Legislature(1993 - 1994)
01/20/1993 03:00 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
January 20, 1993
3:00 p.m.
MEMBERS PRESENT
Rep. Cynthia Toohey, Co-Chair
Rep. Gary Davis, Vice Chair
Rep. Tom Brice
Rep. Pete Kott
Rep. Irene Nicholia
Rep. Harley Olberg
Rep. Al Vezey
MEMBERS ABSENT
Rep. Con Bunde, Co-Chair
Rep. Bettye Davis, excused
COMMITTEE CALENDAR
Overview of the Department of Health and Social Services
WITNESS REGISTER
Dr. Ted Mala
Commissioner
Department of Health and Human Services
P.O. Box 110601
Juneau, Alaska 99811-0601
465-3030
ACTION NARRATIVE
TAPE 3, SIDE A
Number 000
CO-CHAIR CYNTHIA TOOHEY called the meeting to order at 3
p.m. and noted members present.
(Rep. Bunde arrived at 3:01 p.m.)
CHAIR TOOHEY announced the purpose of the meeting was to
hear a 45-minute overview of the Department of Health,
Education and Social Services.
DR. TED MALA, Commissioner of the Department of Health and
Social Services, welcomed the committee to Juneau on behalf
of the department's 2,000 employees and expressed his
pleasure at the prospect of working with the committee.
DR. MALA referred committee members to a 22-page overview of
the department and an organizational chart on the last page.
(The publication, "Alaska Department of Health & Social
Services: An Overview," herein incorporated as Attachment 1,
is on file at the House Health, Education and Social
Services committee room, 106 Capitol, and will be filed at
the Legislative Research Library at the end of the second
session of the 18th Legislature.)
DR. MALA said the department has seven divisions and one
deputy commissioner each for financial programs for direct
services programs.
DR. MALA introduced Dr. Brian Saylor, deputy commissioner
for Direct Services; Deborah Wing, director of the Division
of Family and Youth Services; Loren Jones, director of the
Division of Alcohol and Drug Abuse; Margaret Lowe, director
of the Division of Mental Health and Developmental
Disabilities; Dr. Peter Nakamura, director of the Division
of Public Health.
DR. MALA also introduced Jay Livey, deputy commissioner for
Financial Programs, and his key division directors Kim
Busch, director of the Division of Medical Assistance and
Jan Hansen, director of the Division of Public Assistance.
Dr. Mala also introduced Janet Clarke, director of the
Division of Administrative Services. Dr. Mala expressed the
hope that each division could sometime make its own
presentation to the committee.
Number 096
DR. MALA began his presentation with the Division of Public
Health, referring to page 9 of Attachment 1. The division
has 373 employees across the state, and administers seven
programs, he said. The state provides public health nursing
services to all areas of the state, except the Municipality
of Anchorage, the East Aleutians Borough and the North Slope
Borough, which have assumed responsibilities for their own
public health. He stated the Public Health Laboratories'
main virology lab is based at the University of Alaska,
Fairbanks, with other labs in Anchorage and Juneau. He said
the department has proposed studying the feasibility of
merging the three to save time and money. A radiological
lab has addressed the radioactive contamination at Point
Hope. Information gathered by the Bureau of Vital
Statistics helps the department plan its public health
programs, he explained.
DR. MALA said Alaska has the nation's highest per capita
rate of work related deaths, with 87 deaths on the job in
1992, most of them commercial fishermen who drowned without
wearing life vests, and some from aircraft crashes. In
1991, there were 79 work-related deaths, 38 of them
commercial fishermen, who are involved in the state's
highest-risk job. The department works with the Alaska
office of the National Institute of Occupational Safety and
Health on the problem, Dr. Mala said.
DR. MALA mentioned the Budget Request Units, a program
established by the legislature in 1981, which allow the
legislature to make direct financial grants to special rural
regional health corporations. He said there is currently
debate over the need to continue the program for those
corporations that have since developed mature health care
systems.
DR. MALA referred to an epidemiology bulletin, one of the
department's periodic publications. The department is
planning to publish a 1992 annual report within three weeks,
which would also serve as a report card on public health in
the state, he said.
