Legislature(2019 - 2020)BUTROVICH 205

02/15/2019 01:30 PM HEALTH & SOCIAL SERVICES

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01:31:19 PM Start
01:31:38 PM SB7
03:00:40 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 7 MED. ASSISTANCE WORK REQUIREMENT TELECONFERENCED
Heard & Held
-Invited Testimony Followed by Public Testimony-
-- Teleconference Listen Only --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 15, 2019                                                                                        
                           1:31 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Gary Stevens                                                                                                            
Senator Cathy Giessel                                                                                                           
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator John Coghill, Vice Chair                                                                                                
Senator Tom Begich                                                                                                              
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 7                                                                                                               
"An Act  requiring the Department  of Health and  Social Services                                                               
to apply for a waiver  to establish work requirements for certain                                                               
adults  who  are  eligible  for   the  state  medical  assistance                                                               
program."                                                                                                                       
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
REVIOUS COMMITTEE ACTION                                                                                                      
                                                                                                                                
BILL: SB   7                                                                                                                  
SHORT TITLE: MED. ASSISTANCE WORK REQUIREMENT                                                                                   
SPONSOR(s): SENATOR(s) MICCICHE                                                                                                 
                                                                                                                                
01/16/19       (S)       PREFILE RELEASED 1/7/19                                                                                
01/16/19       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/16/19       (S)       HSS, FIN                                                                                               
02/15/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SENATOR PETER MICCICHE, Bill Sponsor                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Introduced SB 7.                                                                                          
                                                                                                                                
EDRA MORLEDGE, Staff                                                                                                            
Senator Peter Micciche                                                                                                          
Alaska State Legislator                                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Gave the sectional for SB 7.                                                                              
                                                                                                                                
JAMES HARVEY, Assistant Director                                                                                                
Division of Employment and Training Services                                                                                    
Department of Labor and Workforce Development (DOLWD)                                                                           
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions about employment programs                                                              
during the hearing on SB 7.                                                                                                     
                                                                                                                                
SHAWNDA O' BRIEN, Director                                                                                                      
Division of Public Assistance                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 7.                                                                               
                                                                                                                                
JEANNIE MONK, Senior Vice President                                                                                             
Alaska State Hospital and Nursing                                                                                               
Home Association (ASHNHA)                                                                                                       
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
ALYSON CURRY, Legislative Liaison                                                                                               
Planned Parenthood Votes                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
ERIN WALKER-TOLLES, Executive Director                                                                                          
Catholic Community Service                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
AMALY OLFEN, representing self                                                                                                  
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
JUDY ELEDGE, representing self                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Supported SB 7.                                                                                           
                                                                                                                                
DIANA REDWOOD, representing self                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
AMBER SAWYER, representing self                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
ANDREW CUTTING, Fellow                                                                                                          
Alaskan Children's Trust                                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Voiced concerns about SB 7.                                                                               
                                                                                                                                
MAUDE BLAIR                                                                                                                     
Southcentral Foundation                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
JOSH HEMSATH, Volunteer Board Member                                                                                            
Anchorage Neighborhood Health Center (ANHC)                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed to SB 7.                                                                                          
                                                                                                                                
LAURA RHYNER, representing self,                                                                                                
Kenai, Alaska                                                                                                                   
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
CINDY GILDER, representing self                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
BESSIE ODAM, representing self                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
ERIC REIMERS, Policy Coordinator                                                                                                
Alaska Native Health Board                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
MARY SCHALLERT, representing self                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
KATHRYN BOLAK, representing self                                                                                                
Chugiak, Alaska                                                                                                                 
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
JON ZASADA, Policy Integration Director                                                                                         
Alaska Primary Care Association                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
XOCHITL LOPEZ-AYALA, representing self                                                                                          
Homer, Alaska                                                                                                                   
POSITION STATEMENT: Opposed SB 7.                                                                                             
                                                                                                                                
BETHANY MARCUM, Executive Director                                                                                              
Alaska Policy Forum                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Supported SB 7.                                                                                           
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
                                                                                                                                
1:31:19 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:31 p.m.  Present at the                                                               
call to order were Senators Stevens, Giessel, and Chair Wilson.                                                                 
                                                                                                                                
             SB 7-MED. ASSISTANCE WORK REQUIREMENT                                                                          
                                                                                                                                
1:31:38 PM                                                                                                                    
CHAIR WILSON announced  the consideration of SB 7.  He stated his                                                               
plan was  to hear the bill,  take public testimony, and  hold the                                                               
bill in committee.                                                                                                              
                                                                                                                                
1:32:18 PM                                                                                                                    
SENATOR PETER  MICCICHE, Bill Sponsor, Alaska  State Legislature,                                                               
Juneau, Alaska, said  SB 7 is about opportunity.  "This is taking                                                               
the long view toward breaking a  negative cycle, in my view. SB 7                                                               
asks  one  question,  which  is   'Should  Alaskans  who  receive                                                               
Medicaid  benefits have  the requirement  to work?'  I think  the                                                               
answer is yes,  and SB 7 is  a direct path to  achieving that end                                                               
and realizing that opportunity," he said.                                                                                       
                                                                                                                                
SENATOR MICCICHE said that the  Centers for Medicare and Medicaid                                                               
(CMS) is  allowing states to  impose work requirements  under the                                                               
structure of the federal 1115  waiver. This waiver is intended to                                                               
allow states  to approve  experimental or  demonstration projects                                                               
that  give states  additional flexibility  to design  and improve                                                               
their Medicaid program.                                                                                                         
                                                                                                                                
SENATOR MICCICHE  said he wanted  to address the  facts regarding                                                               
work requirements for Medicaid recipients.  SB 7 does not require                                                               
the elderly,  the disabled, or new  mothers to work to  get their                                                               
health benefits.  Work requirements  will not interfere  with the                                                               
ability  of recipients  with a  substance abuse  disorder to  get                                                               
appropriate  treatment.  The  bill provides  for  exemptions  for                                                               
individuals  who are  not  employed,  volunteering, or  otherwise                                                               
exempt if they are in an  education or training program that will                                                               
lead to employment.  There is an extensive list  of exemptions on                                                               
page 2, lines 6-21.                                                                                                             
                                                                                                                                
