Legislature(2021 - 2022)ADAMS 519
02/09/2022 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB281 || HB282 | |
| Presentation: Department of Health and Social and Social Services Executive Order 121 and Fy23 Governor's Budget Request | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 281 | TELECONFERENCED | |
| += | HB 282 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
February 9, 2022
1:31 p.m.
1:31:39 PM
CALL TO ORDER
Co-Chair Foster called the House Finance Committee meeting
to order at 1:31 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Kelly Merrick, Co-Chair
Representative Dan Ortiz, Vice-Chair
Representative Ben Carpenter
Representative Bryce Edgmon
Representative DeLena Johnson
Representative Bart LeBon
Representative Sara Rasmussen
Representative Steve Thompson
Representative Adam Wool
MEMBERS ABSENT
Representative Andy Josephson
ALSO PRESENT
Adam Crum, Commissioner, Department of Health and Social
Services; Sylvan Robb, Assistant Commissioner, Department
of Health and Social Services.
SUMMARY
HB 281 APPROP: OPERATING BUDGET/LOANS/FUNDS
HB 281 was HEARD and HELD in committee for
further consideration.
HB 282 APPROP: MENTAL HEALTH BUDGET
HB 282 was HEARD and HELD in committee for
further consideration.
PRESENTATION: DEPARTMENT OF HEALTH AND SOCIAL AND SOCIAL
SERVICES EXECUTIVE ORDER 121 AND FY23 GOVERNOR'S BUDGET
REQUEST
Co-Chair Foster reviewed the meeting agenda.
HOUSE BILL NO. 281
"An Act making appropriations for the operating and
loan program expenses of state government and for
certain programs; capitalizing funds; amending
appropriations; making reappropriations; making
supplemental appropriations; making appropriations
under art. IX, sec. 17(c), Constitution of the State
of Alaska, from the constitutional budget reserve
fund; and providing for an effective date."
HOUSE BILL NO. 282
"An Act making appropriations for the operating and
capital expenses of the state's integrated
comprehensive mental health program; making capital
appropriations and supplemental appropriations; and
providing for an effective date."
1:36:23 PM
^PRESENTATION: DEPARTMENT OF HEALTH AND SOCIAL AND SOCIAL
SERVICES EXECUTIVE ORDER 121 AND FY23 GOVERNOR'S BUDGET
REQUEST
1:36:28 PM
ADAM CRUM, COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, highlighted that the presentation would cover the
[governor's] proposed Department of Health (DOH) and the
Department of Family and Community Services (DFCS).
SYLVAN ROBB, ASSISTANT COMMISSIONER, DEPARTMENT OF HEALTH
AND SOCIAL SERVICES, began with a PowerPoint presentation
titled "Alaska Department of Health and Social Services,"
dated February 9, 2022 (copy on file). She addressed slide
2 and clarified there was no FY 23 budget for the
Department of Health and Social Services (DHSS); budgets
had been put forth for the two new departments. The slide
reflected the combined budgets for DOH and DFCS. She
pointed out that including the investment for the
reorganization, the cost of the two departments was down
relative to FY 19 by $22 million undesignated general funds
(UGF). She relayed that much of the overall increase
indicated on the slide was federal and a significant
portion of the federal increase was related to the enhanced
Federal Medical Assistance Percentage (FMAP) for Medicaid
that occurred during the [COVID-19] pandemic.
Commissioner Crum moved to slide 3 showing the current DHSS
structure on the left including the commissioner's office,
Finance and Management Services and nine public facing
divisions. He referred to the proposed reorganization as a
"pick and place" method. He detailed the proposal kept the
existing public facing divisions whole and intact and
aligned them by key function area. He elaborated that DOH
would include the Medicaid divisions of Health Care
Services, Behavioral Health, Senior and Disabilities
Services aligned with Public Assistance and Public Health.
He explained that the groups were responsible for payment,
process, and programs and did very little "patient touch"
or direct care. The department's job was to ensure programs
were managed, checks went out the door, and that the
beneficiaries and eligibility process was continuous. He
highlighted that each of the two new departments would
include a commissioner's office and Finance and Management
Services. He explained that Finance and Management Services
was the internal division that moved departments along.
Commissioner Crum explained that DFCS would have to be
broken apart accordingly to ensure services required for
each department were covered, including information
technology, budget, finance, and grants and contracts
staff. The Department of Family and Community Services
aligned facility based services including the Alaska
Psychiatric Institute (API), Juvenile Justice, Alaska
Pioneer Homes, and 24/7 community service of the Office of
Children's Services (OCS).
