Legislature(2017 - 2018)SENATE FINANCE 532
02/17/2017 08:30 AM Senate FINANCE
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| Audio | Topic |
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| Start | |
| Fy 18 Budget Overview: 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
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
February 17, 2017
8:31 a.m.
8:31:04 AM
CALL TO ORDER
Co-Chair Hoffman called the Senate Finance Committee
meeting to order at 8:31 a.m.
MEMBERS PRESENT
Senator Lyman Hoffman, Co-Chair
Senator Anna MacKinnon, Co-Chair
Senator Click Bishop, Vice-Chair
Senator Mike Dunleavy
Senator Peter Micciche
Senator Donny Olson
Senator Natasha von Imhof
MEMBERS ABSENT
None
ALSO PRESENT
Valerie Davidson, Commissioner, Department of Health and
Social Services; Shawnda O'Brien, Assistant Commissioner
for Finance Management Services, Department of Health and
Social Services.
PRESENT VIA TELECONFERENCE
SUMMARY
FY 18 BUDGET OVERVIEW:
DEPARTMENT OF HEALTH and SOCIAL SERVICES
Co-Chair Hoffman announced that the committee would be
considering a presentation from one of the four major cost
driving departments of the state. He relayed that hearings
of this nature usually took place in subcommittee, but that
the standing committee was attempting to better understand
the services provided by the department and a deeper
appreciation of departmental spending. He reminded the
public that the state was in a financial crisis, and
relayed that the senate had a target goal of streamlining
the state's budget by 10 percent of the total $3 billion
deficit. He warned that the state was in "crisis mode" and
had only one year left of CBR savings. He thought that
making structural changes, in addition to revenue measures,
was the prudent way to move forward.
^FY 18 BUDGET OVERVIEW: DEPARTMENT OF HEALTH and SOCIAL
SERVICES
8:33:49 AM
VALERIE DAVIDSON, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES (DHSS), introduced herself and her support
staff.
8:35:23 AM
Commissioner Davidson discussed the presentation
"Department of Health and Social Services - Senate Finance
- FY2018 Department Overview" (copy on file).
Commissioner Davidson turned to Slide 2, "Health & Social
Services":
The Department of Health and Social Services (DHSS)
was originally established in 1919 as the Alaska
Territorial Health Department. With the formal
proclamation of statehood on January 3, 1959, the
department's responsibilities were expanded to include
the protection and promotion of public health and
welfare. These core duties are reflected in the
mission of the department - to promote and protect the
health and well-being of Alaskans - and are outlined
in Article 7, Sections 4 and 5 of the Constitution of
the State of Alaska.
Department Home and Resource Links
http://dhss.alaska.gov
Constitutional Authority - Article 7, Sections 4 and
5:
http://ltgov.alaska.gov/services/alaskas-constitution/
Duties of the Department
http://www.legis.state.ak.us/basis/statutes.asp#47.05
FY18 Proposed Department Budget
https://www.omb.alaska.gov/html/budget-report/
department-table.html?dept=HSS&fy=18&type=Proposed
8:36:25 AM
Commissioner Davidson discussed Slide 3, which showed a bar
graph entitled, 'Department of Health and Social Services
Share of Total Agency Operations.' She noted that the
following five slides had been prepared by the Division of
Legislative Finance (LFD).
SHAWNDA O'BRIEN, ASSISTANT COMMISSIONER FOR FINANCE
MANAGEMENT SERVICES, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, informed the committee that the slide contained a
10-year look back of the department's overall budget for
unrestricted general funds (UGF). She noted that the
decline of UGF beginning in FY 16.
8:37:12 AM
Co-Chair MacKinnon noticed a footnote that indicated that
according to the Department of Labor (DOL), there were
334,628 resident workers in Alaska in 2014. She wondered
whether services were provided by DHSS to non-resident
workers.
Ms. O'Brien requested clarification of the question.
