Legislature(2025 - 2026)ADAMS 519
05/16/2025 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| HB96 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 193 | TELECONFERENCED | |
| + | HB 96 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | HB 104 | TELECONFERENCED | |
| += | SB 64 | TELECONFERENCED | |
HOUSE BILL NO. 96
"An Act establishing the Home Care Employment
Standards Advisory Board; relating to payment for
personal care services; and providing for an effective
date."
6:44:25 PM
REPRESENTATIVE MIKE PRAX, SPONSOR, introduced the bill. He
stated that Alaska faced an increasing number of senior
citizens and other citizens needing home care and services,
and that the need was outpacing the supply of available
providers. He explained that the increase was one of the
drivers behind the legislation. The bill was also being
driven by a proposed change in federal Medicare regulations
that would require an advisory board to assist in the
rebasing of the rates. He stated that Mr. Tony Newman,
Director of Senior and Disabilities Services, was present
to assist with questions, in addition to other individuals
available on the line to answer detailed questions. He
summarized that the bill created an advisory board,
described the terms of office for board members, the
board's composition, and its powers. He added that the bill
required the board to provide a biannual report.
6:46:48 PM
Co-Chair Foster relayed that the committee would hear
invited testimony.
6:47:16 PM
ALEXIS RODICH, RESEARCH AND POLICY DIRECTOR, SERVICE
EMPLOYEES INTERNATIONAL UNION 775, TACOMA, WA (via
teleconference), stated that she was the director of the
Service Employees International Union (SEIU) 775, which was
referred to as the Alaska Caregivers' Union. She explained
that the union represented more than 55,000 direct care
workers in Washington, Montana, and Alaska. She stated that
the union was deeply committed to a strong and sustainable
system of long-term services and supports in Alaska and it
supported HB 96. She relayed that Alaska had been
experiencing a major demographic shift that was increasing
demand for care, particularly for higher-skilled care. Over
the past decade, the state had one of the fastest-growing
senior populations per capita in the nation and the trend
was expected to continue. She noted that older Alaskans and
Alaskans with disabilities were living longer, which was a
positive development.
Ms. Rodich remarked that with age came higher acuity and
more complex care needs. She stated that many caregivers
working with the union had children with developmental
disabilities who were living longer than expected. The
caregivers were concerned about what would happen when they
were no longer available to provide care to patients. She
added that Alzheimer's disease and other forms of dementia
were also becoming more common, which created additional
demand for care services. Given the demographic changes, it
was unsurprising that DLWD had predicted that home care
would be one of the fastest-growing and most in-demand
occupations in Alaska. However, the number of potential
caregivers had declined from a ratio of 15 to 1 in 2018 to
a projected 7 to 1 ratio by 2030. She noted that the
shortage was even more acute in rural and remote areas of
the state.
Ms. Rodich stated that a higher concentration of older
Alaskans lived in Southeast Alaska and on the Kenai
Peninsula than in other parts of the state. She emphasized
that older individuals had built lives and families and did
not want to move to Anchorage or out of state to access the
care they needed as they aged. The union did not want
individuals to be forced into institutional or congregate
care settings, which could cost the state hundreds of
thousands of dollars more per year per person. She warned
that the workforce crisis would continue to worsen and
would become significantly more costly unless the state
took steps to build a strong, well-trained, professional
direct care workforce. She stated that HB 96 helped the
state build its workforce in two ways.
Ms. Rodich stated that the bill ensured the state would
maximize the Medicaid personal care rate by establishing a
labor rate for personal care services. She explained that a
percentage of the Medicaid rate that agencies received for
personal care assistant services must go directly towards
pay and benefits for direct care workers. She noted that in
Alaska, nearly all personal care services were provided
through a consumer-directed "agency with choice" model, in
which agencies had far fewer responsibilities than under a
traditional agency model.
Ms. Rodich stated that under the agency with choice model,
the consumer was responsible for recruitment, scheduling,
training, and hiring, rather than the agency. She asserted
that it was reasonable that a 70 percent share of the
Medicaid rate should go towards paying for services rather
than towards agency overhead. She added that the bill also
created greater transparency in how the Medicaid personal
care rate was being used.
Ms. Rodich relayed that in recent years, many caregivers
had traveled to Juneau, met with legislators, and provided
public testimony to describe how the Medicaid rate
suppressed their wages. The low rate made it impossible for
caregivers to make ends meet without taking on extra jobs,
juggling bills, or going into debt.
6:51:47 PM
Ms. Rodich stated that the legislature responded by
enacting multiple rate increases, including two that
included legislative intent for part of the increase to go
toward caregiver pay and benefits. She shared that some
caregivers received wage increases of $2 to $4 per hour,
which provided significant relief for workers previously
earning $16 per hour. However, many other caregivers did
not receive such increases.
