Legislature(2017 - 2018)SENATE FINANCE 532
05/01/2018 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB193 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 193 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 193
"An Act requiring the Department of Health and Social
Services to apply for a waiver to establish work
requirements for certain adults who are eligible for
the state medical assistance program."
9:36:48 AM
Co-Chair MacKinnon read the title of the bill. The
committee heard the bill on April 12, 2018; at which time
the public hearing was opened and closed.
HEATHER CARPENTER, STAFF, SENATOR PETE KELLY, stated that
the bill took advantage of a new Centers for Medicare and
Medicaid Services (CMS) rule that allowed states to apply
using an 1115 waiver to have work requirements for certain
populations of the Medicaid program. She explained that the
bill would require 20 hours of work and exempt
volunteerism. Other exemptions included if a person was
actively searching for a job or caregiving. On page 2 of
the bill, there was a list of specific exemptions, which
were attempted to be corollary to those for the Temporary
Cash Assistance for Needy Families (TANF) Program. Other
exemptions included pregnancy, participation in a tribal
work program, being a victim of domestic violence, or
experiencing a family hardship outside one's control. The
bill ensured that a person with a substance abuse disorder
was not prevented from obtaining appropriate treatment.
Co-Chair MacKinnon asked Vice-Chair Bishop to review FN 1
and FN 8.
Vice-Chair Bishop reviewed FN 1 from the Department of
Administration. He relayed that the allocation was to the
Office of Administrative Hearings. In FY 19, the cost was
$338,000; in FY 20 the cost was $451,800; in FY 22 through
FY 24 the cost was $564,600. He read from the Analysis on
page 2 of the fiscal note:
DHSS projects that denials and terminations of
Medicaid eligibility pursuant to the new requirements
would generate 188 appeals to OAH in FY 2020, 251
appeals in FY 2021, and 314 appeals in subsequent
years. We defer to DHSS expertise in making these
estimates, but we note that the appeal rates DHSS used
to calculate these estimates are consistent with those
AH has observed in connection with Temporary
Assistance, a program that has a work requirement.
Work requirement appeals are moderately expensive to
process, in that they often require fairly extensive
actual development about the nature of a particular
job termination, the extent of a person's disability,
or similar issues. Our experience in calendar 2017
shows a cost per case of approximately $1,800 for
appeals of this type.
OAH does not currently have the capacity to handle
this caseload. OAH would expect to staff the new
caseload with a total of three full-time, range 24
administrative law judges, one to be added at the
beginning of FY 2020, one approximately halfway
through that year, and the third to be hired at the
beginning of FY 2022. At all times, the workload
projected by DHSS would somewhat exceed the capacity
of these new hires, and excess work would be handled
by judges working on contract. The shortfall to be
handled by contract peaks in FY 2021 and declines to a
lower level thereafter as the third full-time hire
begins work. Each newly-hired full-time administrative
law judge would be sent to the National Judicial
College to attend its training on conducting hearings
related to federal benefit programs. Travel expenses
related to the training, as well as commodities
purchases to equip the new judges with office and
hearing technology, fall primarily in FY 2020 and FY
2022.
9:41:49 AM
Vice-Chair Bishop addressed FN 8 from the Department of
Labor and Workforce Development, which was a zero fiscal
note. He read from the analysis on page 2 of the fiscal
note:
This legislation will likely increase traffic to
Alaska job centers, which may result in increased wait
times for Alaskans seeking assistance with career
services. There is no fiscal impact to the Department
of Labor and Workforce Development as a result of this
legislation.
Co-Chair MacKinnon asked department staff to address fiscal
notes 2 through 7.
JON SHERWOOD, DEPUTY COMMISSIONER, MEDICAID AND HEALTH CARE
POLICY, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, gave a
brief overview of the fiscal notes. He stated there were
six fiscal notes from the Department of Health and Social
Services (DHSS); three of which related to administrative
activities, and three of which related to reductions in
Medicaid services which reflected reductions in Medicaid
services. He noted that one of the effects of the bill
would be a reduction in caseloads as individuals chose not
to comply with the work requirements.
