02/12/2002 03:05 PM House HES
| Audio | Topic |
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+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
February 12, 2002
3:05 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Chair
Representative Peggy Wilson, Vice Chair
Representative John Coghill
Representative Gary Stevens
Representative Vic Kohring
Representative Sharon Cissna
Representative Reggie Joule
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 252
"An Act relating to the construction of certain statutes
relating to children; relating to the scope of duty and standard
of care for persons who provide services to certain children and
families; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 367
"An Act relating to coverage of children and pregnant women
under the medical assistance program; and providing for an
effective date."
- HEARD AND HELD
HOUSE BILL NO. 309
"An Act relating to the Interstate Compact on Placement of
Children."
- BILL HEARING POSTPONED
PREVIOUS ACTION
BILL: HB 252
SHORT TITLE:STANDARD OF CARE FOR CINA SERVICES
SPONSOR(S): REPRESENTATIVE(S)COGHILL
Jrn-Date Jrn-Page Action
04/23/01 1136 (H) READ THE FIRST TIME -
REFERRALS
04/23/01 1136 (H) HES
01/17/02 (H) MINUTE(HES)
01/17/02 (H) HES AT 3:00 PM CAPITOL 106
01/17/02 (H) Heard & Held
MINUTE(HES)
02/07/02 (H) HES AT 3:00 PM CAPITOL 106
02/07/02 (H) <Bill Canceled>
02/12/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 367
SHORT TITLE:MEDICAL ASSISTANCE PROGRAM COVERAGE
SPONSOR(S): REPRESENTATIVE(S)COGHILL
Jrn-Date Jrn-Page Action
01/30/02 2098 (H) READ THE FIRST TIME -
REFERRALS
01/30/02 2098 (H) HES, FIN
01/30/02 2098 (H) REFERRED TO HES
02/04/02 2153 (H) COSPONSOR(S): OGAN, DYSON
02/12/02 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
RYNNIEVA MOSS, Staff
to Representative John Coghill
Alaska State Legislature
Capitol Building, Room 102
Juneau, Alaska 99801
POSITION STATEMENT: Answered questions on HB 252, Version J;
during hearing on HB 367, explained calculations used to arrive
at poverty-level figures.
THERESA TANOURY, Director
Division of Family and Youth Service
Department of Health and Social Services
P.O. Box 110630
Juneau, Alaska 99811-0630
POSITION STATEMENT: Testified on HB 252, saying Version J is
more acceptable than the original bill, but some concerns remain
about the construction section.
JAN RUTHERDALE, Assistant Attorney General
Human Services Section
Civil Division (Juneau)
Department of Law
P.O. Box 110300
Juneau, Alaska 99811-0300
POSITION STATEMENT: During hearing on HB 252, explained the
purpose of the construction section and noted that language in
Version J creates a gridlock for the court.
SUSAN COX, Chief Assistant Attorney General
Civil Division (Juneau)
Department of Law
P.O. Box 110300
Juneau, Alaska 99811-0300
POSITION STATEMENT: During hearing on HB 252, provided
background on AS 47.10.960; explained the reason for its
inclusion in statute and noted that it does not immunize workers
or the state from liability.
NATE MOHATT, Staff
to Representative Sharon Cissna
Alaska State Legislature
Capitol Building, Room 420
Juneau, Alaska 99801
POSITION STATEMENT: During hearing on HB 252, provided
clarification on Amendment 1 and amendments to it.
TONY LOMBARDO
Alaska Association of Homes for Children;
Covenant House
609 F Street
Anchorage, Alaska 99501
POSITION STATEMENT: Testified on HB 252; offered support for
the original version, but said changes in Version J are in line
with the position of the Alaska Association of Homes for
Children; discussed various provisions, specifying support for
proposed changes [in Amendment 1] that incorporate HB 23.
LAUREE HUGONIN, Director
Alaska Network on Domestic Violence and Sexual Assault
130 Seward Street, Room 209
Juneau, Alaska 99801
POSITION STATEMENT: During hearing on HB 252, suggested changes
to language in the bill; advocated for early intervention with
the use of family preservation services.
JAY LIVEY, Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Spoke in opposition to HB 367; explained
that while it would save the state $5 million, $12 million in
federal funds to the state would be forfeited.
BOB LABBE, Director
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 110660
Juneau, Alaska 99811-0660
POSITION STATEMENT: During hearing on HB 367, reported on the
division's Denali KidCare application procedures.
KATHLEEN FITZGERALD
Key Coalition of Alaska
4521 Southpark Bluff
Anchorage, Alaska 99516
POSITION STATEMENT: Testified in opposition to HB 367; said
Denali KidCare is an important piece of health care for Alaskan
families.
THOMAS CONLEY, Pediatrician;
Member, Sitka Borough School District School Board
105 Cascade Street
Sitka, Alaska 99835
POSITION STATEMENT: During hearing on HB 367, advocated for
Denali KidCare to remain unchanged; noted that people who are
self-employed, business owners, or entrepreneurs are those most
often unable to obtain reasonable health care coverage.
MEG MITCHELL
P.O. Box 1842
Homer, Alaska 99603
POSITION STATEMENT: During hearing on HB 367, supported the
existing income eligibility guidelines for Denali KidCare.
DANA LEE HALL, R.Ph.
Village Operations Administrator
Yukon-Kuskokwim Health Corporation
P.O. Box 528
Bethel, Alaska 99559
POSITION STATEMENT: During hearing on HB 367, reported on
Denali KidCare's contributions to health in the Y-K Delta and
advocated for eligibility requirements to remain unchanged.
JIM KOHLER
Tanana Chiefs Conference (TCC)
1408 Nineteenth Avenue
Fairbanks, Alaska 99701
POSITION STATEMENT: Testified in opposition to proposed changes
to Denali KidCare; explained that 20 to 30 percent of TCC
beneficiaries would be cut from the program.
DIANE CLARK
Group Home Daycare
P.O. Box 351
Seward, Alaska 99664
POSITION STATEMENT: Testified in opposition to HB 367; reported
that health care costs are rising and predicted that unpaid
bills would be borne by the state.
TRUDY ANDERSON, Consumer Awareness Manager
Alaska Native Health Board
No address provided
POSITION STATEMENT: Testified in opposition to HB 367;
emphasized that Children's Health Insurance Plan funds are 100
percent reimbursed by the federal government.
GAY WELLMAN
Copper River Native Association
HC 60, Box 227A
Copper Center, AK 99573
POSITION STATEMENT: During hearing on HB 367, reported on Fetal
Alcohol Syndrome services being supported by Denali KidCare
funds and urged members to keep the program unchanged.
NANCY WELLER, Unit Manager
State, Federal, and Tribal Relations
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 110660
Juneau, Alaska 99811-0660
POSITION STATEMENT: During hearing on HB 367, clarified that
cuts to Denali KidCare would affect both Native and non-Native
children.
ACTION NARRATIVE
TAPE 02-8, SIDE A
Number 0001
CHAIR FRED DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05 p.m.
Representatives Dyson, Wilson, Coghill, Kohring, Cissna, and
Joule were present at the call to order. Representative Stevens
arrived as the meeting was in progress.
HB 252-STANDARD OF CARE FOR CINA SERVICES
[Contains discussion of HB 23, which was used as a basis for
Amendment 1 (F.1)]
Number 0167
CHAIR DYSON announced that the first order of business would be
HOUSE BILL NO. 252, "An Act relating to the construction of
certain statutes relating to children; relating to the scope of
duty and standard of care for persons who provide services to
certain children and families; and providing for an effective
date."
Number 0180
REPRESENTATIVE COGHILL moved to adopt the proposed committee
substitute (CS) for HB 252, Version J, 22-LS0454\J, Lauterbach,
2/11/02, as the work draft. There being no objection, Version J
was before the committee.
REPRESENTATIVE COGHILL, sponsor of HB 252, explained that
compelling testimony was heard in a House Finance subcommittee
hearing that highlighted the need for [higher standards for
caseworkers]. He offered that the duty and standard of care
created puts a greater pressure on [caseworkers]. He indicated
the need for balance in approaching this issue, to raise the
standard [of care] and also meet [children's] needs. He said
his concerns are met by repealing the language in statute that
says there is no standard. He expressed his belief that parents
should be included in the bill's language. He characterized
[Version J] as having fewer "teeth" while still providing
"positive movement." He stated that his aide was present to
answer questions during the amendment process.
