Legislature(2019 - 2020)BUTROVICH 205

01/23/2019 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:30:12 PM Start
01:31:04 PM Confirmation Hearing(s)
02:41:15 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Committee Organization/Introduction of Members TELECONFERENCED
+ Consideration of Governor's Appointees: TELECONFERENCED
- Commissioner, Dept. of Health & Social
Services, Adam Crum
-- Teleconference <Invitation Only> --
-- Public Testimony <Time Limit May Be Set> --
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                        January 23, 2019                                                                                        
                           1:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator John Coghill, Vice Chair                                                                                                
Senator Gary Stevens                                                                                                            
Senator Click Bishop                                                                                                            
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S)                                                                                                         
Commissioner, Department of Health and Social Services                                                                        
Adam Crum - Anchorage                                                                                                           
                                                                                                                                
     - CONFIRMATION ADVANCED                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ADAM CRUM, Commissioner Designee                                                                                                
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified during his confirmation hearing.                                                                
                                                                                                                                
ALYSON CURRY, Legislative Liaison                                                                                               
Planned Parenthood Votes                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION   STATEMENT:    Opposed   the   confirmation    of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
CHERYL LOVEGREEN, representing self                                                                                             
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:    Opposed   the   confirmation    of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
JAY BUTLER, M.D., representing self                                                                                             
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:   Supported   the   confirmation   of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
JERRY ALDERMAN, representing self                                                                                               
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:    Opposed   the   confirmation    of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
ZHENIA C. PETERSON, representing self                                                                                           
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:    Opposed   the   confirmation    of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
ROBIN SMITH, representing self                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:    Opposed   the   confirmation    of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
JANET COLON, representing self                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:    Opposed   the   confirmation    of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
ELIZABETH RIPLEY, Chief Executive Officer                                                                                       
Mat-Su Health Foundation                                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION   STATEMENT:   Supported   the   confirmation   of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
MICHELLE OVERSTREET, Executive Director and Founder                                                                             
Mat-Su Youth Housing                                                                                                            
Wasilla, Alaska                                                                                                                 
POSITION   STATEMENT:   Supported   the   confirmation   of   DHSS                                                            
Commissioner Designee Adam Crum.                                                                                                
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:12 PM                                                                                                                    
CHAIR DAVID  WILSON called the  Senate Health and  Social Services                                                            
Standing Committee  meeting to order  at 1:30 p.m. Present  at the                                                              
call  to order  were Senators  Begich,  Coghill, Stevens,  Bishop,                                                              
and Chair Wilson.                                                                                                               
                                                                                                                                
1:31:04 PM                                                                                                                    
CHAIR WILSON  announced the first  order of business was  to elect                                                              
a vice-chair.                                                                                                                   
                                                                                                                                
1:31:09 PM                                                                                                                    
SENATOR STEVENS  moved and  asked unanimous  consent that  Senator                                                              
Coghill be elected as vice-chair.                                                                                               
                                                                                                                                
1:31:14 PM                                                                                                                    
CHAIR  WILSON announced  that without  objection, Senator  Coghill                                                              
would serve as vice-chair. Without objection, it was so ordered.                                                                
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                        
                    CONFIRMATION HEARING(S)                                                                                 
     Commissioner, Department of Health and Social Services                                                                 
                                                                                                                                
                                                                                                                                
1:31:21 PM                                                                                                                    
CHAIR WILSON announced  the next order of business  to come before                                                              
the  committee  was  the  confirmation   hearing  of  Commissioner                                                              
Designee  Adam  Crum  of  the  Department  of  Health  and  Social                                                              
Services  (DHSS).   He  invited  Commissioner  Designee   Crum  to                                                              
testify.                                                                                                                        
                                                                                                                                
1:32:17 PM                                                                                                                    
ADAM  CRUM,  Commissioner  Designee,   Department  of  Health  and                                                              
Social Services,  Anchorage, Alaska, said  he was born  and raised                                                              
in Anchor  Point, Alaska,  as one  of five  siblings. For  several                                                              
years the  family had no  running water  and had to  collect their                                                              
drinking  water from  a spring.  He  spent his  youth hunting  and                                                              
fishing along  the banks  of the Anchor  River. He graduated  from                                                              
Homer  High  School  as valedictorian  and  went  to  Northwestern                                                              
University. He joined  the football team and within  a year he had                                                              
a full-ride scholarship.  He finished by winning  a leadership and                                                              
spirit award voted  on by his coaches and teammates.  He mentioned                                                              
these   achievements   because   assuming   leadership,   pursuing                                                              
excellence,  and taking  on challenge  is  central to  who he  is.                                                              
After earning  a bachelor's degree  in psychology, he  returned to                                                              
Alaska.                                                                                                                         
                                                                                                                                
COMMISSIONER   DESIGNEE   CRUM  said   his   work   as  a   safety                                                              
professional  and  trainer took  him  all  over Alaska.  He  spent                                                              
weeks  at a  time in  villages like  Kaktovik,  Barrow, and  Point                                                              
Hope. He  earned a Master  of Science in  Public Health  from John                                                              
Hopkins  University  Bloomberg  School  of Public  Health.  It  is                                                              
widely  regarded as  the number  one public health  school  in the                                                              
world.                                                                                                                          
                                                                                                                                