SENATOR MICCICHE said  that with SB 7, Alaska will  join at least                                                               
16   other   states   moving  forward   with   similar   Medicaid                                                               
requirements. Since 2015,  there has been a huge  increase in the                                                               
number of  Medicaid recipients in  Alaska. He said he  thinks the                                                               
current estimate is  nearly 210,000 people. SB 7 will  apply to a                                                               
relatively  small  portion  of these  individuals.  Specifically,                                                               
those who can  work but do not. Some have  assumed that requiring                                                               
Medicaid recipients to  work is primarily about  saving money. In                                                               
the  short term  the  legislation would  not  save a  significant                                                               
amount of money.  It is about a break even.  "But think about the                                                               
long-term view.  Think about what  it will  be like to  break the                                                               
cycle not  only for  those that will  become employed,  but their                                                               
children  and  grandchildren  that   break  that  cycle  of  some                                                               
families that have  struggled to find employment for  a very long                                                               
time," he said.                                                                                                                 
                                                                                                                                
SENATOR  MICCICHE  said  other  states  have  developed  creative                                                               
incentives  to getting  Medicaid  recipients back  to work.  This                                                               
legislation is  a conversation starter to  do just that. SB  7 is                                                               
not designed as an immediate  spending reduction, but rather as a                                                               
way  to encourage  people to  join  the community  of people  who                                                               
contribute  every day  to make  Alaska  a better  place to  live.                                                               
There is hope that getting  people off government rolls will lead                                                               
to savings  in the  long term.  It will  encourage people  to get                                                               
involved in  the larger workforce  population, become  engaged in                                                               
their   communities,   build   skills,  get   experience,   build                                                               
confidence, and connect with others  who are doing the same. They                                                               
should be able use those  positive experiences to work themselves                                                               
out of the Medicaid system.                                                                                                     
                                                                                                                                
SENATOR  MICCICHE  said the  default  position  of Americans  and                                                               
Alaskans should be that those who  can work, should work. He said                                                               
we don't know  if the next person  to cure cancer or  be the best                                                               
in whatever  field they  choose is  not relying  on the  state to                                                               
carry them through  every day and missing that  opportunity to be                                                               
the very best  they can be every  day and also be  an example for                                                               
their families and communities.                                                                                                 
                                                                                                                                
1:37:11 PM                                                                                                                    
EDRA  MORLEDGE,  Staff,  Senator  Peter  Micciche,  Alaska  State                                                               
Legislator,  Juneau,   Alaska,  said   SB  7  would   direct  the                                                               
Department of  Health and Social  Services (DHSS) to apply  for a                                                               
Section  1115 waiver  from the  federal  government to  implement                                                               
work  requirements as  a condition  of continued  eligibility for                                                               
Medicaid coverage for the able-bodied  population. A Section 1115                                                               
is broad  and a  way to  ask the federal  government to  bend the                                                               
rules for specifics the state faces.                                                                                            
                                                                                                                                
MS.  MORLEDGE  said that  for  the  first  time the  Centers  for                                                               
Medicare and  Medicaid (CMS)  will accept  waivers that  test the                                                               
hypothesis  that  requiring work  or  community  engagement as  a                                                               
condition of eligibility will result  in more beneficiaries being                                                               
employed and engaged in other  productive activities. The goal is                                                               
that this will result in  increased health and well-being for the                                                               
beneficiaries and  communities. In April last  year the president                                                               
signed  an  executive order  about  reducing  poverty in  America                                                               
which  is intended  to promote  economic mobility,  strong social                                                               
networks, and  accountability. The  executive order has  a strong                                                               
focus on work requirements for work-capable people.                                                                             
                                                                                                                                
MS.  MORLEDGE noted  that  SB  7 has  many  exemptions. The  bill                                                               
targets  a narrow  band of  people on  Medicaid. The  estimate is                                                               
20,000-25,000 people.                                                                                                           
                                                                                                                                
SENATOR MICCICHE said the committee  will hear arguments, such as                                                               
this is asking  people to find employment where  there's no work.                                                               
But   considering  the   state  fiscal   crisis,  the   volunteer                                                               
requirement  could  significantly reduce  the  cost  of what  the                                                               
state  is  providing in  services  as  these people  become  more                                                               
engaged,  gain  skills,  gain confidence.  When  looking  at  the                                                               
fiscal  note, he  said to  remember  that this  is the  long-term                                                               
view.                                                                                                                           
                                                                                                                                
1:40:27 PM                                                                                                                    
SENATOR STEVENS  asked if  he said that  210,000 people  or about                                                               
one in four are Medicaid recipient.                                                                                             
                                                                                                                                
SENATOR MICCICHE  responded that  the reality  is that  less than                                                               
half the people  in the state work, a third  are on Medicaid, and                                                               
more than  half the children born  in Alaska last year  were born                                                               
on Medicaid.  He said  he is  not disparaging  people in  need of                                                               
medical help. Rather,  he wants to provide  opportunities so they                                                               
learn to provide for themselves  and accomplish the most they can                                                               
accomplish in their lifetimes.                                                                                                  
                                                                                                                                
1:41:30 PM                                                                                                                    
MS. MORLEDGE  presented the following  sectional analysis  for SB                                                               
7:                                                                                                                              
                                                                                                                                
     Section 1:                                                                                                                 
        • Amends AS 47.07.036 to add a new  subsection (h)                                                                      
          requiring the  department to  apply for  a section                                                                    
          1115 waiver  to establish  a work  requirement for                                                                    
          adults who are eligible for Medicaid assistance.                                                                      
        • Subsection (h)(1) requires a recipient to submit                                                                      
          proof   of   employment   or  proof   of   seeking                                                                    
          employment,  participation  in an  educational  or                                                                    
          training   program,   volunteering,  engaging   in                                                                    
          subsistence programs, or caregiving.                                                                                  
        • Subsection (h)(2) allows a recipient to meet the                                                                      
          requirements  above  if  they participate  in  the                                                                    
          Alaska  temporary assistance  program  and are  in                                                                    
          compliance  with   the  work  requirement   in  AS                                                                    
          47.27.035.                                                                                                            
        • Subsection (h)(3) provides for  exemptions  from                                                                      
          the work requirement in subsection (h).                                                                               
        • Subsection (h)(4)    provides   for   additional                                                                      
          temporary exemptions from  the work requirement in                                                                    
          subsection (h).                                                                                                       
        • Subsection (h)(5) ensures the  work  requirement                                                                      
          will  not  prevent   a  recipient  from  obtaining                                                                    
          substance abuse treatment.                                                                                            
        • Subsection (h)(6) provides for  notification  of                                                                      
          the work requirement to all  recipients as soon as                                                                    
          practicable, and  requires termination  of medical                                                                    
          coverage for  recipients who become  ineligible as                                                                    
          a result of noncompliance after 90 days.                                                                              
                                                                                                                                