Mr. Sherwood thought there was a disproportionate impact to
federal and state funds. Much of the savings was coming
from costs that were eligible for federal funding; and much
of the expense from services that were not eligible for
federal funding. The combined impact of the fiscal notes
would result in an increase in the General Fund (GF)
budget.
Mr. Sherwood addressed FN 2, which went to Public
Assistance Field Services, and was related to working with
clients and ensuring clients were complying with work
requirements. He noted that there were start-up costs in FY
19 of $173,000. In 2020, the amount grew to about $6.5
million, and then declined somewhat over the following
years as it was expected individuals would fail to comply
with work requirements thereby reducing the caseload. To do
the work would require 49 positions in FY 20, which would
decline to 45 positions in the out years.
9:46:31 AM
Co-Chair MacKinnon thought that FN 2 was very interesting.
She considered that it appeared that the department did not
want to do the activities associated with the bill.
Vice-Chair Bishop asked about the number of the fiscal
note.
Mr. Sherwood specified that he had discussed FN 2, OMB
Component 236.
Co-Chair MacKinnon asked if the fiscal note had $6.1
million for a capital project the update the Medicaid
system could appropriately reflect the proposed work
component.
Mr. Sherwood answered in the affirmative.
Mr. Sherwood addressed FN 3, pertaining to quality control.
The budget allocation was where the department put its fair
hearing work. He informed that the fiscal note involved the
Office of Administrative Hearings and staff from Department
of Administration (DOA) and DHSS. The department expected
that as individuals were denied to failure to comply with
work requirements, there would be an increase in hearings.
There was a small start-up cost of $20,000; and a cost in
FY 20 of $490,200 growing to $591,000 in FY 21; $704,000 in
FY 22; $686,000 in FY 23; and $684,000 in FY 24. There
would be one additional position associated with the fair
hearing representation, and there were no capital
expenditures.
9:49:25 AM
Senator von Imhof mentioned testimony regarding how the
work requirements were similar to that of TANF. She asked
how many people participated in TANF and wondered what the
budget was to manage the program.
MONICA WINDOM, DIRECTOR, DIVISION OF PUBLIC ASSISTANCE,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, stated that there
were about 3,000 cases per month for The Alaska Temporary
Assistance Program (ATAP). In some areas the work was
contracted out, and in some areas state staff completed the
work. Se stated there were about 1,500 individuals in the
Anchorage area that were under mandatory work programs for
TANF, with a $3 million per year contract outsourced to
Nine Star Education and Employment Services to handle the
associated work.
Senator von Imhof asked if the division had thought about
whether the program in the bill made sense to outsource.
Ms. Windom considered that outsourcing would likely cost
more. She estimated that 25,000 individuals would have to
comply with the mandatory work requirements as proposed in
the bill.
Vice-Chair Bishop asked about the Nine Star contract, and
asked what services were provided.
Ms. Windom relayed that when an individual applied with
Nine Star, he or she would meet with a case manager. The
case manager would consider work barriers and facilitate
consumers in completing a self-sufficiency plan that would
illustrate steps to self-sufficiency. Additionally, case
managers could place consumers in volunteer positions,
provide training, and provide help with resum?s and a job
search.
Vice-Chair Bishop asked if the education and training
services could include a General Education Diploma.
Ms. Windom answered in the affirmative.
Mr. Sherwood addressed FN 4, for Public Assistance Work
Services. The note reflected the actual cost of providing
work services to individuals that were subject to the
proposed work requirements. The department had estimated
that 10.5 percent of the state's total Medicaid enrollment
would be subject to the work requirements. He estimated
there would be 15 percent rate of non-compliance in the
first year, 20 percent the second year, and 25 percent in
subsequent years. The bill proposed to provide work
services to a substantial number of people each year, at a
cost of approximately $1000 per person. There were no
capital expenses associated with the note. The supportive
services were not eligible for federal funding and would be
paid for by GF.