COMMISSIONER   DESIGNEE  CRUM  said   he  studied  public   health                                                              
toxicology,  environmental  and   occupational  health  law,  risk                                                              
communication and  public policy and epidemiology.  He wrote white                                                              
papers  on naturally  occurring  asbestos  in western  Alaska,  as                                                              
well as  mercury content in seafood  caught in the  north Pacific.                                                              
He worked as a  consultant and project lead for large  oil and gas                                                              
companies  and  pipeline  and  transportation  companies.  He  did                                                              
environmental  health analysis  and worked  on long-term  strategy                                                              
and organizational  development. He said he experienced  what good                                                              
looks like  first-hand from working  with these companies.  He has                                                              
internalized that and  used it in his work with  other clients and                                                              
organizations.                                                                                                                  
                                                                                                                                
COMMISSIONER  DESIGNEE   CRUM  said  that  out  of   the  need  to                                                              
influence  organizational culture,  he developed  a repertoire  of                                                              
leadership courses  he could facilitate.  For example,  one course                                                              
he is  certified to facilitate is  based on Stephen  Covey's Seven                                                              
Habits  of Highly Effective  People.  He has  been a supporter  of                                                              
MyHouse  in Mat-Su,  which works  with homeless  youth to  provide                                                              
job  opportunities.  Another  group  he  is  involved  in  is  JOY                                                              
International,  which focuses  on  ending sex  trafficking. He  is                                                              
also on  the advisory  board of  the Mat-Su  Salvation Army.  They                                                              
talk  about issues  such as  hungry families,  drug treatment  and                                                              
rehabilitation,  and transitional  housing.  When  he was  looking                                                              
for  additional  resources while  working  with these  groups,  he                                                              
came  across the  Alaska State  Ombudsman  May 2018  report of  an                                                              
investigation  of the Division  of Public  Assistance. The  report                                                              
stated that  since 2016,  there have  been hundreds of  complaints                                                              
about  lack  of  communication,  a backlog  of  applications,  and                                                              
delayed payments                                                                                                                
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM called  the report heartbreaking.  The                                                              
division  was  not responsive  to  people  reaching out  in  their                                                              
moment  of need.  And employees  trying  to do  their best  didn't                                                              
have the  tools to  provide the  best customer  support. What  was                                                              
really   lacking   was   leadership   and   support.   He   brings                                                              
organizational   and  strategic   expertise  and   a  history   of                                                              
developing high-performing  teams and  a winning culture.  He also                                                              
brings compassion.  He has  worked with a  lot of the  constituent                                                              
groups  the  department  services.   He  brings  a  commitment  to                                                              
recognize  and support  the  employees  within the  department  so                                                              
they can  provide the  best possible service.  He believes  he has                                                              
been successful  in starting  down this path.  In seven  weeks, he                                                              
has assembled an excellent team.                                                                                                
                                                                                                                                
1:37:39 PM                                                                                                                    
COMMISSIONER   DESIGNEE   CRUM   directed  attention   to   Deputy                                                              
Commissioner Albert  Wall, a military veteran who  is still active                                                              
in the National  Guard. Mr. Wall  has 20 years of experience  as a                                                              
behavioral health  clinician and previously  worked for DHSS  as a                                                              
budget director  and director of  behavioral health. The  last few                                                              
years  he has  been the  CEO for  the  Peninsula Community  Health                                                              
Services.  He  now  oversees  Family,   Community  and  Integrated                                                              
Services.  He has  worked at  DHSS  and understands  long-standing                                                              
issues and  is motivated to  correct them  for the benefit  of all                                                              
Alaskans.                                                                                                                       
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM  said   the  Deputy  Commissioner  of                                                              
Medicaid  and  Health  Care Policy,  Donna  Steward,  is  uniquely                                                              
suited to this  role because she  spent the last few years  as the                                                              
executive director  of the Office of Rate Review.  Before that she                                                              
was a  research analyst for  the Washington state  legislature and                                                              
has worked  at the  Centers for  Medicare &  Medicaid Services  as                                                              
associate regional  administrator for  the Medicare side.  She has                                                              
vast  experience  working  with  and  for  federal  partners.  She                                                              
understands the actual numbers as they stand in Alaska.                                                                         
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  introduced  Sana Efird.  She was  the                                                              
deputy  commissioner  at the  Department  of Education  and  Early                                                              
Development  and has returned  to DHSS  as Assistant  Commissioner                                                              
of Finance  and Management  Services, a position  she had  been in                                                              
before for  four years. She has  knowledge of the  department, its                                                              
budget, and programs.                                                                                                           
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM noted that Tony Newman  was continuing                                                              
in  his role  as  legislative  liaison for  DHSS  and  that he  is                                                              
incredibly responsive to legislative requests.                                                                                  
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM noted  that  the Health  Care  Policy                                                              
Advisor, Heather  Carpenter, had been  chief of staff  for Senator                                                              
[Pete] Kelly.                                                                                                                   
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM said  that in the  short time  that he                                                              
has  been in  this  role,  he has  visited  as many  employees  as                                                              
possible.  His  first  communication  was to  thank  everyone  for                                                              
their  hard  work  and  service  and  to  remind  them  to  always                                                              
remember the  good they do. DHSS  is a large department  with many                                                              
divisions.  It's  a  safe  bet  that in  any  week  one  of  those                                                              
divisions may make  the news. He wants all employees  to know that                                                              
he understands and  appreciates the jobs they do, and  he is proud                                                              
to work with them during these difficult times.                                                                                 
                                                                                                                                