1:40:04 PM
Ms. Robb moved to slide 4 showing the budget comparison for
DFCS. She stressed the bars on the slide did not reflect
the full department budget. The full budget was shown in
the blue box on the right side of the slide. She noted
departmental support services were not included and
explained that including departmental support in a lookback
through FY 19 would have required going back person by
person to get an accurate comparison. The bars on the slide
reflected the four divisions listed by Commissioner Crum.
She relayed there had been an increase in UGF from the FY
19 to FY 23 budget, which had been spread fairly evenly
between each of the divisions. There had been a designated
general fund (DGF) reduction relative to FY 19 of about $5
million, but it had been mostly flat since FY 22. She drew
attention to the large increase in the "other" category,
which was primarily due to the creation of the Pioneer Home
payment assistance component created during the time
period. The increase reflected interagency receipts as
money transferred to Pioneer Home management. There was a
slight decrease in federal funding, but an increase
overall. The total DFCS budget was $430 million and was the
larger of the two departments in terms of staff, comprised
of 1,820 individuals.
Representative Edgmon stated his understanding that the
change would result in two departments and two
commissioners. He wondered whether the facilities would be
the same or separate. He observed the costs were basically
the same [when comparing the single department and the two
new departments]. He thought it deserved more explanation.
Ms. Robb replied that the last slide of the presentation
laid out the costs incurred as a result of the
reorganization.
Co-Chair Foster noted that Representative Wool and
Representative Johnson had joined the meeting.
1:43:11 PM
Ms. Robb moved to slide 5 and addressed the Pioneer Homes
that operated five levels of care in six different
locations around the state. There were 421 positions with a
total proposed FY 23 budget of $103.6 million including
$38.5 million UGF. There was a UGF reduction from FY 19 of
$3.9 million and a reduction of slightly more than $4
million from the past year. She highlighted a decrement of
$3 million in the payment assistance component. She
explained that $7 million from the component had lapsed the
previous year. The department was keeping what it believed
to be a very conservative cushion of $4 million for the
current year. She relayed that the Anchorage Pioneer Home
recently opened a new "neighborhood" for high acuity
elders. She stated that even if all of the beds in the high
acuity unit required 100 percent payment assistance, it
only used less than half of the $4 million. She relayed
there had been quite a few changes in the Pioneer Homes'
rates and impacts to the number of residents related to
COVID-19 in the past several years. Looking forward, the
department hoped to smooth the curve as it determined the
appropriate level of payment assistance moving forward.
1:45:10 PM
Ms. Robb advanced to the budget for a new appropriation
titled Inpatient Mental Health on slide 6. The
appropriation was comprised of API and Designated
Evaluation and Treatment (DET). She explained the DET
allocation had previously been part of the Division of
Behavioral Health. She detailed it followed the executive
order statutes. She elaborated that as the funds would
follow the statutes into DFCS. The budget for the new
allocation was $70.9 million including $31.6 million UGF.
She added that API comprised $58 million of the $70 million
total.
Ms. Robb moved to slide 7 and discussed the OCS budget. She
relayed that OCS was the largest DHSS division with 587
employees. The division's total proposed FY 23 budget was
$180 million, including $96.1 million UGF. The slide showed
a $1.4 million UGF increment in support of the Alaska
Tribal Child Welfare Compact. The department had been
supporting the compact and engaged with tribes since 2017,
but the $1.4 million increment reflected a significant
increase in investment.
Ms. Robb turned to the Division of Juvenile Justice on
slide 8. She stated there were no significant changes
proposed for the division in FY 23. There were 426 position
control numbers (PCNs) in the division. The large divisions
within DFCS would result in close to 500 more staff than
DOH. The division's FY 23 budget was $59.8 million,
including $57.1 million UGF. The budget was down slightly
relative to FY 22, which was mostly related to SB 55 and
some salary adjustments.
1:48:22 PM
Ms. Robb turned to slide 9 and reviewed the Department of
Health operating budget comparison. She clarified the bars
did not include departmental support services. She
explained the existing departmental support services had
been split between the two new departments; therefore,
there was no way to do an accurate lookback. The totals in
the blue box on the slide were the total budget for DOH
including departmental support services. The department
ended up with 1,446 PCNs and a budget of $3 billion
(primarily due to Medicaid), including $918 million UGF.