Co-Chair MacKinnon explained that the slide contained a box
in the upper left that listed the department's total FY 18
UGF budget was equal to $3,414 per resident worker. She
wondered whether the box text was meant to be a comparison
to the footnote.
Ms. O'Brien explained that the footnote had been prepared
by LFD, and represented the average dollars that the
department was budgeted, per the resident worker based on
DOL data. She added that the figures included people who
were considered residents in the state.
Co-Chair MacKinnon appreciated that the department had used
LFD numbers. She asked why the department had asked LFD to
give management plan instead of actuals over the same
period. She wondered whether the numbers would be
different.
Ms. O'Brien replied that actual data could be provided. She
believed that LFD used the management plan format for all
departments, and that DHSS had not made the request for
them to do so.
8:39:11 AM
Senator Micciche noted the additional text in the box on
Slide 3, which said that the department's UGF budget grew
by $300 million between FY 08 and the FY 18 Governor's
request - an average annual growth rate of 3.1 percent. He
probed the dramatically increased cost of state government
between 2010 and 2013, which he argued had been more than
3.1 percent.
Ms. O'Brien explained that most of the growth had been in
UGF spending, though some was designated general fund (DGF)
dollars. She explained that DGF spending included programs
like the alcohol assessment fund the vaccine fund. She
offered to provide more detail as to the causal effect of
the growth from 2010 to 2013.
Senator Micciche was curious whether all the department's
services were necessary and constitutionally required.
8:41:18 AM
Senator Dunleavy asked whether Ms. O'Brien could outline
programs, and additions to existing programs that occurred
between 2010 and 2013. He wondered how long an individual
had to be in the state before being eligible to receive
benefits through DHSS.
Ms. O'Brien offered to provide specifies detail on the
eligibility requirements for the many DHSS programs.
Senator Dunleavy thought that the information would be
helpful to the dialogue.
8:42:28 AM
Senator Olson asked whether DHSS had considered how the
graph on slide 3 would look when considering the absence of
Medicaid expansion.
Ms. O'Brien responded that there was specific information
about the Medicaid expansion numbers on future slides. She
explained that slide 3 reflected general fund spending. She
relayed that future slides would compare total funds with
overall general fund. She said that for Medicaid expansion
specifically, increases in federal authorization were noted
that reflected as increasing Medicaid program costs, while
decreasing the general fund dollar spend.
Senator Olson asked when the Medicaid payments for seniors
receiving dental benefits was reinstituted in the state,
and how those numbers would affect the graph on slide 3.
Ms. O'Brien replied that she could provide the information
at a later date.
8:44:14 AM
AT EASE
8:44:44 AM
RECONVENED
Commissioner Davidson relayed that the dental benefit had
been added back to Alaska's Medicaid program in
approximately 1998. She offered to provide more detail
about the budget implications of the addition.
8:45:09 AM
Ms. O'Brien spoke to Slide 4, which showed a bar graph
titled "Department of Health and Social Services Line
Items." The slide provided a picture as to how the
department's funding was broken down across all of the line
items in the budget. She shared that the majority of the
budget fell in the grants and benefits line, with the
emphasis being mostly on the benefits. She noted that there
had been growth in the line item.
8:45:44 AM
Ms. O'Brien reviewed Slide 5, which showed a line graph
entitled "Appropriations within the Department of Health
and Social Services (GF Only)." She noted that the graph
illustrated the department's budget broken down by
division, and represented general fund dollars only, by
division. She pointed out to the committee that the largest
expenditure in the department was in the Medicaid Services
component. She reiterated that the department had seen a
decline in state Medicaid spending. She explained that for
most of the divisions it was difficult to see any dollar
change in the budget over the past decade because the
budgets for those divisions were already very low.
8:46:38 AM
Senator Micciche returned to Slide 3, and again mentioned
the budget growth between 2010 and 2013. He said that the
same dramatic increase could be seen on Slide 4, as well.
He believed Slide 5 clearly demonstrated the primary cost
driver of the increase between 2010 and 2013. He reiterated
his desire to determine what services had contributed to
the increase.