Number 0340
RYNNIEVA MOSS, Staff to Representative John Coghill, Alaska
State Legislature, explained the changes from the original bill.
Version J changes the requirement for the Division of [Family
and Youth] Services (DFYS) to adopt regulations setting a duty
and standard of care. Currently, DFYS has policies and
procedures similar to the standards addressed in the bill. She
said Version J takes the pressure off of DFYS to do something
with regulations right away. It does repeal the language in
statute that says there is no duty or standard of care.
Number 0442
THERESA TANOURY, Director, Division of Family and Youth Service,
Department of Health and Social Services, noted that DFYS
appreciates the change provided in [Version J]. She offered
that [DFYS] believes in and has standards; workers are held to a
standard by a code of ethics. "I think this is an easier draft
to swallow," she said. Some concern still exists regarding the
construction, she pointed out; the fiscal note will be
readjusted and brought before the committee.
CHAIR DYSON asked if she had any objection to [page 1] line 8,
which addresses parental rights.
MS. TANOURY replied that she believes the Department of Law has
some opinion on this matter. However, she said this
construction puts parents' interests slightly above those of the
child in question; DFYS objects to this. She indicated that
[current statute] places the child's needs above the parents'
needs. She referenced discussion with Representative Coghill
wherein [DFYS] had suggested a more balanced statement that
would equally promote children's and parents' best interests.
Number 0553
JAN RUTHERDALE, Assistant Attorney General, Human Services
Section, Civil Division (Juneau), Department of Law, offered
that she was testifying only on Section 1, whereas Susan Cox of
the Department of Law could speak to Section 2. Ms. Rutherdale
said AS 47.10.005 is a statutory construction provision; it only
comes up when a statute is ambiguous when applied to a
particular case. The [existing statutory] construction calls
for a court to interpret the statute in a way that promotes the
child's welfare. [Version J], however, calls for this
interpretation to be based on parents' rights to educate and
bring up their children. She offered that this creates a
gridlock for the court: Should the court promote the child's
welfare or recognize parents' inherent rights?
Number 0663
MS. RUTHERDALE told members this language doesn't help the court
in these situations. However, she provided suggestions. She
referred to AS 47.050.65, enacted in 1998 when the child-in-
need-of-aid (CINA) laws were revised; they are the legislative
findings, she said. She suggested the wording in [Version J] is
found in the legislative findings. For example, parents have
the following rights and responsibilities: to provide food,
clothing, shelter, education, and medical care; and to train,
discipline, protect, nurture, and determine where the child
shall live.
MS. RUTHERDALE indicated the legislative findings are saying
that parents possess those types of rights and responsibilities
in raising their children. She suggested that either the
legislative findings say what [Version J] is attempting to say
or that they warrant revision if the legislature's intent is
unclear. Placing those provisions in the construction statute
creates a gridlock that hinders the court. She added that if
problems exist, such as statutes that are ambiguous or difficult
to understand, then perhaps amendments to those provisions are
needed.
Number 0783
CHAIR DYSON summarized his understanding of Ms. Rutherdale's
testimony by saying the Department of Law does not object to the
content of the language; rather, it objects to its placement [in
the construction section].
MS. RUTHERDALE responded that the particular wording "parents
possess inherent, individual rights to direct and control the
education" concerns her. The constitution creates certain
rights; Alaska's constitution has an actual right of privacy,
for example. She explained that creating a statutory
pronouncement of inherent rights to direct and control
education, for example, might cause later complications in
education bills. A parent might say, "I have a right to direct
how ... public funds are spent to educate my child." She said
she'd be happy to draft other language to target [the intended]
meaning. She again offered that the language might already
exist in the findings.
CHAIR DYSON asked about the difference in the importance of the
language, whether it is in the findings or in the construction
section.
MS. RUTHERDALE replied that she was uncertain about the answer.
She pointed out that when she is presenting [a case] to the
court, however, she often points to the legislative findings,
"Your Honor ... this is what the legislature found, ... so you
should find this way because this is really important to the
legislature." The construction provides a similar argument.
Ms. Rutherdale explained that giving clear guidance to the court
to err on a particular side when it is in doubt is an important
directive. The court may consider other things such as the
legislative findings. She concluded that more than one
[directive] in the construction will confuse the court in
determining which way to lean. She stated that this issue would
not come up often; most statutes are clear to judges.
CHAIR DYSON asked what "construction" means as a legal term.
MS. RUTHERDALE answered that it means how a law is construed or
interpreted.
REPRESENTATIVE COGHILL asked for the location of the
aforementioned statutory citation.
MS. RUTHERDALE responded that it is in AS 47.05.[065]. She
noted that it was unusual for it to be placed in the
administration of welfare, social services, and institutions
section, rather than in Chapter 10, which addresses CINA. She
said it is clear, however, that these legislative findings apply
to Chapter 10; they were all part of the same legislative
package.
Number 1020
SUSAN COX, Chief Assistant Attorney General, Civil Division
(Juneau), Department of Law, explained that the language to be
repealed by Section 2 of Version J was part of the "Smart Start"
package enacted by the legislature in 1998. The rationale for
that sentence's insertion was to avoid new liabilities being
created by the Smart Start legislation.
MS. COX told members the "duty and standard of care" section was
included in the package to make clear that the legislature was
not intending to create new civil liabilities or claims for
damages against the state or its employees in the event that
selective Smart Start provisions were not met in their entirety.
The section, she offered, does not immunize the state in any
way; DFYS and its employees can be sued for negligence if
children are not properly protected. The standard in any case
is negligence in the failure to take reasonable care to protect
children. She noted that the rationale for AS 47.10.960 was to
ensure that all the goals in the Smart Start legislation were
not used selectively to create a new claim for damages against
the department or its employees. The statute reads as follows:
Sec. 47.10.960. Duty and standard of care not
created.
Nothing in this title creates a duty or standard of
care for services to children and their families being
served under AS 47.10.
MS. COX offered that she and [Chair Dyson], among other people,
had discussed this at the time; it was part and parcel of the
package when it was enacted.
Number 1153
MS. COX explained the concern of the Department of Law. Defense
attorneys, whose job is to respond to liability claims against
the state, foresee that the implication of repealing this
sentence is that the legislature intends to mean something. The
question is, what is the meaning? Does the legislature intend,
by repealing this language, for the state to be held accountable
in civil claims for damages for any violation of the many
provisions of AS 47.10, for example? If an effort were made to
take action in a child protection case, for example, and the
social workers and the attorneys had presented the best case to
terminate parental rights - and yet the court determined not
enough had been done to establish the case for termination -
does the legislature want to impose potential liability that the
parents could bring against the state? Furthermore, the
protection case may continue and parental rights could
ultimately be terminated, but a claim could still be made.
Number 1222
MS. COX stated that the Smart Start legislation had many goals
and a large fiscal note to hire more caseworkers to reduce
caseloads. She noted that she'd thought it was understood from
the outset that not all of the deadlines and timeframes could
possibly be met initially with the available resources.
MS. COX noted her concern regarding new liabilities being
created by removing this language. She said if the objection to
this language is based on concern that Title 47 doesn't create a
standard of care for serving children and that some wish the
statement to be made that the department must follow it, it is
already clear to the department that is must follow [Title 47].
The department has policies and procedures to implement the law,
and lawyers to help them accomplish that. She said:
If that language is objectionable and needs to be
removed, we would certainly request that if it is not
the legislature's intention to create new liabilities,
that we come up with some substitute language that
makes that point clear.
CHAIR DYSON asked Ms. Cox if removing the language increases the
possibility that state employees would be sued, and whether
removing it creates [greater liability] than if the language had
never been in statute.
MS. COX said it certainly raises the possibility. The language
had been in statute, and it is assumed that the legislature
means everything it says. Taking it out raises the questions of
what the legislature intends to mean and whether it intends to
authorize new claims. She said the argument will certainly be
made; whether a plaintiff would prevail remains to be seen.
Number 1346
MS. COX, in response to a question from Representative Cissna,
explained that the plaintiff determines which party to sue: the
state, the Department of Health and Social Services, the
commissioner, or the social worker personally. The Office of
the Attorney General represents whomever the defendant might be,
in virtually all suits pertaining to carrying out official
duties as a state employee. Most cases in a liability situation
are settled with a payment of state money. She added that it is
the rare situation in which a social worker acts completely
outside the scope of his/her employment, which possibly can lead
to personal liability.
Number 1420
CHAIR DYSON asked if different wording could be used that would
not preclude a standard and that would say the department will
be diligent in following its own policies, procedures, and
regulations.
