Legislature(2021 - 2022)BUTROVICH 205

03/18/2021 01:30 PM HEALTH & SOCIAL SERVICES

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             SB  98-ADULT FOSTER CARE FOR DISABLED                                                                          
2:15:43 PM                                                                                                                    
VICE CHAIR HUGHES announced the  consideration of SENATE BILL NO.                                                               
"An Act  relating to medical  assistance for recipients  of adult                                                               
foster  care services;  establishing  an adult  foster care  home                                                               
license  and  procedures; and  providing  for  the transition  of                                                               
individuals from  foster care  to adult  foster care  homes." She                                                               
stated her  intent to hear an  overview of the bill,  a sectional                                                               
analysis, and testimony on the bill.                                                                                            
2:16:51 PM                                                                                                                    
At ease                                                                                                                         
2:22:50 PM                                                                                                                    
JOHN  LEE,   Director,  Division   of  Senior   and  Disabilities                                                               
Services,  Department  of  Health  and  Social  Services  (DHSS),                                                               
Palmer, Alaska,  turned to Tony  Newman to give  the presentation                                                               
on SB 98.                                                                                                                       
2:23:29 PM                                                                                                                    
TONY   NEWMAN,   Deputy   Director,  Division   of   Senior   and                                                               
Disabilities Services,  Department of Health and  Social Services                                                               
(DHSS),  Juneau, Alaska,  said he  first wanted  to describe  the                                                               
type of person  this bill is meant to serve.  This individual may                                                               
have  started  life   with  a  disability  due  to   a  range  of                                                               
conditions,  from autism  to Down  syndrome,  and sometimes  with                                                               
even  more  complex  and  serious  medical  conditions,  such  as                                                               
cerebral palsy,  cystic fibrosis,  short gut  syndrome, disorders                                                               
that could  mean a lifetime  of intensive medical  treatments and                                                               
prolonged dependence  on technology. Adding to  their challenges,                                                               
these children are also in  foster care because their parents are                                                               
unable or unwilling to give them  the care that they need. At any                                                               
given  time  in  Alaska,  roughly 20-30  children  are  in  state                                                               
custody  with   these  types  of  disabilities.   Thanks  to  the                                                               
wonderful people  who serve  as foster parents  in the  state and                                                               
the state's  waiver programs for people  with disabilities, these                                                               
kids can enjoy a  secure and safe life in a  home sitting, not an                                                               
institution, surrounded by people who  know and love them and are                                                               
often willing  to care for  them throughout their  childhood. The                                                               
need for  this bill arises because  of changes that occur  when a                                                               
child reaches  adulthood. The foster  parents are no  longer able                                                               
to  offer traditional  foster care  once  the child  ages out  of                                                               
state custody.  There are also  some disincentives  and obstacles                                                               
that make  it difficult for  the foster parents to  transition to                                                               
some new type  of caregiving arrangement, which in  turn makes it                                                               
hard for that young person to  stay with the same people, who may                                                               
be the  only people they  know. This  may force the  young person                                                               
into a  new living situation that  can be a traumatic  change. It                                                               
may even require the young person to leave the home community.                                                                  
MR. NEWMAN said that constituents  of then state Senator Dunleavy                                                               
brought  these  concerns  to  his  attention.  In  2017,  Senator                                                               
Dunleavy introduced  a bill,  SB 10, that  sought to  address the                                                               
issue. That  approach was  still being refined  when he  left the                                                               
senate,  but  his  interest in  addressing  the  issue  remained.                                                               
Several  months   ago  he   asked  the   department  to   find  a                                                               
straightforward and  as simple a  way as possible for  the foster                                                               
child and  foster parents to remain  together as a family  when a                                                               
child becomes an adult, if they so choose.                                                                                      
MR.  NEWMAN displayed  a  graphic titled  Adult  Foster Care  for                                                               
Disabled  to  illustrate  how  the bill  attempts  to  provide  a                                                               
solution. The service structure  at Senior Disabilities is fairly                                                               
complex, but  the diagram gets to  the heart of the  matter well.                                                               
The  diagram shows  the typical  current  path for  aging out  of                                                               
foster care  and the proposed path.  A child in foster  care in a                                                               
licensed child family  home habilitation has a stipend  of $157 a                                                               
day or a foster  care stipend of about $70 a  day for these types                                                               
of children  and personal care  services. An adult on  a Medicaid                                                               
home  and  community-based  waiver  receives  adult  family  home                                                               
habilitation at $126  a day with no personal care  services in an                                                               
assisted home  with a  license with a  menu of  additional waiver                                                               
services. The  proposed adult foster  care would have  stipend of                                                               
$115 a day and personal care  services and would be in a licensed                                                               
adult  foster home  with a  menu of  additional waiver  services.                                                               
Constituents have said that personal  care services are valued by                                                               
foster parents  because this can  be some of the  most exhausting                                                               
and challenging work in raising these kids.                                                                                     
MR. NEWMAN  said that  the rate  is reduced  for children  who go                                                               
from child  home habilitation to adult  family home habilitation.                                                               
They  lose personal  care services  because greater  independence                                                               
and self-care  is assumed  for the adult.  The adult  family home                                                               
habilitation  is  reduced because  in  adulthood  they receive  a                                                               