1:40:43 PM                                                                                                                    
COMMISSIONER DESIGNEE  CRUM said he  has three top  priorities for                                                              
DHSS.                                                                                                                           
   • Number one is addressing the overall budget issue. DHSS has                                                                
     one of the  largest budgets in government. They  must do what                                                              
     they can  to reduce  duplicative efforts, gain  efficiencies,                                                              
     and leverage community partners.                                                                                           
   • The second priority is to work on the Alaska Psychiatric                                                                   
     Institute (API).  It has a longstanding number  of issues. As                                                              
     the state's  residential psychiatric treatment  hospital, API                                                              
     plays  a  critical   role  in  the  continuum   of  care  for                                                              
     behavioral  health. For  far too  long API  has not  received                                                              
     its due attention.  This administration committed  to putting                                                              
     API  on  the  correct  course,   to  provide  better  patient                                                              
     outcomes, and  to ensure a safe environment  for patients and                                                              
     staff.                                                                                                                     
   • The third priority is to reduce the backlog of applications                                                                
     at Division  of Public Assistance  (DPA) so these  people can                                                              
     be responded to  and heard. The new DPA leader  is working on                                                              
     new processes  and the support levels to address  and correct                                                              
     this issue.                                                                                                                
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  said another  key item is  addressing                                                              
IT solutions. It  can reduce the burden from  front line employees                                                              
and  allow  them   to  do  their  jobs  better   and  faster.  The                                                              
department  is constantly  looking  at ways  to gain  efficiencies                                                              
while keeping an eye on superior customer service.                                                                              
                                                                                                                                
He said he is  committed to the department, the  people it serves,                                                              
and  the  people he  works  with.  He concluded  by  saying,  "Our                                                              
mission is  to promote  and protect the  health and  well-being of                                                              
all Alaskans.  That is  what I am  committed to  do. I  am humbled                                                              
that Governor  Dunleavy has  asked me to  perform this role  and I                                                              
am honored to be before the committee today."                                                                                   
                                                                                                                                
1:42:23 PM                                                                                                                    
SENATOR  STEVENS said  the  governor  in the  State  of the  State                                                              
address last  night spoke  of the importance  of cracking  down on                                                              
crime,  but  he also  mentioned  the  opioid crisis,  which  falls                                                              
under  Commissioner Designee  Crum's jurisdiction.  He asked  what                                                              
can be done about that.                                                                                                         
                                                                                                                                
COMMISSIONER  DESIGNEE   CRUM  said  the  White   House  yesterday                                                              
continued the public  health emergency for the  opioid crisis. The                                                              
department  will work  with  the federal  delegation  to see  what                                                              
that  means  as  far  as  resources   and  tools.  Andy  Jones  is                                                              
continuing in  the director position  for the Office  of Substance                                                              
Misuse  and Addiction  Prevention  (OSMAP). He  works with  public                                                              
safety, law, and  corrections, and also reaches out  to the public                                                              
to help set  up task forces. The  intent is to bring  a high level                                                              
of awareness and support to this issue.                                                                                         
                                                                                                                                
1:44:03 PM                                                                                                                    
CHAIR WILSON  said last year  the legislature approved  additional                                                              
staffing  to  handle  some  of the  backlog  related  to  Medicaid                                                              
applications.  He as was  sufficient to take  care of  the backlog                                                              
of unprocessed applications.                                                                                                    
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM said he has not had  that conversation                                                              
with budget.  There are open positions  at the Division  of Public                                                              
Assistance (DPA)  but part  of the new  director's priority  is to                                                              
reduce that burden.                                                                                                             
                                                                                                                                
1:45:11 PM                                                                                                                    
SENATOR  COGHILL commented  on the  Medicaid budget  and the  fact                                                              
that  it  is one  of  the  big  budgetary drivers.  He  asked  the                                                              
commissioner  to tell  the committee  what he  had learned  in the                                                              
last seven weeks to help make this more sustainable.                                                                            
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  replied that  Medicaid is 70  percent                                                              
of  DHSS's overall  budget and  his  team will  work with  federal                                                              
partners to  see what they can  do with the overall  plan, perhaps                                                              
with  waivers. Stakeholders  will  be brought  to  the table  with                                                              
providers to work  together on this issue. He said  the goal is to                                                              
run as  clean a business  model as  possible so legislators  don't                                                              
get hit with a bill at the end of  session for the previous year.                                                               
                                                                                                                                