8:47:51 AM
Ms. O'Brien pointed out to the committee that there had
been a significant dip in 2010 (shown on slide 5) at which
time DHSS had received funding from the American Recovery
and Reinvestment Act. She said that one of the drivers of
cost increases after that was the replacement of that
funding in the Medicaid program with UGF dollars. She
stated that another cost driver for the Medicaid Services
program was the increased enrollment in utilization in the
program from 2010 to 2013. She offered to provide further
information regarding how the enrollment had increase over
time.
8:48:46 AM
Ms. O'Brien presented Slide 6, which showed a graph titled
"Appropriations within the Department of Health and Social
Services (All Funds)." She explained that the slide
contained the same information as the previous slide, but
broken down by all the funding sources within the
department. She highlighted that while benefits and
services had increased in Medicaid, UGF spending had been
on the decline since FY 15, which meant that the increase
was largely federal dollars.
Senator Dunleavy asked whether the decrease had been the
result of cost shifting.
Ms. O'Brien replied in the affirmative, but added that
program growth should be considered as well.
8:49:54 AM
Co-Chair MacKinnon queried whether the state accepting the
condition to advertise Medicaid benefits to the general
population when accepting general funds.
Commissioner Davidson answered in the negative.
Co-Chair MacKinnon argued that the department's daycare
assistance program had been advertised on the screen of a
public movie theatre she had recently patronized.
Commissioner Davidson stated that the childcare benefit was
provided to states to be able to support residents in their
work. She continued that many individuals entering the work
market had difficulty paying for the high cost of
childcare. She said that the program helped subsidize the
cost of childcare for working class Americans.
Co-Chair MacKinnon asked whether advertising of the program
was required as a condition of accepting the federal funds.
Ms. O'Brien stated that there was not a requirement by the
federal government to advertise the program. She added that
some of the services offered through the program through
the grantee agencies could support outreach efforts in
communities.
Co-Chair MacKinnon asked whether the state was requiring
grantee to advertise programs.
Ms. O'Brien replied that it was not required, but that it
was within the purview of the program grantees whether to
advertise.
8:52:13 AM
Senator Micciche returned to the issue of cost shifting. He
believed that the figures were proportional to the increase
of GF fund costs. He said that although the federal
investment had increased, the GF trend had followed closely
behind, which he would not define as a cost shift, but an
increase across the board.
Commissioner Davidson contended that the 10-year look back
period between 2008 and 2018, that could be true; however,
the most recent period between FY 15 to FY 18, showed that
the department had been aggressive in refinancing the
Medicaid program to seek more federal dollars to allow for
the saving of GF dollars. She said that a large provision
was included in SB 74, which she would speak to later in
the presentation.
Senator Micciche agreed that the trends in the past 3 years
had been down on state spending and up on federal spending.
8:54:07 AM
Senator von Imhof queried the drivers of the rise in
healthcare costs in the state.
Commissioner Davidson stated that many factors had
contributed to increased cost of healthcare. She said that
the department had seen a decline in the state's economy
over the last several years, which had resulted in more
people being eligible and signing up for Medicaid. She
lamented that as the department's budget was cut, the
healthcare and social services needs of the people in the
state were increasing. She noted that Alaska was a large
state with a small population and as a result a cost driver
for Medicaid was the access to care. She relayed that
emergency medical travel was covered by Medicaid.
8:58:28 AM
Co-Chair MacKinnon asked whether the daycare assistance
program was federally funded, and if it required state
matching funds.
Ms. O'Brien replied in the affirmative.
8:59:05 AM
Ms. O'Brien showed Slide 7, which showed a graph titled
"Department of Health and Social Services - Total Funding
Comparison by Fund Group (All Funds)." She explained that
the slide showed how DHSS funding broke down across funding
categories. She said that as the overall departmental costs
had increased, federal funding had also increased. She
continued to say that general find spending had been on the
decline, while other sources of funding had remained at
consistent levels.
