Legislature(2017 - 2018)BUTROVICH 205

01/25/2017 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:31:39 PM Start
01:32:52 PM Overview: Department of Health and Social Services
02:33:52 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Testimony <Invitation Only> --
+ Department Overview TELECONFERENCED
Commissioner Valerie Davidson
Acting Assistant Commissioner Shawnda O'Brien
**Streamed live on AKL.tv**
                      ALASKA STATE LEGISLATURE                                                                                
        SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                  
                          January 25, 2017                                                                                      
                              1:31 p.m.                                                                                         
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Peter Micciche                                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES -                                                                            
Commissioner Valerie Davidson                                                                                                   
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
VALERIE DAVIDSON, Commissioner                                                                                                  
Alaska Department of Health & Social Services                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided a departmental overview.                                                                         
                                                                                                                                
SHAWNDA O'BRIEN, Acting Assistant Commissioner                                                                                  
Alaska Department of Health & Social Services                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided a departmental overview.                                                                         
                                                                                                                                
DR. JAY BUTLER, Chief Medical Officer and Public Health Director                                                                
Division of Public Health                                                                                                       
Alaska Department of Health & Social Services                                                                                   
Anchorage Alaska                                                                                                                
POSITION STATEMENT: Provided an overview of the Division of                                                                   
Public Health.                                                                                                                  
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:31:39 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:31 p.m.  Present at the                                                               
call  to order  were  Senators Giessel,  Begich,  von Imhof,  and                                                               
Chair Wilson.                                                                                                                   
                                                                                                                                
CHAIR  WILSON  announced  that the  committee's  first  order  of                                                               
business is to elect a vice chair.                                                                                              
                                                                                                                                
SENATOR  GIESSEL moved  that Senator  von Imhof  be elected  vice                                                               
chair of the Senate Health and Social Services Committee.                                                                       
                                                                                                                                
CHAIR  WILSON announced  that without  objection, so  ordered. He                                                               
set forth that  Senator von Imhof will serve as  vice chairman of                                                               
the Senate Health and Social Services Committee.                                                                                
                                                                                                                                
                                                                                                                                
^Overview: Department of Health and Social Services                                                                             
        OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES                                                                  
                                                                                                                              
1:32:52 PM                                                                                                                    
CHAIR   WILSON  announced   that  the   committee  will   hear  a                                                               
departmental  overview from  Valerie  Davidson, commissioner  for                                                               
the Alaska Department of Health and Social Services.                                                                            
                                                                                                                                
1:33:26 PM                                                                                                                    
VALERIE  DAVIDSON, Commissioner,  Alaska Department  of Health  &                                                               
Social   Services  (DHSS),   Juneau,   Alaska,  introduced   DHSS                                                               
personnel to the committee.                                                                                                     
                                                                                                                                
She detailed that DHSS was  originally established in 1919 as the                                                               
Alaska  Territorial Health  Department. Upon  statehood in  1959,                                                               
the department's  responsibilities were  expanded to  include the                                                               
protection  and  promotion  of  public  health  and  welfare,  as                                                               
outlined  in  article   7,  sections  4  and  5   of  the  Alaska                                                               
Constitution. She called attention  to various DHSS website links                                                               
and detailed departmental organization chart.                                                                                   
                                                                                                                                
1:36:09 PM                                                                                                                    
She explained that the Division  of Alaska Pioneer Homes provides                                                               
the highest quality life as  possible and a safe home environment                                                               
for older Alaskans and veterans:                                                                                                
                                                                                                                                
   · Division of Alaska Pioneer Homes:                                                                                          
     ƒDirector: Vickie Wilson;                                                                                                 
     ƒ611 positions;                                                                                                           
     ƒOperating budget: $62.6 million in total funding;                                                                        
        · $34 million unrestricted general funds (UGF) spending;                                                                
     ƒ2.3 percent of DHSS FY2018 operating budget.                                                                             
                                                                                                                                
SENATOR  GIESSEL asked  if the  number of  positions has  changed                                                               
since 2016.                                                                                                                     
                                                                                                                                
COMMISSIONER DAVIDSON  replied that  the number of  positions has                                                               
changed: since 2015, a 4-percent reduction or 23 positions.                                                                     
                                                                                                                                