MS. COX offered that she would be happy to work on language, if
the bill is held over, that hopefully would not create a new
liability, but would send the message that the legislature wants
the department to follow the standard in the bill.
Number 1450
REPRESENTATIVE COGHILL responded that he'd be open to the
foregoing, but wants it clear that there is a continuing
responsibility that creates the liability; excusing [workers] is
unwise. The CINA statute is intended to protect children, he
noted. He said:
We give ... some judicial and some police powers to
people, and we have excused them [by] this exact
language from certain responsibilities; I ... don't
think that's wise. And so, I think this is upping the
limit. I think that it's going to help us to do
things better. I was willing to drop the exact
language for how they should do it, but I still think
we need to have the upward pressure of saying there is
responsibility for the actions that we take.
REPRESENTATIVE COGHILL indicated he thinks it wise to keep the
lines of the limited scope of government clearly defined. He
agreed the responsibility level is elevated here. He said he
isn't sure he's interested in language that will excuse that.
He said he is open to language that will more clearly define
these responsibilities.
Number 1505
CHAIR DYSON added, "And not necessarily appear to be authorizing
lawsuits." He asked Ms. Cox whether this is her concern, should
the language be removed.
MS. COX replied that this is precisely her concern. She offered
that she is definitely concerned about increasing the likelihood
of lawsuits. She clarified that language in the bill does not
immunize social workers in any way; workers and the department
are still subject to litigation under the current law if they
are negligent in the provision of services to children they are
supposed to protect.
REPRESENTATIVE COGHILL said, "It is also true that you said that
by taking this language out, the liability elevates."
MS. COX explained that this provision just says that no specific
line or sentence in the Smart Start legislation can be taken out
and construed to create a claim for damages against the
department or a social worker. The legislation passed that
established timelines for children's cases doesn't, in itself,
create a liability. At the same time, this does not immunize
the department, which can be sued - and is sued - for
negligence. The language in question simply means that nothing
in the bill creates a new cause of action, she said. The
possibility of a suit based on failure to act reasonably in
providing services does exist. However, taking this language
out is an invitation to some to whom it might appear that they
can sue [for failure to meet specific provisions in the Smart
Start legislation].
Number 1600
REPRESENTATIVE COGHILL offered that cases exist wherein a lack
of timeliness has caused harm, and some of those issues need to
be addressed. He added that [the state] requires others to
follow timelines but allows interpretation for one's own
benefit. He stated that he finds this problematic. He said, "I
agree that it does do that, but we have given police powers and
judicial powers to people who are overseeing ... the child-in-
need-of-aid cases. And I think ... the tension there is
important."
CHAIR DYSON announced that he would entertain amendments.
Number 1647
REPRESENTATIVE CISSNA moved to adopt Amendment 1, 22-LS0454\F.1,
Lauterbach, 2/5/02, which read:
Page 1, line 3, following "families;":
Insert "relating to intensive family preservation
services;"
Page 1, following line 13:
Insert new bill sections to read:
"* Sec. 2. AS 47.10.086(a) is amended to read:
(a) Except as provided in (b) and (c) of this
section, the department shall make timely, reasonable
efforts to provide family support services to the
child and to the parents or guardian of the child that
are designed to prevent out-of-home placement of the
child or to enable the safe return of the child to the
family home, when appropriate, if the child is in an
out-of-home placement. Within appropriations
available for the purpose, the department shall also
offer intensive family preservation services when
those services are available and the child's safety in
the home can be maintained during the time the
services are provided. The department's duty to make
reasonable efforts under this subsection to provide
family support services includes the duty to
(1) identify family support services that
will assist the parent or guardian in remedying the
conduct or conditions in the home that made the child
a child in need of aid;
(2) actively offer the parent or guardian,
and refer the parent or guardian to, the family
support services identified under (1) of this
subsection; the department shall refer the parent or
guardian to community-based family support services
whenever community-based services are available and
desired by the parent or guardian; and
(3) document the department's actions that
are taken under [(1) AND (2) OF] this subsection,
including whether intensive family preservation
services were appropriate, offered, used, or
available.
* Sec. 3. AS 47.10.086(b) is amended to read:
(b) If the court makes a finding at a hearing
conducted under AS 47.10.080(l) that a parent or
guardian has not sufficiently remedied the parent's or
guardian's conduct or the conditions in the home
despite reasonable efforts made by the department in
accordance with this section, the court may conclude
that continuation of reasonable efforts of the type
described in (a) of this section are not in the best
interests of the child. The department shall then
make reasonable efforts to place the child in a timely
manner in accordance with the permanent plan and to
complete whatever steps are necessary to finalize the
permanent placement of the child. If the court
concludes that continuation of reasonable efforts of
the type described in (a) of this section are not in
the best interests of the child and intensive family
preservation services were not provided in the case,
the court shall enumerate in the record the reasons
the services were not provided.
* Sec. 4. AS 47.10.142(b) is amended to read:
(b) The department shall offer available
counseling services and intensive family preservation
services to the person having legal custody of a minor
described in AS 47.10.141 and to the members of the
minor's household if it determines that counseling
services or intensive family preservation services
would be appropriate in the situation. If, after
assessing the situation, offering available
[COUNSELING] services to the legal custodian and the
minor's household, and furnishing appropriate social
services to the minor, the department considers it
necessary, the department may take emergency custody
of the minor.
* Sec. 5. AS 47.10 is amended by adding new
sections to read:
Article 3A. Intensive Family Preservation Services.
Sec. 47.10.500. Statewide program. Subject to
AS 47.10.510 and 47.10.520, the department shall,
within appropriations available for the purpose,
provide intensive family preservation services on a
statewide basis. The department may provide the
services directly or through contracts with private
nonprofit providers.
Sec. 47.10.510. Effectiveness required. (a)
The department shall develop measurable standards that
must be met by a provider before a contract may be
awarded to the provider under AS 47.10.500.
(b) The department may not renew a contract with
a provider of services unless the provider can
demonstrate that provision of the services prevented
or terminated out-of-home placement in at least 70
percent of the cases served by the provider and that
out-of-home placement was avoided for a period of at
least six months after termination of the services.
(c) The department may not continue direct
provision of services unless the department can
demonstrate that provision of the services prevented
or terminated out-of-home placement in at least 70
percent of the cases served and that out-of-home
placement was avoided for a period of at least six
months after termination of the services.
Sec. 47.10.520. Eligibility for services. (a)
The department may provide intensive family
preservation services to a child, the child's family,
and other appropriate nonfamily members only if
(1) there are no other available means that
will prevent out-of-home placement of the child or
make it possible to immediately return the child to
the child's home; and
(2) the child has been placed in out-of-
home care or is at actual, imminent risk of out-of-
home placement due to
(A) child abuse or neglect;
(B) a serious threat of substantial harm to
the child's health, safety, or welfare; or
(C) family conflict.
(b) The department need not provide services to
an otherwise eligible family if
(1) services are not available in the
community in which the family resides;
(2) services cannot be provided because the
program is filled to capacity;
(3) the family refuses the services;
(4) the child's case plan does not include
reunification of the child and family; or
(5) the safety of a child, a family member,
or a person providing the services would be unduly
threatened.
Sec. 47.10 530. Solicitation of funding sources.
The department shall solicit federal and private
resources that may be available to fund intensive
family preservation services.
Sec. 47.10.590. Definition. In AS 47.10.500 -
47.10.590, "intensive family preservation services"
and "services" mean intensive family preservation
services, as defined in AS 47.10.990."
Renumber the following bill sections accordingly.
Page 2, following line 6:
Insert new bill sections to read:
"* Sec. 7. AS 47.10.990 is amended by adding a new
paragraph to read:
(28) "intensive family preservation
services" means services provided to a family with a
child who is in an out-of-home placement or is at
imminent risk of out-of-home placement that
(A) are designed to address problems
creating the need for out-of-home placement by
assisting the family to improve parental and household
management competence and by solving practical
problems that contribute to family stress so as to
improve parental performance and enhance functioning
of the family unit; and
(B) have the following characteristics:
(i) are persistently offered but provided
at the family's option;
(ii) are provided in the family's home;
(iii) are available 24 hours a day and
seven days a week;
(iv) are provided within 24 hours of
initial contact for assistance;
(v) are provided for a maximum of 40 days
by a single case worker whose caseload is not more
than two families at any one time; and
(vi) may, in appropriate instances and
subject to available appropriations, include monetary
assistance for special needs of the family, such as to
obtain food, shelter, or clothing or to purchase other
goods or services that will enhance the effectiveness
of other services offered to help preserve the family.
