Legislature(2015 - 2016)HOUSE FINANCE 519
01/27/2016 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Fy 17 Budget Overview: Alaska Mental Health Trust Authority | |
| Fy 17 Budget Overview: Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 256 | TELECONFERENCED | |
| += | HB 257 | TELECONFERENCED | |
| += | HB 255 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HOUSE FINANCE COMMITTEE
January 27, 2016
1:32 p.m.
1:32:00 PM
CALL TO ORDER
Co-Chair Neuman called the House Finance Committee meeting
to order at 1:32 p.m.
MEMBERS PRESENT
Representative Mark Neuman, Co-Chair
Representative Steve Thompson, Co-Chair
Representative Dan Saddler, Vice-Chair
Representative Bryce Edgmon
Representative Les Gara
Representative Lynn Gattis
Representative David Guttenberg
Representative Scott Kawasaki
Representative Cathy Munoz
Representative Lance Pruitt
Representative Tammie Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Russ Webb, Chair, Board of Directors, Alaska Mental Health
Trust Authority; Jeff Jessee, Chief Executive Officer,
Alaska Mental Health Trust Authority; John Morrison,
Executive Director, Trust Land Office; Valerie Davidson,
Commissioner, Department of Health and Social Services;
Sana Efird, Assistant Commissioner, Department of Health
and Social Services.
SUMMARY
FY 17 BUDGET OVERVIEWS:
ALASKA MENTAL HEALTH TRUST AUTHORITY
DEPARTMENT OF HEALTH AND SOCIAL SERVICES
Co-Chair Neuman discussed the meeting agenda.
^FY 17 BUDGET OVERVIEW: ALASKA MENTAL HEALTH TRUST
AUTHORITY
1:32:43 PM
RUSS WEBB, CHAIR, BOARD OF DIRECTORS, ALASKA MENTAL HEALTH
TRUST AUTHORITY (AMHTA), introduced other AMHTA directors.
He relayed that he was pleased to present to the committee
in his role and he believed the trust was a great
organization. He added that he would be much more pleased
if the price of oil was high. However, he did recall that
when he had been the deputy commissioner of the Department
of Health and Social Services, oil had been under $20 per
barrel, but there had been a lot of it. He provided a
PowerPoint presentation titled "House Finance Committee"
dated January 27, 2016 (copy on file). He introduced his
colleagues (listed on slide 2):
Trustees
· Russ Webb, chair
· Mary Jane Michael, vice chair
· Larry Norene, secretary
· Laraine Derr
· Paula Easley
· Carlton Smith
Mr. Webb acknowledged AMHTA's new trustee Jerome Selby. He
provided background information about Mr. Selby.
Additionally, he introduced executive directors of the
trust's advisory boards that included the Advisory Board on
Alcoholism and Drug Abuse, the Alaska Commission on Aging,
and the Governor's Council on Disabilities and Special
Education. He turned to slide 3 titled "Trust
Beneficiaries":
Approximate Number of Trust Beneficiaries
Mental Illness: 34,000
Developmental Disabilities: 13,000
Chronic Alcoholism/Substance-Related Disorders: 20,000
Alzheimer's disease and related dementias: 6,000
Traumatic Brain Injury: 11,000
Mr. Webb added that the number of individuals with
Alzheimer's and related dementia was probably growing
quickly.
Representative Gattis asked if the categories on slide 3
overlapped. She asked how many people the trust was
actually serving.
Mr. Webb answered that the figures (on slide 3) were an
estimate of the number of beneficiaries in the population.
He detailed that each of the programs served a different
number. He agreed that many of the trust's beneficiaries
had co-occurring conditions, but he did not have a precise
number.
JEFF JESSEE, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH
TRUST AUTHORITY, agreed that the trust did not know exactly
how many people there were with co-occurring disorders, but
there was definitely overlap between the categories (on
slide 3).
Representative Gattis asked if any of the numbers shown on
slide 3 were overlapping. She noted that the slide showed a
total of 84,000 individuals. She wondered if there could
possibly be far fewer individuals because they had co-
occurrences.
Mr. Jessee answered that there could be overlap, but it was
not substantial. He detailed that the numbers on slide 3
were categorized by the primary diagnosis. He continued
that it was synthetic national data and there was not a way
of actually counting beneficiaries in Alaska.
Representative Gattis would follow up on how the number had
been arrived upon.
Mr. Webb addressed slide 4 titled "Established Focus
Areas":
1. Disability Justice
2. Substance Abuse Prevention & Treatment
3. Beneficiary Employment & Engagement
4. Workforce Development
5. Housing and Long-term Services & Supports
1:39:13 PM
Co-Chair Neuman asked members to hold their questions until
after the presentation.
Co-Chair Thompson asked how many of the trust's
beneficiaries were currently incarcerated.
Mr. Webb replied that on any given day trust beneficiaries
could account for up to 65 percent of the correctional
population. Over the course of the year they accounted for
about 40 percent.
Mr. Jessee moved to slide 5 and discussed the trust's
current priorities to help the legislature build a
sustainable budget. The trust's beneficiaries were very
impacted by the legislature's action on the budget. He
stated that if the legislature could not build a
sustainable budget the trust's beneficiaries would not have
access to needed services. The two primary areas the trust
saw tremendous opportunity for savings and partnering with
the legislature were Medicaid redesign and justice
reinvestment. He elaborated that the trust believed the
areas were interrelated in a significant way. He pointed to
a bubble chart on slide 5 and indicated that behavioral
health system reform and Medicaid expansion provided a
significant opportunity from a programmatic and budget
standpoint to do the necessary redesign and reinvestment in
order to bring the budget areas under better control.
Mr. Webb addressed slide 6 titled "Why is the Trust so
Engaged with Medicaid Redesign?" He shared that when he had
worked for DHSS, the department had already begun - at
$8.00 per barrel oil - pursuing a strategy to refinance
services funded with General Funds (GF) only, with
Medicaid, in part to gain the benefit of the federal match
and cut down with GF costs. It was a strategy the state had
continued to pursue with what he believed was everyone's
blessing. He stated that systems serving trust
beneficiaries were currently funded primarily through
Medicaid. He furthered that Medicaid services represented
the largest portion of the trust's comprehensive integrated
mental health system of care. He stressed that AMHTA was
committed to the sustainability of the Medicaid program. He
emphasized that it had to be sustainable or services for
trust beneficiaries would fall apart. There were currently
opportunities, which had not existed when the department
had first begun Medicaid refinancing, to change the way
services were structured to obtain better outcomes. He
discussed that there were ways to gain greater federal
participation, which were part of the redesign process.
Mr. Webb stressed the importance of making Medicaid work.
