Legislature(2019 - 2020)CAPITOL 106

04/13/2019 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:34:42 PM Start
01:35:24 PM Confirmation Hearing(s): Department of Health and Social Services, Commissioner
03:37:44 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Please Note Time Change --
+ Consideration of Governor's Appointees: TELECONFERENCED
Commissioner Designee Adam Crum, Dept. of Health
& Social Services
-- Testimony <Invited/Public> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 13, 2019                                                                                         
                           1:34 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Co-Chair                                                                                          
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
Representative Lance Pruitt                                                                                                     
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
OTHER MEMBERS PRESENT                                                                                                         
                                                                                                                                
Representative Sara Hannan                                                                                                      
Representative Grier Hopkins                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
Department of Health and Social Services, Commissioner                                                                        
                                                                                                                                
     Adam Crum - Juneau                                                                                                         
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ADAM CRUM, Commissioner Designee                                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified as appointee for commissioner of                                                               
the Department of Health and Social Services (DHSS).                                                                            
                                                                                                                                
ALYSON CURREY, Legislative Liaison                                                                                              
Planned Parenthood Votes                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
JAYNE ANDREEN                                                                                                                   
Douglas, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
TONYA HALLIDAY                                                                                                                  
Cook Inlet Dental                                                                                                               
Kenai, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
MICHELLE OVERSTREET, Founder & Director                                                                                         
MyHouse                                                                                                                         
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in  support of the confirmation of                                                             
Mr. Adam Crum as commissioner of DHSS.                                                                                          
                                                                                                                                
ZHENIA PETERSON                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
SHELLEY EBENAL, Executive Director and General Counsel,                                                                         
Greater Fairbanks Community Hospital Foundation;                                                                                
CEO, Foundation Health Partners,                                                                                                
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  support of the confirmation of                                                             
Mr. Adam Crum as commissioner of DHSS.                                                                                          
                                                                                                                                
ELIZABETH RIPLEY, CEO                                                                                                           
Mat-Su Health Foundation                                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in  support of the confirmation of                                                             
Mr. Adam Crum as commissioner of DHSS.                                                                                          
                                                                                                                                
GREG WEAVER                                                                                                                     
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
CASEY DSCHAAK                                                                                                                   
Dillingham, Alaska                                                                                                              
POSITION STATEMENT:  Testified in  support of the confirmation of                                                             
Mr. Adam Crum as commissioner of DHSS.                                                                                          
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:34:42 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  IVY  SPOHNHOLZ  called  the  House  Health  and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  1:34  p.m.                                                               
Representatives Jackson, Claman,  Drummond, Zulkosky, Pruitt, and                                                               
Spohnholz  were present  at the  call to  order.   Representative                                                               
Tarr  (via   teleconference)  arrived  as  the   meeting  was  in                                                               
progress.  Also present was Representative Hannan.                                                                              
                                                                                                                                
1:35:24 PM                                                                                                                    
                                                                                                                                
^Confirmation  Hearing(s):   Department  of  Health   and  Social                                                             
Services, Commissioner                                                                                                        
                    Confirmation Hearing(s):                                                                                
     Department of Health and Social Services, Commissioner                                                                 
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that  the only  order of  business                                                               
would be  the confirmation  hearing for  the commissioner  of the                                                               
Department of Health and Social Services.                                                                                       
                                                                                                                                
1:35:59 PM                                                                                                                    
                                                                                                                                
ADAM  CRUM,  Commissioner  Designee,  Department  of  Health  and                                                               
Social Services  (DHSS), shared his  background.  He said  he was                                                               
born and raised in Alaska, grew up  in a cabin in Anchor Point on                                                               
the Kenai  Peninsula, and  spent his  youth hunting  and fishing.                                                               
After graduating from  Homer High School he went on  to receive a                                                               
bachelor's  degree in  psychology  from Northwestern  University.                                                               
Upon returning to  Alaska he worked as a  safety professional and                                                               
trainer on  projects located throughout the  state, including oil                                                               
sites on  the North  Slope, Arctic  villages, and  along Alaska's                                                               
west coast.  He spent weeks  in some villages, which provided him                                                               
the opportunity to see village life firsthand.                                                                                  
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM stated that  he received a  Master of                                                               
Science in Public Health from  Johns Hopkins University, with his                                                               
studies  including subjects  such  as  public health  toxicology,                                                               
environmental  and occupational  health  law, risk  communication                                                               
and public policy,  and epidemiology.  He used  this knowledge to                                                               
write white papers about naturally  occurring asbestos in western                                                               
Alaska and about  mercury content and its presence  and danger in                                                               
seafood caught in the North Pacific.                                                                                            
                                                                                                                                
COMMISSIONER  CRUM said  he worked  as a  consultant and  project                                                               
lead for  large oil  and gas  companies, pipeline  companies, and                                                               
transportation companies.   Work performed included environmental                                                               
health  analysis on  existing and  potential projects,  long-term                                                               
strategy,  and organizational  development.   This work  gave him                                                               
firsthand   experience  with   what  success   looks  like   from                                                               
organizational, cultural,  and leadership  standpoints.   He uses                                                               
this  experience in  his  work for  other  clients and  community                                                               
organizations, and  he has developed  a repertoire  of leadership                                                               
courses that he offers his clients.                                                                                             
                                                                                                                                
1:39:30 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  noted that for a  number of years he  has been                                                               
an  active  supporter  of  MyHouse,  which  provides  educational                                                               
services,  housing, and  opportunities to  homeless youth  in the                                                               
Matanuska-Susitna ("Mat-Su")  Valley.  He has  been involved with                                                               
JOY  International,  a group  that  brings  awareness and  raises                                                               
funds  to stop  sex  trafficking.   He  has  also  served on  the                                                               
advisory board of the Salvation  Army in the Mat-Su Valley, which                                                               
tackles  issues   like  hungry   families,  drug   treatment  and                                                               
rehabilitation, and transitional housing.                                                                                       
                                                                                                                                
COMMISSIONER CRUM  related that in  working with these  groups he                                                               
came  upon the  Alaska State  Ombudsman's May  2018 investigative                                                               
report  on  the  Division  of  Public  Assistance.    The  report                                                               
detailed that since  2016 there have been  hundreds of complaints                                                               
from  individuals  about  lack of  communication,  a  backlog  of                                                               
applications,  and  delayed  payments.     He  found  the  report                                                               
heartbreaking - people were reaching  out in their moment of need                                                               
and weren't  responded to.  But,  on the other side,  the state's                                                               
employees are  trying to do  the best  they can, but  they aren't                                                               
provided  the  necessary tools  or  resources  to give  the  best                                                               
customer service  possible.   It occurred to  him that  what they                                                               
really needed was leadership and support.                                                                                       
                                                                                                                                
COMMISSIONER  CRUM said  he brings  organizational and  strategic                                                               
expertise  in  developing high  performing  teams  and a  winning                                                               
culture.  He also brings compassion.   He has worked with many of                                                               
the  constituent  groups  that  DHSS  serves,  and  he  brings  a                                                               
commitment  to recognize  and support  the  employees within  the                                                               
department  so they  can  provide the  best  possible service  to                                                               
those in need.   During his four months  as commissioner designee                                                               
he  has successfully  started  down this  path  and assembled  an                                                               
excellent team.                                                                                                                 
                                                                                                                                
COMMISSIONER  CRUM introduced  Albert Wall,  Deputy Commissioner,                                                               
Family,  Community  & Integrated  Services.    He said  Mr.  Wall                                                               
previously  worked  within  DHSS  as a  budget  director  and  as                                                               
director of  the Division of  Behavioral Health.   Mr. Wall  is a                                                               
military veteran still active in  the National Guard and has over                                                               
20 years' experience as a  behavioral health clinician.  Mr. Wall                                                               
spent the past couple years  as CEO of Peninsula Community Health                                                               
Services.     Having   previously  worked   at  DHSS,   Mr.  Wall                                                               
understands the long-standing issues  and is motivated to address                                                               
them for the benefit of all Alaskans.                                                                                           
                                                                                                                                
1:41:58 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM noted that  Donna Steward, Deputy Commissioner,                                                               
Medicaid and Health  Care Policy, is uniquely suited  to her role                                                               
from having  spent the  last few years  as executive  director of                                                               
the Office  of Rate Review.   He said Ms. Steward  has previously                                                               
worked  in the  Division  of  Health Care  Services  and for  the                                                               
Tribal Health Care Program in  the commissioner's office.  Before                                                               
that she  worked as a  research analyst for the  Washington State                                                               
Legislature   and  previously   worked   as  associate   regional                                                               
administrator for the  Medicare side of the  Centers for Medicare                                                               
&  Medicaid Services  (CMS).   Ms.  Steward  has vast  experience                                                               
working  with  and  for  the state's  federal  partners  and  she                                                               
understands the actual numbers as they stand in Alaska.                                                                         
                                                                                                                                
COMMISSIONER  CRUM drew  attention to  Sana Efird,  most recently                                                               
the deputy commissioner of the  Department of Education and Early                                                               
Development.    He stated  Ms.  Efird  has  returned to  DHSS  as                                                               
Assistant  Commissioner of  Finance  and  Management Services,  a                                                               
position she held  before from 2012-2016.   Ms. Efird's knowledge                                                               
of the DHSS budget will be a great resource going forward.                                                                      
                                                                                                                                
1:42:39 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM   introduced  Lily  Lou,  MD,   Chief  Medical                                                               
Officer.   He said  Dr. Lou  is board  certified in  neonatal and                                                               
perinatal medicine and was chair  of the Department of Pediatrics                                                               
at  Providence  Alaska  Medical  Center,  as  well  as  executive                                                               
director of  the Children's  Hospital at  Providence.   Dr. Lou's                                                               
broad expertise  and vast  research background  make her  a great                                                               
asset for DHSS and the state.                                                                                                   
                                                                                                                                
1:43:06 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  brought attention to Tony  Newman, Legislative                                                               
Liaison.  He  stated Mr. Newman is responsive  to all legislative                                                               
requests and is a great representative for the department.                                                                      
                                                                                                                                
COMMISSIONER CRUM said another key  person on his team is Heather                                                               
Carpenter, Health  Care Policy  Advisor.   He said  Ms. Carpenter                                                               
came to  his team after  working six  years for the  Alaska State                                                               
Senate.  Ms. Carpenter was  integral to the collaborative process                                                               
that led  to the 2016  bi-partisan passage  of Senate Bill  74, a                                                               
Medicaid reform bill.                                                                                                           
                                                                                                                                
COMMISSIONER CRUM related  that during the short time  in his new                                                               
role  he has  reached out  to and  visited as  many employees  as                                                               
possible.   His  first communication  was to  thank everyone  for                                                               
their  hard  work  and  service  and to  advise  them  to  always                                                               
remember the good that they do.   The department is large and has                                                               
many divisions  and it's a good  bet that one division  will make                                                               
the news on a weekly basis.   He wants all employees to know that                                                               
he understands and appreciates the jobs  they do, and he is proud                                                               
to work  with them  during these difficult  times because  of the                                                               
critical nature of their work.                                                                                                  
                                                                                                                                
1:44:20 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM outlined his top three priorities for DHSS:                                                                   
                                                                                                                                
     1) Address  the overall budget.   With DHSS  having one                                                                    
     of the  largest budgets in government,  efforts will be                                                                    
     made to reduce  duplicative efforts, gain efficiencies,                                                                    
     and leverage  community partners, such as  amending the                                                                    
     72-Hour Rule.                                                                                                              
                                                                                                                                
     2) Work  on Alaska Psychiatric Institute  (API) and its                                                                    
     issues.   The  only  residential psychiatric  treatment                                                                    
     hospital in  Alaska, API plays  a critical role  in the                                                                    
     continuum  of care  for behavioral  health and  for too                                                                    
     long  has  not  received   its  due  attention.    This                                                                    
     administration is committed to  putting API on a course                                                                    
     that provides better patient  outcomes while ensuring a                                                                    
     safe environment for patients and staff.                                                                                   
                                                                                                                                
     3) Reduce  the backlog of applications  at the Division                                                                    
     of Public Assistance (DPA).   The new leadership at DPA                                                                    
     is focused  on tackling  the backlog  issue.   To date,                                                                    
     that  backlog has  been reduced  from 13,355  to 5,257.                                                                    
     To reduce the  backlog and better serve  the public, on                                                                    
     4/2/19 DPA launched an out-stationing project of five                                                                      
     staff at the Alaska Native Medical Center (ANMC).                                                                          
                                                                                                                                
COMMISSIONER CRUM  said another  key item  DHSS is  addressing is                                                               
information  technology (IT)  solutions to  remove the  burden on                                                               
frontline  workers and  allow them  to do  their jobs  better and                                                               
faster.  The  department is looking at ways  to gain efficiencies                                                               
while  providing superior  customer service,  such as  a document                                                               
imaging system  for patient  records that  is compliant  with the                                                               
Health Insurance Portability and Accountability Act (HIPAA).                                                                    
                                                                                                                                
