Legislature(2009 - 2010)HOUSE FINANCE 519

01/28/2009 01:30 PM House FINANCE


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01:36:02 PM Start
01:39:59 PM Department of Health and Social Services Budget Overview
03:16:55 PM Military and Veterans Affairs Budget Overview
04:14:05 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Budget Overviews: TELECONFERENCED
Dept. of Health and Social Services
Military and Veterans Affairs
                    HOUSE FINANCE COMMITTEE                                                                                     
                       January 28, 2009                                                                                         
                            1:36 p.m.                                                                                           
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Hawker  called the  House Finance Committee  meeting                                                                   
to order at 1:36:02 PM.                                                                                                       
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mike Hawker, Co-Chair                                                                                            
Representative Bill Stoltze, Co-Chair                                                                                           
Representative Bill Thomas Jr., Vice-Chair                                                                                      
Representative Allan Austerman                                                                                                  
Representative Harry Crawford                                                                                                   
Representative Anna Fairclough                                                                                                  
Representative Richard Foster                                                                                                   
Representative Les Gara                                                                                                         
Representative Reggie Joule                                                                                                     
Representative Mike Kelly                                                                                                       
Representative Woodie Salmon                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None.                                                                                                                           
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
William Hogan, Commissioner, Department  of Health and Social                                                                   
Services; Alison  Elgee, Assistant Commissioner,  Finance and                                                                   
Management   Services,  Department   of  Health  and   Social                                                                   
Services;   John  Boucher,   Senior   Economist,  Office   of                                                                   
Management  and   Budget,  Office  of  the   Governor;  Craig                                                                   
Campbell,  Adjutant  General,   Commissioner,  Department  of                                                                   
Military & Veterans Affairs.                                                                                                    
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
William Streur,  Deputy Commissioner, Medicaid  & Health Care                                                                   
Policy, Department of Health and Social Services.                                                                               
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
Budget Overview:                                                                                                                
                                                                                                                                
     Department of Health and Social Services                                                                                   
     Military and Veterans Affairs                                                                                              
                                                                                                                                
^DEPARTMENT OF HEALTH AND SOCIAL SERVICES BUDGET OVERVIEW                                                                     
                                                                                                                                
1:39:59 PM                                                                                                                    
                                                                                                                                
WILLIAM HOGAN, COMMISSIONER, DEPARTMENT  OF HEALTH AND SOCIAL                                                                   
SERVICES (DHSS), reviewed his  leadership team as laid out in                                                                   
the "Organizational Chart" Slide 1 (Copy on File).                                                                              
                                                                                                                                
1:41:04 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan introduced  his  staff  and stressed  the                                                                   
importance  of  the  Office  of   Faith-Based  and  Community                                                                   
Initiatives in helping DHSS achieve its mission.                                                                                
                                                                                                                                
Commissioner  Hogan   referred  to  Slide   2:  "Expenditures                                                                   
Category  Comparisons  of general  fund  Authorization".  The                                                                   
four pie charts compare the general  fund expenditure for the                                                                   
department   in  2000   and  2010   and   the  total   budget                                                                   
expenditures in 2000 and 2010.                                                                                                  
                                                                                                                                
Commissioner  Hogan noted  that  the overall  budget  request                                                                   
increase  of  0.2  percent  from  2009 to  2010  is  low.  He                                                                   
stressed  that the programs  and services  DHSS provides  are                                                                   
very important.  He felt this  budget request  was reasonable                                                                   
even  in the  current economic  environment. Co-Chair  Hawker                                                                   
agreed that the incremental budget  increase noted in the 10-                                                                   
year plan for FY10 was small.  He reminded the committee that                                                                   
this  year there  is  potential  for a  multi-billion  dollar                                                                   
deficit and that may make funding more difficult.                                                                               
                                                                                                                                
1:53:36 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan  reviewed  Slide 3.  The  department  has                                                                   
3,670  positions budgeted  under Direct  Field Work,  Program                                                                   
Support  Services,  and Administrative  Management  Services.                                                                   
The table  on the slide  indicates the geographical  location                                                                   
of  programs  and  their  coordinating   position  count.  He                                                                   
admitted  that   3,670  positions  may  seem   excessive  but                                                                   
asserted that the workforce is effective and efficient.                                                                         
                                                                                                                                
Co-Chair  Hawker voiced  that  in the  past  three years  the                                                                   
legislature and  the Office of Children's Services  (OCS) had                                                                   
been working together  to ensure adequate staffing  of OCS in                                                                   
order to serve at-risk children in the state.                                                                                   
                                                                                                                                
1:54:49 PM                                                                                                                    
                                                                                                                                
Co-Chair  Hawker wondered  if  the governor's  hiring  freeze                                                                   
would  affect   the  planned  expansion  of   OCS  positions.                                                                   
Commissioner Hogan revealed that  the hiring freeze would not                                                                   
impact 24-hour  facilities, the Alaska Psychiatric  Institute                                                                   
(API), pioneer  homes, or  juvenile detention facilities.  He                                                                   
reported that DHSS was prepared  to ask the governor's office                                                                   
and the  Office of  Management  and Budget  (OMB) to look  at                                                                   
frontline  social   workers,  public  health   nurses,  adult                                                                   
protective  service workers, and  eligibility specialists.  A                                                                   
memo will  be prepared to  request those positions  be exempt                                                                   
from the hiring freeze.                                                                                                         
                                                                                                                                