Number 245
DR. MALA stated the Division of Mental Health and
Developmental Disabilities, with 440 employees, has many
interested advocacy groups. He outlined the division's
programs and institutions as presented in Attachment 1,
starting on page 13. He noted the Alaska Youth Initiatives
program serves about 77 children, with 26 names on a waiting
list. He said the Advocacy and Public Education includes a
suicide prevention program which distributes $860,000 to
rural villages for home-grown programs, which are sometimes
combined with peer counselor training programs, and with
other drug and alcohol prevention programs. Dr. Mala noted
the department tries to use para-professional workers in
villages to save money and keep services available.
DR. MALA referred to the mental health division's
institutions. The department hopes to replace the Alaska
Psychiatric Institute in Anchorage, a 30-year old
institution with serious structural problems, despite its
acceptable outward appearance. The presence of asbestos
requires frequent costly emergency maintenance, which can
reach $1 million some years for maintenance and asbestos
abatement. Though built with 219 beds, it currently houses
130 patients, and ten years' study has shown a new
institution could have but 114 beds, as long as it was
buttressed by a strong community mental health care program.
Number 330
DR. MALA stated the Harborview Developmental Center mental
hospital in Valdez has reduced its patient load, but still
has some patients of 20 years' residence and more. The
department had considered either closing the hospital or
expanding it to reduce per-resident costs reaching $100,000
per year. The department decided to remodel existing wings
to accommodate elderly patients requiring long-term
psychiatric nursing care, who are difficult to accommodate
at other nursing homes.
Number 341
DR. MALA outlined the Division of Alcohol and Drug Abuse, as
described on page 19 of Attachment 1. The division has 29
workers. Alcohol abuse is the top cause of injury accidents
in the state, and an estimated 35,000 Alaskans suffer from
alcohol abuse. About 30 babies each year are born with
Fetal Alcohol Syndrome, and another 130 with some Fetal
Alcohol Effect, many of them born to Alaska Natives, he
said. Dr. Mala said such births are extraordinarily costly,
resulting in "million dollar babies."
Number 375
DR. MALA noted that department officials traveling around
the state to assess needs and concerns in rural areas have
learned of major problems with alcohol and inhalant abuse.
He added that the department is trying to focus on inhalant
abuse in Western Alaska, after two children in Nome died
after sniffing gasoline.
DR. MALA described the Division of Family and Youth
Services, with 594 employees, divided into Family Services
and Juvenile Corrections functions, as described starting on
page 1 of Attachment 1.
Number 404
In 1992, the division made a major change in philosophy,
trying to keep families with troubled or abused children
intact, instead of removing such children from their
families. This change has resulted in the removal of 140
fewer children from their homes in FY 1993 than in previous
years, Dr. Mala said.
DR. MALA described the state's main juvenile detention
facilities, including the McLaughlin Youth Center in
Anchorage, with both honor cottage and full security
detention areas. Other centers operate in Fairbanks,
Juneau, Bethel and Nome, which with probation officer
services allow young offenders to remain close to home. He
noted the department is trying to train and certify
corrections and probation officers to improve their ability
to detect more serious problems in their charges, such as
sexual abuse or serious mental problems, which might require
them to be in more secure environments.
Number 457
DR. MALA referred to the Division of Medical Assistance,
with 56 employees, based in Juneau and Anchorage, as
described starting on page 7 of Attachment 1. The
department predicts the division's budget ought to rise by
12 percent in fiscal 1994. Dr. Mala said he anticipates the
division will spend about $130 million in state general
funds, and another $160 million in federal funds. He said
the department may be able to win 50-50 matching federal
funds for Medicaid programs the state now pays for alone,
which could save up to $2 million this year.
DR. MALA predicted the issue of containing the high state
costs for Medicaid programs would be an issue for the
legislators. The administration is considering the results
of a task force on cost containment and is planning its
responses. Some possibilities include more managed care,
expansion of some state employees' medical benefits,
centralized drug purchases and electronic billing.
Number 511
DR. MALA referred to the Division of Public Assistance, as
outlined on page 3 of Attachment 1. The division has 428
employees, he said. The demand for welfare services and
attendant costs are rising significantly, by up to 15
percent across the nation. The division receives about $108
million from state funds, and spends about $223 million
including federal matching funds, an amount that he expects
to rise 8.7 percent in the next year.
DR. MALA said state residents receive about $52 million in
federal food stamps each year. In FY 1993 there were 14,920
people receiving food stamps, a number projected to rise to
15,536 next year.
