Legislature(2025 - 2026)ADAMS 519
02/13/2025 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Overview: Fy 26 Budget by the Department of Health | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 53 | TELECONFERENCED | |
| += | HB 55 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HOUSE BILL NO. 53
"An Act making appropriations for the operating and
loan program expenses of state government and for
certain programs; capitalizing funds; amending
appropriations; making supplemental appropriations;
making reappropriations; making appropriations under
art. IX, sec. 17(c), Constitution of the State of
Alaska, from the constitutional budget reserve fund;
and providing for an effective date."
HOUSE BILL NO. 55
"An Act making appropriations for the operating and
capital expenses of the state's integrated
comprehensive mental health program; and providing for
an effective date."
^OVERVIEW: FY 26 BUDGET BY THE DEPARTMENT OF HEALTH
1:39:15 PM
HEIDI HEDBERG, COMMISSIONER, DEPARTMENT OF HEALTH,
introduced herself and her colleagues. She addressed a
PowerPoint presentation titled "Department of Health FY2026
Budget Overview," dated February 13, 2025 (copy on file).
She relayed that on July 1, 2023, the Department of Health
and Social Services reorganized into two different
departments [Department of Health and Department of Family
and Community Services]. The Department of Health (DOH) was
comprised of five divisions shown in an organizational
chart on slide 2. As a small department, DOH had been able
to deep dive into operations of each of its divisions and
had developed a strong leadership team and staff. The
department's division were all focused on the mission to
promote the health, well-being, and self-sufficiency of all
Alaskans (slide 3).
Commissioner Hedberg highlighted that department had been
working on a new website and would be launching soon. She
elaborated that the website would move from a repository of
information to a user-based journey. She explained that
currently users would have to know where a program resided
within a division, which most people did not know. The new
website would allow users to type in the program on the
homepage to locate it and associated programs. The goal was
to help ensure the department was providing access and
information to Alaskans. The website would be mobile
friendly, which was phase one of the project. Phase two
would be language and included Spanish, Tagol, Korean,
Russian, and Hmong. The department recognized that Yupik
was a common spoken language in Alaska, but DOH had not
been able to secure a language bank with Yupik. She asked
members to pass along any information they may have about
language banks with Yupik. The website would also include
chatbot features to make finding information easier.
1:42:14 PM
PAM HALLORAN, ASSISTANT COMMISSIONER, DEPARTMENT OF PUBLIC
SAFETY, reviewed slide 3 beginning with the department's
mission. The department had 1,557 permanent full-time staff
with a budget of just over $3.5 billion. Medicaid
represented 80 percent of the department's overall budget
request and operations that supported Medicaid or were
outside of Medicaid represented $695 million including $290
million in unrestricted general funds (UGF).
Ms. Halloran showed a comparison of the department's budget
from FY 24 to FY 26 on slide 4. The governor's budget
reflected 29 percent of the department's overall request,
while federal authority represented 67 percent. Designated
general funds (DGF) and "other" represented a significantly
smaller portion of the budget at 1 percent and 3 percent
respectively. She detailed that DGF included tobacco
education and cessation funds, alcohol and drug treatment
and prevention funds, recidivism reduction funds, marijuana
education and treatment funds, and more. Other funds for
the department reflected interagency receipt authority, the
Permanent Fund Dividend fund, mental health trust authority
funds, statutory designated program receipts, and the
restorative justice account.
1:43:46 PM
Ms. Halloran moved to Medicaid Services on slides 5 and 6.
Medicaid Services had a budget of just over $2.8 billion.
The Medicaid budget reflected the reversal of a multiyear
appropriation for InterRai. She detailed it was an
assessment tool for individuals seeking Medicaid community
based waiver services or professional care services. The
appropriation for InterRai would continue into FY 26 and
was a collaboration between disability advocates, the
legislature, and the department. Slide 6 provided a
comparison of the Medicaid Services budget from FY 24 to FY
26. General funds represented 26 percent and federal
represented 74 percent of the Medicaid budget. The
department provided Medicaid projections to the legislature
th
on December 15 and would provide updated projections the
following week. She explained that providing updated
projections would ensure the department could address items
that could drastically impact the Medicaid budget that were
unknown when the budget was built in early fall.
Ms. Halloran moved to the Division of Health Care Services
on slide 7. The division provided oversight of Medicaid
operations including the Medicaid Management Information
System (MMIS), Medicaid recovery and reclamation, Medicaid
systems analysis, background check determinations, health
facility licensing and certification, residential facility
licensing and certification, and Medicaid policy and
communications. She highlighted a $962,500 request within
the health facilities licensing and certification
allocation comprised of $295,000 in federal funds and
$667,500 general fund matching funds. The funding aligned
budgeted authority to actual expenditures. To date, the
division had met its budgetary needs through vacancy
savings and transfers from other areas of the division.
Additional authority was necessary for health facilities
licensing and certification to meet its statutory
obligation of licensing and investigating Title 18 and 19
health facilities. The authority was needed to maintain
sufficient staff for federal certification of health
facilities in Alaska including healthcare hospitals,
skilled nursing facilities, hospice programs, home health
agencies, rural health clinics, and other types of health
facilities.
Ms. Halloran turned to slide 8 highlighting the Health Care
Services budget comprised of 34 percent UGF and 53 percent
federal. The DGF represented general fund program receipts
for the division's background check program, which
performed 23,310 background check determinations in FY 24.
1:47:06 PM
Representative Hannan asked Ms. Halloran to repeat the
number of background checks.
Ms. Halloran replied that the number was 23,310.
EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH,
reviewed slide 9 pertaining to pharmacy rebates and tribal
reclaiming. She relayed that the Division of Healthcare
Services (DHS) was also responsible for two programs which
were critical to leveraging savings in the Medicaid
program. The first was tribal reclaiming, which provided
opportunities to receive 100 percent federal match for
certain services provided to tribal members who were
Medicaid eligible. The second was leveraging drug rebate
recoveries for pharmaceutical spend. She highlighted that
the total tribal reclaiming had grown from its initiation
in FY 17 from $34 million to $138 million in FY 24. The
department was seeing about $25 million in general fund
savings per month. The department was also actively
pursuing any opportunities to recovery additional dollars
to offset the costs pharmaceuticals in the Medicaid
program. There were two types of rebate recovery programs:
federal rebates (available to all Medicaid providers and
all states) and supplemental rebates. She elaborated that
with the build up of the pharmacy team in DHS in the past
six or so years, the department had been able to leverage
$138 million in federal rebates. She noted that the slide
did not show an additional $26.8 million in supplemental
rebates received by the department. Savings were shared
between the federal government and the state agency.