1:47:42 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM noted  that shortly  after his  appointment an                                                               
earthquake occurred in Southcentral  Alaska and he witnessed DHSS                                                               
at its  very best as  it implemented  a command center  and swung                                                               
into  to action  to ensure  that the  region's health  and safety                                                               
needs  were addressed.    Over  the past  few  months the  Tribal                                                               
Health Program has exceeded its  targets for refinancing Medicaid                                                               
and developing  new initiatives, which  will likely lead  to even                                                               
more savings in  fiscal year (FY) 2020.  The  department has kept                                                               
its eye  on the  Medicaid Section  1115 Behavioral  Health Waiver                                                               
Demonstration Project  ("Section 1115 Waiver"), the  most complex                                                               
of the  initiatives in Senate  Bill 74, the 2016  Medicaid reform                                                               
bill.   The  department is  determined  to keep  this project  on                                                               
track  to  move Alaska  toward  a  more balanced  and  integrated                                                               
behavioral  health  system.    On this  front,  the  Division  of                                                               
Behavioral  Health  is currently  conducting  a  gap analysis  in                                                               
communities  around the  state to  determine the  needs of  local                                                               
stakeholders.   The Office of  Children's Services (OCS)  is also                                                               
accompanying  the   gap  analysis  teams  to   identify  provider                                                               
capacity  and interest  for  providing  prevention services  that                                                               
will  be  available  through  the   new  [federal]  Family  First                                                               
Prevention  Services  Act.   The  department  continues  to  take                                                               
advantage  of federal  grant opportunities  that  will help  DHSS                                                               
continue to address the opioid epidemic.                                                                                        
                                                                                                                                
1:49:06 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  allowed DHSS has  had its share  of challenges                                                               
since  he started  as commissioner  in  December 2018.   He  said                                                               
stabilizing  API  has  been  a  daily focus  of  his  tenure  and                                                               
improvements are  being made  in patient care  and the  safety of                                                               
patients  and employees.   The  Centers for  Medicare &  Medicaid                                                               
Services (CMS) has extended API's  certification and API has been                                                               
accredited  for three  years as  of April  2019.   The number  of                                                               
staff is  being increased, including the  number of psychiatrists                                                               
and  licensed independent  practitioners,  and there  are 16  new                                                               
nursing  applicants.   Increased staff  means increased  capacity                                                               
and  just this  weekend the  clinical team  made the  decision to                                                               
increase  capacity  to  30  patients.   Still  on  a  provisional                                                               
license, API has a long way to  go and a major CMS decision point                                                               
is anticipated  by 6/30/19, but  improvements are being  seen and                                                               
API is on the right track.                                                                                                      
                                                                                                                                
COMMISSIONER   CRUM   continued   addressing   the   department's                                                               
challenges.  He  said 4,700 beneficiaries in  the Senior Benefits                                                               
Program were informed this week that  DHSS would be unable to pay                                                               
their benefits  for May and June.   The department is  working to                                                               
identify   other  options   that  could   be  offered   to  these                                                               
beneficiaries,   such   as   increased   Supplemental   Nutrition                                                               
Assistance  Program (SNAP)  benefits.   The department  took this                                                               
action because  statute, regulations,  and a  prior legislature's                                                               
fiscal  note  for House  Bill  236,  the bill  reauthorizing  the                                                               
program last  year, are  clear that  when appropriations  for the                                                               
[Senior] Benefits  Program are insufficient  to meet  the demands                                                               
for assistance  in a fiscal year,  DHSS is directed to  reduce or                                                               
eliminate  this cash  assistance  benefit for  that fiscal  year,                                                               
starting with  the highest income  tier.  The department  has not                                                               
requested supplemental  funding for this program  because of this                                                               
guidance.    The prior  legislature  did  provide DHSS  with  $20                                                               
million in  transfer authority  across appropriations  outside of                                                               
Medicaid,  but at  this  time the  department  doesn't know  what                                                               
funding  can  be  moved  from  one  program  to  another  without                                                               
jeopardizing the first  program.  Other programs  are also short-                                                               
funded  this year,  such as  general relief  for assisted  living                                                               
home  residents and  DHSS  is  doing its  best  to resolve  these                                                               
shortfalls within the appropriations the program has received.                                                                  
                                                                                                                                
COMMISSIONER  CRUM concluded  by stating  his goal  is to  ensure                                                               
that, on  his watch, programs  are aligned and managed  to assure                                                               
their  sustainability in  the future.    He is  committed to  the                                                               
department, the people  it serves, and the people  he works with.                                                               
He is committed to the  department's mission, which is to promote                                                               
and protect the health and wellbeing  of Alaskans.  He is humbled                                                               
that Governor Dunleavy has asked him  to perform this role and he                                                               
is honored to be before the committee today.                                                                                    
                                                                                                                                
1:52:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY offered  her appreciation  for the  work being                                                               
done by the DHSS teams.   She requested the commissioner designee                                                               
to talk about what qualifies him  to serve as commissioner of one                                                               
of  the  state's largest  departments  with  one of  the  state's                                                               
largest budgets.                                                                                                                
                                                                                                                                
COMMISSIONER CRUM  replied he has  spent his  professional career                                                               
working  and running  the  business consulting  side,  so he  has                                                               
worked with some  of the largest companies in the  world and they                                                               
have been working  with him on organization and  strategy for how                                                               
they can  operate in Alaska.   He  speaks the language  of public                                                               
health and understands  some of these issues.   His background in                                                               
strategy  and organizational  development are  the qualifications                                                               
the governor was  looking for.  The governor  wanted someone from                                                               
an outside  perspective to come  in with a  considerate objective                                                               
to look at what  is going on and how to improve.   This is why he                                                               
is qualified  for this role.   Some of DHSS's  previous successes                                                               
show that  the department is on  the right track and  the way the                                                               
team is responding has been tremendous.                                                                                         
                                                                                                                                
CO-CHAIR ZULKOSKY  recognized that Johns Hopkins  University is a                                                               
highly regarded  medical university.  She  asked the commissioner                                                               
designee to talk about the  professional health or social service                                                               
related fields to which he has  applied his degrees prior to this                                                               
appointment.                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  responded that  DHSS covers  a broad  array of                                                               
things;  for  example  the  public  health  field  has  emergency                                                               
incident command systems and emergency  response, which have been                                                               
a big part of his work across  Alaska.  This last week was Alaska                                                               
Shield, a  live demonstration throughout  the state about  how to                                                               
transport patients  in the  event of a  pandemic.   While working                                                               
with companies he has applied  his skills to environmental impact                                                               
analysis on  community-based items,  how to look  at epidemiology                                                               
population related  data, a skill  set he has  applied throughout                                                               
his professional career.                                                                                                        
                                                                                                                                
CO-CHAIR  ZULKOSKY stated  that environmental  health, especially                                                               
in a district like hers, is  very important because of its impact                                                               
on the health of Alaskans.   However, she noted, the commissioner                                                               
of DHSS  really focuses on  health care services,  child welfare,                                                               
public assistance  programs, tribal assistance, and  needy family                                                               
programs.  She requested the  commissioner designee to talk about                                                               
his experience in  working with these types of  programs prior to                                                               
his appointment.                                                                                                                
                                                                                                                                
COMMISSIONER CRUM  answered that  DHSS is  such a  big department                                                               
that there is  no individual who has expertise  in everything the                                                               
department covers.  He said he  has worked directly with a lot of                                                               
the key constituent groups that  the department serves, including                                                               
those  that deal  with needy  children,  homeless teenagers,  and                                                               
hungry families.                                                                                                                
                                                                                                                                
1:56:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JACKSON requested  the  commissioner designee  to                                                               
speak further about his time volunteering with MyHouse.                                                                         
                                                                                                                                
COMMISSIONER CRUM  replied that the  MyHouse program is  near and                                                               
dear to  his heart because  it was  an eye opening  experience to                                                               
work with  these youth.   The kids  involved in  situations where                                                               
they have lost  a home must decide whether to  stay in school and                                                               
must look  at the resources they  need.  MyHouse provides  a hand                                                               
up, not  a handout.   The goal  is to give  these kids  what they                                                               
need to be stabilized and give  them warmth and security and then                                                               
encourage them  to pursue degrees  and training and to  give them                                                               
resources to grow  on.  Key members of MyHouse  helped set up the                                                               
Mat-Su  Opioid Task  Force to  work with  that issue  and suicide                                                               
prevention.   It has  been a wonderful  opportunity to  work with                                                               
this group.   Many of these kids left home  because their parents                                                               
were in a bad situation and  they wanted more for themselves, not                                                               
because of a moral  failure on the parts of the  kids.  These are                                                               
kids that a person would do anything for to help them succeed.                                                                  
                                                                                                                                
REPRESENTATIVE JACKSON  asked how the commissioner  designee sees                                                               
these types of non-profits complementing DHSS.                                                                                  
                                                                                                                                
COMMISSIONER CRUM replied DHSS is  working on how to maximize its                                                               
partner groups  and how to  support them moving  forward, whether                                                               
that would be through co-matching  of funds for pilot projects or                                                               
collecting data to  find what are the best  possible outcomes for                                                               
these youth.   Department  offices are  in Juneau  and Anchorage,                                                               
not out in  the community, so it is these  local groups that will                                                               
be successful in addressing these homegrown issues.                                                                             
                                                                                                                                
1:58:50 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY requested  the commissioner  designee to  talk                                                               
about  how, in  his capacity  as commissioner  of DHSS,  he would                                                               
work with tribes throughout Alaska.                                                                                             
                                                                                                                                
COMMISSIONER  CRUM  responded  that  continued  negotiations  are                                                               
scheduled for  mid-May for the  tribal compacting for OCS.   Work                                                               
has  gone on  throughout  the  last year  and  this  could be  an                                                               
expansion  on what  other things  DHSS could  work on  with these                                                               
tribes  to  address  issues  for these  vulnerable  kids  in  the                                                               
villages.  The department will  continue to work with the tribes,                                                               
and he is happy with  DHSS's relationship working with the tribal                                                               
health  organizations, particularly  Alaska Native  Tribal Health                                                               
Consortium  (ANTHC), through  the out-stationing  project working                                                               
through the backlog together and addressing these issues faster.                                                                
                                                                                                                                
CO-CHAIR  ZULKOSKY  recounted  that the  Tribal  Affairs  Special                                                               
Committee recently  heard an  update on  the Alaska  Tribal Child                                                               
Welfare Compact.  She inquired  whether, in regard to the mid-May                                                               
meeting,  the commissioner  designee's  position  is to  continue                                                               
existing partnerships  with tribes  in their current  form within                                                               
the compact as  well as to consider  expanding relationships with                                                               
tribes in the compact.                                                                                                          
                                                                                                                                
COMMISSIONER CRUM answered yes.                                                                                                 
                                                                                                                                
2:00:32 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  related that almost 80,000  Alaskans have been                                                               
covered  by  Medicaid  through  both  traditional  and  expansion                                                               
populations, more  than were  covered four  years ago.   However,                                                               
state spending  has been  less in state  general funds  than four                                                               
years ago,  so the  state is  essentially covering  more Alaskans                                                               
for less state  dollars than it did previously.   No other states                                                               
have been  able to  do that.   A large reason  why that  has been                                                               
made  possible is  through the  state's  partnership with  tribal                                                               
health organizations.   She  requested the  commissioner designee                                                               
to discuss how he plans to continue this work with tribes.                                                                      
                                                                                                                                
COMMISSIONER CRUM  replied he is  excited about  the relationship                                                               
that  is  had.    He  recently  toured  medical  facilities  near                                                               
Kotzebue and being  able to treat elders in  their home community                                                               
is a tremendous  thing.  The department has  reached out numerous                                                               
times  and  he  looks  forward  to continuing  to  reach  out  to                                                               
important stakeholder groups like ANTHC.                                                                                        
                                                                                                                                
CO-CHAIR   ZULKOSKY   offered    her   understanding   that   the                                                               
commissioner   designee  intends   to   continue  expanding   and                                                               
collaborating  partnerships  where  possible,  for  example  with                                                               
tribal health organizations.                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM  responded  yes,  as  evidenced  by  the  out-                                                               
stationing project for the DPA Eligibility Tax.                                                                                 
                                                                                                                                
2:02:13 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  observed  from the  commissioner  designee's                                                               
resume that  he worked for  Northern Industrial Training  for the                                                               
last  10  years, which  sounds  a  bit  different than  what  was                                                               
described by the commissioner designee  as his consulting career.                                                               
She requested further information about  the company, such as the                                                               
number of employees,  the budget that was overseen,  and how that                                                               
prepared  the  commissioner  designee   to  run  a  $3.2  billion                                                               
organization with 3,400 staff.                                                                                                  
                                                                                                                                
