Legislature(2013 - 2014)CAPITOL 106
04/10/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB162 | |
| HB356 | |
| HB380 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 356 | TELECONFERENCED | |
| *+ | HB 380 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 162 | TELECONFERENCED | |
HB 380-WIC SUPPLEMENTAL FOOD PROGRAM VENDOR
3:41:22 PM
CHAIR HIGGINS announced that the final order of business would
be HOUSE BILL NO. 380, "An Act relating to the selection by the
Department of Health and Social Services of vendors under the
federal Special Supplemental Food Program for Women, Infants,
and Children."
3:41:55 PM
REPRESENTATIVE GABRIELLE LEDOUX, Alaska State Legislature,
paraphrased from the sponsor statement, which read:
HB 380 compels the Alaska Department of Health and
Social Services to seek permission from the United
States Department of Agriculture to provide a hardship
exemption to vendor selection and approval criteria in
the Women, Infants, and Children (WIC) supplemental
food program.
Alaska is an increasingly diverse state with people of
many different cultural, religious, and ethnic
backgrounds sharing our local communities. These
cultural enclaves are often populated by people of
low-income status who need government assistance in
making ends meet. Currently one of the only
significant sources of food for the people on
supplemental food programs are big-box stores which
are either too far from the community or do not
provide the items necessary for their unique cultural
or religious needs.
Adding a hardship exemption to the WIC vendor program
would allow those people with specific cultural or
religious sustenance needs to have those needs meet
without undue expense or hardship.
HB 380 recognizes that Alaska is a diverse community
and allows that diversity to be rewarded and to
prosper.
3:43:02 PM
LISA VAUGHT, Staff, Representative Gabrielle Ledoux, Alaska
State Legislature, read from a prepared statement. She stated
that the proposed bill instructed Department of Health and
Social Services (DHSS) to seek a waiver from the U.S. Department
of Agriculture to expand federal Special Supplemental Food
Program for Women, Infants, and Children (WIC) vendor
eligibility. It would allow small Alaskan grocers serving
minority communities with significant language barriers to
accept the WIC vouchers. She opined that the limitations of the
current WIC vendor eligibility requirements harm both Alaska's
minority communities and the local stores serving them. She
stated that locally owned businesses had been excluded at a
great cost to the diverse minority communities which made
Anchorage neighborhoods vibrant. She noted that reliance on WIC
ensured an even more fundamental role of the local shops in the
community. She pointed out that the proposed bill would "re-
prioritize current WIC regulations from favoring big box chains
at the expense of small local businesses." She acknowledged
that, although the control of cost was an important
consideration, the fundamental purpose was to help those who
were most vulnerable. She stated that a cultural component to
the WIC regulations was critical to the health of the minority
communities. She said that a request to expand the WIC vendor
eligibility requirements was the least that could be done for
these communities.
3:45:08 PM
REPRESENTATIVE KELLER questioned how it would be determined
which communities had language barriers, asking if there was
data readily available. He offered his assumption that this was
directed at language barrier communities as it was taken from a
federal guideline.
REPRESENTATIVE LEDOUX replied that there was language in the
federal guidelines which allowed application for an exemption
when language barriers existed. She reported that there was a
significant Hmong community in East Anchorage with limited
English proficiency. She did not know if there were state
records for language challenged communities.
REPRESENTATIVE SEATON asked if the availability of the stores to
the community was part of the issue, as it was necessary to have
transportation to shop at the larger stores.
REPRESENTATIVE LEDOUX replied that this was an issue. She
offered examples for East Anchorage and Mountain View which
necessitated transportation, or an unsafe walk with groceries.
CHAIR HIGGINS asked about the large fiscal note.
REPRESENTATIVE LEDOUX replied that the fiscal note was a
surprise, as the proposed bill was only asking to apply for a
waiver.
REPRESENTATIVE KELLER asked if a waiver request would need a
justification.
REPRESENTATIVE LEDOUX said that it should be done without
spending a huge amount of money. She surmised that language
barriers in communities should be the determinant for the
application for the waiver.
3:49:59 PM
RON KREHER, Director, Director's Office, Division of Public
Assistance, Department of Health and Social Services (DHSS),
explained that the department was challenged as there was no
hard data on the degree for which language barriers created
challenges to access WIC foods. He expressed agreement that
there were language challenges; however, a waiver had to be done
at a statewide level. The federal guidelines for food and
nutrition services recommended the department conduct a survey
and assessment to identify language barriers statewide. He said
that this cannot be done piecemeal. He explained that the
fiscal note reflected a best guess based on similar surveys, but
it would be necessary for a contractor to define the scope. He
acknowledged that there were many communities with a high
percentage of non-English speakers. The data was necessary to
assess whether there were significant barriers to accessing food
in grocery stores, in order to satisfy Alaska and the federal
government to focus resources in those challenged communities.