Representative Stapp stated that a couple of years back,
the state had looked at the staffing in the tribal
reclaiming and rebate program and the legislature had added
some staff. He asked how it had been working out.
Ms. Ricci responded that it was working out very well. The
department was seeing an increase in supplemental rebates
that would not have been possible without the work done by
additional staff on the pharmacy team. The department was
also seeing an increase in the annual amount of additional
federal match to offset general fund services for tribal
reclaiming. She noted there was a slight decline between FY
23 and FY 24 in relation to overall drug rebate recoveries,
which reflected a drop in pharmaceutical spend over the
same time period. She explained that proportionately it was
still growing in terms of rebates to offset the overall
pharmaceutical cost.
Representative Stapp asked about the Office of Health Care
savings and how it was going.
Ms. Ricci answered that the Office of Health Savings was
developed in the commissioner's office and was comprised of
three people considered to be the idea engine. The
individuals were focused on helping identify opportunities
for the department to save money through pursuit of
different innovations. She detailed that day to day
activities in divisions took up much of the time that could
be used for innovating ideas; therefore, the Office of
Health Savings had dedicated staff to think about
innovations (i.e., waivers or opportunities) to support the
divisions and working to implement them. The office had
brought in several million dollars in technical assistance
and grants over the past year. Additionally, the office had
been working with the Department of Law to add two
positions to support additional subrogation activities that
had resulted in about a 30 percent increase in subrogation
activities overall. She offered to provide additional
information in writing.
1:52:05 PM
Representative Bynum stated that many departments were
demonstrating how they spent their money in their budget
overviews but did not specify how the revenue was coming
in. He asked the department to highlight any offsets for
expense the department was bringing in.
Ms. Ricci answered that the information was not depicted in
the slide, but it was in the annual Medicaid Reform Report
which had been shared with the legislature. Typically, with
insurance programs there were certain requirements
regarding who paid first in the event an individual may be
covered under multiple policies or in the event of a car
accident where a person was injured and their insurance
plan may not be responsible for primary costs associated
with the accident. She explained that those situations
involved subrogations or third-party payments. She stated
it was a very important part of the division's work. She
elaborated that the recovery of the payments where Medicaid
may have paid in the primary position, but it was later
determined to not have been the primary payer, was another
source of revenue and savings that came back into the
Medicaid program.
Representative Bynum clarified that he was not requesting
the information on all of the slides but if something came
to mind that was of significance, he would appreciate a
reminder of where the committee could look for additional
detail.
1:54:15 PM
Ms. Halloran reviewed the Division of Public Assistance
(DPA) on slide 10. The division had a budget of just over
$306 million. The division provided eligibility
determinations for nine public assistance programs
responsible for administering the Senior Benefits Payment
Program. Significant budget changes for the division
included a budget increase reflecting the department's
fiscal note for SB 189 that did not get attached to the
bill in the late hours of session closeout in 2024; a
reversal of one-time funding for two items including a
childcare grant program and food security; a reversal of
multiyear funding for Medicaid eligibility
redeterminations; and for addressing the Supplemental
Nutrition Assistance Program (SNAP) backlog. She reported
that 2025 reflected the final year of both multiyear
appropriations.
Representative Galvin looked at the department's goal that
SNAP funds were delivered efficiently in a timely way on
slide 13. She asked if the waitlist had been eliminated.
Commissioner Hedberg responded that the one-time multiyear
appropriations met their original intent. When she had
started as commissioner in November of 2022, the program
faced a significant backlog. She elaborated that there were
36,000 applications across all programs. She clarified
there were about 17 different types of public assistance
programs in the division, including nine predominant ones.
She detailed that of the 36,000 applications, 13,000 were
for SNAP. The department had requested funding from the
legislature to address the immediate need. She explained
that Medicaid redeterminations had begun at the same time
and the same staff were responsible for processing Medicaid
and SNAP. She shared that the department had eliminated the
original backlog due to the extra funding, hardworking
employees, and business redesign. She would elaborate on
the technical aspects, the current status, and what needed
to happen in the future on subsequent slides.
1:57:49 PM
Representative Galvin asked to keep in mind that the
legislature was there to support the department if there
was a need for adjustment to ensure constituents were not
reporting four-hour phone wait times and getting hung up
on. She asked for detail about childcare and food security.
Commissioner Hedberg answered that in March of 2023, the
timeliness rate had been 28 percent [for SNAP]. The
department's current timeliness rate toggled between 60 and
90 percent. The department had made significant improvement
on processing applications, but there was still work to do.
The childcare appropriation was for $7.5 million, and
funding went out to providers at the end of
January/beginning of February for operational expenses.
For food security, a request for proposal (RFP) was awarded
to the Food Bank of Alaska.
Representative Galvin asked about the $7.5 million for
childcare. She asked if the childcare sector was no longer
in need of support.
Commissioner Hedberg referenced the work done on the
governor's taskforce on childcare. The department was
actively working on the taskforce's recommendations. She
believed the one-time funding met the initial need;
however, a significant amount of work within childcare was
needed. The department was currently working on systemic
changes for sustainability in partnership with childcare
providers.
Co-Chair Josephson stated the concern was that there was
such substantial bipartisan support for an immediate fix.
He elaborated that they were having problems with SB 189
[that had passed the previous session]. He referenced the
reverse of one-time funding for childcare. He asked for
verification that there were significant federal reductions
as well.
Ms. Halloran confirmed that two federal COVID-19
appropriations would be removed from the FY 25 budget
associated with childcare including a ~$17 million and ~$11
million. She noted that the funds would be spent through FY
25 and would end.
Co-Chair Josephson stated it illustrated his grave concern.
