Legislature(2021 - 2022)BY TELECONFERENCE
03/02/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Executive Order 119 - Dhss Reorganization | |
| HB76 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | HB 76 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 2, 2021
3:04 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair (via teleconference)
Representative Tiffany Zulkosky, Co-Chair (via teleconference)
Representative Ivy Spohnholz (via teleconference)
Representative Zack Fields (via teleconference)
Representative Ken McCarty (via teleconference)
Representative Mike Prax (via teleconference)
Representative Christopher Kurka (via teleconference)
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
EXECUTIVE ORDER 119 - DHSS REORGANIZATION
- HEARD AND HELD
HOUSE BILL NO. 76
"An Act extending the January 15, 2021, governor's declaration
of a public health disaster emergency in response to the novel
coronavirus disease (COVID-19) pandemic; providing for a
financing plan; making temporary changes to state law in
response to the COVID-19 outbreak in the following areas:
occupational and professional licensing, practice, and billing;
telehealth; fingerprinting requirements for health care
providers; charitable gaming and online ticket sales; access to
federal stabilization funds; wills; unfair or deceptive trade
practices; and meetings of shareholders; and providing for an
effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 76
SHORT TITLE: EXTENDING COVID 19 DISASTER EMERGENCY
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/18/21 (H) READ THE FIRST TIME - REFERRALS
02/18/21 (H) HSS, FIN
02/19/21 (H) HSS REFERRAL REMOVED
02/19/21 (H) BILL REPRINTED
02/26/21 (H) FIN AT 1:30 PM ADAMS 519
02/26/21 (H) -- MEETING CANCELED --
03/01/21 (H) HSS REFERRAL ADDED BEFORE FIN
03/01/21 (H) BILL REPRINTED
03/02/21 (H) HEALTH & SOCIAL SERVICES at 3:00 PM BY
TELECONFERENCE
WITNESS REGISTER
LYNN BIGGS, Senior Director/Strategic Consultant
Casey Family Programs
Yakima, Washington
POSITION STATEMENT: Testified in support of Executive Order 119
and shared a PowerPoint presentation on Casey Family Programs.
RYAN MCKEE, State Director
Americans for Prosperity
Wasilla, Alaska
POSITION STATEMENT: Provided testimony on Executive Order 119.
TREVOR STORRS, President and CEO
Alaska Children's Trust
Anchorage Alaska
POSITION STATEMENT: Provided testimony on Executive Order 119.
CHIEF "PJ" POLLACK B. SIMON, JR., Chief and Chair
Tanana Chiefs Conference
Fairbanks, Alaska
POSITION STATEMENT: Testified on behalf of the Tanana Chiefs
Conference on Executive Order 119.
ADAM CRUM, Commissioner
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented HB 76 on behalf of the bill
sponsor, House Rules by request of the governor.
HEIDI HEDBERG, Director
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
76.
ACTION NARRATIVE
3:03:37 PM
CO-CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:04 p.m.
Representatives Fields, Kurka, Snyder, Spohnholz, Prax, and
Zulkosky were present (via teleconference) at the call to order.
Representative McCarty arrived (via teleconference) as the
meeting was in progress.
^EXECUTIVE ORDER 119 - DHSS REORGANIZATION
EXECUTIVE ORDER 119 - DHSS REORGANIZATION
3:04:35 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would Executive Order (EO) 119 - Department of Health and Social
Services reorganization.
3:05:55 PM
LYNN BIGGS, Senior Director, Strategic Consultant, Casey Family
Programs, testified in support of EO 119. She introduced a
PowerPoint presentation on Casey Family Programs. She began by
outlining her presentation and described the PowerPoint as
discussing the pros and cons of various organizational
structures and reorganization. She commented that committee
members should have access to the Alaska Tribal Child Welfare
Compact technical assistance, findings, and recommendations
regarding the compact. She also noted that she would provide
information on staff turnover, and that committee members should
have a related information packet.
MS. BIGGS stated that Casey Family Programs (CFP) is very
committed to Alaska and improving outcomes for Alaska children,
teenagers, and families. She explained that CFP has been
working with the compact and with tribal state groups on
disproportionality and prevention. She offered some background
information about CFP from slide 2 of her presentation which
read as follows [original punctuation provided]:
? The nation's largest operating foundation focused on
safely reducing the need for foster care and building
Communities of Hope for children and families.
? We work to influence long-lasting improvements to
the safety and success of children, families and the
communities where they live.
Operating in all 50 states, DC, Puerto Rico, and the
Virgin Islands.
Direct agreements with 16 tribes.
9 field offices provide direct services to youth in
care.
MS. BIGGS added that in Alaska CFP has agreements with Tanana
Chiefs Conference, Tlingit and Haida Indian Tribes of Alaska,
and Kawerak, Inc.
3:08:09 PM
MS. BIGGS continued to slide 3 in her presentation, which read
as follows [original punctuation provided]:
Casey Family Programs' Work with Alaska
? Casey Family Programs has been working and investing
in Alaska since the year 2000.
? We have worked with the State, Tribes, philanthropic
organizations, the University of Alaska, and others to
effect positive, improved outcomes for Alaskan
children and families.
? We have sponsored statewide efforts to address
Adverse Childhood Experiences in Alaska and to safely
reduce the need for foster care.
MS. BIGGS commented that one of CFP's biggest concerns has been
disproportionality. She shared that despite numerous efforts
there has not been a reduction in disproportionality. She
resumed presenting with slide 4, which read as follows [original
punctuation provided]:
An Alaska Native infant (age 1 or younger) has a 15%
chance of being the subject of a child abuse and
neglect investigation. An Alaska Native child has an
80% chance of being the subject of a child abuse and
neglect investigation by age 18.
? Casey Family Programs has actively supported efforts
to reduce disproportionality of Native children in
foster care in Alaska.