He reported that all WIC vendors had to meet specific criteria,
and, even if serving a predominantly ethnic population, it was
required to stock sufficient quantities of all the WIC approved
food. He offered an example for quantities necessary for 35 WIC
recipients served by a specific store, which included 394 quarts
of low fat or nonfat milk on the shelves every day, as well as
records to track this. He pointed out that most convenience
stores did not carry this quantity or the full suite of foods
required for WIC stores. He said that it was also necessary to
review the peer groups of different vendors, so there would be
balance. He noted that the proposed bill spoke to barriers
based on language, food preference, and cultural bias. He
pointed out that food preference was not included in WIC, as WIC
only allowed specific foods. If a food item was not WIC
approved, then it could not be purchased under the WIC program.
He offered an example that brown rice was acceptable, while
white rice was not. He stated that the acceptable food list was
nutritionally based and science driven, so there were variables
other than non-English speaking staff for a WIC vendor.
CHAIR HIGGINS asked if food stock was an issue for WIC vendors
in the bush communities.
3:55:09 PM
KATHLEEN WAYNE, Program Manager, WIC, Division of Public
Assistance, Department of Health and Social Services (DHSS),
replied that a participant access study for WIC in rural Alaska
had just been completed The results had been that 25 percent
said that the foods were either not available on a regular basis
or were outdated. She stated that transportation was a key
issue. She relayed that WIC federal regulations required
regular monitoring through inventory reports and on-site
inventories to ensure that clients could get the deserved
benefits.
CHAIR HIGGINS asked what was the result for non-compliance.
MS. WAYNE said there were possible sanctions with the
possibility of termination.
REPRESENTATIVE PRUITT asked if it was possible to receive a
waiver of certain foods for certain populations.
MR. KREHER said that it was not possible, as WIC was the most
heavily regulated program with the most stringent rules in the
Division of Public Assistance.
MS. WAYNE explained that the foods chosen for WIC came from the
Institute of Medicine and were determined for ultimate growth
and healthy development. These foods were usually higher in
cost and nutrient dense.
REPRESENTATIVE PRUITT asked how the lines or scope of a
community were outlined.
3:58:50 PM
MR. KREHER explained that an amendment to the state plan to
expand or provide additional criteria for vendors would be
applied state wide, and not community based. If a community
could demonstrate that 35 WIC recipients were unable to access
WIC foods because of a language barrier, then a vendor would be
eligible for selection as a WIC vendor if they met all the other
criteria, which included documentation, signage, and maintenance
of the full suite of WIC foods. He pointed out that an
applicant needed to first be a food stamp approved vendor.
REPRESENTATIVE PRUITT asked for clarification that, although the
entire state would be granted the exemption, the vendor would
have to indicate that there were 35 people with a language
hardship, and then fulfill the other criteria.
MR. KREHER declared that this was correct. He shared a concern
for an amendment to add a range of small or convenience stores.
He reported that the costs to carry the required range of foods
were much higher for small stores, which would reduce the buying
power of the consumer. He expressed his concern that the
recipients were able to get the most for their benefit, as the
WIC approved foods tended to be higher cost. He expressed
additional concern for the administrative costs for a high level
of monitoring and maintenance. He detailed that WIC was almost
100 percent federally funded and, as administrative program
costs increase, the funding for food would decrease.
REPRESENTATIVE PRUITT asked for clarification that WIC offered a
dollar amount and not a quantity amount to participants;
therefore, the concern was that participants were not able to
purchase as much food if the costs were higher.
MR. KREHER replied that this was one factor. He explained that
the WIC program was not like food stamps, as the approved food
was based on nutritional risk, and a nutritional food assessment
was given to the participants, so the food benefit was
customized to that recipient. He pointed out that a participant
had to shop at a store which carried those prescribed food
products. He declared that WIC was a nutritional health
program.
MS. WAYNE reiterated that recipients were diagnosed for
beneficial foods at a WIC clinic. She explained that, as WIC
had a cap, participation by higher cost stores required
management by the division for those higher costs.
REPRESENTATIVE PRUITT clarified that the cap was on the program
and not on the individual.
REPRESENTATIVE SEATON asked if there could be more than one peer
group at a specific store.
MS. WAYNE replied that federal regulations required WIC to have
cost containment rules. She explained that all states had peer
groups, and that vendors were paid by their peer group. She
said that most states had three or four peer groups, based on
criteria including transportation costs, and that Alaska had 13
peer groups. She explained that the warrants had to go through
a banking contractor for review, and each peer group would be
reviewed for the maximum allowable reimbursement plus 30
percent. She said that any store with a cost higher than this
would only be repaid up to the maximum allowable reimbursement
plus 30 percent, and would incur banking fees.
MR. KREHER, in response to Chair Higgins, said that approval as
a food stamps vendor was "the first bar."