MS. Morledge said that the list  of exemptions in subsection 3 is                                                               
modeled   after  Alaska's   temporary  assistance   program.  The                                                               
guidance letter from  CMS asks states to  align work requirements                                                               
with various state programs.                                                                                                    
                                                                                                                                
CHAIR WILSON  suggested that age  65 may be  too high for  a work                                                               
requirement considering that the average  age of state workers is                                                               
between age 41 and age 44. He asked why that age was chosen.                                                                    
                                                                                                                                
MS. MORLEDGE  replied that she  will doublecheck where  that came                                                               
from but  she believes age  65 is  contained in the  CMS guidance                                                               
letter.  She  noted  the  bill   was  modeled  after  legislation                                                               
introduced in a previous legislature.                                                                                           
                                                                                                                                
CHAIR  WILSON asked  if  the guidance  letter  allowed states  to                                                               
select a different  age or if it had to  be consistent with other                                                               
work program  requirements such as  the exemption  for caretaking                                                               
for a child up to 12  months of age. He offered his understanding                                                               
that other  states have raised  that cap to  school-age children.                                                               
He noted  the committee had  received a lot of  written testimony                                                               
expressing  concern about  that. Finally,  he said  the committee                                                               
received  comments about  the exemption  for  participating in  a                                                               
tribal work  program. For example,  Arizona has an  exemption for                                                               
tribal beneficiaries of federally recognized tribes.                                                                            
                                                                                                                                
MS.  MORLEDGE said  she  will investigate  but  she believes  the                                                               
guidance letter allows states a generous amount of flexibility.                                                                 
                                                                                                                                
CHAIR WILSON noted who was available to answer questions.                                                                       
                                                                                                                                
1:48:46 PM                                                                                                                    
SENATOR GIESSEL asked  for the names of the states  that have had                                                               
their programs approved.                                                                                                        
                                                                                                                                
MS. MORLEDGE said  the information in the  packets indicates that                                                               
waivers  from   Arizona,  Arkansas,  Indiana,   Kentucky,  Maine,                                                               
Michigan,  and New  Hampshire have  been approved.  A portion  of                                                               
Utah's waiver was approved.                                                                                                     
                                                                                                                                
SENATOR GIESSEL asked  how the age range of 18  to 65 compares to                                                               
age ranges of the state plans that have been approved.                                                                          
                                                                                                                                
MS.  MORLEDGE said  the  ranges  vary widely  in  the states  she                                                               
looked  at.  Arkansas increased  the  lower  cap  to age  19  and                                                               
reduced the  upper cap  to somewhere  in the  50s in  response to                                                               
pending lawsuits. She said she  believes there is flexibility but                                                               
she will investigate and see how much ages vary in other states.                                                                
                                                                                                                                
SENATOR  GIESSEL  suggested Alaska  follow  in  the footsteps  of                                                               
states  that  have  successfully withstood  challenges  to  their                                                               
programs.                                                                                                                       
                                                                                                                                
SENATOR  STEVENS asked  if anything  in SB  7 relates  to helping                                                               
people find job or if other programs do that.                                                                                   
                                                                                                                                
MS.  MORLEDGE   responded  that   the  bill  has   nothing  about                                                               
employment  assistance,  but  Senator  Micciche is  open  to  all                                                               
suggestions to accomplish that end.                                                                                             
                                                                                                                                
SENATOR STEVENS said  he did not want to expand  the bill, but it                                                               
would  be worthwhile  knowing  about the  programs  that do  help                                                               
people find jobs.                                                                                                               
                                                                                                                                
MS. MORLEDGE  deferred to the  Department of Labor  and Workforce                                                               
Development.                                                                                                                    
                                                                                                                                
CHAIR  WILSON asked  Mr. Harvey  to respond  to Senator  Steven's                                                               
question  about  the state  work  programs  to help  people  find                                                               
employment or  case management services  that help  people retain                                                               
jobs.                                                                                                                           
                                                                                                                                
1:52:50 PM                                                                                                                    
JAMES  HARVEY, Assistant  Director,  Division  of Employment  and                                                               
Training Services, Department of  Labor and Workforce Development                                                               
(DOLWD),  Juneau,  Alaska, said  the  job  center system  has  14                                                               
offices and also operates on  the Internet. The opportunities are                                                               
mostly  for  individuals  seeking work  voluntarily.  The  Alaska                                                               
state  labor exchange  system is  a  job posting  board to  allow                                                               
employers  to   connect  with  job   seekers.  In  the   case  of                                                               
unemployment insurance  claimants, which  is an exemption  for SB                                                               
7, those individuals  must register in that system  and do active                                                               
job  searches.  There are  other  programs  throughout the  state                                                               
system, notably in  the Department of Health  and Social Services                                                               
(DHSS),  Division  of  Public Assistance,  with  TANF  [Temporary                                                               
Assistance  for Needy  Families]. Individuals  are in  compulsory                                                               
status  and they  receive some  case management  provided by  DPA                                                               
staff or  their contractors.  Case management  goals are  set for                                                               
those  individuals.  DOLWD  operates  several  programs  to  help                                                               
people   in  voluntary   status  with   such  things   as  resume                                                               
preparation,   interview   assistance,    and   possible   skills                                                               
attainment.  Public   Assistance,  Division  of   Employment  and                                                               
Training  Services, Division  of  Vocational Rehabilitation,  and                                                               
Alaska  Housing Finance  are partners  in  the workforce  system.                                                               
There is a  myriad of programs for individuals,  whether they are                                                               
compelled or not compelled to seek employment.                                                                                  
                                                                                                                                
SENATOR STEVENS asked how this  will improve things for the third                                                               
of Alaskans who have never had a job in their lives.                                                                            
                                                                                                                                
MR. HARVEY  replied that  a figure  of 200,000  was put  forth as                                                               
individuals  participating in  Medicaid  with  perhaps 20,000  to                                                               
25,000 falling into  this group. A number of  individuals in that                                                               
group  are  working  and  a  number  of  those  individuals  have                                                               
demonstrated work because they  receive unemployment benefits. He                                                               
said he  does not know the  number of individuals who  have never                                                               
worked.  The   Division  of  Employment  and   Training  Services                                                               
routinely  works with  individuals  who have  little  to no  work                                                               
experience. Many  are young  adult Alaskans.  One program  in the                                                               
workforce system is the Workforce  Innovation and Opportunity Act                                                               
(WIOA)  youth  program.  The division  administers  that  program                                                               
using  grantees throughout  the  state to  engage providers  that                                                               
work with  at-risk youth in  and out  of school. That  program is                                                               
making headway.  The division also  operates the  Mature Alaskans                                                               
Seeking  Skills Training  program for  individuals 55  and older.                                                               
Individuals are  placed in a  work environment to  achieve skills                                                               
that can translate to  unsubsidized employment. Many hard-working                                                               
individuals  work collectively  in the  workforce system  to help                                                               
people who have little to no work experience.                                                                                   
                                                                                                                                