We have sponsored Alaska's Strategic Plan of 2016-
2020 to 'Transform Child Welfare Outcomes for Alaska
Native Children.
? We are strong supporters of Alaska's Tribal State
Child Welfare Compact and its full implementation.
? We participate in Alaska's longstanding Tribal State
Collaboration Group.
3:09:42 PM
MS. BIGGS continued to slide 5 in her presentation, which read
as follows [original punctuation provided]:
Casey Support for the Alaska Tribal Child Welfare
Compact
? Tribes know the needs of their children and
families, their culture and traditions.
? Tribes are best suited to administer and deliver
services.
? Casey Family Programs currently funds two contract
positions: a project manager and a Tribal liaison.
? Casey is committed to supporting the Compact
implementation and sustainability through consulting
and technical assistance, regardless of state agency
structure.
MS. BIGGS shared that in support of the compact, CFP had
contracted with a project manager and tribal liaison.
3:10:42 PM
MS. BIGGS turned attention to on data slides 6 and 7 and
paraphrased the information on the slides. She explained that
the information on the slides underscored the racial disparity
in Alaska. She pointed out that Alaska Native children are 17
percent of the child population, but when looking at poverty,
the number rises to 35 percent. When looking at children
screened for investigation 50 percent are Alaska Native, and 57
percent are confirmed as maltreated, she stated.
MS. BIGGS then addressed the graphs on slide 7. She again noted
that the child population [is] 17 percent [Alaska Native], but
they are entering foster care at a rate of 47 percent for
American Indian or Alaska Native. She continued, stating that
45 percent of kids in care are Alaska Native; children in care
for two years or longer is 48 percent Alaska Native, and youth
aging out of care is 51 percent Alaska Native.
3:12:03 PM
MS. BIGGS moved onto slide 8, which displayed a graph of the
rate of children entering care from 2010-2019. She pointed out
that the rate of children entering care was very high at 21.2
per 1,000 children for Alaska Native children, far exceeding all
the other groups. All of that, she explained, was to underscore
how pervasive the disproportionality issue is. She said that is
why CFP feels so strongly about the compact as a very hopeful
and helpful strategy to improve outcomes.
3:12:51 PM
REPRESENTATIVE PRAX interjected to ask if the committee members
can ask questions now.
CO-CHAIR ZULKOSKY asked for questions to wait until the end of
the presentation.
3:13:08 PM
MS. BIGGS continued to slide 9, which read as follows [original
punctuation provided]:
Alaska Tribal Child Welfare Compact
What is the Compact?
? Groundbreaking opportunity: Government-to-Government
agreement
? A contractual agreement to transfer State general
funds to Tribal Co-signers to provide select services
on behalf of the State.
? 18 Co-signers representing 163 Tribes throughout the
state.
? Took effect January 1, 2018
? State continues to have decision-making authority
over child welfare cases.
? Addresses mutual vision of success, information
sharing, shared responsibility and liability.
MS. BIGGS skipped slide 10 and read from slide 11, which read as
follows [original punctuation provided]:
Challenges to Compact Implementation & Sustainability
? Lack of existing systems to support implementation:
Referral process and tracking outcomes is complex for
State and Tribes.
? High caseloads and turnover of local OCS caseworkers
may make local or regional referrals impossible.
? Lack of adequate State staff and Tribal Co-Signers'
staff dedicated to manage Compact.
State funding for one staff per Co-Signer does not
account for varying capacity among Tribes.
? Lack of staffing that will promote sustainability:
including development and monitoring of quality
improvement measures.
3:14:52 PM
MS. BIGGS moved to slide 12 and paraphrased the information
listed, which showed examples of how some states administer
child and family services through a continuum of structural
configurations. She said one is through multiple cabinet-level
agencies, one is a single consolidated health and human services
agency, and then one other way is through various agency
combinations of child welfare, early childhood [programs],
juvenile justice, and so on.
MS. BIGGS paraphrased slide 13 which read as follows [original
punctuation provided]:
No Research Evidence of an Ideal Organizational
Structure
Governors and state legislatures have long reorganized
state agencies in an effort to improve outcomes and
services.
Research is lacking. The limited research and
extensive state experiences tell us:
? No ideal structure: Every approach has pros and
cons.
? Positive child and family outcomes cannot be
attributed to a particular model.
? No research evidence of improved accountability or
service quality with reorganization.
? Organizational climate and culture (low conflict,
cooperation, role clarity) may contribute more to
outcomes than interagency coordination structures.
MS. BIGGS moved to slides 14 through 17 and informed the
committee she wouldn't go through them [in detail] but said
committee members could see the pros and cons from each
structure.
3:16:56 PM
MS. BIGGS moved to slide 18 and explained her reasoning behind
using the State of Washington as an example. She said it was a
more recent example of the organization and it shows how much
went into that as far as background and planning, stakeholder
engagement, and inclusion of tribes and communities which were
all part of [Washington State's] structure.
MS. BIGGS quickly ran through slides 19 through 21, which
continued to outline the example of Washington State and lessons
that can be learned from it. She noted that the use of data is
extremely important to determine priorities, and that desired
outcome should drive the structure. She said inclusion of
tribes, communities, people with lived experiences, and as many
stakeholders as possible ensures that agency resources are
aligned with desired outcomes. Transition to a new structure
usually takes two to five years: one year or more for
planning/preparing and up to five years for implementation. She
shared that implementation science has been utilized in many of
these, because it usually takes a long time and is disruptive to
some extent.
MS. BIGGS continued to paraphrase from slide 21 sharing that
another lesson was to plan carefully for the separation from a
single consolidated agency to a separated or bifurcated agency,
to ensure that the resources are adequate, and that strong
leadership, continuous improvement systems, and accountability
mechanisms are important regardless of structure.