1:38:09 PM                                                                                                                    
SHAWNDA   O'BRIEN,   Acting    Assistant   Commissioner,   Alaska                                                               
Department of  Health & Social  Services (DHSS),  Juneau, Alaska,                                                               
added  that the  department can  provide specific  information on                                                               
position reductions for FY2017 after the committee meeting.                                                                     
                                                                                                                                
CHAIR WILSON  asked the commissioner  to address  a privatization                                                               
report for the Division of Alaska Pioneer Homes.                                                                                
                                                                                                                                
COMMISSIONER DAVIDSON  replied that as  part of SB 74,  which was                                                               
the   2016  bipartisan   Medicaid  reform   bill,  a   number  of                                                               
privatization  reports  were  required.  She  detailed  that  the                                                               
Division of Alaska Pioneer Homes'  report was originally intended                                                               
to address  facility privatization, but an  amendment changed the                                                               
report   to   pharmaceutical   privatization.  She   added   that                                                               
privatization  feasibility reports  from  the Alaska  Psychiatric                                                               
Institute and the Juvenile Justice  Facilities were included. She                                                               
revealed that  the three-privatization  reports will  be released                                                               
on Friday, January 27.                                                                                                          
                                                                                                                                
She  addressed the  Division of  Behavioral Health.  She detailed                                                               
that  the  division's mission  is  to  manage an  integrated  and                                                               
comprehensive  behavioral-health system  based  on sound  policy,                                                               
effective practice and partnerships:                                                                                            
                                                                                                                                
   · Behavioral Health:                                                                                                         
     ƒDirector: Randall Burns;                                                                                                 
     ƒ369 positions;                                                                                                           
     ƒOperating budget: $134.2 million in total funding;                                                                       
        · $60.2 million UGF spending;                                                                                           
     ƒ4.9 percent of DHSS FY2018 operating budget.                                                                             
                                                                                                                                
She added that  SB 74 required an 1115 [Medicaid]  waiver for the                                                               
department to look at its  behavioral health-system care delivery                                                               
challenges. She  recognized that  the department  has significant                                                               
gaps  within its  care  continuum and  the  result impacts  other                                                               
areas. She specified that the  use of emergency rooms is impacted                                                               
because no  one can legally  be turned  away and some  people use                                                               
the emergency room  to access services that are  not available to                                                               
them.   She    revealed   that   additional    impacts   include:                                                               
corresponding rates of child maltreatment  and child neglect; the                                                               
number  of law  enforcement encounters  with people  experiencing                                                               
unaddressed  behavioral-health   needs;  and   the  corresponding                                                               
number   of   inmates   in   correctional   facilities,   whether                                                               
temporarily in jail or in long-term sentences.                                                                                  
                                                                                                                                
COMMISSIONER  DAVIDSON revealed  that  the department  recognized                                                               
that  after  working  through  SB 74  and  Medicaid  reform,  the                                                               
biggest  opportunity  to make  improvements  was  to address  the                                                               
behavioral-health system.  She asserted  that the  department has                                                               
undertaken a  significant effort in reaching  out to stakeholders                                                               
and  looking at  behavioral-health  system  reform. She  divulged                                                               
that the department has submitted  a concept paper to the Centers                                                               
for Medicare and Medicaid to implement  a reform plan. She said a                                                               
benefit  from an  approved plan  is that  budget neutrality  will                                                               
require the department to show  that service can be provided more                                                               
cost effectively.                                                                                                               
                                                                                                                                
1:43:58 PM                                                                                                                    
She  explained that  the  1115-waiver also  allows  the state  to                                                               
address  a   challenge  from  a  federal   provision  called  the                                                               
Institute for Mental Disease (IMD)  exclusion. She explained that                                                               
the 1115-waiver allows  the state to waive the  IMD exclusion for                                                               
substance-use-disorder treatment services.                                                                                      
                                                                                                                                
She  disclosed that  the department  is moving  forward with  the                                                               
Criminal  Justice   Reform  bill  by  working   with  the  Alaska                                                               
Department of  Corrections. She  remarked that  the state  has an                                                               
opportunity  to either  create more  prisons or  create healthier                                                               
Alaskans.                                                                                                                       
                                                                                                                                
