Legislature(2023 - 2024)ADAMS 519
02/13/2023 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Fy 24 Budget Overview: Department of Family and Community Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 39 | TELECONFERENCED | |
| += | HB 41 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HOUSE BILL NO. 41
"An Act making appropriations for the operating and
capital expenses of the state's integrated
comprehensive mental health program; and providing for
an effective date."
Co-Chair Johnson reviewed the meeting agenda.
^FY 24 BUDGET OVERVIEW: DEPARTMENT OF FAMILY AND COMMUNITY
SERVICES
1:33:59 PM
MARIAN SWEET, ASSISTANT COMMISSIONER, DEPARTMENT OF FAMILY
AND COMMUNITY SERVICES, OFFICE OF MANAGEMENT AND BUDGET,
OFFICE OF THE GOVERNOR, introduced the PowerPoint
presentation titled, "Department Budget Overview," dated
February 13, 2023 (copy on file).
Ms. Sweet began on slide 2. She relayed that the mission of
the Department of Family and Community Service (DFCS) was
to provide support, safety, and personal well-being to
vulnerable Alaskans, which was accomplished through a
"service first" vision. The department had four direct
service divisions and a support service division as well.
The budget for DFCS was just under $460 million for FY 24.
She advanced to slide 3 which depicted an organizational
chart for the department and some of the key focuses of
each division within the department.
Representative Hannan asked for a definition of the
acronyms on slide 3.
Ms. Sweet responded that DES stood for Designated
Evaluation and Stabilization and DET stood for Designated
Evaluation and Treatment.
1:36:33 PM
Ms. Sweet continued on slide 4, which summarized the
reorganization of the Department of Health and Social
Services (DHSS) as mandated by Executive Order 121. The
Alaska Psychiatric Institute (API), the Division of
Juvenile Justice (DJJ), the Alaska Pioneer Homes (APH), and
the Office of Children's Services (OCS) were the four
direct service divisions offering 24/7 care under DFCS. The
commissioner's office and finance and management services
provided operational support.
Ms. Sweet continued on slide 5. She indicated that DFCS was
the third largest department in the state with 1,854 full-
time and permanent positions. The full-time facilities and
grants were split between the two agencies. Departmental
support services included the commissioner's office and
finance and management services included human resources,
procurements, information technology, finance, facilities,
and grants. The two divisions were split between DFCS and
the Department of Health (DOH) when DHSS was split. Due to
the divisions being split between the two new departments,
there was no clean way to show the departmental support
services expenditures for FY 22; therefore, she would be
presenting a departmental overview budget on slide 5 that
strictly included the four direct service divisions.
Ms. Sweet continued on slide 5 and noted that the
difference between the FY 23 management plan budget and FY
24 proposed budget was an increase of 1.7 percent or just
over $6.3 million. She spoke to the differences between the
FY 22 actuals and the FY 24 proposed budget. The difference
between the two might appear large at first glance, but the
disparities could easily be explained. Personal services
played a significant role in two ways: firstly, in FY 22,
the department had a high number of vacancies which reduced
the overall services expenditures in the fiscal year;
secondly, in FY 23 and FY 24, personal services saw
increases in salaries and benefit adjustments.
Additionally, the payment assistance program within APH was
made up of unrestricted general funds (UGF) which were paid
to APH through a reimbursable service agreement (RSA) and
recorded as interagency recipes. Since the payment amount
was dependent upon the number of elders in the homes, the
amount of unspent authority was seen in both the UGF
funding source as well as the interagency funding source
and was essentially doubled. Furthermore, API received a
higher allotment of disproportionate share funding, which
increased expenditures and reduced the amount of
expenditures that were posted to statutory designated
program receipts (SDPR). She explained that SDPR was where
the private pay and insurance collections were recorded.
The department was able to carry forward the collections
and SDPR statutory program receipts from FY 22 into FY 23;
however, the result was a higher than normal lapse in SDPR
funding in FY 22. Interagency receipts and SDPR were the
main reason for the discrepancies between the fiscal years,
which could be seen on the graph on the slide.