1:57:03 PM                                                                                                                    
                                                                                                                                
Representative  Gara asked about  an OCS study  regarding the                                                                   
staffing of  frontline social  workers. He wondered  how many                                                                   
unfilled   positions  there   presently  were   and  if   the                                                                   
department  was short  staffed.  Commissioner Hogan  answered                                                                   
that  a  workload  study recommendation  had  called  for  an                                                                   
increase of 17 frontline social  workers. Over the next three                                                                   
years the department  plans to reach that number.  There is a                                                                   
request in  the FY10 budget for  five social workers  and one                                                                   
administrative  support position. He  could not answer  as to                                                                   
the current vacancy  rate and added he would get  back to the                                                                   
committee with the numbers.                                                                                                     
                                                                                                                                
Representative  Gara   wondered  if  positions   were  vacant                                                                   
because of  low wages. He  asked if there  had been  a recent                                                                   
salary review for social workers.  Commissioner Hogan replied                                                                   
that he did not know.                                                                                                           
                                                                                                                                
ALISON ELGEE, ASSISTANT COMMISSIONER,  FINANCE AND MANAGEMENT                                                                   
SERVICES,   DEPARTMENT  OF   HEALTH   AND  SOCIAL   SERVICES,                                                                   
explained that the  state was in the process  of developing a                                                                   
Request for Proposal  (RFP) that would identify  specific job                                                                   
classes for salary  review. She stated that  frontline social                                                                   
worker  salaries  would be  highlighted  in  the review.  The                                                                   
study  would  compare  Alaska   with  other  states'  public,                                                                   
private, and non-profit  sector employment. The  hope is that                                                                   
the review will be completed early next fall.                                                                                   
                                                                                                                                
2:00:00 PM                                                                                                                    
                                                                                                                                
Representative  Gara wondered  if  support  staff would  also                                                                   
receive a pay  increase. Commissioner Hogan  answered that it                                                                   
was possible.                                                                                                                   
                                                                                                                                
Commissioner  Hogan  discussed  Slide 4  containing  two  pie                                                                   
charts that illustrate Medicaid  direct services in both FY08                                                                   
and  FY10.  There  was  a $46  million  dollar  reduction  in                                                                   
expenditures entering  FY09 which allowed the  current fiscal                                                                   
year to  begin with  savings. A  greater capacity to  project                                                                   
current  and  future  Medicaid  expenditures  should  give  a                                                                   
better  understanding of  when and how  much excess  spending                                                                   
authority is available  for FY09. He felt great  strides have                                                                   
been  made in  cost containment.  He  also thought  extensive                                                                   
technical assistance  to the provider  community has  lead to                                                                   
more accurate Medicaid billing.  The department has been very                                                                   
serious  about  performing  Medicaid audits  which  has  made                                                                   
providers  take   the  provision  of  services   and  billing                                                                   
responsibilities more seriously.  He was not suggesting there                                                                   
was  Medicaid  fraud. Providers  are  being more  careful  to                                                                   
ensure they are  compliant with Medicaid. The  net request in                                                                   
the Medicaid budget is $14 million.                                                                                             
                                                                                                                                
2:05:28 PM                                                                                                                    
                                                                                                                                
Representative Fairclough referenced  page 101 of "The Fiscal                                                                   
Year 2010  Budget: Legislative  Fiscal Analyst's  Overview of                                                                   
the Governor's Request," specifically  the legislative fiscal                                                                   
analyst comment:                                                                                                                
                                                                                                                                
     According to the check write information available                                                                         
     on-line, the FY09 authorization may exceed Medicaid                                                                        
     projections by as much as $40 million.                                                                                     
                                                                                                                                
Representative Fairclough wondered  if Commissioner Hogan was                                                                   
familiar with the  comment. He affirmed he and  he thought it                                                                   
pertained to the federal stimulus package.                                                                                      
                                                                                                                                
2:06:28 PM                                                                                                                    
                                                                                                                                
Ms.  Elgee  agreed  that  the  comment  was  related  to  the                                                                   
potential   for  additional  federal   funding  through   the                                                                   
economic stimulus  package. She pointed out  that the numbers                                                                   
in the  note reflect what  is being debated  in the  House on                                                                   
the federal level.                                                                                                              
                                                                                                                                
Representative  Gara  asked  for  clarification  on  Medicaid                                                                   
reimbursement and the federal  contribution rate. He wondered                                                                   
if  the  rate  was  rising  or  falling.  Commissioner  Hogan                                                                   
replied that it  had come up slightly and accounted  for $7.7                                                                   
million in the  FY10 budget. He understood that  the economic                                                                   
stimulus package could raise the  federal matching percentage                                                                   
to 4.9 percent. This means federal  government would match 55                                                                   
percent  and   the  state  45   percent.  He   anticipated  a                                                                   
substantial boost in the Medicaid budget in FY10.                                                                               
                                                                                                                                
Co-Chair Hawker  explained that there  are a lot  of unknowns                                                                   
concerning the economic stimulus  package. He stated that the                                                                   
general fund  could not be  supplanted by stimulus  funds and                                                                   
that there  could be maintenance  of effort requirements  and                                                                   
other restrictions related to the stimulus funds.                                                                               
                                                                                                                                
Ms.  Elgee  understood  that  the  proposal  currently  being                                                                   
debated in the House could provide  funding across the board.                                                                   
She   explained  that   the  restrictions   Co-Chair   Hawker                                                                   
mentioned   were   under   consideration   in   the   Senate.                                                                   
Discrepancies between  the two bodies have made  it difficult                                                                   
to know what the stimulus will mean to the state budget.                                                                        
                                                                                                                                