SENATOR COGHILL  said he will ponder  what the legislature  can do                                                              
to address  the issue  of trapping people  in the Medicaid  world.                                                              
That is that someone  on Medicaid who gets a raise  may find their                                                              
medical bills are  more than the raise. He also  cited the example                                                              
of  someone with  a child  covered by  Denali KidCare  who had  to                                                              
turn  down a  promotion  in the  Air National  Guard  to not  lose                                                              
eligibility  and have  to pay about  $3,500 a  month. This  person                                                              
had to  turn down a promotion  or quit his  job. He said  that's a                                                              
clear  example of  how  people get  trapped  in a  system that  is                                                              
meant  to  give  them  a hand  up.  He  expressed  hope  that  the                                                              
commissioner  would  help  legislators understand  CMS  rules  and                                                              
what the  department's health  care plan can  and cannot  do under                                                              
the waiver system.                                                                                                              
                                                                                                                                
COMMISSIONER  DESIGNEE   CRUM  said  that  is  an   issue  he  has                                                              
addressed with his  team. He believes there should  be a step-wise                                                              
function  so people  can take  help when  they need  it, but  also                                                              
progress and improve  their lot in life. The  department will look                                                              
for models  that work and perhaps  ask for statutory  change. They                                                              
will also look at the federal side for rules they can adjust.                                                                   
                                                                                                                                
SENATOR COGHILL expressed appreciation for the response.                                                                        
                                                                                                                                
1:51:38 PM                                                                                                                    
SENATOR  BEGICH   mentioned  the   governor's  desire   for  state                                                              
spending to match  resources estimated to be $3.2  billion and the                                                              
DHSS budget  that is  one of the  largest in  the state.  He asked                                                              
how to mesh recognition  and support to employees on  one hand and                                                              
substantial  budget  cuts  on the  other.  He  said today  in  the                                                              
Finance Committee,  Donna Arduin,  the Director  of the  Office of                                                              
Management  and Budget,  said each  department  had to  prioritize                                                              
areas that  would be  supported and what  could be eliminated.  He                                                              
asked  what was  at the bottom  of the  list for  DHSS that  would                                                              
potentially be eliminated in this administration.                                                                               
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  said  people in  his department  have                                                              
noticed that  they can save  quite a bit  of money by  taking care                                                              
of how  the dollars  are spent. This  includes things  like making                                                              
sure processes are  clean and preventing overpayments.  That's the                                                              
first step.                                                                                                                     
                                                                                                                                
SENATOR  BEGICH  referenced  a  meeting  in his  office  when  the                                                              
commissioner mentioned  that all options  were on table.  He asked                                                              
what options  would be on  Table A and  whether he was  looking at                                                              
privatization of the Alaska Psychiatric Institute (API).                                                                        
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM responded  that all options  truly are                                                              
on the table. If  API is privatized, the level of  care would need                                                              
to  meet all  the  requirements.  DHSS  will be  a  mission-driven                                                              
organization.  Each  division  and  every subgroup  will  work  to                                                              
accomplish what is in its mission.                                                                                              
                                                                                                                                
SENATOR BEGICH  asked his  perception of the  mission of  DHSS and                                                              
what he believes  his constitutional obligation is  to uphold that                                                              
mission.                                                                                                                        
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM  answered  that  the  mission  is  to                                                              
promote  and protect  the health  and well-being  of Alaskans.  He                                                              
said the  plan is to identify  and work with the  neediest groups.                                                              
There  will  be  cuts  and  the   department  will  need  to  gain                                                              
efficiencies,  but they  are committed  to  work with  stakeholder                                                              
groups  looking at  available resources  to make  sure the  rug is                                                              
not pulled out from underneath people.                                                                                          
                                                                                                                                
CHAIR  WILSON requested  he send  the  DHSS priority  list to  the                                                              
committee  when   the  budget  is  released  on   February  13  so                                                              
legislators   can  take   that   into  consideration   in   future                                                              
legislation.                                                                                                                    
                                                                                                                                
1:57:11 PM                                                                                                                    
SENATOR BISHOP asked whether he played offense or defense.                                                                      
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM answered both;  in high school  he was                                                              
a linebacker and in college an offensive lineman.                                                                               
                                                                                                                                
SENATOR  BISHOP  responded that  he  asked  because the  state  is                                                              
always playing  defense in  the health care  world and  he wonders                                                              
when a  leader will take the  offense and promote  healthy living,                                                              
similar  to  John   F.  Kennedy's  health  and   physical  fitness                                                              
challenge. He  asked the commissioner  if he  and his team  or the                                                              
governor  had  any  ideas  to  promote  something  like  that.  He                                                              
related that he  spent eight days in Iceland and  was astounded by                                                              
the  lifestyle,  their  physical  fitness, and  how  they  promote                                                              
physical  education for  both  people in  school  and the  private                                                              
sector. He reiterated that the state should get on the offense.                                                                 
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM agreed that getting on  the offense is                                                              
a critical  aspect to changing  the path  of the future.  He noted                                                              
that his  public health  background is  on the preventative  side.                                                              
He said the idea  is to work on innovative measures  to save money                                                              
by  spending  money  on  the  front   end.  He  acknowledged  that                                                              
specific  projects have  not been  targeted but  it is an  ongoing                                                              
conversation as the full team comes together. That.                                                                             
                                                                                                                                
