Legislature(2003 - 2004)
03/25/2003 03:00 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
HB 167-ALCOHOLISM AND DRUG ABUSE GRANTS Number 1699 CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 167, "An Act relating to grants for alcoholism and drug abuse programs; and providing for an effective date." Chair Wilson stated that this is the third hearing for this bill and there are individuals on line that did not have time to speak to the bill in previous hearings. CHAIR WILSON noted for the record that Representative Kapsner has joined the meeting. Number 1616 KEVIN MURPHY, Acting Director, Gateway Center for Human Services in Ketchikan; President, Substance Abuse Directors Association, testified via teleconference on HB 167. He said he believes this is an important bill because of the tremendous impact on programs that will be required to raise the cash match across the state. Many programs are already facing waiting lists. He told the committee that 70 percent of people that need treatment either do not get it or cannot afford it, and the programs serve many of these people. To ask the programs to go back to their communities to pay for an additional 15 percent at this time is really difficult. Mr. Murphy asked the committee to look at an increase of 12.5 percent off the 10 percent match. The programs could at least trim budgets, and the small programs could live with that and not face having to cut services or kill programs. He thanked the committee for their time and asked for consideration of an alternative position to the 25 percent reduction. Number 1532 CHAIR WILSON agreed that HB 167 will implement a 25 percent reduction in the grant funding for alcohol and drug abuse programs, and that while these programs are not funded 100 percent by grant funds, the reduction will have an impact on the programs. Number 1504 STEPHEN SUNDBY, Ph.D., Behavioral Health Director, Bartlett Memorial Hospital and Juneau Recovery Hospital, testified in opposition to HB 167 and answered questions from the members. He said he agrees with Mr. Murphy on the impact of these reductions. There have not been increases in funding in over 10 years, so the communities have had to pick up the slack. He told the committee that the Juneau community well overmatches the 25 percent, so they interpret this as a 15 percent reduction in their grant. What that means is that the hospital will take an $84,000 cut. Currently, the hospital receives a little over $560,000. With that reduction, including benefits, that is a loss of a counselor. So services are going to be reduced if this passes. He asked that the bill not be passed as is because it will reduce services. Number 1453 CHAIR WILSON asked Dr. Sundby what the full budget is for the Juneau Recovery Hospital. DR. SUNDBY told the committee that the full budget is $2.8 million. He said it receives $560,000 from AIDEA [Alaska Industrial Development and Export Authority]. So Juneau Recovery Hospital has met the 25 percent match for years. He commented that what he believes he hears is that this bill will reduce AIDEA's budget for grants. So what AIDEA will have to do is reduce the grant dollars somewhere. CHAIR WILSON inquired if that means this hospital will take a 15 percent reduction. DR. SUNDBY replied that is correct; it will be a 15 percent reduction. He said the way he understands the bill is that the in-kind reimbursement will go from 10 to 25 percent, so it would be a 15 percent cut in the grants that will have to be made up by the communities. REPRESENTATIVE SEATON said he wants to clarify how the numbers work with this bill. He said if a community is already matching over 25 percent, which is what this bill would accomplish, the grant amount would actually get decreased as if there were a match. Even though the hospital is already matching that amount, the hospital will not get the same grant previously obtained. DR. SUNDBY responded that is correct. Even if AIDEA were to keep the Juneau Recovery Hospital at the same grant amount, the money would have to be made up somewhere else. Number 1360 REPRESENTATIVE KAPSNER asked how this reduction will impact people. If the program loses one counselor, how many people will be impacted by that loss? Are some of these people Title 47 individuals in treatment? What does this reduction mean to a waitlist for families and jobs? DR. SUNDBY replied that the outpatient counselors are carrying a caseload of just under 30. If the program were to lose a counselor, that means there are 30 people, just at this moment, that would not be receiving treatment. So these individuals would have to be waitlisted. If those individuals were in treatment for six months, the reduction would impact 60 individuals per year at the barest minimum who would have to be waitlisted. Number 1315 REPRESENTATIVE KAPSNER asked what it means when an individual has to be waitlisted. DR. SUNDBY responded that it means the individual is placed on a list and as soon as someone comes off of treatment and there is a slot open, then the individual begins treatment. REPRESENTATIVE KAPSNER asked if people who are on waitlists typically keep on abusing substances until they begin treatment. DR. SUNDBY said that is correct. REPRESENTATIVE KAPSNER commented that these individuals do not just wait until there is room for them in the program. DR. SUNDBY replied that if they can wait, then these individuals probably would not need the treatment. CHAIR WILSON asked if there is a waitlist right now. DR. SUNDBY said that for many programs there are waitlists, but for the Juneau Recovery