CHAIR  WILSON noted  that the  committee heard  that about  seven                                                               
different work  programs across  four different  departments that                                                               
are working on  similar goals. He asked if  any consideration had                                                               
been given to consolidating the workforce programs in the state.                                                                
                                                                                                                                
MR. HARVEY said  that action is federally driven  and ongoing. It                                                               
is put in place through  the Workforce Innovation and Opportunity                                                               
Act   (WIOA).  That   act  defines   the  partner   programs  and                                                               
collaboration under that Act. As  far as repetitiveness or cross-                                                               
over, these programs  are offered in many  varieties of services.                                                               
Some programs may  be for dislocated workers. Another  may be for                                                               
those receiving  assistance through Alaska Housing  Finance. Then                                                               
there  is  a  program  specific  to  individuals  receiving  TANF                                                               
benefits.  Some  programs  have   a  compelling  factor  for  the                                                               
individual to be  there while others are  for individuals seeking                                                               
change voluntarily.                                                                                                             
                                                                                                                                
CHAIR WILSON related  that he previously worked for  an agency in                                                               
Mat-Su that had two of these  work service programs; none were at                                                               
full capacity and they all did  similar work services. He said it                                                               
seems that  the state could  do better of  consolidating programs                                                               
and the  end user would see  no difference. He commented  that it                                                               
seems that a  more coordinated approach would make  better use of                                                               
resources.                                                                                                                      
                                                                                                                                
CHAIR WILSON  asked a  DHSS representative to  give a  summary of                                                               
the overall costs  reflected in the nine or ten  fiscal notes for                                                               
SB  7. He  also  asked what  the  timeline would  be  to get  the                                                               
program up and ready.                                                                                                           
                                                                                                                                
2:03:06 PM                                                                                                                    
SHAWNDA  O'  BRIEN,  Director,  Division  of  Public  Assistance,                                                               
Department of Health and Social  Services (DHSS), Juneau, Alaska,                                                               
said the  fiscal notes reflect  the costs DHSS believes  would be                                                               
necessary  to  implement the  bill.  She  said the  savings  from                                                               
recipients not in  compliance with the bill are  reflected in the                                                               
Medicaid-related fiscal  notes. The  administrative costs  are in                                                               
the fiscal  notes for Public  Assistance. Those are based  on the                                                               
same  case management  staffing needs  as the  TANF program.  The                                                               
fiscal  note   for  Work  Services  programs   is  for  supported                                                               
services. Those  are the costs  related to job aids  and barriers                                                               
to  receiving  employment.  It  could  be  things  like  training                                                               
programs,  clothing,  tools,  and childcare.  Average  costs  per                                                               
person are built in based on  the average costs for work services                                                               
program for TANF.                                                                                                               
                                                                                                                                
CHAIR WILSON asked for the total cost of all the fiscal notes.                                                                  
                                                                                                                                
MS. O' BRIEN said she had not totaled them up.                                                                                  
                                                                                                                                
2:05:02 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:05:06 PM                                                                                                                    
MS. MORLEDGE directed  attention to a document  she received from                                                               
DHSS that lists the amounts for each of the fiscal notes.                                                                       
                                                                                                                                
SENATOR STEVENS asked for an explanation.                                                                                       
                                                                                                                                
MS. O' BRIEN said  the net savings in FY 2020  is estimated to be                                                               
$17.9  million. The  department  expects to  see  savings in  the                                                               
Medicaid  component based  on  their estimate  of  the number  of                                                               
people who will  be in noncompliance. The  numbers are calculated                                                               
based  on  an  estimate  of   the  overall  enrollment,  required                                                               
participants, and similar programs across state and nation.                                                                     
                                                                                                                                
MS. O' BRIEN said in FY  2021, the savings is about $8.8 million.                                                               
Beyond FY  2022, the savings level  off to about $18  million. At                                                               
some point, the number of people  enrolled in the program and the                                                               
number  of new  people entering  the  program will  level off  so                                                               
there  will  be little  change  in  participation rates  the  out                                                               
years.                                                                                                                          
                                                                                                                                
CHAIR WILSON asked  how long it would take for  the department to                                                               
fully staff and implement this program if it becomes law.                                                                       
                                                                                                                                
MS.  O'  BRIEN answered  that  a  CMS  waiver approval  can  take                                                               
several  months  or longer.  The  department  is hopeful  it  can                                                               
mirror  its request  to  states that  have  received approval  to                                                               
expedite that  approval process.  In a  perfect world,  where the                                                               
approvals are  in place  and all the  regulations can  be updated                                                               
accordingly,  it would  probably  take six  months  to get  fully                                                               
staffed and  trained. The department believes  that existing case                                                               
management system  has the  capacity to  take on  this additional                                                               
work but it will need to be  replaced in the next two years. That                                                               
additional capacity will  be built that into  the capital request                                                               
at that time.                                                                                                                   
                                                                                                                                
CHAIR WILSON opened public testimony.                                                                                           
                                                                                                                                
2:09:29 PM                                                                                                                    
JEANNIE MONK,  Senior Vice President,  Alaska State  Hospital and                                                               
Nursing, Home  Association (ASHNHA), Juneau, Alaska,  stated that                                                               
Alaska  State Hospital  and  Nursing,  Home Association  (ASHNHA)                                                               
understands and appreciates the  interest in workforce engagement                                                               
in  Alaska, and  agrees with  efforts to  support Alaskans  being                                                               
part of the workforce. She  said she appreciates that the sponsor                                                               
is clear  about defining the goal.  It is not about  saving money                                                               
but about engaging  people in the workforce and that  a number of                                                               
important  exemptions  are  provided.  For a  number  of  reasons                                                               
ASHNHA opposes  SB 7 but is  willing to work with  the sponsor to                                                               
improve and address these concerns.                                                                                             
                                                                                                                                