COMMISSIONER CRUM  answered that Northern Industrial  Training is                                                               
a company  he owns with his  family.  At its  biggest the company                                                               
had  75 employees  and it  is known  as "truck  driving, welding,                                                               
heavy equipment"  because that  was a  lot easier  to put  on the                                                               
side of  a truck for marketing.   He ran the  business consulting                                                               
side  of the  company,  located primarily  in Anchorage,  working                                                               
with large oil, gas, transportation,  and pipeline companies.  He                                                               
worked on the strategy side,  being part of project leads dealing                                                               
with   these  companies,   having  oversight,   putting  planning                                                               
operations into place, and programs  for success of multi-billion                                                               
projects on their side.                                                                                                         
                                                                                                                                
CO-CHAIR  SPOHNHOLZ   requested  the  commissioner   designee  to                                                               
specifically  describe   his  volunteer  work  with   the  Mat-Su                                                               
Salvation  Army Advisory  Board  and the  MyHouse homeless  youth                                                               
center.                                                                                                                         
                                                                                                                                
COMMISSIONER CRUM  replied that  he volunteered with  the MyHouse                                                               
mentoring  program  for students.    Scholarships  were given  to                                                               
individuals to provide  them with a goal to shoot  for.  He spent                                                               
a lot of time supporting  the MyHouse suicide prevention programs                                                               
and helping  to grow  the programs.   His  volunteer work  on the                                                               
Salvation  Army   Advisory  Board   had  to  do   with  planning,                                                               
fundraising,  and   setting  up  the  expansion   of  the  Mat-Su                                                               
Salvation Army  unit, which was  growing the storage  section and                                                               
planning of the food pantry section.                                                                                            
                                                                                                                                
CO-CHAIR SPOHNHOLZ disclosed that  her employer prior to becoming                                                               
a  legislator was  the Salvation  Army where  she worked  for the                                                               
Mat-Su  Advisory  Board  amongst  other  advisory  boards  in  18                                                               
communities across the state.                                                                                                   
                                                                                                                                
2:04:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN expressed his  concern with the willingness                                                               
of DHSS  to cut state funds  and, as a process  of that, reducing                                                               
the federal matching  funds that the state is  eligible for under                                                               
various Medicare and Medicaid programs.   He inquired whether the                                                               
commissioner designee  has specific plans  to continue to  try to                                                               
reduce  state  dollars  that  results in  the  loss  of  valuable                                                               
federal  dollars   in  Alaska  or  whether   moving  forward  the                                                               
commissioner designee  can be  counted on  to being  committed to                                                               
maximizing  every federal  dollar the  state can  receive through                                                               
the various federal programs.                                                                                                   
                                                                                                                                
COMMISSIONER CRUM  responded that while going  through this phase                                                               
of this  process, DHSS "had  to reduce some reductions."   Alaska                                                               
Statute (AS) 47.07.036  requires DHSS to triage  its decisions as                                                               
provider rates,  services, and eligibility,  so DHSS  worked that                                                               
way while  trying to maintain  access to  primary care.   Many of                                                               
the  decisions   to  reduce  DHSS's   budget  will   require  the                                                               
compliance  of the  department's federal  partners, and/or  their                                                               
agreement to  it, in  order for the  department to  move forward.                                                               
The  department will  continue to  work  on that,  and DHSS  also                                                               
wants to  keep an  eye on  the amount  of federal  matching funds                                                               
that are being brought into the state.                                                                                          
                                                                                                                                
REPRESENTATIVE CLAMAN noted that  the House Finance Committee and                                                               
the  [Health &  Social Services  Finance] Subcommittee  disagreed                                                               
with the cuts that were  recommended by DHSS and [the committees]                                                               
had   higher  levels   of  state   funding.     He  offered   his                                                               
understanding that DHSS  believes it may have  some discretion to                                                               
not spend money that the  legislature believes should be spent to                                                               
achieve  these federal  matching  funds.   He  asked whether  the                                                               
commissioner  designee expects  to not  follow the  legislature's                                                               
guidance  on  spending  and  to   instead  spend  less  than  the                                                               
legislature is  appropriating, which will  result in the  loss of                                                               
additional federal funds.                                                                                                       
                                                                                                                                
COMMISSIONER  CRUM offered  his  understanding that  many of  the                                                               
items had  been put  back in.   Also, some of  the items  for the                                                               
budget   reductions  for   the   department  required   statutory                                                               
authority and some of those items  have not moved forward at all,                                                               
so he cannot work against those.                                                                                                
                                                                                                                                
2:07:44 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ offered her  belief that Representative Claman                                                               
is  asking whether  the commissioner  designee  intends to  spend                                                               
less money than the legislature appropriates.                                                                                   
                                                                                                                                
COMMISSIONER CRUM answered that that  is a new question he hasn't                                                               
thought about or had time to ponder.                                                                                            
                                                                                                                                
CO-CHAIR SPOHNHOLZ  remarked that that is  an important question.                                                               
She suggested  the commissioner  designee think  about it  as the                                                               
hearing progresses.                                                                                                             
                                                                                                                                
REPRESENTATIVE  CLAMAN  offered  his perception  that  while  the                                                               
commissioner designee  may not have  thought about it,  Ms. Donna                                                               
Arduin, Director,  Office of Management  and Budget,  has thought                                                               
about it extensively and would like  DHSS to spend less than what                                                               
the legislature  recommends.  He  asked whether  the commissioner                                                               
designee is going  to take his orders from Ms.  Arduin or be more                                                               
focused on what the legislature sends.                                                                                          
                                                                                                                                
COMMISSIONER  CRUM  replied he  has  not  been  a part  of  those                                                               
discussions and  he takes his  marching orders from  the governor                                                               
as well as statute and guidance provided by the legislature.                                                                    
                                                                                                                                
2:09:28 PM                                                                                                                    
                                                                                                                                
CO-CHAIR   ZULKOSKY  requested   the  commissioner   designee  to                                                               
describe his level of involvement  in developing the department's                                                               
FY 2020 budget.                                                                                                                 
                                                                                                                                
COMMISSIONER  CRUM responded  he was  involved in  development of                                                               
the budget.   "We worked together to see what  were ways we could                                                               
reduce general fund  spending, as well as how can  we hit some of                                                               
these targets  as we look  towards where  we're at in  the fiscal                                                               
situation."     The   governor's   budget  goal   was  to   match                                                               
expenditures to revenues, and he was involved in that process.                                                                  
                                                                                                                                
CO-CHAIR  ZULKOSKY recalled  that  despite being  invited to  the                                                               
testifier table  on a couple  of occasions throughout  the budget                                                               
subcommittee process, the commissioner  designee did not speak on                                                               
behalf  of  his  department's  priorities  for  FY  2020  or  the                                                               
commissioner designee was not in  attendance of this subcommittee                                                               
hearing.     She  inquired  whether  the   commissioner  designee                                                               
supports the  budget that  was forwarded  to the  legislature for                                                               
consideration, which was  a reduction of roughly  $100 million in                                                               
total to Medicaid.                                                                                                              
                                                                                                                                
COMMISSIONER CRUM replied he is  unsure of what is being referred                                                               
to because he was at almost all of the budget subcommittees.                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  again asked whether the  commissioner designee                                                               
supports the  budget that  was forwarded  to the  legislature for                                                               
consideration for his department.                                                                                               
                                                                                                                                
COMMISSIONER CRUM answered yes.                                                                                                 
                                                                                                                                
2:11:03 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY asked the commissioner  designee to provide his                                                               
position on Medicaid expansion.                                                                                                 
                                                                                                                                
COMMISSIONER CRUM  responded that  DHSS has  done nothing  in its                                                               
budget  phase  to actually  address  anything  when it  comes  to                                                               
eligibility.   It does  bring a great  amount of  federal dollars                                                               
into it and the system has evolved around that.                                                                                 
                                                                                                                                
CO-CHAIR  ZULKOSKY  stated  that  under  Medicaid  expansion  the                                                               
federal government has borne nearly  97 percent of health service                                                               
and  administrative  cost,  providing roughly  $1.13  billion  to                                                               
Alaska  while  the  state's  spending   has  totaled  just  $42.3                                                               
million.   Therefore, Alaska has  leveraged about $27  in federal                                                               
funds  for every  dollar  of direct  spending,  and broadly  that                                                               
amount of federal  investment has fueled more than  $2 billion in                                                               
increased  economic  activity  in  Alaska.   This  has  generated                                                               
thousands  of   jobs  and  millions  of   expanded  earnings  for                                                               
Alaskans,  particularly at  a time  when  the state  has been  in                                                               
recession.   She  inquired whether  the commissioner  designee is                                                               
willing to continue  supporting this type of  leveraging of funds                                                               
in order  to bring in that  amount of federal funding  or whether                                                               
the commissioner  designee opposes it for  ideological opposition                                                               
to federal investment in the health care industry.                                                                              
                                                                                                                                
COMMISSIONER CRUM answered [DHSS]  would continue to support that                                                               
as it  did through its phase  one budget.  The  department is not                                                               
touching  eligibility at  all.   That level  of federal  match is                                                               
very nice for the state.                                                                                                        
                                                                                                                                
CO-CHAIR ZULKOSKY surmised  the commissioner designee's intention                                                               
is to  continue to support  Medicaid expansion  throughout Alaska                                                               
under his leadership as the DHSS commissioner.                                                                                  
                                                                                                                                
COMMISSIONER CRUM replied yes, at  this point nothing is changing                                                               
on that.                                                                                                                        
                                                                                                                                
2:12:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  pointed out  that 33 percent  of Alaskans                                                               
depend on  Medicaid.   She asked  whether the  administration has                                                               
any goals to help empower people to independence in any way.                                                                    
                                                                                                                                
COMMISSIONER  CRUM responded  that a  long-term goal  is to  work                                                               
together toward  solving the problem  of the fiscal cliff,  so as                                                               
individuals grow and  increase their income, they  don't face the                                                               
binary decision of,  "Do they want benefits, yes or  no?"  Giving                                                               
them the  flexibility to increase  their income is  something the                                                               
department is working towards.                                                                                                  
                                                                                                                                
REPRESENTATIVE JACKSON remarked that  that sounds very inspiring.                                                               
She expressed  her concern about  federal dollars and  that there                                                               
are  financial prices  as  well, such  as  federal dollars  being                                                               
limited, and  so as time  goes on the  state is going  to receive                                                               
fewer federal dollars.   She asked whether it a  good goal to try                                                               
to  maximize   every  federal   dollar  for   Alaska's  financial                                                               
sustainability.                                                                                                                 
                                                                                                                                
COMMISSIONER CRUM  answered that  as DHSS  looks at  this process                                                               
with  federal dollars,  in particular  doing  something like  the                                                               
Section 1115 Waiver,  it has to be cost neutral  or a savings for                                                               
the federal  government.  So,  the department would have  to work                                                               
with the  federal government that way.   The idea is  to ensure a                                                               
sustainable program for Alaska.   More flexibility on how [state]                                                               
dollars are  spent in  state could  be a means  of doing  that as                                                               
well, because it  is unknown how the federal  government is going                                                               
to adapt in the future.                                                                                                         
                                                                                                                                
2:15:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   PRUITT  offered   his  understanding   that  the                                                               
commissioner designee has been on the job for four months.                                                                      
                                                                                                                                
COMMISSIONER CRUM replied yes.                                                                                                  
                                                                                                                                
REPRESENTATIVE  PRUITT asked  whether  the commissioner  designee                                                               
averaged a 40-hour work week during that four-month period.                                                                     
                                                                                                                                
COMMISSIONER CRUM  quipped that  a 60-hour week  would be  a nice                                                               
break.   While going through this  process he has traveled  a lot                                                               
given DHSS has many employees  in many locations around the state                                                               
and he wants  to see things firsthand.   He has also  spent a lot                                                               
of time  explaining how the  department is going about  this, the                                                               
strategy,  and  empowering  the  DHSS  team.    The  department's                                                               
mission is  to protect  and promote the  health of  Alaskans, but                                                               
every division  has its  own specific  mission.   The job  of the                                                               
commissioner's office is to support  the divisions in taking care                                                               
of vulnerable Alaskans.                                                                                                         
                                                                                                                                
REPRESENTATIVE  PRUITT  asked  whether  there is  any  reason  to                                                               
expect a  change in dedication  upon the  commissioner designee's                                                               
confirmation.                                                                                                                   
                                                                                                                                
COMMISSIONER CRUM answered no.  He  said his heart is in this and                                                               
he is with the staff in making Alaska better                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT inquired  about the commissioner designee's                                                               
executive team and the number of hours per week they put in.                                                                    
                                                                                                                                
