Legislature(2019 - 2020)BUTROVICH 205

02/20/2019 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:31:05 PM Start
01:31:20 PM SB7
02:09:44 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 20, 2019                                                                                        
                           1:31 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator David Wilson, Chair                                                                                                     
Senator Gary Stevens                                                                                                            
Senator Cathy Giessel                                                                                                           
Senator Tom Begich                                                                                                              
MEMBERS ABSENT                                                                                                                
Senator John Coghill, Vice Chair                                                                                                
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                                                               
     - HEARD & HELD                                                                                                             
PREVIOUS 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                                                                           
02/15/19       (S)       Heard & Held                                                                                           
02/15/19       (S)       MINUTE(HSS)                                                                                            
02/20/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
CRYSTAL BOURLAND, Executive Director                                                                                            
NAMI Juneau                                                                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Opposed SB 7.                                                                                             
KATE FINN, representing self                                                                                                    
Homer, Alaska                                                                                                                   
POSITION STATEMENT: Opposed SB 7.                                                                                             
DIANA CHADWELL, representing self                                                                                               
Delta Junction, Alaska                                                                                                          
POSITION STATEMENT: Opposed SB 7.                                                                                             
SENATOR PETER MICCICHE, SB 7 Sponsor                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified on SB 7.                                                                                        
SHAWNDA O'BRIEN, Director                                                                                                       
Division of Public Assistance                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions related to SB 7.                                                                       
EDRA MORLEDGE, Staff                                                                                                            
Senator Peter Micciche                                                                                                          
Alaska State Legislator                                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified on SB 7.                                                                                        
ACTION NARRATIVE                                                                                                              
1:31:05 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 Begich, Giessel,  Stevens, and Chair                                                               
             SB 7-MED. ASSISTANCE WORK REQUIREMENT                                                                          
1:31:20 PM                                                                                                                    
CHAIR WILSON announced  that the only order of  business would be                                                               
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."                                                                                                    
1:32:30 PM                                                                                                                    
CRYSTAL  BOURLAND,  Executive   Director,  National  Alliance  of                                                               
Mental Illness (NAMI)  Juneau, Juneau, spoke in  opposition to SB                                                               
7.  She  said  NAMI  Juneau  is  a  non-profit  that  focuses  on                                                               
education  and   support  for  individuals  affected   by  mental                                                               
illness.  Medicaid   is  a   lifeline  for   eligible  low-income                                                               
Alaskans,  pregnant  women,  children, friends  and  family  with                                                               
disabilities, and  the elderly. Medicaid  eligibility conditional                                                               
on employment does not help  low-income individuals improve their                                                               
circumstances, but providing  supported employment, job training,                                                               
and comprehensive  health care coverage does.  Access to Medicaid                                                               
often  supports an  individual's ability  to engage  in work  and                                                               
community.  However,  work  requirements may  have  the  opposite                                                               
effect and  undermine an  individual's employment  and management                                                               
of health care needs.                                                                                                           
She said that one serious concern  for NAMI is the effect of this                                                               
bill on  individuals who do  not meet disability  criteria. These                                                               
are the ones who live  with medical conditions, mental illnesses,                                                               
or substance  use disorders. These  individuals may need  to step                                                               
away from work  due to periodic disability or  illness, a decline                                                               
in mental  health, or substance  use treatment.  While exemptions                                                               
"look  good on  paper," these  requirements can  place additional                                                               
stress on  these individuals who  also face health  care coverage                                                               
losses  while  navigating  a   work  requirement  exemption.  The                                                               
processing period  for social  security disability  takes several                                                               
years, so  Medicaid often  provides a  lifeline for  those people                                                               
who  await   their  social  security   disability  determination.                                                               
Residents  in  rural  communities face  challenges  with  limited                                                               
work,  job  training, and  volunteer  opportunities,  as well  as                                                               
challenges of  reporting subsistence activities in  remote areas.                                                               
The  bill does  not  address these  unintended consequences,  she                                                               
1:34:52 PM                                                                                                                    
KATE FINN,  representing self, Homer,  spoke in opposition  to SB                                                               
7. It requires a certain level  of health and health care to have                                                               