Representative  Gara  asked  about federal  and  state  match                                                                   
funds for  DHSS programs such  as Denali Kid Care.  He wanted                                                                   
to  know  what  the reimbursement  rates  are  for  Medicaid.                                                                   
Commissioner Hogan  replied that there are varying  rates for                                                                   
different  programs.  He  proposed  educating  Representative                                                                   
Gara  and his  staff on  Medicaid at  another time  as it  is                                                                   
complicated. Representative Gara  asked if there is a general                                                                   
base federal match for Medicare.  Commissioner Hogan answered                                                                   
that there  is the  one federal  base match of  approximately                                                                   
50/50.  The   match  is  subject   to  change   depending  on                                                                   
population size  and which program the recipient  is enrolled                                                                   
in.                                                                                                                             
                                                                                                                                
2:11:19 PM                                                                                                                    
                                                                                                                                
Co-Chair Hawker  asked about a  reference to the  check write                                                                   
analysis. Commissioner  Hogan explained that the  check write                                                                   
analysis gives  DHSS information  regarding claims paid  in a                                                                   
variety of provider  categories. It tells DHSS  what they are                                                                   
paying out and future payouts  or surplus funds for projects.                                                                   
                                                                                                                                
2:12:55 PM                                                                                                                    
                                                                                                                                
Co-Chair Hawker  emphasized that the check write  analysis is                                                                   
one of several  used by the department for  the projection of                                                                   
program expenditures.                                                                                                           
                                                                                                                                
2:14:12 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan talked of  possible improvements  because                                                                   
of the economic  stimulus package. Co-Chair  Hawker expressed                                                                   
concerns regarding future state  funding of programs expanded                                                                   
by the stimulus package.                                                                                                        
                                                                                                                                
2:16:55 PM                                                                                                                    
                                                                                                                                
Commissioner Hogan assured the  committee that DHSS will work                                                                   
with the committee before accepting  funds available from the                                                                   
stimulus package.                                                                                                               
                                                                                                                                
Co-Chair Hawker  trusted that the dialogue would  continue as                                                                   
the stimulus package is developed.                                                                                              
                                                                                                                                
2:18:47 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan   discussed  the  Bring  the   Kids  Home                                                                   
program, which  brings Alaskan  children residing  in out-of-                                                                   
state psychiatric  treatment  centers home  for care.  At one                                                                   
time  over   500  children  were  residing   in  out-of-state                                                                   
centers. That number  is currently down to 168.  He felt that                                                                   
the  substantial reduction  would not  have occurred  without                                                                   
help  from  the   Mental  Health  Trust  Authority   and  the                                                                   
University  of  Alaska.  The department's  goal  is  to  have                                                                   
enough  facilities   to  house   all  of  Alaska's   juvenile                                                                   
psychiatric  patients by  2013. The  hope is  that this  will                                                                   
lead  to a more  comprehensive  children's behavioral  health                                                                   
service system in the state.                                                                                                    
                                                                                                                                
2:20:01 PM                                                                                                                    
                                                                                                                                
Representative Kelly  asked about the construction  workforce                                                                   
used to build the Bring the Kids  Home facility in Fairbanks.                                                                   
He wondered if the hiring was  handled by the private sector.                                                                   
Commissioner  Hogan replied  that the  facility in  Fairbanks                                                                   
was funded through bonds. He informed  the committee that the                                                                   
services are paid  for with Medicaid but a  state match helps                                                                   
to  operate  the  facility.  He  maintained  that  no  public                                                                   
dollars  were  used  to  build  the  facility  in  Fairbanks.                                                                   
Representative  Kelly asked  if that  was the  case in  other                                                                   
communities.  Commissioner  Hogan  answered that  some  other                                                                   
communities have received federal  public dollars through the                                                                   
Denali  Commission.  He  elaborated that  those  are  smaller                                                                   
residential  facilities  and group  homes with  only  5 or  6                                                                   
beds.                                                                                                                           
                                                                                                                                
Commissioner   Hogan  reported   that  in  FY09   incremental                                                                   
increases for providers  had been made that allowed  a 2 to 6                                                                   
percent increase  in reimbursement rates. The  department has                                                                   
been  working to  establish a  methodology  to determine  the                                                                   
actual  cost incurred  by  providers  for the  services  they                                                                   
offer. The department  has discovered that there  are varying                                                                   
degrees  of  sophistication among  the  providers  concerning                                                                   
cost per unit of service. Commissioner  Hogan maintained that                                                                   
the methodology  must be examined  in order to  offer greater                                                                   
technical assistance to providers.                                                                                              
                                                                                                                                
2:23:53 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan   thought  there  was   solidarity  among                                                                   
providers to commit to incremental  rate increases. The issue                                                                   
is  complicated   and  not  moving  as  quickly   as  he  had                                                                   
anticipated. Some  rates have been  frozen for the  last four                                                                   
years, particularly with home  and community based providers,                                                                   
preventing reimbursement rates from being cost based.                                                                           
                                                                                                                                
2:24:59 PM                                                                                                                    
                                                                                                                                
Commissioner Hogan shared that  rates are now being looked at                                                                   
on  a  regular  basis.  Some  providers  have  not  had  rate                                                                   
increases  since  the  early 1990s  which  could  affect  the                                                                   
availability   of   services   to   economically   vulnerable                                                                   
Alaskans.                                                                                                                       
                                                                                                                                
Representative   Gara   asked   about   the   foster   family                                                                   
reimbursement rate.  Between 1992 and 2008 the  rates had not                                                                   
been  raised.  He  recognized  that the  rates  were  finally                                                                   
raised in FY09 but wanted to know  if they would be regularly                                                                   
reviewed. Commissioner  Hogan answered that he  anticipated a                                                                   
review  every two or  three years.  Co-Chair Hawker  reminded                                                                   
the committee  that an annual  review does not  automatically                                                                   
translate into increased appropriations.  Representative Gara                                                                   
pointed out  that there is a  shortage of foster  families in                                                                   
the  state. He  wondered if  there were  other programs  with                                                                   
regular automatic reimbursement  rate increases. Commissioner                                                                   
Hogan relayed that statute calls  for regular adjustments for                                                                   
hospitals and  nursing homes only.  All providers  would like                                                                   
to be  included in  regular adjustments  for a  reimbursement                                                                   
rate increase.                                                                                                                  
                                                                                                                                
