                                                                                                                                
4:24:35 PM                                                                                                                    
                                                                                                                                
DUANE  MAYES,   Director,  Division  of  Senior   and  Disability                                                               
Services,  Department  of  Health  and  Social  Services  (DHSS),                                                               
introduced the presentation on Senior and Disability Services.                                                                  
                                                                                                                                
4:26:05 PM                                                                                                                    
                                                                                                                                
MAUREEN  HARWOOD, Chief  of  Developmental  Programs, Senior  and                                                               
Disabilities Services,  Department of Health and  Social Services                                                               
(DHSS),  presented  on  Senior  &  Disabilities  Services.    She                                                               
explained  the  infant  learning   program  moved  from  children                                                               
services to senior and disabilities.                                                                                            
                                                                                                                                
MS. HARWOOD  spoke to  slide 24, "IDEA,  Part C  Overview," which                                                               
read as follows [original punctuation provided]:                                                                                
                                                                                                                                
          Congress established this program in 1986 in                                                                          
     recognition of "an urgent and substantial need" to:                                                                        
        • enhance the development of infants and toddlers                                                                       
          with disabilities;                                                                                                    
        • reduce educational costs by minimizing the need                                                                       
          for special education through early intervention;                                                                     
        • minimize the likelihood of institutionalization,                                                                      
          and maximize independent living; and,                                                                                 
        • enhance the capacity of families to meet their                                                                        
          child's needs.                                                                                                        
                                                                                                                                
MS.  HARWOOD explained  that Part  C of  the law  relates to                                                                    
infants and toddlers.  She  added that in Alaska the program                                                                    
had always been  within the Department of  Health and Social                                                                    
Services (DHSS).                                                                                                                
                                                                                                                                
4:29:02 PM                                                                                                                    
                                                                                                                                
       MS. HARWOOD spoke to slide 25, "Minimum Components                                                                       
       Required by IDEA, which read as follows [original                                                                        
     punctuation provided]:                                                                                                     
                                                                                                                                
        • Comprehensive child find and referral system                                                                          
        • Public awareness program focusing on early                                                                            
          identification  of   infants  and   toddlers  with                                                                    
          disabilities and providing  information to parents                                                                    
          of infants  and toddlers through  primary referral                                                                    
          sources                                                                                                               
        • Central directory of public and private EI                                                                            
          services,    resources,     and    research    and                                                                    
          demonstration projects                                                                                                
       • Comprehensive system of personnel development,                                                                         
          including  the training  of paraprofessionals  and                                                                    
          the training of primary referral sources                                                                              
                                                                                                                                
MS.   HARWOOD  advanced   to  slide   26,  "34   CRF  &   303.302                                                               
Comprehensive  Child   Find  system,"   which  read   as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     Scope of Child Find:                                                                                                       
     All infants and toddlers with disabilities in the                                                                          
     State who are eligible for early intervention services                                                                     
     are identified, located, and evaluated including:                                                                          
                                                                                                                                
     Coordination:                                                                                                              
       • Child Find System must be coordinated with all                                                                         
          other major  effort efforts to local  and identify                                                                    
          children by other agencies  with the assistance of                                                                    
          the ICC.                                                                                                              
        • Child Find System is coordinated with:                                                                                
          o Program authorized under Part B                                                                                     
          o  Maternal,  Infant,  and  Early  Childhood  Home                                                                    
             Visiting Program (MIECHV)                                                                                          
          o  Early  Periodic   Screening,   Diagnosis,   and                                                                    
             Treatment (EPSDT)                                                                                                  
          o  Programs under  the Developmental  Disabilities                                                                    
           Assistance and Bill of Rights Act of 2000                                                                            
          o Head Start and Early Head Start                                                                                     
          o SSI program under Title XVI of the SS Act                                                                           
          o  Child protection  and  child  welfare  programs                                                                    
             under the state agency responsible for                                                                             
             administering the Child Abuse Prevention and                                                                       
             Treatment Act (CAPTA)                                                                                              
          o Early Hearing Detection and Intervention (EHDI)                                                                     
          o Children's Health Insurance Program (CHIP)                                                                          
          o Child care programs in the state                                                                                    
                                                                                                                                
MS. HARWOOD advanced to slide 27  showing the steps in the system                                                               
from Identification & Referral to  Intake & Family Assessments to                                                               
Child  Evaluation  &   Functional  Assessment  to  Individualized                                                               
Family Service  Plan Development    which  must all  be completed                                                               
within 45 days  though Service Delivery & Transition.                                                                           
                                                                                                                                
4:33:03 PM                                                                                                                    
                                                                                                                                
MS.  HARWOOD advanced  to slide  28, "State  Partnerships."   She                                                               
highlighted  the   Governor's  Council  and  the   Alaska  Infant                                                               
Learning Providers Association.                                                                                                 
                                                                                                                                
