Legislature(2017 - 2018)CAPITOL 106

05/04/2017 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HJR 20 MEDICAID EXPANSION TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 234 EXTEND ALASKA HEALTH CARE COMMISSION TELECONFERENCED
Heard & Held
+= HB 236 EXTEND SENIOR BENEFITS PAYMENT PROGRAM TELECONFERENCED
Heard & Held
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                          May 4, 2017                                                                                           
                           3:08 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Matt Claman                                                                                                      
Representative Dan Saddler                                                                                                      
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE JOINT RESOLUTION NO. 20                                                                                                   
Urging the United States Congress and the President of the                                                                      
United States to maintain health insurance coverage for                                                                         
individuals currently covered by Medicaid expansion.                                                                            
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 234                                                                                                              
"An Act extending the termination date of the Alaska Health Care                                                                
Commission; and providing for an effective date."                                                                               
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 236                                                                                                              
"An Act extending the Alaska senior benefits payment program."                                                                  
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HJR 20                                                                                                                  
SHORT TITLE: MEDICAID EXPANSION                                                                                                 
SPONSOR(s): REPRESENTATIVE(s) PARISH                                                                                            
                                                                                                                                
04/13/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/13/17       (H)       HSS                                                                                                    
05/04/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 234                                                                                                                  
SHORT TITLE: EXTEND ALASKA HEALTH CARE COMMISSION                                                                               
SPONSOR(s): REPRESENTATIVE(s) GUTTENBERG                                                                                        
                                                                                                                                
04/16/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/16/17       (H)       HSS, FIN                                                                                               
04/25/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/25/17       (H)       -- MEETING CANCELED --                                                                                 
04/27/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/27/17       (H)       Heard & Held                                                                                           
04/27/17       (H)       MINUTE(HSS)                                                                                            
05/04/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 236                                                                                                                  
SHORT TITLE: EXTEND SENIOR BENEFITS PAYMENT PROGRAM                                                                             
SPONSOR(s): REPRESENTATIVE(s) KAWASAKI                                                                                          
                                                                                                                                
04/17/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/17/17       (H)       HSS, FIN                                                                                               
04/25/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/25/17       (H)       -- MEETING CANCELED --                                                                                 
04/27/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/27/17       (H)       Heard & Held                                                                                           
04/27/17       (H)       MINUTE(HSS)                                                                                            
05/04/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE JUSTIN PARISH                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HJR 20 as prime sponsor of the                                                                 
resolution.                                                                                                                     
                                                                                                                                
LISA WORL, Staff                                                                                                                
Representative Justin Parrish                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions on behalf of the sponsor                                                              
of HJR 20, Representative Parrish.                                                                                              
                                                                                                                                
TOM CHARD, Executive Director                                                                                                   
Alaska Behavioral Health Association                                                                                            
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  and  answered questions  during                                                             
discussion of HJR 20.                                                                                                           
                                                                                                                                
VALERIE DAVIDSON, Commissioner                                                                                                  
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  and  answered questions  during                                                             
discussion of HJR 20.                                                                                                           
                                                                                                                                
SETH WHITTEN, Staff                                                                                                             
Representative David Guttenberg                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   During discussion of HB  234, testified and                                                             
answered questions on behalf of  the bill sponsor, Representative                                                               
Guttenberg.                                                                                                                     
                                                                                                                                
KRISTIN CURTIS                                                                                                                  
Legislative Auditor                                                                                                             
Legislative Audit Division                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions during  discussion of HB                                                             
234.                                                                                                                            
                                                                                                                                
MERCEDES COLBERT, Staff                                                                                                         
Representative Scott Kawasaki                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions during  discussion of HB                                                             
234 on behalf of the bill sponsor, Representative Kawasaki.                                                                     
                                                                                                                                
MONICA WINDOM, Director                                                                                                         
Division of Public Assistance                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions during  discussion of HB                                                             
236.                                                                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:08:02 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing Committee meeting to order  at 3:08 p.m. Representatives                                                               
Spohnholz,  Johnston, and  Sullivan-Leonard were  present at  the                                                               
call to order.   Representatives Eastman, Tarr,  and Kito arrived                                                               
as the meeting was in progress.                                                                                                 
                                                                                                                                
                   HJR 20-MEDICAID EXPANSION                                                                                
                                                                                                                                
3:08:49 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be  HOUSE  JOINT RESOLUTION  NO.  20,  Urging the  United  States                                                               
Congress  and the  President  of the  United  States to  maintain                                                               
health insurance  coverage for  individuals currently  covered by                                                               
Medicaid expansion.                                                                                                             
                                                                                                                                
3:09:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JUSTIN   PARISH,   Alaska   State   Legislature,                                                               
paraphrased from the Sponsor Statement  for HJR 20, which read as                                                               
follows [original punctuation provided]:                                                                                        
                                                                                                                                
     This resolution  urges our  United States  Congress and                                                                    
     the  President of  the United  States  to maintain  the                                                                    
     Medicaid   Expansion   to   cover   individual   health                                                                    
     insurance  coverage.   Health  care  is   an  essential                                                                    
     service for our residents.                                                                                                 
                                                                                                                                
     Health  care   coverage  also  benefits   employers  as                                                                    
     healthy employees  are more productive. Alaska  has the                                                                    
     second highest  rate of  residents without  health care                                                                    
     in the nation. This  expansion has provided coverage to                                                                    
     more than  31,000 Alaskans who  would otherwise  not be                                                                    
     covered. As  of March  31st, 2017, Alaska  has received                                                                    
     $413  million total  payments made  under the  expanded                                                                    
     program  reducing   the  number  of   uninsured  people                                                                    
     visiting  emergency   rooms  and   providing  necessary                                                                    
     funding for  behavioral health treatment  and treatment                                                                    
     for substance abuse.                                                                                                       
                                                                                                                                
     I would appreciate your support  for this resolution to                                                                    
     maintain the federal funding for Medicaid Expansion.                                                                       
                                                                                                                                
REPRESENTATIVE  PARISH pointed  out  that Alaska  had the  second                                                               
highest  rate of  residents  without health  care  in the  United                                                               
States.                                                                                                                         
                                                                                                                                
3:11:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked how  much money  the State                                                               
of Alaska  had paid in order  to receive the federal  funding for                                                               
Medicaid Expansion.                                                                                                             
                                                                                                                                