1:41:52 PM
Representative Hannan understood that APH showed as a
designated general fund (DGF). She asked if the funds were
coming from another agency.
MS. Sweet responded that there were a few components within
APH. There was a component that was for payment assistance
and a component that was for operation of the homes
themselves. The RSA from the payment assistance component
supplied the difference between the amount the elders were
able to pay to reside in the homes and the actual cost of
living in the homes.
Representative Hannan thought that the payment assistance
program was showing as a DGF expense, but it was also part
of the UGF allocation.
Ms. Sweet responded that Representative Hannan was correct
and that the program was funded with UGF and paid through
an RSA, which was recorded as an expense of UGF.
Representative Hannan asked whether payment assistance
expenses had increased in the last few fiscal years or
stayed relatively steady as the new pay structure was
implemented. She understood that the goal in changing the
monthly payments at APH was to ensure that residents in the
homes were not removed because they could not pay. There
had been speculation that there would be a steep increase
in the number of residents that would need payment
assistance. She thought it was difficult to tell by looking
at the data.
Ms. Sweet replied that she would follow up with the
information on the amount of payment assistance over the
last few years. She added that it was dependent upon the
number of elders that were in the homes at the time and it
did fluctuate.
Representative Stapp asked about the other category for
funding, which he understood was private payer program
receipts and potentially interagency receipts.
Ms. Sweet responded that Representative Stapp was correct.
Representative Stapp asked for a breakdown of the
contributing factors to the funding increase. He asked what
the main driver was behind the additional source of
revenue.
Ms. Sweet would provide the information.
1:46:16 PM
Representative Josephson asked if interagency receipts
would be coming from DOH.
Ms. Sweet responded that APH fell under DFCS. There was a
component within APH that was dedicated to payment
assistance and provided an RSA to the homes' operations for
the elders who could not pay for residency in the homes
themselves.
Representative Josephson assumed that many of the dollars
were Medicaid dollars.
Ms. Sweet responded in the affirmative. She relayed that
API and APH both received Medicaid which was treated as
interagency receipts and came from DOH through the Medicaid
program.
Ms. Sweet continued on slide 5. In FY 23 through the People
First appropriation, DFCS received a $10 million increment
into the base budget for OCS. Although there was a large
difference between FY 22 actuals and the proposed FY 24
budget, the differences were explained in the "unspent
other" category and the "unspent personal services"
category due to vacancies. She noted that on the upcoming
division slides, the increases would be related to salary
and benefit adjustments. However, she would not be focusing
on those increases because she would like to focus on the
new budget changes between FY 23 and the proposed FY 24
budget.
Ms. Sweet continued on slide 6. The department had 58 full-
time, permanent positions and a budget of $17.9 million.
She reminded members that since departmental support
services were split between the two new departments, she
did not have the data for FY 22 to compare to FY 24. One
thing to note was a transfer of a health program manager
from inpatient mental health into the commissioner's office
to provide departmental oversight of the designated
evaluation and treatment program. Another significant item
was the increase to the complex care coordination unit.
Also, within the commissioner's office, there was a request
for three new positions: a deputy director, an additional
care coordinator position, and a social services associate
position. The Alaska Mental Health Trust Authority (AMHTA)
was supportive of the new positions and had put forth a
request for $150,000 for the unit and the remaining balance
of $324,000 was spread between federal, UGF, and
interagency receipts.
Ms. Sweet advanced to slide 7. She reported that APH had
422 full-time permanent positions and served six homes
across the state with a budget of $107.2 million. The homes
provided nursing services, assistance with dietary needs
and activities of daily living, recreational and social
programs, housekeeping, and meal preparation. The homes
provided for five levels of care with level one being the
most independent going up to level five for those living
with dementia or other complex care needs.