MS.  HARWOOD advanced  to slide  29, "Local  Partnerships."   She                                                               
said local programs  replicate the state partnerships.   She said                                                               
the  graphic displays  how  the local  programs  work with  local                                                               
infant  learning providers  (ILPs).   She highlighted  Parents as                                                               
Teachers and the Office of Children's Services.                                                                                 
                                                                                                                                
MS.  HARWOOD advanced  to slide  30, "Child  Find: Percentage  of                                                               
Birth  to  one  Population  served,"   showing  the  actual  data                                                               
compared to the targets.                                                                                                        
                                                                                                                                
REPRESENTATIVE DRUMMOND asked about the national number.                                                                        
                                                                                                                                
MS. HARWOOD clarified  the black line on the graph  was the state                                                               
target and the state number ended up being higher.                                                                              
                                                                                                                                
REPRESENTATIVE DRUMMOND  asked whether the increase  shown on the                                                               
graph was due to the program being new.                                                                                         
                                                                                                                                
MS.  HARWOOD  said   it  was  due  to   increased  referrals  and                                                               
awareness.                                                                                                                      
                                                                                                                                
4:38:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND  asked whether Alaska is  higher than the                                                               
national average.                                                                                                               
                                                                                                                                
MS. HARWOOD answered in the affirmative.                                                                                        
                                                                                                                                
REPRESENTATIVE ZULKOSKY asked about the "50 percent delay."                                                                     
                                                                                                                                
MS. HARWOOD  answered it referred  to a  50 percent delay  in the                                                               
developmental area,  such as speech  or motor [skills],  for IDEA                                                               
Part  C  eligibility.      She  indicated  the  factor  would  be                                                               
addressed more fully in the subsequent hearing.                                                                                 
                                                                                                                                
MS. HARWOOD  moved to slide  32, "Program Referral  Data" showing                                                               
FY17  Activity  data.  The table  shows  3,547  referrals,  1,855                                                               
evaluations,  and 1,108  new enrollments.    She emphasized  that                                                               
families have to be interested in the services.                                                                                 
                                                                                                                                
MS. HARWOOD  advanced to slide  entitled "Top 5  referral sources                                                               
in  FY   17,"  which  read   as  follows   [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
      Alaska Part C received a total of 3,547 referrals in                                                                      
     FY 17:                                                                                                                     
        • 721 Parent                                                                                                            
        • 719 Physician                                                                                                         
        • 818 Child Protective Services (CPS)                                                                                   
        • 344 Neonatal Intensive Care Unit                                                                                      
        • 208 Alaska Native Medical Center                                                                                      
                                                                                                                                
MS.  HARWOOD   advanced  to  slide   34,  "Referrals   and  total                                                               
enrollment in  FY17".   She  stated the average age  of a child's                                                               
first  referral is  13 months.   Referrals  have increased  by 20                                                               
percent since FY10  while enrollment has increased  by 30 percent                                                               
since FY10                                                                                                                      
                                                                                                                                
MS. HARWOOD  advanced to slide  37, "What families  say," showing                                                               
"some of the best" comments from families.                                                                                      
                                                                                                                                
4:43:53 PM                                                                                                                    
                                                                                                                                
BRITA BISHOP,  Quality Assurance Section  Administrator, Division                                                               
of Behavioral  Health, Department  of Health and  Social Services                                                               
(DHSS), presented on Partners promoting healthy communities.                                                                    
                                                                                                                                
MS.  BISHOP addressed  "Activities for  Young children  and their                                                               
families"  on  slides  39-40, which  read  as  follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
      • Prevention Coalitionspartnering with communities                                                                        
          to strengthen families                                                                                                
        • Provider Networktreating young children with                                                                          
          serious emotional disturbances and their families                                                                     
          o Outpatient    services    mental    health   and                                                                    
             substance use                                                                                                      
          o Residential substance use services for women                                                                        
             and children                                                                                                       
          o Therapeutic family-based treatment homes                                                                            
          o Northern Alaska Shelter Care children birth to                                                                      
             5                                                                                                                  
          o Gap: No residential psychiatric treatment                                                                           
             center beds for children under 12                                                                                  
                                                                                                                                
MS. BISHOP  listed some of  the prevention coalitions.   She                                                                    
gave  a point-in-time  count for  children out  of state  in                                                                    
psychiatric treatment  of 46  children under  12, 5  of whom                                                                    
are under the  age of 8. Slide 40 read  as follows [original                                                                    
punctuation provided]"                                                                                                          
                                                                                                                                