2:27:32 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan felt  DHSS  had a  positive  relationship                                                                   
with the  provider community.  He reaffirmed  that help  from                                                                   
the legislature  was necessary  to ensure a positive  outcome                                                                   
concerning rate increases.                                                                                                      
                                                                                                                                
Vice-Chair Thomas  asked if Commissioner  Hogan had  seen the                                                                   
foster parent application. Commissioner  Hogan replied no. He                                                                   
hoped that the  application was not keeping  good people from                                                                   
applying. The extensive application  process is an attempt to                                                                   
ensure that  children are  placed in  safe and secure  homes.                                                                   
Vice-Chair Thomas  shared he had  tried to apply in  the past                                                                   
and  the forms  were  too overwhelming  without  help from  a                                                                   
field representative.  He has not seen the  application since                                                                   
that time and wondered if it had  been reviewed. Commissioner                                                                   
Hogan  replied  that  he  would  look  into  the  application                                                                   
process and provide an update.                                                                                                  
                                                                                                                                
Representative Crawford remarked  the he had gone through the                                                                   
foster  parent  application  process  and felt  it  could  be                                                                   
improved.  Commissioner  Hogan agreed  the  process could  be                                                                   
streamlined.                                                                                                                    
                                                                                                                                
2:30:48 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan  drew  attention to  the  handout  titled                                                                   
"ADHSS 2009 Priorities" (Copy  on File). The handout outlines                                                                   
major  strategies  for  issues   facing  Alaskans:  substance                                                                   
abuse,  health and  wellness, health  care reform,  long-term                                                                   
care, and vulnerable Alaskans.                                                                                                  
                                                                                                                                
2:32:04 PM                                                                                                                    
                                                                                                                                
Commissioner Hogan  continued with the "DHSS  Overview of 10-                                                                   
Year Plan"  (Copy on  File). Co-Chair  Hawker clarified  that                                                                   
Commissioner  Hogan was  reading from  the DHSS 10-year  plan                                                                   
packet issued by OMB.                                                                                                           
                                                                                                                                
2:32:56 PM     AT EASE                                                                                                        
2:42:44 PM     RECONVENED                                                                                                     
                                                                                                                                
Co-Chair  Hawker asked  about the 10-year  prospects  for the                                                                   
department.  He pointed  out that requesting  a 10-year  plan                                                                   
for  department  budget  overviews   is  essential  to  spark                                                                   
conversation  among the  legislature,  the departments,  OMB,                                                                   
and the  public. He mentioned  the graphic representation  of                                                                   
technical numbers on pages 12 and 13 of the OMB packet.                                                                         
                                                                                                                                
Commissioner Hogan related that  the department had discussed                                                                   
the  Bring the  Kids Home  project and  questions had  arisen                                                                   
concerning how much money the  project needed and how long it                                                                   
would  continue. The  discussion prompted  the department  to                                                                   
change  its view  as  to how  budgets  are  put together.  He                                                                   
explained  that  Medicaid  is   a  big  driver  in  cost  for                                                                   
provision  of services  and operating  expenses. The  federal                                                                   
matching  percentage  fluctuates.   He  maintained  that  the                                                                   
department had worked diligently to craft a 10-year plan.                                                                       
                                                                                                                                
Commissioner   Hogan   shared   that   the   department   has                                                                   
anticipated  implementing "Health  and Social Service  Impact                                                                   
Assessments"  in expectation  of social  issues that  will be                                                                   
compounded by the Alaska Gasline Inducement Act.                                                                                
                                                                                                                                
2:48:09 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan  added that  the  department  had yet  to                                                                   
determine what model to use and include in the numbers.                                                                         
                                                                                                                                
Ms.  Elgee   expressed  that   long-term  Medicaid   modeling                                                                   
software has  allowed the department  to project  the 10-year                                                                   
numbers  comfortably but  other areas  were more  subjective.                                                                   
She related that creating the  10-year projections had been a                                                                   
difficult  but   valuable  exercise   and  had  enabled   the                                                                   
department  to do  some hypothetical  modeling  that had  not                                                                   
been part of past policy discussions.                                                                                           
                                                                                                                                
2:50:03 PM                                                                                                                    
                                                                                                                                
Co-Chair Hawker  asked about the  "Health & Social  Services-                                                                   
All Funds" (Slide 12). Commissioner  Hogan clarified that the                                                                   
red  line   on  the  chart   indicating  the   baseline  plus                                                                   
initiatives  was based  on the  anticipation of  implementing                                                                   
the  initiatives. Ms.  Elgee added  that the  need for  state                                                                   
expenditures  will double  within the  next 10  years if  the                                                                   
department continues with its current operations.                                                                               
                                                                                                                                
2:52:00 PM                                                                                                                    
                                                                                                                                
Co-Chair  Hawker  asked  if the  state  is  looking at  a  $4                                                                   
billion budget  for DHSS in FY19. Commissioner  Hogan replied                                                                   
yes. Co-Chair  Hawker explained that  the low numbers  of the                                                                   
projected 10-year overview were a positive sign.                                                                                
                                                                                                                                