He furthered that because of the way the federal program
was structured there were a number of things that had
prevented the state from making the best use of the
Medicaid funds. For example, when the state had refinanced
services with Medicaid some individuals became ineligible
in the behavioral health system. He detailed that there
were critical populations (i.e. young men at high risk for
involvement with criminal justice system), in many ways due
to substance abuse, traumatic brain injuries, and mental
illnesses, who could not access services because they could
not get through the Medicaid door; therefore, some of the
services had fallen off. He stressed that the state needed
to make the system work for getting the needed outcomes at
a sustainable level.
1:44:26 PM
Mr. Jessee addressed slide 7 titled "Medicaid Redesign":
· The Trust has invested over $600,000 this year on
various contracts to provide a strong base of
information and options to help the state make
strategic decisions regarding Medicaid redesign.
Mr. Jessee relayed that the trust understood that the
effort would be a long-term process. He added that the
department had already been in the process of looking at
reforms and other ways of transforming the state's Medicaid
system. He noted that the process would have to be
accelerated going forward. He furthered that the trust knew
it was a long haul, but it was used to that. He explained
that AMHTA bridged administrations and legislatures. For
example, the Bring the Kids Home program had been an eight-
year effort across three different administrations.
Mr. Jessee turned to slide 8 and addressed that funding had
been used for technical assistance contracts to look at
Medicaid reform from a national perspective. He elaborated
that AMHTA had retained the services of Charles Curie
(former director of the federal Substance Abuse and Mental
Health Services Administration under the [George W.] Bush
Administration) who had taken a particular interest in
Alaska and had spent time in its rural areas. He furthered
that Mr. Curie was currently a consultant for many states
going through Medicaid reform. Mr. Curie was consulting
with Alaska particularly in behavioral health areas to help
determine lessons the state could take from other states.
He noted that Mr. Curie had been very helpful to AMHTA and
DHSS.
1:46:36 PM
Mr. Jessee addressed slide 9 titled "Redesign...Now and in
the Future." He noted that just because the reforms were
under consideration did not mean they would all happen at
once. He read from the slide:
A number of reforms are already under consideration
· 1915 (i)/(k) state plan options for Home-and
Community-Based services
· Primary Care Access Initiative
· Behavioral Health Access Initiative
· Data Analytics/IT infrastructure
· Pilot Accountable Care Organizations
· Alternative Benefit Plans for Expansion Population
Mr. Jessee expounded that if services could be integrated
into primary care, recipients would get better service,
sooner, and at a lower cost. He stated that getting primary
care on board with AMHTA beneficiaries was a high priority.
He stressed that access to behavioral health services was a
problem. They could not throw money at the services;
therefore, it was necessary to determine how to increase
effectivity and efficiency. He stated that it would not
work if AMHTA could not collect and analyze data about the
reforms as they were taking place. He cited Bring the Kids
Home as an example and stated that nothing worked exactly
how it was drawn up on paper; it was necessary to keep
following and analyzing the data to make changes along the
way. He stated that looking at how the state could start
managing care would be critical to saving money. All of the
items listed on slide 9 were already under analysis. He
stated there were many more options. He relayed that the
multitude of moving parts was challenging. He pointed to
various forms of legislation and at least two major reports
currently before the legislature (slide 10). He continued
that somehow during the current session the items needed to
be included in a Medicaid reform bill. He stressed that
passing a bill was critical and AMHTA was willing to do
anything to help facilitate the process. He believed that
the Senate Finance Committee had appointed a subcommittee
to look at the different bills and reports to determine
putting legislation together.
Mr. Webb addressed slide 12 titled "Why is the Trust so
engaged with Justice Reinvestment?":
· Trust beneficiaries account for more than 40%
bookings and 40% of DOC population, each year
· For felony offenses, Trust beneficiaries remain in
jail twice as long as non-beneficiaries
· Recidivism rates are approximately twice as high for
Trust beneficiaries
Mr. Webb elaborated that in some institutions the number of
trust beneficiaries was as high as 75 percent. On any given
day, 65 percent of inmates were trust beneficiaries. He
believed that for misdemeanor offenses, trust beneficiaries
spent 2.5 times longer in jail than non-beneficiaries. He
referred to the governor's report on DOC related to deaths
that had occurred in DOC (some of whom were trust
beneficiaries). He explained that the victim and
perpetrator in most recent death in Anchorage were both
trust beneficiaries. He detailed that the victim had been
under an AS Title 47 hold - due to alcohol or mental
illness - and should not have been confined. The trust had
been working on getting services in place to prevent
individuals from getting into the criminal justice system;
and if obtained to be treated well and safe and to get out
as quickly as possible. He stressed the need for services
in the community in order to help individuals succeed and
stay out of prison. He emphasized that justice reinvestment
was critical to AMHTA.
1:51:56 PM
Mr. Jessee addressed how to keep beneficiaries from going
back to jail on slide 13. The slide illustrated the three-
legged stool model that included: housing, employment, and
support for recovery. He moved to slide 14 titled "Justice
Reinvestment":
There is a critical intersection between criminal
justice reform and Medicaid expansion and re-design in
re-establishing access to behavioral health services
for Trust beneficiaries at high risk of and with
involvement in the criminal justice system.
Mr. Jessee addressed some of the obvious savings. For
example, the state saved money when DOC sent an inmate to a
hospital to get them signed up for Medicaid in order for
the federal government to pay most of the bill instead of
using General Funds as it was currently doing. Many other
parts were dependent upon looking at Medicaid as a way of
funding many of the components. He furthered that DHSS was
being proactive in working with the federal government to
get some flexibility in the state's Medicaid program that
could really help related to justice reinvestment.
1:53:19 PM
Mr. Jessee addressed "What's Next?" on slide 15. He pointed
to a visionary moment a couple of years earlier in the
House Finance Committee where the co-chair [Co-Chair
Neuman] had placed intent language in the budget that
brought together the Alaska Housing Finance Corporation
(AHFC), the Department of Labor and Workforce Development,
and AMHTA to begin to address how to change the criminal
justice system. He stated that the recidivism reduction
plan had set the stage and started the momentum. He
highlighted that the collapse in the price of oil had made
recidivism reduction even more exigent. He addressed other
items on the slide:
· Recidivism Reduction Plan
· DOC -Prisoner Reentry Initiative (AK-PRI)
· Pew Public Safety Initiative, Justice Reinvestment
Project
· Criminal Justice Commission
· SB 91
· Alaska Justice Information Center
Mr. Jessee elaborated that he hoped a plan would
incorporate as many recommendations from SB 91 (sponsored
by Senator John Coghill) as possible. He addressed the
final point on slide 15 and relayed that the joint funding
of the Alaska Justice Information Center had come from the
House Finance Committee. He detailed that the center
allowed for the collection and analysis of the data about
the justice reforms in order to be data driven and
thoughtful as the system evolved. He explained that
Medicaid reform and justice reinvestment were integrally
related.