Hospital there is no waitlist currently. If someone needs treatment today, the hospital can have him or her assessed within a week and into treatment right away. If the hospital were to lose a counselor, then that would put a bigger load on the counselors there, and it is a contributing factor in the turnover rate. The more asked of counselors, the more the stress level goes up, and the more likely the hospital will lose staff. This is a major issue for all of the treatment providers. REPRESENTATIVE KAPSNER asked Dr. Sundby if the 60 people per year he mentioned are only for the Juneau Recovery Hospital, not statewide. DR. SUNDBY responded that is not statewide. He clarified that the number he provided is a conservative estimate for the Juneau Recovery Hospital. Number 1227 REPRESENTATIVE CISSNA commented that if an individual who is on the waitlist begins or continues to drink, in order for the treatment to be successful the individual must be sober. DR. SUNDBY told the members that it is essential to strike when the individual is willing to come into treatment. If the individual does not get in right away, there is a lost opportunity. In response to Representative Cissna question about detoxification, Dr. Sundby said individuals are placed in a medically managed detoxification program if it is available. Currently, that is available and there is no waitlist for that treatment; however, for services beyond that such as outpatient services, an individual may have to wait in line to get that treatment. It is not a very good option, because the individual has probably gone back out and will likely have to go through detoxification again. Number 1150 MR. MURPHY responded to Representative Kapsner's earlier question concerning the number of individuals on waitlists. He said that he will supply the committee with the numbers. Mr. Murphy told the committee that the number is significant, especially with respect to women and children's programs. Alcohol and drug abuse treatment programs are being asked to lessen the impact on the Division of Family and Youth Services, where parents and children have substance abuse issues. This is a population group that has a very high percentage of those needing treatment. There continues to be a greater and greater need of higher-treatment capacities. That is one of the primary reasons this legislation is so crucial at this time. It is essential that the state not reduce treatment capacity. REPRESENTATIVE KAPSNER said that because she is pregnant, she is very concerned about Fetal Alcohol Syndrome (FAS). She asked if individuals who have been identified under Title 47 are waitlisted. MR. MURPHY responded that pregnant women are a first priority and are not waitlisted. Also, anyone who is using needles or may have other health-related issues are at the top of the priority list, and a bed would be found for those individuals. Number 1015 REPRESENTATIVE KAPSNER asked what would happen if a mother had small children. MR. MURPHY responded that the Women's Resource Center in Anchorage does accommodate some children, but it has had to cut its beds from 45 to 17 beds in the last year and a half. There is a definite shortage for a patient who needs placement with small children. Number 0990 REPRESENTATIVE GATTO commented that it is so important to get pregnant women into treatment as soon as possible. He asked Mr. Murphy, if a woman walks in who is pregnant, whether his facility would be able to admit her into treatment right away, or whether she would be placed first on the list to prevent the disaster that will inevitably occur. MR. MURPHY replied that the City of Ketchikan contributes to this program, so between the city and the state grants, the program would find a treatment bed for this woman. He said that for people who come to the treatment facility and show a desire for treatment, his program will find a bed for them or work with them while they are on the waiting list. Number 0907 JANET MCCABE, Chair, Partners for Progress, testified in opposition to HB 167. She told the committee that Partners for Progress is the nonprofit organization that works with Judge Wanamaker's' wellness court [Anchorage Wellness Court]. The organization supports the development of therapeutic courts throughout the state. She asked the members to look at the second page of the handout she provided to the committee titled "Alaska Almanac of Alcoholism and Jail". MS. MCCABE told the committee her organization is opposed to this bill for three major reasons. First, the treatment agencies are really important to the therapeutic courts. These are key elements to their success, since without treatment, agencies there would be no working therapeutic courts. These agencies are already strapped for money, and this bill would require that they raise another 15 percent of the cost at the same time that municipal revenue sharing is being reduced. This actually gives community alcohol-abuse programs a double cut. She pointed out that alcohol abuse is hugely expensive to the state and the public. Regardless of an individual's view of alcoholics, it is a practical matter that treatment be delivered. Of the 8 or 9 percent of problem drinkers, each problem drinker will affect at least four additional people - mothers, fathers, children, families, victims, et cetera. This means that between 30 to 40 percent of Alaska's population is affected by alcoholism. Some of the problems are pretty obvious, for example, driving under the influence of alcohol [DUI], child abuse and neglect, poor health and dependence, domestic