COMMISSIONER CRUM  replied that this  is easily 80-100  hours per                                                               
week.   It includes  traveling back and  forth and  managing many                                                               
different staff.   There is a joke that anybody  who works longer                                                               
than  Tony  Newman wins.    Mr.  Newman  is there  responding  to                                                               
legislator  and   constituent  requests,  media   inquiries,  and                                                               
working with DHSS partners.                                                                                                     
                                                                                                                                
2:18:18 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  commented that Mr.  Newman is well  known for                                                               
his incredible work ethic.                                                                                                      
                                                                                                                                
REPRESENTATIVE PRUITT agreed about Mr.  Newman.  He said Alaska's                                                               
budget process  is unique  because there  are legislators  who do                                                               
not  have  that  type  of  experience.    In  other  states  [the                                                               
commissioner] would  be arguing for  why the amount of  money the                                                               
legislature gave the  department should be expended,  but in this                                                               
case  the State  of Alaska  says [the  commissioner] is  going to                                                               
spend  what  the legislature  says  the  department is  going  to                                                               
spend.  Representative  Pruitt posed a scenario in  which DHSS is                                                               
told to  spend $100, but  the commissioner designee and  his team                                                               
believe the  same services can  be delivered  for $95.   He asked                                                               
whether the  commissioner designee would  spend the $100  or come                                                               
back to  the legislature and  say $95 is  all that is  needed and                                                               
all that is going to be used.                                                                                                   
                                                                                                                                
COMMISSIONER  CRUM  responded  he  does not  believe  in  surplus                                                               
spending,  but he  does  believe in  strategy  for spending  more                                                               
efficiently.  If  there are better ways and  better directions to                                                               
spend  that money,  then that  is something  to do.   Just  for a                                                               
single project that has a list  price, DHSS is not going to spend                                                               
that money  on it.  But  if the department can  spend that toward                                                               
something else that can improve  outcomes, then that is something                                                               
he would be interested in and is the goal of his team.                                                                          
                                                                                                                                
REPRESENTATIVE  PRUITT  noted  that  many  confirmation  hearings                                                               
focus mostly on the qualifications  of the individual and perhaps                                                               
things  that happened  just before  the confirmation  took place.                                                               
What he  rarely hears  during confirmation  hearings is  what the                                                               
appointee expects to  have done successfully.  He  asked what the                                                               
commissioner designee's  goal and mission  are for the  next four                                                               
years in his role at DHSS.                                                                                                      
                                                                                                                                
COMMISSIONER  CRUM answered  that in  taking over  this role  and                                                               
where Alaska  sits at a  crossroads, his long-term goal  and that                                                               
of his  team is how to  actually shift the dollar  spend from one                                                               
end  of the  spectrum to  the other,  moving towards  that value-                                                               
based  side.   One of  the continued  processes with  the Section                                                               
1115 Waiver for  behavioral health is to allow  the department to                                                               
spend dollars for mild and  moderate issues as opposed to severe.                                                               
This would  allow for working  on things and  providing resources                                                               
toward items  like family resiliency,  giving people  in families                                                               
opportunities to  stay strong before  DHSS has to  separate them.                                                               
This  would put  those  resources  out there  and  make Alaska  a                                                               
stronger place by  addressing issues on the frontend.   These are                                                               
items that take longer to solve  than an election cycle and these                                                               
are the items the department is going to try to address.                                                                        
                                                                                                                                
2:21:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  recalled that the commissioner  designee had                                                               
been a political  candidate and therefore some  of his positions,                                                               
such as women's reproductive health,  were printed in literature.                                                               
She said  it is important  for [the department's] policies  to be                                                               
evidence based public health  policies, not ideologically driven.                                                               
She asked  how the  commissioner designee  plans to  approach and                                                               
uphold  women's reproductive  health issues  as well  as lesbian,                                                               
gay, bisexual, and transgender (LGBT)  issues, regardless of what                                                               
his personal beliefs might be.                                                                                                  
                                                                                                                                
COMMISSIONER CRUM replied  that to take this role he  had to sign                                                               
an oath that  he would follow the  law and he will do  that.  The                                                               
courts have decided certain issues and  that is the way they will                                                               
be administered through the department.                                                                                         
                                                                                                                                
REPRESENTATIVE  TARR expressed  hope that  that would  be a  firm                                                               
commitment.   She  commended the  commissioner  designee for  his                                                               
volunteer work and that these  connections will allow him to talk                                                               
to  people in  the communities  and understand  the root  causes.                                                               
She offered her  hope that in his role  the commissioner designee                                                               
will want  DHSS to help other  groups in addition to  the ones he                                                               
has worked with.                                                                                                                
                                                                                                                                
COMMISSIONER  CRUM  responded that  everyone  in  need should  be                                                               
helped and shown love and compassion.   He clarified that when he                                                               
mentioned  his wanting  to help  the  MyHouse kids  who told  him                                                               
their stories and  how they wanted to improve their  lot in life,                                                               
any person who heard their stories  would want to help them.  So,                                                               
yes, the  department will  continue to  take care  of individuals                                                               
throughout [the state].                                                                                                         
                                                                                                                                
2:25:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN  recalled that the House  Finance Committee                                                               
recently voted  to remove funding  for abortions in  the Medicaid                                                               
area.   However,  he noted,  at  least twice  the Alaska  Supreme                                                               
Court has  ruled that the  DHSS has to  make those payments.   He                                                               
requested the  commissioner designee to  provide his view  on the                                                               
department's  obligation to  pay for  those even  if there  is no                                                               
line item in the budget that is finally passed.                                                                                 
                                                                                                                                
COMMISSIONER CRUM  answered that the department  would follow the                                                               
law in  understanding that  the court  has ruled  multiple times.                                                               
He will  have to look at  the department's regulations to  see if                                                               
they are like the ones for  senior benefits where if there are no                                                               
appropriations towards  that then  the department cannot  pay out                                                               
for it.  If  there are regulations, he will also  have to see how                                                               
they match with statute.                                                                                                        
                                                                                                                                
REPRESENTATIVE  CLAMAN posed  a  scenario in  which the  attorney                                                               
general  tells  DHSS  that  it  must  pay  [for  abortions]  from                                                               
whatever funds the department  has available anywhere, regardless                                                               
of regulations, and the only  way to change that obligation would                                                               
be to amend the constitution.   He asked whether the commissioner                                                               
designee would follow the attorney general's advice.                                                                            
                                                                                                                                
COMMISSIONER CRUM replied yes.                                                                                                  
                                                                                                                                
2:27:41 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY requested  the commissioner  designee to  talk                                                               
about his vision for DHSS for the next four years.                                                                              
                                                                                                                                
COMMISSIONER  CRUM responded  that  the department  is trying  to                                                               
address these  issues with flexibility.   How can  the department                                                               
take  care  of Alaskans  in  a  much  more specific  Alaska  way?                                                               
Alaska's system is  unique in that there is a  very robust tribal                                                               
health system, which  a lot of states don't have.   As DHSS works                                                               
with these  groups, as  well as  remote rural  communities, items                                                               
the  department  is  working towards  include  value-based  care,                                                               
social determination of health care, and other items like that.                                                                 
                                                                                                                                
CO-CHAIR  ZULKOSKY noted  that since  January DHSS  has announced                                                               
consideration of  major policy changes  also somewhat  related to                                                               
the  budget, privatizing  API,  restructuring  rates for  Pioneer                                                               
Homes,   potentially  considering   the  elimination   of  senior                                                               
benefits, and reductions to many  programs that serve as a safety                                                               
net to  many low income Alaskans,  like Medicaid.  She  asked the                                                               
commissioner designee to discuss his  role in the decision making                                                               
process in proposing these changes.                                                                                             
                                                                                                                                
COMMISSIONER  CRUM  answered that  DHSS  had  to put  together  a                                                               
budget where  expenditures matched revenues.   Some of  the items                                                               
over which the  department or the legislature  had control, which                                                               
would  be general  fund as  a  required federal  match, were  put                                                               
forth in  bills proposing reductions  in funding.  Many  of those                                                               
items  haven't moved  forward.   The department  serves a  lot of                                                               
people and  has many programs, so  this is very difficult  and is                                                               
not  something being  taken  lightly.   This  was addressing  the                                                               
situation as a whole throughout the state.                                                                                      
                                                                                                                                
CO-CHAIR  ZULKOSKY offered  her appreciation  for the  difficulty                                                               
the commissioner designee is dealing with  on a daily basis.  She                                                               
offered   her  understanding   that  the   commissioner  designee                                                               
supports the  proposed changes of  the last several months  as it                                                               
relates to these programs because of the results for the budget.                                                                
                                                                                                                                
COMMISSIONER  CRUM  replied that  tough  decisions  must be  made                                                               
based on  fiscal reality.   While  [DHSS] doesn't  have a  lot of                                                               
social  net items,  some of  the  items [DHSS]  presented in  the                                                               
budget are  not going  to leave  dependents with  zero.   As this                                                               
moves forward and it is the  will of the legislature that some of                                                               
these  bills do  not  move  forward, those  items  will still  be                                                               
there, and the department will gladly administer those programs.                                                                
                                                                                                                                
2:30:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND  noted DHSS  has  about  $20 million  in                                                               
excess budget  authority to transfer  between programs  as needed                                                               
because the  department is  large and  has emergency  issues that                                                               
are not  necessarily foreseeable by  the legislature at  the time                                                               
the  budget  is established.    The  4,700  people who  will  not                                                               
receive senior benefits for May and  June need that money and the                                                               
department  likely cannot  work  fast enough  to get  alternative                                                               
funding in  place like  SNAP or  other benefits.   She  asked how                                                               
much  of that  $20 million  of excess  budget authority  has been                                                               
transferred  among other  programs this  fiscal year  and whether                                                               
there is  enough remaining  to pay the  senior benefits  of about                                                               
$750,000 for May and June.                                                                                                      
                                                                                                                                
COMMISSIONER  CRUM responded  that DHSS  shared this  information                                                               
with the public  before the regulations and is  doing an analysis                                                               
across the  department to determine whether  funds are available.                                                               
There  was  again a  funding  shortfall  for the  General  Relief                                                               
Program,  which required  a wait  list.   The  team at  Financial                                                               
Management Services is  working through this to see if  it can be                                                               
addressed.    Eligibility  technicians  are working  as  fast  as                                                               
possible to see  if there are individual cases  that will warrant                                                               
increased "stat" benefits, which are 100 percent federal.                                                                       
                                                                                                                                
REPRESENTATIVE DRUMMOND asked again  about what has happened with                                                               
the $20 million in excess budget authority.                                                                                     
                                                                                                                                
COMMISSIONER  CRUM  answered  that  evaluations  are  being  done                                                               
throughout the  department to see if  that can be filled,  but at                                                               
this point there is no clear answer.                                                                                            
                                                                                                                                
2:33:07 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  offered her appreciation that  DHSS is making                                                               
an  effort to  ensure  that people  are  getting notice  earlier,                                                               
which is  better when  talking about a  change in  monthly income                                                               
for people  who only have  incomes of about  $2,200 a month.   It                                                               
creates a lot of unnecessary stress  for seniors who don't have a                                                               
lot of opportunity  to add income.  The average  age of people on                                                               
senior  benefits is  75, the  oldest being  104.   Not doing  the                                                               
homework to  find out if  it is  possible to find  funding before                                                               
notifying  people  is  concerning   and  not  a  very  empathetic                                                               
approach to  public policy.   The statute says "may"  reduce, not                                                               
"shall"  or "must."    The committee  has  earlier expressed  its                                                               
concern  about  eliminating the  Senior  Benefits  Program.   The                                                               
lower income level  for this program is $942 a  month, with these                                                               
people receiving a benefit of $250  a month.  The middle level is                                                               
$1,255 a  month in income, with  this level receiving $175.   She                                                               
inquired  about  the rationale  for  ending  the Senior  Benefits                                                               
Program  when the  majority of  people on  the program  have such                                                               
small monthly  income and the  program in total only  costs about                                                               
$20 million, or $25 million if adequately funded.                                                                               
                                                                                                                                
COMMISSIONER CRUM replied  that the Senior Benefits  Program is a                                                               
statutory program.  It is  straight general fund dollars and that                                                               
was one  of the mechanisms  DHSS could  [use] to meet  its budget                                                               
goal.   Individuals losing income  could have  increased benefits                                                               
elsewhere, which was the rationale for presenting that item.                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  surmised the  budget goal was  more important                                                               
than  ensuring that  people  with  only $992  a  month in  income                                                               
receive   some  assistance   to  help   them  pay   for  heating,                                                               
prescriptions, and food.                                                                                                        
                                                                                                                                