a  job, live  a  subsistence lifestyle,  or  participate in  work                                                               
equivalents. The  "catch 22" is  that people need health  care to                                                               
work but people also need work  to receive health care. While she                                                               
appreciated the  detailed exclusions in the  bill, the exclusions                                                               
were insufficient since some disabilities are less obvious.                                                                     
1:37:27 PM                                                                                                                    
DIANA  CHADWELL,  representing  self, Delta  Junction,  spoke  in                                                               
opposition  to  SB 7.  She  said  disabled  Alaskans who  are  on                                                               
disability  cannot work  because these  disabled people  will not                                                               
receive  their social  security disability  if they  earn income.                                                               
This law would discriminate against  the disabled, special needs,                                                               
and the poor.  She also suggested that changes should  be made to                                                               
1:39:50 PM                                                                                                                    
CHAIR  WILSON   said  that   members'  packets   contain  written                                                               
testimony from  people who were not  able to testify at  the last                                                               
meeting. After first  determining no one else  wished to testify,                                                               
he closed public testimony on SB 7.                                                                                             
CHAIR  WILSON said  the committee  heard testimony  with concerns                                                               
about  exemptions  regarding  age,  tribal  membership,  children                                                               
still in school at ages 18  or 19, students in university classes                                                               
or trade schools,  and an increase in the age  of dependents from                                                               
12 months  to 60 months.  He asked Senator Micciche  for comments                                                               
on whether any of these ideas could be included in amendments.                                                                  
1:41:20 PM                                                                                                                    
SENATOR  PETER   MICCICHE,  Alaska  State   Legislature,  Juneau,                                                               
Alaska, spoke  as sponsor  of SB  7. He  said used  a commonsense                                                               
approach when  drafting SB 7. He  said that his intention  was to                                                               
create opportunities,  but not be  punitive when  removing health                                                               
care. He said  he is open to suggestions to  improve the bill. He                                                               
has heard  some comments in  public testimony on issues  that are                                                               
not affected by the bill. He  characterized this bill as one that                                                               
will help Alaskans become as best  as possible. He noted that the                                                               
Alaska State  Hospital and Nursing Home  Association (ASHNHA) had                                                               
some  good  suggestions  to  improve  the  bill.  The  bill  must                                                               
recognize that Alaska has a  seasonal workforce. Some people work                                                               
very hard for part of the  year, and it's important that seasonal                                                               
workers do  not lose  their health  care in  the off  season. The                                                               
committee  might  need  to  consider  how  to  handle  the  first                                                               
instance when a  recipient doesn't meet the  work requirement. He                                                               
said he did not draw a line  in the sand that separates one group                                                               
of people from others. "We're all  Alaskans. We want to help them                                                               
to succeed," he said.                                                                                                           
1:43:10 PM                                                                                                                    
SENATOR STEVENS asked  about a comment in  earlier testimony that                                                               
related it took years to qualify for exemptions.                                                                                
CHAIR  WILSON surmised  that the  comment might  have been  about                                                               
applying for the waiver.                                                                                                        
SENATOR STEVENS agreed.                                                                                                         
1:43:57 PM                                                                                                                    
SENATOR MICCICHE said  the timeline for the  federal Section 1115                                                               
waiver  issued  by Centers  for  Medicare  and Medicaid  Services                                                               
[CMS]  for work  requirements is  not clear.  The department  can                                                               
apply  for the  1115  waiver  and the  state  could review  other                                                               
states' records to gain efficiencies  in the application. He said                                                               
that  the  other  states'  waivers   are  in  various  stages  of                                                               
execution. It was  difficult for him to give a  hard timeline for                                                               
when the waiver process would be completed.                                                                                     
CHAIR WILSON  added that the  1115 waivers don't have  a specific                                                               
timeline for a  federal response to states, unlike  the "1332 and                                                               
1915 waivers".                                                                                                                  
SENATOR  STEVENS asked  for further  explanation  of the  federal                                                               
1115 waiver.                                                                                                                    
1:45:26 PM                                                                                                                    
SHAWNDA  O'BRIEN,   Director,  Division  of   Public  Assistance,                                                               
Department  of Health  and Social  Services (DHSS),  Juneau, said                                                               
this bill would  require DHSS to file for a  Section 1115 waiver,                                                               
which will  take some  time for approval.  She said  the division                                                               
would  review other  states' applications  and mirror  what other                                                               
states have done in order to make their process more efficient.                                                                 
CHAIR WILSON asked her to define an 1115 waiver.                                                                                
MS.  O'BRIEN  offered  to  respond  in  writing  to  outline  the                                                               