3:19:08 PM
MS. BIGGS turned to slide 22, "High Costs of Child welfare
Workforce Turnover for Children & Families," which read as
follows [original punctuation provided]:
? Studies in Colorado and Wisconsin found that case
worker turnover dramatically increases the time to
achievement of a permanent family for children in
foster care.
? A study by the U.S. Government Accountability Office
(GAO 03-357) found that caseworker turnover
contributed to states' failure to meet federal
performance standards including:
Timely response in child protection investigations,
Timely closure of investigations (an important
factor in both workload and families' need for
resolution),
Frequency of caseworker contact,
Maltreatment recurrence, and
Timely attainment of permanency for children in out
of home care.
MS. BIGGS read from slide 23, "Other Costs of Child Welfare
Workforce Turnover," which read as follows [original punctuation
provided]:
? Direct costs of overtime, worker separation, and
hiring/training new staff.
? Domino Effect: Remaining staff are more likely to
leave.
? Indirect costs for other workers (increased
paperwork and case management, emotional exhaustion,
supervisors redirecting time to providing direct
service).
? Financial costs: Every time a caseworker leaves, the
cost to the child welfare agency is 30200 % of the
exiting employee's annual salary.
MS. BIGGS next shared slide 24, which read as follows [original
punctuation provided]:
What Causes Caseworkers to Leave?
? A meta-analysis of 22 studies identified 36
variables that most affected caseworkers' intention.
? Factors that have the greatest effect: Stress,
emotional exhaustion, organizational commitment, job
satisfaction.
What are the Essential Foundational Steps that
Agencies Need to Take?
? Conduct their own outreach and inquiry to determine
the causes of their workers' dissatisfaction and
turnover.
? Develop and implement a comprehensive workforce
development plan that responds to the state workforce
needs.
? Build a supportive agency culture, regardless of
agency structure.
MS. BIGGS moved to slide 25, "What Works to Reduce Turnover?"
and presented a list which read as follows [original punctuation
provided]:
What Works to Reduce Turnover?
1. Analysis of turnover and organizational
environment; assessment of caseload/ workload.
2. Building, leading & elevating a comprehensive
workforce development plan.
3. Identifying the right competencies: Job analyses,
specialized positions to support best practices.
4. Educating/preparing the right students: University-
agency partnerships, financial supports for students &
existing staff.
5. Finding/hiring the best applicants.
6. Onboarding and welcoming new staff.
7. Providing incentives and a range of supports for
staff.
8. A comprehensive training system.
9. Effective management and supervision.
10. Healthy agency climate and culture.
MS. BIGGS concluded the presentation and asked for questions.
3:22:39 PM
CO-CHAIR ZULKOSKY noted that there are many others who want to
testify, and they only have time for a couple of questions.
REPRESENTATIVE PRAX recollected that Ms. Biggs had mentioned
that 80 percent of Native children end up in abusive situations
but offered his understanding that the Native culture is built
upon raising children. He commented that he didn't understand
that, because it was an inherent contradiction and suggested
there must be more to it than that. He asked Ms. Biggs to
elaborate on that.
MS. BIGGS asked Representative Prax to clarify whether he was
asking why there is an 80 percent chance of an Alaska Native
child being the subject of child abuse.
3:24:13 PM
CO-CHAIR ZULKOSKY interjected that "this is probably not the
environment for that conversation, and any questions about
disproportionality and cultural impacts are probably best suited
for additional testifiers at another time." She said the focus
of the meeting was on the structure of the department and not
the disparities that are identified. She told Ms. Biggs she
didn't have to spend her time talking about the impacts or the
specifics of cultural implications but asked her if she could
talk about "any contributing factors to disproportionality."
MS. BIGGS said one of the contributing factors is institutional
racism. She argued that sometimes the questions of safety and
risk are complicated and should be separated to determine if the
child is unsafe or at risk. She also suggested that sometimes
social workers don't have a lot of experience and are sometimes
biased.
REPRESENTATIVE PRAX asked if the study is something CFP
conducted for the state, or if it was general theory.
MS. BIGGS responded that these statistics came from data that
showed how Alaska Native children were disproportionately in
foster care.
REPRESENTATIVE PRAX asked if Ms. Biggs looked at Alaska's care
system specifically.
CO-CHAIR ZULKOSKY clarified for Ms. Biggs that there were new
members on the committee since the last time she presented, so
it could be helpful to discuss CFP's work with the Department of
Health and Social Services (DHSS).
MS. BIGGS responded that the organization has worked in Alaska
since 2000 with both the state and tribes. The goal is to
improve outcomes for children in foster care and to reduce
disproportionality. She said that more recently CFP has been
focusing on prevention and strategies like in home services.
3:28:41 PM
REPRESENTATIVE SPOHNHOLZ asked about the challenges in tribal
child welfare compacting and asked if there is a specific driver
that challenges that, or if there are a series of factors.
MS. BIGGS responded that she thinks there was a series,
including a lack of staff dedicated to implementation, the
complexity of some of the scopes of work, and a lack of
processes in place to successfully implement it.
REPRESENTATIVE SPOHNHOLZ agreed that one staff doesn't seem
enough to support the work. She discussed the lessons learned
from Washington State and asked about the two to five years
necessary to implement a complex transition.
MS. BIGGS responded that there needs to be more stakeholder
engagement. She argued more time needs to be spent with those
most impacted by a transition to create buy-in and input. She
said this included current staff, community members, and
children with lived experiences, other agencies, and
philanthropic organizations.
3:32:33 PM
RYAN MCKEE, State Director, Americans for Prosperity, shared his
testimony regarding EO 119. He stated that Americans for
Prosperity did not have an official stance on EO 119 but did see
some benefits to bifurcating DHSS. He pointed out that it is a
large department with over 3,400 employees, and that splitting
it up would help focus on more specific portions of everything
that is in DHSS. He argued that with more specific tasks
assigned to employees, they would have a better chance to excel
at their jobs rather than trying to tackle everything that comes
at them. He noted that the Office of Children's Services (OCS)
has roughly a 50 percent turnover rate, which costs about $13
million a year. He also argued that a lot of work and
improvement needs to come from the Medicaid sector and that is
why the organization would support DHSS's employees being able
to focus more on those specific tasks.