* Sec. 8. AS 47.17.030(d) is amended to read:
(d) Before the department or a local government
health or social services agency may seek the
termination of parental rights under AS 47.10, it
shall offer protective social services and pursue all
other reasonable means of protecting the child. The
department or agency shall also consider the
eligibility of the child and family for intensive
family preservation services under AS 47.10.500 -
47.10.590."
Renumber the following bill sections accordingly.
Page 2, following line 7:
Insert a new bill section to read:
"* Sec. 10. The uncodified law of the State of
Alaska is amended by adding a new section to read:
STUDY. (a) The Department of Health and Social
Services shall conduct a study in at least one region
of the state in order to
(1) develop a valid and reliable process
for accurately identifying clients who are eligible
for intensive family preservation services;
(2) collect data on which to base
projections of service needs, budget requests, and
long-range planning related to intensive family
preservation services;
(3) develop regional and statewide
projections of needs for intensive family preservation
services;
(4) develop a cost estimate for
implementation and expansion of intensive family
preservation services on a statewide basis;
(5) develop a long-range plan and time
frame for ultimately making intensive family
preservation services available to all eligible
families; and
(6) collect data regarding the number of
children in foster care, group care, institutional
care, and other out-of-home care due to medical needs,
mental health needs, developmental disabilities, and
juvenile offenses and to assess the feasibility of
expanding intensive family preservation services
eligibility to include all of these children.
(b) By November 30, 2004, the Department of
Health and Social Services shall submit a report to
the governor describing the study required under this
section and including the department's conclusions and
recommendations that are based on the study. The
department shall notify the legislature that the
report is available.
(c) In this section, "intensive family
preservation services" has the meaning given in
AS 47.10.990."
Renumber the following bill sections accordingly.
Page 2, line 8:
Delete "2"
Insert "6"
Page 2, line 9:
Delete "Section 3"
Insert "Section 9"
Delete "sec. 2"
Insert "sec. 6"
Page 2, following line 10:
Insert a new bill section to read:
"* Sec. 13. Except as provided in secs. 11 and 12
of this Act, this Act takes effect July 1, 2002."
[End of Amendment 1; please note that it amends Version F, the
original bill, whereas the committee was now working from
Version J.]
CHAIR DYSON asked whether there was any objection to putting
Amendment 1 before the committee. There being no objection,
Amendment 1 was before the committee.
Number 1690
REPRESENTATIVE CISSNA offered an amendment to Amendment 1, to
delete lines 1 and 2 [of the amendment], which read:
Page 1, line 3, following "families;"
Insert "relating to intensive family preservation
services;"
CHAIR DYSON asked whether there was any objection. [The
foregoing amendment to Amendment 1 was treated as adopted.]
REPRESENTATIVE CISSNA noted that a second amendment to Amendment
1 would change line 4 [page 1 of the amendment] to read, "Page
2, following line 1:". This change is to reflect Version J, she
explained. [The original amendment language read, "Page 1,
following line 13:".]
CHAIR DYSON asked if there was any objection. There being no
objection, [the second amendment to Amendment 1] was adopted.
Number 1751
CHAIR DYSON asked whether the dates had been straightened out.
REPRESENTATIVE CISSNA replied yes.
CHAIR DYSON announced that Amendment 1 has pen-and-ink changes
that are part of the official amendment. [The only pen-and-ink
change on members' copies was a date change in Section 10,
subsection (b): following "By November 30," delete "2003" and
insert "2004". Therefore, that change was treated as part of
Amendment 1.]
Number 1790
CHAIR DYSON called an at-ease at 3:37 p.m. He called the
meeting back to order at 3:40 p.m.
[Attention would return to Amendment 1 after adoption of
Amendment 2.]
Number 1811
REPRESENTATIVE CISSNA began discussion of what would become
[Amendment 2]. She indicated Section 3 in Version J should have
been deleted. She noted that Amendment 1 has a new Section 3.
CHAIR DYSON suggested moving an amendment to Version J that
deletes the language in Section 3 on page 2, line 1. [Page 2,
line 1, read: "Section 1 of this Act takes effect immediately
under AS 01.10.070(c)."]
CHAIR DYSON announced that the foregoing was the proposed
amendment [Amendment 2]. He asked whether there was any
objection. There being no objection, [Amendment 2] was adopted.
Number 1882
REPRESENTATIVE CISSNA returned attention to Amendment 1. She
explained that [Section 2 of the amendment] gives the department
an additional resource, in order to meet the new standard of
care required in [Version J]. The language had originated in HB
23 [sponsored by Representative Cissna], which proposed a pilot
study for intensive family preservation services. These
services provide that a standard of care be in place through a
program that the courts can use as a new tool.
Number 1939
REPRESENTATIVE CISSNA explained that this tool could be utilized
by the department now, but isn't currently being chosen as such.
This allows the courts to allow families to choose an intensive
family preservation program as an alternative to having their
children removed from the home. This puts workers in the home,
working with the family while keeping the child safe. She
emphasized that the first consideration in this program is the
safety of the child. More than 30 states have successfully
adopted this model; it originated over 20 years ago and has had
very successful outcomes. She offered that her aide would
explain the more technical adaptations in [Amendment 1] that he
has worked out with Representative Coghill's aide.
Number 2000
CHAIR DYSON asked Representative Cissna if she had intended to
imply that intensive family preservation services cannot be
provided if the child has been removed from the family.
REPRESENTATIVE CISSNA answered, "Yes, they can and they are, in
other states that have adopted them." She said these services
are most effective when provided before the child is removed,
but are still a reasonable alternative after removal if the
courts decide it is appropriate. It is a court decision, she
emphasized.
Number 2027
REPRESENTATIVE WILSON asked if her understanding was correct
that the services are most effective right before the child is
removed; at this point, the family is in crisis and is more
likely to do anything to retain custody.
REPRESENTATIVE CISSNA concurred, adding that after a child has
been removed, a crisis dynamic can exist. The [intensive family
preservation model] is a crisis model. Another reason to
provide services before the child is removed is because many
studies have shown damage to children due to absence from their
parents, during which bonds can be broken. She offered that the
better situation avoids damage to the child.
Number 2074
NATE MOHATT, Staff to Representative Sharon Cissna, Alaska State
Legislature, offered to clear up questions regarding the "pen-
and-ink changes" made to Amendment 1. [The only change on
members' copies was the date-change specified earlier, but Mr.
Mohatt's copy of Amendment 1 had changes that brought it into
alignment with Version J.]
MR. MOHATT indicated [the third amendment to Amendment 1],
therefore, would be to delete lines 12-15 on page 4 of Amendment
1, which read:
Renumber the following bill sections accordingly.
Page 2, following line 6:
Insert new bill sections to read:
CHAIR DYSON restated the foregoing and asked whether there was
any objection. There being no objection, the third amendment to
Amendment 1 was adopted.
Number 2144
MR. MOHATT stated that [the fourth amendment to Amendment 1]
would be to delete lines 18-21 on page 5 of Amendment 1, which
read:
Renumber the following bill sections accordingly.
Page 2, following line 7:
Insert a new bill section to read:
CHAIR DYSON restated the foregoing and asked whether there was
any objection. There being no objection, the fourth amendment
to Amendment 1 was adopted.
Number 2160
MR. MOHATT offered that [the fifth amendment to Amendment 1]
would be to delete lines 16-29 on page 6 of Amendment 1, which
read:
Renumber the following bill sections accordingly.
Page 2, line 8:
Delete "2"
Insert "6"
Page 2, line 9:
Delete "Section 3"
Insert "Section 9"
Delete "sec. 2"
Insert "sec. 6"
Page 2, following line 10:
Insert a new bill section to read:
CHAIR DYSON restated the foregoing and asked whether there was
any objection. There being no objection, the fifth amendment to
Amendment 1 was adopted.
CHAIR DYSON requested that a clean copy be provided to the
committee before start of business on Thursday [February 14].
He noted that the Department of Law would be encouraged to make
suggestions as well, and to talk to [Representative Coghill and
Representative Cissna] before coming to the meeting.
Number 2189
REPRESENTATIVE CISSNA told members that one significant piece
that presumably will affect [DFYS's] financial view of this is
the cost. Foster care in Alaska costs $8,000 to $17,000 a child
each year. Other states incur costs between $2,000 and $8,000 a
family each year for intensive family preservation services, she
explained - substantially less.