He highlighted that childcare was a top priority for the
State Chamber of Commerce. He felt investment was needed
immediately.
2:01:56 PM
Representative Hannan asked about the extension of the
senior benefits. She remarked that a bill had been passed
to extend the program that had lapsed. She highlighted that
the $470,000 [shown on slide 10] did not begin to approach
what was needed for the $24 million program.
Ms. Halloran confirmed that the overall budget for the
Senior Benefit Program was $24 million for FY 26. She noted
there was a small increment of $470,800 to address the
increased population entering the program.
Representative Hannan asked how long it had been since the
payment amount had been increased for senior benefits. She
understood there were three payout levels and a couple of
years back the amount had been static.
Commissioner Hedberg replied that the department would
follow up with the information.
Co-Chair Foster noted he had met with Commissioner Hedberg
and DPA Director Deb Ethridge. His district had been
inundated with the SNAP backlog issue. He thought it seemed
like much of the backlog may be in western Alaska. He asked
what went away if the state was not spending the $8.8
million [shown on slide 10]. He asked if it was staff,
contracted third-party support, or technology.
Commissioner Hedberg answered that the funding was to pay
for long-term nonpermanent positions, which would end at
the end of the calendar year. The funding also provided
contractual support. The department was currently in
conversations on how to meet the needs and stay current
with its timeliness in processing. She would follow up with
additional information.
2:03:43 PM
Co-Chair Foster asked how many non-permanent positions
would go away.
Commissioner Hedberg replied, "30."
Co-Chair Foster stated there had been a recent Legislative
Budget and Audit meeting where audit reports had been
discussed. He thought the audit pertaining to the SNAP
backlog may not have been made public yet. He asked if the
audit was still underway.
Ms. Halloran replied that the department received the
management letter that week. There was an internal process
underway where the department would respond prior to the
finalization of the report.
Co-Chair Foster stated his understanding that at some point
the legislature would see a report on the issue.
Representative Stapp referenced the end of the long-term
nonpermanent positions addressing the SNAP backlog. He
remarked that the SNAP payment error rate was significant
the last time he looked. The legislature recently passed a
bill that would likely increase the number of SNAP
applications. He believed the bill's effective date was
July 1. He asked if the department was anticipating a spike
in applications.
Commissioner Hedberg answered that Representative Stapp was
referring to the broad-based categorical eligibility. The
department was currently working on information technology
(IT) modernizations. The department's number one goal was
not falling behind on its timeliness. She relayed that
moving forward the department would have to make decisions
and it was consistently evaluating its staffing needs and
operations. She referenced the payment error rate for SNAP.
When she stepped into the role, the certification period
was six months. She had made the decision and had notified
federal partners that the department was moving the
timeframe to 12 months. When the department made the
decision to prioritize getting the food to qualifying
Alaskans, it took all of the cases that would have gone
through the quality control process and eliminated it,
which artificially inflated the payment error rate.
Additionally, because the department was not compliant with
interviews, it had increased the payment error rate. She
reported that both of the issues had been resolved and the
error rate was decreasing.
Representative Stapp asked how many applications were
currently in backlog.
2:07:58 PM
Commissioner Hedberg asked for clarification on the
question.
Representative Stapp clarified that he was asking about all
programs.
Commissioner Hedberg responded that there were 29,000, of
which, 21,000 were associated with Medicaid. She explained
that pertaining to Medicaid, there were issues with the
data system which was not a reflection of the untimely
processing. She deferred to a colleague for additional
information.
2:09:04 PM
DEB ETHERIDGE DIRECTOR, DIVISION OF PUBLIC ASSISTANCE,
responded that the Medicaid backlog was around 21,000
applications. She explained that the data associated with
the number was not clean or correct. She elaborated that
individuals apply for Medicaid benefits through an online
portal via the federal facilitated marketplace. Individuals
could apply via their myAlaska account online or they could
drop an application off. The division was unable to de-
duplicate at times and could not tell whether it was an
application or a renewal form. Additionally, because of the
timeliness issues people often submitted more than one
application for Medicaid and if an individual changed
household the division received additional applications.
The division had gone through various exercises to de-
duplicate and comb through the data. The Medicaid backlog
had been closer to 28,000 at one point and the division had
cleared just over 7,000 duplicates. She reported that the
division's AIRES system would shut down in the middle of
processing an application and the applicant was unable to
close the program. To fix the problem an eligibility worker
had to open the application in the EIS eligibility
information legacy system. She explained that the process
left an application hanging out there as if there was no
benefit; however, the individual was actually receiving
services. The division was about to put out an RFP to
modernize the non-MAGI [modified adjusted gross income]
Medicaid category, which would correct the issue and result
in improved fidelity in the data.
Representative Stapp remarked that he was already aware of
her answers and wanted them highlighted for the committee.
He stated there were good reasons for the existing backlog.
He elaborated that the EIS system ran on Cobalt software.
He relayed that a law passed by the legislature could
significantly increase the number of public assistance
applications. He noted there had been technical issues with
AIRES since its creation. He was concerned about the
elimination of the long-term non-permanent positions who
were tasked with assisting with the work. He knew the
department had done an excellent job and planned well;
however; he did not want to trade one backlog in SNAP for a
backlog in all of the other programs. He asked if the
department was certain it would be able to keep up to
ensure Medicaid applications were timely and delivered.
Commissioner Hedberg responded that it was a top priority
to meet the timeliness on processing the applications. She
acknowledged that while progress had been made, the
department still had work to do. She recognized the
concerns about the broad-based categorical eligibility.
There were different aspects involved including an
administrative burden that was reduced by implementing the
broad-based categorical eligibility. She explained there
was tight coordination between the commissioner's office
and DPA; the two entities met almost daily to assess how
staff could be supported and what the numbers were and how
to create efficiencies. She noted that future slides in the
presentation would demonstrate how the department had
categorized efficiencies and the progress to date.
2:13:55 PM
Co-Chair Josephson shared some of the concerns with solving
the backlog. He had some anxiety about retreating from the
state's improved position.