COMMISSIONER  CRUM responded  it  is  very tough  and  not a  fun                                                               
position  to be  in.   He  pointed  out that  a  number of  other                                                               
programs are  there that  help care for  the senior  community if                                                               
heating assistance is  needed as well as other  items seniors can                                                               
apply for.   This  item, unfortunately,  hasn't moved  forward in                                                               
the House.                                                                                                                      
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  related  that  in her  experience  with  the                                                               
Salvation Army,  funding for the  heating assistance  program had                                                               
been  decreasing over  the years  and often  there wasn't  enough                                                               
funding  for the  Salvation Army  to give  heating assistance  to                                                               
people who were  eligible.  So, she said, relying  on those other                                                               
programs to  provide assistance  is concerning  when it  is known                                                               
that  those  programs   are  underfunded  as  well.     The  DHSS                                                               
commissioner  has  challenges to  meet  a  budget goal,  but  the                                                               
commissioner also  has a mission  goal.  Mission-focused  work is                                                               
the work done  at the Salvation Army and MyHouse  and is the work                                                               
of  making sure  that people  who  need that  care get  it.   The                                                               
absolute number one job of the  DHSS commissioner is to make sure                                                               
the department delivers  on that mission.  It  is concerning that                                                               
the budget  is getting in  the way of the  commissioner's ability                                                               
to deliver on that mission.                                                                                                     
                                                                                                                                
2:38:13 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY asked whether,  as commissioner, Mr. Crum would                                                               
champion budgetary needs  as he sees them to  adequately meet the                                                               
needs  of the  department's  mission, or  would  Mr. Crum  remain                                                               
within the  confines of the  budget as proposed by  people around                                                               
him and instead consider cutting access to programs.                                                                            
                                                                                                                                
COMMISSIONER CRUM answered  that as DHSS presented  cuts it tried                                                               
to diversify out  across different groups, that  there were other                                                               
safety nets  available for these  individuals.   As commissioner,                                                               
it is  his job to  manage the programs  as best as  possible with                                                               
the budget that is provided to him.                                                                                             
                                                                                                                                
CO-CHAIR ZULKOSKY  concluded that as commissioner  Mr. Crum would                                                               
not prioritize the  mission and champion the  leveraging of funds                                                               
and partnerships  where possible,  but would instead  stay within                                                               
the confines of the budget and cut programs from there.                                                                         
                                                                                                                                
COMMISSIONER CRUM  responded that managing most  effectively with                                                               
the  budget presented  would actually  dictate that  he needs  to                                                               
leverage  partnerships  more;  to  actually  use  more  of  those                                                               
revenues and try to expand upon the dollars that are available.                                                                 
                                                                                                                                
CO-CHAIR ZULKOSKY  stated she doesn't  hear an answer  other than                                                               
the commissioner designee  would stay within the  confines of the                                                               
budget and cut from there.                                                                                                      
                                                                                                                                
2:39:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON noted the  current legislature is still in                                                               
the process  of creating a  budget this legislative  session, and                                                               
therefore nothing  has yet been  cut because the  discussions are                                                               
about what  is going  to happen.   She  asked whether  the Senior                                                               
Benefits Program for  which there may not be funding  for May and                                                               
June is from decisions made prior to the current administration.                                                                
                                                                                                                                
COMMISSIONER CRUM  confirmed that  the available dollars  for the                                                               
Senior Benefits Program are the funds appropriated last year.                                                                   
                                                                                                                                
CO-CHAIR SPOHNHOLZ  noted there  is a second  supplemental budget                                                               
that will  be coming through  and offered her  understanding that                                                               
the  commissioner designee  could  request a  supplemental.   She                                                               
asked  whether the  commissioner designee  is willing  to make  a                                                               
supplemental  request  to  ensure  full  funding  of  the  Senior                                                               
Benefits Program this year.                                                                                                     
                                                                                                                                
COMMISSIONER  CRUM responded  that DHSS  is going  to finish  its                                                               
evaluation process of whether  there are intra-departmental funds                                                               
that  could  be transferred  to  see  if [making  a  supplemental                                                               
request] is necessary.                                                                                                          
                                                                                                                                
2:41:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT  pointed out  that there  is a  proposal to                                                               
reduce  the Permanent  Fund Dividend  by $1,700,  which is  a lot                                                               
more  than what  is being  talked about  here for  some of  these                                                               
seniors.  He said going down  the budgetary path doesn't get into                                                               
the  discussion  about  whether   the  commissioner  designee  is                                                               
qualified to do  the job.  Moving the discussion  back to whether                                                               
the commissioner designee  is qualified for the  job, he inquired                                                               
whether  API  was  a  budgetary  decision  for  the  commissioner                                                               
designee or a management decision.                                                                                              
                                                                                                                                
COMMISSIONER CRUM  answered that  API was a  management decision.                                                               
More dollars  need to  be invested  into API  in order  to ensure                                                               
patient care and safety, as well as employee safety.                                                                            
                                                                                                                                
REPRESENTATIVE PRUITT  stated it  is important to  recognize that                                                               
this was  a broken system  from prior to Mr.  Crum's appointment,                                                               
yet the  commissioner designee  is taking  heat for  actions that                                                               
were taken before he  was appointed.  He said he  too sees API as                                                               
a  management challenge,  not a  budgetary challenge  and that  a                                                               
corner is  being turned with  API.  Regarding  qualifications for                                                               
leadership, he asked whether the  commissioner designee thinks he                                                               
made the right decision on API.                                                                                                 
                                                                                                                                
COMMISSIONER CRUM  replied he absolutely  stands by  his decision                                                               
and added  that he had the  authority to make the  decision under                                                               
Title 47.  This was not taken lightly  and as a leader he has the                                                               
responsibility ultimately for the  patient care at that hospital.                                                               
A survey team  was on site working on  addressing long-term items                                                               
when an  immediate jeopardy was  reported and that was  more than                                                               
he could  accept at that point.   It is  his job to take  care of                                                               
those individuals and so  a team was brought in to  do that.  The                                                               
department  is  working  toward stabilization  at  the  facility.                                                               
There have  been two  full cycles of  retraining, the  culture is                                                               
being rebuilt,  and a level of  stability is being put  in place.                                                               
For years  API had the executive  team turn over so  there was no                                                               
stability.   It  has  been  nice to  be  commended  by the  joint                                                               
commission and for API to be  recommended for three full years of                                                               
funding for Medicaid and Medicare.                                                                                              
                                                                                                                                
2:44:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ said  her  concern  about selecting  Wellpath                                                               
Recovery Solutions  ("Wellpath") to  run API is  no secret.   The                                                               
amount of  attention the commissioner  designee has given  API is                                                               
appreciated.   It  is well  known  that this  much attention  was                                                               
needed  a year  ago.   The  previous  administration learned  its                                                               
mistakes too late, and its budget  request for API was similar to                                                               
what  the commissioner  designee  has requested  with the  budget                                                               
amendment, which  is $44 million.   The attention to  API matters                                                               
because the people in API cannot advocate for themselves.                                                                       
                                                                                                                                
CO-CHAIR SPOHNHOLZ stated  her concern is about  the process that                                                               
has  been undertaken.   Essentially,  an emergency  situation was                                                               
used as the Trojan  horse to get in the door  to justify a single                                                               
source contract  of over five  years.  Representative  Claman has                                                               
compared  that to  allowing  the company  that  was within  three                                                               
miles of  the Minnesota bypass  the opportunity to bid  on repair                                                               
of the  bypass after  the earthquake in  December and  then award                                                               
that  company the  opportunity to  do all  of the  maintenance in                                                               
that  area for  the next  five years.   It's  using a  short-term                                                               
crisis  as a  justification for  a very  major restructuring.   A                                                               
single source contract was given to  a company that has a dubious                                                               
health and  safety track  record across the  country.   She asked                                                               
what  knowledge the  commissioner designee  had about  Wellpath's                                                               
health and safety record prior to his signing of the contract.                                                                  
                                                                                                                                
COMMISSIONER CRUM  responded he  was well informed  of Wellpath's                                                               
record,  particularly  the  company's  very good  record  in  the                                                               
states  of  Massachusetts  and  Florida.   As  part  of  its  due                                                               
diligence,  the  department talked  with  leaders  in both  those                                                               
states and  got glowing  reviews about  the company's  ability to                                                               
take  over  and  transform  what   were  once  very  violent  and                                                               
destitute hospitals.  Working in  the psychiatric field is a very                                                               
litigious field and there are going  to be lawsuits all the time.                                                               
Given the number  of facilities Wellpath manages, it  is going to                                                               
have  a lot  of lawsuits;  API has  a lot  of standing  lawsuits.                                                               
Even Providence was sued just  last week for psychiatric care and                                                               
that is not  even the facility's primary function.   Wellpath has                                                               
a lot  of key  performance indicators  it must  meet for  this to                                                               
continue on.   The state  is not abdicating  its responsibilities                                                               
to  care  for  these  patients.   Dollars  will  continue  to  be                                                               
invested in this,  along with an increased  governance board that                                                               
has a lot more teeth.                                                                                                           
                                                                                                                                
2:47:54 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked what the  performance metrics are in the                                                               
contract.                                                                                                                       
                                                                                                                                
COMMISSIONER  CRUM answered  that  the  performance metrics  are:                                                               
stabilization of the  facility, maintaining federal accreditation                                                               
and certification, and  getting to the point  where full capacity                                                               
is  possible.    Anything  to  do with  capacity  is  a  clinical                                                               
decision  and  management  has  no say  over  the  capacity;  the                                                               
psychiatrists on  staff make that determination  based upon staff                                                               
loads and what can be handled.                                                                                                  
                                                                                                                                
CO-CHAIR  SPOHNHOLZ noted  she has  a master's  degree in  public                                                               
administration  and   a  subject  she  studied   was  performance                                                               
metrics,  which is  "knowing that  you get  what you  measure and                                                               
that  you need  tools to  be able  to get  out of  a contract  if                                                               
somebody  isn't   performing  to   that  standard."     What  the                                                               
commissioner designee described are  one-time things that open up                                                               
eligibility for  phase two.   She asked what  performance metrics                                                               
would be looked  at year in and year out  to ensure that Wellpath                                                               
is  not  just keeping  the  doors  open  and accredited,  but  is                                                               
actually ensuring that patients are getting the care they need.                                                                 
                                                                                                                                
COMMISSIONER CRUM  replied [DHSS] would continue  to evaluate the                                                               
standards of care  to make sure, and that both  the community and                                                               
the state would be involved.   [The department] is not abdicating                                                               
its responsibility  on this and  will ensure that  those patients                                                               
are taken care of as things  move forward.  In the contract there                                                               
is an out clause for [DHSS.]                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked about the criteria for the out clause.                                                                 
                                                                                                                                
COMMISSIONER CRUM responded that if  [DHSS] wanted it could break                                                               
in service.                                                                                                                     
                                                                                                                                
CO-CHAIR SPOHNHOLZ inquired whether that is at any time.                                                                        
                                                                                                                                
COMMISSIONER CRUM offered  his belief that there is  a notice for                                                               
a certain number of days.                                                                                                       
                                                                                                                                
CO-CHAIR SPOHNHOLZ  further inquired  whether the  contract could                                                               
be ended at any time because [DHSS] isn't happy.                                                                                
                                                                                                                                
COMMISSIONER CRUM offered his belief that it is yes.                                                                            
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked whether it  is [DHSS] or  Wellpath that                                                               
will be doing the quality assurance.                                                                                            
                                                                                                                                
COMMISSIONER  CRUM answered  that part  of the  quality assurance                                                               
program  is tied  into accreditations  and it  hasn't been  fully                                                               
decided whether  that is  going to  be on the  side of  [DHSS] or                                                               
Wellpath,  but  the  governance  board will  have  to  see  those                                                               
numbers as well.                                                                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ  suggested that DHSS do  the quality assurance                                                               
so that  it is known  that Wellpath  is not "cooking  the books,"                                                               
because as  recently as 2018,  in Florida, Wellpath was  found to                                                               
have an  understaffed hospital  and, as  a result,  patients were                                                               
harmed,  and  a person  died.    She  concurred  that this  is  a                                                               
litigious field, and noted that  90 percent of the 1,110 lawsuits                                                               
that have been  described were found not to be  in order, meaning                                                               
110 were in order and there  were findings in those lawsuits.  It                                                               
is important  that a really  good job be  done.  She  argued that                                                               
the performance  metrics described  by the  commissioner designee                                                               
are not actually terribly substantive  when talking about a five-                                                               
year  contract   to  run   the  state's   in-patient  psychiatric                                                               
institute.                                                                                                                      
                                                                                                                                
2:49:56 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  moved to the  topic of block grants  and said                                                               
Alaska's successfully  redesigned Medicaid  system now  serves 63                                                               
percent (79,000) more people than four  years ago and is doing so                                                               
for  11  percent   less  in  state  spending.     She  said  [the                                                               
administration] is  proposing that Alaska  be the first  state in                                                               
the nation  to move to  block grants.  Historically  block grants                                                               
have  not worked  very well  for geographically  large but  small                                                               
population  states.    She   inquired  whether  the  commissioner                                                               
designee  has any  hesitation about  Alaska playing  the role  of                                                               
guinea pig as it  relates to being the first in  the nation to do                                                               
block grants.                                                                                                                   
                                                                                                                                