2:54:27 PM                                                                                                                    
                                                                                                                                
Representative  Salmon asked about  departmental funding  and                                                                   
programming  concerning   suicide  prevention.   Commissioner                                                                   
Hogan responded that the department  is actively working with                                                                   
the Suicide Prevention Council.  He did not have exact dollar                                                                   
amounts  available.  The focus  in  FY09 is  on  Northwestern                                                                   
Alaska  because  the  suicide  rates in  that  area  are  the                                                                   
highest  in the  state. He  pointed out  that the  department                                                                   
could  provide  resources  and  hoped  communities  would  be                                                                   
proactive in seeking  out solutions. The issue  of suicide is                                                                   
complicated  by substance  abuse  and economic  hardship.  He                                                                   
stated that he  would provide the dollar amounts  for suicide                                                                   
programs as quickly as possible.                                                                                                
                                                                                                                                
2:56:14 PM                                                                                                                    
                                                                                                                                
Co-Chair  Hawker  asked  what  DHSS's approach  had  been  to                                                                   
initiatives for the programs it  supports. Commissioner Hogan                                                                   
replied that the department had  looked at historical trends.                                                                   
                                                                                                                                
2:57:25 PM                                                                                                                    
                                                                                                                                
Commissioner  Hogan stressed  that  defaulting to  historical                                                                   
trends had been the best option given the shortage of time.                                                                     
                                                                                                                                
Co-Chair  Hawker  queried the  department's  contribution  to                                                                   
deficit reduction  strategies  over time. Commissioner  Hogan                                                                   
stated that the department would  examine all of its programs                                                                   
to determine where budget reductions could be made.                                                                             
                                                                                                                                
2:58:56 PM                                                                                                                    
                                                                                                                                
Vice-Chair Thomas  wondered if  people could be  dropped from                                                                   
social  service programs  if they  fail to  quit smoking.  He                                                                   
felt  that  people   who  smoke  cigarettes   will  become  a                                                                   
financial  burden  to  the  state  through  eventual  medical                                                                   
costs. He  elaborated on  the ills of  smoking and  wanted to                                                                   
know  what  was being  done  about  prevention.  Commissioner                                                                   
Hogan stated that it was a matter  of personal responsibility                                                                   
and  a system  should be  created  to help  people make  good                                                                   
choices. He agreed  that the bad choices made  by some people                                                                   
using the  social service  programs add  significant  cost to                                                                   
the healthcare system.                                                                                                          
                                                                                                                                
Representative  Fairclough asked if  there were vacancies  on                                                                   
the  board   of  the   Alaska  Suicide  Prevention   Council.                                                                   
Commissioner  Hogan  thought  that all  appointments  to  the                                                                   
board had  been made. He hoped  in the future there  would be                                                                   
more collaboration  between the  department and  the council.                                                                   
Representative Fairclough asked  him to double check that the                                                                   
board was fully functioning.                                                                                                    
                                                                                                                                
Co-Chair  Stoltze wondered  if applicants  with a history  of                                                                   
drug abuse could be required to  be drug tested when applying                                                                   
for  social service  programs.  Commissioner Hogan  responded                                                                   
that applicants  who have gone  through the court  system are                                                                   
required  to submit  to  drug screening.  He  added that  the                                                                   
majority   of   individuals   that  are   involved   in   the                                                                   
department's  substance abuse system  are subject  to regular                                                                   
urinalysis. Co-Chair Stoltze emphasized  that he did not want                                                                   
to brand possible  recipients but he felt if  money was going                                                                   
to be  spent it should  not be on  people who use  drugs. Co-                                                                   
Chair Hawker  asked if the department  was able to  make drug                                                                   
screening   a  requirement   for   Medicaid  eligibility   in                                                                   
particular.  Commissioner  Hogan  replied  it would  take  an                                                                   
increase of  capacity and capability  to test  every Medicaid                                                                   
applicant. Co-Chair  Hawker added that the practice  would be                                                                   
unconstitutional.                                                                                                               
                                                                                                                                
3:07:39 PM                                                                                                                    
                                                                                                                                
Representative Joule  interjected that revisiting  efforts to                                                                   
tighten airport security on the  local level, particularly in                                                                   
rural communities,  could alleviate  some of the  social ills                                                                   
throughout the state.                                                                                                           
                                                                                                                                
3:10:19 PM                                                                                                                    
                                                                                                                                
Representative   Kelly   asked   if  the   numbers   in   the                                                                   
department's 10-year plan reflected inflation.                                                                                  
                                                                                                                                
3:11:21 PM                                                                                                                    
                                                                                                                                
JOHN  BOUCHER, SENIOR  ECONOMIST,  OFFICE  OF MANAGEMENT  AND                                                                   
BUDGET, OFFICE OF  THE GOVERNOR, explained that  there was no                                                                   
overall built-in constant inflation adjustment.                                                                                 
                                                                                                                                
Representative  Kelly  asked   for  more  clarification.  Mr.                                                                   
Boucher informed  the committee that some programs  had built                                                                   
in an inflation factor of 2.75  percent and some did not. The                                                                   
dollars in  the presentation  are a  combination of  the two.                                                                   
Ms. Elgee  added that the  2.75 percent inflation  factor was                                                                   
employed in the case of Medicaid.                                                                                               
                                                                                                                                
3:13:25 PM:    AT EASE                                                                                                        
3:14:54 PM:    RECONVENED                                                                                                     
                                                                                                                                
^MILITARY AND VETERANS AFFAIRS BUDGET OVERVIEW                                                                                
                                                                                                                                
CRAIG  CAMPBELL, ADJUTANT  GENERAL, COMMISSIONER,  DEPARTMENT                                                                   
OF MILITARY & VETERANS AFFAIRS, began his presentation.                                                                         
                                                                                                                                