wider  menu of  waiver  services to  promote their  independence.                                                               
Instead of a foster care license,  if children remain in the same                                                               
home, the foster  parents need an assisted  living license, which                                                               
has  considerably higher  expectations  for  safety policies  and                                                               
procedures and  space requirements.  To summarize,  when children                                                               
become adults, the  foster parents lose the  foster care stipend.                                                               
The  children have  lost  the ability  to  receive personal  care                                                               
services, and foster parents would have  to set up their homes to                                                               
meet  the licensing  requirements  for an  assisted living  home.                                                               
While  the  young  adult  would have  wider  range  of  potential                                                               
services to draw  from, if they have a  severe medical condition,                                                               
their  ability   to  take  advantage  of   those  services,  like                                                               
transportation  or employment  services, may  be limited.  Foster                                                               
parents face high  hurdles and difficult choices  to maintain the                                                               
youth in  their homes.  There are  other living  arrangements and                                                               
approaches  that  the  foster  parents   and  the  former  foster                                                               
children can  pursue to stay  together. The foster  parents could                                                               
increase the  rates they receive  by certifying as a  group home,                                                               
but those other options have  expectations and drawbacks that are                                                               
frequently less attractive.                                                                                                     
MR. NEWMAN said that SB 98  makes it easier for the former foster                                                               
parents and foster  children to stay together  longer. Instead of                                                               
offering adult  family home habilitation,  foster parents  can be                                                               
certified  as  adult foster  parents  and  receive stipends  with                                                               
lighter expectations around  providing habilitative services, but                                                               
those pay  more than a  basic room-and-board style  rate. Instead                                                               
of an assisted  living home license, the  department would create                                                               
a new adult foster care  home license, with requirements that are                                                               
more akin  to child  foster home than  assisted living  home. The                                                               
menu  of other  services would  still be  available to  those who                                                               
could benefit  from them. Best of  all will be the  continuity of                                                               
care the  bill will allow.  Nobody would  be forced into  the new                                                               
arrangement. These  other options  would still be  available, but                                                               
for those  who want to stay  together as a family,  this could be                                                               
an attractive option.                                                                                                           
2:31:46 PM                                                                                                                    
SENATOR  BEGICH offered  the clarification  that he  is seeing  a                                                               
continuation. The  department is  trying to maintain  a continuum                                                               
that respects  the living arrangements  that have worked  for the                                                               
youth  as  they transition  into  adulthood.  It is  tempting  to                                                               
receive a  government block on  the ability  to do this.  This is                                                               
good public policy to ensure continuum  of care for those who are                                                               
less able to take care of themselves.                                                                                           
MR. NEWMAN replied that is a perfect summary of the bill.                                                                       
SENATOR COSTELLO  said she appreciates  the bill. She  has spoken                                                               
to many foster  care youth. She asked if there  is an issue where                                                               
one  group of  Alaskans is  provided an  opportunity and  another                                                               
isn't. She could see that a  lot of other foster care youth would                                                               
want to  continue in their foster  care home. She asked  if there                                                               
is a path for them.                                                                                                             
MR. LEE said he is engaged  in dialogue with a consultant for the                                                               
Centers for  Medicare and  Medicaid Services  (CMS) to  make sure                                                               
that this  will be  a viable  option to  pursue and  will receive                                                               
Medicaid funding. He asked her to repeat the second question.                                                                   
SENATOR COSTELLO  asked if there  is a  path forward if  a family                                                               
wants to continue with aged-out foster youth.                                                                                   
MR.  LEE  answered if  the  children  are  not  on a  Senior  and                                                               
Disabilities  waiver  and  are solely  receiving  services  as  a                                                               
foster care  youth, they  become adults and  they can  make their                                                               
own  decisions,  of  course, in  conjunction  with  their  former                                                               
foster  care parents.  He  asked Chrissy  Vogeley  to offer  more                                                               
insight on that.                                                                                                                
2:35:02 PM                                                                                                                    
CHRISSY   VOGELEY,  Community   Relations   Manager,  Office   of                                                               
Children's  Services, Department  of Health  and Social  Services                                                               
(DHSS), Juneau,  Alaska, said for  youth not on  waiver services,                                                               
they can  continue to live with  their foster parents if  that is                                                               
agreeable to all.                                                                                                               
SENATOR REINBOLD asked what the stipend rates are based on.                                                                     
MR. LEE answered  that the child family home  habilitation $157 a                                                               
day rates  are set by the  division with help from  the Office of                                                               
Rate Review. The  $70 a day is an approximation  for what a child                                                               
at this  level of  need would require.  The Office  of Children's                                                               
Services offers  a foster  care stipend that  ranges from  $30 to                                                               
over  $100  a day,  depending  on  the  child's  need, so  it  is                                                               
approximate  $70 a  day. The  rate goes  down to  $126 a  day for                                                               
family home  habilitation because it  is assumed that  the adults                                                               
have a  higher level of independence  as adults. They also  get a                                                               
menu of additional  waiver services, such as help  with meals and                                                               