different waivers and to identify the requirements.                                                                             
SENATOR STEVENS clarified that a  waiver is requested through the                                                               
department  and  is  submitted  to  the  federal  government.  He                                                               
acknowledged that  it would be  frustrating if it takes  years to                                                               
MS.  O'BRIEN  reiterated  that the  department  might  gain  some                                                               
efficiencies and  streamlining of  the process by  reviewing what                                                               
other states who have applied for waivers have done.                                                                            
1:46:59 PM                                                                                                                    
SENATOR  GIESSEL drew  the committee's  attention  to a  National                                                               
Academy  for State  Health Policy  document  in members'  packets                                                               
which she  said partially summarized  the waiver. She  read, "New                                                               
policy   allowing  states   to  implement   work  and   community                                                               
engagement  requirements. States  must seek  federal approval  to                                                               
require nonelderly,  nonpregnant, and nondisabled adults  to meet                                                               
these  requirements to  qualify for  a full  or partial  Medicaid                                                               
CHAIR  WILSON offered  to provide  members with  the department's                                                               
explanation of the waivers, which is a very complicated system.                                                                 
1:48:04 PM                                                                                                                    
SENATOR  BEGICH   said  that  last  year   former  Senator  Kelly                                                               
introduced this  bill and SB  7 seems substantially the  same. He                                                               
said  he  reviewed   the  prior  bill's  fiscal   notes  to  find                                                               
efficiencies. He  noticed that  the figures  have changed  in the                                                               
fiscal  notes for  SB 7.  The original  assumption was  that 10.5                                                               
percent  of  recipients would  be  moved  off public  assistance,                                                               
which has been increased to 25  percent in the fiscal note for SB                                                               
7. He asked for explanation  of the substantial difference in the                                                               
fiscal notes.                                                                                                                   
MS.  O'BRIEN responded  that assumptions  last  year [for  former                                                               
Senator Kelly's  bill] were  based on  enrollment. This  year the                                                               
division  based some  of  its assumptions  on  the existing  TANF                                                               
(Temporary  Assistance  for   Needy  Families)  work  requirement                                                               
programs.  The  division has  not  seen  as  much growth  in  the                                                               
Medicaid program as it did initially, she said.                                                                                 
1:50:18 PM                                                                                                                    
SENATOR BEGICH  pointed out that  this represented a  150 percent                                                               
difference, so the increase in the figure is rather substantial.                                                                
MS.  O'BRIEN   said  the  division   based  the   assumptions  on                                                               
anticipated  program  success  that envisions  that  more  people                                                               
would be off assistance and back in the workforce.                                                                              
SENATOR BEGICH  said if  the bill  were to  pass, that  the state                                                               
already  has  an 1115  waiver  in  progress.  He asked  how  many                                                               
waivers a  state can have  and if the  state would need  to amend                                                               
its waiver.                                                                                                                     
MS.  O'BRIEN answered  that the  department would  request a  new                                                               
waiver separate from the one that is in progress.                                                                               
1:51:18 PM                                                                                                                    
SENATOR BEGICH asked for a general  timeline on the waiver if the                                                               
bill is signed into law this year.                                                                                              
MS. O'BRIEN  replied that the fiscal  notes are based on  a start                                                               
date of December  31, 2019 to allow time for  the waiver approval                                                               
process and to update its  regulations. She said that the program                                                               
would  begin  on  July  1,  2019.  The  staff  training  and  the                                                               
notification  to   those  affected   by  the  bill   would  occur                                                               
concurrently  during the  approval  process and  adoption of  new                                                               
1:52:54 PM                                                                                                                    
SENATOR  GIESSEL said  that other  states  have implemented  work                                                               
requirement  programs. She  noted that  many states  have a  work                                                               
requirement of 80 hours per  month. She asked Senator Micciche if                                                               
he had  any data that indicated  the success or outcome  of these                                                               
programs. She noted that members'  packets contain materials from                                                               
SENATOR  MICCICHE  pointed  out  that the  program  has  been  in                                                               
existence for  about 13  months. The  National Academy  for State                                                               
Health Policy  document developed  a spreadsheet  that identifies                                                               
which states have  applied, the stage of  implementation, and the                                                               
work requirement  hours. He  agreed that  the requirement  for 20                                                               
hours  [per week]  is something  of a  standard. He  preferred to                                                               
have  a monthly  total instead  of  a weekly  average to  capture                                                               
volunteer  opportunities  in  places where  employment  might  be                                                               
1:55:16 PM                                                                                                                    
EDRA  MORLEDGE,  Staff,  Senator  Peter  Micciche,  Alaska  State                                                               
Legislator, Juneau,  said that  Legislative Research  Services is                                                               