3:16:55 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell  explained   that  the  department  is                                                                   
composed of a variety of divisions.                                                                                             
                                                                                                                                
3:17:58 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell began  with  the issue  of the  Alaska                                                                   
Territorial Guard.  A decade ago  Senator Ted  Stevens passed                                                                   
federal legislation  that allowed  territorial guard  members                                                                   
to   receive  official   recognition   as  retired   military                                                                   
personnel.  The  guard  members   had  been  denied  military                                                                   
retirement  benefits   for  60  years.  In   2004  the  first                                                                   
certificate  was  issued  allowing   the  recipient  to  draw                                                                   
military retirement benefits.  There are currently 27 members                                                                   
who  receive full  military  retirement  benefits because  of                                                                   
their service  in the ATG.  Over 1000 applications  have been                                                                   
processed.                                                                                                                      
                                                                                                                                
3:20:05 PM                                                                                                                    
                                                                                                                                
Commissioner   Campbell   continued  that   presently   those                                                                   
benefits are under  scrutiny and are being challenged  by the                                                                   
U.S. Army.  He had  been informed  on January  27, 2009  that                                                                   
benefits  would   be  discontinued  in  two   months.  He  is                                                                   
confident that  with Alaska's two senators working  the issue                                                                   
through the  congressional process,  the law will  be changed                                                                   
and  there will  be  no interruption  of  benefits to  Alaska                                                                   
Territorial Guard members.                                                                                                      
                                                                                                                                
3:21:50 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell  relayed that  over the last  few years                                                                   
the Army  National Guard (ANG)  has been transforming  from a                                                                   
scout  group into  a battlefield  surveillance brigade.  They                                                                   
now have  the equipment and  training to support  active-duty                                                                   
army soldiers deployed worldwide.  The training also provides                                                                   
the guard with a skill set beneficial  to Alaska in emergency                                                                   
response  situations. The  guard will  maintain 2000  members                                                                   
and the  main readiness centers  in Nome, Bethel,  and Juneau                                                                   
will remain  intact. The headquarters  will be  in Anchorage.                                                                   
He expected that  the transformation will be  completed in 24                                                                   
months.                                                                                                                         
                                                                                                                                
3:23:30 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell reported  that the Defense Base Closure                                                                   
and  Realignment   Commission  (BRAC)  has   recommended  the                                                                   
closing of the  Kulis ANG base. The guard would  be relocated                                                                   
to Elmendorf  United States Air  Force (USAF) Base.  The land                                                                   
at  the  Anchorage  International  Airport,  where  Kulis  is                                                                   
currently  located, is  valuable  land for  the airport.  The                                                                   
land can be used for other opportunities  which will generate                                                                   
more civilian jobs.                                                                                                             
                                                                                                                                
3:24:39 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell  communicated that the project  will be                                                                   
entirely  federally  funded.   The  project  will  cost  $150                                                                   
million and is currently on schedule.                                                                                           
                                                                                                                                
3:25:33 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell explained  that the relocation of Kulis                                                                   
to Elmendorf will  save the state money because  Elmendorf is                                                                   
a federally  funded  USAF base.  The department  is still  in                                                                   
negotiations  with the  USAF to  determine  what the  overall                                                                   
operational  costs will  be. The Alaska  National Guard  will                                                                   
maintain  two  air force  units  and  2000 guardsmen  in  the                                                                   
state.                                                                                                                          
                                                                                                                                
3:26:44 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell declared that  across the  country the                                                                   
United  States National  Guard  is attempting  to reduce  the                                                                   
number of  air force units per  state to one.  The department                                                                   
has an air force unit at Eielson  and at Kulis, soon to be at                                                                   
Elmendorf. If  the pressure from  the federal  National Guard                                                                   
is successful  one  of Alaska's  air force  units will  be at                                                                   
risk. By establishing the USAF  as the department's strongest                                                                   
proponent for  maintaining two air force units,  Alaska gains                                                                   
leverage  against the  federal  National  Guard. The  state's                                                                   
current   relationship  with   the  USAF   is  good   and  is                                                                   
strengthened  by a mutual  understanding that the  relocation                                                                   
of the Kulis base is necessary for the future of the state.                                                                     
                                                                                                                                
3:28:04 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell talked about  the Alaska Military Youth                                                                   
Academy. The academy  is the fourth strongest  in the nation.                                                                   
Several years  ago the legislature converted  academy funding                                                                   
from  the general  fund over  to  the educational  foundation                                                                   
formula. This  change was  critical as  the program  does not                                                                   
qualify  for federal public  education  funds because  of its                                                                   
military style training.                                                                                                        
                                                                                                                                
3:29:23 PM                                                                                                                    
                                                                                                                                
Commissioner   Campbell  furthered   that  securing   funding                                                                   
through the  educational foundation  formula has  allowed the                                                                   
academy  to  build a  highly  successful  program with  a  95                                                                   
percent graduation rate.                                                                                                        
                                                                                                                                
3:31:41 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell continued that  the method  of funding                                                                   
for the academy works well and should remain the same.                                                                          
                                                                                                                                
Commissioner Campbell addressed  the Emergency Management and                                                                   
Homeland Security  Division. The  division had been  split in                                                                   
two in  the past  and in  2001 there  were only three  people                                                                   
working in the Division of Homeland Security.                                                                                   
                                                                                                                                
3:33:22 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell  stated   that  three  years  ago  the                                                                   
divisions  were combined  for efficiency.  At that time  both                                                                   
programs  employed a  grant program  and  a response  program                                                                   
that worked countercyclical  to each other. The  division, as                                                                   
it is now structured, is thriving  and cognizant of the needs                                                                   
of communities throughout the state.                                                                                            
                                                                                                                                