She  addressed the  Office of  Children's Services  and explained                                                               
that  the division's  mission is  to  prevent and  to respond  to                                                               
child maltreatment  in order to  ensure safe children  and strong                                                               
families:                                                                                                                       
                                                                                                                                
   · Office of Children's Services:                                                                                             
     ƒDirector: Christy Lawton;                                                                                                
     ƒ533 positions;                                                                                                           
     ƒOperating budget: $152.4 million in total funding;                                                                       
        · $86 million UGF spending;                                                                                             
     ƒ5.6 percent of DHSS FY2018 operating budget.                                                                             
                                                                                                                                
COMMISSIONER  DAVIDSON  described  the Division  of  Health  Care                                                               
Services  and said  the division's  mission is  to manage  health                                                               
care coverage  for Alaskan's  in need. She  pointed out  that the                                                               
division oversees  the Medicaid and health  facilities group. She                                                               
specified  that  the  division  does  not  include  the  Medicaid                                                               
payments that  go out  the door. She  detailed that  the division                                                               
makes sure that  providers get paid and  inspected facilities are                                                               
safe for Alaskans:                                                                                                              
                                                                                                                                
   · Division of Health Care Services:                                                                                          
     ƒDirector: Margaret Brodie;                                                                                               
     ƒ128 positions;                                                                                                           
     ƒOperating budget: $21.4 million in total funding;                                                                        
        · $8.2 million UGF spending;                                                                                            
     ƒ0.8 percent of DHSS FY2018 operating budget.                                                                             
                                                                                                                                
1:46:48 PM                                                                                                                    
She  addressed the  Division of  Juvenile  Justice and  explained                                                               
that  the  division's  mission  is  to  hold  juvenile  offenders                                                               
accountable for  their behavior,  promote safety  and restoration                                                               
of  victims in  communities, and  to assist  offenders and  their                                                               
families to develop skills to prevent crimes:                                                                                   
                                                                                                                                
   · Division of Juvenile Justice:                                                                                              
     ƒDirector: Rob Wood;                                                                                                      
     ƒ456 positions;                                                                                                           
     ƒOperating budget: $56.5 million in total funding;                                                                        
        · $53.6 million UGF spending;                                                                                           
     ƒ2.1 percent of DHSS FY2018 operating budget.                                                                             
                                                                                                                                
CHAIR  WILSON  pointed  out  that two  centers  are  planned  for                                                               
closure. He noted that the  Ketchikan facility has already closed                                                               
and asked  if the communities  with closed or  closing facilities                                                               
have provided feedback.                                                                                                         
                                                                                                                                
COMMISSIONER  DAVIDSON  revealed  that the  department  met  with                                                               
facility employees  as well as  the City of Ketchikan  on whether                                                               
alternative facility services could  be provided, but the numbers                                                               
were cost prohibitive.  She noted that the Nome  facility will be                                                               
specifically addressed in the  upcoming privatization report. She                                                               
revealed that  the Nome  facility was  allocated funding  for one                                                               
year, but the  governor's proposed FY2018 budget  did not provide                                                               
an  extension.  She asserted  that  concerns  will be  raised  on                                                               
whether the  anticipated savings  from closing the  Nome facility                                                               
will be seen.                                                                                                                   
                                                                                                                                
1:49:43 PM                                                                                                                    
SENATOR BEGICH revealed  his history in the  Division of Juvenile                                                               
Justice  and  noted  that  he  was  directly  involved  with  the                                                               
Ketchikan  and Nome  facilities.  He asked  to  confirm that  the                                                               
state  has  been able  to  extract  itself  from its  lease  with                                                               
Ketchikan when the facility was transferred back.                                                                               
                                                                                                                                
COMMISSIONER DAVIDSON answered yes.                                                                                             
                                                                                                                                
SENATOR BEGICH  addressed the  Nome facility  and noted  that the                                                               
division's policy has been based  on sound practice. He disclosed                                                               
that the division  has opposed privatization due  to youth system                                                               
abuses  in  the  Lower  48.  He  pointed  out  that  Commissioner                                                               
Davidson referenced  possible questions and controversy  with the                                                               
Nome  facility's   pending  report.  He  asked   if  Commissioner                                                               
Davidson could  give the  committee a  preview on  Nome's pending                                                               
privatization report.                                                                                                           
                                                                                                                                