3:12:27 PM                                                                                                                    
                                                                                                                                
LISA  WORL, Staff,  Representative Justin  Parrish, Alaska  State                                                               
Legislature, replied  that the  state match  was five  percent of                                                               
the total  amount.  She  added that the Alaska  Native population                                                               
had additional  coverage through the Indian  Health Service (IHS)                                                               
at 100 percent.                                                                                                                 
                                                                                                                                
REPRESENTATIVE PARISH  noted that  for every  $1 the  state paid,                                                               
there was a federal match of $19.                                                                                               
                                                                                                                                
3:13:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked if  the recent  changes to                                                               
the Patient  Protection and  Affordable Care  Act would  have any                                                               
effect on Alaska.                                                                                                               
                                                                                                                                
REPRESENTATIVE  PARISH  offered his  belief  that  Alaska may  be                                                               
moving toward a  per capita allocation of funds,  which he deemed                                                               
as not  good for  Alaska given  the disproportionate  health care                                                               
costs and other systemic challenges in the state.                                                                               
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  for  more explanation  to                                                               
the per capita allocation.                                                                                                      
                                                                                                                                
REPRESENTATIVE  PARISH   explained  that  each  state   might  be                                                               
allotted  a  certain  amount  of   funds  in  proportion  to  its                                                               
population rather  to than the  actual economic and  health needs                                                               
of the state.                                                                                                                   
                                                                                                                                
3:14:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  directed attention  to page 2,  line 11,                                                               
of  the proposed  resolution, and  read:   "the state  spends the                                                               
second lowest percentage of state  funds on Medicaid."  She asked                                                               
about the source of this information.                                                                                           
                                                                                                                                
MS. WORL  deferred to the  representative from the  Department of                                                               
Health and Social Services.                                                                                                     
                                                                                                                                
REPRESENTATIVE   JOHNSTON   asked    about   the   reduction   to                                                               
uncompensated  care through  Medicaid  Expansion.   She  reported                                                               
that although the  projection had been for  Medicaid expansion to                                                               
reduce  the expensive  emergency  room care  and  allow for  more                                                               
preventative care,  nationally and in Alaska  emergency room care                                                               
had increased.   She  declared that the  policy was  not matching                                                               
the outcomes.   She  added that  it was not  just an  increase to                                                               
emergency room usage  but also to emergency room  transport.  She                                                               
expressed her concern with the statement on page 2, line 13.                                                                    
                                                                                                                                
3:16:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PARISH directed  attention  to page  2, line  13,                                                               
which   read:      "Whereas  Medicaid   expansion   has   reduced                                                               
uncompensated  care  provided  by  Alaska hospitals  by  tens  of                                                               
millions of  dollars, which helps  reduce costs to  all patents,"                                                               
and stated that this did not  directly address the issue to which                                                               
Representative Johnston  had referred.   He opined  that although                                                               
there  was   a  higher  overall  use   of  emergency  facilities,                                                               
previously people  would have  stayed home  and "duct  taped over                                                               
the injury."  He stated that  31,000 more people, if an emergency                                                               
room visit  was necessary,  would now have  some sort  of funding                                                               
instead  of receiving  uncompensated care.   He  added that  most                                                               
bankruptcies in the country were the result of medical debt.                                                                    
                                                                                                                                
3:18:28 PM                                                                                                                    
                                                                                                                                
TOM   CHARD,  Executive   Director,   Alaska  Behavioral   Health                                                               
Association,   explained  that   the  Alaska   Behavioral  Health                                                               
Association was  a group of  leaders from about 60  mental health                                                               
and  drug and  alcohol treatment  centers across  the state.   He                                                               
shared  his  experience  from  both  before  and  after  Medicaid                                                               
expansion in Alaska.   He said that prior to  September 2015, and                                                               
Medicaid expansion  in Alaska, in  order to qualify  for Medicaid                                                               
an  individual  had  to  fall   into  one  of  several  different                                                               
categories, which  included: had  a child  or dependent;  or, was                                                               
deemed to be disabled, which  was often a designation through the                                                               
social  security administration.   He  explained that  for people                                                               
with mental  illness, it  was necessary  to present  paperwork to                                                               
the social security administration to  initiate the process to be                                                               
deemed  disabled  in   order  to  qualify  for   Medicaid.    For                                                               
individuals  with  substance  abuse   disorders,  as  the  social                                                               
security  administration  did  not  consider  this  a  qualifying                                                               
disability, it did  not make any difference whether  a person was                                                               
poor  or disabled.    Consequently, there  were  many people  who                                                               
could  not access  care, even  as the  grant system  attempted to                                                               
"put  a patch  on  that"  with the  use  of unrestricted  general                                                               
funds.  He  pointed out that the effects  of untreated behavioral                                                               
health  disorders   were  "really  pressing  our   system."    He                                                               
explained  that  Medicaid  expansion offered  some  resources  to                                                               
these individuals to allow access  to treatment and care and that                                                               
although  the system  was gearing  up to  provide that  access to                                                               
treatment, it was  a heavy lift to transition a  system which was                                                               
financed by grants to a  system which was reimbursed by Medicaid.                                                               
He  declared  that his  group  was  very supportive  of  Medicaid                                                               
expansion because the  people who had needed  treatment all along                                                               
could now get  access to the necessary treatment.   He added that                                                               
this was keeping families together  and keeping people out of the                                                               
public  safety and  criminal  justice  system.   He  moved on  to                                                               
discuss the  national vote regarding  the Patient  Protection and                                                               
Affordable  Care Act  and  discussed the  opioid  crisis and  the                                                               
pandemic  problems   in  the  state  with   alcohol,  drugs,  and                                                               
untreated mental illness.   He emphasized that there  was a "very                                                               
high  degree of  uncertainty hanging  out there  right now."   He                                                               
explained that many  individuals had not had  access to treatment                                                               
for  years, and  now that  they had  access, it  was unknown  for                                                               
whether there  would be continued  access.  He  acknowledged that                                                               
there were things  in the Patient Protection  and Affordable Care                                                               
Act that were  not working and suggested to fix  those things and                                                               
keep the things  that were working.  He  emphasized that Medicaid                                                               
expansion was  working phenomenally  well, especially  in Alaska,                                                               
and  he expressed  hope that  people would  receive the  care and                                                               
treatment   needed.     He  stated   support  for   the  proposed                                                               
resolution.                                                                                                                     
                                                                                                                                