violence, and all the costs associated with this problem. The cost of alcohol abuse in Alaska is $453,000,000. Treatment programs like this should not be cut. It is important to think of the long-term problem. Number 0725 MS. MCCABE told the committee that one Fetal Alcohol Syndrome (FAS) child will cost the public about $1.4 million over the child's life. Alcohol abuse is the gorilla in our midst, and community programs designed to address alcohol abuse should not be cut. The final reason for opposition to this bill is that last year when the legislature passed HB 225 increasing the tax rate on alcoholic beverage sales, it was directed that half of the tax collected be deposited in the Alcohol and Drug Abuse Treatment Fund. Much of this money comes from local businesses and communities, and she said it does not seem consistent with the previous policy to cut treatment money this year. In conclusion, she said she believes this bill is contrary to the intent of the Alcohol Beverage Sales Tax last year and especially harmful to the Alaska population overall. Number 0649 MARLA LIPPARD, Clinical Director, Gastineau Human Services, testified in opposition to HB 167. She told the committee that Gastineau Human Services (GHS) provides correctional services, substance abuse, and mental health treatment, and is opposed to HB 167, which would raise the match from 10 to 25 percent. All regions of Alaska currently lack the treatment capacity to deal with their local needs. The demand far exceeds the capacity to provide treatment. The statistics just given by Partners for Progress demonstrate that it makes no sense to lower the treatment capacity. Public safety, emergency health services, and the criminal justice system end up paying more. Families and communities end up paying more in personal losses. If the formula from respected national research shows $7 is paid for every $1 invested in treatment, she said this kind of cut will cost the state an estimated $21 million in other costs. Across Alaska, programs will have to find an additional $3.6 million in their communities to make up the difference, when most municipalities are struggling to keep core services. Ms. Lippard told the committee that treatment facilities in some communities are going to close. Treatment programs have not had an increase to their budgets, primarily through state grants, in 10 years. It has already cost their operating budgets 25 percent. MS. LIPPARD said that HB 167 would cut $1.5 million out of programs serving thousands in the Anchorage bowl area. It would cut nearly $250,000 for programs out of Bristol Bay. It would cut more than $500,000 in programs serving Southeast communities, and nearly $350,000 out of the Fairbanks area. Gastineau Human Services serves 300-400 indigent and low-income individuals in the Juneau area every year. It is done on a $360,000 budget and cannot be done on any less. There is a waitlist at any time of approximately 70 people. In summary, Ms. Lippard asked the committee to consider 12.5 percent or 15 percent, but not 25 percent, as a reduction. Number 0425 JANET FORBES, Outpatient Coordinator, Gastineau Human Services, testified in opposition to HB 167. She said GHS has a waiting list that is two to three months out. That is one to two people per day that are waiting for assessments. It puts the community at risk and it puts families at risk. Gastineau Human Services receives referrals from the court system at enormous rates. The inmate substance abuse treatment (ISAT) program was cut from the prisons, so that means GHS will be getting those individuals into the treatment programs. If this money is cut, GHS will probably lose two or three counselors, while the number of individuals who require case management will continue to rise. This will put more and more people at risk. She urged the committee to definitely consider not cutting this funding. Number 0331 MS. FORBES noted that GHS's treatment program picks up FAS issues, mental health issues, and medical issues, and serves the person as a whole. This bill is not just cutting treatment of chemical dependency. She urged the committee not to cut these programs. She agreed with Ms. Lippard's statement that possibly 12 percent or 15 percent, but not 25 percent [would be an acceptable reduction]. CHAIR WILSON asked if GHS collects statistics to see what percentage is successful. Number 0246 MS. FORBES replied that it does keep statistics, which are turned in to the state. Recovery is a process and GHS normally sees individuals once, twice, or even three times through the system. That is not uncommon. Gastineau Human Services has had individuals who have come through the program that were chronic alcoholics. These are people that lived on the street, that are now leading fruitful lives. At times they relapse, but they keep coming back, and that is the key. These people are employed, off the street, and not into the criminal justice system as they used to be. CHAIR WILSON asked what percentage have been successful through the GHS program. MS. LIPPARD responded that for individuals who complete GHS's program, after one year approximately 70 percent have full-time employment. CHAIR WILSON asked what is the percentage of those who complete the program. MS. LIPPARD replied that 40 percent complete the program. She told the committee that GHS has assistance in getting completion because many [referrals] are court-mandated. CHAIR WILSON asked for clarification that of the 40 percent who complete the program, 70 percent are full-time employed after one year. MS. LIPPARD