Number 2233
REPRESENTATIVE JOULE said he was interested in having an answer
at the following meeting regarding the availability of this
service throughout the state.
Number 2267
CHAIR DYSON asked Ms. Tanoury if she'd been aware that
[Amendment 1] was going to be offered.
MS. TANOURY replied yes.
CHAIR DYSON recounted that Ms. Tanoury had indicated in
discussion with himself a year ago that it is DFYS's goal now to
provide whatever services a troubled family needs in order to
function. He asked what [Amendment 1] would change for DFYS.
Number 2290
MS. TANOURY offered her assumption that [Amendment 1] is
identical to HB 23, which calls for DFYS to use existing funding
to provide [intensive family preservation services]. She said
this is a specific model in which caseloads are reduced to two
cases per worker; it is a six-week service model. She pointed
out the importance of having the right families receive this
service; it might not be the right service for every family.
She indicated DFYS would have to work with existing grantees to
determine how to implement this model; she surmised it would be
a grant model rather than through state employees.
MS. TANOURY explained that some funding would be required for
the study; she estimated an $80,000 fiscal note, which was the
amount for HB 23. She concluded that [Amendment 1] calls for
DFYS to use existing funding, which means working with existing
grantees that provide family support services, family
preservation services, and a time-limited family reunification
service model. [Amendment 1] would provide a specific model
under that grant program. She remarked, "It would impact those
grantees to the extent we don't know how we would work with
those grantees on this model."
TAPE 02-8, SIDE B
Number 2342
CHAIR DYSON asked Ms. Tanoury if HB 252, as amended, forces DFYS
to do a pilot.
MS. TANOURY said that is her understanding. In response to
further questions, she said the amendments will significantly
alter the fiscal note, and that a new fiscal note would be
prepared before the [February 14] meeting.
[Elmer Lindstrom, Deputy Commissioner, Department of Health and
Social Services, declined to testify but suggested the
Department of Law might have a fiscal concern.]
Number 2286
TONY LOMBARDO, Alaska Association of Homes for Children;
Covenant House Alaska, testified via teleconference. The Alaska
Association of Homes for Children represents 450 licensed
residential beds for the provision of services to Alaskan
children, he noted. He offered support for the original version
of the bill. He observed that significant changes had been made
today, but he indicated that these changes are still in line
with the position of the Alaska Association of Homes for
Children.
MR. LOMBARDO turned attention to Section 1, the construction
section of the bill itself. He said this section is "read by
the court like a headline to each section that follows." He
expressed his opinion that any change to the construction
section will be perceived as a clear enunciation of best
practices in every aspect of CINA proceedings. The social
workers in the Alaska Association of Homes for Children believe
that such an enunciation of best practices is positive, he told
members.
MR. LOMBARDO referenced Department of Law testimony that
indicated this section could be confusing to the court; he said
guiding legal principles exist such as "in pari materia," which
means the court will have the opportunity to read related
sections along with the construction section. Mr. Lombardo
said, "We continue to support that; we think that's a good
section." He offered that this could just as easily be
expressed in policies or regulations. He surmised, however,
that this might be more work for the department than what was
accomplished today.
MR. LOMBARDO turned to Section 2 of the bill. He suggested that
repealing AS 47.10.960 may or may not result in changes for the
state. Changing the liability can create the perception of an
opportunity, and this is always a risk, he said. He said people
sue the state all the time if they feel they have been wronged
by a state agency. He continued, "The bottom line for us is
that we champion accountability for all state agencies working
with children." He added that any step in that direction is a
good one.
Number 2170
MR. LOMBARDO told members, "The potentiality ... in the first
bill for creating kind of an onerous series of regulations
through the state was a problem. We didn't want to see them
have to do a lot of expensive work that took time away from the
kids. So we're glad that you're dropping that." He stated his
continued support for [the provisions from HB 23]; the family
reunification services championed by Representative Cissna have
always been an excellent idea, he added.
Number 2125
LAUREE HUGONIN, Director, Alaska Network on Domestic Violence
and Sexual Assault, noted that she was just now seeing Amendment
1 for the first time. She expressed concern about the
implementation of family preservation services. It is important
to have safeguards in place when working with families in which
there are adult victims, she offered. It is also important to
think through how "family" is defined when attempting to reunify
a family; this applies to both domestic violence situations and
sexual-abuse-of-a-minor situations when the offender is a
parent. She stated that this requires special skills and
thought, and it is not something to be entered into lightly.
MS. HUGONIN turned attention to page 4, line 4, of Amendment 1,
which read [beginning on line 3]:
(5) the safety of a child, a family member,
or a person providing the services would be unduly
threatened.
She suggested this indicates there is some level of threat that
is acceptable. Therefore, she asked the committee to consider
removing the word "unduly".
Number 2040
MS. HUGONIN brought attention to page 3, line 25 [Amendment 1],
which read:
(C) family conflict.
She requested that it be changed. She asked, "What is family
conflict? What does that concept entail?" She asked whether
this means that people just can't work things out, or means
domestic violence. She noted that family preservation services
in other states have been tried in some of the worst-case
scenarios. She said, "I think there may be some examples out
there where these services are at the front - they're with
neglected families."
MS. HUGONIN indicated it might be a better use of funds to
target families with problems earlier; this could prevent later,
more serious problems. She noted her impression that these
services are focused on families with serious problems, instead
of earlier intervention in families in which neglect is the
problem. "It's probably pretty late in the process to be
thinking about a new model of doing that, but maybe for further
dialogue you could look at trying to help those families who are
still in the neglect stage," she added.
Number 1994
REPRESENTATIVE CISSNA agreed with Ms. Hugonin. She said this
model has been used very successfully with domestic violence
situations in which there has been a restraining order. She
remarked:
As we know, that's the most crucial time sometimes,
[and] some of the most dangerous times [are] right
after you have a worker in the home that can be there
for long periods of time. And sometimes ... the
worker goes and stays with the person who has made the
... restraint order to make sure that the family
member is safe.
REPRESENTATIVE CISSNA said the [intensive family preservation]
model has worked very well in this type of situation. She
agreed the money should be spent on [earlier intervention],
noting that this [model] has been proposed because it offers one
last chance at the "teachable moment." She concurred with Ms.
Hugonin's suggestion to define "family conflict."
Number 1919
CHAIR DYSON announced that HB 252 would be held over until
[February 14].
CHAIR DYSON called an at-ease at 4:07 p.m. He called the
meeting back to order at 4:10 p.m.
HB 367-MEDICAL ASSISTANCE PROGRAM COVERAGE
CHAIR DYSON announced the next order of business, HOUSE BILL NO.
367, "An Act relating to coverage of children and pregnant women
under the medical assistance program; and providing for an
effective date."
Number 1880
REPRESENTATIVE COGHILL, sponsor, explained that HB 367 addresses
the [income eligibility level] of the Denali KidCare program.
Right now, the program's level is 200 percent of the poverty
level; HB 367 seeks to bring this down to 150 percent. The bill
also contains "housekeeping" measures addressing such issues as
removing the hyphen from "child-care". He explained that the
drafter had taken this opportunity to clean up some language.
REPRESENTATIVE COGHILL pointed out that the real [intent of HB
367] is on page 4, lines 5 and 9, wherein the [household income
threshold] is changed from 200 percent to 150 percent of the
federal poverty guideline. He posed questions: What does this
translate into for a family of three to five? How does this
relate to child health care? He explained that he'd broached
this issue two years ago, proposing a change to 100 percent of
the [federal poverty guideline]. "I barely got out of here
alive," he said. Representative Coghill continued:
It was just asking the question, was that expansion
really what we wanted to do? And the resounding
answer was yes, that is something that they wanted to
do. And it was under the Smart Start program that
passed some years ago. But once again, I'm here
asking us the question: Is this really the direction
we want to go?
There [are] two sides to it - there's the dollar side
and there's a policy side. To me, the policy side of
an expanding subsidy level for health care is
something that ... I'm not willing to go for. There's
a dollar side that right now, under the fiscal
condition we're in, can we really afford to go down
this road further?
But what I'm not saying, and I want everybody to hear
this real clear ..., is there is not a need out there.
The need for child health care is there, just as sure
as we're sitting here. So, I understand that there
are going to be some people who are going to say, "We
can't afford to do that anymore." But I think that
has to be part of the legitimate discussion of "what
are we going to do to fill the $800 million hole in
Alaska."