3:25:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked if,  once someone received a social                                                               
security disability, they could return to work.                                                                                 
                                                                                                                                
3:25:34 PM                                                                                                                    
                                                                                                                                
MR.  CHARD   spoke  about  a   program  that  attempted   to  get                                                               
individuals  the necessary  benefits  counseling,  so they  could                                                               
return  to work.   He  said  there were  therapeutic benefits  to                                                               
work.                                                                                                                           
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked about the outcomes  for behavioral                                                               
health  in  those states  that  began  Medicaid expansion  before                                                               
Alaska.   She declared that  the problems with  behavioral health                                                               
and  homelessness  were expanding  nationally  and  asked if  any                                                               
states were "doing it well."                                                                                                    
                                                                                                                                
MR.  CHARD  offered his  belief  that  Department of  Health  and                                                               
Social Services had  done an amazing amount of work  on reform of                                                               
the  behavioral health  system  to meet  some of  the  gaps.   He                                                               
declared  that  Medicaid  expansion  was  a  huge  support.    He                                                               
reported  that  some  states  were ahead,  and  that  Alaska  was                                                               
studying  the  health  care service  delivery  systems  of  other                                                               
states.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  if  Alaska  was  reviewing  both                                                               
states  with and  without Medicaid  expansion in  its search  for                                                               
best practices.                                                                                                                 
                                                                                                                                
3:28:11 PM                                                                                                                    
                                                                                                                                
MR. CHARD  said that his  group was conferring  with associations                                                               
in the  other states, always asking  for what could be  done with                                                               
the  available  resources.   He  stated  that Medicaid  expansion                                                               
offered more  available resources.   In  reference to  an earlier                                                               
question  from Representative  Sullivan-Leonard,  he pointed  out                                                               
that  the  essential  health benefits  included  in  the  Patient                                                               
Protection  and  Affordable  Care  Act  specifically  called  for                                                               
access to mental  health and substance abuse treatment.   He said                                                               
that current amendments to the  Patient Protection and Affordable                                                               
Care Act  would allow states to  option out of or  define as they                                                               
desire the  essential health  benefits.   He asked  that everyone                                                               
consider the  impacts on  access to  mental health  and substance                                                               
abuse treatment services, and what  that essential health benefit                                                               
does for the people in the state.                                                                                               
                                                                                                                                
3:30:07 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ shared  her background  while  working with  the                                                               
Salvation Army  programs, and the  difficulty for  expanding when                                                               
necessary.  She stated that  Medicaid expansion met the needs and                                                               
asked what it could mean to  those who need these services if the                                                               
program was cut back.                                                                                                           
                                                                                                                                
3:31:04 PM                                                                                                                    
                                                                                                                                
MR.  CHARD  stated that  as  substance  abuse was  a  grant-based                                                               
treatment system, it had been  realized early on that significant                                                               
federal  resource to  pay for  the same  services would  help the                                                               
state with  budget problems by  reducing the use  of unrestricted                                                               
general  funds.    He declared  that  should  Medicaid  expansion                                                               
vanish,  there  would again  be  a  reliance on  the  grant-based                                                               
system, currently reduced  because of the new resource.   He said                                                               
that  the grant  reduction had  necessitated a  need to  identify                                                               
priority populations and  that even some of the  providers had to                                                               
limit their referral sources.                                                                                                   
                                                                                                                                
3:33:04 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  mused that a  contraction of  Medicaid expansion                                                               
would necessitate  an increase of the  unrestricted general funds                                                               
contribution.                                                                                                                   
                                                                                                                                
MR.  CHARD expressed  his agreement.   Without  a rebalancing  of                                                               
resources, even when pulling out  the high-risk pool, there would                                                               
be increased pressure in the  emergency departments, prisons, and                                                               
other places where unrestricted general funds were spent.                                                                       
                                                                                                                                
3:34:21 PM                                                                                                                    
                                                                                                                                
VALERIE  DAVIDSON,  Commissioner,  Office  of  the  Commissioner,                                                               
Department  of Health  and Social  Services (DHSS),  relayed that                                                               
the  proposed  resolution  encouraged  the  continuation  of  the                                                               
Medicaid  expansion program,  and she  shared more  details about                                                               
the program and  the experience with it in Alaska.   She reported                                                               
that   there  were   32,958  Alaskans   covered  under   Medicaid                                                               
expansion,  about 4.48  percent  of the  state  population.   She                                                               
stated  that about  $445  million  in claims  had  been paid  for                                                               
services in  the following areas:   $126.4 million  for inpatient                                                               
hospital   services;  $81.4   million  for   outpatient  hospital                                                               
services;  $109.7 million  in  professional  and clinic  services                                                               
such  as  specialists;  and  $30  million  in  behavioral  health                                                               
services,  which   included  mental  health  and   substance  use                                                               
disorder  treatment  services.    She  declared  that  behavioral                                                               
health  coverage  was critical  to  the  criminal justice  reform                                                               
efforts.  She  added that the claims also  included $45.6 million                                                               
in prescriptions  and $20 million in  medically necessary travel,                                                               
which ensured  that Alaskans  without access  to a  specialist in                                                               
their  community  could   be  cared  for  in   the  next  closest                                                               
community.                                                                                                                      
                                                                                                                                
COMMISSIONER  DAVIDSON spoke  about the  match rate  for Medicaid                                                               
expansion and explained that states  which had expanded beginning                                                               
on  January 1,  2014, enjoyed  three full  calendar years  at 100                                                               
percent  federal match.   Beginning  in calendar  year 2017,  the                                                               
federal match was  95 percent, and the state paid  5 percent.  In                                                               
calendar  year  2018,  the  federal  match  was  94  percent;  in                                                               
calendar  year 2019,  the federal  match was  93 percent;  and in                                                               
calendar year  2020, the federal  match would become  90 percent.                                                               
She  stated that  for 2017,  although  the federal  match was  95                                                               
percent, the effective state match  rate was 3.26 percent because                                                               
for  Indian  Health Service  (IHS)  beneficiaries  who were  also                                                               
Medicaid  beneficiaries  and  received services  through  an  IHS                                                               
facility, the  federal match was  100 percent.  She  reminded the                                                               
committee  that Governor  Walker had  negotiated an  agreement to                                                               
change  the tribal  claiming  policy and  allow  100 percent  for                                                               
travel policy  and services  which began in  an IHS  facility but                                                               
were referred  to a non-tribal  facility to extend that  level of                                                               
care.  She reported that in  the current fiscal year, the general                                                               
fund savings for Alaska had been about $32 million.                                                                             
                                                                                                                                