8:59:50 AM
Commissioner Davidson relayed that the following 12 slides,
8 through 19, included 99 rows and 122 columns of budget
item detail. She related that she did not plan to discuss
the detail row by row, but would point out significant
highlights. She said that the matrix had been prepared at
the request of the other body, and was a helpful way to
examine the department's budget in detail. She relayed that
the columns were numbered down the left to track the 99
lines of detail. She discussed the columns along the top,
which detailed the following formation, respectively:
Allocation and/or Program; Funding (in thousands) (UGF,
DGF, Fed, and other); number of Employees (in the unit);
number of Alaskans Served; percentage Cost (of the program
recovered) through Fees; Rating of Importance to Mission
(using criteria provided by the other body - a "critical"
rating suggests that the program directly accomplishes the
department's constitutional or statutory mission statement,
a rating of "important" means that the program may not
directly relate to core services, but provides indirect
support and services that would need to be reassigned if
the program did not exist, a "beneficial" rating means that
the program enhances and supports core services, or
provides beneficial and efficient services to a wide range
of Alaskans but could not be removed without direct impact
to the core service, and the "status quo" - meaning that it
has been historically funded, or had been funded because of
a statutory requirement but had not real effect on core
services or potentially hampered agency funding);
Rating of Effectiveness (rated a scale of 1 to 3: 1-
"getting the job done", 2- "getting the job done, but with
substantial opportunity for improvement", 3- "not getting
the job done and limited opportunity for improvement");
Constitutional Requirement; Federally Required; Required by
State. She explained that the grey horizontal rows were
summaries, not all the information was filled in because
the detail could be found in the other columns. She spoke
to Item 1:
Allocation and/or Program:
Department of Health and Social Services
Total Funding: $2,724,939.1
UGF: $1,063,072.8
DGF: $97,099.9
Fed: $1,463,744.8
Other: $101,021.6
Total Number of Employees:
3,492
Number of Alaskans Served:
All Alaskans
percentage Cost of through Fees:
2.64 percent
Constitutional Requirements:
Article 7.4
Article 7.5
Required by Statute:
44.29, Department of Health and Social Services
9:03:51 AM
Co-Chair Hoffman asked whether there were any ratings in
the "3" category.
Commissioner Davidson stated that there were none in the FY
18 budget.
Co-Chair Hoffman asked whether the state had considered
privatizing services to seniors in Alaska Pioneer's Homes.
Commissioner Davidson agreed that much of the assisted
living facilities in the rural areas of the state are
provided by Indian Health Services (IHS) organizations and
allowed the department to take advantage of 100 percent
federal match, which was always in the state's best
interest. She related that the Pioneer Home model did not
exist in other states, but noted that some states had
veteran's nursing homes that might be comparable. She noted
that SB 74 had originally required the department to
conduct a privatization study of the Pioneer Homes in the
state, but that upon passage, the task had been scaled back
to considering the pharmaceutical services in Pioneer
Homes. She said that the department had issued a request
for proposal (RFP) twice and had received no responses to
date.
9:06:39 AM
Senator Micciche reiterated that the committee was focusing
on constitutionally required services. He argued that
Articles 7.4 and 7.5, of The Constitution of the State of
Alaska were incredibly general and did not define a
specific level of service. He believed that Commissioner
Davidson would need to reevaluate her priorities about
which services were necessary for the care of the people of
Alaska. He suggested that that the definition of what was
constitutionally required of the department should be
curtailed. He categorized the state's constitution as a
"thin book that was general in nature."
9:08:11 AM
Co-Chair MacKinnon asked whether Commissioner Davidson
could describe the magnitude of the dollars that supported
the department under DGF.
Ms. O'Brien stated that the largest DGF fund categories
were in public health and public assistance. She detailed
that the types of funds under those categories were the PFD
Hold Harmless funding, Tobacco Education Secession funding,
alcohol and recidivism funds, vaccination assessment funds,
and general fund program receipt authority.