Ms. Rodich continued that no one had a clear understanding
of how agencies allocated the rates and increases because
there did not appear to be consistent data collection or
analysis. She explained that the second way the bill would
strengthen the long-term care workforce was by creating the
Workforce Standards Advisory Board (WSAB). The proposed
board was modeled after similar entities in Nevada and
Washington. She explained that the board would bring
together stakeholders most impacted by the home care
system, including providers, caregivers, clients, and DOH
to identify and plan for long-term workforce needs and
asses whether the rates were adequate to meet the needs.
She explained that the board would create a mechanism for
each group of stakeholders to work together to determine
priorities, recommend solutions, and evaluate whether the
state was adequately resourced and prepared for the future.
Ms. Rodich emphasized that demographic changes had already
begun and the caregiver shortage was already apparent. The
committee had heard painful testimony from caregivers who
had been required to move loved ones to Anchorage to access
adequate care, or had left their jobs to provide unpaid
care in order to qualify for paid services. She asserted
that HB 96 represented an opportunity for Alaska to take
action to ensure that Alaskans in need of care both now and
in the future received less costly care.
6:53:46 PM
Representative Jimmie asked for more information about
congregate care settings being more costly to the state
every year.
Ms. Rodich responded that a 2019 study conducted by DOH
found that care provided in the home cost 59 percent less
than services delivered through intermediate care
facilities for individuals with intellectual or
developmental disabilities. The same study found that home
care services could cost 45 to 90 percent less than nursing
home care for seniors and people with disabilities. In FY
24, the average cost per individual for in-home personal
care services under the state plan was $13,265, compared to
$143,000 for care in nursing homes.
Ms. Rodich emphasized that the difference in cost was
significant and investing in home care not only resulted in
substantial savings for the state but also positively
impacted the economy. There was a well-known study by
LeadingAge which found that each additional dollar paid to
a direct care worker had a multiplier effect in the
community ranging from 1.6 to 2.1. Investment in home care
could have a considerable economic benefit across various
communities due to the demand for care workers throughout
the state.
6:55:50 PM
Representative Jimmie noted that she had a question for Mr.
Tony Newman. She asked what options existed for individuals
in rural Alaska who needed care, and if the needs were
currently being met.
TONY NEWMAN, DIRECTOR, DIVISION OF SENIOR AND DISABILITY
SERVICES, DEPARTMENT OF HEALTH, confirmed that there was a
greater need for home care services in rural Alaska,
including personal care and residential habilitative
services such as group homes. He stated that he did not
have specific figures available at the moment but the
department was currently pursuing several initiatives.
During the previous legislative session, a bill had passed
establishing a new service known as adult host home care
[SB 57, passed in 2023], which allowed for the development
of settings that were less intensive than assisted living
homes and made it easier for smaller home-based settings to
achieve licensure. He offered reassurance that there were
ongoing efforts to develop the services that were necessary
to allow individuals to stay in their rural communities as
they aged.
Mr. Newman stated that regulations for the bill passed in
2023 had been under development. He explained that the
department had created an allowance for legally responsible
individuals to be paid to provide certain kinds of care,
primarily personal care. He clarified that a legally
responsible individual who normally would not be permitted
to receive payment for providing care, such as a parent or
spouse, would be allowed to do so under the bill. He added
the provision was introduced during the COVID-19 pandemic
and the department had continued the payment allowance
beyond the conclusion of the public health emergency. The
department was in the process of developing regulations to
make it a permanent feature of Alaska's health care system.
He reiterated that the provision would enable individuals
to access services in their home communities without
needing to move to a larger city. He noted that the
department was taking a number of steps to better reach
rural Alaska.
Representative Jimmie commented that she hoped the policy
would become permanent. She relayed that it was difficult
for elders in rural communities to leave their villages and
familiar surroundings and culture, including traditional
foods and interactions with family. She described the
experience of her aunt, Bessie, who had participated in the
program, and noted that before learning its official name,
she had referred to it as "Auntie Bessie Care." She
expressed her support for the continuation of the program
in Alaska.
6:59:35 PM
Co-Chair Foster asked for a review of the fiscal note.
BRODIE ANDERSON, STAFF, REPRESENTATIVE NEAL FOSTER,
reviewed the fiscal impact note from DOH, OMB component
2663, control code poXlb. He stated that the fiscal note
included FY 26 appropriations as follows: personal services
at $132,300, travel at $2,000, services at $24,000, and
commodities at $5,000, for a total operating cost of
$163,300. He explained that the amount would be funded
through $81,600 in federal receipt authority and $81,700 in
general fund match.
Mr. Anderson continued that in FY 26, the department
planned to add one support position and in FY 27, a second
position would be added, which would increase personal
services to $270,200. He stated that travel would remain at
$2,000, while services would increase to $48,000 and
commodities would increase to $7,000. He reported that the
total operating cost in FY 27 would be $327,200, with
corresponding increases to both general fund and UGF match.
The fiscal note also required regulation changes by the
department. He stated that one full-time health program
manager would be hired in FY 26 and a second would be hired
in FY 27. He explained that services and commodities costs
would increase accordingly, and that there would be one-
time commodity costs of $3,000 in each year the positions
came on board.
