Legislature(2019 - 2020)CAPITOL 106
04/13/2019 01:30 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): Commissioner, Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 13, 2019
1:34 p.m.
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):
Commissioner, Department of Health and Social Services
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 Adam Crum as commissioner of DHSS.
JAYNE ANDREEN
Douglas, Alaska
POSITION STATEMENT: Testified in opposition to the confirmation
of Adam Crum as commissioner of DHSS.
TONYA HALLIDAY
Cook Inlet Dental
Kenai, Alaska
POSITION STATEMENT: Testified in opposition to the confirmation
of Adam Crum as commissioner of DHSS.
MICHELLE OVERSTREET, Founder & Director
MyHouse
Wasilla, Alaska
POSITION STATEMENT: Testified in support of the confirmation of
Adam Crum as commissioner of DHSS.
ZHENIA PETERSON
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to the confirmation
of 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
Adam Crum as commissioner of DHSS.
ELIZABETH RIPLEY, CEO
Mat-Su Health Foundation
Wasilla, Alaska
POSITION STATEMENT: Testified in support of the confirmation of
Adam Crum as commissioner of DHSS.
GREG WEAVER
Wasilla, Alaska
POSITION STATEMENT: Testified in opposition to the confirmation
of Adam Crum as commissioner of DHSS.
CASEY DSCHAAK
Dillingham, Alaska
POSITION STATEMENT: Testified in support of the confirmation of
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 were Representatives Hannan and Hopkins.
^CONFIRMATION HEARING(S): Commissioner, Department of Health and
Social Services
CONFIRMATION HEARING(S):
Commissioner, Department of Health and Social Services
1:35:24 PM
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 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.
The first is to address the overall budget. He explained that
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. The second priority is to work on Alaska
Psychiatric Institute (API) and its issues. He stated that 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. Commissioner Crum said the
third priority is to reduce the backlog of applications at the
Division of Public Assistance (DPA). He said 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 the department'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 is 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 incident of 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 from 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 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 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
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 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 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 the state to "a ten-
hundred-million-a-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 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
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 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 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 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 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
[opinion] 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 3:38 p.m.
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