Mr. Jessee spoke to the trust's long-term funding strategy
on slide 16. He referred to talk he had heard from the
legislature about the trust's propensity to come up with
program ideas that used GF as a fund source, which created
a challenge. He agreed that the trust did do some of that,
which was one of the values of the trust; it was a venture
capital fund that allowed AMHTA to try some ideas to
determine what worked. He furthered that much of the
trust's funding also went to long-term ongoing projects. He
detailed that 39 percent of the trust's budget came through
the state budget in the form of Mental Health Trust
Authority Authorized Receipts (MHTAAR) and 25 percent came
from authority grants. Between the two, 65 percent of the
trust's budget was committed to long-term support of
programs. He explained that there was not just a focus on
the "next shiniest thing," but about supporting key parts
of the mental health program. The trust recognized that the
current year was a huge challenge for the budget. He
addressed FY 17 operating increments on slide 17. The
primary focus for the upcoming year was on information
technology and telehealth service system improvements. The
improvements were part of the effort to build a sustainable
budget by using IT and telemedicine to reduce costs. The
more the trust could do to serve people remotely would be a
big cost saver.
1:57:56 PM
Mr. Jessee addressed the FY 17 capital budget request on
slide 18. He explained that the capital budget was not the
normal bricks and mortar - most of the money was not for
constructing things. For example, many of the funds for the
Homeless Assistance Project and the Special Needs Housing
Grant were for ongoing operating, which were granted
annually for three-year periods. He stressed that it was
absolutely critical that the capital budget remain in the
budget because it accounted for a critical safety net for
the trust's most vulnerable beneficiaries. He turned to
slide 19 titled "Cash Assets at End of FY15." The pie chart
broke out the trusts cash assets, which totaled $550
million. He detailed that the total included a combination
of the original settlement, inflation proofing, Trust Land
Office contributions ($100 million), Trust Land Office real
estate acquisitions, unrealized appreciation, and budget
reserves (the most critical part of the trust's budget). He
explained that the budget reserves were needed for the
trust to continue to make a payout in times of recession.
Mr. Jessee relayed that the trust used a percentage of
market value (POMV) strategy rather than relying on income,
profit, or loss from year-to-year (slide 20). Currently the
POMV for the trust's payout was 4.25 percent. The FY 17
anticipated income was presented on slide 21. He detailed
that the payout equaled approximately $20 million. He
explained that the prior year's average lapse was
approximately $3 million. He noted that if an agency did
not use all of the money the trust had allocated, the funds
were deposited back into the fund and were available for
reallocation by the trustees in future years. The land
office average spendable income was over $4 million. The
average interest was $187,000 and total anticipated income
was almost $29 million per year.
Mr. Jessee turned to slide 22 titled "Payout History." The
chart illustrated that the payout had started at a fairly
low level, primarily because the budget reserve was built
up over time. As the reserve had grown and had been
inflation proofed, trustees had been able to increase the
payout. He pointed out that income had also increased over
time.
2:00:59 PM
Mr. Webb turned to slide 23 titled "Trust Land Office":
GOAL: Match or exceed spendable income generated by
cash investments
KEY STRATEGIES:
· Acquiring income-generating real estate
· Exploring and marketing mineral resources
· Land trade with Forest Service to increase
marketable timber
Mr. Webb stated that AMHTA understood that "we are all in
this together." The trustees recognized that it was their
responsibility to do everything possible to help generate
income that the trust could use to provide services,
supports, and venture capital for trust beneficiaries. He
highlighted that the trust had 1 million acres of land, but
half of the total only included subsurface rights. All of
the impediments that hindered development of the resource
base in Alaska applied to the trust just as they applied to
the private sector. He added that the trust faced some
additional challenges that the private sector did not
necessarily face. He discussed that the trust had a good
bit of principal and income generated by the Trust Land
Office. The trustees recognized that the trust had to do
more and had set an ambitious goal for the land office to
match or exceed spendable income generated by cash
investments (from non-cash investments). The trust had
asked John Morrison (executive director of the Trust Land
Office) to develop a plan to achieve the goal as quickly as
possible over time, with the recognition that it would not
occur over night. He noted that there would be interim
goals along the way to ensure progress was made.
JOHN MORRISON, EXECUTIVE DIRECTOR, TRUST LAND OFFICE,
highlighted slide 24 titled "Trust Land Office Annual
Revenue - FY1995-FY2015." The slide included a graph
representing the income the Trust Land Office had generated
since inception in 1995. He pointed out that in the 20
years the land office had generated $180 million in
principal and income revenue. The land office mission was
to maximize revenue for the trust; it made all of its
resources decisions in the best interest of the trust and
its beneficiaries. He shared that the office had taken on
the mantra to diversify, develop, and defend the trust
assets. He pointed to the left side of the graph (1995 to
2010) and noted that 2011 had been a pivotal year of
change. He noted that the various colors on the bars
represented income streams from different trust assets. He
detailed that pink and green represented land and timber
transactions, which were both non-repeatable events. The
transactions had been large cash contributions of mostly
principal that were available to be invested. However, he
noted that once the land had been sold or the timber had
been harvested it was gone. Beginning in 2010 and 2011 the
land office had taken on an active engagement to diversify
its income streams, specifically focusing on areas where it
could generate predictable and repeatable income revenue,
which was much more difficult to come by than one-time
infusions of principal from the sale of an asset. Over
time, the land office had developed from a typical land
office towards a sophisticated, fixed asset model manager.
2:05:35 PM
Mr. Morrison addressed a chart on slide 25 related to
changing timber revenue from FY 95 to FY 15. The darker
green portion of the chart represented timber revenue since
inception compared to all other revenue shown in light
green. The land office and been working with the U.S.
Forest Service for many years in Southeast Alaska to
exchange roughly 20,000 acres of trust land with 20,000
acres of forest service land across several communities.
Much of the land the land office wanted to exchange was
located in areas that were not as marketable as they would
like; the land office hoped to trade it for other land
including trees that would be marketable and harvestable.
In the future, the trust expected to come forward with
legislation to move the exchange forward. Additionally, the
land office could not focus on any one resource base. He
elaborated that at one point in time timber had provided
plenty of revenue, but those days were gone.
Mr. Morrison turned to a chart on slide 26 and addressed
revenues versus expenditures. The chart illustrated
principal revenue in blue and income revenue in green. He
pointed out that the income revenue was always above
operating expenses (shown in purple). The land office
strived to specifically provide more income revenue than
costs. He believed the land office was providing great
value to the trust in its responsible management of the
assets. He noted that the income revenue line was
directionally correct with a continuous increase over time.