MS. MONK  maintained that the new  Medicaid eligibility standards                                                               
could  restrict needed  access to  health care  for Alaskans  who                                                               
have  jobs, who  have disabilities,  chronic illnesses,  or other                                                               
health care  needs. The majority  of adults enrolled  in Medicaid                                                               
are  working, but  many  work  in low-wage  jobs  with no  health                                                               
insurance  and inflexible  conditions. Adding  these requirements                                                               
would add to existing stressors.  Losing health care coverage can                                                               
make  it harder  for  Alaskans  to work.  She  described the  $17                                                               
million  cost savings  as  a cost  shift.  Those people's  health                                                               
needs won't  go away, but  their coverage will, and  those health                                                               
care needs will be absorbed  elsewhere in the health care system,                                                               
probably in  the emergency room.  ASHNHA is concerned  about less                                                               
coverage  for people  who are  already working  and about  adding                                                               
another  layer of  administrative paperwork.  There is  already a                                                               
huge  backlog in  processing Medicaid  applications. The  program                                                               
lacks   the  capacity   to   implement   and  assess   additional                                                               
eligibility  requirements.  ASHNHA  is also  concerned  that  the                                                               
legislation  lacks  detail.  DHSS  needs  more  guidance  in  the                                                               
development  and  implementation  of the  work  requirements  and                                                               
clear guidelines on  how support will be provided  to help people                                                               
find employment, training, or volunteer opportunities.                                                                          
                                                                                                                                
MS. MONK said ASHNHA believes there  are options to improve SB 7.                                                               
For example, Michigan  has a robust IT system  that allows people                                                               
to report their  work activities online on a  monthly basis. That                                                               
state started  with a  work requirement  of 20  hours a  week and                                                               
then  moved to  80 hours  per month  to better  accommodate shift                                                               
work. There  should also  to be an  allowance for  seasonal work.                                                               
Seasonal   workers  could   lose  health   benefits  because   of                                                               
inconsistent  work.  She urged  the  committee  to take  care  to                                                               
create  a well-designed,  efficient program  that will  encourage                                                               
work  engagement  while  maintaining  health  care  benefits  for                                                               
Alaskans.                                                                                                                       
                                                                                                                                
2:14:12 PM                                                                                                                    
ALYSON  CURRY,  Legislative  Liaison, Planned  Parenthood  Votes,                                                               
Juneau, Alaska, said  she too was testifying  to express concerns                                                               
and oppose SB  7. She explained that Planned  Parenthood works to                                                               
ensure  that everyone  has access  to health  care regardless  of                                                               
their income or circumstances. About  a quarter of their patients                                                               
are Medicaid recipients and about  90 percent are women. She said                                                               
the  enrollment restrictions  in  SB 7  will  decrease access  to                                                               
health care  and have  a disproportionate  impact on  women. Most                                                               
Medicaid  enrollees who  can work  already do  so. If  they don't                                                               
work, typically  it is because  of barriers  like transportation,                                                               
housing, job  training and availability, and  education. While SB                                                               
7  has exemptions,  they  are inadequate  and  vague. These  work                                                               
requirements and  the administrative burden of  seeking exemption                                                               
would   result   in   even  eligible   enrollees   losing   basic                                                               
preventative  care without  increasing their  economic stability.                                                               
Research has  shown that implementing work  requirements does not                                                               
reduce  poverty but  can push  people deeper  into poverty.  SB 7                                                               
would harm  the state budget.  Investing in preventative  care is                                                               
highly cost  effective. The  state saves $7  for every  dollar it                                                               
invests in family planning. She  asked the committee to oppose SB                                                               
7  and instead  invest  in proven,  cost-effective strategies  to                                                               
improve access to health care and improve economic security.                                                                    
                                                                                                                                
2:16:27 PM                                                                                                                    
ERIN  WALKER-TOLLES,   Executive  Director,   Catholic  Community                                                               
Service, Juneau, Alaska, said she  previously was Chief of Policy                                                               
and  Program Development  for the  Division of  Public Assistance                                                               
(DPA), as  well as  the director of  TANF and  SNAP [Supplemental                                                               
Nutrition  Assistance  Program], so  she  is  familiar with  work                                                               
requirements involved with TANF.  She echoed Ms. Monk's comments.                                                               
In addition  to what Ms.  Monk noted, Ms. Walker-Tolles  said she                                                               
is most  concerned about rural  Alaskans. She reported  that when                                                               
implementing  TANF work  requirements,  DPA found  there were  no                                                               
volunteer  opportunities in  rural Alaska.  It took  a tremendous                                                               
effort  to  create  some volunteer  opportunities  that  did  not                                                               
provide  enough  hours, much  less  for  a larger  population  of                                                               
Medicaid recipients. She said she  applauds efforts to align work                                                               
requirements,  but  there  are   pros  and  cons.  The  federally                                                               
mandated   TANF   work    verification   requirements   make   it                                                               
prohibitively  difficult  to collect  and  verify  that work  has                                                               
happened. If  the bill goes  forward, she asked the  committee to                                                               
consider  allowing self-attestation  for  people doing  volunteer                                                               
and  community work  and for  self-employment. It  takes a  great                                                               
deal  of  work to  get  employers  and supervisors  at  volunteer                                                               
activities to  attest and people  who do subsistence had  to have                                                               
nonrelatives verify their subsistence activity.                                                                                 
                                                                                                                                
MS. WALKER-TOLLES  highlighted that TANF exempts  Native villages                                                               
with  unemployment  rates  of  50   percent  or  more  from  work                                                               
requirements.  She  urged  the committee  to  include  a  similar                                                               
exemption if  the bill  goes forward. She  said she  supports the                                                               
exemptions for  medical conditions and disabilities  but in rural                                                               
Alaska,  local  health  providers   are  not  available  to  give                                                               
verification  of medical  conditions  and  disability. DPA  found                                                               
that in rural  Alaska the people most in need  of Medicaid, those                                                               
with  existing conditions,  simply fell  off the  program because                                                               
they couldn't access a doctor.                                                                                                  
                                                                                                                                
2:20:02 PM                                                                                                                    
AMALY   OLFEN,   representing   self,  Juneau,   Alaska,   stated                                                               
opposition to  SB 7 because  it will overburden people  with more                                                               
paperwork for a service that  already requires a lot of paperwork                                                               
to  qualify. It  will also  create additional  paperwork for  the                                                               
department,  which could  delay  life-saving medical  procedures.                                                               
She said Alaska is  unique in many issues and is  one of the most                                                               
expensive  states to  live in.  Many are  employed full  time and                                                               
still require  Medicare. If one of  the goals of the  state is to                                                               
save  money,  the  conversation should  first  be  about  helping                                                               
people find  jobs before talking  about limiting  people's access                                                               
to health  care. She suggested  the state first pay  attention to                                                               
the   root   causes   of  unemployment   before   it   implements                                                               
restrictions and limitations on medical assistance.                                                                             
                                                                                                                                