        • Other DBH Program Supports                                                                                            
          o Housing                                                                                                             
         o Peer Navigation and Family Support Services                                                                          
          o Flexible    Funding   "Individualized   Services                                                                    
             Program"                                                                                                           
        • Other Cross System Work                                                                                               
          o Complex Behaviors Collaborative                                                                                     
          o Improving Child Welfare Outcomes                                                                                    
          o Housing Vouchers                                                                                                    
          o Neo-natal Abstinence Syndrome                                                                                       
                                                                                                                                
MS. BISHOP gave examples of flexible funding and its                                                                            
recipients.      She   described   the   complex   behaviors                                                                    
collaborative.                                                                                                                  
                                                                                                                                
4:52:08 PM                                                                                                                    
                                                                                                                                
MS. BISHOP  advanced to slide  41, "System Development  for Young                                                               
Children  and their  families," which  read as  follows [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
        • Training and Technical Assistance     supporting                                                                      
          system development to expand access and improve                                                                       
          treatment                                                                                                             
          o Alaska Child Trauma Center                                                                                          
          o Cross walk to qualify young children for                                                                            
             Medicaid services                                                                                                  
          o Yearly training conferences                                                                                         
        • 1115   Medicaid     WaiverBehavioral      Health                                                                      
          Demonstration Project                                                                                                 
          o Priority populations include at-risk children                                                                       
             and families                                                                                                       
          o Implement evidence-based screening tools to                                                                         
             identify behavioral health needs at all ages                                                                       
          o Expand in-home and mobile response services for                                                                     
             children and families                                                                                              
                                                                                                                                
REPRESENTATIVE  PARISH  asked  whether   there  is  anything  the                                                               
division needs from the legislature.                                                                                            
                                                                                                                                
MS. BISHOP  answered the division  is "early in the  process" for                                                               
the 1115 Medicaid Waver.                                                                                                        
                                                                                                                                
4:55:12 PM                                                                                                                    
                                                                                                                                
CHRISTY  LAWTON, Director,  Office  of  Children Services  (OCS),                                                               
presented on Strengthening Families.   She spoke to research from                                                               
the  Center for  Study  on Social  Policy  regarding support  for                                                               
families.     She  listed   five  protective   factors:  parental                                                               
resilience, social connections, knowledge  of parenting and child                                                               
development, concrete  support in times  of need, and  social and                                                               
emotional competence.                                                                                                           
                                                                                                                                
5:00:40 PM                                                                                                                    
                                                                                                                                
MS. LAWTON spoke to "Family support and preservation services"                                                                  
on slides 44-46, which read as follows [original punctuation                                                                    
provided]:                                                                                                                      
                                                                                                                                
     Family Support Services                                                                                                    
     Community-based primary prevention services designed                                                                       
     to:                                                                                                                        
        • Increase the strength and stability of families,                                                                      
          particularly those with young children.                                                                               
        • Increase parents' competence in parenting skills                                                                      
          and enhance child development.                                                                                        
        • Services include:   in-home  supports;   ongoing                                                                      
          family    assessment;   facilitated    access   to                                                                    
          resources   such    as   transportation;   service                                                                    
        coordination; and parent education and support.                                                                         
                                                                                                                                
     Family Preservation Service                                                                                                
     Intensive services designed  for families when children                                                                    
     are at  risk of  future out-of-home placement  in order                                                                    
     to keep families together and  to create a safe, stable                                                                    
     and supportive family environment.                                                                                         
        • Grantees provide coordination of services to meet                                                                     
          the  identified  needs  of the  family,  including                                                                    
          transportation;  service  plan implementation  and                                                                    
          monitoring;  assessment  of family  progress;  and                                                                    
          parenting education and support.                                                                                      
                                                                                                                                
     Family Support Current Grantees                                                                                            
        • Alaska Family  Services:  Wasilla,   Palmer  and                                                                      
          surrounding areas                                                                                                     
        • Cook Inlet Tribal Council: Anchorage                                                                                  
        • RurAL CAP: Anchorage                                                                                                  
        • Frontier Community Services: Soldotna and Kenai                                                                       
        • Nome Community Service : Nome                                                                                         
        • Resource Center   for  Parents   and   Children:                                                                      
          Fairbanks                                                                                                             
        • Sprout Family Services:  Homer  and  surrounding                                                                      
          areas                                                                                                                 
        head2right SFY17: 432 children & 268 families served                                                                    
        head2right Total Funding: $550,000. Funded by Federal Grant,                                                            
         Community Based Child Abuse Prevention (CBCAP)                                                                         
        head2right Target Population: Alaska families who do not                                                                
          have an open case with OCS                                                                                            
        head2right Families can self-refer, or be referred by the                                                               
          community.                                                                                                            
        head2right Grantees must use evidence informed approaches,                                                              
          such as Parents as Teachers                                                                                           
                                                                                                                                