MR. MCKEE said that from a fiscal standpoint, Americans for
Prosperity realizes that there will be added costs, specifically
the 13 new positions and the 15 declassified positions. He
noted that the organization is opposed to any duplicate
positions. it does not see any doubling of efforts in EO 119,
but sees it as focused on alignment of current operations.
3:36:01 PM
REPRESENTATIVE SPOHNHOLZ asked Mr. McKee about how simplifying
workloads would reduce turnover in OCS. She observed that EO
119 doesn't simplify OCS, but instead creates new administrative
executive positions, which she argues wouldn't change the
workload. She asked if Americans for Prosperity supports
creating more administrative overhead without providing more
simplicity or frontline workers.
MR. MCKEE responded that Americans for Prosperity has not taken
a position on EO 119 yet. He said the organization thinks the
additional positions are necessary to split [DHSS] into two
different groups, but it is not supportive of a blanket increase
in administrative positions. He commented that while more
information is needed, the organization does see some benefits.
REPRESENTATIVE SPOHNHOLZ argued that the proposal creates
additional executive leadership positions and doesn't simplify
front line workers' duties in any way, in effect creating more
bureaucracy and overhead.
3:38:28 PM
CO-CHAIR FIELDS stated that for a long time Americans for
Prosperity did not acknowledge the beneficial economic impacts
of public employment. He asked about the change in its approach
to economic development in Alaska.
MR. MCKEE responded that the organization has not changed its
stance on certain issues. He clarified that the organization is
not opposed to public employees, who he said play a crucial role
in Alaska. However, he argued that the organization does see
that [EO 119] could be beneficial and is willing to explore the
opportunity. He indicated the organization is interested in the
discussion surrounding this issue and to see how it would play
out to separate the two divisions.
3:40:41 PM
TREVOR STORRS, President and CEO, Alaska Children's Trust,
stated that his testimony would focus solely on 119 and not the
potential bifurcation of the Office of Children's Services. He
stated that as the statewide leader in the prevention of child
abuse and neglect, the Alaska Children's Trust (ACT) applauds
the commissioner [of the Department of Health and Social
Services (DHSS)] for challenging how the current system is
functioning. He informed the committee members that ACT and
DHSS have teamed up to host discussions with leaders serving
children and families and to co-host a townhall meeting for the
public. However, he noted, (ACT) is neither for nor against the
bifurcation. He said the goal of his testimony was to share the
questions and concerns that ACT and its partners have related to
the bifurcation, which have been shared with DHSS.
MR. STORRS said the most important questions are whether the
bifurcation would improve supports and services, and how [it
would achieve that]. He shared that according to the Annie E.
Casey Foundation, overall, Alaska is ranked 36th in the nation
for children's wellbeing. He said that nearly 15 percent of
Alaska's children live at or below the national poverty level,
only one third are kindergarten ready, and most are reading
below proficiency at the third and fourth grade level. He
continued and pointed out that Alaska has the third largest rate
of uninsured children and annually over 3,000 children in the
foster care system. He also noted that even pre-COVID-19,
suicide ideation was up for children in Alaska. He argued that
it is important that DHSS outline how the bifurcation will
empower children and families to thrive.
MR. STORRS said a question he has heard from many organizations
and individuals is "Why now?" He pointed out that in two weeks,
it will have been a full year since COVID-19. People are
overwhelmed and exhausted, he said. He defined toxic stress as
prolonged activation of stress responses in the absence of a
protective relationship, which he argued captured the impact of
COVID-19. He explained that toxic stress response can have a
huge toll on people's physical and mental health.
3:44:57 PM
MR. STORRS stated that the proposed bifurcation is a huge change
that individuals in and outside of DHSS will have to manage. He
opined that so much has been asked of these organizations over
the past 12 months, and Alaska needs them to remain strong. He
asked if the change was so imperative that it needed to happen
now, or if it could wait. He further asked, if this was
imperative, what steps are being taken to ensure individuals and
organizations receive the support needed to manage the
additional anxiety it is causing.
MR. STORRS said a major complaint shared has been a lack of
shareholder engagement, and again noted that ACT will be hosting
discussions regarding the bifurcation, although some
stakeholders find this late in the process. He explained that
waiting to engage with stakeholders within days of the deadline
has caused trust issues with community partners.
MR. STORRS said an additional concern is how the bifurcation
will be cost neutral. He said there will be additional costs
that will have to come from existing funding. He asked where
this funding will come from and how it will impact the programs
it is being taken from. He explained that the greatest fear for
organizations is that a greater burden will be put on families
and organizations. He argued that community partners want DHSS
to be successful, but they cannot help without being truly
invited to the table. He concluded that Alaskans all share the
same goal of wanting families and children to thrive. He
challenged the committee members to imagine the outcome if
[stakeholders and government] were to join forces to make Alaska
the best state to grow up in.
3:47:39 PM
CO-CHAIR SNYDER asked about the upcoming town hall and who can
attend.
MR. STORRS responded that there are two town halls and the first
is specifically targeting community partners. He said anyone
who provides services is welcome, although this is targeted at
executive level [individuals] who deal with policy changes. The
second will be broadcasted for anyone in the public to join,
hear about the bifurcation, and ask questions.
3:49:40 PM
REPRESENTATIVE MCCARTY asked about the workforce and caseload
for OCS. He asked if there was a point when ACT will be taking
a position, and if the committee members would be able to hear
back on what the position is.