2:22:25 PM                                                                                                                    
JUDY  ELEDGE,   representing  self,  Anchorage,   Alaska,  stated                                                               
support for SB 7. She  offered her understanding that Medicaid is                                                               
for the  elderly, the disadvantaged,  and young children  and she                                                               
supports  that  100  percent.  She  related  that  she  testified                                                               
against Medicaid  expansion out of  concern that it  would spread                                                               
the money so thin that people  who really needed it would not get                                                               
full services. She  said she sees that happening  with people who                                                               
work with disabled  children. She shared that she is  over 65 and                                                               
continues to  work so she  has no  objection to raising  the work                                                               
requirement to 65.  She related that she has lived  and worked in                                                               
the school  system in rural Alaska  since 1997 and has  seen many                                                               
jobs  go unfilled  in the  school. Volunteer  positions are  also                                                               
available. She  emphasized that  the State  of Alaska  should not                                                               
give  money  to  able-bodied  people who  are  not  working.  She                                                               
maintained  that people   and  the people  who have  been working                                                               
want  to know  where it  ends. She  concluded that  nobody should                                                               
oppose the requirement to work 20 hours a week.                                                                                 
                                                                                                                                
2:25:26 PM                                                                                                                    
DIANA  REDWOOD,  representing  self,  Anchorage,  Alaska,  stated                                                               
strong opposition to  SB 7. She opined that  work requirements do                                                               
not help low income people  get medical services. Instead, it may                                                               
lead to  low income people  losing health care  coverage. Studies                                                               
show that  work requirements, including  under the  TANF program,                                                               
do not increase  work or decrease poverty. In  fact, the majority                                                               
of people subject to work  requirements remain poor, became poor,                                                               
or lost access to health care  services. She said she wonders how                                                               
many people would fall under SB  7 since the majority of Medicaid                                                               
recipients already work.  She suggested there are  better ways to                                                               
promote  work such  as such  as programs  to boost  education and                                                               
skills  and  helping provide  childcare  for  women returning  to                                                               
work. Otherwise,  it looks like  the state is trying  to increase                                                               
bureaucracy to reduce people's access  to health care and that is                                                               
the wrong way to go.                                                                                                            
                                                                                                                                
2:27:18 PM                                                                                                                    
AMBER SAWYER, representing self,  Anchorage, Alaska, related that                                                               
she worked until  September 1, 2012, when she had  a car accident                                                               
because she  had a  seizure due to  undiagnosed epilepsy.  She is                                                               
now officially disabled,  but it took many years  even though she                                                               
had a mass in  her brain. She said it is not  easy to qualify for                                                               
Medicaid. She tried  to work, but when people found  out when she                                                               
had seizures, she  lost jobs. Now she's had brain  surgery and is                                                               
not allowed  to work.  These are  the types  of people  that need                                                               
considerations, she said.                                                                                                       
                                                                                                                                
2:30:07 PM                                                                                                                    
ANDREW   CUTTING,  Fellow,   Alaskan   Children's  Trust   (ACT),                                                               
Anchorage, Alaska,  stated that  ACT values parents  working. The                                                               
data  shows that  dual  income families  do  better than  single-                                                               
income  families. He  related  that  ACT had  a  webinar on  work                                                               
requirements and how they are  being implemented in other states.                                                               
He  suggested the  committee consider  that  it is  not just  the                                                               
number of  people on the  rolls but what  happens to the  rest of                                                               
the community. Oftentimes, when  work requirements exclude people                                                               
from services,  they hit the safety  net, so there is  a transfer                                                               
of cost. Instead  of low prevention costs  on Medicaid, emergency                                                               
rooms costs increase and everyone  shares those costs. He posited                                                               
that even if the bill had  zero cost, there are not enough people                                                               
in the system to make this a  cost savings for the state. Even on                                                               
the aggressive  side, this  would apply  to perhaps  9,000 people                                                               
and  the rough  savings would  be about  $4 million.  Some states                                                               
spent more than  $100 million enacting similar  programs and some                                                               
are fighting  legal battles to  push a program through.  He urged                                                               
the committee to  look at the Montana model as  an example of one                                                               
state where it worked.                                                                                                          
                                                                                                                                
SENATOR STEVENS  asked whether he  was saying this  program would                                                               
cost $100 million and save $4 million.                                                                                          
                                                                                                                                
2:33:15 PM                                                                                                                    
MR. CUTTING  said the $100  million was an example  from Kentucky                                                               
or Arkansas. Both of those states  had a very aggressive model to                                                               
remove  people from  the system.  That  is not  what is  proposed                                                               
here, but he encouraged the committee  to look at those states as                                                               
examples of  red tape and bureaucracy  that was put in  place. He                                                               
acknowledged that  Alaska is a  different model that  has smaller                                                               
numbers.                                                                                                                        
                                                                                                                                
2:33:45 PM                                                                                                                    
MAUDE  BLAIR, Southcentral  Foundation,  Anchorage, Alaska,  said                                                               
that she appreciates that Senator  Micciche wants to build people                                                               
up  to make  them  self-sufficient and  they  could volunteer  in                                                               
places with few  jobs, but Southcentral Foundation  is opposed to                                                               
the bill. She  echoed the sentiments of Ms. Monk  and Ms. Walker-                                                               
Tolles and predicted  that the bill would be  difficult for rural                                                               
Alaska.  She  explained  that  many  people  who  meet  the  work                                                               
requirement  may be  removed from  the rolls  because they  don't                                                               
understand  how to  report to  the state.  In much  of the  state                                                               
English is  not the  first language and  many places  are without                                                               
access  to  the Internet  for  reporting  compliance. For  Alaska                                                               
Native  and American  Indian people,  Medicaid  expenses are  100                                                               
percent reimbursable to  the state by the  federal government. If                                                               
another hurdle is  created for Alaska Native  and American Indian                                                               
people to have  access to Medicaid, they won't  apply. That would                                                               
reduce money coming into the state to help pay for health care.                                                                 
                                                                                                                                