CHAIR HIGGINS expressed his appreciation for the WIC program.
He asked about the waiver for language, and he opined that when
language barriers existed, people would prefer to shop in their
neighborhood. He asked if the store could apply at any time to
be a food stamp vendor and then a WIC vendor.
MR. KREHER explained that this was possible. He said that a
factor for cost containment was to find "the sweet spot for the
number of retailers that you have in the community." He
explained that it was necessary to have enough vendors to allow
adequate access for the population, but not so many vendors to
increase the overall program costs. He allowed that it was more
complicated in urban areas. He expressed agreement that a store
could apply, and reported that there were 175 WIC vendors
statewide with 23 vendors located in Anchorage. He said that
the division would definitely review an area that was a "food
desert." He shared that any significant language barrier which
impeded access by WIC recipients to food would be addressed by
the division. He said that it was not difficult to request an
amendment to the state plan, and it would not require any
legislation. He stated that the division would still want to
have the hard data as WIC was an evidence driven program.
4:11:42 PM
CHAIR HIGGINS clarified that any food retail store could apply,
and the division would review the application.
MR. KREHER replied that the Food and Nutrition Service approved
the food stamp vendors and that his division approved the WIC
vendors. He reminded the committee that it was necessary to
first become a food stamp vendor.
MS. WAYNE relayed that the current state plan limited WIC
participation to full service grocery stores, unless, such as in
rural areas, participant needs necessitated a look at other
stores.
REPRESENTATIVE SEATON asked if a peer group, which included big
box and full service grocery stores, would be reimbursed based
on the entire peer group. He asked if other vendors in the peer
group would be reimbursed at the same cost.
MS. WAYNE replied that there were a few different peer groups in
Anchorage, which included super stores and medium size stores.
She said that there would be differences even with the big
stores for having a different peer group, although the
reimbursement prices were based on the peer group, which was
statewide. She surmised that an urban, non-full grocery store
peer group would require a maximum allowable reimbursement, even
though it was evident that there would be a higher prices.
REPRESENTATIVE PRUITT asked, as there were program costs, if
there was a limit to the number of stores accepting WIC.
MS. WAYNE expressed her agreement, stating that it was necessary
to justify the addition of another store. She said there had
not been concerns voiced by clients or local agencies for
problems with language barriers. She reported that the WIC
approved food list had pictures and brands to facilitate
language issues.
REPRESENTATIVE PRUITT asked if the tags were required on all the
WIC approved foods.
4:17:55 PM
REPRESENTATIVE TARR said that she represented the most diverse
neighborhood in the U.S., with challenges that included a lack
of engagement in traditional systems. She suggested that
transportation issues were different for different communities,
and could require other adjustments in the approach to the
problems.
MR. KREHER expressed recognition for the language challenges and
suggested involvement with community work experience and the
language center to help with outreach and education to other
individuals.
REPRESENTATIVE TARR offered an anecdote about a local store
which carried certain items that were not obtainable anywhere
else. She asked how farmer's markets had been expanded to
include WIC approval.
MR. KREHER replied that the farmer's market program had been a
collaborative effort, and expressed his hope that the program
would continue to grow.
REPRESENTATIVE TARR said that the clientele at farmer's markets
were now more diverse because of the expanded options.
MR. KREHER noted that the department tried to provide additional
funds.
4:23:24 PM
CHAIR HIGGINS opened public testimony.
4:23:34 PM
ARTHUR YANG, Owner, Dragon Oriental Store, stated that his store
would like the opportunity to serve the Hmong community as a WIC
vendor, as that community had issues with transportation and
language barriers. He said that, as a small convenience store,
he would not exceed the cap on the WIC coupon. He reported
that, as there was a language barrier, community members did not
know who to talk with or who to bring their complaints. He
shared that many of the Hmong community came from a country
where the government was always right, so they had no idea who
to bring any complaints. He said there were more than 5,000
Hmong in Alaska. He asked to be considered for the WIC program
in his convenience store, as he could better serve the Hmong
community. He stated that the Farmers Market produce was more
expensive than the regular supermarket. He said that his fee
would not be over the cap.
CHAIR HIGGINS asked if he was a food stamp vendor.
MR. YANG said that he was, and had been for more than a year.
CHAIR HIGGINS asked if he had applied to be a WIC vendor.
MR. YANG replied that his application had been denied, as
regulations did not allow smaller convenience stores, similar to
his.
CHAIR HIGGINS asked about the requirement for maintaining the
stock on hand, and if his store was able to meet this
requirement.
MR. YANG said that they could maintain the stock to meet the WIC
criteria. He declared that he could provide service to the
Hmong, within walking distance, so they would not face the
language barrier.