MR. STORRS explained that he did not address [bifurcation]
purposefully, since it was not part of EO 119. He said that ACT
has similar concerns [about OCS]. He commented that [DHSS
Commissioner Crum] has been working with the [Alaska Tribal
Health Compact] tribal caucus and will be having further
discussions with ACT around [OCS]. He said ACT is putting
together a letter and getting different partners to review it
and sign on to bring the commissioner and his team up to speed
on where [ACT and its partners] as community leaders are at, and
how they can help DHSS be successful.
MR. STORRS mentioned that he had testified before the previous
legislature's House Standing Committee on Health and Social
Services, and he offered to forward that testimony to current
members.
3:52:36 PM
CO-CHAIR ZULKOSKY shared that her office will share that
information.
REPRESENTATIVE MCCARTY asked if Mr. Storrs could share solutions
for this issue.
MR. STORRS said he would be happy to, but there wasn't time
today. He stated that everyone is correct that OCS is overrun.
He said to see fewer families in the childcare system, "we
really need to work upstream." He argued that data needs to be
used to have an authentic conversation about what the state can
be doing. He offered examples of working with youth, making
sure that the school systems have a comprehensive human
development curriculum [which teaches] how trauma impacts the
brain, and how the brain develops, because all the kids going
through K-12 are the future parents.
MR. STORRS shared that 7075 percent of the kids in the child
welfare system were unplanned and unwanted, which puts them at
the highest risk level. He argued for making sure that
contraceptive family planning [is available] in Alaska. He
acknowledged how that could be a challenge to some people's
personal values, but good family planning is very key. He also
pointed out that poverty puts families at greater risk because
they have less access to support services, resources, and skills
and knowledge needed to be successful. He explained that if
families can space out their children, their level of poverty is
decreased. He again said the problem is upstream, mentioned
shortening "the line," and indicated that would result in fewer
cases going through the child welfare system.
3:56:07 PM
REPRESENTATIVE SPOHNHOLZ thanked Mr. Storrs for his work and the
work of his team at ACT in keeping families together. She also
thanked him for bringing up the issue of toxic stress in the
middle of COVID-19 and agreed that employees in the department
of Health and Social Services were also experiencing this level
of stress. She thanked him for facilitating stakeholder
engagement through townhalls. She raised concern that the
public townhall was scheduled after the legislature's deadline
to act on EO 119. She stressed that DHSS is a large department
and many individuals and private businesses across the state
will be impacted by this. She asked what meaningful stakeholder
engagement would look like.
MR. STORRS responded that partners feel same, and that there
should have been a better plan after the announcement was made
for these kinds of conversations to happen. He said ACT
understood why DHSS may not have done stakeholder engagement
with the question of bifurcation, since it is a big organization
and internal experts may best be able to answer that question.
He suggested that the big question is how to make sure the
services are consistent. To do that [would require] listening
sessions [with partners], synthesizing the information and going
back to providers with a proposal, and then asking for further
feedback, he said. He commented that he is excited that the
commissioner is looking into having a key liaison between
partners and stakeholders. He said that there are issues with
trust with DHSS, but the stronger the [stakeholders']
relationship [with DHSS], the more successful they will be.
REPRESENTATIVE SPOHNHOLZ said stakeholder engagement sounded
like a very complicated process and probably needed more than
one or two listening sessions.
MR. STORRS agreed and said it would be better to sit down and
discuss this topic. He said he didn't want it to seem like ACT
was coming up with [an answer] and suggested that a small task
force would need to come up with a plan and find ways to enact
that plan.
4:02:14 PM
CO-CHAIR ZULKOSKY asked if ACT was engaged in substantive
conversations about the concept of splitting DHSS prior to the
announcement in December.
MR. STORRS responded no. He shared that he was not contacted.
He said it was indicated that he was on a list to have been
given a heads up prior to [the announcement], but he was the one
who made the initial contact.
4:03:23 PM
CO-CHAIR ZULKOSKY acknowledged that discussion was running long,
but she felt it was an important topic.
CHIEF "PJ" POLLACK B. SIMON, JR., Chief and Chairman, Tanana
Chiefs Conference (TCC), shared that TCC is an intertribal
consortium that provides health and social services to 16,000
Alaska Natives living Fairbanks and the surrounding villages.
He mentioned that TCC is a cosigner to the Indian Health
Services Compact, the agreement which gives TCC the authority to
provide health services to tribal members on behalf of the
United States Federal Government. He explained that TCC is also
a member of the Alaska Native Health Board which is a nonprofit
that assists in implementation of tribal self-determination
through advocacy.
CHIEF SIMON stated that TCC utilizes services from every
division of the Department of Health and Social Services
(DHSS),and is disproportionately represented as beneficiaries of
these programs. He shared that TCC is a co-signer to the Alaska
Tribal Health Compact and the Alaska Child Tribal Welfare
Compact and has worked along-side the state through many
administrations on various work groups and collaborations.
4:06:01 PM
CHIEF SIMON said TCC does not support the bifurcation, as it
would create a separation between programs and services that are
necessarily intertwined. He stated that the proposed separation
of the Office of Children's Services (OCS), the Division of
Public Assistance, and the Division of Behavioral Health is
baffling, because OCS couldn't support families in crisis
without working with the other divisions. He argued that
similar comments could be made about the Division of Juvenile
Justice because of the need for behavioral health intervention.
He continued, asking the justification of splitting the Alaska
Pioneer Homes from the Division of Senior and Disability
Services.
4:07:42 PM
CHIEF. SIMON stated that TCC is both a health agency and a
social services agency. He argued that one system makes sense
because they are able to provide holistic, wraparound, and
patient centered services. He said TCC achieved less overhead
and a reduction in positions by keeping services under one roof.
He offered an example wherein patient presents at the clinic and
has a food security issue, and a case manager is able to contact
the client services division and connect the patient with the
necessary services. He continued listing the benefits for
tribal members of the interconnected design of TCC.
