Legislature(2005 - 2006)CAPITOL 106

05/03/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 288 MEDICAID PERSONAL NEEDS ALLOWANCE TELECONFERENCED
Heard & Held
+ SB 150 ALASKA CHILDREN'S TRUST FUND GRANTS TELECONFERENCED
Moved Out of Committee
+ HB 271 LIMIT OVERTIME FOR REGISTERED NURSES TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
SB 150-ALASKA CHILDREN'S TRUST FUND GRANTS                                                                                    
                                                                                                                                
CHAIR WILSON  announced that the  first order of business  was CS                                                               
FOR  SENATE BILL  NO. 150(HES)  "An  Act relating  to the  Alaska                                                               
children's trust grant awards."                                                                                                 
                                                                                                                                
3:30:10 PM                                                                                                                    
                                                                                                                                
JASON  HOOLEY,   Staff  to  Senator  Fred   Dyson,  Alaska  State                                                               
Legislature, presented  SB 150  on behalf  of the  Senate Health,                                                               
Education and Social Services  Standing Committee, sponsor, which                                                               
is chaired by Senator  Dyson.  He said that in  the late 80s, the                                                               
Alaska  Children's  Trust  was  created  by  the  legislature  to                                                               
provide  start-up funding  to community-based  programs dedicated                                                               
to  preventing  child  abuse.    The  amount  of  the  grants  is                                                               
prescribed in state statute.  Since  then, he said, "the board of                                                               
trustees   has   requested   some   additional   flexibility   in                                                               
determining the amount of grants  that they award."  The proposed                                                               
legislation would  meet that  request by:   removing  the $50,000                                                               
annual cap  on the  grants; refining the  funding formula  set in                                                               
statute;  including a  four-year  limit on  the  grant awards  in                                                               
order to  enforce the  original intent to  provide seed  money to                                                               
the  community  organizations;  setting  up  a  requirement  that                                                               
applicants include a self-sustainability  plan in their proposal;                                                               
and  giving the  board of  trustees  the authority  to reduce  or                                                               
eliminate  grants in  order to  enforce  program requirements  or                                                               
performance goals.                                                                                                              
                                                                                                                                
3:31:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER asked what triggered the bill.                                                                           
                                                                                                                                
3:32:06 PM                                                                                                                    
                                                                                                                                
JOEL  GILBERTSON,  Commissioner,   Office  of  the  Commissioner,                                                               
Department  of  Health  and  Social  Services  (DHSS),  said  the                                                               
commissioners   of  the   Department  of   Education  and   Early                                                               
Development and  the Department of  Health & Social  Services, by                                                               
their office, were appointed to  the Alaska Children's Trust when                                                               
it was initiated; however, the bulk  of the members are not state                                                               
employees.  In response to  Representative Gardner's question, he                                                               
said what prompted the legislation  to move forward was a strange                                                               
circumstance,  which is  that  the  trust has  not  done any  new                                                               
grants in  over two years.   Because the funding doesn't  go into                                                               
operations, but rather  is used to start  up innovative programs,                                                               
getting them  up and  running, and moving  on to  something else,                                                               
the original statute contemplated  a step-down in funding support                                                               
over a  four-year period.   Some legislators assumed that  by the                                                               
fifth  year,  the program  being  funded  would  be on  its  own;                                                               
however, the statute  is vague.  As a result,  there are programs                                                               
that have continued to receive  a base amount of approximately 25                                                               
percent into the eighth year.                                                                                                   
                                                                                                                                
COMMISSIONER GILBERTSON  said the  challenge with  the Children's                                                               
Trust  is  that   the  principal  of  the  fund   has  not  grown                                                               
drastically and  has a  fairly conservative  investment strategy.                                                               
The grant  making comes  solely from the  interest that  the fund                                                               
earns; the principal  cannot be touched.  Because  the market has                                                               
been fairly  flat, there  has been a  relatively fixed  amount of                                                               
money that comes out of earnings  of the fund on an annual basis;                                                               
it has ranged from between  $210,000-$240,0000 per year.  He said                                                               
there comes a point in which a  25 percent obligation to 30 to 40                                                               
grants  fully  utilizes  the  money and  doesn't  allow  for  new                                                               
funding.    The  key  element  of  SB  150  is  to  clarify  what                                                               
Commissioner  Gilbertson  said was  the  intent  of the  original                                                               
legislation,  which is  that after  the four  years of  step-down                                                               
funding, the amount goes to zero.   He described the process as a                                                               
natural attrition every four years,  which would allow new grants                                                               
to be brought onto the program.                                                                                                 
                                                                                                                                