COMMISSIONER CRUM  replied that  currently there is  no mechanism                                                               
for the federal government to provide block grants for Medicaid.                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked whether it is just an idea.                                                                            
                                                                                                                                
COMMISSIONER  CRUM  responded  that  the idea  was  to  let  [the                                                               
federal government]  know that Alaska  wanted to be out  in front                                                               
whatever these solutions  were.  There were  some statements from                                                               
him in the media, but the last line  was cut off.  As a result of                                                               
asking  this, [DHSS]  is now  working  with CMS  and the  federal                                                               
delegation  to figure  out other  possible solutions  for Alaska.                                                               
It was a foot in the door,  let Alaska be first on something, and                                                               
an Alaska-specific solution is needed.                                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ inquired whether  the commissioner designee is                                                               
saying that [DHSS] is not pursuing block grants.                                                                                
                                                                                                                                
COMMISSIONER  CRUM  answered  that  should such  an  option  come                                                               
available  from  CMS it  is  something  that  will be  given  due                                                               
consideration, "but  at this point in  time that is not  our main                                                               
plan."                                                                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ said "that is  not our main plan" isn't really                                                               
an answer to her question.                                                                                                      
                                                                                                                                
2:52:38 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  stated that  the mission of  the work  done by                                                               
state  government  is  highly embedded  and  endemic  within  the                                                               
budget  that the  legislature  passes.   That  is  the way  state                                                               
legislators as state  leaders talk about the  values they support                                                               
and the programs they support.   Recognizing that DHSS has one of                                                               
the  largest budgets  and is  a budget  driver for  the State  of                                                               
Alaska, a concerted effort has  been made to evaluate where there                                                               
are  cost  savings.    The  governor  made  a  statement  to  the                                                               
president supporting Medicaid block grant  models.  What is known                                                               
about  block grants  is that  funding levels  are fixed,  meaning                                                               
that the program  is rendered unable to  automatically respond to                                                               
any sort  of increased need,  particularly in times  of recession                                                               
or  economic downturns.    This  also means  that  a block  grant                                                               
cannot respond  the same  way to a  faltering economy  or greater                                                               
need  throughout   communities,  essentially   destabilizing  the                                                               
economy  over time,  and worsening  the  downturn.   It makes  it                                                               
difficult for Americans  and Alaskans to be able to  get into the                                                               
workforce  or  remain  in  the  workforce  if  there  are  health                                                               
conditions  and ultimately  it  could  increase government  costs                                                               
over time because  it is pushing people who don't  have care into                                                               
emergency rooms  across the state, pushing  up uncompensated care                                                               
costs.  She asked whether  DHSS under the commissioner designee's                                                               
leadership would champion  the model of block grants  when it has                                                               
been proven  that block grants over  time are not a  sound policy                                                               
decision  in terms  of  long term  sustainable  cost savings,  or                                                               
whether  the commissioner  designee would  consider remaining  in                                                               
the same  type of  Medicaid model that  the state  currently has,                                                               
which would be much more responsive  to the needs of Alaskans and                                                               
likely  have cost  savings over  time with  increased investments                                                               
from the federal government.                                                                                                    
                                                                                                                                
COMMISSIONER CRUM offered his appreciation  for the data and said                                                               
presenting items like that makes  block grants seem not feasible.                                                               
Going down the  road of long-term feasibility has  not been done,                                                               
so when  this occurs  it will  require consideration  on [DHSS's]                                                               
end as well.   It is wanted  to pursue any options  that give the                                                               
flexibility to  address a  lot more issues  in Alaska  and [DHSS]                                                               
wants to drive dollars towards the  local side and deal with mild                                                               
and  moderate  issues   as  opposed  to  severe   issues.    [The                                                               
department] will be in touch as it continues down this path.                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  requested  the commissioner  designee,  as  a                                                               
close  advisor  in  the  governor's  cabinet,  to  speak  to  how                                                               
involved the  commissioner designee  was in  the decision  to ask                                                               
President Trump to lean into a Medicaid block grant model.                                                                      
                                                                                                                                
COMMISSIONER CRUM replied  that it has gotten a  lot of attention                                                               
and shown  that Alaska  wants to be  on the front  side.   It has                                                               
determined and driven  a lot of conversations that way.   How can                                                               
this be done on an Alaska-specific  model?  The driving intent of                                                               
that was  to put  Alaska out  in front, that  Alaska wants  to be                                                               
first  and  so  Alaska  would  like  to be  a  part  of  any  new                                                               
considerations or guidance that [the federal government] has.                                                                   
                                                                                                                                
CO-CHAIR  ZULKOSKY asked  whether the  commissioner designee  was                                                               
actively involved  in suggesting  to the  governor to  suggest to                                                               
President  Trump  that Alaska  is  interested  in Medicaid  block                                                               
grants.                                                                                                                         
                                                                                                                                
COMMISSIONER CRUM answered no.                                                                                                  
                                                                                                                                
2:56:42 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY returned  to the topic of API.   She noted that                                                               
DHSS  Deputy Commissioner  Wall  had appeared  before the  Senate                                                               
Health & Social Services Standing  Committee regarding the no-bid                                                               
contract with Wellpath.  When  asked whether the department would                                                               
reconsider pursuing  a competitive  bid process  given Providence                                                               
Hospital's interest  in competing for  a contract, Mr.  Wall said                                                               
the  decision would  be up  to  the commissioner.   She  inquired                                                               
whether,  as  the  commissioner,  Mr. Crum  would  be  issuing  a                                                               
competitive request for proposals (RFP)  for Phase Two or for the                                                               
long-term management of API.                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM responded  that that  decision currently  lies                                                               
with the chief procurement officer.                                                                                             
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked whether  Mr. Crum would  be encouraging                                                               
the chief procurement officer to pursue that.                                                                                   
                                                                                                                                
COMMISSIONER CRUM answered that  that discussion will continue as                                                               
the department  looks at API.   It is an  ever-evolving situation                                                               
that has the department's attention.                                                                                            
                                                                                                                                
CO-CHAIR ZULKOSKY  related that  while he  was before  the Senate                                                               
Health  & Social  Services Standing  Committee,  the DHSS  deputy                                                               
commissioner stated,  "The contract  with Wellpath  and decisions                                                               
regarding moving  forward with other  providers would have  to be                                                               
taken  into consideration  by the  commissioner's  office."   She                                                               
requested  that  DHSS  provide  follow-up  on  the  plans  moving                                                               
forward  and what  the plan  of action  will be,  given nonprofit                                                               
Alaska-based providers  have expressed interest  in competitively                                                               
bidding for the long-term management of that facility.                                                                          
                                                                                                                                
2:57:57 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  drew attention  to  the  topic of  per-  and                                                               
polyfluoroalkyl substances (PFAS).  She  said that for quite some                                                               
time the health department had a  clear statement that if the sum                                                               
concentration  of  the  five  PFAS  of  concern  were  above  the                                                               
Department of Environmental Conservation's  (DEC) action level of                                                               
70  parts per  trillion (ppt)  to immediately  stop drinking  the                                                               
water and stop  using it to prepare baby formula.   She expressed                                                               
her  surprise, given  the commissioner  designee's background  in                                                               
environmental health and safety, to  learn that that has now been                                                               
updated and  the specific language  referencing the  DEC standard                                                               
of 70 ppt removed.  She requested an explanation for this.                                                                      
                                                                                                                                
COMMISSIONER CRUM replied  it was decided, as a  state, to follow                                                               
the  Environmental  Protection  Agency's  (EPA)  health  advisory                                                               
guidance of 70  ppt for the sum of two  PFAS contaminants.  Long-                                                               
term studies are being done on  this emerging issue.  The Centers                                                               
for  Disease Control  and  Prevention (CDC)  and  the Agency  for                                                               
Toxic Substances  and Disease  Registry (ATSDR)  are going  to do                                                               
long-term longitudinal studies at eight  sites around the U.S. to                                                               
figure this  out because there  is no concrete  determined levels                                                               
across the  board.   Many states have  standards, but  they vary.                                                               
Because of  where Alaska is  standing at,  it was decided  to tie                                                               
Alaska to the current EPA standard.                                                                                             
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked whether the EPA standard is 70 ppt.                                                                    
                                                                                                                                
COMMISSIONER CRUM  confirmed [it is  70 ppt]  for the sum  of two                                                               
[PFAS contaminants].                                                                                                            
                                                                                                                                
CO-CHAIR SPOHNHOLZ  inquired why  that information was  taken out                                                               
of the statement on the state's public health web site.                                                                         
                                                                                                                                
COMMISSIONER CRUM responded he would check on that.                                                                             
                                                                                                                                
CO-CHAIR SPOHNHOLZ  reiterated that  the section of  the sentence                                                               
that clearly described  the standard has been removed.   She said                                                               
this is concerning from a public health standpoint.                                                                             
                                                                                                                                
COMMISSIONER CRUM thanked  the co-chair for bringing  this to his                                                               
attention and said it will be taken care of.                                                                                    
                                                                                                                                
3:00:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  noted the committee  has been asking a  lot of                                                               
questions about leadership rationale  because the role assumed by                                                               
commissioner  designee  is  protecting   access  to  some  really                                                               
critical programs  for many vulnerable  Alaskans, and  the budget                                                               
is   tied  to   managing  these   issues.     The  administration                                                               
recommended  eliminating  the  hold   harmless  provision  as  it                                                               
relates  to   the  permanent  fund  and   individuals  on  public                                                               
assistance.   Elimination of this  program does not  save general                                                               
fund dollars and  serves as a critical safety net  for low income                                                               
Alaskans who  for a  short period of  time after  receiving their                                                               
permanent fund  [dividend] are  bumped out  of eligibility.   She                                                               
asked  whether   the  commissioner   designee  was   involved  in                                                               
suggesting that Alaska eliminate the hold harmless provision.                                                                   
                                                                                                                                
COMMISSIONER CRUM answered this is  not a general fund issue, but                                                               
rather comes  directly from  the permanent  fund, or  where those                                                               
dollars come from.  For that to  go away there would have to be a                                                               
bill.  He offered his belief that a bill has not been presented.                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ stated she is not introducing a bill.                                                                        
                                                                                                                                
CO-CHAIR ZULKOSKY,  given that the  hold harmless  provision does                                                               
not  save general  fund dollars,  asked whether  the commissioner                                                               
designee  supports   eliminating  the  hold   harmless  provision                                                               
program and  potentially exposing  Alaskans to  being at  risk of                                                               
losing benefits that they would otherwise qualify for.                                                                          
                                                                                                                                
COMMISSIONER CRUM  responded that  payment of the  full permanent                                                               
fund dividend would  more than mitigate that  coverage, which was                                                               
pointed out by Representative Pruitt.                                                                                           
                                                                                                                                
CO-CHAIR ZULKOSKY  requested the  commissioner designee  to state                                                               
whether he supports eliminating the hold harmless program.                                                                      
                                                                                                                                
COMMISSIONER CRUM answered yes.                                                                                                 
                                                                                                                                
REPRESENTATIVE PRUITT  pointed out  that about $43  per permanent                                                               
fund  dividend is  paid  for  the hold  harmless.    He said  the                                                               
committee  seems to  be  centrally focused  instead  of having  a                                                               
different discussion about  maybe going to a  quarterly payout or                                                               
something  else.   It is  more of  a budgetary  conversation that                                                               
doesn't   necessarily  speak   to  the   qualifications  of   the                                                               
individual before  the committee.  The  commissioner designee has                                                               
demonstrated  very  well his  understanding  of  the issues,  and                                                               
perhaps that is where the  committee should keep its comments and                                                               
questions.                                                                                                                      
                                                                                                                                
3:03:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  noted that  early on in  the API  process the                                                               
commissioner  designee  exerted  emergency  authority  over  API.                                                               
This was  confusing because as  the ultimate arbitrator  the DHSS                                                               
commissioner already has authority over  API.  She asked what new                                                               
tools were  given to  the commissioner  designee by  exerting the                                                               
emergency authority.                                                                                                            
                                                                                                                                
COMMISSIONER CRUM  replied that  there is  a statute  that allows                                                               
the DHSS  commissioner to assume  control of any  licensed health                                                               
facility,  either  temporarily  or permanently,  and  insert  the                                                               
commissioner's own management,  and that was the  tool used since                                                               
API is a licensed health facility in the state of Alaska.                                                                       
                                                                                                                                