Number 1763
REPRESENTATIVE COGHILL said this does affect policy, although he
doesn't expect [savings in HB 367] to fill the $800 million
[fiscal gap]. He remarked, "The argument that the investment
into children's health care is going to be cheaper at this end
than at the other end, I agree with." He offered that this
argument is an important part of the discussion. On the other
hand, he added his belief that there are families between the
150 percent and 200 percent levels that can afford [health
care]. He said, "Before I'm willing to take money out of
somebody else's pocket to pay for this, I'm willing to say,
'You've got to be a part of that discussion too.'" He told
members that his aide would explain the family income levels
associated with the aforementioned percentages. He drew
members' attention to a chart in the committee packet showing
income levels and the different, adjusted federal poverty
levels.
Number 1694
RYNNIEVA MOSS, Staff to Representative John Coghill, Alaska
State Legislature, explained that Alaska's [poverty level] is
set at 125 percent of the federal poverty level.
CHAIR DYSON asked for clarification.
MS. MOSS replied that the federal poverty level for a family of
four is a monthly income of $1,472. Alaska's poverty level is
set 25 percent higher by the federal government; therefore,
Alaska's poverty level is set at a monthly income of $1,840.
Exemptions such as the permanent fund dividend, Native
corporation dividends up to $200 per recipient, income of
nonbiological or nonadoptive parents, and income of a step-
parent are not considered as income for eligibility purposes for
Denali KidCare.
MS. MOSS explained that a family of four, under the 200 percent
of the federal poverty level - which is based on the 125 percent
initial adjustment - can have an annual income of $44,160.
Adding [last year's amount] of the permanent fund dividend
[times four] to this income, the result is $51,561. This is a
monthly income for a family of four of $3,680, without the
dividend. By contrast, the 150 percent level to which HB 367
proposes to lower the 200-percent figure would change the [pre-
dividend] monthly income to $2,760; this translates to an annual
income of $33,120. A family of four would add approximately
$5,400 [of permanent fund dividends] to that figure to arrive at
nearly $40,000, Ms. Moss explained.
Number 1568
REPRESENTATIVE WILSON commented that [the foregoing income
levels] would include teachers who are single parents; she noted
that many teachers earn less than that, although they have
insurance.
MS. MOSS clarified that the Denali KidCare program is not for
people who already have insurance through their employer.
Number 1543
REPRESENTATIVE WILSON recounted that an upset mother recently
had informed Representative Wilson that the mother's health care
provider had told her to drop her health insurance and sign up
for Denali KidCare; this switch would result in less paperwork
and more ease for the provider, the mother had been told.
Representative Wilson explained that this provider was one that
receives state funds. Representative Wilson reported that more
than one parent had told her this. She noted that she did not
know how prevalent this problem actually was, but said this
parent was aggravated by the incident.
Number 1475
REPRESENTATIVE COGHILL explained that a discrepancy was
discovered in some of the numbers; he noted that he'd asked the
[Department of Health and Social Services] to present some of
the monthly costs [for clarification purposes]. He added,
however, that he was "content to let the people [testify]
because it really is a policy call, no matter what the numbers
shake out at."
Number 1448
CHAIR DYSON expressed interest in hearing a brief statement from
the department.
REPRESENTATIVE JOULE asked whether Chair Dyson intended to move
HB 367 out of committee at this hearing.
CHAIR DYSON replied that he did not believe the committee would
hear all the testimony at this hearing. He confirmed for
Representative Joule that the bill would not be moved at this
hearing.
Number 1425
JAY LIVEY, Commissioner, Department of Health and Social
Services, spoke in opposition to HB 367. He noted that should
this bill be enacted, approximately 3,800 children and 722
pregnant women would lose coverage. He concurred that this bill
reduces [income] eligibility levels from 200 to 150 percent of
[the federal] poverty level.
COMMISSIONER LIVEY pointed out that the fiscal note indicates
the proposed reduction would save about $5 million in general
funds; however, it means the state would lose approximately $12
million in federal funds. Denali KidCare funding is such that
for every dollar spent, about 71 cents comes from the federal
government, he explained. In addition to providing health care
for children and pregnant women, Denali KidCare allows the state
to leverage federal funds into the state's health care system.
COMMISSIONER LIVEY turned attention to savings associated with
[the diminution of coverage]. He pointed out that these savings
will be shifted to other payers because these children who lose
coverage will go somewhere to receive care - most likely, the
emergency room. Unpaid emergency room bills will generally be
paid by the state; other payers in the system will pay some of
that bill. When that happens, that bill will probably not be
paid at the 70/30 federal-share rate; he suggested that the
state will pay a larger share [than 30 percent].
Number 1334
COMMISSIONER LIVEY turned to Representative Wilson's concern
about people being told to sign up for Denali KidCare. He
explained that there is a 12-month waiting period [for
coverage]. When a person applies for Denali KidCare coverage,
he/she is asked about other insurance coverage. A person who
has insurance is not eligible to sign up for the program.
Consequently, the aforementioned parent who was told to drop her
coverage and sign up for Denali KidCare would be unable to get
coverage in that manner. He noted that there would be a waiting
period; the children would have to go without coverage for a
period of time.
Number 1303
REPRESENTATIVE WILSON asked how this issue of an applicant's
insurance coverage is policed.
COMMISSIONER LIVEY replied that quality checks are done on
applications.
Number 1276
BOB LABBE, Director, Division of Medical Assistance, Department
of Health and Social Services, explained that through the
Division of Public Assistance, quality control reviewers have
found this is not occurring to the extent one might think
because of anecdotes. He reported that some applicants have
dropped insurance and applied for coverage; he indicated there
was good cause to do so in some cases. "For the most part, it's
not occurring to that extent," he added.
MR. LABBE said [the division] has advised grantees not to advise
people in that manner; some were not aware of the
disqualification and the fact that some people would be left
[without coverage]. He added, "I can't say there aren't some
instances where things happen or get by, but ... we've done a
quality review on that, and it was not ... going on to any
extent." He offered to obtain the related report for members.
Number 1216
MR. LABBE, in response to a question from Chair Dyson, explained
that a "spot check" is done on people who have applied and been
approved, to view the circumstances [present at the time of
application]; he noted that this is an intensive review.
CHAIR DYSON asked whether an individual's personal records can
be "invaded" to find out whether he/she has insurance elsewhere.
Number 1175
MR. LABBE replied, "I'm not sure that we can, the way you're
saying it. We do have, though, if a person has applied, ...
access to information that comes through ... them and from the
providers that submit claims, as well as from other 'data-match'
sources." He indicated most of the information is gathered when
asking the applicant questions such as: Where do you work?
Does that employer offer health insurance coverage? He said the
application process is fairly simple, but the quality-control
review process is much more detailed.
CHAIR DYSON said, "My question is, do you have access to
peoples' records, whether or not they have entered into a
private relationship with an insurance carrier?"
Number 1131
MR. LABBE answered, "Not generally." He stated that [the
division] has access to the applicant's employer to determine
whether the employer provides coverage. He explained that this
is generally where this is addressed.
REPRESENTATIVE COGHILL inquired what it takes to waive the 12-
month [waiting period].
Number 1112
MR. LABBE replied that the division has [created] a formula to
look at household circumstances. He stated that he did not know
the numbers exactly, but offered that the division has approved
about half-a-dozen requests for waivers. He indicated the
waivers have been granted based on income and family
circumstances; this [waiver-request review] is handled in his
office in Juneau. He stated that approximately 95 percent of
the waiver requests have been denied. He added that the number
of waivers was not large.
COMMISSIONER LIVEY, in response to a question from Chair Dyson,
clarified that the qualifying threshold is 200 percent of the
Alaska income level, which is the federal poverty level adjusted
[upward] 25 percent to account for Alaska's cost of living.
CHAIR DYSON surmised that it is close to the 250 percent level,
as compared to the Lower 48 [poverty] level.
COMMISSIONER LIVEY replied, "I don't think that's the math, but
I'd have to think about it for a minute."
CHAIR DYSON queried about the process the department had used to
decide that a multiplier of two was the correct threshold to set
for Alaskans.