9:53:43 AM
Mr. Sherwood reviewed FN 5(DHS), which pertained to
Medicaid Services - Behavioral Health. He reiterated that a
decrease in Medicaid caseloads would be a result of some
percentage of non-compliance. The bill would reduce the
Medicaid spend by the reduction of the number of
individuals that qualified. He explained that Medicaid
reduction was allocated between three of the four Medicaid
Service Components: Behavioral Health, Adult Preventive
Dental Services, and Medicaid Health Services. There was no
reduction to the Senior and Disability Services, as the
consumers of those services would be exempt from the
proposed work requirements. The department projected a
reduction to Behavioral Health Services of $4.6 million n
2020, $6.2 million in FY 21, and $7.7 million in FY 22 and
beyond. There was no positions or capital associated with
the fiscal note.
Mr. Sherwood spoke to FN 6 (which pertained to Adult
Preventive Dental Medicaid Services. He detailed that the
fiscal note reflected part of the allocated reduction in
Medicaid Services due to the projected caseload reduction.
In FY 20 there would be a reduction of $494,300; in FY 21
there would be a reduction of $659,100; and in FY 22 and
out years there would be a reduction of $823,900. There
were no capital costs or positions associated with the
fiscal note.
Mr. Sherwood addressed FN 7 for Healthcare Medicaid
Services. He identified that the fiscal note reflected part
of the allocated reduction in Medicaid Services due to the
projected caseload reduction. This note reflected the
largest component of the reduction. In FY 20, the reduction
would be approximately $25.8 million; in FY 21, the
reduction would be approximately $34.4 million; and in FY
22 and out years, the reduction would be approximately
$42.9 million. There were no capital costs or positions
associated with the fiscal note.
9:57:27 AM
Senator von Imhof referenced her earlier question about
outsourcing. She thought Ms. Windom had been unsure about
whether outsourcing would save money. She wondered if
completing a Request for Proposals process would inform the
question. She estimated that the fiscal notes totaled $28.8
million. She asserted that there were entities, and perhaps
a data management company, that would to expand revenue
options in the state and make new investments.
Ms. Windom relayed that there was a possibility the state
would not be reimbursed by Medicaid for work that was
contracted out for work services. Medicaid guidance had
communicated that it would not pay for specific work
services. For state staff, the department used an
allocation code that allowed for 50 percent federal
reimbursement. She thought that if the state pursued an
1115 waiver for work requirements, it could submit a
Request For Information (RFI, a less formal process than an
RFP) to see if there were interested parties.
Senator von Imhof asked if the process would be to obtain a
waiver, then complete an RFI.
Ms. Windom believed it was possible to pursue a waiver and
put an RFI out at the same time.
9:59:28 AM
Co-Chair MacKinnon referred back to FN 2, which included 49
requested positions. She understood the cost associated
with the capital expenditures and necessity of updating the
records system. She asked the department to go into some
detail about why it needed the 49 new technicians for
employment services when Department of Labor and Workforce
Development (LWFD) usually handled the work.
Ms. Windom stated that when the fiscal note was being
developed, the department had looked at the services
provided for the state's ATAP clients. She discussed the
list of services provided by Nine Star case managers, and
noted that there were state staff in other areas that did
the same work. She did not believe that state staff
provided the level of detail of a self-sufficiency plan.
Co-Chair MacKinnon asked if self-sufficiency plans were
required through Medicaid.
Ms. Windom stated that the guidance from CMS stated that if
the state were to pursue work requirements for Medicaid, it
would have to provide supportive services to the client in
seeking employment.
Co-Chair MacKinnon asked if the support work could be done
by LWFD or contracted out.
Ms. Windom answered in the affirmative.
Co-Chair MacKinnon asked what the addition of 49 positions
would do to the state's pension obligation rate. She asked
about the department's vacancy rate and wondered how many
dollars were associated with it. She asked about filling
the vacant positions.
Mr. Sherwood agreed that there was a certain degree of
constant vacancy and anticipated filling the positions in
2020. He noted that the positions would decline slightly as
the caseload diminished. He could not elaborate on the
effects on the state's pension obligation. He stated that
the department would expect when going into negotiations
with CMS on the 1115 wavier, to have discussions about
options for reimbursement for some of the work that could
be characterized by administrative. The department would
consider doing contracting if it was feasible, but for the
purposes of the fiscal note, the department took a
conservative approach since it was not known if contracting
the work was the wisest financial course.