CHIEF SIMON said DHSS's frequently asked questions page
indicated that this change is being made to "streamline the
focus of the Department of Health" and to "make meaningful
interventions for those Alaskans who are experiencing crisis or
supporting their loved ones." He argued that it is unclear how
the proposal will meet either objective, especially in a time
when the state budget is in crisis. He argued that there is no
data or information on how this new unit will lead to better
healthcare delivery. He said the data did not justify the
creation of a new department, which would mean a new
commissioner, staffing, facility, and other costs.
CHIEF SIMON argued this is money the state does not have. He
recounted that over the past few years, the state has been in a
crisis due to declining oil revenue, and the insufficiency of
other revenue sources to support basic state services. He
argued that there have been annual budget cuts that led to
reduced services championed by the current administration. He
opined that in the midst of this financial environment,
splitting DHSS did not make sense and would lead to larger cuts
in services down the road.
4:12:04 PM
CHIEF SIMON said CCT seeks to work with the commissioner to
ensure any reorganization of DHSS benefits Alaskans. He
disagreed with the administration that the proposed
reorganization would amount to minimal additional costs, since
the units already exist. He then challenged the idea that the
reorganization would provide services to Alaskans better and
more efficiently. He questioned how this would lead to better
services if funds were diverted from actual services to
administration.
CHIEF SIMON observed that the programs in the new Department of
Family and Community Service are those the administration has
tried to privatize. He said it was time for the state to
provide these programs with the support they need and to stop
expecting a private operator to do better.
CHIEF SIMON said that in conclusion, TCC does not support this
proposal and believes it would lead to worse outcomes than the
status quo. He reiterated that TCC is happy to collaborate with
the state on ways that improve outcomes. He added that he hopes
TCC and other tribes around the state are consulted before
future proposals are announced. He requested more engagement
and more tribal leaders at the table. He shared that 2,800
Alaska Native children were currently in foster care, making up
64 percent of all Alaska children in foster care. He said that
an investment in children's services is an investment in the
future of Alaska.
4:15:36 PM
REPRESENTATIVE SPOHNHOLZ commented that Chief Simmon's insights
were very important and asked him what meaningful stakeholder
engagement would look like, and whether he felt like it had
taken place.
CHIEF SIMON responded that TCC would like more Alaska Native
leaders meeting with DHSS, and to be more involved in decisions.
He said they were not engaged before the governor made this
proposal. He commented that being in children's services is
very tough, and family separation is hard. He argued that the
children's safety is jeopardized by the proposed structure.
REPRESENTATIVE SPOHNHOLZ asked Chief Simon what would meaningful
stakeholder engagement about splitting DHSS look like, and if he
had a sense of what a process would look like before he would
feel comfortable supporting a potential split of DHSS.
CHIEF SIMON replied that TCC was not engaged before this
decision was made by the Office of the Governor. He said he
felt [splitting the department] was not very helpful, especially
not while the state was in decline over oil revenue and during a
pandemic.
4:18:50 PM
REPRESENTATIVE PRAX asked about how TCC works. He asked if TCC
provides services or refers to other service providers.
CHIEF SIMON answered that TCC provides services and described it
as a "one-stop-shop."
REPRESENTATIVE PRAX asked if TCC is encouraging more involvement
by the tribes. He asked if children are being taken out of the
Native culture through OCS.
CHIEF SIMON said that it is all about service, regardless of the
children going to different types of families. He said the
children and their safety were of upmost priority. He
emphasized the committee members were discussing children's
lives. He again noted that 64 percent of children in foster
care are Alaska Native.
REPRESENTATIVE PRAX replied that he would like to chat more
later.
CHIEF SIMON said that this is no disrespect to lawmakers. He
explained that TCC is trying to deliver a high level of service
in remote locations in a nonstandard fashion. He restated TCC
felt strongly that DHSS splitting would only impede services.
He said that when families are split up it is traumatic for all
involved, and TCC strives to make it less traumatic.
4:22:59 PM
REPRESENTATIVE KURKA said he appreciated Chief Simon's comments
and concerns about the trauma being done to children. He shared
that he has not decided if is for or against the bifurcation,
but the current system does not work. He said the statistics he
was hearing were horrible, and something was broken. He shared
that several of his family members are foster parents and he had
heard case workers speak positively towards the change.
4:25:27 PM
CO-CHAIR ZULKOSKY asked Ms. Biggs if she can help the committee
identify with Representative's Kurka's comments if it is a
structural issue with the department, or if it is an issue of
the culture and environment of the department.
MS. BIGGS responded that what Co-Chair Zulkosky said was true,
and it was an issue of caseloads and high turnover. She said
this is why Casey Family Programs is a proponent of having
tribes increasingly take care of their children with support and
services so that these outcomes improve, which would also
alleviate stress on OCS.
4:26:50 PM
CHIEF SIMON commented that it isn't about culture; it is about
providing a high level of service. He said all the employees
with TCC are doing the very best they can to provide
opportunities for children.
4:28:41 PM
CO-CHAIR ZULKOSKY announced that EO 119 was held over.
HB 76-EXTENDING COVID 19 DISASTER EMERGENCY
4:29:39 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 76, "An Act extending the January 15,
2021, governor's declaration of a public health disaster
emergency in response to the novel coronavirus disease (COVID-
19) pandemic; providing for a financing plan; making temporary
changes to state law in response to the COVID-19 outbreak in the
following areas: occupational and professional licensing,
practice, and billing; telehealth; fingerprinting requirements
for health care providers; charitable gaming and online ticket
sales; access to federal stabilization funds; wills; unfair or
deceptive trade practices; and meetings of shareholders; and
providing for an effective date."