1:52:01 PM                                                                                                                    
COMMISSIONER  DAVIDSON  replied  that  she could  not  provide  a                                                               
preview. She noted that the  previous and current administrations                                                               
have   explored  partnering   with   the   Norton  Sound   Health                                                               
Corporation (NSHC)  as a tribal  health organization to  not only                                                               
improve services, but to take  advantage of a 100-percent federal                                                               
match. She  revealed that  NSHC did not  indicate an  interest in                                                               
taking over the  Nome facility. She asserted  that providing care                                                               
as  close  to  home  as  possible  results  in  better  outcomes;                                                               
however,  the state's  budget environment  does  not always  make                                                               
that possible. She  noted that the Juneau  facility was available                                                               
in Southeast when the Ketchikan  facility closed, but Nome is the                                                               
only detention facility located in the Northwest Alaska.                                                                        
                                                                                                                                
1:54:23 PM                                                                                                                    
She commented on the Division  of Public Assistance and explained                                                               
that the  division's mission is  to provide  self-sufficiency and                                                               
basic living expenses to Alaskans in need:                                                                                      
                                                                                                                                
   · Division of Public Assistance:                                                                                             
     ƒActing Director: Monica Windom;                                                                                          
     ƒ557 positions;                                                                                                           
     ƒOperating budget: $305.1 million in total funding;                                                                       
        · $136.3 million UGF spending;                                                                                          
     ƒ11.2 percent of DHSS FY2018 operating budget.                                                                            
                                                                                                                                
She  revealed that  the number-one  complaint  is the  division's                                                               
inability to  provide timely customer service.  She detailed that                                                               
a combination  of recent  Medicaid expansion  and budget  cuts to                                                               
public assistance  has resulted in  long wait periods.  She noted                                                               
that even with  a new centralized-call center,  the division will                                                               
not be able to meet customer service expectations.                                                                              
                                                                                                                                
1:57:42 PM                                                                                                                    
CHAIR WILSON asked  if the data represents  all public assistance                                                               
programs.                                                                                                                       
                                                                                                                                
COMMISSIONER DAVIDSON answered yes. She  revealed that there is a                                                               
toll-free  phone  number  to  expedite  Medicaid  enrollment  for                                                               
pregnant women  to make  sure Alaskan women  have good  access to                                                               
prenatal care  to ensure  a healthy baby.  She added  that people                                                               
with  urgent  needs  and  certain   incomes  can  receive  public                                                               
assistance for risk of eviction or getting utilities shutoff.                                                                   
                                                                                                                                
She addressed  the Division of  Public Health and  specified that                                                               
the division's  mission is to  protect and promote the  health of                                                               
Alaskans:                                                                                                                       
                                                                                                                                
   · Division of Public Health:                                                                                                 
     ƒDirector: Dr. Jay Butler;                                                                                                
     ƒ425 positions;                                                                                                           
     ƒOperating budget: $117.4 million in total funding;                                                                       
        · $43 million UGF spending;                                                                                             
     ƒ4.3 percent of DHSS FY2018 operating budget.                                                                             
                                                                                                                                
She revealed that Dr. Butler  is the national president of Alaska                                                               
State and Territorial Health Officials  and noted that his policy                                                               
initiative  is on  substance-use  disorders, specifically  opioid                                                               
addiction.                                                                                                                      
                                                                                                                                
CHAIR WILSON noted  that the Division of  Public Health's mission                                                               
and  scope has  been scaled  back. He  asked that  the division's                                                               
core functions be addressed.                                                                                                    
                                                                                                                                
2:01:06 PM                                                                                                                    
DR.  JAY   BUTLER,  Chief  Medical  Officer   and  Public  Health                                                               
Director, Division of Public Health,  Alaska Department of Health                                                               
&  Social   Services,  Anchorage,  Alaska,  disclosed   that  the                                                               
division has  absorbed much of  its 22  percent UGF cut  over the                                                               
past three  years with most  of the UGF going  into public-health                                                               
nursing.  He  admitted  that closing  public-health  centers  has                                                               
proved to be challenging and  some services have been reduced. He                                                               
revealed that some public-health  centers no longer have resident                                                               
public-health nurses in town and  an itinerant nurse makes visits                                                               
on a regular basis or for emergencies.                                                                                          
                                                                                                                                