Co-Chair MacKinnon asked whether there were waivers
available in the department that could extend benefits
beyond the statutory requirements.
Ms. O'Brien stated that there was an exemption allowance
for people to receive benefits, beyond what they would
normally be eligible for otherwise, with the Alaska
Temporary Assistance for Needy Families (TANIF); the
exemptions were evaluated on a case by case basis, and the
number of people who received the exemption was minimal
when compared to the overall service population.
Co-Chair MacKinnon asked whether DHSS could provide more
information as to whether it was the same small group of
people or number families receiving the exemption
habitually. She noted that the program had been intended to
lead to families transitioning out of exemption status.
Ms. O'Brien recalled seeing that there were approximately
168 people. She said she could get back to the committee
with an average dollar figure. She shared that the
extenuating circumstances with people needing benefit
extension had to do with significant barriers to work, and
there was specific focus in the division to help those
families. She offered to provide specific examples on
situational trends at a later date.
9:11:53 AM
Co-Chair MacKinnon asked how many people were on TANIF.
Ms. O'Brien agreed to provide a current caseload count.
Senator von Imhof noted that the current administration at
the federal level was working to cut Medicaid and
administer block grants to states to pay for recipients.
She said that if the state spent more money on patients
than the block grant covered, the state would have to pay
the difference. She recalled that the Governor had
requested millions of dollars for the FY 16 Supplemental
Budget. She wanted to know what DHSS was going to do to
deal with the state's fiscal crisis.
Commissioner Davidson affirmed that the department's FY 17
budget had included $27 million supplemental request. She
explained that the request represented claims that had been
reprocessed through the Medicaid Management Information
System (MMIS), built for the state by Xerox, which had
failed to work on its go-live date of October 1, 2013. She
said that through great effort the department had improved
the system, but that the clean-up from prior years when the
system was not working had been costly. She stated that
certification of the MMIS system was currently awaiting
determination. She lamented that the change in the federal
administration had slowed the process. She relayed that the
lack of certification hindered the department's ability to
claim an enhanced federal match, form 50 percent, to 75
percent, for maintenance and operation of the system.
9:16:10 AM
Commissioner Davidson furthered that the department had
made advances to providers throughout the state who had
provided healthcare services to Medicaid beneficiaries,
while under a system that was incorrectly processing
claims. She stated that those advance payments totaled
$165.3 million, $122.2 million had been recovered, and the
outstanding balance was $43 million. She said that the
department anticipated a 90 percent payback, or $38.7
million, by June 30, 2017.
Commissioner Davidson admitted that there were critical
bugs that remained in the system. She said that advances
were no longer being paid to providers, because they were
being paid through the MMIS system. She related that there
were too many possibilities about what might happen at the
federal level for the department to address any one
specifically. She said that if the decision was made
nationally to go to block grants, Alaska would not fare
well. She explained that block grants were advantageous for
states with large populations that were relatively
concentrated in a small number of population centers and
did not need to travel to get healthcare. She added that
the grants also favored states that had a relatively low
cost of care. She shared that states with less stable
economies would not fare well under a grant program. She
explained that the allocations for the grants would be made
at the beginning of the year and would not be allocated
again until the beginning of the next year, which would be
difficult for an economy in decline because there would be
no mid-year correction for people who enrolled mid-year.
9:20:28 AM
Commissioner Davidson continued to discuss the negative
effects of switching to a grant block program would have on
the state.
Senator von Imhof demanded to know what the commissioner
would do with a budget that was short several hindered
million dollars for FY 18.
Commissioner Davidson replied that when the changes were
made at the federal level, DHSS would have to make
necessary adjustments to the Medicaid program. She
reiterated that the details of what would occur on the
national level were still unknown, which made them
difficult to plan for.
Senator von Imhof rebutted that she hoped that the
commissioner was considering the possible changes now,
rather than waiting to see what would happen on the
national level.
9:23:00 AM
Vice-Chair Bishop requested additional detail on fraud
investigation within the department.