Ms. Halloran returned to the presentation on slide 10. She
clarified that in addition to the 30 positions leaving
specifically associated with the SNAP backlog, there was
another multiyear increment specific to Medicaid
eligibility redeterminations, which was another 30
positions. She advanced to slide 11 which compared the DPA
budgets from FY 24 to FY 26. The decrease from the FY 25
management plan was just over $13 million UGF and $35
million in federal funds. Contributing factors included the
reversals just discussed and two large American Rescue Plan
Act (ARPA) multiyear appropriations within the Child Care
Assistance Program, which had also been discussed earlier
in the meeting.
Co-Chair Josephson looked at slide 10 and referenced Ms.
Halloran's mention of redeterminations. He understood that
if the temporary staff was not needed, it was not needed.
He thought that if they could be hired in some other
capacity it was all the better. He referenced Ms.
Halloran's statement that the staff working on childcare
and food security was often the same staff working on the
SNAP backlog. He asked if he was correct.
Commissioner Hedberg responded in the negative and
clarified that it was very different. She explained that
the multiyear reversal for Medicaid unwinding had
associated long-term non-permanent positions that were
being reversed out. Childcare and food security had funding
that went through DOH out to providers or the Food Bank of
Alaska.
Commissioner Hedberg advanced to slide 12 titled "Public
Assistance Statewide Profile FY2024." She recognized that
there was a tremendous amount of work that flowed through
DPA. The slide showed a monthly representation of
recipients leveraging any of the public assistance
programs. She reported that the 28 percent timeliness in
March of 2023 had been an all-time low. She relayed that
the timing coincided with coming out of the pandemic and
federal changes were being implemented. The department had
been faced with how to support its staff, clients needing
benefits, and meet the division's mission of providing
financial assistance and help individuals to self-
sufficiency. She shared that DPA had made great strides
over the past two years. She noted that the next slide
would address changes that had been made and how DPA was
making progress. She highlighted there were 65,778 Alaskans
on SNAP benefits, which was a significant increase from two
years earlier.
2:18:13 PM
Representative Hannan asked about slide 12. She used senior
benefits averaging 10,663 recipients monthly as an example.
She asked if the recipients would also likely be counted in
the 65,778 Alaskans receiving SNAP benefits. Alternatively,
she asked if individuals were only counted once in the
assistance recipient numbers on the slide.
Ms. Etheridge responded that they could be duplicated.
Recipients could be receiving a senior benefit, a Medicaid
benefit, or a SNAP benefit.
Representative Hannan asked if the individuals would also
qualify for adult public assistance.
Ms. Etheridge responded that adult public assistance was
for age, blind, and disabled and it was a supplemental
program for low income individuals on supplemental security
income.
Commissioner Hedberg advanced to slide 13 titled "Drivers
of Improvement." She expressed gratitude to Ms. Etheridge
for stepping into a difficult role and working with staff
through substantial change management. The slide showed the
work broken out into four different areas including client
engagement, workforce enhancements, policy streamlined, and
IT improvements. She shared how the department had been
focusing on how to simplify the process for public
assistance applicants. She relayed that all of division's
offices were now open for same-day service. She elaborated
that an Alaskan could visit an office with their supporting
documentation, complete their application, complete an
interview if required, and receive a determination. She
noted it was progress that had not been available a couple
of years back. Additionally, staffing had been increased
for DPA's virtual contact center and all of the
applications were now available online. The division was
leveraging smart form technology where the system made
additional questions available to an applicant if needed,
which was enhancing the amount of time required to complete
an application.
Commissioner Hedberg continued to address slide 13. She
relayed that DPA was working on a multiprogram smart form
application to help clients and application processing
technicians. In the summer of 2024, DPA launched Alaska
Connect, which allowed Alaskans to login into a portal on
myAlaska where they could submit applications, renew
benefits, report a change of status, or upload documents.
Phase two would launch in the coming summer and would allow
individuals to update their demographics through the online
portal. For example, clients would be able to update their
address if they moved, they would see notices mailed, see
reminder dates on when an application was up for renewal or
when an interview was needed, and they would see their
benefit amounts.
2:24:03 PM
Commissioner Hedberg explained that the department was
providing substantially more information to clients and
ensuring that there was access to the information.
Additionally, DPA was sending reminders via text message to
Medicaid and SNAP beneficiaries notifying them when to
renew an application or when they were about to receive a
phone call for an interview. Lastly, the division had
adopted a one and done model. She elaborated that when a
client called or came into an office, the eligibility
technician would see all of the applications the individual
had applied for and would process all of the applications
as much as possible with the client present. She stated the
one and done process was a business process redesign that
had helped with the efficiency and flow of the information.
She had been out in the community in the last week, and it
was heartwarming to learn from social services
organizations that the advancements were making a
difference. There were still connectivity issues with
unstable internet for Alaskans in rural areas. The division
was open to ideas on how to continue to meet the needs of
individuals living in rural communities who may not have
stable internet.
Commissioner Hedberg relayed that in terms of workforce
enhancements the division had been working hard to support
employees. She reported that the division had a high
turnover rate, which was multifactorial. The division had
been working to improve the culture and work environment
for its staff. The division had installed security in its
large offices a couple of years back to ensure staff feel
safe at work and that situations could be deescalated when
they arose. Additionally, DPA began using the survey tool
Qualys in the past year to gather information from
employees and providers. The department wanted to hear
about the issues and ideas for solutions to create more
efficiencies. The tool helped lead into the quality
improvement process that looked at the root cause analysis
when identifying errors and improvements for operational
efficiencies. Staff had been provided with larger computer
screens and internet bandwidth had been increased as much
as possible for staff efficiency. The division had recently
completed the business process redesign on the training
unit. The division began leveraging adult training theory,
which decreased the amount of time that eligibility
technicians were in training, so they were able to start
processing applications faster under supervision until they
felt more comfortable. She remarked that it had been a game
changer for many employees. Finally, the division had held
numerous town halls and meetings with staff on their needs
and ideas and how the division could improve the work.
Co-Chair Foster relayed that he had met with the
commissioner earlier and highlighted that if people in the
villages did not have money for food, they did not have
money for internet. He remarked that villages did not have
public libraries where people could go use the internet.