1:52:20 PM
Representative Galvin asked if Ms. Sweet could offer some
information on the vacancies. She had met with a few people
who were concerned about employees at APH providing
additional levels of care for which they were not trained.
Ms. Sweet responded that APH were currently reporting a
14.5 percent vacancy rate for residents with 63 of the 422
positions vacant as of the end of December of 2022. She
noted that APH would be giving a presentation to the
committee in a few weeks and she would ensure that the
presentation would include information on the impacts of
the vacancies on the level of provided care.
Representative Ortiz asked if there were statistics that
suggested that there were empty beds at the homes not due
to lack of demand, but due to lack of employees.
Ms. Sweet responded that she did not have the information
but would ensure that it was included in APH's upcoming
presentation.
Co-Chair Johnson would also like more information on the
vacant rooms.
Representative Cronk asked how much revenue was brought
back into the homes.
Ms. Sweet replied that she would be talking about the
budget on the next slide. She did have occupancy statistics
for each of the homes individually, but the average
occupancy rate was 93.6 across all of the homes. The home
with the lowest occupancy rate was in Anchorage with a rate
of 81.9 percent. The Anchorage home had a lower occupancy
rate because some rooms had to be strategically vacated in
order to conduct a number of remodeling projects.
1:56:27 PM
Ms. Sweet continued on slide 8. Within the homes, the
department had processed a minor fund switch from UGF to
statutory designated program receipts due to an increase in
pharmacy collections. There were two impacts within the DGF
section for APH: firstly, in the FY 24 budget request,
there was an increase of $1.25 million in general program
receipts which would allow for the expending of collected
receipts for things like kitchenware and furniture within
the homes; secondly, on January 1 of 2023, the Social
Security Administration (SSA) benefit rate increase went
into effect, therefore APH rates increased as well because
they were directly tied to the SSA benefit rates. The slide
showed the FY 23 supplemental request of $700 million which
would allow the increase of program receipt authority in
order to fund the anticipated increases in collections. In
response to Representative Cronk's earlier question, the
total revenue brought back into the home was $38.6 million
in 2022.
Representative Coulombe understood that the proposed FY 24
budget included a request of $1.25 million in DGF for APH
due to the consistent high capacity at the homes. She asked
if the request related to the cost of renovations or if it
was simply because the homes were going through supplies
quickly due to the high capacity.
Ms. Sweet responded that there had been an increase in
insurance and private pay that exceeded the amount of
authority allowed by the funding source. The authority was
limited and more collections were incoming than the
authority allowed. The request would allow the department
to reinvest the funds back into the homes.
Ms. Sweet continued on slide 9. The inpatient mental health
operating budget was $75.2 million and the RDU was
comprised of designated evaluation and treatment (DET) and
API. For the purpose of explaining the changes in the
budget, she advanced to slide 10. She indicated that DET
was transferred to the department from the Division of
Behavioral Health through Executive Order 121. The increase
seen on the slide was a result of expanded funding from HB
172 and totaled $904,000. The remaining funding was
$525,000 in UGF and $150,000 in interagency receipts which
were specific for the following programs: designated
evaluation and stabilization (DES), DET, the
disproportionate share hospital ("DISH" funding), and
secure transport agreements.
2:02:19 PM
Representative Hannan asked why the chart on slide 10
showed a large chunk of federal money for FY 22 and no
federal money for FY 23 and FY 24.
Ms. Sweet responded that when DFCS was part of DHSS, it
managed the program and was able to submit claims directly
to Medicaid because it was within the same department. In
2023 when the unit was transferred, it had to be moved from
the federal source in order to bill Medicaid.
Representative Hannan understood that it was still federal
money, but for accounting purposes it was no longer called
federal money and was now referred to as interagency
receipts.
Ms. Sweet responded in the affirmative.
Representative Stapp requested for Ms. Sweet to break out
interagency federal receipts from other funding because it
was confusing to track.
Ms. Sweet would be happy to accommodate the request.