DR. BUTLER detailed that public-health  nurses have a broad range                                                               
of activities that include:                                                                                                     
                                                                                                                                
   · Client services;                                                                                                           
   · Outbreak response;                                                                                                         
   · Infectious disease containment;                                                                                            
   · Working with local officials on emergency preparedness                                                                     
     planning.                                                                                                                  
                                                                                                                                
He  noted  that  some  client  services are  often  not  billable.  He                                                          
summarized that the rest of the  division has a core of general funds,                                                          
but  the larger  revenue's  portion  are from  federal  grants or  fee                                                          
authority.                                                                                                                      
                                                                                                                                
2:03:13 PM                                                                                                                    
SENATOR  BEGICH  asked  if  Dr.  Butler  can  carry  forward  the                                                               
division's mission in the face of budget cuts.                                                                                  
                                                                                                                                
DR. BUTLER answered yes, on a  broad basis. He specified that the                                                               
division continues  to carry  out its  mission in  the protection                                                               
and promotion of health for all Alaskans.                                                                                       
                                                                                                                                
SENATOR BEGICH queried  if Alaskans are safe  if itinerant nurses                                                               
are  being  sent  into  communities  rather  than  having  nurses                                                               
onsite.                                                                                                                         
                                                                                                                                
DR.  BUTLER  admitted  that  not having  immediate  access  to  a                                                               
health-care provider does increase the risk of a problem.                                                                       
                                                                                                                                
COMMISSIONER  DAVIDSON  added  that  the gap  has  been  made  up                                                               
through a  partnership with the  Alaska Tribal Health  System and                                                               
community-health centers  that are  federally funded  through the                                                               
Health Resources and Services Administration (HRSA).                                                                            
                                                                                                                                
2:07:16 PM                                                                                                                    
She addressed  the Division of  Senior and  Disabilities Services                                                               
and specified that  their mission is to  promote the independence                                                               
of Alaska's  seniors and persons with  physical and developmental                                                               
disabilities:                                                                                                                   
                                                                                                                                
   · Senior and Disabilities Services:                                                                                          
     ƒDirector: Duane Mayes;                                                                                                   
     ƒ173 positions;                                                                                                           
     ƒOperating budget: $67.8 million in total funding;                                                                        
        · $42.5 million UGF spending;                                                                                           
     ƒ2.5 percent of DHSS FY2018 operating budget.                                                                             
                                                                                                                                
COMMISSIONER DAVIDSON noted that  services provided in Senior and                                                               
Disabilities Services through Medicaid  are captured elsewhere in                                                               
the Medicaid costs.                                                                                                             
                                                                                                                                
She addressed  DHSS's service population and  priorities: [health                                                               
and  wellness across  the lifespan;  health care  access delivery                                                               
and  value;  safe  and   responsible  individuals,  families  and                                                               
communities].  She set  forth that  the  department's breadth  of                                                               
Alaskans served spans from prenatal to after death.                                                                             
                                                                                                                                
CHAIR  WILSON asked  if  the department  has a  way  to rank  and                                                               
prioritize programs in each division.                                                                                           
                                                                                                                                
COMMISSIONER  DAVIDSON   replied  that  ranking  programs   is  a                                                               
challenge. She specified  that DHSS provides statutorily-required                                                               
services and the  department is not allowed to  choose to provide                                                               
one service over another.                                                                                                       
                                                                                                                                
CHAIR WILSON  concurred that DHSS must  follow federal guidelines                                                               
and state  statutes for core  services, but noted that  there are                                                               
ancillary services  that sometimes  support the core  services as                                                               
well.  He asked  if there  is a  way to  come up  with a  program                                                               
matrix or  program evaluation to prioritize  importance. He noted                                                               
that other states have ranked their services and programs.                                                                      
                                                                                                                                
2:11:21 PM                                                                                                                    
COMMISSIONER  DAVIDSON pointed  out  that  DHSS provided  another                                                               
committee with  a list of  99 program and  allocation priorities.                                                               
She detailed  that the  programs were  ranked as  being critical,                                                               
program  importance was  based on  the committee's  criteria, and                                                               
the level  of effectiveness was  evaluated on a  descending scale                                                               
of 1 to 3.                                                                                                                      
                                                                                                                                