SENATOR  BEGICH  pointed  out  that  federally,  7  million  fewer                                                              
people are  insured and that burden  falls on emergency  rooms and                                                              
hospitals.  The  smallest  hospitals in  Alaska  suffered  because                                                              
they didn't  get their Medicaid  reimbursement in a  timely manner                                                              
and, if the state  reduces Medicaid, will eventually  have to deal                                                              
with  the  expense  of those  additional  emergency  services.  He                                                              
asked  the  commissioner  if  he was  considering  a  block  grant                                                              
waiver   proposal    coming   from   the    current   presidential                                                              
administration  because that  raises some  concern. He  referenced                                                              
the  statement that  DHSS  plans  to identify  and  work with  the                                                              
neediest  groups   and  noted   all  people   in  Alaska   have  a                                                              
constitutional  right to  abortion and  family planning  services,                                                              
which  the  state   does  compensate  through  Medicaid   for  the                                                              
neediest  citizens. He  asked  if the  state  will continue  doing                                                              
that.                                                                                                                           
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM  said   the  department  has  ongoing                                                              
negotiations  for  a  1115  [Medicaid]   waiver,  which  is  their                                                              
ability  to  work  with federal  partners  to  tailor  an  Alaska-                                                              
specific solution  that is cost-neutral or a  cost-savings for the                                                              
state  while also  providing  better  services. He  asked  Senator                                                              
Begich to repeat the second question, which he did.                                                                             
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM  said  he  will follow  the  law.  He                                                              
added,  "As  it  stands  now,  Alaska  law  and  the  federal  law                                                              
maintains we have to do that."                                                                                                  
                                                                                                                                
SENATOR  BISHOP  asked for  assurance  that  he was  committed  to                                                              
improving  the  mental  health   assets  in  the  state.  He  also                                                              
reminded  the  commissioner  that  in  their  earlier  meeting  he                                                              
cautioned  that for  every  action there  is  a reaction.  Senator                                                              
Bishop asked  him think about  that and  weigh the change  when he                                                              
does any cost-benefit analysis and due diligence.                                                                               
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM answered that he and  the governor are                                                              
committed  to  working  on  the  behavioral  health  situation  in                                                              
Alaska.  He  visited  Fairbanks   Memorial  Hospital  recently  in                                                              
recognition of  the state partnering  with the hospital  to expand                                                              
psychiatric  beds in the  emergency room.  He said the  department                                                              
is  trying  to  find innovative  solutions  around  the  state  to                                                              
address   behavioral   health.   He   is   excited   that   Deputy                                                              
Commissioner  Wall   has  a  background  in  this.   He  said  the                                                              
department  will work with  community partners  and have  had many                                                              
conversations   with  possible   different   funding  sources   to                                                              
leverage local as much as possible.                                                                                             
                                                                                                                                
SENATOR  BISHOP  asked if  the  several  acting directors  in  the                                                              
department were placeholders during the recruiting process.                                                                     
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  replied that  that the Public  Health                                                              
director  is now  full time  and  recruitment is  ongoing for  the                                                              
directors  of  Senior  and  Disabilities   Services  director  and                                                              
Behavioral Health.                                                                                                              
                                                                                                                                
2:04:49 PM                                                                                                                    
SENATOR  COGHILL commented  that although  DHSS is  under a  court                                                              
order to pay  for abortions, that doesn't mean  DHSS can't educate                                                              
people   about  alternatives.   He   encouraged   other  ways   of                                                              
communicating with people in those circumstances.                                                                               
                                                                                                                                
SENATOR  COGHILL  highlighted  the  sustained  high  turnover  and                                                              
vacancy  rates at  the  Office of  Children's  Services (OCS).  He                                                              
said OCS  has to work with  people who are experiencing  the worst                                                              
circumstances of their  lives but doesn't seem to be  able to show                                                              
them out of the  dysfunction. He said it is commendable  that some                                                              
kids  are   saved  but   many  times   families  are   intimidated                                                              
inappropriately.  He asked  who is  tasked to  work in that  arena                                                              
and what new ideas can be expected.                                                                                             
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM  said discussions  about children  are                                                              
very sensitive and  emotional. Everyone wants to  provide the best                                                              
service, care  and protection  for children  whether it  is inside                                                              
the family  or not.  It is a  delicate balance  that the  staff at                                                              
OCS  has to  manage. Natalie  Norberg is  the full-time  director.                                                              
DHSS is  working on  creative solutions to  deal with  the vacancy                                                              
rates. Internal  talks are ongoing  about how to  encourage people                                                              
to apply,  keep their caseloads low,  and keep their morale  up so                                                              
they don't  leave. The department  is also working on  an internal                                                              
communication  bank to  help families  to see  OCS as a  resource,                                                              
not the person coming to take their kids away.                                                                                  
                                                                                                                                
SENATOR  COGHILL urged  him to  let  legislators know  if he  sees                                                              
places where the state statutes could be improved.                                                                              
                                                                                                                                
