Legislature(2019 - 2020)BUTROVICH 205

03/01/2019 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:30:41 PM Start
01:31:16 PM SB7
01:59:11 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 7 MED. ASSISTANCE WORK REQUIREMENT TELECONFERENCED
Moved CSSB 7(HSS) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 1, 2019                                                                                          
                           1:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator John Coghill, Vice Chair                                                                                                
Senator Cathy Giessel                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Gary Stevens                                                                                                            
                                                                                                                                
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."                                                                                                                       
                                                                                                                                
     - MOVED CSSB 7(HSS) OUT OF COMMITTEE                                                                                       
                                                                                                                                
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                                                                           
02/20/19       (S)       Heard & Held                                                                                           
02/20/19       (S)       MINUTE(HSS)                                                                                            
03/01/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
STACY BARNES, Director                                                                                                          
Governmental Relations and Public Affairs                                                                                       
Alaska Housing Finance Corporation (AHFC)                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented AHFC's public housing  rent reform                                                             
program during the hearing on SB 7.                                                                                             
                                                                                                                                
CATHY STONE, Director                                                                                                           
Public Housing                                                                                                                  
Alaska Housing Finance Corporation (AHFC)                                                                                       
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:  Presented  on AHFC's  public  housing  rent                                                             
reforms 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 about SB 7.                                                                            
                                                                                                                                
EDRA MORLEDGE, Staff                                                                                                            
Senator Peter Micciche                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Spoke on behalf of the sponsor of SB 7.                                                                   
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                              
1:30:41 PM                                                                                                                  
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call to order  were Senators Coghill, Giessel,  Begich, and Chair                                                               
Wilson.                                                                                                                         
                                                                                                                                
             SB 7-MED. ASSISTANCE WORK REQUIREMENT                                                                          
                                                                                                                                
1:31:16 PM                                                                                                                    
CHAIR WILSON announced  that the only order of  business would be                                                               
SB 7,  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."                                                                                              
                                                                                                                                
SENATOR  WILSON  asked  the Alaska  Housing  Finance  Corporation                                                               
representative to talk about their rent reform program.                                                                         
                                                                                                                                
1:32:22 PM                                                                                                                    
CATHY  STONE, Director,  Public Housing,  Alaska Housing  Finance                                                               
Corporation  (AHFC),   Anchorage,  said  AHFC's   Public  Housing                                                               
Division  launched a  rent reform  program in  2014. The  program                                                               
took  recipients for  public housing  voucher programs  and split                                                               
them  into two  groups. AHFC  created a  classic program  for the                                                               
elderly and  disabled and continued  housing assistance  for them                                                               
at the same levels. AHFC created  a path to incentivize people to                                                               
work or increase their educational  opportunities. Under the Step                                                               
Program, their public assistance would  run out after five years.                                                               
The  process included  stepping down  the rental  assistance with                                                               
the expectation  that recipients would  pay more of  their income                                                               
in rent. AHFC provided significant  support to recipients through                                                               
a  program called  Jumpstart, including  case management  to help                                                               
provide  recipients with  incentives to  work, to  increase their                                                               
education, save money, and increase their financial literacy.                                                                   
                                                                                                                                
MS.  STONE  said the  program  has  had excellent  outcomes.  The                                                               
program recipients are not yet in  the fifth and final year, when                                                               
assistance  will  end.  Since 2014,  AHFC  has  seen  recipients'                                                               
annual  gross  income  increase  dramatically,  from  $19,000  to                                                               
$29,000 and  annual earned income also  increased. The percentage                                                               
of people working 32 or more  hours per week went from 40 percent                                                               
to 56 percent. When participants earn  more it frees up money for                                                               
AHFC  to  use   to  help  more  people.   Because  subsidies  are                                                               
decreasing, AHFC can  add more vouchers into  the community. AHFC                                                               
has seen  an increase  of almost  a thousand  vouchers throughout                                                               
the state.  The program  has had positive  outcomes and  has been                                                               
successful due  to the program's  additional case  management and                                                               
support,   which  has   helped   people   increase  their   self-                                                               
sufficiency.                                                                                                                    
                                                                                                                                