2:08:11 PM
Mr. Webb thanked the committee for its time.
Co-Chair Neuman noted that in the past there had been
discussion on how treatment after arrest would impact
recidivism. He asked for Mr. Jessee's thoughts on the
issue.
Mr. Jessee replied that a huge percentage of the state's
jail population were pretrial individuals. He explained
that most of the crimes were associated with substance
abuse. He stated that if treatment could be delivered to
the individuals at the point of entry into prison - when
many of the individuals were highly motivated to get out of
trouble by getting sober - it would be a huge piece of the
long-term strategy to bring budgetary stability to the
criminal justice system. He emphasized that the more the
state could do to provide access to treatment before
individuals even went to trial, would be a huge step
forward. Currently there was not capacity to deliver
treatment even to individuals who wanted the services.
Co-Chair Neuman remarked on Mr. Jessee's earlier testimony
that the first thing they were trying to develop was a
recidivism reduction plan, which had been followed with
work by Pew and beneficiaries' recommendations. He surmised
that the next step would be to work towards allowing
treatment after arrest. He stated that in many cases it
took two years before a person was sentenced. He remarked
that the goal was to provide people with opportunities to
access treatment.
Mr. Jessee agreed.
Vice-Chair Saddler wondered how many beneficiaries knew
they were beneficiaries. Mr. Webb answered that individuals
receiving services knew they were beneficiaries. He did not
have specific numbers for each of the various programs, but
could work with DHSS to get the information to the
committee. He believed there were many individuals who were
either undiagnosed and did not know or who may be diagnosed
but may not be aware they were a trust beneficiary. He did
not know how to count that.
2:11:12 PM
Representative Gattis referred to a person who had been in
Goose Creek Correctional Center who had been released from
prison in the past month. She elaborated that he was a
military veteran with post-traumatic stress disorder. The
individual had been fearful about leaving jail because he
knew that without treatment he would probably reoffend. The
individual had begged to receive treatment. She stated that
it had been very difficult to figure out how to gain access
to services. She emphasized the importance of improving the
system.
Representative Gara referred to a discrepancy between the
number of people needing treatment and the available
treatment. He believed there was a growing recognition in
the legislature that the situation did not provide a cost
savings. He wondered if there was a measurement on what the
state and private sector would need to do to raise the
level of available treatment to match the level of those
needing it. He spoke specifically to heroin addiction and
noted that many communities did not have the treatment
available. He furthered that when individuals did not have
access to treatment they committed felonies and made drug
dealers more powerful. He asked about the specific
treatment lag related to heroin abuse.
Mr. Jessee answered that there was not an effective system
to determine the overall unmet need. Many agencies did not
keep a waitlist; therefore, it was not possible to track
the number of people who had asked for services. He knew
the lag was substantial, because they knew of many
individuals who had sought treatment but had not received
access. The key was to find the most efficient way to
provide access to treatment, which was the reason they were
looking at primary care, a funding mechanism, and some
cost-effective systems that were not just stand alone silo
programs. He stated that Medicaid expansion was a huge
piece of the picture. He remarked that Medicaid expansion
would apply to single individuals between the ages of 18
and 65 who did not have much money. He remarked that the
cohort sounded like many of the individuals coming out of
prison. He relayed that thousands of the individuals would
be eligible for Medicaid under expansion. He addressed the
heroin issue and stated that it was getting worse every
day. He believed there was work to be done along the entire
continuum, beginning with physicians and how they prescribe
opioids. More importantly, was how physicians worked with
their patients to get them successfully off opioids. He
stated that even the treatment community was chasing the
capacity issue.
2:15:54 PM
Representative Gara addressed the lands issue. He stated
that he was not a big fan of giving the Trust Land Office
the most controversial lands to make money off of. He spoke
specifically to the Chuitna Mine, which was now in the
hands of the land office. He stated that many people knew
the pros and cons of the specific project. He spoke to the
litigation and permitting costs in defending opposition to
the mine from fishermen and village residents. He asked if
the land office paying for the litigation or if it was
funded by the Department of Natural Resources.
Mr. Morrison answered that as the land holder, the trust
had a lessee pursuing the mine. If the land office was a
party to the lawsuit it would bear the cost, otherwise it
was not the land office's responsibility. He added that the
land office was only the land owner and not a permitting
agency.
Representative Gara asked if the Chuitna Mine had cost the
land office money. Mr. Morrison replied in the affirmative.
He detailed that there had been some significant costs to
the land office pertaining to staff time and resources, in
addition to interaction with the attorney general's office.
Representative Kawasaki thanked Mr. Jessee for serving on
the Criminal Justice Commission and remarked on the
importance of seeing the value in the continuum. He noted
there were numerous criminal justice reforms coming through
in tandem partly due to a rising corrections budget
including options such as supervised release. He asked if
the trust would be prepared for individuals coming out of
the prison system. He wondered how to prevent recidivism
once the individuals were out.
Mr. Jessee answered that the trust and the departments had
been working hard on the issue in a collaborative way. He
spoke to the positive working relationship between the
current [DHSS] department and other agencies. He noted that
recently the commission had been lamenting that DHSS did
not have a seat on the commission. He spoke to the
importance of the relationship and collaboration between
the different involved agencies. He stressed the importance
of getting something done.
Representative Kawasaki asked whether Mr. Jessee believed
that if the bills including sentencing reform and
supervised release pass that DHSS and AMHTA would be able
to take up "that part, that sort of slack..."
Mr. Jessee answered that a Medicaid reform bill also needed
to be passed.
2:20:10 PM
Representative Kawasaki asked for an explanation of income
generating real estate (slide 23) related to the Trust Land
Office. He asked if it was in-state housing or out-of-state
acquisitions.
Mr. Morrison answered that the land office's income
generating real estate was solely focused on out-of-state
acquisitions of a variety of different real estate.
Co-Chair Neuman asked Mr. Morrison for a report on the land
office's total land, leases, land for sale, and other in
order to learn how the office operated. He asked for a
report on the Chuitna Mine project and the associated
costs.
Representative Edgmon commended the presenters for
providing a presentation focused on sustainable budgeting.
He remarked that three-quarters of the state's inmates were
in the non-violent category. He asked about the 60 percent
portion of the prison population with mental illness. He
queried what portion of the non-violent offenders struggled
with mental illness.
Mr. Webb answered that the commission had a report done
related to inmate information and they would provide it to
the committee. He did not recall the percentage or if the
data was broken out by violent versus non-violent
offenders. He recalled that it was primarily broken out
into misdemeanor versus felony cases. He shared that he had
been a probation officer in the past and his wife was
currently a district court judge who ran the mental health
court in Anchorage. He assured the committee that virtually
all individuals in the mental health court were trust
beneficiaries and many individuals in regular court
hearings were trust beneficiaries as well. He noted that
the vast majority of those offenders were non-violent. He
stated that there were non-violent offenders who were held
in corrections for lengthy time periods, sometimes awaiting
a competency evaluation. He elaborated that sometimes a
person was held longer in corrections awaiting an
evaluation than they would if they were actually sentenced.