Mr. Sherwood continued his remarks. He thought there was a
degree of certainty with the approach taken in the fiscal
notes; while there was a higher degree of uncertainty in
the viability of contracting an entity to do the work of
the proposed 49 positions.
10:04:30 AM
Co-Chair MacKinnon mentioned her history at the legislature
and shared her concern that the department was requesting
support beyond the actual need to implement the program.
She referenced FN 2 and FN 4. She wondered if the
additional request for personnel should be eliminated from
FN 2. She referenced open "hollow" Position Control Numbers
(PCNs). She found it difficult to increase the department
by 49 positions while increasing contribution to the Public
Employees' Retirement System while there was an unknown
amount of open PCNs. She asked the members for input on
whether the fiscal note should be modified or if the
members shared her concerns.
Senator von Imhof discussed Medicaid expansion, and the
approximately 40,000 additional enrollees from the two
previous years. She asked how many new employees were hired
to handle the new enrollees.
Ms. Windom stated that there were no new employees hired,
but there was a backlog of 17,000 Medicaid applications.
Senator von Imhof recalled that a large part of the backlog
was due to a computer and technology issue.
Ms. Windom stated that there was a variety of factors that
had contributed to the backlog, including computer issues.
Caseworkers were working in two systems. She referenced
charts that showed the growth of the application backlog,
which did increase after expansion.
Senator von Imhof asked why the department had not
considered temporary outsourcing to help catch up on the
backlog.
Ms. Windom informed that federal regulations required a
state employee to authorize Medicaid benefits as well as
Alaska Supplemental Nutrition Assistance Program (SNAP)
benefits.
10:08:26 AM
Co-Chair Hoffman asked if the department had requested 41
new positions to address the backlog.
Ms. Windom answered in the affirmative.
Vice-Chair Bishop asked about the estimated number of
people that would be affected by the proposed work
requirements in the bill.
Ms. Windom stated that 22,000 individuals were 10 percent
of all Medicaid recipients. The department had researched
the group of recipients to determine what percentage was
working already or were children, which equaled about 10
percent of Medicaid recipients. Of the 10 percent, the
department considered which individuals would be exempt
from the proposed work requirement. A national study had
shown that about 10 percent would have a mandatory work
requirement if it was implemented.
Senator Micciche thought it seemed as though there was not
a lot of credit given toward the idea of entire families no
longer needing to be on Medicaid. He thought the
department's approach was interesting. He discussed the
high number of people on Medicaid in the state. He thought
85 percent of Medicaid spending was on children. He asked
if the department considered the number of children which
would no longer qualify for Medicaid if parents were
working and no longer dependent on Medicaid.
Mr. Sherwood stated that the department had not estimated a
particular number of children expected to go off Medicaid
rolls. The exemptions in the bill included certain parents,
and it was more likely exemptions would be in certain
families. He stated that the income eligibility standards
for children were higher than adults. A modest income that
might eliminate an adult from eligibility may not
necessarily eliminate a child from eligibility. The
department had not felt comfortable making the assumption
that the bill would reduce children's Medicaid coverage.
10:12:20 AM
Senator Micciche thought the legislation had an aspect of
breaking a cycle and helping people realize potential. He
thought that the fiscal notes engendered an ongoing
dependence on Medicaid. He thought there would be a larger
percentage of people that would (through obtaining work) be
successful and no longer need Medicaid services. He
realized the department was being conservative. He was
resistant to the proposed new positions. He thought the
state had made it too easy. He thought the state put
obstacles in the way of potential success. He did not think
the department had given any credit to the probability of
families going off Medicaid because of achieving successful
employment.
Co-Chair MacKinnon asked for Mr. Sherwood's thoughts.
Mr. Sherwood stated that there were individuals coming and
going from Medicaid all the time. He thought it was very
difficult to estimate the impact the bill would have in
elevating people off of Medicaid long term versus simply
ensuring people stayed engaged in the workforce. He would
not debate the concept that implementation of the bill
would change things over time. He questioned when the state
would see the impacts. He stated that the department
endeavored to make reasonable assumptions and to avoid
making highly speculative guesses about the effects of new
programs.