There was a substantial increase in UGF from the previous
year, primarily comprised of a $45 million increment for
Medicaid. She noted the presentation included a separate
slide on Medicaid.
Ms. Robb addressed the Division of Behavioral Health
operating budget comparison on slide 10. The division had
some fund source shifts because the governor's budget had
not been built with the assumption the reverse sweep would
pass; therefore, some of the amount was backfilled with
UGF. The division also included a proposed decrement of
$790,000 UGF to behavioral health treatment and recovery
grants.
1:50:30 PM
Ms. Robb advanced to the Division of Public Assistance with
458 PCNs on slide 11. The only significant change was a
proposed decrement of $215,000 UGF related to a reduction
in the device count. She explained the information
technology (IT) cost throughout the department was related
to the number of existing devices. The method provided a
much fairer way for the department because there were
divisions such as API where staff did not all have a
device, whereas some staff had multiple devices. She
reported the division had been reduced by 121 positions the
previous year and the decrement reflected the associated
decrease in the device count.
Representative Edgmon looked at the Division of Public
Assistance and asked for verification that much of the work
provided by the division involved processing applications.
Ms. Robb agreed. She detailed the division was responsible
for confirming eligibility for more than a dozen programs
administered by the department.
Representative Edgmon asked how things had changed in
recent years in terms of paper versus digital applications
and the resulting cost savings.
Commissioner Crum responded that when the administration
took over there had been a backlog of over 15,000
applications at the Division of Public Assistance. One of
the administration's primary objectives had been to ensure
to address the issue. He explained that through a change in
leadership and moving towards an electronic document
management system and the implementation of virtual call
centers, the department had eliminated the backlog as well
as multiple letters of correction from federal partners.
The change had resulted in better serving Alaskans and
gained efficiencies. There had been an associated reduction
in 121 positions in FY 22 and $9 million in associated
savings. The division had done a tremendous amount of work
processing federal assistance related to the COVID-19
response. He stated there were new expanded items that
required a bit of a manual process including emergency
allotment SNAP benefits, the pandemic EVT benefits for
school lunches, and other similar programs.
1:53:56 PM
Representative Edgmon wanted to ensure that individuals who
were hoping to receive benefits had electronic access. He
remarked there had been substantial discussion on broadband
capability and how it would change in the future. He wanted
to ensure someone in the village of Manokotak knew how to
apply if they could no longer submit a hard copy.
Commissioner Crum answered that the Centers for Medicare
and Medicaid Services (CMS) allowed telephonic signature
for Medicaid eligibility. He detailed the process took
quite a bit of time on the phone; there was a 45-minute
disclaimer that had to be read verbally over the phone in
order to meet the criteria. Individuals without internet
access could utilize mail-in paper applications or
telephonic procedures to ensure accessibility to all
corners of the state.
Co-Chair Foster asked for verification Commissioner Crum
had said there was a 45-minute disclaimer. He was a bit
shocked by the timeframe and thought it would be a
deterrent.
Commissioner Crum answered in the affirmative. He explained
that the department tried to encourage other ways to access
the application. He stated there were times individuals
wanted to undergo the telephonic process. He stated it did
not happen often, but it was a time sink for the
eligibility technician and the individual seeking
assistance.
Co-Chair Foster thought there had to be some other
solution.
Ms. Robb followed up on a question from Representative
Edgmon and relayed there was an $8 million capital request
that would help with developing online applications and
notifications. She shared that in the past, the Division of
Public Assistance would send and receive 4 million pieces
of mail per year. She stated it would be a benefit to
Alaskans needing the benefits in addition to the division.
1:56:23 PM
Representative LeBon looked at slide 10 related to the
Division of Behavioral Health. He asked how a decrement to
behavioral health grants may impact the Interior.
Commissioner Crum answered that he could follow up on the
question. He remarked that since the passage of SB 74 in
2016, the state had reduced behavioral health grants as it
transitioned behavioral health services to the 1115 waiver
to take advantage of the Medicaid expansion population and
the 23 new services provided. The department understood
there would always be a time and place for grants because
not everything would meet the Medicaid definition of
medical necessity. As a result, grants would decrease
slightly. He noted the jump had been very slight in the
current year compared to past years. He would follow up
with the information on impact to the Interior and
grantees.