He stated that it was a significant problem. He stated that
trust beneficiary felons spent twice as long in prison as
non-beneficiary felons, while trust beneficiary
misdemeanants spent 2.5 times as long in prison when
compared to non-beneficiary misdemeanants. He concluded
that it was a significant portion of the overall
corrections population and cost.
2:25:15 PM
Mr. Jessee added that a large number of the non-violent
offenders were in prison for drug or alcohol offences. He
stated that the country had learned the hard way that it
was not possible to imprison its way to solving the
addition problem and the war on drugs. Additionally, it was
very expensive. He stated that there were a significant
number of people in prison for non-violent offences who
were addicts and that prison was not helping them.
Representative Edgmon noted that Mr. Jessee had placed
emphasis on Medicaid expansion and its value to AMHTA. He
asked about the trust's reach to beneficiaries and how
expansion would allow services to stretch.
Mr. Jessee answered that individuals who were now eligible
had been unresourced [prior to Medicaid expansion]. He
detailed that individuals going to a mental health center
or substance abuse treatment provider were often told by
providers that they only received a certain amount of grant
money, lost money on every Medicaid person they served, and
had to use some of their grant money to subsidize the low
Medicaid reimbursement rate. He questioned how many totally
unresourced individuals could be brought into service - the
answer was not very many. He furthered that by increasing
eligibility for what amounted to health insurance allowed
providers to have a payment source to begin to build the
capacity needed to serve people. He spoke to criminal
justice reform and discussed that many individuals were in
jail due to substance abuse issues. He discussed that DOC
had begun to rebuild its treatment programs for individuals
in prison, but if there was no support for recovery upon
release from prison, the individuals would go back to
prison. He stated that overlaying the Medicaid expansion
population with the individuals coming out of prison
indicated that it was the same group. He added that it was
the group the state had to resource in order to have the
capacity to do justice reinvestment.
2:28:13 PM
Representative Wilson spoke about the timing of
assessments. She wondered how much the state was spending
on assessments (down the line versus pretrial) and whether
there was follow up to determine whether treatment was
received. She was interested to know how many more
assessments would be needed in pretrial. She wondered about
current treatment in jails. She knew there was very little
treatment offered in Fairbanks jails. She wondered if
individuals going through treatment received a certificate
or other. She wondered how many of the trust clients were
"mixed up" in the Office of Children's Services (OCS)
process. She guessed that the figure exceeded 80 percent.
She believed an area that was not discussed frequently was
whether a person received appropriate treatment or merely
treatment that enabled the state to check a box that
treatment had occurred. She wondered if there was anyone
following up with the clientele, she did not believe so.
She discussed the state tearing families apart and the
difficulty of putting them back together. She needed help
to understand how AMHTA worked with that population, which
was also competing for a limited amount of mental health
treatment services. She reasoned that unless someone was
keeping track, it would be very difficult to determine
where the funds needed to go. She continued that it had
nothing to do with Medicaid expansion; the group currently
qualified for Medicaid. She wondered if AMHTA had looked at
the specific population.
Mr. Webb replied that he had been a child protection social
worker in the past. He affirmed that when AMHTA had looked
at its cases, approximately 80 percent involved substance
abuse on the part of the parent or caretaker. He stated
that children's mental health was covered with Medicaid;
many, but not all parents had Medicaid coverage. He
stressed that the capacity issue was the big problem. He
questioned whether there was capacity to provide
appropriate treatment for parents when it was needed and
whether the individuals would accept the treatment. He
relayed that he had learned from his past experience that
the state did not have the capacity. He did not know the
current figure related to kids placed in out-of-home care.
He stated that it used to be much too long; it was also
expensive. He agreed with statements made by Representative
Wilson. Many of the children ended up in the juvenile
justice system and later the adult criminal justice system.
He had personally witnessed the situation from a child's
early formative years, through the juvenile justice system,
and on to the criminal justice system. He emphasized that
it was a common occurrence.
2:33:20 PM
Representative Wilson remarked that the state spent a lot
of money on parents in court when nothing was truly
happening. She did not believe the money was spent in an
intelligent way. She stated that the parents did not have
an advocate. She stressed that it was the Office of
Children's Services, not parents' services. She believed it
was time to place more focus on the parents, who she
believed were doing their best. She stated that if the
money currently being spent could be channeled to the right
places, it could stop the current trend, and the state
would win in many areas. She understood that AMHTA had a
full plate, but she hoped the issue was on its radar.
Mr. Webb answered that the issue was on AMHTA's radar.
Representative Munoz referred to Mr. Webb's testimony about
a case in Anchorage where a person had been murdered in
prison. She shared that she had grown up with the
individual in Juneau. She detailed that a number of
failures had occurred consecutively with the man's case.
She made corrections related to the situation. She
explained that he should have never been held in prison.
She furthered that he had been picked up for loitering and
had been held in prison for two weeks before his legal
guardian was contacted; he had been murdered in jail the
following day. Prior to the arrest, he had been living in
stable housing until the State of Alaska had shut down the
group home where he had lived. The state had failed to
follow him into a new housing placement. She spoke to the
importance of follow through.
Mr. Webb replied that both the victim and perpetrator had
been through his wife's mental health court. His wife had
been the judge who had ordered the competency evaluation of
the perpetrator. He stated that the case had been
heartbreaking. He spoke to system failures and relayed that
both the victim and perpetrator had been in jail because
they had both lost housing.
2:37:14 PM
Representative Guttenberg believed the trust's work was
going down a positive path and was providing the state with
tools for improvement. He wondered about the optimum place
to provide treatment in one place in order to prevent
something negative from happening. He wondered how many
people the state could keep out of jail by giving a certain
number of treatments in order to prevent fewer people from
going to jail and to decrease violence. He wondered if
there was an optimal number related to treatment. He asked
if there was a program indicating that the state was moving
in the right direction. He reasoned that at some point when
funds to corrections were cut, negative things happened in
other areas.
Mr. Webb answered that he did not believe such a report
existed. He spoke to the importance of the question. He
stated that everything is a balance. He furthered that the
state was balancing public safety with the cost of creating
public safety. Over the years the state had put all of its
"eggs in the basket" of confinement and punishment to
achieve public safety. He discussed that government was
risk adverse; it was hard to take a chance and it was much
easier for district attorneys to recommend the harshest
penalty, be tough on crime, and recommend no bail because
it protected the attorney for acting in the interest of
public safety. He relayed that the goal was to get smarter
in how the state did business by assessing actual risk that
people present. There were tools available to assess and
mitigate risk. He did not know if an absolute cost could be
placed on achieving the balance, but he was happy for the
trust to look into the issue. He relayed that other states
(e.g. Texas) had undertaken similar system reforms.