Mr. Sherwood continued to say that with regard to the
positions, most of the eligibility work required ongoing
monitoring of the cases. The department had done what it
could to streamline eligibility, but the bill required more
contact and it was not comparable to other work the
department did.
10:16:48 AM
Vice-Chair Bishop asked how many pages and resultant staff
time was required for an 1115 waiver.
Mr. Sherwood stated that the waivers could vary from very
simple to very complicated waivers with hundreds of pages.
He considered that the work requirement would require
submissions of evidence to CMS that appropriate exceptions
and supports had been implemented. All waivers were subject
to cost neutrality. He cited that the department had
included some modest start-up costs, including expenditures
for an actuary to help with the cost-neutrality
determination. He thought the bill implementation would
require policy work and negotiations. Alaska would not be
the first state to implement such a bill, but he thought
every state had done it differently.
Mr. Sherwood continued discussing the 1115 waiver, and
relayed that the department was currently working on one
for behavioral health. The waiver was time consuming and
took resources, particularly policy resources. The
department expected to support the proposed change with a
minimal amount of additional resources.
Vice-Chair Bishop referenced the departmental analysis that
quantified the number (on FN 2) and asked if the department
had identified the top number of barriers to employment.
Ms. Windom relayed that the department did not have such
information for Medicaid recipients, and did not have the
means to gather the data.
Co-Chair MacKinnon considered striking the employee request
from the fiscal note, and directing the administration to
work with LWFD. She was not sure how to proceed with regard
to the requested positions. She thought the department had
plenty of PCNs. She thought that the Office of Children's
Services had approximately 60 vacancies, a majority of
which did not have associated funding. She asked for
committee feedback on the matter of the positions
requested.
10:20:36 AM
Senator Micciche supported Co-Chair MacKinnon's idea. He
thought the department had a desire for more employees
based on a variety of reasons. He emphasized that the cost
of Medicaid had to be managed. He supported a creative way
to deal with the work requirement that did not necessitate
49 new employees.
Co-Chair Hoffman asked how the positions being discussed
fit into the fact that the proposed work requirement would
necessitate finding jobs for 20,000 individuals. He
observed that the jobs in the state were on the decline,
and people were leaving the state. He discussed the decline
of the national unemployment rate, while the Alaska
unemployment rate was substantially higher. He thought the
plan to address getting 22,000 jobs was very ambitious. He
wanted to ponder the interplay of job attainment, success
of the program, and suggested listening to LWFD for
feedback.
Vice-Chair Bishop did not disagree in totality with what
Co-Chair MacKinnon had suggested. He questioned the
barriers to employment and thought there needed to be more
assessment of the 22,000 individuals in question. He
suggested that he would like to see the commissioners of
DHSS and LWFD provide opinions on the matter.
Senator Micciche thought Alaska's unemployment rate was
generally higher than that of the Lower 48, save for when
the Lower 48 was in a deep recession. He reminded that the
bill did not reference a requirement to work, but rather a
requirement to contribute. He thought money spent on
healthy adults and families was taken from seniors and
people with disabilities. He thought if the same spending
was directed toward creating opportunities and teaching
work ethic would be important. He agreed that the state
needed to look for opportunities. He was willing to invest
in developing people's skills for success.
10:25:38 AM
Co-Chair MacKinnon reiterated that it was her intent to
zero out the requested positions, but not the funding - in
order to contract out with a non-profit or a governmental
receipt exchange with LWFD in order to provide work support
services. She thought the issue was that the department was
standing up a whole unit to handle employment, while there
were skills in LWFD. She referenced the loss of a job
center in Eagle River. She stated that the employment
services technicians ranged from $85,000 to $115,000 per
person to help an individual find a job. She thought that
the task could be done better with a private non-profit or
an intergovernmental agreement. She wanted to know if the
committee supported eliminating the added positions.
Senator von Imhof reiterated Senator Micciche's comment
that there were always volunteer opportunities. She thought
the bill was permissible to volunteer activity. She
pondered outsourcing. She referenced Ms. Windom's comment
about a requirement for state employees to determine
Medicaid eligibility. She thought other states had
outsourced part of Medicaid eligibility and she was going
to research the option for non-state employees.