Representative Wool stated that the chart on slide 10
excluded API. He asked if the grants were for other
providers outside of API. He referenced the new Crisis Now
program being formed by the Alaska Mental Health Trust
Authority (AMHTA). He asked where the public interfaced
with behavioral health other than API.
Commissioner Crum answered that behavioral health grants
administered by the Division of Behavioral Health were for
providers who may not be signed up to be a Medicaid
provider. For example, sobering centers did not meet the
CMS definition of medical necessity to be paid for by
Medicaid dollars. The department had worked to create a
bridge in order for behavioral health providers to use and
receive behavioral health grants to provide services while
they signed up to become an 1115 provider in order to
receive Medicaid funding and offset. He explained that more
money was coming into the behavioral health system via
Medicaid than it would be via grants.
1:59:21 PM
Ms. Robb moved to the Division of Public Health operating
budget comparison on slide 12. The slide aimed to identify
the COVID-19 funds coming into the department in order to
show a better picture of the budget absent the unusual
influx of funding. There were no significant changes to the
division's budget with the exception of fund source changes
related to the governor's budget not counting on the
passage of the reverse sweep. The division's total FY 213
budget was $125.2 million, including $48 million UGF. The
division housed 427 PCNs and operated through a number of
different sections.
Ms. Robb turned to the budget for the Division of Health
Care Services on slide 13. The division's budget included a
decrement of $201,000 UGF related to a 50 percent reduction
to a contract for a pilot program. She elaborated that the
work would be funded through a Medicaid 1915 fee waiver
going forward. During the period from FY 19 to FY 23 the
division's budget had been relatively stable.
2:01:30 PM
Ms. Robb reviewed the FY 23 budget for the Division of
Senior and Disabilities Services on slide 14. There had
been no significant increments or decrements proposed for
the division. The division's total proposed budget was
$64.2 million, including $37.6 million UGF. She noted the
division's budget had been remarkably stable.
Ms. Robb discussed Medicaid Services on slide 15. The
budget included a $45 million increment, which brought the
division's total budget to $3.4 billion, including $656
million UGF. She reminded the committee that since the
start of the public health emergency, the state had been
receiving an enhanced Federal Medical Assistance Percentage
(FMAP) of 6.2 percent. She explained the enhanced FMAP had
greatly benefited the Medicaid budget. She reported the
division had received the enhanced FMAP for two quarters in
FY 20, which allowed the department to lapse almost $60
million from Medicaid. The enhanced FMAP had been received
for the entire FY 21 and had lapsed $88 million in the last
year. The enhanced FMAP was available for the entire FY 22
and the department did not anticipate lapsing any funds.
She relayed that the public health emergency had been
extended 90 days at a time by the federal government;
therefore, the department did not want to build the
division's budget counting on the continuation of the
enhanced FMAP into FY 23. The proposed budget included the
normal FMAP rate. She noted there were 263,000 Alaskans
enrolled in Medicaid in FY 22 and 182,000 people had used
the service.
2:04:18 PM
Ms. Robb reviewed the Departmental Support Services budget
comparison on slide 16. She explained that what was shown
in FY 23 would not be found in the budget because it was a
combination of departmental support services for both of
the new departments. She explained that the method enabled
a comparison of the budgets across time. The blue box
showed the proposed departmental support services budget as
$15.5 million and 62 staff for DFCS and $39 million and 176
staff for DOH.
Representative Wool referenced Ms. Robb's statement that
260,000 Alaskans were enrolled in Medicaid and only 180,000
used it. He asked if the data reflected the prior year's
numbers.
Mr. Robb agreed the information was year to date for FY 22.
She detailed that typically the numbers recorded for
Medicaid took place after the close of the fiscal year to
ensure there were unduplicated recipients. Thus far there
were 263,000 individuals enrolled. Anyone who was enrolled
on March 18, 2020 could not be removed from the Medicaid
rolls during the pandemic with several exceptions including
death, moving out of state, or requesting to be removed.
Representative Wool stated that he had heard repeatedly
that 30 to 35 percent of Alaskans were on Medicaid. He
understood the data from the department reflected year to
date and there was more time in the fiscal year; however,
he observed that 180,000 out of 260,000 was quite a bit
less. He remarked that the Medicaid spend presumably only
included enrollees who required service. He believed the
dollars were divided amongst fewer people than enrollees.
Ms. Robb agreed.
Representative Wool asked what percentage of Medicaid
enrollees used Medicaid in a typical year.