2:35:52 PM                                                                                                                    
JOSH  HEMSATH,  Volunteer  Board Member,  Anchorage  Neighborhood                                                               
Health Center  (ANHC), Anchorage, Alaska, informed  the committee                                                               
that  the Anchorage  Neighborhood Health  Center (ANHC)  began in                                                               
Anchorage nearly  45 years serving  people out of a  trailer. Now                                                               
it  has more  than  80 staff  members. About  45  percent of  the                                                               
patient population at  ANHC uses Medicaid when  the state average                                                               
is 20  percent. He expressed  three key  concerns about SB  7. It                                                               
will decrease access to care,  increase costs and complexity, and                                                               
punish  people   with  significant  challenges.  Only   the  most                                                               
vulnerable  25,000  Alaskans  will  be  impacted  by  this  bill.                                                               
Previous attempts  to pass similar  legislation show  that three-                                                               
quarters of those  people will qualify for  an exemption, leaving                                                               
only  5,000  to  6,000  people   unable  to  qualify  with  these                                                               
requirements. Because  this is a new  program, it is hard  to say                                                               
who those  are, but they  are probably people who  work temporary                                                               
or seasonal jobs and cannot  meet the weekly 20 hour requirement.                                                               
He  suggested that  the work  requirements  of SB  7 create  more                                                               
complexity  and  administrative overhead.  The  bill  is a  major                                                               
undertaking  with  little to  no  cost  savings. Previous  fiscal                                                               
notes  show it  will  cost  $300 to  $500  million  to start  the                                                               
program.  This is  inconsistent  with efforts  to contain  costs.                                                               
Finally, the  majority of Medicaid  recipients are  working, many                                                               
in  low-wage  jobs  that  do  not  provide  coverage.  The  5,000                                                               
Alaskans  who would  not be  able to  prove their  exemptions are                                                               
already struggling.                                                                                                             
                                                                                                                                
2:39:15 PM                                                                                                                    
LAURA RHYNER, representing self, Kenai,  Alaska, said SB 7 adds a                                                               
lot  of red  tape  to  an overburdened  system,  which can  cause                                                               
delays  for people  seeking essential  medical services.  Several                                                               
years ago, she  was on Medicaid while between  seasonal jobs that                                                               
did not  provide insurance. Just  recently she received  a letter                                                               
dated November  6, 2018, from  the Division of  Public Assistance                                                               
stating that her November 2016  application had been received and                                                               
additional information  was requested. She said  most Alaskans on                                                               
Medicaid are working,  many in jobs that are  seasonal, low wage,                                                               
and with no insurance.                                                                                                          
                                                                                                                                
2:41:49 PM                                                                                                                    
CINDY GILDER, representing self,  Anchorage, Alaska, said she can                                                               
appreciate the philosophy that someone  capable of working should                                                               
not  use federal  tax  dollars and  limited  state resources  for                                                               
their  medical care,  but  based on  data  she questions  whether                                                               
there  is a  problem and  this is  the right  fix. A  2017 Kaiser                                                               
Foundation study looked  at nonelderly family work  status and it                                                               
showed that nonwork  status for Alaska was 21  percent. Given the                                                               
administrative burdens associated with  this bill, she questioned                                                               
whether this legislation  was the right mechanism  to help people                                                               
who want to work get back to work.                                                                                              
                                                                                                                                
CHAIR WILSON noted that were  about 20 people waiting to testify.                                                               
He reminded everyone that they could submit written testimony.                                                                  
                                                                                                                                
2:43:58 PM                                                                                                                    
BESSIE ODAM,  representing self,  Anchorage, Alaska,  stated that                                                               
she  was speaking  in opposition  to  SB 7.  She emphasized  that                                                               
Medicaid  should  be accessible  to  anybody  who seeks  it.  The                                                               
process is  already difficult and  overly complex.  She suggested                                                               
that   the  conversation   surrounding  Medicaid   and  accessing                                                               
services  should   be  about  making  access   easier,  not  more                                                               
requirements. SB 7 assumes people  on the Medicaid program aren't                                                               
willing  to work  or volunteer,  which is  not the  case. If  the                                                               
concern  is that  too much  money is  spent on  Medicaid, another                                                               
option  should  be  considered.  Studies  in  other  states  that                                                               
require work  or volunteering  for eligibility,  show it  is more                                                               
expensive to  implement the program.  Alaska is already  short on                                                               
funds and implementing this program  will cost Alaskans more than                                                               
the system already in place.                                                                                                    
                                                                                                                                
2:45:59 PM                                                                                                                    
ERIC  REIMERS, Policy  Coordinator, Alaska  Native Health  Board,                                                               
Anchorage, Alaska, stated  that the Alaska Medicaid  program is a                                                               
critical  component of  the Alaska  Tribal Health  System (ATHS).                                                               
Imposing work  requirements would have systematic  impacts across                                                               
the system. He explained that ATHS  is a system of care comprised                                                               
of  the voluntary  agreements with  30 tribes  and tribal  health                                                               
organizations. It is the most  comprehensive health system in the                                                               
state and  country and  is critical to  the Alaska  public health                                                               
system.   He   said   the  high   unemployment   in   the   state                                                               
disproportionately  impacts rural  communities.  The Bristol  Bay                                                               
Borough has  an unemployment rate  double the  statewide average.                                                               
Imposing  work  requirements  in  these  rural  communities  will                                                               
increase administrative  costs and  uncompensated costs  and lead                                                               
to  delays  in  care  that  will lead  to  more  expensive  care.                                                               
Imposing work requirements  will cause people to  be removed from                                                               
the rolls.  This will impact  the Medicaid  expansion population,                                                               
which receives  one of the  highest federal matches.  Not getting                                                               
the  federal reimbursement  leaves money  on table  that Alaskans                                                               
have paid  for with taxes.  As previously mentioned,  the federal                                                               
government has  a moral, legal, and  fiduciary responsibility for                                                               
the  health  and  well-being  of   Alaska  Natives  and  American                                                               
Indians, so  it reimburses the  state for all  Medicaid expenses.                                                               
He said  ATHS' written testimony  further explains  the statewide                                                               
impact of imposing work requirements.                                                                                           
                                                                                                                                
2:48:16 PM                                                                                                                    
MARY  SCHALLERT, representing  self,  Anchorage, Alaska,  advised                                                               
that  she is  testifying  in opposition  to SB  7.  She said  she                                                               
worked 15 years as a  psychiatric mental health outpatient nurse.                                                               
Sometimes severely  mentally ill  patients would have  great days                                                               
and other  days they could  only survive as inpatients  at Alaska                                                               
Psychiatric Institute. She  said it does not make  sense to think                                                               
these  people  should be  required  to  work. She  described  her                                                               
sister with  Down syndrome who would  like to but cannot  work to                                                               
demonstrate  that  each person  is  unique  in their  disability.                                                               
Putting  this extra  requirement  on a  vulnerable population  is                                                               
wrong.                                                                                                                          
                                                                                                                                
