Legislature(2023 - 2024)BUTROVICH 205
04/04/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB106 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 106 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 106-HOME AND COMMUNITY-BASED WAIVER SERVICES
3:31:02 PM
CHAIR WILSON announced the consideration of SB 106 SENATE BILL
NO. 106 "An Act relating to home- and community-based services
under the medical assistance program; and providing for an
effective date."
He asked Senator Giessel to introduce the bull.
SENATOR KAUFMAN joined the committee.
3:31:33 PM
SENATOR GIESSEL, District E, speaking as the sponsor of SB 106,
highlighted the following points to introduce the legislation:
• Healthcare is most effectively and economically provided in
the home setting.
• People typically feel most at peace and calm in their own
homes, which is effective healthcare as it promotes the
body's defenses to be most functional and health-restoring.
• It is less expensive to stay in one's own home, rather than
an institution.
• The workforce in the healthcare industry is in short
supply.
• Medicaid emergency rules during the pandemic provided
reimbursement for family members providing these services.
• SB 106 would continue the financial reimbursement for
family members who provide services as a legally
responsible individual (LRI). The payments would be through
Medicaid.
• There would be requirements to assure the LRIs are
competent to provide the care.
• The emergency declaration related to the pandemic ends May
11. The Department of Health is asking the federal
government for an extension while it requests making the
program put forward in SB 106 permanent.
• If the extension isn't approved, LRIs will not be paid.
• If it were to pass, SB 106 would allow legally responsible
individuals to apply to a caregiving agency, where they
would be trained and employed through that agency while
providing care for their family.
• Enabling family caregivers to be paid for their services
can reduce financial strain, help alleviate stress, prevent
caregiver burnout, and promote better health outcomes for
both the caregiver and the patient.
• SB 106 can save the state money and improve the overall
quality of care for recipients of medical assistance by
reducing the need for institutional care. Alaskans will
receive better care.
• SB 106 would make a big difference in rural Alaska where
care from family is often the only option.
CHAIR WILSON asked Paige Brown to present the sectional
analysis.
3:35:33 PM
PAIGE BROWN, Staff, Senator Cathy Giessel, Alaska State
Legislature, presented the sectional analysis for SB 106:
Senate Bill 106 (Version B)
Sectional Analysis
Section 1. Amends AS. 47.07.045 and adds a new
subsection:
This allows the state to allow a legally
responsible individual to be paid to provide
personal care for a person who receives Medicaid
under the 1915(k) state plan option.
Section 2. Amends uncodified law by adding a new
section:
This allows the state to amend and submit Section
1 for federal approval of the revised state plan.
Section 3. Amends uncodified law by adding a new
section:
This legislation will only take effect if the
U.S. Department of Health and Human Services
approves the amendment submitted under Section 2.
If the federal government approves the amendment,
the commissioner of health shall notify the
revisor of statutes not less than 30 days after
receiving notice of the approval.
Section 4. Effective date conditional on approval by
federal government
Legislation would take effect on the 31st day
after the commissioner of health receives notice
of approval of the amendment in Section 1 from
the U.S. Department of Health and Human Services.
Section 5. Immediate effective date
3:36:54 PM
At ease.
3:37:19 PM
CHAIR WILSON reconvened the meeting and moved to invited
testimony on SB 106.
3:37:44 PM
ALEXIS RODICH, Director, Research and Policy, Service Employees
International Union 775, Washington D.C., testified by
invitation in support of SB 106. She spoke to the broader
benefits of allowing legally responsible family members to be
paid as personal care attendants. She stated that this would
help with the increasing workforce shortage by growing the pool
of potential caregivers. She reported that, per capita, Alaska
has the fastest-growing senior population in the US and one of
the highest rates of dementia in residents over age 65. The
workforce shortage makes it difficult for families to find the
right caregiver for their situation and for existing caregivers
to take needed time off. Rural Alaska in particular is affected
by the workforce shortage and in-home care is often the only
option. Alaskans who can't find care in their community are
forced to move, leaving behind their culture, family, and
community.
MS. RODICH stated that it makes good economic sense to allow
legally responsible individuals to become caregivers. She
reported that according to AARP, an estimated 85,000 Alaskans
provide unpaid care to a friend or family member which is
estimated to be worth $1.2 billion per year. Often, these unpaid
caregivers have had to reduce their paid work hours in jobs
outside the home or leave the workforce altogether. The result
is increased financial precarity for themselves and their family
which can create higher reliance on public assistance programs.
She pointed out that when family members are paid to be
caregivers, they have money to spend in the community which
stimulates the economy. Finally, the outcomes are more positive
when family members provide the care because there is more
familiarity and shared cultural values. She thanked the
committee for its support.
3:40:48 PM
VERONICA PAGE, representing self, Anchorage, Alaska, testified
by invitation in support of SB 106. She urged the committee to
support SB 106 to allow somebody to be paid for caring for a
member of their family permanently. She shared her personal
story of providing 24-hour care for her fiancé for the past 12
years. He was in a debilitating car accident just before their
wedding. They never got married because Alaska law prohibits
somebody from being paid to be a caregiver for a family member
and she had to work to keep a roof over their head. She opined
that Alaskans should have a choice. A person who wants to take
care of a family member should be paid for that work just as a
non-family member is paid. She urged the committee to help
families like hers and pass SB 106.