For some of the individuals who had technology, he was out
in 27 villages over the past summer, and he had seen many
old flip phones that required hitting a button numerous
times to type an individual letter. He supported the
division's goal of being more technologically innovative,
but he requested maintaining some level of old school
resources in place such as the ability for clients to
contact the office via phone. He remarked that people took
for granted that many people in many areas had access to
internet; however, it was not the case in some areas.
2:28:55 PM
Representative Allard stated that what Co-Chair Foster had
said correlated well with seniors who were veterans. She
agreed it was necessary to have access to applications on
paper and the ability to call an office. She remarked that
it was hard for seniors living in remote areas to get
things done with technology. She supported the use of pen
and paper in some scenarios and she did not believe it was
always efficient to go through the internet. She supported
coming up for a better plan for rural communities.
2:30:05 PM
Commissioner Hedberg replied that the division still saw a
large amount of paper applications. She had recently
explained to a federal agency it was necessary for the
division to have one foot in the basics and one foot in
technology. She had told the agency that if you could make
it work in Alaska you could make it work in any state. She
agreed with the comments by Co-Chair Foster and
Representative Allard.
Representative Tomaszewski referred to workforce
enhancements and observed that 24 percent of the division's
workforce worked remotely from home. He asked if it was a
trend that was increasing or decreasing. He asked how it
worked for workforce enhancement and happy workers.
Ms. Etheridge answered that when she started as the
director most of the DPA workers were teleworking; the
public assistance offices had not been open. She relayed
that through the process of reopening offices, staff had
returned to the office in order to meet individuals in
person and provide same-day service. Generally, people were
working at least four days a week in the office. There were
some staff without direct client service who could work one
or two days in the office and telework the rest of the
time. She relayed that if the division saw people needing
some additional support they may be asked to come back into
the office.
Representative Tomaszewski referenced a snapshot from
October of 2024 showing 23 percent of the division's
employees working from home. He asked if the number of
people working from home was shrinking or if there was a
rotation of individuals working from home.
2:32:44 PM
Ms. Etheridge replied that the information Representative
Tomaszewski was referencing was a snapshot in time. The
division had an increase in number of staff who were
working in the office for larger spans of time. There were
a number of staff with telework agreements where staff may
be working remotely one or two days a week, or they had a
telework agreement to work overtime from home.
Co-Chair Josephson asked for verification that the response
provided by Ms. Etheridge was specific to DPA.
Ms. Etheridge replied in the affirmative.
Representative Allard asked for the number of DPA
employees.
Ms. Etheridge replied that the division had just over 400
employees.
Representative Allard asked how many of the total employees
teleworked.
Ms. Etheridge replied that she would have to follow up with
the exact number. She stated that it was significant
number.
Representative Allard asked if the department would come
back to brief the committee.
Co-Chair Josephson replied it was unlikely.
Representative Allard wanted to know the difference in
productivity between employees working in the office and
teleworkers. She had a concern that the productivity was
not as high for teleworkers. She wanted to see the numbers.
She thought the department should anticipate the questions.
She wanted the information on the public record.
Ms. Etheridge responded that she understood the question.
She explained how work happened with DPA eligibility
workers. The division operated on a statewide basis and
used a workflow management tool called Current. She
detailed that eligibility workers were all assigned a skill
set. For example, an eligibility worker may focus on SNAP
and Medicaid only, while another worker may have a skill
set to work on all programs. The work was received by
eligibility technician 1s where a case was registered in
the system and was assigned to be worked through the
current workflow management system. An eligibility had to
"claim next" in the current system and leadership could
tell exactly how much time an individual was taking to
process a case, how many cases they work on, and how much
time they spent idle because they did all of the work in
the workflow management system. When she initially started
the division set a baseline requirement of working five
cases per day or they would be required to come back into
the office to receive additional support. Through
continuous quality improvement they realized that five
cases per day was arbitrary because it did not reflect
cases that were difficult versus easy to work. She
elaborated that it had resulted in people potentially not
producing as much as they could because five was the
standard or producing what looked like less but they were
taking more difficult cases.
Ms. Etheridge elaborated that DPA had transitioned to key
performance indicators where supervisors supervised staff
based on their productivity in the key performance
indicators. She explained it was based on statewide the
length of time an average transaction took depending on the
program. Supervisors had access to a daily report where
they could monitor individuals whether they were in the
office or working remotely and supervisors would step in
when someone was taking too long to process a case. She
relayed that if there was consistent lower productivity,
those individuals were likely pulled back into the office.
Representative Allard appreciated the answer. She thought
it sounded like there was a good check and balance in
place.
2:38:35 PM
Representative Bynum asked about crossover collaboration
with the Department of Labor and Workforce Development
(DLWD) workforce enhancement and development.
Ms. Etheridge responded that DPA had a fairly close working
relationship with DLWD. She relayed that DPA offices were
often collocated with DLWD including in Juneau and Kenai.
When individuals applying for positions within DPA
struggled with completing the application, DPA referred
them to DLWD for help filling out the application. She
highlighted that it was a gateway for individuals to become
better applicants for DPA and any other position they may
want. She explained that DLWD may be working with an
individual and was aware that DPA had open positions. For
example, in Fairbanks there were fliers outside DLWD.
Additionally, within DPA there was a SNAP employment and
training program and a work services program for the
Temporary Assistance for Needy Families (TANF) program. She
noted that at times individuals moved from the work
services programs to become public assistance employees.
Representative Bynum asked if DPA worked with workforce
development to help develop its workforce.
Ms. Etheridge answered that DPA had programs to support
staff when they needed workforce development support and
they may refer staff if they needed support in learning,
but there was nothing specific.
Representative Tomaszewski thanked the department for the
key performance indicator discussion, which he found
helpful. He noted that the data he had looked at showed the
entire department. He asked if it cost more for the
department to have teleworkers. He wondered if there were
other costs associated with telework.
Commissioner Hedberg answered, "No." She was not aware of
any other costs. She explained that telework was an
agreement of where a person worked, and the department did
not pay for anything at a person's house.