Senator von Imhof did not feel comfortable moving forward
and striking the entire fiscal note. She contemplated
rebuilding the fiscal note. She felt she did not have
enough information to respond to Co-Chair MacKinnon's
request for committee support in changing the fiscal note.
Vice-Chair Bishop thought Co-Chair MacKinnon had asserted
that she wanted to cut positions and not funds. He
considered that LWFD should work with DHSS to determine the
skill sets and employability of the 22,000 individuals in
question. He thought employment was more important than
volunteering.
10:29:48 AM
Senator Micciche supported the reduction of employees in
the fiscal note as suggested by Co-Chair MacKinnon. He
wanted to see a lower fiscal impact on FN 2. He thought it
was important to address obstacles in CMS. He wanted to see
creativity from the department in using outside sources
whenever possible.
Co-Chair Hoffman asked if Mr. Sherwood felt that the
department could comply with the legislation if the
positions were removed.
Mr. Sherwood stated that the question was difficult to
answer, as the department could only proceed through an
1115 demonstration waiver that had to be approved by CMS.
He continued that CMS had laid down strict guidelines about
waiver approval, and the policy was written with litigation
defense in mind. He considered that there were a lot of
requirements imposed upon states to move forward, to ensure
that individuals subject to the work requirements had
adequate protection. He was unsure if the department could
get a waiver approved without the requested positions. He
thought it might be possible to get the waiver approved
with less than the requested positions but reiterated that
there was uncertainty. The fiscal note reflected reasonable
certainty in moving forward to meet the requirements of CMS
policy.
10:32:23 AM
Co-Chair Hoffman asked if the state should go about trying
to address the problem in a different way or give the
legislation the best possible chance by funding the
positions to get the job done.
Co-Chair MacKinnon thought the committee wanted success and
she thought the fiscal note overstated the needs of the
department. She discussed growth in Medicaid expansion, and
what she considered a lack of GF dollars to support the
expansion. She did not think that the legislature needed to
hand out 49 positions when there were positions on the
books without funding. She thought providing the funds for
the positions without funding was a way to move forward
successfully without having to create new PCNs. She
pondered the number of PCNs that existed with no funding
attached.
Co-Chair Hoffman looked at page 2 of FN 2, which stated
that 20 hours of work was required to get an 1115 waiver.
He did not believe that 240,000 hours to get the waiver was
not substantial and not required.
10:35:39 AM
Senator Micciche asserted that the individuals being
discussed were wonderful people. He thought certain
individuals would always need Medicaid services. He wanted
to make the bill successful but did not want to supplement
other areas of DHSS in order to do so.
Co-Chair MacKinnon asked if Ms. Windom had stated that TANF
had a work requirement.
Ms. Windom stated that an ATAP recipient must participate
in work programs, and there was a lifetime limit for the
benefit. In some areas, the department contracted the work
program out; in Anchorage the state contracted with Nine
Star for about $3 million per year to serve 1,500 cases per
month. She could not define how long case managers worked
with each client because it widely varied between
individuals.
Co-Chair MacKinnon estimated that if there were the 1,500
consumers per month as was discussed, it would be
equivalent to over 15,000 individuals per year.
Ms. Windom agreed.
Co-Chair MacKinnon considered the potential number of
individuals being served by ATAP as compared to the
potential number if the bill was passed. She discussed
tracking issues with consumers that went on and off of the
system.
Co-Chair MacKinnon recognized that Senator Stevens was in
attendance. She relayed that the committee was considering
FN 2 and she had suggested striking the requested positions
from the fiscal note in interest of looking at a different
outsourcing method.
Co-Chair MacKinnon asked about the credibility of the $6
million capital request and referenced the Analysis on page
5 of the fiscal note:
Capital Budget:
$6,120.0 (10% GF Match, 90% Fed)
Changes to the eligibility computer system, Alaska's
Resource for Integrated Eligibility Services, will be
required to include information on compliance with
work requirements and to support denial or closure of
cases due to non-compliance.