3:46:51 PM
SARAH KRUG, representing self, Anchorage, Alaska, testified by
invitation in support of SB 106. She works as a care-
professional educator and as a direct-care provider. She is
raising three children on her own, one of whom has cerebral
palsy. She shared that her 17-year-old son requires
institutional-level care but with support from caregivers can
use a power wheelchair to move and an iPad to communicate. She
was attending college when her son was born but she had to drop
out because she couldn't find the specialized care he needed
outside an institution. She never returned to school and is only
qualified for low-paying jobs. After waiting seven years, her
son received a waiver for services, but it was still a struggle
to find and retain caregivers. The revolving door created a
sense of abandonment for a child who did not understand the
reason and it was stressful for the rest of the family.
MS. KRUG said caregivers aren't paid very well and they are in
short supply, which places an excessive burden on families.
Because of the inconsistency in available care, she's been
unable to work enough to support the family. Right now she's the
one providing the consistent and quality care her son requires.
Being paid for some of the work she does for her son has been
beneficial for the whole family. She emphasized that allowing
family members to be paid caregivers creates financial
sustainability for families like hers and keeps people like her
son out of expensive institutions and in their homes and
communities.
She said COVID created chaos but it also provided an opportunity
to reevaluate the way things are done and find better solutions.
She said there is no easier one-size-fits-all solution than to
allow an individual the option to be paid for providing care for
a disabled family member. She urged the committee to make
Alaska's care system better by supporting SB 106.
3:50:56 PM
CRYSTAL HOWARD, representing self, Wasilla, Alaska, testified by
invitation in support of SB 106 which would allow legally
responsible persons to be paid caregivers. She has been a nurse
and caregiver for 24 years, including for her family. She shared
that in 2012 her six-year-old son was diagnosed with a rare
autoimmune disease and he was dependent on transfusions for a
year. She had to quit her job and her family relied on donations
for necessities. She eventually had to send her eight-year-old
son to live with his grandmother. She said her mental health
suffered during this highly intense situation, but if she had
been able to receive an income while caring for her son, she
would have been relieved of some of the constant worry. She
emphasized that SB 106 is extremely important for the many
struggling, unpaid caregivers in the state. She said we need to
do better because the need for family caregivers will only
increase with the changing demographic.
3:53:48 PM
CHAIR WILSON opened public testimony on SB 106.
3:54:01 PM
MARGE STONEKING, Advocacy Director, AARP Alaska, Anchorage,
Alaska, testified in support of SB 106. She agreed with the
previous testimony that the direct-care workforce shortages that
accelerated during the pandemic resulted in an increase in
family caregivers in Alaska. While most are unpaid, the federal
public health emergency that authorized paid family caregivers
for those who were receiving Medicaid benefits has helped, but
this system too is threatened by workforce shortages. She
explained that Medicaid Home and Community-Based Services
support elders and people with disabilities who are living at
home.
MS. STONEKING cited the following recent data from AARP: family
caregivers in Alaska provide an estimated 88 million hours of
unpaid care for loved ones each year; and in 2021, the 94,000
unpaid caregivers in Alaska provided care valued at $1.7
billion. She said this is a significant increase from pre-COVID
and it differs from the nationwide trend of fewer family
caregivers in the same period. This is likely driven by the
rapidly aging population in Alaska and the severity of the
state's workforce crisis. She stated that AARP supports SB 106
to make permanent the flexibility to allow legally responsible
individuals to be paid caregivers in the existing homecare
agency model. She added that AARP continues to advocate for
policy changes to support family caregivers with a more flexible
system to help elders age in place. This includes things like a
participant-directed service model in which Medicaid recipients
can hire friends, family, and neighbors directly without relying
on homecare agencies.
3:57:08 PM
PATRICK REINHART, Executive Director, Governor's Council on
Disability and Special Education, Division of Senior and
Disabilities Services, Department of Health (DOH) Anchorage,
Alaska, thanked the committee for hearing SB 106 and Senator
Giessel for bringing it forward. He stated that providing more
flexible options of care for people with disabilities and
seniors is a great idea that should continue. This is
particularly important for rural areas where it is very
difficult to find people to do this work.
3:58:53 PM
CHAIR WILSON closed public testimony on SB 106. He asked the
sponsor if she had any closing remarks.
3:59:06 PM
SENATOR GIESSEL stated that when she first looked at this topic,
she recognized that there is a huge need in rural Alaska. Her
initial perception was that there were adequate home health
agencies in urban Alaska but she subsequently learned that's not
accurate. Urban area needs SB 106 as much as rural Alaska. She
shared a personal experience with in-home caregiving.
4:01:03 PM
CHAIR WILSON set an amendment deadline and held SB 106.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB106 Vsn B.PDF |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB106 Sponsor Statement.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB106 Sectional Analysis.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106 FN DOH SDS.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106-Support-Morris-3.27.23.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106-Support-Krug-3.20.23.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106-Support-Mulholland-3.27.23.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106-Support-Reiss-3.27.23.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106-Support-Williams-3.22.23.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106- Support-Page-4.3.23.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB106 - Support Bonner.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106 - Support Dalaune_Redacted.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |
| SB 106 DOH Medicaid Svcs.pdf |
SHSS 4/4/2023 3:30:00 PM |
SB 106 |