2:42:21 PM
Commissioner Hedberg continued to review slide 13. She
addressed the bullet point "Policies Streamlined." One of
the first decisions had been to extend the certification
period for SNAP from six to twelve months, which reduced
the churn of Alaskans coming in every six months for
renewal. The division had become fully compliant with SNAP
interviews as part of its business process redesign in its
training program. Additionally, on December 1, 2024, the
USDA gave approval for the Elderly Simplified Application
Project (ESAP) certification pertaining to adults who were
65 years old and older with a disability, which was
qualified by the federal Food Nutrition Services agency.
She relayed that prior to December there was a 24-month
certification period for individuals qualifying for ESAP.
The certification period had been extended to 36 months.
The extension provided continuity for the population and
evened out a lot of the certifications for eligibility
technicians. She stated that when the shift had been made
it was 41 percent of the SNAP population.
Ms. Etheridge continued to address slide 13. She relayed
that DPA had taken several steps to determine how to
administratively simplify the programs and provide better
customer service to Alaskans. She reported that staff were
finding it very difficult to get basic questions answered.
She provided an example where a staff member had a question
about eligibility, what income to count, who a household
member was, and what dates of employment to look at and
they had to stop their work to ask a peer or trainer for
assistance. She explained that it took a significant amount
time and energy away from eligibility technicians. The
division was creating an internal search engine that would
enable workers to ask questions and receive clear and
concise answers from DPA policy manuals. The change would
provide better customer service to staff, decrease the
error rate, and ensure more quality decisions were made.
Ms. Etheridge noted that Alaska had a special section of
the [federal] farm bill. She relayed that in rural Alaska,
communities outside of a 50-mile radius of a public
assistance office could have a fee agent serving as a
delegate of the state. The agent could take an application
to preserve the date of the application and an individual's
interview. She stated it was difficult to get people to
want to be fee agents; therefore, the farm bill contained a
section to enable a "postponement of interview" option. She
elaborated that for SNAP cases in rural areas, DPA would
receive an application and do a cold call to try to conduct
an interview (if the individual was not available the
caller would leave a message that they would try back in
five minutes). She elaborated that if the division was
unable to reach the person, they would certify and get the
benefits out to the person, schedule an interview, and give
enough time for the mail to reach the person so they could
make their interview.
2:48:23 PM
Ms. Etheridge relayed there was now an interview queue and
a missed interview queue on the virtual contact center
because many times the mail arrived after a person's
interview was scheduled. The division would be doing the
same thing for recertifications and applications with the
caveat that verifications would be needed in order to
certify. She believed the items would be a game changer for
rural Alaska. She stated it would increase the division's
ability to be timely and it was only issuing benefit for up
to two months depending on the timing of the interviews.
She noted it was similar for expedite. She elaborated that
expedite meant a person had less than $150. She underscored
it was critical that the division had the ability to be
responsive to Alaskans.
Representative Bynum asked if a fee agent was paid through
a federal program. He noted Ms. Etheridge indicated it
could be a difficult person to find. He asked how they were
paid.
Ms. Etheridge answered that fee agents went through a
training with DPA and entered into a contract to be paid on
a per application basis at $25 per application. The agent
was responsible for sending the division and invoice for
reimbursement by DPA.
Representative Bynum asked if the cost was paid by the
state or federal government.
Ms. Etheridge replied that the cost was paid with state
funds.
Representative Bynum referenced Ms. Etheridge's discussion
of using phone calls as an option to work with clients to
get applications filled out. He asked if DPA was using
teleconference or telephone.
Ms. Etheridge replied they were using telephone.
Representative Hannan directed a question to Commissioner
Hedberg. She referenced Commissioner Hedberg's discussion
about extending the elderly simplified application
certification up to 36 months. She referenced her statement
that it was 41 percent of SNAP beneficiaries. She asked if
41 percent of the state's SNAP beneficiaries were elderly.
Commissioner Hedberg answered the individuals needed to be
65 years or older and have a disability as defined by Food
Nutrition Services (FNS) housed under USDA.
Representative Hannan asked if the number was 41 percent of
total SNAP recipients. She thought there were far more
families with children on SNAP.
Ms. Etheridge responded that it was household. The members
of the household had to be 65 or older and disabled and
they could also have children who were not of working age.
2:51:29 PM
Commissioner Hedberg turned to slide 14 titled "Division of
Public Assistance: IT Modernization." She shared that two
years ago the legislature made a large appropriation to pay
for the modernization. She addressed ARIES maintenance and
operations shown on the right of the slide. She elaborated
that the small project management team within DPA working
with contractors had shifted the document management system
and ARIES into the cloud, which positioned the division for
future advancements by aligning updates to the technical
infrastructure. Additionally, it provided easier access to
the data in a more secure, adaptable way. She directed
attention to a bullet point pertaining to the integrated
eligibility enrollment system. The division had antiquated
systems and the appropriation was to get from to current
position to where they needed to be. There were two RFPs
going out in the current year including one to migrate the
non-MAGI categories off of the mainframe and the second was
to migrate SNAP off the mainframe. The RFPs would go out
soon for contractors to begin work. Once the first two
programs moved, the TANF and cash programs would be
migrated off the mainframe. The project was estimated to be
completed by 2028.
Commissioner Hedberg addressed a bullet point pertaining to
enhancing client engagement on slide 14. The division had
implemented text messaging and secure document upload. The
division had multiple eForms recognizing it was still
necessary to keep paper forms for some clients.
Additionally, phase two of the client portal was launching.
She referenced earlier discussion by Ms. Ricci about the
division's ex-parte process for Medicaid. She explained it
was an automated process that would help with
redetermination and many efficiencies would be gained by
increasing the ex-parte process. In November 2024, the
division had leveraged some technology to identify incoming
emails containing applications or renewals and
automatically place them in the document management system.
In the coming year DPA would be working on data integration
between all of its platforms to help eligibility
technicians and clerical staff to not have to toggle
between different platforms. She noted that verification
was an important tool for verifying an individual qualified
for public assistance. The process was currently manual and
DPA would be working to automate the process to reduce the
time the eligibility technicians spent processing
applications. Additionally, the division was required to
mail out a lot of notifications. She explained that when
mail went to wrong addresses it was returned to the
division and the division received a large volume of snail
mail. The division was purchasing equipment that would
automate the mail coming back in. The equipment would scan
the incoming mail and upload the new addresses in order for
the division to connect with its clients. She highlighted
other areas within DPA including the Women, Infant, and
Children (WIC) program with its new system called Spirit
currently in a phased roll out; and the Child Care program
office with a phased roll out of the new Alaska Child Care
Information System.