Commissioner Davidson spoke to Slide 8, items 2 - 4:
Allocation and/or Program:
Alaska Pioneer Homes (503)
Funding (in thousands)
$62,625.6
$$33,999.4 UGF
$17,477.7 DGF
$696.7 Fed
$10,451.8 Other
Number of Employees:
611
Ms. O'Brien stated that Pioneer Homes comprised 2.3 percent
of the overall DHSS budget. She said that the majority of
the staff provided direct services, working in the homes,
with the residents.
9:24:56 AM
Ms. O'Brien turned to Slide 9, item 5:
Allocation and/or Program
Behavioral Health (483)
Funding (in thousands)
$134,237.4:
$60,186.4 UGF
$27,120.3 DGF
$15,803.0 Fed
$31,127.7 Other
Number of Employees
369
Ms. O'Brien relayed that the division comprised 4.9 percent
of the department's overall budget. She noted row 11, and
shared that the Alaska Psychiatric Institute had the
majority of the division's staff, 251 employees, who
provided direct services to patients in the hospital. She
said that row 6 listed treatment and recovery grant
components, which was where the largest amount of UGF was
reflected, the funding was used for grant services, and
substance use prevention and treatment. She said that an
overall reduction of over $10 million in UGF had been
witnessed over the past three fiscal years due to SB 74.
9:26:13 AM
Ms. O'Brien discussed Slide 10, items 15 - 23:
Allocation and/or Program:
Children's Services
Funding (in thousands)
$152,415.0:
$86,064.7 UGF
$5,6000.0 DGF
$53,575.3 Fed
$7,175.0 Other
Number of Employees:
533
Ms. O'Brien related that the Office of Children's Services
(OCS) made up 5.6 percent of the department's overall
budget. She shared that the majority of the staffing for
OCE was in Front Line Social Workers at 476 employees. She
relayed that rows 20 through 23 were the Foster Care and
Guardianship Payments.
9:27:01 AM
Ms. O'Brien spoke to Slide 11, itemss 24 - 29:
Allocation and/or Program
Health Care Services (485)
Funding (in thousands)
$21,399:
$8,159.3 UGF
$2,079.6 DGF
$9,951.2 Fed
$1,208.9 Other
Number of Employees:
128
Ms. O'Brien said that the division comprised .8 percent of
the overall budget of the department and was responsible
for the payment processing of all the Medicaid services
payments. She said that the staff in the division were
directly involved in the Medicaid redesign work and SB 74
imitative efforts. She noted row 25, Catastrophic and
Chronic Illness Assistance, and said that the overall
budget had been reduced by $1.3 million, over the past
three fiscal years, due to Medicaid expansion.
Co-Chair Hoffman asked how often DHSS reviewed the fees
that were changed by the department for different programs.
Ms. O'Brien stated that fees for the Pioneer Homes had been
most recently reviewed in 2017 and had resulted in a rate
increase. She said that the fee structure for Public Health
Nursing had been under review.
Commissioner Davidson interjected that the department was
taking careful consideration for fee increases that would
save DHSS money, but increase fees in another department.
She said that DHSS's biggest customer for public health
labs was the Department of Corrections (DOC) and increasing
the lab fees would increase the expense to DOC, which would
not result in the saving of additional state resources. She
said that correlations of this nature had stopped the
department from increasing certain fees.
Co-Chair Hoffman agreed that decisions of that nature
should be scrutinized to determine the net result to the
state overall, and not just individual departments.
Commissioner Davidson stated that the department had done
the research and had implemented fee increased where a
demonstrable benefit to the state had been determined.
9:30:26 AM
Co-Chair MacKinnon questioned the savings to the state from
the Medicaid expansion. She requested a detailed
explanation of the rate increases at Pioneer Homes.
Ms. O'Brien believed the rate increase for the current year
had been approximately 1.3 percent. She agreed to provide
specific amounts for each year to the committee.
Co-Chair Hoffman asked what the delinquency rate was for
Pioneer Home fees.
Ms. O'Brien agreed to provide the information.