Mr. Jessee replied that there was no easy button. He stated
that the goal was to find the sweet spot where the
investment was bringing a desired return without throwing a
lot of money at the last piece. He used the Bring the Kids
Home program as an example. He detailed that there were
still 100 kids out-of-state because the cost for developing
services in Alaska for the specialized population was
prohibitive. He communicated that the state would be
looking for the same sweet spot in the justice system
reforms as well. He referred to Medicaid fraud and the
associated costs. He stated that it was possible to spend
$100 million and still not catch every fraudulent case. He
relayed that the state could not afford to provide
treatment to everyone, all of the time, at any time. He
addressed determining how much treatment to provide based
on a positive return on investment. He stated that it was
not a relevant question at the current stage because it was
too far off. He believed the time would come where the
state did get close enough to address the question. He
reasoned that if the state kept watching the data and
analyzing the results, he believed the state would know
when it reached the point of diminishing returns.
2:43:10 PM
Representative Guttenberg noted that many times it was
possible to see how treatment versus no treatment impacted
individuals by tracking two or three individuals. He spoke
to the difference in court time, jail time, and the re-
criminalization process. He was aware there was no sweet
spot or easy answer. However, the more examples provided
would help the legislature to focus on making the right
decisions.
Co-Chair Neuman stated that the legislature and Congress
funded behavioral health programs for substance abuse
treatment. He opined that the problem was getting the money
to the street. He stated there were behavioral health
programs that did not apply for grants due to the
cumbersome amount of associated paperwork needed for
compliance. He wondered if the flow of funds to clients was
impeded due to too much regulation.
Mr. Jessee replied in the affirmative. He agreed that
accountability was needed, but people needed to be able to
do their jobs to achieve desired outcomes instead of
spending too much time on paperwork. The department had
asked Tom Chard with the Behavioral Health Association and
Kate Burkhart with the mental health and alcohol boards to
look at the issue and they had come up with a good list of
recommendations for some changes. He was not certain about
the current status of the department's process. He relayed
that it would be a piece of the behavioral health redesign
within the larger Medicaid redesign. He questioned how to
find the sweet spot for accountability without impeding the
outcome that was trying to be achieved. He stated that
having a willing partner at the department was a huge piece
of the puzzle that had not always been available.
Co-Chair Neuman thanked the presenters and stated that
AMHTA provided significant and respected work.
AT EASE
2:47:19 PM
RECONVENED
2:53:03 PM
^FY 17 BUDGET OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL
SERVICES
2:53:15 PM
VALERIE DAVIDSON, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES (DHSS), provided a PowerPoint presentation
titled "Department of Health and Social Services, House
Finance, FY2017 Department Overview" dated January 27, 2016
(copy on file). She expressed appreciation for the
opportunity to present the department's overview in
furtherance of their mission to promote and protect the
health and wellbeing of Alaskans. She indicated that
additional detail would be provided by the department's
divisions during the budget subcommittee process. She
introduced various colleagues within DHSS.
2:55:26 PM
Commissioner Davidson addressed slides 3 through 6 that
included detail on the department's eight divisions and
their directors. The Alaska Pioneer Homes was run by Vickie
Wilson and its mission was to provide the highest quality
of life in a safe home environment for older Alaskans and
veterans. The Division of Behavioral Health acting director
was Randall Burns and the division's mission was to manage
an integrated and comprehensive behavioral health system
based on sound policy, effective practices, and
partnerships. The Office of Children's Services was
directed by Christy Lawton and the mission was to prevent
and respond to child maltreatment in order to ensure safe
children and strong families. The Division of Health Care
Services was directed by Margaret Brodie and their mission
was to manage healthcare coverage for Alaskans in need. The
Division of Juvenile Justice was run by Rob Wood and the
division's mission was to hold juvenile offenders
accountable for their behavior, promote the safety and
restoration of victims and communities, and assist
offenders and their families in developing skills to
prevent crime. The Division of Public Assistance was
directed by Sean O'Brien and aimed to provide self-
sufficiency and basic living expenses to Alaskans in need.
The Division of Public Health was directed by Dr. Jay
Butler and worked to protect and promote the health of
Alaskans. The Division of Senior and Disabilities Services
was run by Duane Mayes and its mission was to promote the
independence of Alaskan seniors and persons with physical
and developmental disabilities.
2:57:27 PM
Co-Chair Neuman asked Commissioner Davidson to return to
slide 3 and review numbers on the slides.
Commissioner Davidson returned to slide 3 and detailed that
the Alaska Pioneer Homes represented about 2.3 percent ($62
million total including $32 million in undesignated general
funds (UGF)) of the department's FY 16 operating budget.
Co-Chair Neuman spoke to the state's aging senior
population, the waiting list to get into the Pioneer Homes,
and the increase in the cost in medical services. He asked
if there was an expectation that the cost to operate the
Pioneer Homes would increase.
Commissioner Davidson answered that there had been an
increasing level of acuity in Pioneer Homes' residents. She
detailed that in the past some of the residents had only
required Level 1 services (a low number of services).
Presently the facilities were seeing an increased need for
services (Levels 2 and 3). She furthered that because the
state did not have many other providers offering
Alzheimer's related services, the Pioneer Homes had become
the default treatment centers in the state.
Co-Chair Neuman remarked that individuals had the
opportunity to stay in the Pioneer Home as their health
deteriorated (based on income). He believed the cost for
Level 3 services was $7,000 to $8,000 per resident per
month, which was almost completely covered by the state.
Commissioner Davidson replied that the department could
provide the committee with a more detailed breakdown of the
costs for each level of care at a later time. She affirmed
that the higher levels of care were more expensive. She
explained that typically Level 1 residents may be in the
home because they had a spouse in the facility who required
Level 2 or 3 services.
Representative Wilson stated that numbers were needed to
understand how many people the Pioneer Homes were serving
in each of the three service levels.
Commissioner Davidson replied that the department typically
provided the information when the divisions did their
detailed presentations, but she would add it to the list.
Commissioner Davidson addressed Health Care Services on
slide 4. The division administrative portion accounted for
$22 million of the total DHSS operating budget including
$8.6 million in UGF. She noted that the figures did not
include Medicaid payments. The Division of Juvenile Justice
accounted for $60.3 million ($56.2 million UGF) or 2.2
percent of the department's total operating budget.