CHAIR  WILSON  noted that  the  levels  of effectiveness  of  the                                                               
programs were all  listed as "1" or "2". He  remarked that he did                                                               
not  see  the   criticalness  or  ranking  in   the  report  that                                                               
Commissioner Davidson referenced.                                                                                               
                                                                                                                                
COMMISSIONER  DAVIDSON answered  that  DHSS  has sustained  large                                                               
cuts  over the  last three  years  and some  of the  lower-ranked                                                               
programs were eliminated from the department's budget.                                                                          
                                                                                                                                
CHAIR WILSON replied  that his intent is to work  towards a rank-                                                               
in-order program report.                                                                                                        
                                                                                                                                
SENATOR  BEGICH suggested  that Commissioner  Davidson provide  a                                                               
list of eliminated  entities to identify the areas  that were not                                                               
effective.                                                                                                                      
                                                                                                                                
COMMISSIONER DAVIDSON  replied that  DHSS can  provide a  list of                                                               
services that  either the  department is  no longer  providing or                                                               
made cuts  to. She  specified that  the governor's  FY2018 budget                                                               
request  reflects  the  ranking   and  the  priorities  from  the                                                               
administration;  DHSS   turns  that   information  over   to  the                                                               
Legislature  for  assessment  and  the  department  redesigns  or                                                               
eliminates programs based on the  Legislature's budget. She added                                                               
that  DHSS  also  seeks  out  more  federal  authority  or  other                                                               
partnerships  to fill  a critical  function  that the  department                                                               
feels is important to Alaska.                                                                                                   
                                                                                                                                
2:15:08 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
2:15:55 PM                                                                                                                    
CHAIR WILSON called the committee back to order.                                                                                
                                                                                                                                
SENATOR  VON  IMHOF  asked  that   the  list  referenced  by  the                                                               
commissioner  be  provided  to  the  committee  and  to  separate                                                               
ancillary  programs from  those that  are provided  due to  state                                                               
statutes or federal guidelines.                                                                                                 
                                                                                                                                
COMMISSIONER  DAVIDSON  revealed that  the  report  to the  other                                                               
committee  did provide  the information  that  Senator von  Imhof                                                               
requested. She  specified that the  report also included  data on                                                               
funding  sources,  costs,  employees,   the  number  of  Alaskans                                                               
served, levels of effectiveness and rankings.                                                                                   
                                                                                                                                
SENATOR BEGICH specified  that he is strictly looking  for a list                                                               
of programs eliminated,  who was served and how  many people were                                                               
served.                                                                                                                         
                                                                                                                                
2:18:26 PM                                                                                                                    
MS.  O'BRIEN  addressed  DHSS's FY2018  budget,  specifically  on                                                               
formula  versus   non-formula  programs.   She  noted   that  the                                                               
department's largest  formula program  in its budget  is Medicaid                                                               
services.  She  detailed  the  formula  and  non-formula  program                                                               
percentages as follows:                                                                                                         
                                                                                                                                
   · Medicaid-Federal: 43 percent                                                                                               
   · Medicaid-general fund (GF): 22 percent                                                                                     
   · All other formula: 10 percent                                                                                              
   · Non-formula-grants and benefits: 6 percent                                                                                 
   · Non-formula-"other" line items: 19 percent"                                                                                
                                                                                                                                
MS.  O'BRIEN  noted that  the  "other"  formula programs  in  the                                                               
department are  housed in the Children  Services Division, Public                                                               
Assistance Division,  and the Health Care  Services Division. She                                                               
specified  that grants  and  benefits go  out  directly to  serve                                                               
Alaskans  and "other"  non-formula  items include  administrative                                                               
costs, leasing, etc.                                                                                                            
                                                                                                                                
2:20:25 PM                                                                                                                    
She  addressed  the  department's  FY2018 adjusted  base  to  the                                                               
governor's budget. She detailed  that overall FY2018 UGF spending                                                               
is  $190 million  less than  FY2015. She  revealed that  services                                                               
have  been  maintained  through increased  federal  authorization                                                               
while  UGF spending  has  been reduced.  She  added that  formula                                                               
programs   are  tied   directly  to   standards  in   statute  or                                                               
regulation.                                                                                                                     
                                                                                                                                