Representative Josephson noted that the DET program was
essentially an equivalent classification as was given at
smaller API hospitals.
Ms. Sweet replied that the DET program included the portion
of funding that went to the DISH hospitals, which included
API. There were DET and DES programs that funded hospitals
that provided treatment and stabilization services. The
programs intended to support mental health needs without
needing to transfer a patient to API.
2:06:03 PM
Ms. Sweet advanced to slide 11. She relayed that API had
326 full-time and permanent positions and a budget of $60
million. It was the only full service psychiatric hospital
in the state and had a maximum capacity of 80 licensed
beds. She indicated that 60 of the beds were in the adult
civil unit, 10 were in the adolescent unit, and 10 were in
the forensic competency restoration unit.
Ms. Sweet moved to slide 12. There were two new programs
being proposed in FY 24 to help the number of Alaskans
charged with a crime to restore the individual to forensic
competence: the out-patient program and the jail-based
competency restoration program. The budget request included
four new full-time positions and one new part-time position
to standup the new programs. The department was working on
securing a location in Anchorage for the out-patient
competency restoration program and continuing its
collaboration with the Department of Corrections (DOC) on
the jail-based program. The request was an increase of
$800,000 in UGF.
Co-Chair Johnson asked if there were any monies that came
from DOC.
Ms. Sweet responded that the restoration services would be
provided by API staff, but staff would be traveling on-site
to provide services to those who were in jail. The
individuals receiving care were in the jail systems
themselves, but she did not have any information about
DOC's budget.
Co-Chair Johnson wondered about the inmates who were in API
facilities because of decisions made by the court. She
asked how the funding worked for inmates in API facilities.
Ms. Sweet responded that the inmates were in the care of
DFCS. She explained that API helped the individuals to
achieve competency so that they could go to trial. The jail
based restoration would be for individuals who were in jail
and awaiting trial, and the out-patient program was
intended to help those who had committed lesser crimes or
were out on bail.
Co-Chair Johnson asked about individuals who were post-
trial and were likely to not be released. She was aware
there were some individuals at API in that situation.
Ms. Sweet responded that she would need someone from API to
offer more information.
Co-Chair Johnson asked if DOC paid for post-trial
individuals.
Ms. Sweet would follow up in writing with the requested
information.
2:10:02 PM
Representative Tomaszewski asked about the $60 million in
the FY 24 budget for 326 positions at API. He surmised that
broke it out to roughly $185,000 per position. He asked for
a list of the top ten positions and the associated
compensation.
Ms. Sweet would provide the information.
Representative Coulombe asked if AMHTA was contributing to
the program in any way.
Ms. Sweet responded that the department did not have AMHTA
authority for the two specific programs.
Representative Josephson asked if the new department knew
what was happening in a court room when an individual was
found to be unrestorable and incompetent to stand trial. He
was wondering whether the Department of Law (DOL) and DFCS
talked to each other.
Ms. Sweet responded that the department spoke to DOL but
she herself did not. There was a full-time employee at DFCS
who was the DET and DES coordinator and was directly
involved in all of the Title 47 cases.
Ms. Sweet advanced to slide 13. She relayed that OCS had
614 full-time positions and worked to ensure the safety,
permanency, and well-being of children by strengthening
families, engaging communities, and partnering with tribes.
There were 21 offices across five regions and the overall
budget was $195 million.
Co-Chair Johnson asked if Ms. Sweet knew the vacancy rate
for OCS.
Ms. Sweet responded that the vacancy rate for OCS was just
under 22 percent at the end of December of 2022. She did
not have it broken out but would be happy to provide
information on the vacancy rate for direct front-line
social workers. She noted that the vacancy rate was higher
for social workers.
Representative Josephson commented that the subcommittee he
used to chair in FY 22 believed the employment crisis was
so severe at OCS that workers should get retention bonuses;
however, the governor vetoed the bonuses and had a plan for
his own bonuses in FY 23. He asked how the plan had worked.