1:35:42 PM                                                                                                                    
SENATOR BEGICH  asked what percentage  of recipients  are working                                                               
32 hours or more per week.                                                                                                      
                                                                                                                                
MS. STONE said that 58  percent of program recipients are working                                                               
32 hours or more per week.                                                                                                      
                                                                                                                                
SENATOR  BEGICH  asked  what  the   connection  is  between  this                                                               
information and SB 7.                                                                                                           
                                                                                                                                
CHAIR  WILSON said  that at  the February  20, 2019  hearing, the                                                               
committee discussed how this program is  similar to SB 7 in terms                                                               
of the  work requirements. He  surmised that a  correlation might                                                               
exist between  people who are  on housing vouchers and  those who                                                               
may be affected by SB 7.                                                                                                        
                                                                                                                                
1:37:08 PM                                                                                                                    
SENATOR  BEGICH asked  about the  paperwork requirements  for the                                                               
program and  the type of  support AHFC provides to  help families                                                               
in the rent reform program achieve self-sufficiency.                                                                            
                                                                                                                                
1:37:40 PM                                                                                                                    
MS. STONE  answered that people  coming into the  housing program                                                               
fill out  the same  type of  paperwork used  when signing  up for                                                               
assistance.  Once the  applicant is  classified as  a "work-able"                                                               
family  member, the  person would  be referred  to a  "Jumpstart"                                                               
specialist  for   case  management.  The  case   manager  reviews                                                               
information, including  income, budget, education,  housing needs                                                               
and goals.  All AHFC requires  is that the case  managers include                                                               
the data in  the main database used for housing  and to report to                                                               
the U.S. Department of Housing  and Urban Development (HUD). Case                                                               
management   software  is   used   to  track   how  clients   are                                                               
progressing, their housing needs, income, and incentives.                                                                       
                                                                                                                                
SENATOR  BEGICH asked  if a  Jumpstart specialist  is a  fulltime                                                               
AHFC employee and how many staff work in that capacity.                                                                         
                                                                                                                                
MS. STONE said  that AHFC hired eight  Jumpstart specialists that                                                               
serve the entire  state, with five specialists  in Anchorage, two                                                               
in Juneau, and one in Fairbanks.                                                                                                
                                                                                                                                
SENATOR BEGICH asked how many clients are served in the program.                                                                
                                                                                                                                
MS. STONE  answered that  750 people are  enrolled in  level one,                                                               
which  is the  highest-needs  population. Level  two  is open  to                                                               
everyone, which  is tracked less strenuously.  She estimated that                                                               
approximately  3,000  people  participate  in  the  Step  program                                                               
across  the  state.  Of  those,   about  half  receive  Jumpstart                                                               
assistance, she said.                                                                                                           
                                                                                                                                
1:40:40 PM                                                                                                                    
SENATOR BEGICH related his understanding  that about 1,500 people                                                               
get services from the eight Jumpstart specialists.                                                                              
                                                                                                                                
MS. STONE agreed.                                                                                                               
                                                                                                                                
1:41:13 PM                                                                                                                    
STACY  BARNES,   Director,  Governmental  Relations   and  Public                                                               
Affairs,  Alaska Housing  Finance Corporation  (AHFC), Anchorage,                                                               
said that  under federal law  AHFC is designated as  a moving-to-                                                               
work  agency, which  is  why it  is  able to  do  this work.  She                                                               
explained that  the late U.S.  Senator Ted Stevens had  worked on                                                               
this a number of years ago. AHFC receives federal funding under                                                                 
a block grant that allows them the flexibility to provide                                                                       
housing and resources in communities.                                                                                           
                                                                                                                                