4:30:17 PM
ADAM CRUM, Commissioner, Department of Health and Social
Services, presented HB 76 on behalf of the bill sponsor, House
Rules by request of the governor. He explained that HB 76 was
introduced by the governor pursuant to AS.26.23.020 and AS
26.23.025. He explained that these two statues provide that a
disaster proclamation may not remain in effect longer than 30
days unless extended by the legislature and provides what
information is required to the legislature when the governor
declares a condition of disaster emergency concurrently with the
issue of a proclamation.
COMMISSIONER CRUM said that on January 15, 2021, the governor
issued a proclamation of a public health disaster emergency in
response to the COVID-19 pandemic. He noted that a bill was
transmitted to the House on January 21, 2021, proposing to
extend the public health disaster emergency to September 30,
2021, or until the commissioner of DHSS certified that there is
no longer an outbreak of COVID-19. The bill also includes other
provisions to protect the public and economic health of the
state. He explained that absent legislative action, the public
health emergency expired on February 14, 2021.
COMMISSONER CRUM shared that the administration evaluated the
current COVID-19 response. He said this involved evaluating
previous response efforts authorities provided under the Alaska
Disaster Act and the current statutory authority under the
Alaska Public Health Emergency. He shared that DHSS also met
with numerous stakeholders and providers to discuss operations
and response efforts if the disaster declaration wasn't
extended, and the department received feedback.
COMISSIONER CRUM paraphrased the beginning of subsection (e) of
AS 26.23.020, which read as follows:
(e) A proclamation of a disaster emergency activates
the disaster response and recovery aspects of the
state, local, and interjurisdictional disaster
emergency plans applicable to the political
subdivisions or areas in question
COMMISSIONER CRUM explained this allowed for unified command
structure to support local jurisdictions and the statewide
public healthcare system and response to the pandemic.
4:34:47 PM
COMMISSIONER CRUM continued in explaining the impact of HB 76.
He paraphrased subsection (f), which read as follows:
(f) During the effective period of a disaster
emergency, the governor is commander in chief of the
organized and unorganized militia and of all other
forces available for emergency duty. The governor may
delegate or assign command authority by appropriate
orders or regulations.
COMMISSIONER CRUM said this allowed the administration to use
the National Guard for certain response purposes such as contact
tracing.
COMMISSIONER CRUM paraphrased subsection (g), paragraph (1),
which read as follows:
(g) In addition to any other powers conferred upon the
governor by law, the governor may, under AS 26.23.010
- 26.23.220,
(1) suspend the provisions of any regulatory
statute prescribing procedures for the conduct of
state business, or the orders or regulations of any
state agency, if compliance with the provisions of the
statute, order, or regulation would prevent, or
substantially impede or delay, action necessary to
cope with the disaster emergency;
COMMISSIONER CRUM explained this was used for emergency
procurement contracts for additional cold chain shippers of
testing and supplies and hiring of personnel to support public
health plans. He shared that it also allowed for increased
flexibility in how the state cared for and provided services to
populations in congregate settings and facilities.
COMMISSIONER CRUM said the state did not use the authority from
paragraph (2) of subsection (g). He drew attention to paragraph
(3), which read as follows:
(3) transfer personnel or alter the functions of state
departments and agencies or units of them for the
purpose of performing or facilitating the performance
of disaster emergency services;
COMMISISONER CRUM explained that the state repurposed the
Division of Public Health to respond to COVID-19.
COMMISSIONOR CRUM skimmed through the rest of subsection (g) and
highlighted paragraphs used in response to the COVID-19
pandemic. He explained that paragraph (7) was the authority
used to implement testing requirements for travel. He said that
paragraph (9) was used for non-congregate housing for the
homeless, for travelers that tested positive, and for healthcare
workers. He said that paragraph (10) was used to distribute
personal protective equipment (PPE), testing supplies, and
vaccines and therapeutic treatment. He pointed out that the
administration did not use paragraphs (4), (5), (6), (8) or
(11).
4:38:13 PM
COMMISSIONER CRUM summarized that not all these authorities were
used. He noted that of the authorities that were used, they
were not all necessarily utilized at the same time. He then
asked, "How does Alaska proceed to a recovery phase, moving
beyond the disaster and emergency?" He said the state could
take a more limited approach. He argued this will also help the
state's economic metrics.
COMMISSIONER CRUM reiterated that through the evaluative process
the administration went through after the disaster declaration
expired on February 14, 2021, the administration realized it
didn't need all the authorities available under the Alaska
Disaster Act. He explained that the administration hopes to use
a more targeted approach by using uncodified law to establish
the needed authorities. He said the authorities that are
identified as important include allowing the Department of
Health and Social Services (DHSS) to manage vaccine distribution
and the therapeutic response to COVID-19, and to allow DHSS to
cooperate with the Federal Government, with respect to blanket
waivers, the 1135 Waiver, Appendix K authorities, as well as the
application and distribution of Emergency Allotment (EA)
Supplemental Nutrition Assistance Program (SNAP) benefits.
COMMISSIONER CRUM said another part was to allow the Department
of Military & Veterans' Affairs (DMVA) to assist DHSS. He said
the DMVA would receive authority from the governor to allow
activation of the Alaska Guard to respond to the pandemic and
coordinate with the Federal Emergency Management Agency (FEMA).
He said there was also the authority for the use of telehealth
and telemedicine for healthcare providers currently licensed in
another state, as well as immunity for employers, governmental
agencies, or persons engaged in the state response.
COMMISSIONER CRUM summarized his presentation. He stated that
the administration understood Alaska's need to progress to a
recovery phase, but also to have the tools to respond as things
change. He said it is possible to continue a safe response plan
without providing the broad authority of a public health
emergency disaster declaration. He noted that standalone bills
had been introduced in the other body to address changes for
shareholder meetings, licensing issues, and telemedicine.
4:42:35 PM
CO-CHAIR SNYDER asked Commissioner Crum if he had a presentation
to go with his testimony.
COMMISSIONER CRUM said [there was no presentation].
CO-CHAIR SNYDER asked if Commissioner Crum's testimony meant the
administration was backing away from the need for HB 76.