She revealed that 74 percent  of the department's overall budget,                                                               
including all funding sources, are formula programs:                                                                            
                                                                                                                                
   · Office of Children's Services                                                                                              
     ƒ$33 million in UGF spending.                                                                                             
     ƒ1.2 percent of DHSS budget.                                                                                              
   · Division of Health Care Services                                                                                           
     ƒ$153,000 in UGF spending.                                                                                                
     ƒLess than 1 percent of DHSS budget.                                                                                      
   · Division of Public Assistance                                                                                              
     ƒ$109 million in UGF spending.                                                                                            
     ƒ4 percent of DHSS budget.                                                                                                
   · Medicaid                                                                                                                   
     ƒ$580 million in UGF spending.                                                                                            
     ƒ21.4 percent of DHSS budget.                                                                                             
                                                                                                                                
2:25:05 PM                                                                                                                    
COMMISSIONER DAVIDSON  addressed major DHSS  activities happening                                                               
as follows:                                                                                                                     
                                                                                                                                
   1. Medicaid redesign:                                                                                                        
        · Presentation on Friday, January 27.                                                                                   
                                                                                                                                
   2. Tribal and federal partnerships:                                                                                          
        · DHSS  has  aggressively  advanced  federal  and  tribal                                                               
          partnerships to ensure Alaskans continue to receive                                                                   
          critical services.                                                                                                    
                                                                                                                                
   3. Child welfare:                                                                                                            
        · Working  with  its  tribal   partners  to  improve  the                                                               
          department's   Indian   Child    Welfare   Act   (ICWA)                                                               
          compliance.                                                                                                           
        · Realize  efficiencies in  the adjudication  of children                                                               
          in need of aid: one family-one court, one family-one                                                                  
          judge.                                                                                                                
        · Working with the court system  to implement changes for                                                               
          better children and family outcomes.                                                                                  
        · 3,000 children are in out-of-home placements.                                                                         
        · Repeat maltreatment has seen a reduction.                                                                             
        · Encouraging tribal-service  organizations to  work with                                                               
          tribal-health partners to make sure services are                                                                      
          better coordinated.                                                                                                   
        · 1115-waiver   work   to   assist   with   consolidating                                                               
          reunification services within communities.                                                                            
        · Providing   telehealth   equipment    to   extend   the                                                               
          department's reach with limited dollars.                                                                              
                                                                                                                                
2:29:50 PM                                                                                                                    
COMMISSIONER  DAVIDSON  addressed  opioid misuse  and  addiction,                                                               
noting  the  governor's  interest   in  undertaking  a  five-part                                                               
strategy as recommended by the Opioid Policy Task Force.                                                                        
                                                                                                                                
CHAIR WILSON  asked for  a brief overview  of the  Human Services                                                               
Community Matching  Grant and  the Community  Initiative Matching                                                               
Grants.                                                                                                                         
                                                                                                                                
COMMISSIONER DAVIDSON explained that the  major cut for the Human                                                               
Services Community  Match Grant occurred in  the Community Health                                                               
Aid  Training  Program  which  provides  training  for  community                                                               
health  aides.  She revealed  that  the  department was  able  to                                                               
reduce the  grant's UGF by  negotiating with Tribal Health  for a                                                               
100-percent federal match.                                                                                                      
                                                                                                                                
MS. O'BRIEN specified that the  two grant programs offer services                                                               
to  supplement other  grant programs  in  communities. The  Human                                                               
Services Matching  Grant goes out to  several different providers                                                               
or grantees  to offer additional supplements  for: housing needs,                                                               
food for shelters, etc. The  Community Initiative Matching Grants                                                               
goes   out  to   three-different   grantees  and   some  of   the                                                               
municipalities like Anchorage. She set forth that the reductions                                                                
are representative of funds that were not being spent.                                                                          
                                                                                                                                
SENATOR GIESSEL asked that a list be provided for the cost of                                                                   
optional services that the state provides in Medicaid.                                                                          
                                                                                                                                
2:33:52 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Committee at 2:33 p.m.                                                                                                          

Document Name Date/Time Subjects
Senate HSS Overview Presentation for 1-25-17.pdf SHSS 1/25/2017 1:30:00 PM
Departmental Overview DHSS