1:41:53 PM                                                                                                                    
CHAIR WILSON solicited a motion to adopt the proposed committee                                                                 
substitute for SB 7.                                                                                                            
                                                                                                                                
SENATOR COGHILL moved to adopt the committee substitute (CS) for                                                                
SB 7, work order 31-LS0196\M, as the working document.                                                                          
                                                                                                                                
SENATOR GIESSEL objected for purposes of discussion.                                                                            
                                                                                                                                
1:42:15 PM                                                                                                                    
CHAIR WILSON reviewed the changes made in the committee                                                                         
substitute for SB 7, Version M:                                                                                                 
                                                                                                                                
     On page  1, line 7: Adds  a short title, "This  Act may                                                                    
     be  known  as  the Medicaid  Work  Opportunities  Act."                                                                    
     (Requested by Senator Wilson.)                                                                                             
                                                                                                                                
     On   page  2,   line  1:   Changes  the   minimum  work                                                                    
     requirement  from 20  hours per  week to  80 hours  per                                                                    
     month,  to allow  more flexibility.  (Requested by  the                                                                    
     sponsor.)                                                                                                                  
                                                                                                                                
     On page  2, line  3: Adds postsecondary  and vocational                                                                    
     programs  to the  list of  activities  a recipient  can                                                                    
     participate in. (Requested by Senator Wilson.)                                                                             
                                                                                                                                
     On page  2, line 12:  Changes the ages  permitted under                                                                    
     exemptions from  18 to 19  and from  65 to 60  years of                                                                    
     age. (Requested by the sponsor.)                                                                                           
                                                                                                                                
     One page  2, line  13: Changes the  age of  a dependent                                                                    
     child  from 12  months (one  year) to  six years.  This                                                                    
     change  will  now  exempt   parents  or  caretakers  of                                                                    
     dependent children  up to six years  of age. (Requested                                                                    
     by Senator Wilson.)                                                                                                        
                                                                                                                                
1:44:14 PM                                                                                                                    
     On page  3, lines 4  through 11: Subsection 6  has been                                                                    
     rewritten   to   provide   for  notification   of   all                                                                    
     recipients of  work requirements as soon  as the waiver                                                                    
     is approved and, not less  than 90 days after providing                                                                    
     notice,  termination of  medical  assistance for  those                                                                    
     who become ineligible. This  section also requires DHSS                                                                    
     to provide information for the  Department of Labor and                                                                    
     Workforce   Development   and  its   employment-related                                                                    
     training programs. (Requested by the sponsor.)                                                                             
                                                                                                                                
     On page  3, lines 12  through 15: This is  new language                                                                    
     that provides  for a bridge of  up to 12 months  if the                                                                    
     recipient meets  the work requirements  but his  or her                                                                    
     additional earnings make  that recipient ineligible for                                                                    
     assistance. (Requested by the sponsor.)                                                                                    
                                                                                                                                
     Page  3, line  16: This  is new  language which  adds a                                                                    
     Section  3  and  an immediate  effective  date  clause.                                                                    
     (Requested by Senator Wilson.)                                                                                             
                                                                                                                                
1:45:32 PM                                                                                                                    
SENATOR BEGICH referred to correspondence  from Laura Lucas, MSW,                                                               
Laura  Keller  and  Sherri Roberds  with  the  American  Diabetes                                                               
Association,  and Jessie  Menkens  with the  Alaska Primary  Care                                                               
Association. In his own review  of the chart, Arkansas appears to                                                               
be  the  only  one  actively  using  the  work  requirements.  He                                                               
reported  that  18,000  or approximately  23  percent  have  been                                                               
removed  from Medicaid  as  a result  of  the work  requirements.                                                               
Arkansas  uses  a  flexible  three-month  time  period  for  work                                                               
reporting. He  pointed out the proposed  committee substitute for                                                               
SB 7 goes from  20 hours a week to 80 hours  for the timeframe of                                                               
one month.                                                                                                                      
                                                                                                                                