COMMISSIONER  GILBERTSON noted  that  the trust  has received  an                                                               
earmark   in  the   last  federal   fiscal   year  for   specific                                                               
programming; however, that funding doesn't  go into the corpus of                                                               
the fund.  He offered further details.                                                                                          
                                                                                                                                
3:37:02 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  directed attention  to a  booklet in  the committee                                                               
packet, entitled,  "Alaska Children's Trust Annual  Report 2004,"                                                               
and noted that on page 12 the grantees are listed.                                                                              
                                                                                                                                
3:37:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER noted that the  bill would also repeal the                                                               
cap on grants,  and she asked how  that fits in with  the idea of                                                               
trying to make money for new programs.                                                                                          
                                                                                                                                
COMMISSIONER   GILBERTSON  responded   that  the   cap  provision                                                               
probably has less direct application in  the short term.  He said                                                               
he thinks  the trustees would like  to be able to  "be positioned                                                               
where they could  do something sizeable in this  state," should a                                                               
large amount  of money became  available.  He stated,  "What I've                                                               
seen is  we can spend  a lot of  money doing very  little things,                                                               
and  at the  end of  the day,  they rarely,  in their  cumulative                                                               
weight and  success, accomplish what you  can get done if  you do                                                               
one sizeable project and you put  your money behind it."  He said                                                               
the scope  of child abuse is  wide and, because there  is a small                                                               
amount  of money,  the mission  needs to  be tightly  defined and                                                               
funds need  to be targeted  around accomplishing "a  clear change                                                               
around  what the  trustees define  as child  abuse and  neglect."                                                               
Without SB 150,  he cautioned, there will be no  new grant making                                                               
for the third straight year.                                                                                                    
                                                                                                                                
3:40:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  said  she  has  been  asking  about  "the                                                               
measurements"  for the  last  seven  years she  has  served as  a                                                               
Representative, and  she has  yet to see  the programs  come back                                                               
with them.  She stated, "Creating  the model is almost as much of                                                               
a necessity it  seems to me as  doing a lot of  other things that                                                               
wouldn't have lasting effect."                                                                                                  
                                                                                                                                
3:41:27 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON  encouraged  the  committee  to  involve                                                               
Margo McCabe in  the discussion, because she is the  chair of the                                                               
trust, while he is just a  member.  In response to Representative                                                               
Cissna's  concern, he  said he  thinks the  trustees will  "self-                                                               
acknowledge  that  there  really  hasn't  been  good  performance                                                               
measures in the  grants."  He offered examples.   He mentioned an                                                               
idea of moving from grants to performance contracts or measures.                                                                
                                                                                                                                
3:43:04 PM                                                                                                                    
                                                                                                                                
MARGO  MCCABE, Chair,  Alaska Children's  Trust, said  she thinks                                                               
Commissioner Gilbertson has  done a good job  covering the intent                                                               
of  the  proposed  legislation   and  explaining  why  the  trust                                                               
supports it.   She  echoed the  commissioner in  emphasizing that                                                               
over  the last  couple of  years the  trust has  only had  enough                                                               
money to fund recurring grants.   She said the trust thinks there                                                               
are a  lot of innovative  programs in existence worth  looking at                                                               
and would like  to have its money  freed up to do  so.  Regarding                                                               
performance measures, she said the trust  is about to issue a new                                                               
[request for  proposals (RFP)] and  has done good work  in giving                                                               
examples of  performance measures that  grantees can track.   She                                                               
said there  is a system  in place for  the trustees to  meet with                                                               
grantees to  ensure they  are meeting the  indicators.   She said                                                               
she thinks  SB 150  will move  the trust  closer to  ensuring the                                                               
grantees are  performing and will  sustain the programs  once the                                                               
grant  monies  are  gone.   She  concluded,  "The  sustainability                                                               
requirement just enforces what we're putting in our RFP."                                                                       
                                                                                                                                
MS. MCCABE, in  response to a request from the  chair, listed the                                                               
Alaska Children's Trust board members.   In response to a follow-                                                               
up comment  from Chair  Wilson, she  agreed that  currently there                                                               
are not many members from smaller  communities.  In response to a                                                               
question  from  the  chair,  she  noted  that  the  trustees  are                                                               
appointed to the board by the governor.                                                                                         
                                                                                                                                