DR. MALA stated about 12,380 people receive federal energy
assistance. Aid to Families with Dependent Children was
paid to about 12,485 in FY 1993, a number he said was
projected to rise to 13,858 next year. Adult Public
Assistance was paid to 8,908 people in the last fiscal year,
a number projected to go up to 9,664 in the next year.
DR. MALA said the department is working on ways to reduce
these numbers and expects much public and committee
discussion on the issue. He discussed his goal to link
state welfare and employment services programs in
communities, possibly locating them in the same building.
He described a current program, under which an applicant
cannot receive welfare without accepting federal education
or job training, and which offers free child care during
such training. The program served 925 people last year, and
the department expects to have 1,340 next year, he said.
Number 549
DR. MALA described the Division of Administrative Services,
as outlined starting on page 21 of Attachment 1.
DR. MALA said a department-wide problem is the lack of
sufficient modern equipment, such as computers to allow
staff to perform more direct services and less clerical
work. Such equipment could make research data available
on-line to staffers around the state.
DR. MALA complained that unfunded federal mandates such as
the Americans With Disabilities Act which requires the state
to spend millions, to improve handicapped access to public
facilities, but providing no funding. Another example is a
measure aimed at limiting transmission of blood-borne
pathogens on the job, administered by the U.S. Department of
Labor's Occupational Safety and Health Administration. The
state has been fined under the measure, and needs to budget
for compliance, Dr. Mala said.
TAPE 3, SIDE B
Number 000
DR. MALA briefly mentioned several areas of activity in the
department, including international circumpolar cooperation.
He said it is important to work with Canada and Russia to
plan disaster response, and emergency medical treatment of
those in remote areas. Given increasing international
travel across the Bering Sea, he said, Alaska and Russia
should arrange rapid emergency response by the nearest
emergency response technicians, regardless of the victims'
citizenship.
DR. MALA mentioned the reorganization of welfare fraud and
medical assistance prevention programs in the state, and the
assignment of an Alaska State Trooper to welfare fraud
prevention. He noted that some cases have resulted in
confiscation of some property for sale at auction to recover
state funds. Such programs can receive generous federal
matching support, up to 90-10 matches, he said.
Number 030
In summarizing his presentation, DR. MALA invited the
committee to hear presentations from his division directors,
and reminded the committee of the scope of his mission and
budget, which reaches $700 million per year, including
federal matching funds.
Number 070
CHAIR TOOHEY thanked Dr. Mala for his presentation and
entertained questions from the committee.
Number 080
REP. IRENE NICHOLIA asked which three villages were
participating in the mental health division's Village
Research and Demonstration Projects, as outlined in
Attachment 1.
Number 100
DR. MALA responded he didn't know, but would find out and
tell her.
REP. NICHOLIA asked if that program was part of the
Behavioral Health Aide program
DR. MALA answered that the aide program overlaps with that
and other programs.
REP. NICHOLIA asked if funds for the demonstration projects
program would be increased this year, and whether local
health services programs would be involved in establishing
such projects.
DR. MALA said he would have his legislative liaison, Elmer
Lindstrom, work with her on those programs. Dr. Mala stated
it was up to the legislature to decide whether the state
would fund regional or community health service providers.
REP. NICHOLIA further asked whether the Division of Family
and Youth Services' Purchased Services program was a
statewide program.
MS. DEBORAH WING, director of the Division of Family and
Youth Services, answered that Purchased Services covers a
wide range of services, through contracts, grants and bids,
and rural communities are aware of their options to
participate.
In response to Rep. Bunde's question, JANET E. CLARKE,
director of the Division of Administrative Services, said
her division employs about 100 people.
REP. BUNDE asked if there were efforts to encourage more
communities to follow the example set by Anchorage, the
North Slope Borough and the Aleutians East Borough in
assuming local public health responsibilities from the
state.
DR. MALA answered that the department has been working this
year to produce state health plans that might call for such
action. He said Fairbanks voters have repeatedly rejected
such an initiative out of fear it would increase their
taxes, and Ketchikan had a similar experience.
REP. BUNDE expressed his concern over the high rate of teen
pregnancy in Alaska and encouraged Dr. Mala to address that
problem.
DR. MALA remarked that the department had recently put a
public health nurse in the Juneau-Douglas High School to
work with students on that problem.