In order to implement work requirements for Medicaid,
ARIES must be reprogrammed to add fields to indicate
if a recipient is exempt from the work requirement,
how they're participating (along with how
participation was verified), allow for the actual
disqualification, and new notices must be added. The
division will also be required to create a new
interface with the Case Management System. This system
is used to track work activities and issue supportive
service payments for ATAP recipients
10:39:40 AM
Ms. Windom stated that the department had a program
management office that was tasked with updating areas of
the agency. The office had estimated the cost to update
Alaska's Resource for Integrated Eligibility Services
(ARIES) to include work requirements. She offered to
provide more information as to how the office had arrived
at the amount of capital request for the system update.
Co-Chair MacKinnon asked if the eligibility determination
as proposed by the bill could be run through ATAP's system
and then interface with the Medicaid system.
Ms. Windom stated that there was a separate system for
tracking work status of ATAP clients. She thought it would
likely be possible to utilize for tracking the proposed
work requirements for Medicaid recipients; however, an
interface would have to be developed. She discussed
features of ARIES that would require system changes to
implement the bill if passed.
Co-Chair MacKinnon wondered why the ATAP report could not
be used for individual clients of Medicaid.
Ms. Windom stated that the ARIES system was rules-based and
automated. There was no way to solely use the ATAP report
to implement other features of Medicaid.
10:42:30 AM
Co-Chair MacKinnon brought up FN 4, which included a
request for $20 million GF. She asked for the department to
discuss grants and benefits referenced in the fiscal note.
Ms. Windom stated that the department had considered ATAP
recipients and what kind of supportive services were
provided. On average, the division had spent about $1,000
per year per client for supportive services.
Co-Chair MacKinnon thought the numbers were high and
thought there was opportunities to have a different
department do the work.
Senator Micciche supported a Medicaid work requirement for
healthy individuals. He supported LWFD helping to train and
place individuals for employment. He thought there were
ample volunteer opportunities in even the most remote parts
of the state. He thought it was important to hear from LWFD
regarding the department's role and what a comprehensive
plan might look like.
Co-Chair MacKinnon asked if the department had further
thoughts on the fiscal notes.
Mr. Sherwood answered in the negative.
Co-Chair MacKinnon thanked Mr. Sherwood and Ms. Windom for
their service.
10:46:19 AM
Co-Chair Hoffman thought all legislators wanted to have
citizens of the state contribute to the economy and provide
for families. He thought there was a problem with the
Medicaid program, which expanded and cost the state
millions of dollars. He thought there was a question as to
whether the state could continue to provide the services,
which he considered to be in competition with other state
services. He had great concern about Medicaid and thought
reversing the trend could be contentious.
Co-Chair MacKinnon wanted to discuss the fiscal notes more
thoroughly at a meeting later in the day, and to hear from
DOL. She wanted to under the DHSS vacancy rate and how many
positions did not have associated funding.
Co-Chair Hoffman thought it would be interesting to see a
snapshot of unemployment in the state from LWFD, to
consider the employment trends and available jobs in the
current economy. He thought the information would be an
integral part of resolving the question of work
requirements. He commented that government played a big
role in the economy of the state, as well as the
educational system.
Co-Chair MacKinnon recognized acknowledgement from LWFD in
the gallery.
10:49:54 AM
Vice-Chair Bishop thought that LWFD would also be able to
provide information as to methodology on tracking
unemployment. He thought there was a cohort of individuals
that had completely ceased seeking employment.
Co-Chair MacKinnon explained that Vice-Chair Bishop was the
former commissioner for LWFD.
Senator Micciche wondered how the state could invest a
proportion of the $1.2 billion invested in DHSS to help
develop employment and skills rather than spend it
continuously on a growing population of individuals
dependent upon Medicaid. He wanted to learn more about
constraints on the 1115 waiver. He wanted to know where
there was leeway to privatize as much as possible.
Co-Chair MacKinnon planned on bringing the bill up in the
afternoon meeting.
SB 193 was HEARD and HELD in committee for further
consideration.
Co-Chair MacKinnon discussed the agenda for the afternoon.
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