commented that GHS surveys these individuals at that one-year mark, and while they may be employed when surveyed, does not mean they have been employed the entire year. It is a state survey that is designed and worded by the state. The question reads something like: "Are you employed full-time (30 to 40 hours)." Number 0065 REPRESENTATIVE KAPSNER asked Ms. Lippard if she knows of other indicators of success. She said she knows there are functional and working alcoholics. If so, what are those indicators? MS. LIPPARD said an obvious indicator is whether the individual is drunk or not. REPRESENTATIVE KAPSNER asked if an indicator could be fewer family visits to the shelter or that the individual was a binge drinker, but not to the extent that the person lost his/her house, car, or job. MS. LIPPARD said that there are indicators such as fewer visits to the hospital, or law enforcement involvement. She offered to forward the outcome statistics to the committee that she feels might be helpful. TAPE 03-28, SIDE A Number 0001 CHAIR WILSON asked Mr. Lindstrom if he could present the committee with statistics on the success of treatment programs throughout the state. Are there some programs that have been more successful than others? Number 0068 ELMER LINDSTROM, Special Assistant to the Commissioner, Office of the Commissioner, Department of Health and Social Services, testified on HB 167 and answered questions from the members. Mr. Lindstrom asked the members to look at the "Chemical Dependency Treatment Outcome" study that he referred to at the last committee hearing on this bill. This study was done in 1998, and while the department does collect ongoing data, the department does not have any more recent reports to share with the committee. MR. LINDSTROM asked the members to look at the Executive Summary of the report. These bullets will give the committee a good sense of the types of outcomes that the department felt confident provided good data at that point in time. It is quite consistent with outcomes in other jurisdictions. Generally speaking, clients in outpatient treatment who receive at least 50 hours of care have the best chance of success. There is a somewhat less successful rate for residential patients because those patients are more severely impacted than folks that are in outpatient treatment at the outset. He told the committee he does not have any really current data, but he said he believes this might be useful information for the committee. Number 0231 REPRESENTATIVE KAPSNER asked if the statistics are comparable with other states. MR. LINDSTROM responded that these outcome statistics are very comparable with other jurisdictions. He pointed to the [undated] "Dear Reader" letter in the packet [Chemical Dependency Treatment Outcome Final Report - December 1998] where it says [paragraph four, last sentence], "These findings also compare very positively to studies done at programs elsewhere in the nation." Mr. Lindstrom said he would follow up with the division to see if there is more current data available, but he believes this is the best and most credible information collected. CHAIR WILSON read the first bullet in the Executive Summary, where it said: Of Alaskan patients surveyed, 56 percent of those in outpatient programs abstained from alcohol for one year after treatment, compared to 42 percent of residential patients. Outpatients in the study received an average of 59 hours of care, while patients in residential programs received an average of 39 days of inpatient care. Number 0366 MR. MURPHY told the members that he has been working with a committee for the last six months that includes the Division of Alcoholism and Drug Abuse, the Division of Mental Health and Developmental Disabilities, and the Center for Substance Abuse Treatment to have a web-based evaluation system that will be coming on line in the next six months. In terms of having an integrated outcome data system, this is something the Substance Abuse Directors Association has pushed for. He said this program will provide the outcome data needed on a daily basis to assist in policy decisions. Number 0481 MR. LINDSTROM told the committee that the department would be happy to sit down with the committee and have an in-depth briefing and discussion on the subjects of outcome, treatment, and success. Number 0499 REPRESENTATIVE COGHILL pointed out that the issue is as huge and deep as the committee wants to go in Alaska, and that there are some specifics in the package that he wants to ask Mr. Lindstrom about. Representative Coghill said there are 58 programs out of the 115 programs that are exempted from the match requirements. There are 15 programs that are under-$30,000 grants that show a 10 percent match rate. He said he got a letter from Pamela Watts in which she suggested that these programs be held harmless. Representative Coghill asked if that is true under this particular legislation. MR. LINDSTROM responded that while he has not counted up the numbers, he suspects that Representative Coghill has counted accurately. These are the small suicide-prevention grants for small communities that are exempted entirely. Some other prevention grants were exempted entirely, such as the local match requirement for some small treatment programs, very specifically serving women and children for some of the reasons the members have heard in previous testimony. The department retains the ability under statute to further exempt programs from the match on an individual basis. However, the department wants to caution the committee that an