Representative Gara asked about slide 4 related to the
Office of Children's Services (OCS). He believed the
division's mission should be [to ensure] safe and
successful children. He felt that sometimes after a
response to a crisis there was not the necessary follow
through to help a child succeed. He noted that OCS did work
on many things, but he observed that a goal for successful
children was left out of the mission.
3:03:23 PM
Commissioner Davidson thanked Representative Gara for his
comments. She addressed slide 4 and relayed that the Office
of Children's Services accounted for $151.4 million ($87.4
million UGF) or 5.5 percent of the department's total
operating budget. She moved to slide 5 and addressed the
Division of Public Assistance budget of $313.7 million
($147 million UGF) or 11.4 percent of the DHSS operating
budget. She noted that many of the programs were federal
pass through programs. She moved to the Division of Public
Health, which represented $134.7 million ($49.6 million
UGF) or 5 percent of the department's operating budget
(slide 6). Senior and Disabilities Services represented
about 2.7 percent of the budget or $73.5 million ($48.6
million UGF).
Commissioner Davidson turned to slide 7 and addressed the
department's service population. The chart listed the
department's three primary priorities including health and
wellness across the lifespan; health care access delivery
and value; and safe and responsible individuals, family,
and communities. She pointed to the bottom of the chart
indicating that the department served Alaskans from
prenatal to death (including burial assistance).
3:06:11 PM
SANA EFIRD, ASSISTANT COMMISSIONER, FINANCE and MANAGEMENT
SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
addressed slide 8 that illustrated the process the
department had undergone to examine the activities under
the divisions to determine how the programs fit within the
department's identified mission. The chart broke the
department into priority, core services, divisions and
funding sources for each. She explained that each tear drop
illustrated on the chart represented the divisions and how
their budget aligned to each of the core services. Slide 9
included a comparison between total budgets for FY 15 and
FY 16; in total the department's budget had decreased $75.3
million. She noted that the slide also illustrated how the
total funds were allocated between the department's three
priorities.
Ms. Efird turned to slide 10, which illustrated the journey
the department had been on in the past year. She discussed
that DHSS originally focused on ensuring that all of the
pieces of the division's programs and activities aligned to
help achieve the department's mission, priorities, and core
services. The next piece was related to establishing the
department measurements that would roll up into its
objectives, core services, and priorities in order to
provide a snapshot of the department's performance. The
chart was the first step towards identifying the
information. She explained that the illustrations had been
created by utilizing inexpensive software to collect
information to visually show where the department stood on
its performance measures toward its priorities and core
services. The left hand side of the chart included three
dashboards representing the department's three priorities
(health and wellness across the lifespan; health care
access delivery and value; and safe and responsible
individuals, family, and communities). Each dashboard
included red, yellow, and green with a level marker
indicating the department's performance in each priority.
The core service fed into the dashboards, which also showed
objectives. Other charts on the slide showed which
measurements fed into each of the dashboards to determine
what was shown on the priority dashboard.
3:10:55 PM
Co-Chair Neuman asked for verification that the department
was judging itself based on the priorities. Ms. Efird
replied in the affirmative. She clarified that the
information shown on slide 10 pertained to the department
as a whole. She explained that each of the divisions would
extract some of their key measurements and performance to
show the committee. She furthered that the dashboards
represented another tool to measure the department's
success in working towards aligning its budget and spending
funds on items to achieve its priorities. The department
was still working to determine where it could pull
information from that showed outcomes instead of only
focusing on the number of people coming through the door.
Vice-Chair Saddler asked where the results-based budgeting
had helped the department better manage its priorities and
budget. He referred to the dashboard illustrations (slides
10 and 11) and asked for verification that green was good,
yellow indicated that improvement was needed, and red was
unacceptable.
Ms. Efird replied in the affirmative. She elaborated that
it was the department's first attempt without spending
significant money on a software program that would help
DHSS have a point of collection for department measures.
She furthered that the information was not as sophisticated
as they would like because it did not necessarily measure
the balance of efficiencies and funds; however, it was a
starting place. She addressed what the performance-based
model had done for the department. She stated that the
model had given DHSS a platform to speak from in one voice.
She discussed that they were working to illustrate to each
of the divisions how their work contributed to achieving
the department's priorities. She furthered that the model
had created a cross-divisional conversation to determine
any duplications and to look at ways to support and
leverage programs. The department was also starting to
collect information on how all of the various pieces fit
together to achieve the department goals.
3:14:15 PM
Commissioner Davidson addressed FY 16 highlights of budget
changes on slide 13. She began with updated information on
the status of Medicaid expansion. Through the end of
December [2015], 7,957 Alaskans had been enrolled through
expansion. As predicted, more men than women had enrolled
(approximately 4,267 men and 3,690 women). Total claims
paid through December were about $21.6 million (100 percent
federal receipts). She relayed that the department did
expect the number to increase. She explained that under
federal Medicaid rules there was a one year timely filing
limit. She expounded that providers offering services to
Medicaid beneficiaries had up one year to bill for services
provided. She shared that the information would be posted
on the DHSS website in order to provide transparency and
better information to the public about Medicaid
beneficiaries including where they lived, services
accessed, and other.
Commissioner Davidson discussed that the way Medicaid
beneficiaries were counted could be difficult to manage.
She explained that people went on and off of Medicaid
constantly throughout the year. For example, a person may
get a job and may no longer qualify for Medicaid or a
person may lose a job and suddenly qualify for Medicaid.
She furthered that at the end of the year the department
could look at how many unduplicated Alaskans had been
covered by Medicaid; it would typically be a higher number
(e.g. around 148,000 Alaskans). Whereas, at a point in time
the number may be lower. For example, in December there had
been 129,366 Alaskans enrolled in Medicaid including the
expansion population. The largest Medicaid population was
in Anchorage and Mat-Su, followed by the Interior,
Southwest, Gulf Coast, Southeast, and Northern Alaska. She
reiterated that the information would be posted on the DHSS
website. Children accounted for the majority of the
Medicaid beneficiary population at 54 percent, with an
additional 2 percent experiencing disabling conditions.
Currently (under expansion) seniors accounted for 6 percent
of the Medicaid population, 21 percent were parent
caretakers, and 11 percent were adults with disabling
conditions. She added that the information would be updated
monthly on the department's website.
3:17:45 PM
Commissioner Davidson continued to address points on slide
13. She addressed the Alaska Pioneer Homes rate increase to
8.5 percent scheduled to take effect February 1, 2016. She
detailed that it was the first time the rate had been
increased in many years. Additionally, there was a request
for letters of interest to the public inquiring whether any
organizations or companies were interested in taking over
the management and operations of Pioneer Homes. The
department would report back to the legislature about what
kind of interest it received. She addressed the third
bullet point on slide 13 related to the reprogramming of
the Ketchikan Youth Facility. The department recognized
that the state did not have sufficient treatment
facilities, especially for adolescents. She expounded that
DHSS was currently pursuing an opportunity with the Centers
for Medicare and Medicaid Services (CMS) to redesign and
reprogram the Ketchikan facility in order to provide more
intensive services to youth throughout the state. She
explained that the youths requiring detention would be
transferred to the facility in Juneau.