3:39:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD   asked  about   the   Medicaid                                                               
rewrite, and mused  that the overall savings would  be about $400                                                               
million.  She noted that as  there would be a decrease in federal                                                               
funding, there would be an increase in state funding.                                                                           
                                                                                                                                
3:40:36 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON  asked to continue speaking  about Medicaid                                                               
expansion and then come back to this question.                                                                                  
                                                                                                                                
3:40:53 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked if the committee could hold its questions.                                                                
                                                                                                                                
3:41:08 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON  added that Medicaid expansion  had infused                                                               
a  significant amount  of cash  into the  Alaska economy,  almost                                                               
$445 million most  of which was federal dollars.   She noted that                                                               
this had  a significant economic  impact with a benefit  to every                                                               
community in  which health care  was provided.  She  relayed that                                                               
the biggest  beneficiaries of this economic  boost were Anchorage                                                               
and the  Matanuska-Susitna area.   She reported that  the current                                                               
administration had  declared that  Medicaid expansion  and reform                                                               
move forward  hand in hand,  as the additional  federal resources                                                               
from Medicaid  expansion provided a  cushion for providers  to do                                                               
things more  creatively.   She shared  that currently  there were                                                               
significant gaps in  the behavioral health care  system, and that                                                               
over the past year, Department  of Health and Social Services had                                                               
been engaged  with providers  and stakeholders  to develop  a new                                                               
way to provide behavioral health  services in Alaska.  She stated                                                               
that more flexibility  was desired, as some of  the current rules                                                               
did  not  provide  the  flexibility which  Alaska  needed.    She                                                               
reported  that  Department  of Health  and  Social  Services  was                                                               
negotiating for a  1115 waiver with the Centers  for Medicare and                                                               
Medicaid  Services, which  would provide  this flexibility.   She                                                               
stated  that Alaska  had been  challenged  by a  rule called  the                                                               
Institutions  for Mental  Disease exclusion.   This  federal rule                                                               
stated that  a facility  with more than  16 treatment  beds could                                                               
not bill  for Medicaid.   There  had recently  been an  effort to                                                               
serve  people  in a  homelike,  less  restrictive setting,  which                                                               
meant  that substance  use treatment  facilities  in Alaska  were                                                               
often too large.  She reported  that the Centers for Medicare and                                                               
Medicaid  Services  had  indicated  a willingness  to  amend  the                                                               
existing   1115   Behavioral   Health  waivers   to   waive   the                                                               
Institutions  for  Mental Disease  exclusion.    She spoke  about                                                               
other reforms  included in  Senate Bill  74 which  provided broad                                                               
authority for  the Department  of Health  and Social  Services to                                                               
look at new  reform opportunities being made  available and would                                                               
allow them  to move forward quickly.   She stated that  there was                                                               
also  provision  to  address  the  over-utilization  of  Medicaid                                                               
beneficiaries.   She  explained a  voluntary program  which would                                                               
reach out  to Medicaid beneficiaries who  over-utilized emergency                                                               
room services  to help them  find a  primary care provider.   She                                                               
shared that  beneficiaries love having  a primary  care provider,                                                               
and that the department would  follow up with these beneficiaries                                                               
to  remind them  of appointments,  help with  transportation, and                                                               
other  issues.   She  shared  that  there was  another  mandatory                                                               
program  for individuals  with acute  conditions which  increased                                                               
contact;  whereas another  program  pursued by  the Alaska  State                                                               
Hospital  and  Nursing  Home  Association  was  a  public-private                                                               
partnership  working with  emergency  departments.   She  relayed                                                               
that there  was a coordinated care  demonstration project looking                                                               
for interested parties for better  care coordination services for                                                               
Medicaid  beneficiaries   in  Alaska.     She  stated   that  the                                                               
department  recognized the  opportunity to  get people  treatment                                                               
with early intervention  and to "build healthier  Alaskans."  She                                                               
pointed out  that with  early intervention  for access  to health                                                               
care services  upon release from  incarceration there was  a much                                                               
better  outcome  for  reduced  recidivism.    She  declared  that                                                               
Medicaid expansion  was a critical component  of criminal justice                                                               
reform.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked  why  the  cost for  uncompensated                                                               
care  in the  hospitals  had  already started  to  drop prior  to                                                               
Medicaid expansion.                                                                                                             
                                                                                                                                
COMMISSIONER  DAVIDSON  said  that   this  information  had  been                                                               
provided  by   the  Alaska  State   Hospital  and   Nursing  Home                                                               
Association.                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ suggested that Alaska  State Hospital and Nursing                                                               
Home Association  be available  for questions  at the  next House                                                               
Health and Social Services Standing Committee meeting.                                                                          
                                                                                                                                
3:54:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked  if the  Indian  Health  Services                                                               
(IHS)  was  fully  responsible  for the  health  care  for  those                                                               
qualified individuals.                                                                                                          
                                                                                                                                
3:54:29 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON   explained  that  the  IHS   covered  its                                                               
beneficiaries,  Alaska  Natives  or American  Indians,  and  that                                                               
federal law required IHS and  tribally operated health facilities                                                               
to  pursue  third  party reimbursement  from  private  insurance,                                                               
Medicaid, Medicare, or  any other source.  She  declared that IHS                                                               
was considered the  payor of last resort under federal  law.  She                                                               
explained  that the  tribal health  organizations in  Alaska were                                                               
only funded at  about 50 percent of their level  of need based on                                                               
the  federal assessment  of necessary  funding.   In response  to                                                               
Representative   Johnston,  she   explained   that  the   federal                                                               
government reimbursed  at 100 percent  for IHS  beneficiaries who                                                               
were also Medicaid beneficiaries  receiving their care through an                                                               
IHS facility, in recognition of  the federal trust responsibility                                                               
to tribes and tribal members.                                                                                                   
                                                                                                                                
3:57:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  reflected  on the  increase  of                                                               
state match  for Medicaid expansion  and asked how  the projected                                                               
savings of $400 million would be accomplished.                                                                                  
                                                                                                                                