2:09:11 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
                                                                                                                                
2:09:30 PM                                                                                                                    
ALYSON  CURRY,  Legislative  Liaison,  Planned  Parenthood  Votes,                                                              
Juneau, Alaska,  said Planned Parenthood opposes  the confirmation                                                              
of Adam Crum due  to his lack of experience delivering  health and                                                              
social  services. Instead  of appointing  someone who  understands                                                              
health  policy,  Governor  Dunleavy has  appointed  someone  whose                                                              
ideology  lines up  with  his own.  When Mr.  Crum  ran for  state                                                              
senate  in  2016, he  ran  on  a platform  of  cutting  government                                                              
programs and  restricting a woman's  constitutional right  to make                                                              
decisions  about her  own  body. Alaska  needs  somebody who  will                                                              
implement  proven and  effective strategies  for improving  public                                                              
health and decreasing  health disparities across  communities. The                                                              
state  has  some  of  the  highest   rates  of  suicide,  domestic                                                              
violence, sexual  assault, and sexually transmitted  infections in                                                              
the  nation. The  state needs  a commissioner  with the  necessary                                                              
experience to tackle  these challenges and advance  bold solutions                                                              
to  improve  the   health  of  all  Alaskans  across   the  state,                                                              
especially  for  historically marginalized  communities  that  are                                                              
more likely  to lack  access to  critical health  care and  social                                                              
services.    Anti-reproductive    health   and    small-government                                                              
ideologies  are  not good  substitutes  for policy  expertise  and                                                              
experience.                                                                                                                     
                                                                                                                                
2:11:44 PM                                                                                                                    
CHERYL LOVEGREEN,  representing self, Anchorage, Alaska,  said she                                                              
was concerned for  two reasons: Mr. Crum's lack  of experience and                                                              
his possible  bias. He has no  experience as a manager  within the                                                              
department or  in leading  a large department  like DHSS.  He does                                                              
not have the  best skill set for  this appointment. He  said he is                                                              
not a health  care policy guy.  He was endorsed by  an anti-choice                                                              
group in  a recent  campaign. She questioned  how he  will support                                                              
the rights of  women and teens who need comprehensive  health care                                                              
and information,  including family  planning and abortion.  Alaska                                                              
has  a  public  health  crisis  in  opioid  use,  unintended  teen                                                              
pregnancies,  mental health,  and  other issues.  The state  needs                                                              
health  care professionals  who  already know  how  to turn  these                                                              
things around.                                                                                                                  
                                                                                                                                
2:13:33 PM                                                                                                                    
JAY   BUTLER,   M.D.,  representing   self,   Anchorage,   Alaska,                                                              
identified himself  as the former  Chief Medical Officer  for DHSS                                                              
and for a brief  time, the commissioner. He said  he first met Mr.                                                              
Crum when  he learned  he would replace  him as the  commissioner.                                                              
He  worked with  him for  a week  and  found him  to be  a man  of                                                              
integrity who  cares about  welfare of the  state and  its people.                                                              
He   understands  organizational   structure   and  function   and                                                              
population-based approaches to improving health.                                                                                
                                                                                                                                
DR. BUTLER  noted that Mr.  Crum is a  fast learner. He  joined in                                                              
their  phone calls  when DHSS  activated  its emergency  operation                                                              
center after the  Anchorage earthquake [on November  30, 2018]. On                                                              
his first  day as commissioner  he faced two internal  emergencies                                                              
with a  cool head. He  said Mr. Crum is  the right person  for the                                                              
job.                                                                                                                            
                                                                                                                                
2:15:58 PM                                                                                                                    
JERRY  ALDERMAN, representing  self, Anchorage,  Alaska, said  Mr.                                                              
Crum has an  impressive resume and is  a smart guy, but  he has no                                                              
background  for this  job. He's  never  worked in  health care  or                                                              
social  services. He  has  not managed  a  government agency.  Mr.                                                              
Alderman  said he  doesn't like  it  when politicians,  especially                                                              
males, start  talking about  what his daughter  can and  cannot do                                                              
with her body.                                                                                                                  
                                                                                                                                
2:17:20 PM                                                                                                                    
ZHENIA  C. PETERSON,  representing self,  Anchorage, Alaska,  said                                                              
she wanted  to echo  what other  people have  said. Mr.  Crum does                                                              
not have  the knowledge or experience  to run something  as big as                                                              
DHSS.  He's  never worked  in  a  health-related  field or  had  a                                                              
background  in health policy.  His statements  about reducing  the                                                              
size  of government  should be  a  concern to  the committee.  She                                                              
worries  that his  initiatives  would cause  many  people to  lose                                                              
jobs  and would  cut funding  to  health care  services that  many                                                              
Alaskans  rely on.  His  connection  to right-to-life  groups  and                                                              
past statements  about women receiving basic health  care services                                                              
make her worry about her constitutional rights being taken away.                                                                
                                                                                                                                