3:34:55 PM                                                                                                                    
                                                                                                                                
Representative  Kelly asked  if the population  of the  youth                                                                   
academy  had increased  recently and  if there  is a  waiting                                                                   
list.                                                                                                                           
                                                                                                                                
3:36:35 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell reported  that this year's  graduating                                                                   
class   is  the  largest   in  academy   history.  Over   400                                                                   
applications are processed per  year. Out of the 300 students                                                                   
accepted each  year, 250 students  graduate. The  academy has                                                                   
one  full  female  and  three  male  platoons.  He  felt  the                                                                   
facility  would not  be run  as effectively  if expanded.  He                                                                   
mentioned the  possibility of another academy  to accommodate                                                                   
student overflow.  There is no waiting list  for the academy.                                                                   
There are  always more applications  than open  positions. He                                                                   
felt  the true  demand for  the  academy lies  at around  400                                                                   
students.                                                                                                                       
                                                                                                                                
3:38:54 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell  added  that  the  facility  could  be                                                                   
expanded to accommodate more students.                                                                                          
                                                                                                                                
Vice-Chair  Thomas stated  that  he had  received  complaints                                                                   
from vets  who were  denied a  permanent fund dividend  (PFD)                                                                   
because they had been deployed  to Kuwait, a non-combat zone,                                                                   
and  wondered  if  Commissioner  Campbell was  aware  of  the                                                                   
problem.  He spoke  of soldiers  deployed to  Iraq with  post                                                                   
traumatic  stress   disorder  (PTSD)   who  could   not  find                                                                   
employment  and  soldiers  with  substance  abuse  and  other                                                                   
health  problems. He  worried that soldiers  were ashamed  to                                                                   
seek  help from  the military  and  queried the  department's                                                                   
involvement with PTSD cases in Alaska.                                                                                          
                                                                                                                                
3:42:57 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell  replied that he  was aware of  the PFD                                                                   
issue. He asked  for time to research the issue  and get back                                                                   
to the committee. The Alaska Army  National Guard has not had                                                                   
many soldiers serve multiple tours  of duty. The average tour                                                                   
of duty  can last one to  four years. He stressed  that there                                                                   
are many  programs available to  help soldiers with  PTSD but                                                                   
that the  programs may be hard  to access. The  Yellow Ribbon                                                                   
Program requires  that soldiers be evaluated at  30, 60, and,                                                                   
90 days  after returning  from deployment  in order  to catch                                                                   
health issues. A  full-time chaplin has been  hired to travel                                                                   
throughout  the  state  to  visit  with  soldiers  and  their                                                                   
families as needed.                                                                                                             
                                                                                                                                
3:46:16 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell  parlayed   that  the  department  has                                                                   
developed  the  Warrior  Transition  Program  to  accommodate                                                                   
soldiers  still under  Army authority  with  PTSD issues.  He                                                                   
pointed  out that  this  program  was not  available  several                                                                   
years ago. He  explained that the majority of  National Guard                                                                   
members are working  for the guard mainly on  the weekend. He                                                                   
stressed  that the  department  encourages  soldiers to  talk                                                                   
about possible  destructive issues. He felt  comfortable that                                                                   
the problems  among soldiers who  had been deployed  with the                                                                   
guard have not  been major abuse problems. He  impressed upon                                                                   
the  committee  the  he  personally   would  assist  soldiers                                                                   
experiencing difficulty receiving help.                                                                                         
                                                                                                                                
3:48:11 PM                                                                                                                    
                                                                                                                                
Representative  Gara asked  about a  past intensive  outreach                                                                   
effort to  locate the Alaska  Territorial Guardsmen  who were                                                                   
entitled  to retirement  benefits. He  asked how many  people                                                                   
had  been  located  to  date   and  how  many  are  receiving                                                                   
benefits.                                                                                                                       
                                                                                                                                
3:49:41 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell  replied  that there  are  six  people                                                                   
working  on  the  project.  He  explained  that  he  was  not                                                                   
personally  overseeing   the  program.  He  noted   that  the                                                                   
outreach  program  is exceptional  and  is endorsed  by  many                                                                   
groups around the state.                                                                                                        
                                                                                                                                
3:50:54 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell furthered  that the program has located                                                                   
6,600  people who  have served  in the past;  of those,  1300                                                                   
have  been  processed,   700  have  been  approved,   27  are                                                                   
currently  receiving  benefits,  and  56  are  qualified  but                                                                   
waiting to receive benefits. Representative  Gara wondered if                                                                   
the  process  was  taking  too  long.  He  feared  that  some                                                                   
qualified   guardsmen   may   have   already   passed   away.                                                                   
Commissioner   Campbell   felt   that  the   department   was                                                                   
effectively  engaging with  every community  involved in  the                                                                   
program.                                                                                                                        
                                                                                                                                
Co-Chair Hawker  queried Commissioner Campbell's  approach to                                                                   
reaching departmental goals within the next 10 years.                                                                           
                                                                                                                                
3:54:49 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell  avowed that  there will be  no general                                                                   
fund supplemental  for FY09; however,  a supplemental  may be                                                                   
necessary for  fuel and utility  expenses that come  from the                                                                   
state.  Co-Chair  Hawker  responded that  the  committee  has                                                                   
anticipated the supplemental.                                                                                                   
                                                                                                                                
