Legislature(1997 - 1998)
04/15/1998 09:07 AM Senate HES
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* first hearing in first committee of referral
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SB 266 - MEDICAID COVER/HEALTHY FAMILIES AK PROGRAM
CHAIRMAN WILKEN asked Jay Livey to continue the presentation on SB
266, beginning with page 4, Chapter 19 (Section 9).
JAY LIVEY, Deputy Commissioner of the Department of Health and
Social Services (DHSS), asked Karen Pearson to address the section
on the Healthy Families Alaska Program.
KAREN PEARSON, Division of Public Health, DHSS, stated Chapter 19
contains two parts. The first part establishes the Healthy
Families Alaska Program in statute and describes the program's
operations.
SENATOR GREEN asked if the Healthy Families Alaska Program has been
a one year program in the past.
MS. PEARSON responded the program has existed through
appropriations.
MS. PEARSON explained the Healthy Families Alaska Program has one
main goal: to prevent child abuse and neglect. DHSS knows that
most families function at the level they can and nurture and care
for their children, but some families have certain stresses that
place them at risk for abuse and neglect. Healthy Families, in the
geographic areas that it serves, screens families for those risk
factors. If a family chooses to accept services from the Healthy
Families Program, a worker will discuss with the client the
stresses that can lead to abuse and neglect, such as substance
abuse, domestic violence in the home, a history of abuse of any
kind in the family, and/or financial stresses. If the family
chooses to enroll in the program, the family determines its goals
and what services and assistance it needs from Healthy Families.
Services available include assistance in getting substance abuse
treatment, counseling, access to housing services, or a number of
other things. Healthy Families Program workers simultaneously
teach families appropriate expectations for young children so that
parents use appropriate child rearing techniques. The program is
geared to the individual family's needs and to help the family
develop skills and abilities to deal with crises. The program is
available to pregnant women and parents of newborns (AS 47.19.030)
who can receive services for up to three to five years. Research
has shown that lasting outcomes do not occur when programs are
designed to help families deal with an immediate crisis. Families
need help dealing with several crises until they develop their own
coping mechanisms.
MS. PEARSON explained Section 47.19.040 describes the duties of
DHSS. It ensures that local agencies get the training and support
they need to run a good program. The program is based on service
delivery by paraprofessionals with the belief that people respond
better to a worker who has the same experiences and cultural
background. The most important characteristics of paraprofessionals
are empathy and support. The paraprofessionals do not provide
specialty counseling; they help the family access the professionals
they need. This section also requires DHSS to establish screening
and evaluation methods, and to ensure that all service providers
work together to prevent duplication of services, to deal with
problem resolution within the program, and to monitor and evaluate
services for the sake of accountability. Section 47.19.050
pertains to the individualized support plan in which the family
sets its own goals. The plan is reviewed and updated with the
family on an ongoing basis. Section 47.19.900 addresses
confidentiality and mandates that no records on any individual
family ever be released. The only types of data that would be
compiled by the program are aggregate numbers.
Number 167
SENATOR GREEN asked if any place already exists where a person can
receive the same services, in whole or in part, as those offered by
the Healthy Families Alaska Program.
MS. PEARSON replied some similar programs exist. The Head Start
Program is a home-visit based program that provides services to
children ages birth to three but its focus is on child development
and school readiness. Other programs exist but use a different
approach. The Healthy Families Alaska Program is specific to child
abuse and neglect prevention. Head Start provides services to
clients who are low income. The Healthy Families Program is not
income based.
SENATOR LEMAN asked whether the confidentiality section provisions
would preclude a court order to provide records.
MS. PEARSON said it would not.
SENATOR LEMAN asked if existing DHSS regulation provides for that
exception.
MS. PEARSON said it does.
Number 200
SENATOR GREEN asked if churches and synagogues are considered to be
culturally appropriate and community based, and could provide
services according to the language on page 5, lines 12 - 15.
MS. PEARSON stated if Senator Green was questioning whether DHSS
could give a grant to a church or synagogue to provide services,
she could not answer at this time. She pointed out that several
churches and synagogues have been involved because they are
partnered with local agencies.
DEPUTY COMMISSIONER LIVEY stated that DHSS does have the ability to
give grants to religiously affiliated organizations because it
already gives grants to Catholic Community Services in Juneau to
provide various kinds of social services.
SENATOR GREEN commented that churches were included, in the welfare
reform legislation, as entities to provide services in places where
no other agencies existed. She noted she would like to see
religious organizations included in this bill as well.