exemption from a program would by all likelihood require further reductions elsewhere in the grants. Number 0664 MR. LINDSTROM said he does not intend to turn the meeting into a budget meeting, but asked the members to look at the budget proposed by the governor relative to the current work plan in the current year. There is a significant increase when all funding sources are considered of about $4 million for substance abuse programs. The department is focusing on those program areas mentioned earlier, specifically, women and children, and adolescents in rural areas. There are a whole host of changes that are going on, and there are losses of federal funds in some areas, a loss of mental health trust funds in some areas, and some increases in mental health trust funds in other areas. A lot of things are going on in the budget, but the bottom line and the demonstration of this administration's commitment to substance abuse treatment "when you net all of those out" is that there is about a $4 million increase in funding. MR. LINDSTROM said what was heard from a lot of treatment providers this afternoon is that it will not be easy to get there. He said he is not underestimating the problems folks were describing with regard to how difficult it will be to meet the enhanced match requirement, nor does he want to minimize the work that providers and the state will have to do to help generate additional Medicaid funding into the programs. But if everyone works together and things go as the administration believes it can, he said the end result for fiscal year 2004 will be an increase in total funding for substance abuse treatment programs in the state. Number 0776 MR. LINDSTROM said that in the absence of this bill's passing, he does not want any of the providers to believe that necessarily means that the $1.6 million associated with this bill will somehow magically be restored to the budget. These funds are out of the budget as proposed by the governor, and it will be a budget reduction in the absence of this bill. REPRESENTATIVE COGHILL reiterated that there is a provision in this bill to provide exemptions where it can be demonstrated as necessary. At this point, over half of the programs have already demonstrated that need. Thirteen of those programs are in those exempt areas or Class A grant awards, which are $30,000-limit grants. A significant portion of the programs are being relieved of this possible reduction. He said for those that are not exempt, community effort will be appropriate. CHAIR WILSON announced that she will hear the last person signed up to testify today. At the next meeting there will not be any testimony taken. Number 0894 ERIN CRUZ, Correctional Programs Director, Gastineau Human Services, testified in opposition to HB 167. She told the members that she sees 700 people per year come through the community residential center; 10 percent of those go through the treatment programs, and they are all indigent and coming out of prison. These people need to have treatment before they can go to school, work, or get on their feet. Number 0950 MS. CRUZ told the committee if this treatment goes away there will be other repercussions that will occur. There will be an increase in domestic violence, an increase in fetal alcohol syndrome, and other domino effects with these people not getting into treatment. There will probably be a $40,000 cut, but [GHS is] dealing off of a budget of $360,000. The budget has already been dropped to $330,000, and if another $40,000 is cut, the legislature needs to understand that there will be repercussions. It will affect not only alcoholics, but also their families. There will be a lot more people in hospitals. Ms. Cruz said that while she hears all the numbers, the real impact is what will happen to the people. She pointed out that one in six people in Alaska is an alcoholic. Number 1010 REPRESENTATIVE CISSNA asked about the workforce issue. She said she is aware of the enormous pressure on nonprofit organizations with cuts to the budgets and rising insurance costs. She asked if the decrease in funding will affect GHS's ability to get workers and retain them. Number 1075 MS. CRUZ responded that this cut will absolutely affect its employees. She said GHS has been working on the 2004 budget and finds that it will be a $153,000 loss in the behavioral health programs, and two programs have ended that were very beneficial to this community. Many programs are at or just below the break-even point, and GHS is really scrambling for grants. She told the committee that May 1 is the last day of the recycling program, the junk busters program will end, and several other programs cannot be done anymore. Gastineau Human Services will lose one to three counselors. Its personnel work at 150 percent, and it is not possible to ask more of them. There has been discussion about cutting wages, but if that is done, GHS will lose people. Number 1123 CHAIR WILSON commented that these are not easy decisions that have to be made, and no matter what the members do, it affects people. CHAIR WILSON announced that next Thursday this bill will be heard again. This has been the third hearing on HB 167, so testimony will not be taken at that meeting. Number 1167 REPRESENTATIVE COGHILL asked if there would be a vote on a proposed amendment today. CHAIR WILSON stated that there would not be any votes taken today. At the next meeting there will be discussion among committee members, and amendments will be taken up at that time. [HB 167 was held over.]
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