COMMISSIONER DAVIDSON  explained that the trends  in Alaska since                                                               
2015 for the  Medicaid program showed reduction in  the amount of                                                               
general  fund  spending   with  increased  federal  participation                                                               
because  of  Medicaid  expansion  and  the  new  tribal  claiming                                                               
policy.  She said that those  referenced savings were over a six-                                                               
year period with the implementation  of the reform opportunities,                                                               
which had  reduced the  general funds  and increased  the federal                                                               
match.                                                                                                                          
                                                                                                                                
3:58:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  offered her  belief that  Medicaid expansion                                                               
would provide  behavioral health services  to many who  would not                                                               
have had  access to those services.   She asked if  there was any                                                               
tracking regarding these outcomes.                                                                                              
                                                                                                                                
COMMISSIONER DAVIDSON stated  that many people in  Alaska had not                                                               
ever  had  access to  health  care.    She reiterated  that  many                                                               
behavioral  health providers  offered  what they  could with  the                                                               
resources they had.   She reported that since  September 1, 2015,                                                               
$30 million  in behavioral health  services had been  provided to                                                               
Alaskans enrolled in  Medicaid expansion.  She  relayed that many                                                               
of  the  providers  were nonprofit,  grass  roots  organizations,                                                               
which  provided services  to  the  best of  their  ability.   She                                                               
pointed out  that as there was  a limit to the  amount of charity                                                               
care  offered  while  still  being able  to  meet  expenses,  the                                                               
federal  dollars   from  Medicaid  expansion  had   allowed  many                                                               
organizations  to continue  to provide  services to  Alaskans who                                                               
needed access to care.                                                                                                          
                                                                                                                                
4:01:38 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON shared  that the  department had  received                                                               
letters  "that just  make you  cry from  people whose  lives have                                                               
been saved."   Without Medicaid  expansion, many of  these people                                                               
would not  have been  able to  get the  necessary services.   She                                                               
declared  that she  was excited  about  the opportunity  offered,                                                               
stating that "people can't work,  they can't hunt, and they can't                                                               
fish, if they're not  well enough to do so."   She stated that it                                                               
was necessary to  have Alaskans healthy enough to do  the work in                                                               
any resource,  and now, for  the first time, 32,000  Alaskans had                                                               
access to health care which they did not have before.                                                                           
                                                                                                                                
4:03:13 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ offered  her belief  that health  care was  what                                                               
stands  between many  people  and independence,  self-sufficiency                                                               
and a  vibrant quality of  life.  She acknowledged  that although                                                               
there  was a  care  for dollars,  the reason  was  for people  to                                                               
realize their full potential.                                                                                                   
                                                                                                                                
4:04:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  reflected on  the Medicaid  expansion effort                                                               
and the testimony regarding a  pent-up demand from people who had                                                               
not  had access  to health  care.   She offered  her belief  that                                                               
there had been  an expectation for an early on  increase in costs                                                               
due  to initial  access and  a  need to  "catch up  on all  their                                                               
health care  needs."  She  asked if there  was any way  to follow                                                               
that trend.                                                                                                                     
                                                                                                                                
4:05:23 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON expressed agreement  that this had been the                                                               
experience  of Alaska  and other  states.   She pointed  out that                                                               
Alaska  had  more people  eligible  for  Medicaid expansion  than                                                               
initially anticipated.   She noted that also,  because the Alaska                                                               
"economy  unfortunately  continues  to  tank,"  there  were  more                                                               
Alaskans eligible  for regular Medicaid  services.   She reported                                                               
that  a  significant  part  of the  spending  was  for  inpatient                                                               
hospital care, as  people had been putting off  their health care                                                               
because they could not afford to go.   This had included a lot of                                                               
lifesaving   operations.      She   added  that   the   cost   of                                                               
pharmaceuticals  was higher  than expected,  including treatments                                                               
for high blood  pressure and diabetes.  She noted  that there was                                                               
also  a  high  utilization  for   travel,  as  it  was  medically                                                               
necessary  to  access  specialists  who were  not  in  the  small                                                               
villages.                                                                                                                       
                                                                                                                                
4:07:43 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HJR 20 would be held over.                                                                       
                                                                                                                                
          HB 234-EXTEND ALASKA HEALTH CARE COMMISSION                                                                       
                                                                                                                                
4:08:07 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be HOUSE BILL NO. 234, "An  Act extending the termination date of                                                               
the  Alaska   Health  Care  Commission;  and   providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
4:08:34 PM                                                                                                                    
                                                                                                                                
SETH  WHITTEN,  Staff,  Representative David  Guttenberg,  Alaska                                                               
State  Legislature,   paraphrased  from  the   Sponsor  Statement                                                               
[included in  members' packets], which read  as follows [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     The   Alaska   Health   Care   Commission   was   first                                                                    
     established by Governor Palm on  December 4, 2008 under                                                                    
     Administrative  Order #246.  In  2010, the  legislature                                                                    
     passed  SB 172,  establishing  the  Alaska Health  Care                                                                    
     Commission  in Statute.  The  legislature's intent  was                                                                    
     that the Commission would be  a permanent instrument to                                                                    
     address the need  for health care reform  in our state.                                                                    
     The  Commission worked  to  identify opportunities,  as                                                                    
     well  as a  broad  set of  strategies,  to improve  the                                                                    
     quality, accessibility and  availability of health care                                                                    
     for  all citizens  of the  State. These  strategies and                                                                    
     recommendations  can  be   found  in  the  Commission's                                                                    
     reports that were issued annually from 2009-20 14.                                                                         
                                                                                                                                
     In 2015 the Commission  was defunded. Alaska's need for                                                                    
     health  care reform  remains one  of the  most critical                                                                    
     challenges we  face. At $10  billion in  total spending                                                                    
     annually25%   of which  is  administered  by the  state                                                                    
     government   health care  is  one  of Alaska's  largest                                                                    
     consumer product  industries. When this  enormous scale                                                                    
     is considered  in conjunction with  the fact  that that                                                                    
     the state  government is the  largest single  payer for                                                                    
     those  services,   there  is   a  clear  need   for  an                                                                    
     instrument that  identifies the  costs and  benefits of                                                                    
     the health  care system  and identifies  strategies for                                                                    
     ensuring sustainability  therein. Extending  the Alaska                                                                    
     Health Care  Commission will give  the state a  tool to                                                                    
     address this crucial priority.                                                                                             
                                                                                                                                
MR. WHITTEN added  that health care was a very  complex issue and                                                               
it was  changing across  the country,  "and certainly  maybe even                                                               
more so in Alaska."                                                                                                             
                                                                                                                                