CHAIR WILSON  said she would  like to see more  representation on                                                               
the board from rural Alaska.                                                                                                    
                                                                                                                                
3:46:26 PM                                                                                                                    
                                                                                                                                
MS. MCCABE  concurred.  She  said many  of the grantees  are from                                                               
smaller communities  around the  state, so a  considerable amount                                                               
of time is spent focusing on those communities.                                                                                 
                                                                                                                                
3:47:11 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON  said   the  trust  conducts  geographic                                                               
mapping of some  of the issues around child abuse.   He mentioned                                                               
a media  campaign that  focuses on modeling  behaviors.   He said                                                               
child abuse and neglect occurs  in every community in Alaska, but                                                               
there  is  great  disparity geographically,  which  needs  to  be                                                               
acknowledged as resources are being put forth.                                                                                  
                                                                                                                                
3:49:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER inquired about  license plate and heirloom                                                               
birth certificate programs.                                                                                                     
                                                                                                                                
MS. MCCABE  said those  programs, which  are offered  through the                                                               
Office  of  Vital Statistics,  were  in  place before  she  began                                                               
serving  on  the board  and  have  become self-sustaining.    She                                                               
deferred further comment to the commissioner.                                                                                   
                                                                                                                                
3:50:22 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON  noted that  the trust  does not  have an                                                               
administrative  budget  or  staff,  but  has  done  a  tremendous                                                               
volunteer  effort getting  involved  in RFPs  and contracts,  and                                                               
going above  and beyond  what normal trustees  would have  to do.                                                               
He said the  Department of Revenue provides support  to the trust                                                               
by  managing  the financial  accounts,  investing  the fund,  and                                                               
providing  a portion  of staff  time  to advise  the trustees  on                                                               
financial issues.   The  Department of  Health &  Social Services                                                               
provides  administrative  support  and   uses  resources  in  its                                                               
department  for the  actual administration  of the  grants.   The                                                               
heirloom certificates  and license plates  are two other  ways to                                                               
raise  funds.     He  described  the   heirloom  certificates  as                                                               
"slightly  more ornate  than the  traditional document  you would                                                               
get from vital statistics."                                                                                                     
                                                                                                                                
3:51:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON expressed  concern regarding  removing the                                                               
$50,000 cap.   He  noted that  the highest  grants the  trust has                                                               
given have  been for  $20,000, and  it would  appear that  if the                                                               
trust  went  above  $50,000,  then   all  the  efforts  would  be                                                               
concentrated  in the  most  populated  areas of  the  state.   He                                                               
questioned  if there  really  is  a need  to  remove  the cap  or                                                               
whether the trust  is just looking at possibly  having more money                                                               
to grant in the future.                                                                                                         
                                                                                                                                
COMMISSIONER GILBERTSON  said he thinks it's  important to remove                                                               
the  cap.   First, it  would position  the trust  going into  the                                                               
future as  the corpus of  the fund  grows.  Also,  smaller grants                                                               
are not  as efficient.   He said it  shouldn't be assumed  that a                                                               
single grant cannot have statewide  application; the trustees are                                                               
committed to a  statewide application of the trust.   In fact, on                                                               
a  per capita  basis, the  grants are  probably heavily  weighted                                                               
towards  rural  regions, which  he  opined  is appropriate.    He                                                               
concluded, "It's very  difficult for us to manage  the trust with                                                               
some of the constraints that are placed on it right now."                                                                       
                                                                                                                                
MS. MCCABE  said that she  supports lifting  the cap in  order to                                                               
position the trust  board to receive larger grants  in the future                                                               
which then can  be distributed in the most appropriate  way.  She                                                               
said there  is no intent to  change the strategy in  terms of how                                                               
many [grants] are  distributed.  She stated,  "We're committed to                                                               
continue funding programs all around the state."                                                                                
                                                                                                                                
COMMISSIONER GILBERTSON  offered some  examples of how  the trust                                                               
uses  its  funds.   He  noted  that  the  trust has  been  unable                                                               
administratively to  expend funds given to  the it to do  a media                                                               
campaign because of the existing statute.                                                                                       
                                                                                                                                
CHAIR WILSON asked who holds the trust accountable.                                                                             
                                                                                                                                
3:56:52 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON  replied  that  the trust  is  a  public                                                               
entity  appointed by  the  governor.   Ultimately,  he said,  the                                                               
individual ultimately  responsible is  the commissioner  of DHSS.                                                               
He explained:                                                                                                                   
                                                                                                                                