2:07:53 PM
Ms. Robb responded it was referred to as the utilization
number. She relayed the number had been above 80 percent in
the past. Utilization had been declining over time and had
been the lowest in 2020 at 71 percent. She reported there
had been a halt on elective procedures in the end of 2020
and many people had felt uneasy going into medical
facilities unless absolutely necessary.
Representative Wool asked about the status of the dental
option for Medicaid recipients. He wondered whether it had
impacted the utilization rate.
Commissioner Crum replied that the adult preventative
dental program was still in place as it had been prior to
FY 19. He would follow up with the utilization rate.
Representative LeBon remarked that the state had expanded
Medicaid about six to seven years back. He asked for detail
about the Medicaid population. He wondered how many
individuals were enrolled and what the utilization rate
was.
Commissioner Crum answered throughout the COVID-19 response
the department had been unable to do enrollment
verifications or remove individuals from Medicaid rolls
the number of eligible and enrolled members had greatly
increased. Throughout FY 18 through FY 20, there had been
about 220,000 to 230,000 enrollees. He would provide the
historical information in writing including the numbers
prior to Medicaid expansion compared to current numbers.
2:10:22 PM
Representative LeBon asked for the general profile of an
Alaskan brought into Medicaid under expansion about six
years back.
Commissioner Crum answered that the Medicaid expansion
population included individuals between the age of 18 and
64 who were just above the poverty line. The individuals
included able bodied adults (i.e., adults who were not
disabled or pregnant).
Ms. Robb turned to slide 17 showing the cost related to
implementing the executive order. She pointed to the middle
of the slide showing the required strategic investment of
about $1.9 million. The funding was primarily comprised of
interagency receipts in addition to $434,000 in general
funds and $313,000 in federal funds. The administration was
requesting 11 new PCNs and was reclassifying 10 positions.
Representative Edgmon asked if there would be a healthcare
specialist on the governor's staff that would be a conduit
to the governor's inner circle.
Commissioner Crum answered that he did not know. He noted
that every governor's office historically changed on their
policy advisors and expertise.
Representative Edgmon asked for verification that the
commissioner did not know.
Commissioner Crum answered in the affirmative. He did not
know what the future staffing of the governor's office
would be. He highlighted that by splitting the department,
an additional expert would be added at the cabinet level
who could focus on the items. He detailed that the position
would be facilities and child welfare based for DFCS and
Medicaid assistance and public health based for DOH.
Representative Edgmon pointed out that a healthcare policy
advisor was an important position regardless of whether the
department remained as is or was split into two or three
components. He remarked that organizational charts
referenced a tribal liaison and departmental organization
liaison; however, he did not see the associated PCNs in the
FY 23 budget request.
Commissioner Crum answered that the two positions had come
about from the department's stakeholder engagement. The
department had talked with tribal partners about whether
there could be a tribal liaison in the commissioner's
office. There was currently an outstanding administrative
order specifying that all divisions across the state were
required to have a divisional based tribal liaison, which
would continue to be in effect. The goal of the
commissioner's office based tribal liaison was to continue
items such as conversations about how to maintain the
informal things in order to work together.
Commissioner Crum relayed the department had gained
strategies in the past year on how to approach the federal
government for innovations together. He explained that
because the positions had come about via stakeholder
engagement, the department was going through the process
after the 60-day consideration period. He expounded that if
the executive order became law, the administration would
determine which roles would be assigned [to the two
departments] and how to name the individuals. The work was
underway, and the administration had made a commitment to
the Alaska Native Health Board to get the names prior to
the effective date.
2:15:12 PM
Representative Edgmon referenced Commissioner Crum's
earlier statement there was gray area between the
reorganization of the department and the budget
implications. He agreed with the statement. He looked at
slide 7 showing the OCS budget. His stated his ears had
perked up at the words tribal compact. He relayed his
understanding that the Dunleavy administration had been
fairly lukewarm on the tribal compact. He highlighted that
several years back Governor Dunleavy had vetoed $3.4
million for tribal compact. He referenced the department's
mention of 587 OCS employees statewide. He underscored that
the one element about the department he received the most
complaints and concern about was the lack of ability for
OCS to do its job.