4:10:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked  for an  explanation to  the zero-                                                               
fiscal note.  She asked if  all the Alaska Health Care Commission                                                               
reports were available on-line.                                                                                                 
                                                                                                                                
MR. WHITTEN replied that the reports were available.                                                                            
                                                                                                                                
REPRESENTATIVE JOHNSTON  said that no  matter what the  result of                                                               
the  proposed   bill,  the  already  completed   work  was  still                                                               
available on-line.                                                                                                              
                                                                                                                                
MR.  WHITTEN  replied  that these  reports  would  be  available,                                                               
although  he was  unsure  if the  Alaska  Health Care  Commission                                                               
website would be maintained after the end of the fiscal year.                                                                   
                                                                                                                                
4:11:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON   asked  if   the  Alaska   Health  Care                                                               
Authority was "mainly in response to Medicaid reform."                                                                          
                                                                                                                                
4:11:57 PM                                                                                                                    
                                                                                                                                
MR. WHITTEN  said that he was  not an expert, and  he shared that                                                               
per  Senate  Bill  74,  the  Alaska  Health  Care  Authority  was                                                               
undergoing a feasibility study, due  for completion at the end of                                                               
the  current  fiscal  year.     Contingent  on  that  study,  the                                                               
legislature would  determine what to  do with Alaska  Health Care                                                               
Authority.                                                                                                                      
                                                                                                                                
4:12:44 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  reported that the  Alaska Health  Care Authority                                                               
was  not under  the purview  of Department  of Health  and Social                                                               
Services,  but  under  the Department  of  Administration  as  it                                                               
related  to the  role  of the  department as  an  employer.   She                                                               
explained that  there was a  review to determine  the possibility                                                               
of consolidating  the various health  care plans and  health care                                                               
coverage  paid for  by the  state.   She stated  that it  was not                                                               
related to the Alaska Health Care Commission.                                                                                   
                                                                                                                                
4:13:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked  about  the sunset  audit  which  had                                                               
recommended to not extend the  Alaska Health Care Commission.  He                                                               
asked about  the benefits for maintaining  the commission, noting                                                               
that there would be an expense  to the legislature, even as there                                                               
was a zero-fiscal note.                                                                                                         
                                                                                                                                
4:14:12 PM                                                                                                                    
                                                                                                                                
MR. WHITTEN  replied that  the commission  had been  inactive and                                                               
not  funded since  2015.    He explained  that  an  audit by  the                                                               
Legislative Budget  and Audit  Committee reviewed  the commission                                                               
to determine whether  it was meeting its legislative  intent.  He                                                               
reported  that the  committee had  suggested that  the commission                                                               
needed  to  do  more.    The committee  had  reported  after  the                                                               
previous sunset  audit for  the commission  that although  it had                                                               
identified some  issues and  determined some  recommendations, as                                                               
well as created  some useful data, the commission  needed to move                                                               
toward  implementation.     He  relayed  that   there  were  some                                                               
differences of  opinion on the  committee for whether it  was the                                                               
job  of the  commission to  implement a  health care  plan.   The                                                               
statute   stated    that   the   commission   was    to   provide                                                               
recommendations  for and  foster the  development of  a statewide                                                               
plan  to  address  quality, accessibility,  and  availability  of                                                               
health care for all citizens of the state.                                                                                      
                                                                                                                                
4:15:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  offered his opinion after  reading the audit                                                               
that it  was development of  a plan  and not implementation  of a                                                               
plan that the  commission was tasked in statute.   He stated that                                                               
to date,  as a plan  had not  been developed, the  commission had                                                               
not   been   meeting   its    legislative   intent,   hence   the                                                               
recommendation for the sunset.                                                                                                  
                                                                                                                                
4:16:27 PM                                                                                                                    
                                                                                                                                
MR.  WHITTEN offered  his understanding  that  Chapter 18  stated                                                               
that    the   commission    was    responsible   for    providing                                                               
recommendations for  and fostering  development of  the statewide                                                               
plan.    He  reported  that  his review  of  the  transcripts  of                                                               
meetings prior to the de-funding  had revealed that conversations                                                               
with  the Legislative  Budget and  Audit  Committee declared  the                                                               
need  to   move  away  from   recommendations  and   move  toward                                                               
implementation.   He offered  his belief  that testimony  by Kris                                                               
Curtis to  the Legislative Budget  and Audit  Committee indicated                                                               
that  "they [the  commission] weren't  doing enough  to implement                                                               
the plan.  That feedback had  been provided to the commission and                                                               
that while  there was some  momentum building at that  point, the                                                               
point which they were de-funded in  2015, ... put all that on the                                                               
back burner."                                                                                                                   
                                                                                                                                
4:18:07 PM                                                                                                                    
                                                                                                                                
KRISTIN CURTIS, Legislative  Auditor, Legislative Audit Division,                                                               
Alaska  State Legislature,  reported that  the recommendation  in                                                               
the  sunset  audit findings  had  been  due  to  the lack  of  an                                                               
actionable plan,  and she  offered her  belief that  although the                                                               
commission  had created  a framework,  this framework  lacked the                                                               
actionable  components  to  effectively  impact  health  care  in                                                               
Alaska because  it did  not go  far enough  to explain  how these                                                               
high  level  recommendations  and  framework  were  going  to  be                                                               
implemented.  She  suggested that this may  have caused confusion                                                               
regarding  the use  of  "implementation."   She  opined that  the                                                               
framework was not a plan, and  hence, did not meet the purpose of                                                               
the statute.                                                                                                                    
                                                                                                                                
4:19:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  stated that she had  watched the                                                               
Alaska Health  Care Commission  since its  inception, as  she had                                                               
been  working in  the governor's  office.   She  reported that  a                                                               
clear   plan   was   never  developed   as   requested   by   the                                                               
administrative order, which she deemed  to be "problematic."  She                                                               
explained that she did not discount  the work which had been done                                                               
by  this  commission,  although she  had  concerns  that  another                                                               
extension  of  the  commission   would  continue  with  the  same                                                               
results.   She asked if  it would  be beneficial to  consider new                                                               
legislation to clearly  identify the direction for  a health care                                                               
commission,   as   opposed   to   continuing  the   use   of   an                                                               
administrative  order   which,  she  opined,  has   "caused  some                                                               
difficulty."                                                                                                                    
                                                                                                                                