Co-Chair Neuman thanked the department for looking into the
privatization of Pioneer Homes. He remarked that he and
Commissioner Davidson had discussed juvenile justice
centers in the past and where there had been a movement to
try to move more civil cases over to tribal entities. He
asked for an update.
Commissioner Davidson replied that the conversations with
tribal organizations continued, but were in very
preliminary stages. She referred to legislation offered by
Senator Pete Kelly (SB 74) that included a directive to
DHSS to explore privatizations of the Division of Juvenile
Justice facilities. She relayed that the Norton Sound
Health Corporation had expressed interest in the operation
of the facility in Nome. The department had the opportunity
to realize the savings for 100 percent federal match. She
explained that when an Indian Health Services beneficiary
who was also eligible for Medicaid received their care
through an IHS facility, the services were considered 100
percent federal match. She shared that the previous year
stated that the preceding year Governor Bill Walker had
sent a letter to Secretary Sylvia Burwell [Secretary to the
U.S. Department of Health and Human Services] inquiring
about 1115 waiver opportunities in order to position Alaska
to better partner with tribal health organizations to take
advantage of 100 percent federal match. The real challenge
had been to determine what was considered through an IHS
facility. Historically, CMS had specified that travel and
accommodation services were only covered at 50 percent and
services referred beyond the tribal health system's
capacity to provide the care were also not through an IHS
facility and were therefore only covered at 50 percent
federal match (slightly higher for children). The
administration had communicated that it would like to do an
1115 waiver that would allow 100 percent reimbursement for
travel and accommodation services because they felt it was
a critical access to care issue (the beneficiaries did not
have the access without the travel and accommodation
service). The administration had also said that if it was
beyond the tribal health system's capacity to provide a
service, which would require a patient to go to a non-
tribal hospital or facility, the patient should be
considered 100 percent federal match because they started
in a tribal health facility. She furthered that Secretary
Burwell had sent a letter to Governor Walker answering that
an 1115 waiver would not be the solution because it
required budget neutrality for the federal government.
Alternatively, Secretary Burwell had communicated that the
federal government would change national policy to be able
to accommodate the request, which would impact Alaska and
34 other states with a significant tribal presence. She
stressed that it was probably Alaska's biggest opportunity
for saving. Consequently, DHSS was continuing to negotiate
with CMS about the specifics. She relayed that DHSS would
do its best to determine if there was any opportunity to
retroactively apply the policy. She emphasized that it was
a tremendous opportunity for Alaska. She noted that South
Dakota was also aggressively pursuing the opportunity. The
state was fortunate that it had a great working
relationship with CMS. She shared that she had previously
worked for tribal health for 15 years and they had tried to
get the federal match the entire time she had been there.
3:25:02 PM
Ms. Efird addressed the reduction to the Senior Benefits
Program in FY 16 of approximately $2.6 million (slide 13).
She detailed that the program had three payment levels
(based on income levels): $125, $175, and $250. The
reduction would be taken to the highest income level
(lowest payment level) and would affect about 5,348
seniors.
Co-Chair Neuman asked for the cost per year. Ms. Efird
replied that the current Senior Benefits Program had about
$20 million for FY 17. There had been approximately $22.6
million prior to the reductions. She noted that the
governor had proposed the same number for FY 17.
Representative Guttenberg asked about the Pioneer Home rate
increase. He hoped it meant the Pioneer Homes could charge
more and get reimbursed more. He asked if there was any
impact on the residents.
Commissioner Davidson answered that DHSS would bill Pioneer
Home residents for the rate increase; it could be billed to
insurance, Medicaid, or self-pay. The Pioneer Homes had a
sliding fee scale for self-pay residents. She communicated
that residents would not be thrown out on the street.
Representative Gara asked for verification that people
using self-pay would pay the 8.5 percent increase.
Commissioner Davidson replied in the affirmative.
Commissioner Davidson thanked the committee for providing
funds for the additional positions for the Office of
Children's Services to address its increased utilization
for children needing out of home services. She detailed
that 13 of the positions had been filled and an additional
10 would be filled within the next 30 days. The remaining 3
positions would be filled within 60 days. Additionally, the
department had been able to transfer 2 other positions
interdepartmentally.
Co-Chair Neuman asked for verification that the department
had the funds in hand for the needs (e.g. office space,
computers, and other). Ms. Efird replied in the
affirmative.
Representative Wilson asked the department to follow up
with the number of positions filled with case workers
versus social workers. She asked where the positions were
located. She wondered how many families each case worker
was assigned to; she stated that many families had more
than one child that may be assigned to one caseworker. She
spoke to the reunification rate of children going back to
their parents. She had observed that most reunification had
been to parents or a family member, but she did not believe
placing a child with a family member qualified as
reunification.
3:29:34 PM
Co-Chair Thompson noted that the 26 positions had been
funded with federal money. He remarked that there had been
an indication that the money may not continue in the
future. He asked for an update.
Ms. Efird replied that there had been a number of different
changes throughout the budget process. She detailed that in
conversations with OCS and the Division of Public
Assistance, some Temporary Assistance for Needy Family
(TANF) funds had been identified, that could be used to
cover the child advocacy centers' funding from the
department. She furthered that General Funds to the
department had been cut, but had subsequently been added
back. There was a small amount of federal funding
associated with the positions that the department could
collect. The federal dollars that had been identified were
TANF funds that could now be used for the child advocacy
centers. The department did not anticipate that the funding
would be reduced in the next few years.
Representative Gara asked about the current number of
foster children in Alaska. He noted that the number had
risen to 2,500 from 1,700, but he believed the figure was
presently over 2,800. Commissioner Davidson replied that
there were currently over 2,800 foster children.
Co-Chair Thompson addressed the agenda for the following
day.
ADJOURNMENT
3:33:02 PM
The meeting was adjourned at 3:32 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| AMHTA Overview HFIN presentation .pdf |
HFIN 1/27/2016 1:30:00 PM |
|
| DHSS-HFIN Dept Overview FY2017- FINALa.pdf |
HFIN 1/27/2016 1:30:00 PM |
|
| DHSS LegLog 3589 DHSS HFIN Overview Responses.pdf |
HFIN 1/27/2016 1:30:00 PM |
|
| FY2016 Alignment Visual HSS_Funding Breakdown.pdf |
HFIN 1/27/2016 1:30:00 PM |
DHSS |