DEPUTY COMMISSIONER LIVEY responded that DHSS might be constrained
by the requirement that the organization receiving the grant must
be an organized, non-profit, social service organization.
SENATOR GREEN asked Mr. Livey to develop language to provide for
that ability.
Number 236
CHAIRMAN WILKEN asked for information about the Healthy Families
Programs in operation today.
MS. PEARSON informed committee members that eight local agencies
are operating in Alaska today. Seven of the programs are delivered
through local agencies, the Kenai program is operated by DHSS
staff. The Juneau program is administered through Catholic
Community Services; DHSS funds one staff person in the Southcentral
Foundation; there is a program in the Mountainview community of
Anchorage, the Mat-Su Valley, Fairbanks; a program in the Bristol
Bay area which combines funding with the ICWA program and provides
services in some of the villages; and a program in Bethel.
CHAIRMAN WILKEN asked the amount of the program's funding.
MS. PEARSON replied the amount is $1.4 in grant monies, and about
$270,000 for running the Kenai program.
CHAIRMAN WILKEN asked if the program leverages any federal money.
MS. PEARSON responded it does, but not in terms of the local
agencies, except for the Southcentral Foundation. That foundation
has a federal grant from the Maternal Child Health Bureau.
Number 261
DEPUTY COMMISSIONER LIVEY made the following remarks about SB 266.
DHSS's major focus in SB 266 is to ensure that children have good
health care. The bill expands medicaid coverage for children whose
family's income is up to 200 percent of the poverty level, and
maintains the expansion for pregnant women at that same poverty
level. DHSS believes that expanding health care coverage to 200
percent of the poverty level will complement the welfare reform
program because a lot of welfare recipients returning to the work
force will not have health care coverage. DHSS does not want
people to quit jobs and apply for public assistance to get medicaid
coverage for their children. By providing this program through a
medicaid expansion, more federal money will be leveraged. SB 266
is a relatively inexpensive investment on behalf of the state in
order to receive a lot of federal money. That money will help to
build a health care infrastructure in rural Alaska. Deputy
Commissioner Livey reminded committee members that something needs
to be done this year or the state will lose its federal allotment
of $5.6 million. DHSS believes this program is a good investment
in terms of the benefits it will provide in the future.
SENATOR GREEN asked what amount 200 percent of the poverty level
equals.
DEPUTY COMMISSIONER LIVEY replied for a family of three, the level
of income would be about $33,000 per year, or about $16 per hour.
Number 297
SENATOR GREEN asked if any thought has been given to using the same
income guidelines in the eligibility requirements for all programs
so that children at age 17 would be eligible at the same income
level as children at age 7.
DEPUTY COMMISSIONER LIVEY stated that approach makes sense because
under the current guidelines, a 14 year in a family might not be
covered by medicaid while a younger sibling is. Those eligibility
requirements are complicated for the families and for program
staff. DHSS wants all programs to set the eligibility requirement
at 200 percent of the poverty level, regardless of the child's age.
SENATOR GREEN asked if DHSS has determined the number of people who
will be eligible at the 200 percent level, 175 percent level, 150
percent level, etc., and whether using the 200 percent income
guideline will increase the number of eligible applicants to the
point to where services cannot be provided to all.
DEPUTY COMMISSIONER LIVEY explained that at the 133 percent level,
DHSS could serve about 1600 additional children and no additional
pregnant women because that group is already being served at that
level. At the 200 percent level, DHSS could serve an additional
4,000 children and 781 pregnant women. At that level, DHSS
estimates that coverage could be provided at a cost of $4 million
in general funds which would leverage about $11 million in federal
funds.
Number 315
SENATOR GREEN questioned whether DHSS would eliminate some of its
current programs because they will no longer be necessary and
whether an overall reduction in costs might occur.
DEPUTY COMMISSIONER LIVEY said the different programs are really
parts of one program. The difference between them is the level of
coverage a person qualifies for depending on his/her income. DHSS
would wipe out the different income levels for eligibility
determination and use one level.
BOB LABBE, Division of Medical Assistance, DHSS, added that the
current levels are the federal required minimum levels that all
states must have. One of DHSS's goals is to have a common standard
which will require a statutory change. DHSS believes that the 200
percent level is the most advantageous to maximize federal funds
because Alaska's population is not that large. If any lower level
is used, the state will not be taking full advantage of the federal
block grant. He noted he provided an analysis of the numbers to
Senator Parnell.