He said that  rural Alaska suffers from  chronic unemployment. In                                                               
some  villages it  is  half  the population  of  the village.  He                                                               
related  his  understanding  that considerations  were  made  for                                                               
subsistence  activities, but  he  is deeply  concerned about  the                                                               
burden  this  will place  on  people  who  need health  care.  He                                                               
reiterated  his concern  is whether  the  state will  be able  to                                                               
provide health care  as part of its commitment  to public health.                                                               
He  said  that testimony  provided  by  Alaskans underscores  and                                                               
reinforces that concern. He has  met with members from the Alaska                                                               
State Hospital  and Nursing Home Association  (ASHNHA), emergency                                                               
room   doctors,  and   other  groups.   He  has   been  receiving                                                               
significant levels  of concern  about this bill.  He is  not sure                                                               
what  the long-term  aim goal  is and  whether it  will have  the                                                               
consequences the sponsor and committee intended.                                                                                
                                                                                                                                
SENATOR  BEGICH expressed  an interest  in the  new fiscal  notes                                                               
because of  the changes made  in Version  M. He said  the changes                                                               
made by  Senator Micciche  and Senator  Wilson's office  are good                                                               
ones. The changes in eligibility  age may reduce the fiscal note.                                                               
He  asked  what  level  of   support  will  be  needed  from  the                                                               
department to match the Jumpstart specialists' effort.                                                                          
                                                                                                                                
CHAIR   WILSON   said   that  he   still   has   concerns   about                                                               
implementation. He  wondered what  changes could  be made  in the                                                               
bill to help  the majority of Alaskans. He  acknowledged that the                                                               
new  fiscal  note  will  not  be updated  until  the  bill  moves                                                               
forward. However,  he asked  whether Ms.  O'Brien could  speak to                                                               
some of the potential impacts.                                                                                                  
                                                                                                                                
1:49:57 PM                                                                                                                    
SHAWNDA  O'BRIEN,   Director,  Division  of   Public  Assistance,                                                               
Department  of Health  and Social  Services (DHSS),  Juneau, said                                                               
the  department  has  not  done any  new  calculations,  but  she                                                               
anticipated  forthcoming  changes due  to  the  number of  people                                                               
included or excluded.                                                                                                           
                                                                                                                                
CHAIR WILSON  asked if  the changes in  the age  exemptions would                                                               
increase or decrease the fiscal note.                                                                                           
                                                                                                                                
MS. O'BRIEN said she does not  have the data today to reflect the                                                               
changes made in  the committee substitute. She was  unsure of how                                                               
many recipients were over the age  of 60 or the effect of raising                                                               
the requirement age  from 18 to 19 years old.  The department has                                                               
also  been  cross matching  data  with  health care  services  to                                                               
determine the  recipients who are designated  for substance abuse                                                               
or  mental health  treatment. She  acknowledged  that the  figure                                                               
would likely be revised slightly for that.                                                                                      
                                                                                                                                
SENATOR BEGICH said he looked forward to seeing those numbers.                                                                  
                                                                                                                                
1:51:26 PM                                                                                                                    
SENATOR  COGHILL said  there are  other programs  that allow  for                                                               
extended work  on Medicaid.  He asked how  this program  will fit                                                               
in.  He  further  asked  for  a  description  of  other  Medicaid                                                               
exceptions.                                                                                                                     
                                                                                                                                
MS. O'BRIEN asked for clarification.                                                                                            
                                                                                                                                
SENATOR  COGHILL  said  he  was  interested  in  eligibility  for                                                               
Medicaid. Some  programs allow recipients who  are ineligible for                                                               
Medicaid to obtain  extensions. He asked her to  explain how that                                                               
process will work with this bill.                                                                                               
                                                                                                                                