Representative Edgmon stressed that the system did not work
in some instances; however, he believed a tribal compact
represented an unlimited ability to tap into the
disproportionate number of Alaska Natives who cycled
through the foster care system, OCS, and DHSS. He
appreciated the governor recognizing the issue and
including money, but he thought it rang a bit hollow. He
highlighted that in 2017 the tribal compact had great
effort and organization and tremendous stakeholder
involvement across every sector. He stated it had
languished for a period of time and the administration was
returning to the idea as if it could be a silver wand or
magic bullet. He wanted to do ensure the state did
everything possible to seize upon the opportunity. He
emphasized that if the budget numbers were changed or the
587 PCNs were reduced, the state needed to start involving
tribes.
Commissioner Crum appreciated the comments by
Representative Edgmon. He stated that OCS was a very
challenging place to work because the work was traumatic to
the employees. Over time there had been an increasing
vacancy rate of case carrying workers. He stated the tribal
compact was an exciting prospect because it brought
prevention home to communities. He elaborated that Alaska
Natives comprised 15 percent of the state's population,
while 65 percent of the children in foster care were Alaska
Native. He highlighted the need of engaging at a local
level. He stated the administration had been big proponents
of the child welfare compact throughout.
Commissioner Crum elaborated that because it was a compact,
a consultation was a very iterative process in terms of
what went forward. He stated that one of the unique aspects
about the compact was that it had been signed but there had
never been a specific legislative funding increment. He
expounded that internal OCS funding had been used to
support the compact. He explained that a current year
budget would pass, and the department would enter
negotiations over which services would be provided for the
remainder of the fiscal year. He reported that the
department had successfully negotiated with tribes in two
separate negotiations in the past year to bring forward a
legislative item to increase investment.
Commissioner Crum explained that the additional $1.4
million would bring the total investment towards the Tribal
Child Welfare Compact up to $3.1 million. The funding would
enable the department to perform work throughout FY 22 and
have preventative measures entered into the mix for FY 23.
The department appreciated the legislature's efforts in
prior years to insert the funding; however, because the
department had not undergone the consultation process it
could not have spent the money. The recent negotiations had
been very successful and going forward the increment would
have its own line item in the budget. There would be
visibility into performance metrics as tribes took
advantage of the opportunity and prevented children from
entering into the system.
2:19:43 PM
Representative Rasmussen stated it had been brought to her
attention there was a court case involving a father who had
been able to relinquish his parental rights while his child
was in foster care. She assumed it meant the father would
no longer have to pay child support. She asked if there
were currently children under the care of OCS who had
parents paying child support.
Commissioner Crum replied, "Yes, there are." He explained
that sometimes on complex placement where a child may need
to be in an assisted living facility there were still
enveloped parents who maintained custody of the child but
could not care for them. He stated it was a mixed bag. He
stated that child welfare was a painful aspect for
families, children, and OCS workers.
Representative Rasmussen understood the court case she had
mentioned was one of the first cases due to the gray area
in statute. She asked if the situation could become a
substantial budgetary item in the future if parents decided
to begin relinquishing their rights and no longer paid
child support.
Commissioner Crum replied that he did not know enough about
the topic. He would confer with staff and follow up.
2:21:50 PM
Ms. Robb had concluded her presentation and was available
for questions.
Representative Wool referenced the statement that one of
the new departments would be more public facing and the
other would be responsible for the payment side of things.
He wondered why public health would be included in a
payment facing side as opposed to a public facing side.
Commissioner Crum pointed to the list of services on the
left side of slide 3 and clarified that with the exception
of the commissioner's office and Finance and Management
Services all of the divisions listed were public facing and
interacted with the public. The commissioner's office and
Finance and Management Services were internal. He clarified
the administration was calling DFCS its "direct care"
department given its work with patients, elders, and
community members around the clock.
Representative Wool thanked Commissioner Crum for the
clarification.
Representative Edgmon asked how the split would occur
physically. He wondered whether the facilities would be the
same.
Commissioner Crum answered the goal was for no change in
leadership or footprint for the public facing divisions. He
elaborated that API, the Division of Juvenile Justice, and
the Pioneer Homes had very set facilities. There would be
no change in the OCS headquarters or field offices.
Additionally, in DOH, Health Care Services and the Division
of Public Assistance had been consolidating their footprint
over the past two years as a natural course of business as
the department examined its utilization and leases. He
noted that the Division of Senior and Disabilities Services
and Division of Behavioral Health also fell into that
category. There would be changes in the location of the
commissioner's offices within the Frontier Building in
Anchorage and the Administrative Office Building in Juneau.