2:18:47 PM                                                                                                                    
ROBIN SMITH, representing  self, Anchorage, Alaska,  said Mr. Crum                                                              
is unqualified  for the position  of commissioner of DHSS,  one of                                                              
most difficult management  jobs in the state. When  he ran for the                                                              
legislature  in 2016, he  described himself  as a business  owner,                                                              
truck driver,  and carpenter.  His resume  states that  he managed                                                              
75 people  and handled multimillion  contracts. That is a  far cry                                                              
from managing a  department of over 3,000 people and  a budget the                                                              
size of  DHSS's. His  degree from  John Hopkins  School of  Public                                                              
Health  is in  occupational and  environmental  hygiene. The  John                                                              
Hopkins description  of the  degree does  not mention  the medical                                                              
field. He  has never  worked in  a medical  arena. Alaska  has the                                                              
most  expensive   care  in  America,  which  makes   it  the  most                                                              
expensive  care   in  the   world.  No  one   has  been   able  to                                                              
successfully  reduce  the  cost  in Alaska.  It  is  an  extremely                                                              
complex issue  that should be addressed  by the smartest  and most                                                              
qualified person  available. She said  she is deeply  disturbed by                                                              
the  nomination  because it  shows  a  lack  of respect  for  real                                                              
health care  professionals. She would  not trust him  to implement                                                              
policies  for  women  and  families   because  he  has  identified                                                              
himself  as pro-life.  She said  she  fears he  will work  against                                                              
women.                                                                                                                          
                                                                                                                                
2:22:17 PM                                                                                                                    
JANET  COLON,  representing  self, Anchorage,  Alaska,  said  that                                                              
during  Mr. Crum's  campaign two  years ago for  state senate,  he                                                              
proudly advertised  that he  was against a  women's right  to make                                                              
decisions about her  own body. As a nurse with 20  years of public                                                              
health  experience, this  is a  grave  concern. She  said she  has                                                              
observed women  trying to get money  to come in from  rural Alaska                                                              
to get health care  in Anchorage. She has seen  increased rates of                                                              
sexually  transmitted diseases  among teens.  As a sexual  assault                                                              
nurse, she's  seen increased  sexual violence  against women.  The                                                              
state needs  an unbiased commissioner  who cares about  the health                                                              
of all women in Alaska.                                                                                                         
                                                                                                                                
2:24:00 PM                                                                                                                    
ELIZABETH   RIPLEY,  Chief   Executive   Officer,  Mat-Su   Health                                                              
Foundation, Wasilla,  Alaska, said she  met Adam Crum at  the Mat-                                                              
Su  Business  Alliance,  where   he  and  his  business,  Northern                                                              
Industrial Training,  have won many  awards and helped  the Mat-Su                                                              
economy. He has  been an active donor and supporter  of MyHouse, a                                                              
local  nonprofit  addressing  youth   homelessness.  He  sees  the                                                              
complexity of health  and social issues like homelessness.  He has                                                              
a heart  for this  work. He has  a master's  in public  health and                                                              
many of  the challenges DHSS faces  can be improved  by maximizing                                                              
the public  health model on  both the prevention  and intervention                                                              
side  of  things.  As  commissioner  he  wants  DHSS  to  be  more                                                              
strategic and  efficient and  effective at  meeting its  top goals                                                              
and objectives.  DHSS needs someone  with the business  acumen and                                                              
budgetary  skills,  management  knowledge,  workforce  development                                                              
expertise,  and the  communication and  emotional intelligence  to                                                              
pull this off. He  has these skills and experiences.  She said she                                                              
looks forward  to partnering with  Mr. Crum to deliver  more value                                                              
for the state's health and social services dollars.                                                                             
                                                                                                                                
2:26:06 PM                                                                                                                    
MICHELLE  OVERSTREET,  Executive   Director  and  Founder,  Mat-Su                                                              
Youth  Housing,  Wasilla,  Alaska,  said  Mr.  Crum  has  been  an                                                              
advisor to  MyHouse for the past  eight years. He has  supported a                                                              
public  health  office  in  their  building  that  specializes  in                                                              
reproductive   health.  He   has  supported   MyHouse's  goal   of                                                              
providing reproductive  health services to homeless  youth. He has                                                              
never  opposed any  kind  of services  to  the  youth they  serve.                                                              
There  are   many  assumptions  about   how  he  will   behave  as                                                              
commissioner. He  is a man of integrity  with a huge heart  with a                                                              
passionate  desire  to make  Alaska  better. He  is  an expert  on                                                              
budget  and  fiscal  management.   He  has  given  her  advice  on                                                              
directing a nonprofit.  He helped a MyHouse employee  with a small                                                              
child    strategize    because   her    increasing    compensation                                                              
disqualified  her for  Medicaid  services.  Mr. Crum  demonstrated                                                              
not just  compassion, but  knowledge and  creative thinking  about                                                              
how to  use the  Medicaid expansion  with a  step-down system  for                                                              
people in the same  situation as their client. To  not appoint him                                                              
would be a real shame and a detriment to the state, she said.                                                                   
                                                                                                                                
SENATOR BEGICH asked  whether there was any limit  to the services                                                              
in MyHouse's reproductive health clinic.                                                                                        
                                                                                                                                
MS. OVERSTREET  said there were  limits to the onsite  clinic, but                                                              
they are partnered  with a local provider. The  local provider can                                                              
coordinate  everything  from  educational   sessions  to  abortion                                                              
services provided elsewhere.                                                                                                    
                                                                                                                                