MS.  O'BRIEN offered  to research  this  and report  back to  the                                                               
committee with more detail. If  someone was eligible for Medicaid                                                               
but fell under one of  the bill's exemptions, the recipient would                                                               
not be required  to participate in the  work requirement program.                                                               
She  said  that  if  Senator   Coghill  was  asking  whether  the                                                               
department  would  change   someone's  eligibility  determination                                                               
because of  another program's  rules, that she  was not  aware of                                                               
any provision.  She pointed out that  recipients lose eligibility                                                               
for Medicaid due to life changes, including being above income.                                                                 
                                                                                                                                
1:53:35 PM                                                                                                                    
SENATOR COGHILL  recalled some  opportunities for  recipients who                                                               
became ineligible  for Medicaid  that had  a timeframe  to retain                                                               
assistance under certain circumstances,  such as Denali Kid Care,                                                               
Title 20, and regular Medicaid.                                                                                                 
                                                                                                                                
MS. O'BRIEN  answered that yes,  there were some  exemptions. She                                                               
offered  to research  the different  categories that  would allow                                                               
someone to remain eligible and report back to the committee.                                                                    
                                                                                                                                
SENATOR  COGHILL  said  he thought  that  information  should  be                                                               
considered as the bills go  forward because the criteria might be                                                               
disparate.                                                                                                                      
                                                                                                                                
CHAIR WILSON asked the department to provide the list.                                                                          
                                                                                                                                
1:55:15 PM                                                                                                                    
SENATOR  BEGICH   said  that  AHFC  provided   information  about                                                               
Jumpstart specialists.  He asked  whether the new  positions were                                                               
assigned to help people work through this process.                                                                              
                                                                                                                                
MS. O'BRIEN  replied yes, the  fiscal note [from the  Division of                                                               
Public Assistance]  identified the division's needs  in the first                                                               
year of  implementation. The division also  estimated the figures                                                               
for outgoing years, which would  decline over the course of time.                                                               
She said  that the positions needed  would decrease incrementally                                                               
until the third  year of implementation, when  the activity would                                                               
likely level off.                                                                                                               
                                                                                                                                
1:56:06 PM                                                                                                                    
SENATOR GIESSEL removed her objection.                                                                                          
                                                                                                                                
1:56:22 PM                                                                                                                    
CHAIR WILSON  found no  further objection  and the  CS for  SB 7,                                                               
work order 31-LS0196\M, was adopted.                                                                                            
                                                                                                                                
1:56:37 PM                                                                                                                    
EDRA  MORLEDGE,  Staff,  Senator  Peter  Micciche,  Alaska  State                                                               
Legislature,  Juneau, relayed  that Senator  Micciche appreciated                                                               
the  committee's work  on  the  bill and  that  he  was ready  to                                                               
continue the process.                                                                                                           
                                                                                                                                
1:57:12 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
1:57:15 PM                                                                                                                    
SENATOR  COGHILL moved  to report  the committee  substitute (CS)                                                               
for   SB   7,  Version   M,   from   committee  with   individual                                                               
recommendations and attached fiscal note(s).                                                                                    
                                                                                                                                
There being no  objection, the CSSB 7(HSS) was  reported from the                                                               
Senate  Health and  Social Services  Standing Committee  with the                                                               
understanding that  Legislative Legal was authorized  to make any                                                               
necessary technical or conforming adjustments.                                                                                  
                                                                                                                                
1:57:49 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
1:59:11 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 1:59 p.m.                                                                                         

Document Name Date/Time Subjects
SB 7 Chart of States 1.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 What Other States are Doing.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 Chart of States 2.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 MACPAC Waiver Information.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 AHFC Step Program.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 AHFC 2017 Annual Rept Rent Reform.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 AHFC 2018 Annual Rept Rent Reform.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 Sectional Summary v M.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 Public Input 3.1.19.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
APCA letter for submission - SB7 - Medical Assistance Work Requirement.pdf SHSS 3/1/2019 1:30:00 PM
SB 7
SB 7 - AHFC Public Housing Rent Reform Results FY 14 to Jan 2019.pdf SHSS 3/1/2019 1:30:00 PM
SB 7