There would also be changes in the Finance and Management
Services side. He stated it would be one of the biggest
changes; Finance and Management Services would be carrying
the brunt of the reorganization. He elaborated that
individuals working in IT together would go from one
department to another. He explained that individuals who
had worked on programs that were primarily with DFCS they
would continue to maintain the programs.
2:25:59 PM
Representative Edgmon referenced the complex nature of the
department. He did not believe the meeting was doing
justice to the complexity of the proposed change. He
believed the presentation had only skimmed the surface. He
remarked that the executive order was another topic. He
elaborated that the executive order was 97 pages long and
contained budget implications on every page. He stated he
personally felt very inadequate in terms of his own
contributions to the meeting discussion.
Co-Chair Foster agreed that the department was huge. He
stated there were major impacts in terms of services being
offered to the public. He considered perhaps the impacts
would be great and there may be things the committee was
not fully understanding at present. He relayed the
committee could return to the discussion again in the
future.
Commissioner Crum offered that he had more time if the
committee needed to extend the meeting.
Co-Chair Foster relayed his office would reach out to the
department regarding extending the discussion another time.
Representative Rasmussen asked if there was a current
salary cap for the amount of compensation a commissioner
could receive.
Commissioner Crum answered that the salary for a
commissioner was set in statute.
Representative Rasmussen asked if there was a cap on the
salary for a deputy commissioner and on the number of
deputy commissioners or assistant commissioners within a
department.
Commissioner Crum answered that he did not believe there
was a cap on the salary for a deputy commissioner. He
elaborated that salary typically depended on whether an
individual had come from state service. There were
typically protocols on how far out a deputy commissioner
could be "stepped out" in the salary range. The structure
varied by department.
2:28:40 PM
Representative Rasmussen stated that in theory a deputy
could make more than a commissioner. She thought the change
seemed to provide some budget structure and force some more
fiscal responsibility.
Commissioner Crum agreed and stated that the change allowed
for more legislative oversight by breaking up the
"behemoth" that is the Department of Health and Social
Services. He elaborated that the DHSS budget was equal to
12 state departments in addition to the legislature, court
system, and judiciary combined. The department had as many
PCNs as five other state departments combined. He explained
that the breadth and depth of the services were vast;
therefore, the objective associated with the reorganization
was to align key functions and avoid disruption to services
to beneficiaries or payments to providers. He referred to
the reorganization as the "pick and place" method where
there would be no change in leadership or footprint for the
public facing divisions. The goal was for the public to see
no change in the receipt of services.
Representative Wool stated it was a hugely complex
undertaking and agency. He wondered if the endeavor was the
best thing to undertake in the fourth year of an
administration. He noted that a new administration may have
to untangle the situation. He thought it seemed like
something to undertake at the beginning of a four-year
term.
2:31:04 PM
Commissioner Crum appreciated the remarks. He stated that
the idea had been tossed around by numerous
administrations. He shared that he had kept a great deal of
the division directors from the prior administration; the
individuals had worked for the state for many years. He
relayed that the idea for the proposal had come from those
employees. Over the past year the department had continued
its stakeholder engagement in a robust way in order for
stakeholders to understand the change would not disrupt
services and would allow time for commissioners offices and
policy staff to further engage with community members and
to deal with half the crises at one time.
Commissioner Crum highlighted that OCS, API, Juvenile
Justice, and the Pioneer Homes all had unique problems,
including the fact that they were all facility based. He
stated that deferred maintenance and long-term investment
were different plans and skill sets to address the issues.
He pointed out that the aforementioned groups were not
primarily Medicaid based. He noted that Medicaid's $2.6
billion budget was one of the driving factors of the
state's overall budget. He stated that Public Health and
Medicaid tended to take the air out of the room. He used
the Pioneer Homes as an example and noted that eligibility
would follow an elder into the Pioneer Home.
Co-Chair Foster stated the committee would likely follow up
on the topic in the future.
HB 281 was HEARD and HELD in committee for further
consideration.
HB 282 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster reviewed the schedule for the following
day.
ADJOURNMENT
2:33:47 PM
The meeting was adjourned at 2:33 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS Presentation HFIN FY 23 Budget- EO 2-9-2022.pdf |
HFIN 2/9/2022 1:30:00 PM |
|
| EO 121 01182022.pdf |
HFIN 2/9/2022 1:30:00 PM |