Ms. Sweet responded that DFCS had been partnering with its
sister agency, the Department of Administration (DOA), on
getting letters of agreement finalized and approved by both
unions. The agreements were almost finalized and once
approved, the agreements could be implemented. For the
first time, the department had seen a decrease in the
turnover in its frontline staff.
Representative Josephson noted that the subcommittee two
years ago was told that the workers at OCS were changed and
damaged by their work. The state had funded a clinician to
assist the workers. He asked if a clinician or psychologist
had ever been provided to OCS workers.
Ms. Sweet responded that the Mental Health Clinician III
position had been created for the purpose of helping with
the trauma that the staff at OCS had experienced.
2:15:42 PM
Representative Galvin asked about the 22 percent vacancy
rate. She thought it was a lot of unspent money and
represented a lot of care that was not able to be given.
She had not looked at what specifically had been done but
she was curious if there were plans to address the unspent
monies in addition to retention bonuses and working with a
psychologist. She wondered how the legislature could help.
Ms. Sweet replied that the department appreciated the
sentiment and there would be another presentation that
addressed the problem in more detail. The presentation
would discuss what the division was doing to help with
morale, training programs, and partnerships with
universities.
Ms. Sweet moved to slide 14. The first item of note was a
new program within OCS to assist with foster youth aging
out of the system, which was a budgetary increase of
$385,000, of which $235,000 was being supplied by AMHTA.
The program would partner with the existing independent
living program within OCS to provide expanded services to
youths. The other item of note was a fund source change
from general funds to a general fund match to accurately
reflect the state's share of the federal spending. Both the
general fund and general fund match fell under the UGF
category and was a net zero, but as it was a significant
dollar amount, she wanted to highlight it.
Ms. Sweet continued to slide 15. The Division of Juvenile
Justice (DJJ) had 424 full-time permanent positions, six
facilities, and 13 probation officers across the state and
a budget of $62.1 million. It used a restorative justice
approach which meant a focus on rehabilitation of the youth
offenders and restoration of victims and communities.
Ms. Sweet advanced to slide 16. There were no significant
changes in the budget related to DJJ. The increases seen on
the slide were strictly related to the salary and benefit
adjustments in UGF and within the federal programs.
Ms. Sweet summarized the presentation. She relayed that the
DFCS proposed budget had a number of technical changes as
required by HB 172, the majority of which were salary and
benefit increases. There were four new budget items: the
increase in program general receipts for APH, the funding
and new positions within API, the complex care coordination
unit within the commissioner's office, and the increase for
foster youth who were aging out of the system. The total
amount of UGF funding for the four new budget items was
$1.1 million. She concluded the presentation.
2:21:11 PM
Representative Stapp thought the federal receipts for
Medicaid should be consistent, however private care for
individuals who had long-term care insurance might not be
consistent. He asked if a potential liability for the state
would be created in the event that the requested revenues
did not materialize.
Ms. Sweet responded that the payment assistance program
within APH was intended to support the elders within the
homes. While there was an increase in receipts currently
due to private pay and insurance collections, the increase
might not continue in the future. If there was a reduced
amount of collections in future years, the payment
assistance program would compensate for it.
Co-Chair Edgmon commented that the committee had received a
presentation from AMHTA recently and among the proposed FY
24 grants was $772,000 in grants for DFCS. He offered Ms.
Sweet an opportunity to expand upon the purposes of the
grants.
Ms. Sweet replied that she touched on the new funding items
for FY 24 and there were a number of items in AMHTA that
were continuations from prior years that she did not
specifically address. She would be happy to provide the
information in writing.
Co-Chair Edgmon asked if she had a ballpark idea of how the
$772,000 in grants would be spent.
Ms. Sweet responded that what came to mind were some grants
that were continuing from prior years and going into OCS.
It was a combination of funding for OCS as well as
departmental support services within the commissioner's
office.
Co-Chair Edgmon thought that it would be helpful for the
committee to get a breakdown of the spending.