Number 1005
COMMISSIONER LIVEY explained that this decision was made when
the federal CHIP [Children's Health Insurance Plan] proposal was
first made. He noted that Alaska had several choices to make,
such as whether to have a Medicaid program or a stand-alone
program. He offered that the state chose a Medicaid program for
several reasons. For one, a stand-alone program, by federal
law, must cover individuals who are also eligible for the Indian
Health Service (IHS). In a stand-alone program, Alaska's costs
for covering IHS-eligible Alaska Natives would not be reimbursed
at 100 percent. On the other hand, if the state covers the cost
of IHS-eligible individuals through Medicaid, the state receives
100 percent of the cost of that care, reimbursed from the
federal government. He explained that Alaska has the highest
percentage of IHS beneficiaries anywhere in the country. For
that reason alone, it made sense to [choose a Medicaid system].
COMMISSIONER LIVEY recalled that when the [department] looked at
the income threshold, it had a policy discussion similar to what
Representative Coghill is suggesting: At what point should the
state stop subsidizing health care and a private citizen be
[responsible] for his/her own coverage? He said the 200 percent
level was chosen because it appeared to be a level of income at
which individuals and families had trouble purchasing their own
insurance. The insurance market was not sufficiently developed
for a parent to purchase a policy for a child, he offered.
COMMISSIONER LIVEY indicated these types of policies were
difficult to obtain and expensive. This issue was discussed
with executives from some of the state's largest insurance
companies; these executives told [the department] that low-
income insurance is not necessarily one of the companies' prime
focus markets. Commissioner Livey explained that this low-
income-insurance market has high administrative costs because
people enter and leave this coverage frequently. He concluded,
"It seemed to us that 200 percent ... was a reasonable cutoff in
terms of what a family could afford or what was available to
them out in the market."
Number 0878
CHAIR DYSON asked if Representative Coghill was "in the
ballpark" when saying that a family of four has an income
eligibility of about $44,000 plus whatever is added by the
dividend.
COMMISSIONER LIVEY replied, "Correct."
CHAIR DYSON added, "And it would be reduced down to [$]33,000-
and-change, plus the dividend?"
COMMISSIONER LIVEY answered that he had not done the math
himself, but presumed that number was correct.
Number 0843
REPRESENTATIVE WILSON stated that when a woman visits the doctor
and finds out she is pregnant, right away [she is advised] to
sign up for WIC [Special Supplemental Nutrition Program for
Women, Infants, and Children] because it is retroactive to
before she became pregnant. Representative Wilson asked how
much overlap [of benefits] there is between WIC and [Denali
KidCare].
COMMISSIONER LIVEY pointed out that these programs provide two
different services. Whereas WIC provides services related to
nutrition, Medicaid is more medically oriented. The services
would not necessarily overlap.
REPRESENTATIVE WILSON asked what other [coverage] pregnant women
apply for. She also asked [which entity] pays for doctor bills.
MR. LABBE offered his assumption that it would have to be the
Medicaid program. Noting his belief that WIC does not pay for
any kind of medical services, he offered to check on this for a
certainty. He said there are "linkages," however; when people
apply for WIC, they can pick up applications for Denali KidCare
at those offices.
REPRESENTATIVE WILSON indicated this is the focus of her
question - what program "kicks in" - because she has been to
clinics that [offer multiple applications for programs]. She
said, "That makes sure that the clinic or the doctor gets paid
for maternity care throughout that pregnancy." She expressed
interest in knowing whether the 722 pregnant women alluded to
earlier who wouldn't receive Denali KidCare coverage might
qualify under some other program.
Number 0726
COMMISSIONER LIVEY offered his belief that there is no overlap
of coverage for prenatal care; he said he'd make certain that is
the case.
CHAIR DYSON indicated his desire to ensure that witnesses be
able to testify who would be unable to testify on February 14.
REPRESENTATIVE STEVENS expressed concern about the salary
levels; he indicated this can be misleading. Many teachers do
not earn $44,000; when benefits are added, however, the result
far exceeds $44,000. He asked whether many professional or
fully employed people use [Denali KidCare].
Number 0676
COMMISSIONER LIVEY observed that many families with incomes
between the 150 percent and 200 percent poverty levels are
working families. Generally, these are families who do not have
an option to purchase health care through their employer.
REPRESENTATIVE STEVENS noted that he was specifically interested
in discovering whether families with insurance were seeking
coverage. "Are there a lot of teachers in your program?" he
queried.
MR. LABBE stated that he wouldn't necessarily know. He offered
his impression that most of the people [using Denali KidCare]
are self-employed, such as people in the building trades. Some
may qualify on the income level, but they typically have
coverage through the district, the state, or some other entity.
Number 0520
KATHLEEN FITZGERALD, Key Coalition of Alaska, testified via
teleconference in opposition to HB 367. She stated that Denali
KidCare is an important piece of health care for Alaskan
families. She stated that the coalition believes Denali KidCare
promotes the best outcomes for children; when they are healthy,
they can learn. Pregnant women who receive prenatal care are
less likely to deliver children with health care problems or
disabilities. She added that the coalition believes that
families with children with disabilities [between the 150
percent and] 200 percent range have a difficult time due to
increased costs associated with raising a child with
disabilities. The coalition supports the 200 percent level for
this reason, she indicated.
Number 0412
MS. FITZGERALD added, "We also think that it's just good
business to provide that coverage; even though it costs us 5
million in Medicaid dollars, what it saves us in the federal
dollars and provides for the medical community and for healthy
families is really important to us." She concluded, saying that
the Key Coalition is strongly opposed to reducing the income
level for Denali KidCare.
Number 0348
MS. FITZGERALD read a letter from someone unable to attend the
hearing, as follows:
I am a single parent with four children, three still
at home. I work full-time and attend the University
of Alaska half-time in order to secure a future for my
children and myself. Even with full-time employment,
I still struggle financially and need some temporary
support until I have completed my education.
Denali KidCare ... has been a wonderful benefit for
our family. I no longer have to decide if they can
make it until Monday because I can't afford to take
them to the doctor, gambling on their health over
money. It has made access to medical treatment by
reducing the financial burden that is ... often
expected at the time of treatment. My children no
longer have to ask, "Can we afford glasses or
medicine?" Denali KidCare has decreased the stress
level in our home by affording access to needed
medical care for my children.
CHAIR DYSON announced that witnesses may send written testimony,
which would be distributed to members.
Number 0250
THOMAS CONLEY, Pediatrician; Member, Sitka Borough School
District School Board, testified via teleconference and thanked
members for the opportunity to testify. He offered that he has
been in practice in Alaska for 27 years. He characterized
patients as falling into three [medical-coverage] classes:
patients who are poor and covered by Medicaid; patients who have
considerable resources or insurance and can afford self-care;
and patients such as fishermen, small business owners, and
entrepreneurs who do not have access to insurance and must
obtain care on a "self-pay" basis. Dr. Conley stated that this
latter group of people is the group "left behind" in terms of
medical care. These patients would frequently wait until a
[health concern] was severe before seeking treatment; they
skimped on prenatal care and child [health] care. He suggested
that the price to this population to secure care was frequently
quite high; this was often eventually paid by the state.
Number 0148
DR. CONLEY offered that should these people be dropped from
coverage, the state would wind up paying considerably more down
the road. He added that he serves on the school board in Sitka;
as a member, he observes that problems not addressed early in
life frequently become problems for the school system. He
concluded by expressing his opinion that the program should
continue as it is; it is covering something that needs to be
covered.
CHAIR DYSON reminded participants that there has been no talk of
discontinuing the program.
TAPE 02-9, SIDE A
Number 0043
MEG MITCHELL testified via teleconference in support of
retaining Denali KidCare [eligibility] at the current level.
She clarified that she is not a parent; therefore, this is not a
program from which she can benefit. She stated that she has
worked with families administering a child-care-assistance
program in Homer; in this role, she was able to tell parents
about this "incredible program" that the state offered. She
indicated the best impact of the program is that it helps
working families. She mentioned that the Denali KidCare motto
is insuring Alaska's children and our future; she urged members
to pay attention to the need for providing children with health
care insurance.
Number 0127
MS. MITCHELL offered her belief, based on the state's current
economy, that there is no reasonable option for obtaining health
care coverage for one's children. Alaska does not have many
jobs that offer such coverage, she said. There is nothing else
for parents to do if they are not fortunate enough to have a job
that does so. "This is the program that is benefiting our
working families, and I would really like to see the state
continue to support ... the working families," she said. She
noted that the economy is "not looking good," and that it isn't
easy for families to meet all its needs in Alaska. She
indicated Alaska's [poverty rate] is set higher than the rest of
the nation due to the high cost of living. She urged members to
not change the current Denali KidCare program.