in the  process of gathering  that data. However, the  agency has                                                               
not  yet found  any  definitive studies.  Implementation by  some                                                               
states has been  held up by lawsuits and other  programs have not                                                               
been operational long enough to acquire data, he said.                                                                          
SENATOR  GIESSEL  directed  attention  to a  report  in  members'                                                               
packets from  January 2018 about Arkansas  [Work Requirements Are                                                               
Working in Arkansas: How commonsense  welfare reform is improving                                                               
Arkansans' lives].  She said  that the  report is  positive, that                                                               
Arkansas  saw  incomes  more  than triple  for  people  who  left                                                               
welfare and  found work,  which also resulted  in savings  to the                                                               
state. She expressed  an interest in the  impact Alaska's program                                                               
might  have  on  the  self-esteem and  independence  people  from                                                               
employment, and the example it  would set for their children. She                                                               
recalled that  the report  from Kansas  was also  quite positive,                                                               
that  participants  significantly  increased  their  income,  far                                                               
offsetting the  benefits these recipients received  from TANF and                                                               
other  aspects  of  Medicaid.  She said  she  looked  forward  to                                                               
receiving research from Legislative Legal Research Services.                                                                    
1:57:59 PM                                                                                                                    
SENATOR MICCICHE said that the  Arkansas report is related to its                                                               
welfare  reform. The  report was  issued before  the Centers  for                                                               
Medicare  and  Medicaid Section  1115  Medicaid  waiver for  work                                                               
requirements.  This  program  was  one of  the  reasons  for  his                                                               
interest  in developing  the bill.  He  said that  the number  of                                                               
able-bodied, childless adult food  stamp enrollment dropped by 70                                                               
percent.  Their recipients  had incomes  more than  triple within                                                               
two years of  leaving public assistance, which  offset their lost                                                               
food stamp  benefits. Taxpayers in  Arkansas saved more  than $28                                                               
million a year.  He said that Arkansas also  had relative success                                                               
in reductions  to its  Supplemental Nutrition  Assistance Program                                                               
(SNAP) and TANF.                                                                                                                
SENATOR  MICCICHE  said  that  SB  7  relates  to  Medicaid  work                                                               
requirements by creating opportunities  for Alaskans. He directed                                                               
attention  to other  studies in  members' packets,  including the                                                               
Economic  Research Center  at the  Buckeye  Institute study  that                                                               
estimated  women could  earn an  additional $212,000  and men  an                                                               
additional $323,000 over the course  of their careers while still                                                               
receiving  Medicaid work  requirements. Under  SB 7,  the program                                                               
would encourage  education, job training, social  interaction and                                                               
community participation. It would  also ensure accountability for                                                               
able  bodied persons  on public  assistance by  using a  regular,                                                               
structured  process to  help them  improve their  social-economic                                                               
conditions rather  than living  a life  of dependency.  This bill                                                               
would still  provide health  care benefits  for those  willing to                                                               
work  or volunteer.  At  some point  people  would likely  obtain                                                               
private insurance, he said.                                                                                                     
He said  that he is trying  to separate this discussion  from the                                                               
arguments against  this program  from those who  directly benefit                                                               
from public  assistance or  the providers  of these  programs. He                                                               
emphasized  that  the  work  requirement  program  would  provide                                                               
opportunities   for   individuals  currently   receiving   public                                                               
assistance to succeed.                                                                                                          
2:01:06 PM                                                                                                                    
SENATOR  GIESSEL   pointed  out   that  Alaska   Housing  Finance                                                               
Corporation  (AHFC) has  seen positive  impacts  in its  program,                                                               
once participants  were provided support and  low-income housing.                                                               
She said that the work  requirement program will provide a safety                                                               
net for people,  but not a permanent solution.  She asked whether                                                               
the committee could obtain information on the AHFC program.                                                                     
CHAIR WILSON said his office  has requested information from AHFC                                                               
about the  Step Program,  which is a  five-year plan  for housing                                                               
vouchers. He offered to share that report with the committee.                                                                   
2:02:02 PM                                                                                                                    
SENATOR BEGICH  asked if Senator  Micciche's office  provided the                                                               
Arkansas report in members' packets.                                                                                            
MS.  MORLEDGE answered  that the  sponsor  provided the  Arkansas                                                               
report  for the  purpose of  showing that  work requirements  are                                                               
working in other states.                                                                                                        
SENATOR BEGICH  said Arkansas did  not have its CMS  Section 1115                                                               
waiver until  March 2018.  He clarified that  Arkansas now  has a                                                               
lawsuit about work requirements.                                                                                                