7:02:19 PM
Representative Johnson explained that she had known an
elder in her community who had since passed away, along the
elder's husband. Both individuals were retired teachers and
had carried some type of private insurance through
employment. Although the individuals had received home
health services, the services were not Medicaid-funded but
were provided through a separate program. She relayed that
the elder had expressed concerns over the years about the
lack of training received by the attendants. She noted that
even though the elder had been in her 80s, she had been
afraid to leave her husband alone with an attendant, as the
attendants had not been trained in tasks such as helping
her husband get up or walk with a gait belt. She asked
whether the bill would apply to privately funded services
or if it was limited to Medicaid-funded care.
Representative Prax responded that the bill applied only to
Medicaid-funded services. However, he thought it was
reasonable to expect that clearly defined Medicaid
standards might extend to other types of care, including
private services. He reiterated that the bill specifically
applied to Medicaid-funded care.
Representative Johnson noted that she had looked into the
matter years ago and found the lack of standards for
privately funded care to be a challenge. She noted that
there had been no clear route to implementing standards
because the program had not been state-funded. She asked
whether a department representative might be able to
clarify further.
Representative Prax responded that the bill would likely
lead to more standardized care due to the clearer
definitions provided for Medicaid services. He noted that
some individuals accessed services through long-term care
insurance, which was often unaffordable. He stated that
many people were ineligible for Medicaid and lacked long-
term care insurance. The bill did not directly address the
gap but might eventually benefit individuals who were
ineligible for Medicaid.
Representative Johnson thought that the issue deserved
further examination. She stated that regardless of whether
care was funded by Medicaid or long-term care insurance,
the system lacked adequate review of how to ensure that in-
home care worked effectively. She emphasized the importance
of trained individuals being available to provide care, but
she acknowledged the need to start small before progressing
to broader reforms.
7:07:03 PM
Representative Bynum thought that the bill addressed a
genuine need and that the investment would result in a
return. He expressed confidence that Representative Prax
had thoroughly researched the issue. He asked what would
happen if the bill passed but the positions outlined in the
fiscal note were not filled. He asked how it would affect
the state's ability to implement the bill.
Representative Prax responded that if the bill were not
funded in the current fiscal year, it would delay the
development of regulations. He added that the impact would
depend on the timing and content of forthcoming federal
regulations. He stated that the delay could hinder efforts
to comply with expected federal requirements.
Representative Bynum asked if DOH could shift its
priorities to implement the bill in the event of a budget
shortfall. He thought the bill should be a high priority.
He acknowledged the state's tight budget and remarked that
departments often reprioritized when presenting fiscal
notes.
Representative Prax suggested that Mr. Newman respond to
the question.
Mr. Newman responded that a new federal rule called the
Medicaid Ensuring Access Rule required the state to
establish an advisory board similar to the one proposed in
the bill. The rule also mandated that by 2030, personal
care workers and other home health care workers receive 80
percent of the Medicaid rate paid to agencies providing the
services. He noted that the advisory board would need to be
established by July of 2026. If the bill did not pass and
the department could not hire the necessary staff, the
department would still try to establish the board in time
to meet the federal requirement. He relayed that additional
guidance from the federal government on how to implement
the various provisions of the rule was anticipated to be
forthcoming. He added that immediate efforts would focus on
establishing the advisory board and that the 80 percent
reimbursement rule would be phased in by 2030.
Representative Galvin noted that the bill proposed a 70
percent reimbursement but the federal requirement was 80
percent. She asked if the intent was to move gradually
toward the federal standard.
Mr. Newman responded that the bill included a phased
approach, with a 70 percent benchmark by 2026 and an 80
percent benchmark by 2036. He noted that the federal
government currently required 80 percent by 2030, but the
bill allowed for a longer implementation period.
7:12:18 PM
Co-Chair Foster invited Representative Prax to make closing
comments.
Representative Prax reiterated that the bill represented a
worthwhile effort, and he thought there would be financial
benefits to the state. He acknowledged that it was
difficult to make definitive predictions but there appeared
to be significant space between the level of service
offered by personal care services and that of skilled
nursing facilities. He asserted that if the bill succeeded
in increasing the supply of personal care services, there
would be a net savings to the state due to a reduced
reliance on more expensive skilled nursing care.
Representative Prax clarified that the bill aimed to
support appropriately skilled workers. He relayed that the
bill did not require personal care workers to be licensed
practical nurses or have comparable qualifications. He
emphasized that the goal was to deliver effective and
appropriate services. The bill would improve service
delivery, especially in rural areas, and generate long-term
cost savings.
Co-Chair Foster announced that the amendment deadline for
HB 96 was Saturday, May 17, 2025, at 5:00 p.m. He noted
that there could be some flexibility with the deadline.
HB 96 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster reviewed the meeting agenda for the
following day.