Number 360
SENATOR GREEN questioned whether it is possible that this program
will provide a disincentive to employers to provide health care
coverage for employees.
DEPUTY COMMISSIONER LIVEY replied that the question of how to
prevent employers who are currently providing coverage from
discontinuing that coverage has been considered by Congress and by
this Legislature. The Robert Wood Johnson Foundation has studied
other states who have established similar expansions. The
Foundation concluded that if the expansion deals primarily with
children then that kind of "crowd out" does not occur, nor does it
occur until eligibility includes people above the 200 percent of
poverty level. He noted DHSS has also looked at ways to put
barriers up to keep individuals from crossing over from employer
coverage to medicaid coverage.
CHAIRMAN WILKEN welcomed Senator Ward. He then informed committee
members that written testimony sent by people from Fairbanks had
been placed in committee packets.
Number 386
MARGO WARING, staff to the Alaska Mental Health Board, made the
following comments. The Board has spent a fair amount of time
discussing SB 266 and is very supportive of the expansion of
medicaid coverage for children and pregnant women. The Board hears
frequently, in discussions with parents, about the difficulty of
accessing mental health coverage for children, particularly for low
income families. The Board believes that access to early
intervention services provided through Medicaid could make
significant differences in the lives of children with emotional
disturbances. Whatever costs are incurred through medicaid will be
offset by preventing children from becoming involved with the state
juvenile justice and other systems later on. Regarding the Healthy
Families Program, the Board is cognizant of the importance of
identifying high risk families and providing them with needed
services. Reduction in the rates of abuse and neglect is essential
to any kind of prevention and early intervention strategy of
serious emotional disturbance in children later in their lives
because abuse and neglect are one of the strong environmental
factors that create serious emotional disturbances in children. SB
266 is a very cost effective intervention strategy because it
targets those at risk families. Intervention will occur at birth,
before children experience the traumas that can lead to later
psychiatric difficulties.
SENATOR GREEN asked whether the Alaska Mental Health Board has
given direct grants to the Healthy Families Program from the Mental
Health Trust.
MS. WARING stated she did not believe so but would defer to someone
else from the Trust for that answer.
Number 427
TANA BULKLEY, a Healthy Families Alaska Program client, gave the
following testimony. She is the mother of four children, ages 15,
13, 7, and a newborn. She was young when she had her first two
children and did not have much of a family support system. She
had a lot of trouble parenting at that young age, especially with
her daughter, who was neglected and has been in treatment for
several years. Ms. Bulkley was forced to do a lot of things on her
own with her first two children. She finished her GED and returned
to school in an attempt to succeed, but it was a struggle. She was
not aware of any help available until her children were four or
five years old. When her newborn was born, she was given a
questionnaire at the hospital that asked her whether she wanted
help through the Healthy Families Program. A worker comes to her
home, provides her with reading materials, and offers child
development tips. She emphasized the most important factor in the
success of the Healthy Families Program is that the worker comes to
the client's home, which is extremely important to mothers with
newborns and infants.
KIM CHAMPNEY stated she is completing her MSW by doing field work
with the Healthy Families Program in Juneau. She felt strongly
about coming to the hearing today because she has seen the impact
the program has had on families she has worked with. Ms. Bulkley
represents a group of parents who are not receiving home visiting
services because the program is full right now but her situation is
valuable to share because she has raised children with and without
aid from the Healthy Families Program. Had Ms. Bulkley received
services from the Healthy Families Program for her first two
children, she would have been matched with a home visitor who would
have helped her to identify her immediate needs such as adequate
housing, child care, job training or employment opportunities among
other things. Ms. Bulkley's daughter was involved in a serious
accident when she was 18 months old. Had a family support worker
been involved, the worker could have advocated for services such as
physical therapy or respite care. The family support worker would
have helped Ms. Bulkley learn effective parenting skills and the
support could have lasted until her children were five years old.
Her children entered the state system at about the age of five
which could have been avoided had Ms. Bulkley had help from a
family services worker. Ms. Bulkley's family is beating the odds
and pulling together which is what the program is about. Ms.
Champney stated it is important to establish the program in statute
so that it can be implemented statewide in a uniform manner and be
accountable to the public.
CHAIRMAN WILKEN noted no one else was present to testify on SB 266.
He informed committee members that a companion bill, HB 369, is
moving through the House and he planned to see how the committee
can help the efforts of that bill, or vice versa.
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