3:04:01 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ said she is  confused because as commissioner,                                                               
Mr. Crum would  already have that authority  within his framework                                                               
since  API  is a  public  institution  and  the director  of  API                                                               
fundamentally reports to the DHSS  commissioner.  She offered her                                                               
understanding that the statute allows  the commissioner to assume                                                               
authority over  a private  hospital that isn't  living up  to the                                                               
standards of care that are necessary in the state of Alaska.                                                                    
                                                                                                                                
COMMISSIONER  CRUM  responded  that  the  decision  to  use  this                                                               
statutory   authority   was   made  in   conjunction   with   the                                                               
department's   partners  at   the   Department   of  Law   (DOL).                                                               
Responding further, he confirmed that DOL recommended it.                                                                       
                                                                                                                                
CO-CHAIR SPOHNHOLZ  inquired about the additional  tools provided                                                               
by the statute.                                                                                                                 
                                                                                                                                
COMMISSIONER CRUM  answered, "It  elevated this  to the  level to                                                               
where we  understood exactly what was  going on and it  made it a                                                               
public issue, so we knew ... we're going to take care of it."                                                                   
                                                                                                                                
CO-CHAIR SPOHNHOLZ  commented she still  is not certain  why that                                                               
was  needed, but  that the  commissioner designee  is saying  DOL                                                               
told him he needed to do that.                                                                                                  
                                                                                                                                
COMMISSIONER CRUM confirmed the aforementioned.                                                                                 
                                                                                                                                
3:05:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  recalled informal discussions, not  before the                                                               
committee, with the commissioner  designee about the department's                                                               
efforts  in approaching  CMS for  approval  of proposed  Medicaid                                                               
cuts.   She requested  the commissioner  designee to  describe in                                                               
detail  the  efforts  DHSS  has made  since  January  in  seeking                                                               
approval from CMS for Medicaid cuts.                                                                                            
                                                                                                                                
COMMISSIONER CRUM replied he is  not comfortable addressing it at                                                               
this time  because DHSS  is waiting on  some extra  guidance that                                                               
will help determine the direction DHSS is working on.                                                                           
                                                                                                                                
CO-CHAIR  ZULKOSKY  offered  the committee's  understanding  that                                                               
there is  an approval process that  needs to happen, and  CMS may                                                               
not  ultimately approve  what DHSS  is  potentially proposing  or                                                               
considering.   It would  seem that state  government should  be a                                                               
public  and   transparent  process  and  that   the  commissioner                                                               
designee  would  feel  comfortable   in  talking  about  it  with                                                               
legislative  bodies.   She asked  how  the commissioner  designee                                                               
anticipates it would impact Alaska's  Medicaid program if the CMS                                                               
does not approve the proposed cuts.                                                                                             
                                                                                                                                
COMMISSIONER CRUM  inquired whether the co-chair  is referring to                                                               
the Phase One cuts for Medicaid.                                                                                                
                                                                                                                                
CO-CHAIR ZULKOSKY said she is referring to CMS rate reductions.                                                                 
                                                                                                                                
COMMISSIONER CRUM responded  yes, [DHSS] is "working  with CMS on                                                               
that for those items."  He  apologized for having thought the co-                                                               
chair was talking about the Phase Two process.                                                                                  
                                                                                                                                
CO-CHAIR  ZULKOSKY   asked  whether  the   commissioner  designee                                                               
intends  to  come  back  to  the  legislature  next  year  for  a                                                               
supplemental if CMS does not  approve those reductions and [DHSS]                                                               
is required to pay more than what was budgeted.                                                                                 
                                                                                                                                
COMMISSIONER  CRUM responded,  "If  that is  the  case, then  yes                                                               
[DHSS] would have to do so."                                                                                                    
                                                                                                                                
3:07:03 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ related  that  in the  original proposal  for                                                               
Tier I  rate reductions, community  access hospitals  and primary                                                               
care  providers were  amongst those  that were  carved out.   She                                                               
further related  that the rebasing  of behavior health  rates was                                                               
just  completed  and  that  the   state  has  a  substance  abuse                                                               
challenge.   She  inquired whether  the commissioner  designee is                                                               
prepared, if funding  is available, to also  carve out behavioral                                                               
health  providers   from  the   rate  reductions   and  inflation                                                               
withholding.                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  answered yes.   He  added that  DHSS evaluates                                                               
this  process and  as the  Section  1115 Waiver  also comes  into                                                               
action the  department will evaluate  with its partner  groups as                                                               
well  to see  if there  is  funding available  to appropriate  as                                                               
such, and then  yes, the department will continue  down that road                                                               
to make sure it is funded.                                                                                                      
                                                                                                                                
CO-CHAIR SPOHNHOLZ  stated she  thinks that  is wise  because her                                                               
experience at  the Salvation Army  was that  it took a  while for                                                               
DHSS to  transition from grants  over to Medicaid funding.   Part                                                               
of the  problem in  that transition was  that the  Medicaid rates                                                               
weren't  adequate  to  actually  cover  the  amount  of  cost  of                                                               
delivering service.   Even  though the Salvation  Army is  a bare                                                               
bones budget operation it struggled  to make its Clitheroe Center                                                               
operation continue  to pencil  out.   As director  of development                                                               
and communications  her job was  to backfill and ensure  that the                                                               
doors  were  kept open.    The  rebasing  process was  no  sooner                                                               
finished when providers  heard that there was going to  be a rate                                                               
reduction and they  hadn't even seen the results  of the rebasing                                                               
go into effect.  This made  it difficult for people to understand                                                               
how they were  going to get to the other  end of their behavioral                                                               
health care system redesign.  It  gives her some comfort that the                                                               
commissioner designee is saying he is willing to protect them.                                                                  
                                                                                                                                
3:09:42 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ opened public testimony.                                                                                     
                                                                                                                                
3:10:11 PM                                                                                                                    
                                                                                                                                
ALYSON  CURREY, Legislative  Liaison,  Planned Parenthood  Votes,                                                               
testified in opposition  to the confirmation of Mr.  Adam Crum as                                                               
commissioner of  DHSS.   She said  her organization  believes Mr.                                                               
Crum lacks experience with health  care policy, delivering health                                                               
and social  services, and his  ideology is fundamentally  at odds                                                               
with the  department's mission.   In his 2016 campaign  for state                                                               
senate,  Mr.  Crum  ran  on  a  platform  of  cutting  access  to                                                               
government  programs  and  restricting a  woman's  constitutional                                                               
right  to make  decisions about  her own  body and  anti-abortion                                                               
activists  are supporting  his nomination  for this  very reason.                                                               
In  a   November  2018  article   with  Alaska  Public   Media  a                                                               
representative  from  Alaska Right  to  Life,  which opposes  all                                                               
abortion, noted  that the organization  endorsed Mr. Crum  in his                                                               
run  for  state  senate  because  of  his  commitment  to  ending                                                               
abortion and that  the organization hoped Mr. Crum  could make an                                                               
impact on  ending abortion in his  role at DHSS.   The department                                                               
oversees  access  to  health care  services,  including  abortion                                                               
care,  for  people  with  low  incomes in  the  state.    Planned                                                               
Parenthood  Votes recognizes  and respects  that everybody  has a                                                               
variety of  opinions on abortion,  but feels that someone  who is                                                               
fundamentally opposed to  those services should not  be in charge                                                               
of controlling access to those same services.                                                                                   
                                                                                                                                
MS.  CURREY  stated Alaska  needs  a  leader who  will  implement                                                               
proven and  effective strategies for improving  public health and                                                               
decreasing  health disparities  across communities.   Alaska  has                                                               
some of the  highest rates of suicide,  domestic violence, sexual                                                               
assault,  and  sexually  transmitted infections  in  the  nation.                                                               
Alaska needs a  commissioner who has the  experience necessary to                                                               
tackle  these challenges  and advance  bold  solutions that  will                                                               
improve the health  of all Alaskans across  the state, especially                                                               
historically  marginalized communities  that are  more likely  to                                                               
already lack access to health care  and social services.  So far,                                                               
the  ideas  presented  to  the legislature  by  DHSS  to  contain                                                               
Medicaid  costs  would not  accomplish  these  goals, they  would                                                               
further  exacerbate the  public health  problems communities  are                                                               
currently  facing.   Alaska  needs  a  commissioner that  can  be                                                               
counted on  to promote healthy  communities and  families without                                                               
limiting  access to  care.   Between presentations  by department                                                               
staff  in numerous  committees  and  the commissioner  designee's                                                               
noticeable absence  from many of  them, Planned  Parenthood Votes                                                               
is not confident that Mr. Crum  is the best fit for this position                                                               
and asks the committee to reject his nomination.                                                                                
                                                                                                                                
3:13:03 PM                                                                                                                    
                                                                                                                                
JAYNE ANDREEN testified in opposition  to the confirmation of Mr.                                                               
Adam Crum  as commissioner of DHSS.   She said she  is before the                                                               
committee as  someone who has  worked in  Alaska for the  last 37                                                               
years in health  and human services.  She has  worked in both the                                                               
private and public  sector and worked in  leadership roles within                                                               
the  state.   She has  also served  as a  national trainer  for a                                                               
health  policy   curriculum  that   was  developed  out   of  the                                                               
University of  North Carolina, Chapel  Hill, from 2009-2017.   As                                                               
such, she has trained hundreds  of human health service providers                                                               
on how  to do public  policy, all  the way from  determining when                                                               
policy is needed, to analyzing policy,  to when it will best meet                                                               
the needs of whatever the  group is looking at, to implementation                                                               
and evaluation  and that  is where she  brings her  main concern.                                                               
She has not met  Mr. Crum, but hears he is a  nice guy, which she                                                               
appreciates.                                                                                                                    
                                                                                                                                
MS.  ANDREEN  expressed her  concern  about  Mr. Crum's  lack  of                                                               
experience, particularly in the area  of health and human service                                                               
policy and how to  go about doing that, which is  one of the most                                                               
critical  components of  being a  commissioner.   A  commissioner                                                               
must  have good  management skills  and good  people skills,  and                                                               
must  understand and  know how  to effectively  implement policy.                                                               
Mr. Crum has gone on the record  saying he is not a health policy                                                               
type of  guy.   She is  concerned looking at  the number  of very                                                               
significant  policies that  have come  out of  the administration                                                               
and DHSS.   Maintenance  of the Senior  Benefits Program  for the                                                               
state's most vulnerable elders is one  of the issues she has been                                                               
concerned  about over  the last  several years.   What  she heard                                                               
today is  that the driving  force for  most of the  policies that                                                               
have come out is  based on the need to cut the  budget.  What she                                                               
is concerned Mr.  Crum may not bring to the  table is the ability                                                               
to  look at  who this  is going  to impact,  how it  is going  to                                                               
impact them,  in what ways can  that be mitigated, and  what ways                                                               
can it be  worked around.  She recently attended  two hearings on                                                               
the Senior Benefits Program in  which DHSS staff said they didn't                                                               
know what the impact of eliminating  the program would be on many                                                               
of the  people in  the program.   That concerns  her.   The staff                                                               
keeps saying it  is very complex and that these  people could get                                                               
food stamps  and that  there might be  other programs  that could                                                               
help them,  but staff  couldn't give concrete  numbers.   That is                                                               
the  kind of  information that  has to  be gathered  and assessed                                                               
upfront  before a  policy is  put  into place  or even  proposed.                                                               
There are 4,700 people in the  state who are very concerned about                                                               
losing  two months'  worth of  stipends.   She is  also concerned                                                               
that  in  an  over  $3  billion budget,  staff  doesn't  know  if                                                               
$800,000 can be found to fill that gap.                                                                                         
                                                                                                                                
MS. ANDREEN  offered her  belief that many  of the  policies that                                                               
DHSS  has  been  working  on implementing  are  coming  from  the                                                               
governor's office,  not from Mr.  Crum's leadership.   She agreed                                                               
Mr. Crum's  statement is true  that he takes his  marching orders                                                               
from  the governor,  but said  one of  the responsibilities  of a                                                               
good commissioner is to be able  to come back to the governor and                                                               
say  it is  understood  what  is wanted,  but  here  is what  the                                                               
department's  analysis  shows, what  the  options  are, what  the                                                               
evidence  is, what  the data  tells,  to help  the governor  make                                                               
decisions that are going to be  in the best interest of Alaskans'                                                               
health  and wellbeing.   While  Mr. Crum  is a  nice guy  and has                                                               
excellent  educational credentials,  she  isn't sure  he has  the                                                               
qualities that are most specifically needed for this position.                                                                  
                                                                                                                                