2:30:07 PM                                                                                                                    
CHAIR  WILSON closed  public testimony  and asked  Mr. Crum  if he                                                              
wanted to address his qualifications.                                                                                           
                                                                                                                                
COMMISSIONER  DESIGNEE CRUM said  he does not  come from  a public                                                              
health policy background,  but DHSS needs someone who  can look to                                                              
long-term strategy  and understand  what to do, because  difficult                                                              
times  are ahead.  DHSS needs  someone at  the helm  who can  take                                                              
care of things and  he has put together a fantastic  team to guide                                                              
him through the process.                                                                                                        
                                                                                                                                
2:31:15 PM                                                                                                                    
SENATOR STEVENS  asked what  strategies he  employed to  deal with                                                              
homeless  youth  and  if  that  would  be  his  responsibility  as                                                              
commissioner.                                                                                                                   
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM replied that for whatever  reason many                                                              
homeless  youth throughout  Alaska  have coalesced  in the  Mat-Su                                                              
Borough. There  are massive  tent cities. The  idea was to  find a                                                              
community solution  to give  the teens  resources they  need, such                                                              
as substance abuse  counseling. The model is hand  up not handout.                                                              
The  teens must  understand  they  have to  work  as  part of  the                                                              
process.  He  said  it  will  not   be  part  of  his  purview  as                                                              
commissioner to  do that, but  the administration wants  to ensure                                                              
that all Alaskans have these opportunities to move ahead.                                                                       
                                                                                                                                
SENATOR  BISHOP said  he has the  utmost respect  for Dr.  Butler.                                                              
Many  do not  know that  DHSS  is part  of  the state's  emergency                                                              
response team  and Mr. Crum is  very familiar with how  to execute                                                              
emergency  response. He  pointed out  that Mr.  Crum said  that he                                                              
would adhere to the law and implement the law.                                                                                  
                                                                                                                                
SENATOR  BISHOP said  his philosophy  is that  if everyone  around                                                              
him is thinking  the same thing, then someone is  not thinking. He                                                              
asked Mr. Crum to respond to that.                                                                                              
                                                                                                                                
COMMISSIONER  DESIGNEE  CRUM  said that  during  meetings,  people                                                              
volunteer to  play devil's  advocate. His  management style  is to                                                              
encourage diverse  thoughts to ensure  the team puts out  the most                                                              
and the best solutions.                                                                                                         
                                                                                                                                
SENATOR BEGICH  asked, considering  the public testimony,  whether                                                              
he  is confident  that he  can put  political  ideology aside  and                                                              
focus DHSS's goals on the best scientific evidence available.                                                                   
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM responded absolutely. He  has a degree                                                              
from  a school  that is  one  of the  best  in the  world that  is                                                              
science-based.                                                                                                                  
                                                                                                                                
SENATOR  COGHILL  said  some  of  the  questions  revolved  around                                                              
reproduction rights  and abortion.  That is the legislature's  job                                                              
to answer  those. He said  he has seen  commissioners come  and go                                                              
with a  bias either  way. It is  not big issue  if he  follows the                                                              
law, but  Mr. Crum  will deal  with public  health issues  such as                                                              
disease management  and things that create hunger  for bad things,                                                              
whether drugs  or alcohol.  He asked if  he had anything  to share                                                              
about his vision regarding public health.                                                                                       
                                                                                                                                
COMMISSIONER  DESIGNEE   CRUM  replied  that  the   phrase  social                                                              
determinants  [of  health]  are   buzz  words  heard  a  lot  now.                                                              
Preventative  measures   of  behavioral  health  issues   are  key                                                              
aspects of  addressing public health.  The department is  going to                                                              
be more proactive and work across departments.                                                                                  
                                                                                                                                
COMMISSIONER DESIGNEE  CRUM concluded by stating he  is an Alaskan                                                              
first and  foremost. His family  is here and  he wants to  stay in                                                              
this state, which is why he wanted to take this role.                                                                           
                                                                                                                                
2:38:44 PM                                                                                                                    
CHAIR  WILSON stated  that in  accordance with  AS 39.05.080,  the                                                              
Senate  Health and  Social  Services Standing  Committee  reviewed                                                              
the following  and recommends  the appointment  be forwarded  to a                                                              
joint session for consideration:                                                                                                
                                                                                                                                
Commissioner, Department of Health and Social Services                                                                        
Adam Crum - Anchorage                                                                                                           
                                                                                                                                
Signing  the   reports  regarding   appointments  to   boards  and                                                              
commissions  in no way  reflects individual  members' approval  or                                                              
disapproval  of   the  appointees;  the  nominations   are  merely                                                              
forwarded to the full legislature for confirmation or rejection.                                                                
                                                                                                                                
2:39:15 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:40:53 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
2:41:15 PM                                                                                                                    
There  being no  further business  to come  before the  committee,                                                              
Chair  Wilson adjourned  the  Senate  Health and  Social  Services                                                              
Standing Committee at 2:41 p.m.                                                                                                 

Document Name Date/Time Subjects
HSS Commissioner DHSS Crum Resume.pdf SHSS 1/23/2019 1:30:00 PM
Comm-Designee Adam Crum CV