2:03:08 PM                                                                                                                    
MS.  MORLEDGE said  Arkansas has  a lawsuit,  but its  waiver was                                                               
SENATOR BEGICH  responded that Arkansas's  waiver was  granted in                                                               
August of 2018,  but three months later a  lawsuit challenged it.                                                               
However,   the  improvements   in   Arkansas   were  related   to                                                               
requirements in  Arkansas and  not this  waiver since  the waiver                                                               
has not been in existence long enough to obtain the data.                                                                       
MS. MORLEDGE agreed that was true.                                                                                              
SENATOR BEGICH  asked how  many of lawsuits  were pending  in the                                                               
Lower  48. He  expressed  concern that  Alaska could  potentially                                                               
risk a lawsuit if this bill were to pass.                                                                                       
MS.  MORLEDGE   answered  that  Legislative  Legal   Services  is                                                               
researching this issue.                                                                                                         
2:04:27 PM                                                                                                                    
SENATOR MICCICHE said the state  has no way of predicting whether                                                               
it  will be  sued on  any piece  of legislation.  He cannot  stop                                                               
working  to   improve  the  lives  of   Alaskans  worrying  about                                                               
SENATOR  STEVENS  said  the   report  highlighted  the  wonderful                                                               
success in  Arkansas in terms  of reducing public  assistance. He                                                               
asked for  clarification on the  difference between  the Arkansas                                                               
program and the program proposed in SB 7.                                                                                       
SENATOR MICCICHE replied that he  provided the Arkansas report as                                                               
a model  to show  what can  occur when  people are  encouraged to                                                               
take  advantage of  temporary support  programs  to become  self-                                                               
sufficient  and  independent. He  offered  his  belief that  this                                                               
program has a direct correlation to Medicaid.                                                                                   
He  said  that  SB  7  would  allow  people  to  retain  Medicaid                                                               
benefits, but  require able bodied recipients  to start advancing                                                               
and developing their potential, so  that one day these recipients                                                               
will likely not require Medicaid.                                                                                               
He said  that other states  found the 1115 waiver  practices were                                                               
proven to be successful with a  subset of the Medicaid and public                                                               
assistance   populations.   He   acknowledged   that   the   work                                                               
requirement program will  not work for everyone. The  goal is not                                                               
to  take away  needed health  care, but  to lessen  dependency on                                                               
state  and   federal  programs  such   as  Medicaid   and  public                                                               
2:06:51 PM                                                                                                                    
SENATOR STEVENS  said he  was unsure  if the program  in SB  7 is                                                               
exactly like the Arkansas program.                                                                                              
CHAIR  WILSON  said the  first  state  to  go through  [the  1115                                                               
waiver] process  is Kentucky. He  was unsure if it  has prevailed                                                               
in a lawsuit on work requirements.                                                                                              
SENATOR BEGICH  responded that a follow-up  lawsuit was initiated                                                               
in  Kentucky   last  month.  He  reported   that  Governor  Bevin                                                               
initiated the  waiver process early  in 2017 and it  was approved                                                               
in January 2018.                                                                                                                
2:08:26 PM                                                                                                                    
CHAIR WILSON said  he would hold SB 7 and  consider amendments at                                                               
the next hearing.                                                                                                               
SENATOR BEGICH asked  whether anyone was working  with the Alaska                                                               
State Hospital  and Nursing  Home Association  (ASHNHA) regarding                                                               
their suggestions for SB 7.                                                                                                     
SENATOR MICCICHE noted the ASHNHA  letter in members' packets and                                                               
said he  does not support all  their ideas, but he  wants this to                                                               
work for Alaskans that depend  on Medicaid for their health care.                                                               
He  said  he looks  forward  to  working  with the  committee  to                                                               
develop the best bill to help Alaskans move forward.                                                                            
[SB 7 was held in committee.]                                                                                                   
2:09:44 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee at 2:09 p.m.                                                                                                 

Document Name Date/Time Subjects
SB 7 Chart of Requirements and Exemptions.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 Buckeye Institute Report 12.3.18.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 Modern Healthcare Article.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 Fiscal Note Summary 2.11.19.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 Public Input 2.20.19.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB7 Chadwell.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 League of Women Voters of AK.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 FGA Letter to Chair Wilson 2018.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 FGA Work Requirement Paper 1.9.2019.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
ASHNHA comments on medicaid work requirements 2-13-19.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 A Snapshot of Exempted Groups Nationwide - NASHP.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 A Snapshot of Age Requirements Nationwide - NASHP.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 A Snapshot of Qualifying Activites Nationwide - NASHP.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 A Snapshot of ACA Implementation Nationwide - NASHP.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 A Snapshot of Hour Requirements Nationwide - NASHP.pdf SHSS 2/20/2019 1:30:00 PM
SB 7
SB 7 A Snapshot of Work Requirements Nationwide - NASHP.pdf SHSS 2/20/2019 1:30:00 PM
SB 7