MS.  CURTIS shared  that there  was ambiguous  statutory language                                                               
and added that  more clarity for direction from  the Alaska State                                                               
Legislature  would   be  helpful  to  ensure   that  all  parties                                                               
understood the expectations moving forward.                                                                                     
                                                                                                                                
4:20:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  suggested that the  House Health                                                               
and  Social  Services  Standing   Committee  could  look  at  new                                                               
legislation  in moving  forward,  instead of  following the  same                                                               
path as previously.                                                                                                             
                                                                                                                                
4:21:26 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ, reflecting  on an  earlier discussion  with the                                                               
sponsor of the bill, offered  her observation that the mandate of                                                               
the Alaska  Health Care Commission  was not  always implementable                                                               
and  that there  was some  tension for  its implementation.   She                                                               
suggested  that two  bosses with  two  different instructions  is                                                               
"almost always gonna end up with  a sub-par product."  She shared                                                               
that the  bill sponsor would like  to see the commission  stay on                                                               
the  books and  move  forward.   She reported  that  it had  been                                                               
agreed to  work on a  proposed revision  to narrow the  scope and                                                               
ensure that the commission was  serviceable in the current health                                                               
care environment.   She opined that the use  of an administrative                                                               
order and  then a statute created  more than eight years  ago was                                                               
no longer practical.                                                                                                            
                                                                                                                                
4:23:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked  how this would work  as the commission                                                               
was due to expire on June 30, 2017.                                                                                             
                                                                                                                                
4:23:47 PM                                                                                                                    
                                                                                                                                
MS. CURTIS  explained that although the  commission would sunset,                                                               
the board  had a one-year  wind down administrative period.   She                                                               
reported that this had occurred with other sunsets.                                                                             
                                                                                                                                
4:24:18 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked  if this would mitigate the need  for a new                                                               
sunset audit.                                                                                                                   
                                                                                                                                
4:24:25 PM                                                                                                                    
                                                                                                                                
MS. CURTIS expressed her agreement if  a bill was passed prior to                                                               
July 1, 2018.                                                                                                                   
                                                                                                                                
4:24:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  asked what  activities the  commission would                                                               
be responsible for during this  upcoming sunset period.  He asked                                                               
if the staff  would have identified duties to  perform until this                                                               
was addressed.                                                                                                                  
                                                                                                                                
4:25:04 PM                                                                                                                    
                                                                                                                                
MS. CURTIS offered her belief  that currently there was no staff,                                                               
no  funding, and  no committee.   She  offered her  understanding                                                               
that  there was  an intent  to keep  the law  on the  books, even                                                               
though the members' terms had expired.                                                                                          
                                                                                                                                
4:25:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  asked if the  commission were allowed  to go                                                               
into  sunset, would  the  statute remain  for  a possible  future                                                               
authorization.                                                                                                                  
                                                                                                                                
4:26:22 PM                                                                                                                    
                                                                                                                                
MS.  CURTIS  offered her  understanding  that  the statute  would                                                               
stay, and she suggested to ask Legislative Legal Services.                                                                      
                                                                                                                                
4:26:43 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ  said  that  there  would  be  a  follow-up  for                                                               
clarification to these questions.                                                                                               
                                                                                                                                
[HB 234 was held over.]                                                                                                         
                                                                                                                                
         HB 236-EXTEND SENIOR BENEFITS PAYMENT PROGRAM                                                                      
                                                                                                                                
4:27:11 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be  HOUSE BILL  NO.  236,  "An Act  extending  the Alaska  senior                                                               
benefits payment program."                                                                                                      
                                                                                                                                
4:27:29 PM                                                                                                                    
                                                                                                                                
MERCEDES  COLBERT, Staff,  Representative Scott  Kawasaki, Alaska                                                               
State  Legislature,   paraphrased  from  the   Sponsor  Statement                                                               
[included in  members' packets, which  read as  follows [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     House  Bill  236  would   extend  the  Senior  Benefits                                                                    
     Program sunset  clause to  2022, ensuring  another four                                                                    
     years of support for low  income seniors across Alaska.                                                                    
     Without action, the program would end in 2018.                                                                             
                                                                                                                                
     The   Senior  Benefits   Program  protects   low-income                                                                    
     seniors by  providing them with modest  cash assistance                                                                    
     to pay  for expenses  like food,  heating, electricity,                                                                    
     transportation and prescription medication.                                                                                
                                                                                                                                
     The  program  was  established in  2007  and  currently                                                                    
     provides assistance  to nearly 12,000 Alaskans  ages 65                                                                    
     and older with incomes at  75 percent, 100 percent, and                                                                    
     175 percent  of the  federal poverty  level. Assistance                                                                    
     ranges from  $47 to $250  a month for  eligible seniors                                                                    
     depending on  income and the size  of the appropriation                                                                    
     from the Alaska State  Legislature. The Senior Benefits                                                                    
     Program is  a successor  to the Longevity  Bonus, which                                                                    
     was created in 1972.                                                                                                       
                                                                                                                                
     This important program protects  seniors who have spent                                                                    
     a lifetime building  this state. It lends  a small hand                                                                    
     to low-income seniors who need  assistance to help make                                                                    
     ends   meet.  Terminating   this   program  would   put                                                                    
     thousands of  seniors at risk  for losing means  to buy                                                                    
     essential  items necessary  for  maintaining a  healthy                                                                    
     lifestyle.                                                                                                                 
                                                                                                                                
4:28:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked what  determined the amount  of the                                                               
benefit.                                                                                                                        
                                                                                                                                
4:28:54 PM                                                                                                                    
                                                                                                                                
MS. COLBERT explained  that the assistance amounts  were based on                                                               
income  level relative  to  the federal  poverty  level, from  75                                                               
percent to  175 percent,  dependent on the  award.   She reported                                                               
that there were also other  eligibility requirements, that assets                                                               
were not  counted toward income,  that the income  levels changed                                                               
annually  as  the federal  poverty  level  changed, and  that  an                                                               
eligible senior  could not be  in jail, and  could not be  in the                                                               
Alaska Pioneer Home,  the Alaska Veterans' home,  a nursing home,                                                               
or a public or private institution for mental disease.                                                                          
                                                                                                                                
4:29:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  about  the goal  for  each of  the                                                               
calculations.   As eligibility was  based on the  federal poverty                                                               
level, what  was the  desired level to  raise each  individual in                                                               
the program.                                                                                                                    
                                                                                                                                