2:56:54 PM
Representative Bynum referenced Commissioner Hedberg's
appreciation for a legislative appropriation into the new
infrastructure. He asked if the current budget was
sufficient to maintain the infrastructure going forward.
Commissioner Hedberg responded that the department felt
confident with the current funding. She relayed that there
would be a lot of cost savings when moving off of the
mainframe. She believed through the transition of the
technologies the division was gaining and getting off of
the old legacy systems, the division would be able to
maintain its budget.
2:57:47 PM
Ms. Halloran reviewed the Division of Behavioral Health
(DBH) on slide 15. The division identified behavioral
health needs across Alaska and developed and implemented
strategies to meet those needs. The division maintained
Alaskans behavioral health system in partnership with
grantees and providers with a budget of just over $94
million. She highlighted several budget changes beginning
with a $1.5 million request for a crisis call center
comprised of $750,000 in mental health trust receipts and
$750,000 general fund mental health funding. The call
center provided for 24/7 statewide coverage for 988 calls
as well as 1-877-266-HELP. The center provided a free
confidential talk line for Alaskans at risk of suicide or
in emotional distress. The center had been in operation for
over 20 years and had answered the suicide prevention line
now 988 calls since its inception. The current call
center contract began in 2022 and ended at the end of the
current fiscal year on June 30, 2025. The department would
issue an RFP for a new contract. There had been an increase
in Alaskans utilizing the call center in recent years
resulting from statewide and national media campaigns. In
recent years the contract had partially been supported by
ARPA funding and other federal programs, which were
expiring. She relayed that $15 million was needed to
maintain current services.
Ms. Halloran highlighted the second item was a reduction of
$3.7 million in designated program receipts including the
Marijuana Education and Treatment Fund, Recidivism
Reduction Fund, the Alcohol Drug Treatment and Prevention
Fund, and the Tobacco Cessation and Education Fund. The
division primarily used the funds for grants and
reimbursable services agreements with other state agencies.
The third budgetary change was a $5 million increase in
federal authority for DBH. The division managed 20
different federal grant awards at any given time. The
additional authority would mean the division would not have
to hold back and toggle funds from fiscal year to fiscal
year.
Co-Chair Josephson referenced the reduction in designated
program receipts. He viewed it the funds as source of
revenue and he considered that just because the source was
reduced did not mean the problems were not there. He asked
why not find a substitute revenue source. Alternatively, he
asked if the reduction indicated there was less use of
intoxicating substances. He assumed that was not the case.
Ms. Ricci responded that relying on the specific revenue
sources for programs was always challenging because they
reflected certain variables outside of the state's control.
In light of the decrease in tax revenue, the division was
thinking about how it could mitigate the impact to existing
programs. She could not speak to whether the use of
marijuana or tobacco had increased or decreased relative to
the tax. She noted it would be a question for the
Department of Revenue. The division was looking at some of
the programs supported through the funding. She relayed
that some of the programs were reimbursable services
agreements (RSA) to other divisions or departments and DBH
had provided those entities with notice that the funding
may be impacted based on tax receipts. The department would
continue to think about how to mitigate the impact of the
reduction in funds. She noted it was the nature of the
variable programs.
3:02:40 PM
Representative Galvin referenced the statement that the
nature of the funds going to better behavioral health was
inconsistent. She asked asked why not make a request for
consistent funding from the state. She was confused to see
the decrease. She highlighted the federal receipt authority
request for grants [on slide 15]. She wondered why there
was no request to fill the hole left by the reduction
designated general funds.
Ms. Ricci replied that it was important to put into context
the grant funds as one of many funding streams that
supported a variety of different behavioral health
programs. The $5 million in federal receipt authority was
not intended for the same types of services the other tax
revenues had been used for. She considered the funding of
the services with a variable tax revenue funding source and
believed it had been a decision made with the legislature
evaluating how best to use the revenues with the
recognition that the tax revenues would shift over time.
She remarked that while it represented a decrease the
division would have to manage, there was also $122 million
added to the behavioral health system through the 1115
Medicaid waiver. The services may not translate into the
exact services supported through the grants [being
reduced], but it was important to look at the entirety of
the funds available to the behavioral health system. There
were gaps the department wanted to address, but there had
been significant strides in federal and state funding
increases to support the behavioral health system.
3:05:10 PM
Representative Galvin appreciated the assessment and the
department finding ways to distribute $122 million. She
remarked that the department had done a great job building
a road map. She believed it was on the legislature to help
identify and fill any funding gaps and help the department
meet its mission of a comprehensive and integrated
behavioral health system.
Ms. Ricci added that one of the department's areas of focus
was the development of certified community behavioral
health clinics. She relayed that a portion of the $5
million in federal grant authority was because the
department was awarded $1.6 million in federal funds to
pursue planning and development for implementing certified
community behavioral health clinics. She stated it was a
promising model; some clinics were operating in Alaska but
they could not receive the enhanced Medicaid program
funding until the Medicaid program established its own
certification system. The federal grant funding would
enable the department to begin planning out the services
and it hoped to begin implementation work towards the end
of the fiscal year.
Representative Hannan asked about the crisis call center.
She shared that she had been a legislative member of the
state suicide prevention council. She did not realize the
council was not in the department's base budget. She asked
if the increment on slide 15 was an additional $1.5 million
anticipating an increase in the RFP. Alternatively, she
wondered if the council was not in the budget because the
contract for current operation was expiring.
Ms. Halloran answered that the crisis call center had
existed for over 20 years. She explained that the
utilization had drastically increased with the advertising
around 988. As a result, the need was greater and
additional staff was necessary.