9:31:54 AM
Ms. O'Brien reviewed Slide 12, items 30 - 42:
Allocation and/or Program
Juvenile Justice (319)
Funding (in thousands)
$56,534.3:
$53,630.9 UGF
$1,521.2 Fed
$1,382.2 Other
Number of Employees
456
Ms. O'Brien shared that the division made up 2.1 percent of
the department's overall budget. She noted that rows 31
through 39 reflected the division employees, who provided
direct services in detention facilities and probation
offices. She pointed out to the committee that the
Ketchikan Regional Youth Facility had closed in September
of 2016 and the Nome Youth Facility would close in 2018.
Co-Chair MacKinnon thought it appeared as if there were
about 456 employees providing services to approximately
1200 youth.
Ms. O'Brien replied in the affirmative. She elaborated that
the numbers represented the point in time (FY 16) that the
documents were prepared.
Co-Chair MacKinnon asked if the ratios and cost were
comparable to what other states were doing.
Ms. O'Brien stated that based on the recent feasibility
study, the numbers represented what would be necessary, at
the minimum level, for each of the facilities. She believed
that the numbers were comparable to other states.
Co-Chair MacKinnon clarified that she was questioning the
cost as compared to the population served.
Ms. O'Brien stated she could provide more information.
9:35:04 AM
Ms. O'Brien presented Slides 13 and 14, items 43 - 57:
Allocation and/or Program
Public Assistance
Funding (in thousands)
$305,089.0:
$136,331.1 UGF
$18,542.7 DGF
$136,066.8 Fed
$14,148.4 Other
Number of Employees
557
Ms. O'Brien said that the division comprised 11.2 percent
of the departments overall budget, with most of the staff
in field services. She shared that the Adult Public
Assistance program was the largest UGF recipient in the
division, with the expenditures being used to satisfy the
state's maintenance of effort requirement for Medicaid.
Ms. O'Brien highlighted Slides 15 and 16, items 58 - 70:
Allocation and/or Program
Public Health
$117,372.1:
$43,015.3 UGF
$25,804.7 DGF
$41,436.3 Fed
$7,115.8 Other
Number of Employees
425
Ms. O'Brien stated that the division made up 4.3 percent of
the department's overall budget. She pointed to row 60, the
public health nursing component, which was where much of
the staffing was for the division. She noted row 70,
Community Health Grants, which had recently been reduced in
the divisions budget through refinancing efforts resulting
from SB 74. She said that program was currently 100 percent
federally funded in most cases.
Ms. O'Brien discussed Slide 17, rows 71 - 79:
Allocation and/or Program
Senior and Disabilities Services (487)
Funding (in thousands)
$67,768.7:
$42,506.4 UGF
$21,802.5 Fed
$3,459.8 Other
Number of Employees
173
Ms. O'Brien stated that the division made up 2.5 percent of
the department's overall budget. She relayed that Medicaid
services were not represented in the divisions budget, but
could be found in the Medicaid Services component. She
related that most of the staffing could be found providing
direct program related services in the division.
9:37:47 AM
Ms. O'Brien spoke to Slide 18, items 80 - 89:
Allocation and/or Program
Department Support Services (106)
Funding (in thousands)
$47,582.6:
$16,768.4 UGF
$17,763.5 Fed
$13,050.7 Other
Number of Employees
240
Ms. O'Brien shared that the division comprised 1.7 percent
of the department's overall budget and the majority of the
staffing was information technology services.
Co-Chair Hoffman queried what percentage of the component
was in Juneau.
Ms. O'Brien noted that most of the staff was in Juneau.
Senator Micciche referred to item 82, and asked what the
work done by the 12 public affairs positions.
Ms. O'Brien explained that the public affairs group dealt
with public information in public health, outbreak, media
contacts, and program-related requirements.
Commissioner Davidson added that DHSS did much of its
advertising for wellness and prevention within the
division. She used the example of the recent marijuana
legalization, and recounted that the DHSS public
information team had developed and effective advertising
campaign warning teens if the dangers of marijuana on the
developing brain.