Ms. Sweet would provide the information.
2:24:11 PM
Representative Hannan commented that the information on DJJ
caught her off-guard because it received so little federal
money. She presumed that many of the children encountered
by OCS ended up in DJJ. She noted that Medicaid and
Medicare stopped when an adult was incarcerated in a
prison. She wondered how the process worked within DJJ and
asked what she might be missing considering the low number
of federal dollars.
Ms. Sweet responded that the federal grants within DJJ came
from the Department of Justice (DOJ) and the grants were
small. The youth that were in the care of DJJ received
medical coverage from DJJ unless they were admitted to a
hospital and were there for over 24 hours, in which case
the individual would be covered by Medicaid.
Representative Hannan understood that even if a young
person had Medicaid coverage before being incarcerated in a
juvenile facility, the federal reimbursement for any care
was suspended upon their incarceration.
Ms. Sweet responded in the affirmative.
Co-Chair Johnson summarized the requests the committee had
made for more information.
2:26:58 PM
Representative Coulombe asked for detail on the goal of the
complex placement and care unit.
Ms. Sweet replied that there were a number of youth and
adults that were presenting to DFCS because they did not
have a good place to go. As an example, there was a youth
that recently came into the department's care who could not
get their needs met by API or any of the facilities in the
state. The call from the youth lasted an entire weekend as
DFCS, the commissioner, DOH, and community partners were
working to find an appropriate facility for the youth. She
relayed that similar problems were happening more
frequently. The department was creating a complex care unit
within the commissioner's office to ensure that there was a
specialized resource for complex placement cases. The
department was going to work with partners in-state to
increase the capacity for both youth and adults who were
presenting with complex and high acuity needs.
Additionally, the department was working with partners out-
of-state so there would be other options if the department
was not able to find an individual a suitable placement in
Alaska. The focus of the unit was to ensure that the
placement for an individual was based on the individual's
specific needs and that they could work towards rejoining
their community.
Representative Coulombe asked how many individuals would
need complex care and placement. She was struggling with
the concept because she thought complex placement cases
would be the responsibility of DOH.
Ms. Sweet replied that DCFS was working with DOH on
creating a database of providers and services that were
available. The departments were collaborating on licensing
and expanding services in existing facilities. In order to
stand up the unit in 2023, a complex care coordinator
position had been created and DCFS had hired someone for
the position.
Co-Chair Johnson ensured that Ms. Sweet had made note of
the follow-up requests.
2:31:21 PM
Representative Hannan understood that there had been a
presentation in the Senate on the litigation from DOJ suing
the state over its inability to meet the needs of its
complex care individuals. She had not read the conclusions
from DOJ but presumed that it directed the state to
construct facilities and offer services that had high
sticker prices. She wondered if the committee would receive
a similar briefing on the litigation.
Co-Chair Johnson explained that the current focus was the
subcommittees and to address higher level funding
overviews. She indicated that she would add Representative
Hannan's request to a "to be considered" list.
Representative Hannan thanked Co-Chair Johnson and
commented that the state needed to figure out how to meet
the needs of Alaskan families because needs were currently
not being met.
Representative Josephson asked if there was linkage between
the complex care unit and the DJJ lawsuit.
Ms. Sweet replied that there was a link in that the unit
was trying to ensure that complex placements were
available.
Representative Coulombe understood that the unit was not
creating any new space for care, but it was a navigational
tool.
Ms. Sweet responded no, the unit was not creating new space
but was ensuring that the state and DFCS had built a team
to help meet the individual needs of those who came into
the department's care.
HB 39 was HEARD and HELD in committee for further
consideration.
HB 41 was HEARD and HELD in committee for further
consideration.
Co-Chair Johnson reviewed the agenda for the following
day's meeting.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HFIN DFCS Budget Overview Presentation 2.13.23.pdf |
HFIN 2/13/2023 1:30:00 PM |
HB 39 |