COMMISSIONER CRUM replied yes. He said that when the
declaration expired, the administration had to determine how it
would maintain the response. From that, the administration
identified what was needed to have legal coverage going forward
and to make sure it could continue distributing the vaccines and
therapeutics. He said that from public response there was
concern about using the Disaster Declaration Act any further.
He said the administration had been trying to work with federal
partners to make sure that any specific language necessary gave
the administration the cover needed to continue the response.
4:44:51 PM
REPRESENTATIVE MCCARTY clarified that the state felt it was no
longer in an emergency status with COVID-19 and asked if that
was the reasoning for changing the decision.
COMMISSIONER CRUM answered that it has to do with the definition
of the word "disaster." He said the words carry "a certain
connotation." He acknowledged that there was a current public
health emergency, but said it was "with a little 'e' and not a
capital." He stated that the administration has identified ways
it can still access the necessary authorities.
REPRESENTATIVE MCCARTY asked if the state's new status of not
having an emergency in place had any bearings on federal COVID-
19 funds.
COMMISSIONER CRUM responded that the two items tied to state
action were the non-congregate sheltering order, which was being
worked on with FEMA, and the EA SNAP benefits. He said this
could be tied into a law that would be used for future
approvals.
REPRESENTATIVE MCCARTY asked if this has any bearing on data
collection to assess if COVID-19 is becoming better or worse.
COMMISSIONER CRUM responded that data collection is still
possible through standing authority.
4:47:47 PM
REPRESENTATIVE SPOHNHOLZ asked how this changed the ability to
require testing for non-residents who come into the state. She
noted that much of Alaska has limited healthcare, and this had
been an important measure to prevent the spread of COVID-19.
COMMISSIONER CRUM responded that the authorities the state
requested do not include the authority to require pre-travel
testing.
REPRESENTATIVE SPOHNHOLZ asked for clarification if Commissioner
Crum didn't think it's necessary for non-residents to get tested
if and when they come into Alaska.
COMMISSIONER CRUM said it is important to identify who is coming
into the state and shared that now the administration is working
directly with the tourism industry. He said the barriers [for
testing] had been removed by keeping the infrastructure in place
and removing the testing fee.
REPRESENTATIVE SPOHNHOLZ commented that the commissioner is
trying to adapt, and she appreciated that. She expressed that
she thought it in an important public health measure to require
testing for people coming into Alaska. She pointed out that
Alaska has a high number of non-resident workers and tourists.
COMMISSIONER CRUM agreed that it has been an important tool.
4:50:52 PM
CO-CHAIR SNYDER brought up that on January 14, 2021, when the
last disaster declaration passed, Alaska had 193 [new cases of
COVID-19], food insecurity at about 12 percent, and unemployment
claims remained elevated. She also pointed out that that day
Alaska had 124 new cases with increasing food insecurity. She
opined that the current statistics were similar [to when the
last disaster declaration was issued], but the administration
was pursuing authority in a more piecemeal fashion and asked for
explanation on Commissioner Crum's strategy.
COMMISSIONER CRUM responded that DHSS is trying to operate in a
timely manner, and that is why there is a trimmed down response.
He said they had to adjust [without the approval for a new
declaration] on February 14, 2021. He pointed out that the
distribution of the vaccine has been a priority and has helped
reduce hospitalizations from COVID-19.
4:53:26 PM
REPRESENTATIVE KURKA asked how many positive cases of COVID-19
were found by testing travelers, thus resulting, in preventing
those cases from entering Alaska. He then said that he
understood that contact tracing was possible in the beginning,
but his perception was that it fell apart because there were so
many cases. He asked what the point of screening was if the
state could no longer contact trace.
COMMISSIONER CRUM turned to Heidi Hedberg to address the
question.
4:54:53 PM
HEIDI HEDBERG, Director, Division of Public Health, Department
of Health and Social Services, answered questions about HB 76.
She said airport testing began on June 6, 2020, and it has
screened almost 500,000 travelers and identified almost 3000
positives. She opined that it had been a successful endeavor.
In terms of contact tracing, she said DHSS engaged in contact
tracing once it found someone was positive and asked the
individual to notify everyone that he/she came into contact with
for more than 15 minutes within six feet. She stated that that
had really helped to lower the number of positive cases.
REPRESENTATIVE KURKA asked what percentage of cases are
successfully tracked through contact tracing.
DIRECTOR HEDBERG said DHSS would have to follow up with that,
but they do use a database. She said they could compare
percentages of where individuals were exposed, although that
varied through communities across the state.
REPRESENTATIVE KURKA commented that it was clear from DHSS's
online information dashboard how many ICU beds are being used
for COVID-19 patients. He asked what the number of active cases
was, rather than new cases.
4:58:52 PM
COMMISSIONER CRUM shared that underneath the dashboard one can
download raw summary data to look at patients on the COVID-19
aspect.
4:59:26 PM
DIRECTOR HEDBERG responded that when it comes to active cases,
the Center for Disease Control (CDC) said individuals need to
quarantine for 10 days, but some individuals can be symptomatic
for much longer. She said during the summer DSS removed the
"recovered" cases from the dashboard because it is person
specific.
5:00:28 PM
CO-CHAIR ZULKOSKY shared that they have run out of time and
asked if the commissioner could be available during the next
meeting for additional questions.
COMMISSIONER CRUM said he would be there.
5:01:14 PM
REPRESENTATIVE SPOHNHOLZ clarified a misunderstanding that 64
percent of Alaska Native children are not in foster care, rather
64 percent of children in foster care are Alaska Native. She
shared that there are 190,000 children in Alaska, and about
38,000 of them are Native. Alaska only has 2,800 children in
foster care, she explained.
CO-CHAIR ZULKOSKY announced that HB 76 would be held over.
5:02:34 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:03 p.m.