     Family Preservation "Circle of Support" Grantees                                                                           
        • Nome Community Center: Nome                                                                                           
        • Alaska Family  Services:  Wasilla,   Palmer  and                                                                      
          surrounding areas                                                                                                     
        • Cook Inlet Tribal Council: Anchorage                                                                                  
        • Women in Safe Homes: Ketchikan, Metlakatla                                                                            
        • Resource Center for Parents and Children                                                                              
  head2right Target Population: Families referred by OCS only.                                                                  
        head2right Grant requires warm hand off where the OCS                                                                   
          worker, the family and the grantee meet together                                                                      
          for the service intake, in order to promote                                                                           
          family engagement.                                                                                                    
                                                                                                                                
5:01:54 PM                                                                                                                    
                                                                                                                                
MS. LAWTON pointed to the clause on slide 47, Alaska Child                                                                      
Welfare Tribal Compact, which read as follows [original                                                                         
punctuation provided]:                                                                                                          
                                                                                                                                
     "Alaska  Native  Tribes know  what  is  best for  their                                                                    
     children,  Alaska Native  families and  communities are                                                                    
     the  best  places for  their  children  to thrive,  and                                                                    
     Alaska  Native children  steeped in  the love,  values,                                                                    
     and  culture of  their Tribe  have the  best chance  of                                                                    
     being healthy, engaged members of society."                                                                                
       Whereas clause, pg. 3, Alaska Tribal Child Welfare                                                                       
     Compact                                                                                                                    
                                                                                                                                
MS. LAWTON progressed to slide 48, "The Compact Creates                                                                         
Opportunities, which read as follows [original punctuation                                                                      
provided]:                                                                                                                      
                                                                                                                                
     For change and innovation                                                                                                  
        • Early intervention   and   prevention   services                                                                      
          through the sharing of Protective Services                                                                            
          Reports                                                                                                               
      • Tribes/Tribal Organizations    will   have   the                                                                        
          opportunity  to reach  out  to  support and  offer                                                                    
          services  to  families  more  upstream  to  reduce                                                                    
          further maltreatment                                                                                                  
                                                                                                                                
MS.  LAWTON  spoke  to  slide 49,  "Child  Abuse  Prevention  and                                                               
Treatment Act (CAPTA):                                                                                                          
                                                                                                                                
     • States must ensure all children less than 3-years                                                                        
          of   age who  are involved in a substantiated case                                                                    
          of  child abuse  or  neglect are  referred to  the                                                                    
          Infant Learning/Early Intervention program                                                                            
                                                                                                                                
        • Infant Learning/Early Intervention Program                                                                            
          Provides home-based child  development services to                                                                    
          children  aged birth  up to  3-years  of age,  who                                                                    
          have  moderate   to  severe  mental   or  physical                                                                    
          handicapping  conditions   or  are  at   risk  for                                                                    
          developing  these  conditions. For  each  eligible                                                                    
          child the infant learning  program must develop an                                                                    
          Individualized  Family  Service  Plan  (IFSP)  for                                                                    
          providing services.                                                                                                   
                                                                                                                                
MS.   LAWTON  described   challenges   involved  in   timely                                                                    
referrals.  She  said Alaska receives some  funds from Child                                                                    
Abuse  Prevention and  Treatment Act  (CAPTA) and  therefore                                                                    
there are requirements for reporting and policy procedures.                                                                     
                                                                                                                                
5:07:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZULKOSKY  asked  about   the  $500  thousand  and                                                               
whether it is split between grantees.                                                                                           
                                                                                                                                
MS. LAWTON  answered the  amount is  the total  of what  is split                                                               
between grantees.                                                                                                               
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked whether  the process  is improving                                                               
and whether it is digitized.                                                                                                    
                                                                                                                                
MS.  LAWTON answered  the system  is automated  once details  are                                                               
entered  into the  Online  Resource for  the  Children of  Alaska                                                               
(ORCA) system.  She indicated there can be a lag time.                                                                          
                                                                                                                                
REPRESENTATIVE JOHNSTON asked  what the risks were  should it not                                                               
be completed timely.                                                                                                            
                                                                                                                                
MS. LAWTON answered if the details are not entered timely, often                                                                
the family has moved, or the staff aren't prepared for the phone                                                                
call referral.                                                                                                                  
                                                                                                                                
REPRESENTATIVE JOHNSTON suggested the process could be made                                                                     
shorter.                                                                                                                        
                                                                                                                                
MS. LAWTON answered it could be looked into.                                                                                    
                                                                                                                                
5:11:15 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the joint                                                                 
House Health and Social Service Standing Committee and House                                                                    
Education Standing Committee meeting was adjourned at 5:11 p.m.                                                                 
                                                                                                                                
                                                                                                                                

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