Co-Chair MacKinnon asked whether DHSS was using smoke
cessation funds for second-hand smoke issues related to
marijuana.
Commissioner Davidson replied in the negative. She said
that the marijuana tax funds had not been designated to the
department for use for public health messages. She said an
existing team and funds were used.
9:41:54 AM
Senator Dunleavy hoped to determine whether the federally
required funds were actually required, or if they could be
interpreted as allowable.
Commissioner Davidson offered the example on Line 88,
Information Technology Services, which reflected that the
program was federally required. She said that in order to
be able to bill correctly, and to submit reports to the
Centers for Medicare and Medicaid services, the department
had to have certain systems in place. She added that the
department was required to comply with Health Insurance
Portability and Accountability Act (HIPAA) standard, which
was also a federal requirement.
Senator Dunleavy asked whether the federal requirement was
the exact program on line 88, or simply required paperwork
needed to be done.
Commissioner Davidson detailed that DHSS was required to
provide certain information and to have functioning
systems; in order for the department to have functioning
systems that meet the federal requirement the employees on
line 88 were necessary.
Senator Dunleavy maintained his position that perhaps the
positions were not completely necessary.
9:44:49 AM
Senator Micciche added that the state was going to have to
cut positions if the legislature failed to pass a
sustainable budget. He directed committee attention to Page
9, item 14, which listed Residential Child Care (253) as
federally required. He argued that the item was not
constitutionally required. He felt that the commissioner
thought that the item was required, but that it was not an
actual legally required program. He lamented that, due to
the financial crisis, the state could no longer afford all
the programs offered by the department. He warned against
using the Constitution and Alaska State Statutes as an
excuse, or defining code, for establishing program
requirements.
9:47:42 AM
Commissioner Davidson agreed that reasonable people could
disagree over an analysis of what services were most
important to provide. She referred to the line item that
the senator had questioned. She explained that the
Residential Child Care program supported children who
experienced severe childhood trauma and were in residential
treatment services. She elaborated that the program
serviced children who were in state custody who had
experienced significant trauma to the point where they
needed behavioral health services.
Senator Micciche thought he may have chosen an unfortunate
example, but he believed he had made his point.
Senator Dunleavy maintained that some of the department's
programs might not be legally required, he believed that
all items should be called into question and potentially
eliminated. He repeated his semantic argument concerning
what was required and what was "required" under the law.
Commissioner Davidson stated that the document was the
department's best analysis what was required by law.
Co-Chair Hoffman surmised that Senator Dunleavy was
attempting to separate the "niceties from the necessities".
9:51:23 AM
Vice-Chair Bishop referred to Slide 5, and asked whether
there were any programs that had been created using ARRA
those funds that were being sustained by general funds.
9:51:55 AM
Senator Olson reiterated Senator Micciche's thoughts that
the State Constitution was not the ultimate authority of
law, but was a "condensation of a much larger thought
process that went into a work product called The
Constitution." He worried about the cost of litigation that
could result because of not following constitutional
guidelines.
9:53:44 AM
Co-Chair Hoffman stated that the overall issue was what
level of service the state should provide to citizens
considering the current financial crisis.
Senator Micciche commented that the conversation would
continue during subcommittee meetings.
Senator Dunleavy reiterated his previous concerns about the
necessity of spending on certain programs that might not be
constitutionally mandated.
9:56:49 AM
Co-Chair Hoffman summarized the budgetary process.
Commissioner Davidson thanked the committee, and commented
that based upon current projects for FY 18, the department
would be taking administrative actions to reduce
departmental costs. She relayed that more detail would be
provided during subcommittee hearings.
Co-Chair Hoffman discussed housekeeping.
ADJOURNMENT
9:59:18 AM
The meeting was adjourned at 9:59 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 021717 DHSS SFC Presentation.pdf |
SFIN 2/17/2017 8:30:00 AM |
Operating Budget FY18 |