4:30:37 PM                                                                                                                    
                                                                                                                                
MONICA   WINDOM,  Director,   Division   of  Public   Assistance,                                                               
Department  of Health  and Social  Services,  explained that  the                                                               
dollar  amounts for  senior benefits  were set  in statute.   She                                                               
stated that  she did  not know  the reason  for the  exact dollar                                                               
amounts.                                                                                                                        
                                                                                                                                
4:30:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked how  long it  had been  since those                                                               
figures had been re-calculated.                                                                                                 
                                                                                                                                
MS. WINDOM replied that it had been since 2007.                                                                                 
                                                                                                                                
4:31:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  reported that previously there  had been                                                               
a longevity  bonus for which  every senior  over 65 years  of age                                                               
qualified,  which  had  been changed  to  a  needs-based  program                                                               
during the administration of Governor Murkowski.                                                                                
                                                                                                                                
4:31:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   offered  her  belief  that   although  the                                                               
percentage  amount was  set  in statute,  the  dollar amount  was                                                               
annually adjusted for inflation.                                                                                                
                                                                                                                                
4:32:11 PM                                                                                                                    
                                                                                                                                
MS.  WINDOM  clarified  that  the income  limit  for  each  level                                                               
increased with the federal poverty level.                                                                                       
                                                                                                                                
4:32:23 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  asked if  the dollar amount  allowed was  set in                                                               
statute, and not by budget.                                                                                                     
                                                                                                                                
4:32:35 PM                                                                                                                    
                                                                                                                                
MS.  WINDOM expressed  her agreement,  with one  exception.   She                                                               
explained  that the  regulations  had been  updated  to allow  an                                                               
adjustment of  the benefit  levels if  the appropriation  was not                                                               
enough  to meet  the  needs  based on  the  caseload  size.   She                                                               
pointed out  that in the past  year, the bottom two  income tiers                                                               
had been  fully funded, whereas the  top income tier was  given a                                                               
flat amount  of $76, based  on a projection of  the appropriation                                                               
and the number of recipients in the program, rather than $125.                                                                  
                                                                                                                                
4:33:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  mused that the governor  had removed the                                                               
top tier from the current budget.                                                                                               
                                                                                                                                
MS. WINDOM replied, "I don't recall."                                                                                           
                                                                                                                                
CHAIR  SPOHNHOLZ  asked  that  Ms. Colbert  report  back  to  the                                                               
committee.                                                                                                                      
                                                                                                                                
4:33:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked about projections for  the next few                                                               
years and any impacts to the program.                                                                                           
                                                                                                                                
4:34:19 PM                                                                                                                    
                                                                                                                                
MS. WINDOM replied  that based on history, it  was estimated that                                                               
caseloads would increase about 2 percent each year.                                                                             
                                                                                                                                
4:34:30 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked  how this annual increase  of caseloads was                                                               
reflected in "hard numbers."                                                                                                    
                                                                                                                                
MS. WINDOM  reported that in  FY17, the highest income  level was                                                               
the only level that had decreased.   She shared that this highest                                                               
income level  had 5066  recipients in  FY14, and  currently there                                                               
were 4873 recipients.                                                                                                           
                                                                                                                                
4:35:54 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  asked for a  follow up with this  information to                                                               
better understand  the trend and  the baseline in order  to grasp                                                               
the scope of the program.                                                                                                       
                                                                                                                                
4:36:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  directed attention to page  2 of                                                               
the  senior  benefits  program fact  sheet,  which  reported  the                                                               
increase for the number of recipients from 2011 to 2015.                                                                        
                                                                                                                                
MS. WINDOM reported that in  2011 there were 10,576 recipients in                                                               
the  program, and  that in  the  current year,  2016, there  were                                                               
11,629 recipients.                                                                                                              
                                                                                                                                
4:37:14 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ appointed  a subcommittee to work on  HB 236 over                                                               
the interim  with the  bill sponsor and  the departments:   Chair                                                               
Spohnholz,  Representative  Tarr,  and  Representative  Sullivan-                                                               
Leonard.                                                                                                                        
                                                                                                                                
[HB 236 was held over.]                                                                                                         
                                                                                                                                
4:38:10 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:38 p.m.                                                                                                          

Document Name Date/Time Subjects
HJR 20 Supporting Document - Medicaid-Expansion-Just-the-Facts-April-2016 5.1.2017.pdf HHSS 5/4/2017 3:00:00 PM
HHSS 5/16/2017 3:00:00 PM
HJR 20
HJR 20 Supporting Document - State Savings From Medicaid OMB 5.1.2017.pdf HHSS 5/4/2017 3:00:00 PM
HHSS 5/16/2017 3:00:00 PM
HJR 20
HJR 20 Supporting Document - Uncompensated care 5.1.2017.pdf HHSS 5/4/2017 3:00:00 PM
HHSS 5/16/2017 3:00:00 PM
HJR 20
HJR 20 ver J 5.1.2017.PDF HHSS 5/4/2017 3:00:00 PM
HHSS 5/16/2017 3:00:00 PM
HJR 20
HJR 20 Sponsor Statement 5.1.2017.pdf HHSS 5/4/2017 3:00:00 PM
HHSS 5/16/2017 3:00:00 PM
HJR 20
HJR 20 Supporting Document - Medicaid Dashboard 5.1.2017.pdf HHSS 5/4/2017 3:00:00 PM
HHSS 5/16/2017 3:00:00 PM
HJR 20
HB234 Supporting Document Chapter 18.09 Health Care Commission Statute.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-AHCC Annual Report 2014.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-AHCC-Audit 2013.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-AHCC-Final-Report-Audit 2017.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB 234 ver A 4.17.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Sponsor Statement 4.17.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Fiscal Note DHSS--DSS 4.25.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document-Support Letter 4.24.17.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB234 Supporting Document Office of the Governor_ Administrative Order 246.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HB 234
HB 236 ver A.PDF HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Sponsor Statement.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents AARP Letter Support.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents Alaska Commission on Aging.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents Arneson Support Letter.pdf HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 9/28/2017 2:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236
HB236 Supporting Documents Senior Benefits Program Fact Sheet.PDF HHSS 4/25/2017 3:00:00 PM
HHSS 4/27/2017 3:00:00 PM
HHSS 5/4/2017 3:00:00 PM
HHSS 2/6/2018 3:00:00 PM
HB 236