3:56:07 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell pointed  out the highlights of the 2010                                                                   
budget request. He  explained that the budget is  the same as                                                                   
the FY09  budget, minus  the cost of  fuel ("Summary  of DMVA                                                                   
10-year Plan Assumptions"  Copy on File). He  maintained that                                                                   
the budget  is transparent  and invited  the public  to visit                                                                   
his website to  view the department's strategic  plan, annual                                                                   
report, and annual budget for the past six years.                                                                               
                                                                                                                                
3:57:50 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell revealed that  $50,000 would  be added                                                                   
to veteran's  services. This is  possible through  money left                                                                   
over from  the FY08  budget. The extra  funding will  add two                                                                   
more veterans services officers.                                                                                                
                                                                                                                                
4:00:17 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell spoke  of the  long-range view  of the                                                                   
department.  The construction  of a  Bethel Readiness  Center                                                                   
(Armory) is a top priority. He  explained that in 2004, 2005,                                                                   
and  2006  the  state matched  federal  funds  to  build  the                                                                   
center.  The National  Defense Appropriation  Act Budget  put                                                                   
$16 million in for the Bethel  armory, so the federal funding                                                                   
match is now available.                                                                                                         
                                                                                                                                
Commissioner  Campbell  elaborated   that  there  were  other                                                                   
obstacles. The land established  for the building was full of                                                                   
refrigerators, cars,  and other waste. The  department worked                                                                   
with  the  city, cleaned  up  the  trash,  and put  in  fill.                                                                   
Because  the fill has  altered the  landscape, run-off  water                                                                   
from rain and snow is not draining  sufficiently, which could                                                                   
put surrounding residencies  at risk for flood.  To solve the                                                                   
problem the fill must be raised,  the project scaled back, or                                                                   
a new  location must  be established.  He maintained  that he                                                                   
was  not  asking  the committee  for  more  funding  for  the                                                                   
project. The  request is for  permission to have  $258,000 in                                                                   
operating  costs included  in the yearly  budget starting  in                                                                   
2011. He  added that the  center is number  two on a  list of                                                                   
three readiness  centers. The center in Juneau  was completed                                                                   
three years ago and the hope is to build the third in Nome.                                                                     
                                                                                                                                
4:03:22 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell   expected  a  $138,000   to  $149,000                                                                   
increase in personnel cost per  year over the next decade. He                                                                   
believed operating  costs could also rise. He  asked that the                                                                   
committee pay  attention to the  effects of inflation  on the                                                                   
needs of the department.                                                                                                        
                                                                                                                                
4:05:24 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell   informed  the  committee   that  the                                                                   
department  is working  to begin  a  new program  to build  a                                                                   
state  veteran's  cemetery  in   the  Interior.  The  veteran                                                                   
population  in   and  around  Fairbanks  could   qualify  the                                                                   
Interior for a veterans cemetery;  however, it would not be a                                                                   
fully federally  funded and  operated veterans cemetery.  The                                                                   
federal government  would pay  to build  the cemetery  if the                                                                   
state agrees  to cover operating  expenses. Many  states have                                                                   
participated  in  this  program. The  project  would  require                                                                   
$750,000 up front  in architectural and engineering  costs to                                                                   
the state.  The federal government  would pay $5  million for                                                                   
construction  costs; annual operations  would cost  $250,000.                                                                   
The department's  10-year projection had  initially requested                                                                   
four  $250,000   increments  for  the  construction   of  the                                                                   
cemetery.                                                                                                                       
                                                                                                                                
4:07:51 PM                                                                                                                    
                                                                                                                                
Commissioner Campbell explained  that on January 16, 2008 the                                                                   
Veterans  Administration advised  the  department that  costs                                                                   
had  been  overestimated.  The  actual  cost  would  only  be                                                                   
$750,000, the  caveat being that the department  cannot apply                                                                   
for federal  funding for the project  until the state  made a                                                                   
commitment  to the  full $750,000  for  operation costs.  The                                                                   
department  recommends  that  the state  fund  the  $750,000.                                                                   
Commissioner   Campbell  stated   that  the  application   is                                                                   
prepared and the cemetery would take two years to build.                                                                        
                                                                                                                                
4:09:22 PM                                                                                                                    
                                                                                                                                
Commissioner  Campbell mentioned  a  number of  appropriation                                                                   
requests  found  in the  10-year  plan  that pertain  to  the                                                                   
authority  to  spend federal  money.  He concluded  with  two                                                                   
charts  on Slide  5 comparing  the  federal government  match                                                                   
with  the state  match.  Commissioner Campbell  stressed  the                                                                   
significance of the federal funding  the department receives.                                                                   
He  discussed  the  capital  funds  charts  located  Slide  4                                                                   
showing the value to the state  of accepting federal dollars.                                                                   
He clarified  that  he did not  believe in  asking for  state                                                                   
money  simply  because  federal   money  was  available.  The                                                                   
department  asks for  federal  money that  is  right for  the                                                                   
state.   He  urged   the   committee   to  take   that   into                                                                   
consideration when  examining the Department of  Military and                                                                   
Veterans Affairs budget.                                                                                                        
                                                                                                                                
4:14:05 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
The meeting was adjourned at 4:14 PM.                                                                                           
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
DHSS-5 Priorities-1.27.09.pdf HFIN 1/28/2009 1:30:00 PM
DHSS Org Chart & Financials-1.27.09.pdf HFIN 1/28/2009 1:30:00 PM
MILITARYVETAFFAIRS_Plan 2009.pdf HFIN 1/28/2009 1:30:00 PM
H&SS_Plan 2009.01.27 HFC.pdf HFIN 1/28/2009 1:30:00 PM
DMVA Overview 10 yr plan - Talking Points.pdf HFIN 1/28/2009 1:30:00 PM
HB 81