     Procedurally, the  way the trust actually  works is the                                                                    
     trustees  make the  spending decisions,  those spending                                                                    
     decisions are  integrated into the grant  making of the                                                                    
     Office  of Children's  Services  and, as  commissioner,                                                                    
     I'm  the one  who actually  signs the  authorization to                                                                    
     expend the  funds, ... approves  the RFP,  and approves                                                                    
     the grant awards.                                                                                                          
                                                                                                                                
CHAIR WILSON asked if [the  trust] would object to reporting each                                                               
year to  both the  Senate Health,  Education and  Social Services                                                               
Standing  Committee and  the House  Health, Education  and Social                                                               
Services Standing Committee.                                                                                                    
                                                                                                                                
3:58:13 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON responded  that the  trust publishes  an                                                               
annual report that  documents where the funds go, and  he said he                                                               
could  certainly  make  a  commitment to  the  chair  that  every                                                               
legislator gets a copy.                                                                                                         
                                                                                                                                
REPRESENTATIVE  SEATON   referred  to  [the   sponsor  statement,                                                               
included  in  the  committee  packet,   which  includes  a  chart                                                               
describing the funding  formula].  He questioned  whether the way                                                               
the chart was written may be ambiguous.                                                                                         
                                                                                                                                
COMMISSIONER  GILBERTSON  explained  that the  funding  scale  is                                                               
existing law.  He said the  grantee comes forward with a proposal                                                               
with an  amount for a program  set.  The percentages  are figured                                                               
each year  from the set amount.   In response to  a question from                                                               
Chair Wilson,  he reiterated that  everyone he has spoken  to has                                                               
said the intent was that there  would be a natural turnover after                                                               
four years,  but that  sentence is  missing in  statute.   Of the                                                               
sixteen grantees going into the  upcoming grant years, 12 of them                                                               
will be past  four years, three of the remaining  the fourth year                                                               
and one will be in its third year.   There will be no grantees in                                                               
the first or second year.                                                                                                       
                                                                                                                                
4:02:59 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON, in  response to  a question  from Chair                                                               
Wilson as  to where  that language exists  in the  bill, directed                                                               
attention to page 2, lines 7-8, which read:                                                                                     
                                                                                                                                
         (d) The board may not award grants to a single                                                                         
     project or program for more than four years.                                                                               
                                                                                                                                
COMMISSIONER  GILBERTSON, in  response  to  a follow-up  question                                                               
from Chair  Wilson, said  there are  two more  areas in  the bill                                                               
with "salient  pieces of  new language."   One  part of  the bill                                                               
would  require the  grantees to  have a  sustainability or  self-                                                               
sufficiency plan.  The other new language read as follows:                                                                      
                                                                                                                                
          (g) The board may reduce or discontinue a grant                                                                       
     awarded or  distributed under this section  at any time                                                                    
     during the  grant period  if the  project is  not being                                                                    
     successful   in   accomplishing  its   objectives,   as                                                                    
     determined by the board.                                                                                                   
                                                                                                                                
4:04:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   CISSNA   reiterated   her   concerns   regarding                                                               
performance measures.  She said  the state needs to have partners                                                               
in  the  private  sector  that provide  services.    She  offered                                                               
further examples.   She suggested adding language  to include new                                                               
organizations with ideas for programs.                                                                                          
                                                                                                                                
4:06:52 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   GILBERTSON   said   he   doesn't   disagree   with                                                               
Representative Cissna.   He  said he  has a  lot programs  in his                                                               
department   that  need   to  be   addressing  the   issues  that                                                               
Representative Cissna is  talking about.  He  said questions that                                                               
need to be addressed are:   "How do we bring competition into the                                                               
marketplace for  grant making; ...  how do we make  our decisions                                                               
on awarding  grants based  on performance -  on outcomes  that we                                                               
the  payer  have set;  and  how  do  we  hold our  grantees,  ...                                                               
contractors, ... vendors, or our  providers accountable for those                                                               
outcomes?"  He added that the  Alaska Children's Trust is not the                                                               
entity to engage  in that conversation, because  the sole purpose                                                               
of the trust is about primary prevention and keeping it simple.                                                                 
                                                                                                                                
CHAIR WILSON closed public testimony.                                                                                           
                                                                                                                                
4:09:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to  report CSSB  150(HES)  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSSB  150(HES)  was                                                               
reported out of  the House Health, Education  and Social Services                                                               
Standing Committee.                                                                                                           

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