Number 186
REP. BUNDE asked about the possibility of selling Harborview
mental hospital in Valdez to a private operator.
DR. MALA remarked the department would love to do so, but to
date has had no takers. He said the state has repeatedly
offered to sell the facility, which incorporates the city
hospital, to the city for $1, also without success. A
proposal to close Harborview down and place its residents in
communities failed due to lack of money or infrastructure,
Dr. Mala said.
REP. BUNDE stated that Lloyd Rupp, commissioner of the
Department of Corrections, had in conversations mentioned
the possibility of having those in short-term alcohol and
drug intervention programs pay the costs for such programs.
Rep. Bunde asked Dr. Mala whether there were plans to
implement such an action.
DR. MALA said no, partly because some of those involved are
minors, but he indicated his willingness to consider Rep.
Bunde's suggestion that permanent fund dividends could be
used to compensate treatment costs even for minors.
REP. BUNDE asked whether parents of children born with fetal
alcohol syndrome were asked to pay any of the cost.
DR. MALA said such costs are so high that even taking
parents' permanent fund dividends would represent but a
small fraction of the total costs. He added that there have
been several cases in which such children or their estates
have later tried to sue their parents for negligence, though
apparently without success.
Number 242
REP. BUNDE informed Dr. Mala that a bill may be introduced
to allow minors charged with major crimes to be tried as
adults in state courts. He also asked how often residents
in McLaughlin Youth Center return to the prison system.
DR. MALA answered that the rate of recidivism into crime is
about 50 percent, a rate lower than he would have thought.
He said he did not know how often inmates at McLaughlin
returned to that same institution, but he would find out and
relay the information.
REP. BUNDE applauded the idea of linking employment services
and welfare, and asked Dr. Mala for more suggestions on how
to slow and reverse the rate of increase in welfare rolls.
DR. MALA said he intended, during a more detailed
presentation on the Division of Public Assistance, to
discuss ideas on how to reduce the financial incentives for
people to enroll in, or remain in, welfare programs. The
department is examining the possibility of receiving federal
waivers to allow state welfare recipients to retain savings
or otherwise get ahead financially, and he would like to
make a more detailed presentation on such plans. Dr. Mala
announced the department would attend a special two-day
meeting of the National Governors' Association on welfare
reform, to be held in Oregon in early February.
Number 297
CHAIR TOOHEY asked whether the state compensates those
cities and boroughs that accept public health
responsibilities for such programs.
DR. MALA replied that the state pays such cities an amount
equal to what such services would cost the state.
REP. G. DAVIS inquired as to the truth of the idea that
Alaska's welfare system is so generous as to attract
indigents from outside the state.
DR. MALA answered that his staffers said no.
REP. G. DAVIS also asked whether the department could find
itself paying increasing amounts of money to provide health
care to citizens of Russia.
DR. MALA responded that the department's international
cooperation with Russia is limited to emergency services to
those in the Bering Sea.
REP. NICHOLIA asked how the announced $460,000 cut in
federal funding for alcohol and drug abuse prevention
programs in Alaska in FY 1994 would impact the state's
efforts in that area.
DR. MALA said the cut was a significant source of worry, and
the department was seeking replacements for that money.
REP. NICHOLIA also asked where the counseling, emergency
shelters, family mediation, patenting classes, home
detention services and other elements of the family
preservation program would be offered, and expressed her
hope that they could be offered in Bush Alaska.
DR. MALA remarked such programs would be offered in the
state's major communities.
Number 349
BRIAN SAYLOR, Deputy Commissioner for Direct Services, noted
the department was reviewing the responses to a request for
proposals on intensive home-based services and would soon
issue its short list.
At Rep. Nicholia's query, MR. SAYLOR said the department was
working that the department does work with regional health
organizations on such programs.
REP. NICHOLIA asked how the department's circumpolar health
initiatives related to regional health concerns.
MR. SAYLOR said the initiatives help bring Natives together
across international lines to address such problems as
alcoholism and other community health problems through
traditional methods and to try to improve current programs.
ADJOURNMENT
CHAIR TOOHEY thanked Dr. Mala and his staff for their
presentation. There being no further business before the
committee, Chair Toohey adjourned the meeting at 4:10 p.m.
| Document Name | Date/Time | Subjects |
|---|