Number 0200
DANA LEE HALL, R.Ph., Village Operations Administrator, Yukon-
Kuskokwim Health Corporation (YKHC), testified via
teleconference, noting that the village operations program
includes the health aide program, home care worker program, and
an advanced-training program. She explained that [YKHC] began
its well-child program in the Yukon-Kuskokwim (Y-K) Delta;
health aides were trained to provide services such as EPSDT
[Early and Periodic Screening, Diagnosis, and Treatment] well-
child exams in villages. The mission at YKHC is to ensure that
health care is delivered as close as possible to people's homes,
she said; Denali KidCare has allowed them to do so. She noted
that another priority of YKHC is to enroll all pregnant women in
Medicaid in order for them to receive appropriate care.
Number 0328
MS. HALL offered that many village residents qualify for
Medicaid, but many other residents have low-paying jobs without
insurance. These low-paid residents are not teachers. They may
work for the village corporations or the tribal councils, or
they may work as ancillary staff in the school. She pointed out
that [YKHC] is witnessing increased Medicaid enrollment under
the Denali KidCare program; this includes a 4-to-5 percent
increase over the past year.
MS. HALL said the lack of adequate prenatal care is [YKHC's]
most serious concern, however. She offered that prenatal care
is the single most cost-effective health care expenditure and
ensures the best outcomes for babies. Denali KidCare was
created to meet the needs of uninsured children and pregnant
women with incomes too great for traditional Medicaid
eligibility and too low to obtain insurance or pay directly for
health care, she reported. The cost of delivering care in the
Bush is "astronomical", she noted. A trip from Kotlik to Bethel
to obtain care is $400 a person. Although she offered her
understanding of the state's financial situation, she said
providing preventative services for children and pregnant women
is money well spent. She urged that Denali KidCare income
requirements remain unchanged.
Number 0453
REPRESENTATIVE STEVENS asked for clarification about the 100
percent federal health care coverage for Native children. He
also asked whether this proposed reduction would affect only
non-Native children.
Number 0486
COMMISSIONER LIVEY replied that IHS beneficiaries who are
Medicaid-eligible can sign up for Medicaid. The state pays the
Medicaid bill and is fully reimbursed by the federal government.
REPRESENTATIVE STEVENS expressed his understanding that all
[Native] children would continue to be fully covered by the
federal government; only non-Native children would fall under
the provision [in HB 367], should it pass.
COMMISSIONER LIVEY replied that this is true in 98 percent of
the cases.
Number 0550
JIM KOHLER, Tanana Chiefs Conference (TCC), testified via
teleconference in opposition to the proposed change to the
Denali KidCare program. He said, "We believe that the 200
percent of poverty is an accurate level of poverty of patients
who can afford insurance." He noted that should this go into
effect, 20 to 30 percent of TCC beneficiaries would be cut off
of Denali KidCare. In addition, he said, "We would also lose
the federal funding for this program, [because] it's our
understanding that if [an] Alaska Native is served under Denali
KidCare, 100 percent of the money comes from the federal
government and not the state. We believe this to be a good
investment of the federal funds for Alaska Natives."
CHAIR DYSON queried, "Would you say that you're serving a lot of
folks who don't qualify as Natives?"
MR. KOHLER replied, "No. Tanana Chiefs just sees Alaska
Natives."
CHAIR DYSON expressed his understanding that all Alaska Natives
would be fully qualified [under IHS].
Number 0624
DIANE CLARK, Group Home Daycare, testified via teleconference,
noting that she is representing herself, a single parent with
two children, as well as Group Home Daycare. She stated that
she does not support HB 367, and that she is thankful she has
Denali KidCare for her children for preventative care. She
offered that the program has been beneficial to her children.
As a daycare provider, she is witness to the needs of parents
for health care [for their children]. The cost of health care
is rising, she explained; it has doubled in her area. She
indicated that if HB 367 passes, health care expenses that
parents are unable to pay will be borne by the state; if the
state is unable to pay, the federal government pays. She
characterized this as a vicious cycle.
MS. CLARK added that lower self-esteem and a higher crime rate
would result from the bill's passage. Denali KidCare coverage
now provides a greater chance for families to receive well-child
care and to detect health problems early on. She noted that a
higher self-esteem is the result of greater stability [provided
by Denali KidCare coverage]. She thanked members for their time
and expressed her hope that this bill would not pass.
Number 0760
TRUDY ANDERSON, Consumer Awareness Manager, Alaska Native Health
Board, testified via teleconference. She explained that the
Alaska Native Health Board is a statewide nonprofit corporation
established more than 30 years ago to promote spiritual,
physical, mental, social, and cultural well-being and pride of
Alaska Native people. The board of directors represents
regional and village health providers from across the state. In
most cases, she noted, these organizations are the only health
care providers for their region, serving both Native and non-
Native patients who would otherwise have virtually no access to
health care services. She emphasized that the CHIP funds are
100 percent reimbursed by the federal government for Alaska
Natives and IHS beneficiaries who use Denali KidCare and
Medicaid. She said, "We are opposing HB 367 and urge the
legislature not to pass this bill."
Number 0859
GAY WELLMAN, Copper River Native Association, testified via
teleconference and explained that she wished to speak on behalf
of the association as well as herself. She stated that the
Copper River Native Association provides services to both Native
and non-Native residents. One service it provides is for
treatment for Fetal Alcohol Syndrome (FAS); Denali KidCare is an
integral part of enabling the association to provide that FAS
service. Denali KidCare assists in paying the out-of-state
doctor for diagnosis and services. She stated that this service
would be difficult to provide, were HB 367 to pass.
MS. WELLMAN explained that several years ago, she and her
husband were earning more than the $44,000 [eligibility] limit;
her husband was working in the private [sector] and she for the
federal government. She reported that they had difficulty
finding coverage for their children; she was unable to afford
coverage through her job for more than herself. Although they
found a policy that was initially affordable, rates were raised
within several months' time and continued to rise. Eventually,
her family was unable to afford this policy, she said.
Number 0945
MS. WELLMAN summarized by stating that the insurance that is
available for families is really not affordable. Often these
companies do not pay what they should when a claim is filed, she
said. She indicated that her family was reimbursed $200 for a
$3,000 medical bill for one of their children. She said, "I
hope that you will keep it the way it is; it would certainly
help us out here greatly."
Number 0978
COMMISSIONER LIVEY asked department personnel to assist him in
responding.
NANCY WELLER; Unit Manager; State, Federal, and Tribal
Relations; Division of Medical Assistance; Department of Health
and Social Services, clarified that if the income level [for
program eligibility] is lowered, it would affect all children of
all races. She said, "Medicaid would not be getting the hundred
percent pass-through funds for Native children because they
would no longer be covered at that income level."
CHAIR DYSON queried whether there wasn't other medical care
available for Native Alaskan children.
MS. WELLER replied that Native health coverage is funded
directly through Indian Health Service funds at approximately 60
percent of the need. This funding level is documented in many
studies, Ms. Weller said. She stated that the U.S. Congress had
allowed [IHS] to bill Medicaid for services to assist [IHS] in
covering the cost of health care for beneficiaries.
CHAIR DYSON asked for further clarification [in the future]. He
expressed his understanding that children who would not qualify
under Denali KidCare would still qualify to have 60 percent of
their medical bills paid by IHS.
MS. WELLER responded that the IHS system is funded for 60
percent of the need of Alaska Native people.
CHAIR DYSON queried, "Does 60 percent of the need ... not mean
paying 60 percent of the bills?"
COMMISSIONER LIVEY noted that it probably means that the health
corporations do not have enough money to pay for all of the
medical services for their beneficiaries. Therefore, the
corporations have to choose what is covered and what is not
covered. He explained that 60 percent of the need is covered by
the federal government; 40 percent is not covered. Whether or
not a corporation would choose to cover prenatal care or
children is up to the corporation.
Number 1102
CHAIR DYSON said, "So we're talking about 60 percent of the
aggregate need, not of a particular individual." [He received
confirmation from both Commissioner Livey and Ms. Weller that
this is correct.]
REPRESENTATIVE COGHILL referenced a study indicating $63 million
comes directly to Alaska through IHS. He said, "So there is
money going to health care in Alaska." He indicated [HB 367]
would not destroy that; it still allows 60 percent to be
[covered]. He expressed his opinion that this should be debated
in the House Finance Standing Committee.
CHAIR DYSON announced that HB 367 would again be heard by the
committee on February 14. [HB 367 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:03 p.m.
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