CHAIR   WILSON   apologized   for  the   technical   difficulties                                                               
preventing  people  from  the Fairbanks  Legislative  Information                                                               
Office from testifying.                                                                                                         
                                                                                                                                
2:50:40 PM                                                                                                                    
KATHRYN BOLAK, representing self,  Chugiak, Alaska, opposed SB 7.                                                               
She said she  has heard from family and friends  in Arkansas that                                                               
the work  requirement has  been a  nightmare because  of computer                                                               
glitches  and a  complex online  reporting system.  She suggested                                                               
they look  at the McGonigal  case. She  asked if this  bill makes                                                               
sense in a  time of budget cuts for a  department that is already                                                               
understaffed  and underwhelmed.  She  has serious  doubts it  can                                                               
deal  with all  the individual  cases and  the many  appeals. She                                                               
asked if  the money for  the program  will come from  lesser care                                                               
for the most vulnerable. She is  now covered by Medicaid. She got                                                               
sick a  few years ago  and lost  her business. She  never thought                                                               
she would need a program like Medicaid.                                                                                         
                                                                                                                                
2:53:32 PM                                                                                                                    
JON  ZASADA, Policy  Integration  Director,  Alaska Primary  Care                                                               
Association (APCA),  Anchorage, Alaska,  said the  Alaska Primary                                                               
Care  Association is  Alaska's primary  care safety  net provider                                                               
that guarantees  access regardless  of ability  to pay.  He noted                                                               
that thirty-five  percent of their  patients are on  Medicaid. He                                                               
said APCA submitted a letter  outlining their concerns with SB 7.                                                               
First,  the  work  requirement   does  not  adequately  encourage                                                               
Medicaid beneficiaries  to find  and keep jobs.  He said  APCA is                                                               
interested  in   the  Montana  Health  and   Economic  Livelihood                                                               
Partnership. Second,  the loss of  Medicaid coverage and  loss of                                                               
treatment  is   dangerous  to  beneficiaries  and   patients  and                                                               
expensive to  Alaska's health care  system. He agreed  with other                                                               
testimony that care provided without  coverage is shifted to more                                                               
expensive  systems, such  as  the emergency  room  and legal  and                                                               
correction  system.   Third,  the   state  is  ill   equipped  to                                                               
administer   the  program   when   more   than  16,000   Medicaid                                                               
applications  are  still  pending.  Finally,  every  APCA  clinic                                                               
spends   a   lot  of   time   supporting   clients  in   gaining,                                                               
understanding,  and maintaining  coverage. The  churn, especially                                                               
in  smaller  communities  with  seasonable  employment,  will  be                                                               
profound for those patients and staff at clinics.                                                                               
                                                                                                                                
2:56:30 PM                                                                                                                    
XOCHITL LOPEZ-AYALA,  representing self, Homer, Alaska,  said she                                                               
opposes SB 7  and as a constituent urges Senator  Stevens to vote                                                               
no. She  said she  came from  a family  that accessed  health and                                                               
social services  for low-income people  and this bill  won't help                                                               
those  working  to  come  out  of  poverty.  Governor  Dunleavy's                                                               
proposed  budget  slashes funding  for  many  programs so  effort                                                               
should be focused on helping  Alaskans to find employment and not                                                               
make being on Medicaid a job in  itself. It is just more hoops to                                                               
find  health care,  she  said. She  encouraged  the committee  to                                                               
improve  access  to health  care  and  workforce engagement,  not                                                               
create more barriers.                                                                                                           
                                                                                                                                
2:57:44 PM                                                                                                                    
BETHANY   MARCUM,  Executive   Director,  Alaska   Policy  Forum,                                                               
Anchorage, Alaska, stated that in  2017 the Walker administration                                                               
projected  that   23,273  able-bodied  adults  would   enroll  in                                                               
Medicaid expansion at  the cost of $7,500 per  person. The actual                                                               
expansion population enrollment in 2017  reached over 35,000 at a                                                               
cost of  nearly $10,500 per  person. She agreed that  the federal                                                               
government  is responsible  for a  portion of  Medicaid expansion                                                               
costs, but it will not  subsidize the program indefinitely. Able-                                                               
bodied adults should  not be prioritized over the  truly needy on                                                               
traditional Medicaid. She opined that  the solution for Alaska is                                                               
more work.  She said  she would  be happy  to share  the research                                                               
that  shows  that  work requirements  offer  enrollees  a  better                                                               
future  through the  power of  work.  Able-bodied adults  leaving                                                               
welfare found  work in diverse  industries and more  than tripled                                                               
their  income. Adding  Medicaid  work  requirements makes  sense.                                                               
This  can emphasize  the power  of  work to  transform lives  and                                                               
break the  cycle of dependency  and preserve resources  for truly                                                               
needy Alaskans.                                                                                                                 
                                                                                                                                
3:00:17 PM                                                                                                                    
CHAIR WILSON  held SB  7 in committee  and kept  public testimony                                                               
open.                                                                                                                           
                                                                                                                                
3:00:40 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 3:30 p.m.                                                                                         

Document Name Date/Time Subjects
SB 7 Version LS-0196A.PDF SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 Sponsor Statement.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 Sectional Summary.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 AS 47.07.020.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 AS 47.27.035.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 AS 47.07.036.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 NCSL Medicaid_Waivers_State.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 State Waivers List _ Medicaid.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN Dept Admin Ofc of Admin Hearings.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN DHSS Medicaid Svds Adult Dental.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN DHSS Medicaid Svcs Behavioral Health Medicaid Svcs.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN DHSS Medicaid Svcs Health Care Medicaid Svcs.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN DHSS Public Assistance Field Services.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN DHSS Public Assistance Work Services.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN DLWD Unemployment Ins.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 - FN DLWD Workforce Svcs.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB7 FN - DHSS - Quality Control.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 Section 1115 Demonstrations _ Medicaid.gov.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 Snapshot of State Proposals.pdf SHSS 2/15/2019 1:30:00 PM
SB 7
SB 7 Chart of Requirements and Exemptions.pdf SHSS 2/15/2019 1:30:00 PM
SB 7