4:30:41 PM
SHENG YANG, Dragon Oriental Store, reported that other members
of the community asked her for help with language and other
issues. She offered anecdotes about shopping in other stores
when language was a barrier. She said that allowing the WIC
program into the smaller stores would be a help to the entire
minority community.
MAIKUE HER explained that there were language problems when
using the larger stores and that it was much easier for shopping
in the smaller community stores.
4:36:15 PM
MAGGIE YANG, (translated by Sheng Yang), Dragon Oriental Store,
said that Hmong customers came to the Dragon Oriental Store
because it was difficult for them to go to other WIC vendors, as
transportation and language was often a barrier. She said that
this difficulty often resulted in minority customers buying too
much at one time, and not being able to use all of the food.
She said that this store was conveniently located. She
explained that many minority customers did not want to go to the
big stores as there was not anyone to help them, and they were
humiliated or embarrassed.
4:39:43 PM
CHAIR HIGGINS closed public testimony.
CHAIR HIGGINS asked how long it would take to go through the WIC
application process.
MS. WAYNE replied that the application process required
confirmation that the store was a food stamp vendor, submission
of a list of available foods, and a pre-approval visit by the
division to ensure the foods were all there. It was a
relatively short process if the foods were all there. She
pointed out that the state plan, at this point, still only
allowed full service stores, except in areas for participant
access concerns.
CHAIR HIGGINS asked if the proposed bill would affect this
situation.
MS. WAYNE offered her belief that the bill proposed a waiver to
allow a non-full service grocery store to participate in WIC in
an area with a language barrier.
CHAIR HIGGINS asked if the proposed bill was asking for a
federal waiver.
MS. WAYNE said that the waiver would go into the state plan, but
would still require approval by the U.S. Department of
Agriculture (USDA). She reported that the USDA had questioned
who would determine that there were 35 participants in need of
the service.
CHAIR HIGGINS asked if there was any opportunity for smaller
vendors to get WIC approval.
MS. WAYNE replied that some stores were terminated, resulting in
a search for replacement stores. She explained that the
criteria was based on participants having access to food, and
the state plan currently limited this to full service grocery
stores, with an exception where there were no other stores in
the community for this service.
REPRESENTATIVE SEATON asked if this was the exception for rural
village stores.
MS. WAYNE replied that this was correct.
REPRESENTATIVE SEATON asked for more information about the
sanctions.
MS. WAYNE explained the sanction points. She stated that a
store would have multiple chances to correct any problems. She
reported that independent research on other state vendor
policies which allowed for cultural waivers were for areas with
no other access for food, no grocery stores, in the community.
REPRESENTATIVE SEATON asked if the sanction points would lead to
termination or a reduced reimbursement rate.
MS. WAYNE replied that the price was based on the maximum
allowable reimbursement plus 30 percent, and there was not any
other fiscal action.
CHAIR HIGGINS asked if the exemptions already established for
the bush communities could be used in this circumstance.
MR. KREHER explained that the exemption for the villages was
based on no other options for vendor selection for access to
food. He explained that language barriers that could not be
addressed at another store would also be a separate exemption.
He declared that sanction points were used to help a vendor get
back in line.
REPRESENTATIVE TARR asked if there was any flexibility in the
WIC food selection.
MR. KREHER replied that there was not any flexibility, as the
food selection was driven by the Food and Nutrition Service
based on nutritional science.
CHAIR HIGGINS offered his belief that it may be necessary for
another WIC vendor in order to help the population in that area.
4:48:04 PM
REPRESENTATIVE KELLER moved to report HB 380, Version 28-
LS1616\N, Mischel, 3/27/14, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, HB 380 was moved from the House Health and Social
Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 380 Sponsor Statement.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 380 |
| HB 380.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 380 |
| HB0356A.pdf |
HHSS 3/20/2014 3:00:00 PM HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB 356 Wellness Presentation.pdf |
HHSS 3/20/2014 3:00:00 PM HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB 356 Background Materials.pdf |
HHSS 3/20/2014 3:00:00 PM HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB 356 Presentation 3 20 2014.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB 356 Background Material.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB 356 Mayo Clinic vitamin D for health a global perspective.pdf |
HHSS 3/20/2014 3:00:00 PM HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB356 Support KPBSD.pdf |
HHSS 3/20/2014 3:00:00 PM HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB356-DOA-DRB-03-14-14.pdf |
HHSS 3/20/2014 3:00:00 PM HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB 356 sponsor statement.pdf |
HHSS 3/20/2014 3:00:00 PM HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB380-DHSS-WIC-04-09-14.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 380 |
| HB 380 Research.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 380 |
| HB 380 Research.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 380 |
| HB 356 Cost Savings per year with vitamin D.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 356 |
| HB 380 Letter of Support.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 380 |
| HB 380 Letter of Support.pdf |
HHSS 4/10/2014 3:00:00 PM |
HB 380 |