Ms. Ricci confirmed it was an additional increase to the
budgeted amount. The crisis call center was a bit
complicated to track over the years because it had existed
for 20 years and because the services it provided and the
model for providing the services continued to evolve over
time. She explained that the suicide prevention line had
morphed into a crisis contact center. The center connected
with the federal 988 requirement that made the services
available nationwide and incorporating things like the
ability to send text messages and the opportunity to follow
up with individuals to connect them to services and
potentially appointments. The department also viewed the
crisis contact center as being essential to further
establish the crisis stabilization and crisis response
programs in Alaska. She explained there had been some good
work done, but it was an area that needed building out
including crisis stabilization centers. She noted that
having the IT platform necessary to support the call center
growth was key. She explained it was all part of the reason
for the increase. She viewed it as a shift or evolution in
the model over the last 20 years.
Representative Hannan stated it was what she wanted to hear
that it was an expansion responding to increased demand.
She reported that the council heard continuously that
because the effort was nationwide and in the states that
had the most success it also meant it linked to subservice.
She elaborated that Utah was the exemplar of the suicide
crisis lines where the University of Utah dispatched a
crisis team to the phone caller, which could not happen in
Alaska.
3:12:06 PM
Representative Hannan elaborated that Alaska's call center
was in one location and rural communities had no better
response delivery than when 988 went live. She stated the
legislature needed to do a better job to get more services
available to respond to communities and people in crisis
calls. She stressed that the crisis center did an amazing
job of trying to stabilize, but many communities did not
have services. She stated it was one of the pieces of the
federal rollout that was successful in many other places,
but Alaska did not have enough providers, access to care,
and crisis stabilizations centers set up to see individuals
once they made a lifeline call. She was more than happy to
advocate passionately for the additional money because 988
had saved lives.
Ms. Halloran reviewed slide 16 showing a three-year
comparison for the DBH budget. The majority of the
division's UGF was general fund mental health authority
which comprised 26 percent of its budget and the federal
share was 31 percent.
Ms. Ricci advanced to slide 17 titled: "Behavioral Health
Spend: Medicaid & Grants." The slide reflected important
shifts in how the behavioral health system was funded in
Alaska.
Representative Tomaszewski asked what percentage of the
grants were comprised of federal and state funding.
Ms. Ricci replied that she would follow up on how the $51
million was broken out. The majority were general fund
grant dollars, but there was a level of federal grants
through different federal entities that may also flow into
DBH. She did not know how much of those were included in
the number on slide 17. She stated her understanding that
the vast majority on the slide were UGF dollars.
Representative Tomaszewski requested the list of recipients
and the breakdown.
Co-Chair Josephson requested a review of the most pertinent
information on slide 20.
Ms. Halloran reviewed slides 20 through 21 pertaining to
the Division of Senior and Disabilities Services (SDS). The
division's work was comprised of Adult Protective Services,
assessment review, early intervention, the Infant Learning
Program, grant services, Intellectual and Developmental
Disabilities Unit, provider certification and compliance,
and more. The primary change was a companion change to the
Medicaid Services appropriation, which was a reversal of a
multiyear appropriation for InterRai. Slide 21 showed the
division's budget was just under $73 million, reflecting a
decrease of $1.5 million from management plan.
3:16:54 PM
Ms. Halloran moved to the Division of Public Health (DPH)
on slide 22. The division was responsible for diagnosing
and investigating health problems and hazards in Alaskan
communities and informing Alaskans on health issues,
mobilizing partnerships to identify and solve health
problems, support community health efforts, provide linkage
for Alaskans to health services, ensure adequate public
health infrastructure, and monitor and evaluate health
service effectiveness. The appropriation included one
increase in general fund program receipts to increase the
Strengthening Healthcare Access Recruitment Program I
(SHARP I). The program received general fund program
receipts from healthcare agencies across the state, which
was matched with federal Health Resources Systems
Administration (HRSA) loan repayment program funds. The
department was seeing increased utilization of agencies in
the program. The division also saw a reduction related to
designated general funds, similar to DBH. She highlighted a
reversal of several multiyear appropriations for COVID.
Many of the appropriations would terminate at the end of
the current fiscal year. Others would be carried into FY 26
in the amount of approximately $70 million in COVID funds.
Co-Chair Josephson asked what the intent was for the
funding.
Commissioner Hedberg answered that the funding would be
used for one-time expenditures, much of which was related
to data integration. For example, funding would be used for
data integration in the state lab's information management
system.
3:19:25 PM
Representative Galvin asked about the reduction of DGF
based on the Department of Revenue's projections. She asked
what would be lost within DPH.
Commissioner Hedberg answered that DPH was looking at its
overall budget to determine how to refocus its funding. She
used the After School Program as an example and explained
that it leveraged some of the funds. The program would make
sure the funds continued through FY 26 as DPH continued to
evaluate its budget to meet the needs with existing
resources.
Representative Galvin surmised the division was figuring
out a way to move things around perhaps there was funding
associated with vacancies to cover what may normally be
lost without the funds.
Commissioner Hedberg responded affirmatively. The division
was making sure it could take care of it and evaluate.
Ms. Halloran moved to slide 23 pertaining to the DPH budget
comparison from FY 24 to FY 26. The division also
administered two smaller appropriations including the Human
Services Community Matching Grant Program and the Community
Initiative Matching Grant Program. The overall decrease was
just under $150 million; however, a number of the items
would roll back into the department at the end of the
fiscal year when it realized year-end balances.
Ms. Halloran discussed Department Support Services on
slides 24 and 25. She relayed that the division provided
for all health support functions within the department
including human resources oversight, procurement, grants
and contracts, information technology, finance and revenue,
cost allocation, audit response, and administrative
support. There were two budget changes including a request
for an increase in interagency receipt authority in order
for the division to allocate support costs out to the
department and a reversal of a multiyear homeless
management information system increment terming out at the
end of FY 25.
Co-Chair Josephson thanked the department.
HB 53 was HEARD and HELD in committee for further
consideration.
HB 55 was HEARD and HELD in committee for further
consideration.
Co-Chair Josephson reviewed the meeting for the following
day.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DOH - HFIN FY 26 Budget Dept Overview .pdf |
HFIN 2/13/2025 1:30:00 PM |
HB 53 HB 55 |