3:17:27 PM                                                                                                                    
                                                                                                                                
TONYA  HALLIDAY, Cook  Inlet Dental,  testified in  opposition to                                                               
the confirmation of  Mr. Adam Crum as commissioner of  DHSS.  She                                                               
stated Mr. Crum does not have  the knowledge or experience to run                                                               
the largest  and most complicated  agency in the state,  and that                                                               
by  his  own admission  he  is  not a  health  policy  guy.   His                                                               
retooling of  how the most  vulnerable Alaskans  are collectively                                                               
cared for has  led to crises at  API and the Pioneer  Homes.  His                                                               
health policy,  driven by strategies that  drive efficiencies and                                                               
cost savings within the system, has  led us to a [$1] million per                                                               
month contract with  Wellpath and huge cost  increases at Pioneer                                                               
Homes for  residents.  Since Mr.  Crum took over DHSS,  there has                                                               
been an alarming trend of  delayed and slow payments to providers                                                               
and  of only  paying care  coordinators  once per  month.   While                                                               
waiting  until  the  last  moment  to pay  or  deny  claims,  the                                                               
department is shifting the cost  to providers at the detriment of                                                               
their   livelihoods.     Also,   the  increasing   of  the   pre-                                                               
authorization process affects recipients'  ability to seek timely                                                               
care  and hamstrings  providers'  ability to  provide that  care.                                                               
Medicaid  block grants  don't work  and  will do  more harm  than                                                               
good.    What  atrocities  will   Mr.  Crum  have  in  store  for                                                               
children's  services,  juvenile  justice, senior  and  disability                                                               
services,  and public  assistance when  he believes  that getting                                                               
people off  of state-paid health  care and into  sustainable jobs                                                               
will be  a priority?   Not everyone  receiving state  services is                                                               
employable, which is why many  are receiving state services.  Mr.                                                               
Crum's strategy to  cut and gut behavioral  health, including the                                                               
funding  of the  Suicide Prevention  Council, is  horrific.   She                                                               
urged the committee to vote no on confirming Mr. Crum.                                                                          
                                                                                                                                
3:19:50 PM                                                                                                                    
                                                                                                                                
MICHELLE  OVERSTREET,  Founder  &  Executive  Director,  MyHouse,                                                               
testified  in support  of the  confirmation of  Mr. Adam  Crum as                                                               
commissioner of  DHSS.  She  stated Mr.  Crum has been  a mentor,                                                               
volunteer,  and advisory  board member  for MyHouse  almost since                                                               
its founding.   Mr. Crum does have the  qualifications that would                                                               
be needed.   She understands some of the concerns  that have been                                                               
expressed about  policy, but given  Alaska has the  highest rates                                                               
in the  nation of  domestic abuse,  suicide, child  sexual abuse,                                                               
and  sexual  assault, it  is  time  for  a  fresh set  of  ideas.                                                               
MyHouse knows  Mr. Crum  to be a  creative and  innovative leader                                                               
from  his work  with the  organization.   Mr.  Crum answered  the                                                               
committee's questions  with integrity and that  is his character.                                                               
MyHouse has experience with Mr.  Crum in an advisory capacity for                                                               
the youth  it serves, many of  whom are marginalized and  left by                                                               
the  wayside, and  there was  no  discrimination for  any of  the                                                               
youth by  Mr. Crum.   His  concern is for  the betterment  of the                                                               
youth and the  betterment of Alaska.  That isn't  to say he would                                                               
exclude other  groups like seniors  or those with other  kinds of                                                               
disabilities,  but  it  is  speaking to  his  character  and  his                                                               
commitment  to  increasing  access  to  services  and  empowering                                                               
people  to  become  the  best  they   can  be.    MyHouse  is  an                                                               
organization that utilizes public health  in its building, and it                                                               
utilizes  a lot  of  the same  philosophies  and strategies  that                                                               
Planned  Parenthood does,  and  she  has never  had  Mr. Crum  be                                                               
negative  about the  demographic  that  is served.    He has  the                                                               
ability to  turn the tide  for a lot  of things that  MyHouse has                                                               
been trying to change  in Alaska for a long time.   She urged the                                                               
committee to offer Mr. Crum the support to do that.                                                                             
                                                                                                                                
3:23:33 PM                                                                                                                    
                                                                                                                                
ZHENIA PETERSON  testified in opposition  to the  confirmation of                                                               
Mr. Adam Crum  as commissioner of DHSS.  She  said that while Mr.                                                               
Crum has  experience running a  business in Alaska, he  has never                                                               
worked in a health related field  and does not have background in                                                               
working  with  public  policy.   This  is  concerning  given  his                                                               
primary  job  is overseeing  numerous  health  departments.   Mr.                                                               
Crum's past  statements about  the size  of state  government and                                                               
reducing  government   budgets  cause  her  to   worry  that  his                                                               
initiatives will  put people out of  jobs and cut funding  to the                                                               
health  care  services   that  many  Alaskans  rely   on.    Also                                                               
concerning are Mr. Crum's ties to  the Alaska Right to Life group                                                               
and  past  statements about  women  receiving  basic health  care                                                               
services.   She fears that  Mr. Crum  will, when the  time comes,                                                               
make a decision  on women's right to choose that  is based on his                                                               
personal  ideology.   As a  woman  living in  Alaska she  worries                                                               
about her constitutional and health  rights being taken away from                                                               
her because of somebody else's  agenda and priorities.  She urged                                                               
the committee to reject the appointment of Mr. Crum.                                                                            
                                                                                                                                
3:25:45 PM                                                                                                                    
                                                                                                                                
SHELLEY EBENAL,  Executive Director and General  Counsel, Greater                                                               
Fairbanks Community  Hospital Foundation; CEO,  Foundation Health                                                               
Partners (FHP), testified  in support of the  confirmation of Mr.                                                               
Adam  Crum as  commissioner  of  DHSS.   She  explained that  FHP                                                               
offers  a full  continuum  of health  care  services to  Interior                                                               
northern  Alaska residents.    These  services include  Fairbanks                                                               
Memorial Hospital and  Tanana Valley Clinic and  Denali Center, a                                                               
long-term care facility.   During Mr. Crum's first  few months on                                                               
the  job  the FHP  board  invited  the commissioner  designee  to                                                               
Fairbanks.   Since that first  meeting Mr. Crum has  made himself                                                               
available to  the board  on several  occasions and  has continued                                                               
dialogue about existing needs and  services in the Interior.  His                                                               
door has always been open, and  he has been available to approach                                                               
problems in a reasonable manner.   Mr. Crum asks great questions,                                                               
as well as the right questions,  about what is and isn't working.                                                               
He  was  engaging,  earnest,  a quick  study,  and  was  solution                                                               
oriented.   From  his  first three  months on  the  job Mr.  Crum                                                               
appears  to  be committed  to  gain  the knowledge  necessary  to                                                               
address the issues  facing DHSS.  The  state's challenging budget                                                               
constraints are understood by FHP.   The commissioner's difficult                                                               
task of  identifying ways to  reduce the costs  while maintaining                                                               
services  for Alaska  is appreciated.    Her organization  stands                                                               
ready   to  continue   working  with   the  department   and  the                                                               
commissioner designee  to identify  solutions to  problems facing                                                               
Alaska's health  care delivery system.   She urged  the committee                                                               
to support Mr. Crum's confirmation.                                                                                             
                                                                                                                                
3:28:30 PM                                                                                                                    
                                                                                                                                
ELIZABETH  RIPLEY, CEO,  Mat-Su Health  Foundation, testified  in                                                               
support of the  confirmation of Mr. Adam Crum  as commissioner of                                                               
DHSS.    She noted  the  foundation  shares ownership  in  Mat-Su                                                               
Regional Health  Center.  She  first met  Mr. Crum at  the Mat-Su                                                               
Business Alliance  where he and  his family's  business, Northern                                                               
Industrial Training,  have won multiple awards  for growing their                                                               
business and helping the Mat-Su economy.   Since then she has had                                                               
the opportunity  to interact  with Mr.  Crum in  his new  role as                                                               
commissioner and she  has been impressed with how  quickly he has                                                               
come  to understand  the department,  Alaska's health  care needs                                                               
and  challenges, and  the complicated  funding streams,  systems,                                                               
and  statutes that  drive health  care delivery  in Alaska.   Mr.                                                               
Crum has  expressed appreciation and  support for DHSS  staff for                                                               
their efforts  to improve health  care and  he is trying  to help                                                               
the divisions break down silos  and be more strategic, efficient,                                                               
and effective.   Mr. Crum has  a heart for this  work and coupled                                                               
with his  business acumen will  go a  long way toward  making his                                                               
tenure  successful.   He is  trying to  negotiate a  path forward                                                               
with  CMS to  meet the  governor's goal  of reducing  health care                                                               
costs  to  the state  and  reducing  the  health care  costs  for                                                               
Alaskans.     Mr.  Crum  knows   Alaska  has   behavioral  health                                                               
challenges, including an  opioid crisis.  He  recognizes the need                                                               
to shift  investment to  prevention and  early intervention.   He                                                               
grasps  the  benefits  of  maximizing  investments  in  home  and                                                               
community  services.    Mr.  Crum understands  that  he  and  his                                                               
leadership are being  counted on to figure out how  to make these                                                               
shifts to get more value  and better health outcomes for Alaskans                                                               
from their health care delivery system.                                                                                         
                                                                                                                                
MS. RIPLEY  said her foundation  has some concerns  about changes                                                               
to Medicaid  that have  been put  forward by  the administration,                                                               
but the  foundation feels  that its concerns  are being  heard by                                                               
Mr.  Crum.    The  foundation's position  has  always  been  that                                                               
Medicaid reform  offers opportunities for efficiencies  that must                                                               
be  explored.    The  foundation   has  expressed  to  DHSS  that                                                               
behavioral health  and home and community  based providers should                                                               
be excluded from the proposed  provider rate cut.  The foundation                                                               
has  also   discussed  how  private  sector   investment  in  the                                                               
community to  build out behavioral health  services and long-term                                                               
services  support  is dependent  in  part  on a  stable  Medicaid                                                               
environment.   There is  a need  to have someone  at the  helm of                                                               
DHSS  who has  the  business acumen,  the  finance and  budgetary                                                               
skills,   the   workforce    development   expertise,   and   the                                                               
communication and  emotional intelligence to lead  change and Mr.                                                               
Crum  has those  skills and  experiences.   She looks  forward to                                                               
partnering with  DHSS to  deliver more value  for its  health and                                                               
social services dollars.                                                                                                        
                                                                                                                                
3:31:44 PM                                                                                                                    
                                                                                                                                
GREG WEAVER  testified in opposition  to the confirmation  of Mr.                                                               
Adam Crum  as commissioner of  DHSS.   He said the  committee had                                                               
some  direct questions  of  Mr. Crum,  but there  were  a lot  of                                                               
indirect answers or  answers that went nowhere.  He  met Mr. Crum                                                               
over 12  years ago  when he  was employed  at the  family's truck                                                               
driving school and  he witnessed a lot of things  he wasn't happy                                                               
with between  students and  instructors.   Mr. Crum  doesn't have                                                               
the character  or leadership qualities,  nor has Mr.  Weaver seen                                                               
any accomplishments or government  experience in Mr. Crum's life.                                                               
He urged the committee to vote no on Mr. Crum's appointment.                                                                    
                                                                                                                                
3:33:27 PM                                                                                                                    
                                                                                                                                
CASEY DSCHAAK  testified in  support of  the confirmation  of Mr.                                                               
Adam  Crum as  commissioner of  DHSS.   The  question before  the                                                               
committee is whether Mr. Crum is  qualified for the position.  It                                                               
does not have anything to do  with whether members agree with Mr.                                                               
Crum's  policies or  the  direction  that he  wants  to take  the                                                               
department.   Mr. Crum has  experience managing a large  group of                                                               
people and  a disparate number  of competing  requirements, which                                                               
is  what the  commissioner position  will require.   Many  of the                                                               
[committee's]  questions have  been leading  and many  have given                                                               
Mr. Crum  no choice regardless of  whether he answers yes  or no.                                                               
He  cautioned the  committee to  look  at whether  the person  is                                                               
being  evaluated  on  his  ability  or  on  his  policies.    The                                                               
committee should not hold this  appointee responsible for being a                                                               
doctor  or someone  who has  long-term experience  in the  health                                                               
field.   What needs  to be  looked at is  whether this  person is                                                               
able to manage  this department and Mr. Crum is  a very qualified                                                               
person to management this department.                                                                                           
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  responded there  might  be  a difference  of                                                               
agreement on  what the importance of  the committee's questioning                                                               
is.  When running a $3.4  billion organization it is fair game to                                                               
have a  conversation about the  policies in order  to demonstrate                                                               
whether the  applicant has  the chops  and has  done the  work to                                                               
demonstrate  readiness for  the job.   This  committee takes  its                                                               
responsibility to  vet this candidate  very seriously  because it                                                               
is so important.                                                                                                                
                                                                                                                                
3:36:56 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ left public testimony open.                                                                                  
                                                                                                                                
3:37:44 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 3:37 p.m.                                                                                                          
                                                                                                                                

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