transportation. That  is why the  rate goes  down to $126  a day.                                                               
His office  came up  with the rate  of $115 a  day for  the adult                                                               
foster care in  consultation with partners. The  office wanted to                                                               
find  a  rate  that  was  not   as  high  as  adult  family  home                                                               
habilitation    because    there   are    fewer    administrative                                                               
requirements. The office  wanted this to be  attractive for those                                                               
who  want to  pursue the  adult foster  care license  without the                                                               
administrative burdens.                                                                                                         
2:38:20 PM                                                                                                                    
SENATOR REINBOLD  asked how  the parents get  this money  and are                                                               
there any parameters about how to use the money.                                                                                
MR. NEWMAN said his office will  need regulations to work out the                                                               
details about the  expectations about the level  of care provided                                                               
by adult foster parents. It will  be a lot like foster childcare.                                                               
His  office  will take  the  lead  from  the  way the  Office  of                                                               
Children's Services provides payment to foster parents.                                                                         
VICE CHAIR HUGHES asked Ms. Vogeley to also respond.                                                                            
MS.  VOGELEY said  that  foster care  payments  are paid  monthly                                                               
directly to foster parents in a manner of their choosing.                                                                       
SENATOR REINBOLD clarified the two  options are direct deposit or                                                               
a check. She asked if it is a lump sum for the entire month.                                                                    
MS. VOGELEY replied yes.                                                                                                        
SENATOR  REINBOLD asked  what happens  if  the care  is only  two                                                               
weeks and a month's stipend has been deposited.                                                                                 
MS. VOGELEY  answered that she  believes payments are  paid after                                                               
the month.  There have  been situations  of overpayments  and the                                                               
office requests the money to be returned.                                                                                       
SENATOR BEGICH  offered that his  sister was a foster  parent and                                                               
was paid after the fact.                                                                                                        
VICE CHAIR  HUGHES asked how  many disabled foster youth  turn 18                                                               
each year.                                                                                                                      
MR. NEWMAN answered that it could range from none or 10 a year.                                                                 
VICE  CHAIR   HUGHES  asked  what   the  range   of  disabilities                                                               
applicable for this situation is.                                                                                               
MR.  LEE  said the  bill  is  talking  about youth  eligible  for                                                               
waivers. This means  that they have been assessed  such that they                                                               
could  receive  care  in an  institution,  an  intermediate  care                                                               
facility or a skilled nursing  facility. These conditions include                                                               
severe  cerebral palsy,  short gut  syndrome, Down  syndrome, and                                                               
2:43:40 PM                                                                                                                    
VICE CHAIR HUGHES  commented that it would be  difficult for them                                                               
to live independently. She opened public testimony.                                                                             
2:44:04 PM                                                                                                                    
LOIS EPPERSON,  representing self, Wasilla, Alaska,  said she has                                                               
been a  foster childcare provider  since the 90s for  children on                                                               
waivers. She is  licensed as an assisted living  home because the                                                               
girl they have had  in their home for 18 years  aged out of child                                                               
foster care. In order to keep  her in their home their option was                                                               
to become an assisted living home.  They have taken care of three                                                               
children on waivers  over the last 30 years until  they moved out                                                               
or passed  away. These  are kids who  are severely  brain damaged                                                               
from birth  trauma. The  person they  have now  requires complete                                                               
total care. She cannot roll over on  her own. She must be fed and                                                               
bathed. This  is the  type of  child who  would benefit  from the                                                               
bill. When  they age out  of child  foster care, they  could just                                                               
roll over  into an adult  foster care license with  their current                                                               
licenses and  the home and  services would not be  disrupted. Her                                                               
young adult is  never going to improve and  cannot take advantage                                                               
of other services  like transportation. She will  always need the                                                               
same level of care or greater as she ages.                                                                                      
MS. EPPERSON  said they call  themselves foster parents  but they                                                               
are assisted living providers. They  provide 24 hour care and the                                                               
only help is  respite. The client has some day  hab hours, so she                                                               
can  get in  a van  and get  out of  the house.  They are  paid a                                                               
stipend  by through  the agency  they work  through. They  have a                                                               
care coordinator  and act as  guardians for her. They  must abide                                                               
by all  regulations for  an assisted living  home designed  for a                                                               
multipatient facility. Adult foster care  would make life for the                                                               
client and the home simpler and easier.                                                                                         
VICE CHAIR  HUGHES thanked her for  her efforts and asked  if she                                                               
worked with Senator Dunleavy on this a few years ago.                                                                           
MS. EPPERSON replied  that she was one of three  women working on                                                               
then SB 10. They have been trying to work on this for years.                                                                    
VICE CHAIR  HUGHES said she was  glad to see the  efforts come to                                                               
2:49:23 PM                                                                                                                    
LINDA  GIANI, representing  self, Wasilla,  Alaska, said  she has                                                               
been  working on  trying  to get  this  legislation passed  since                                                               
2011. She first  started working with a former  governor and then                                                               
Senator Dunleavy and  some house representatives. It  has been up                                                               
and down.  Governor Dunleavy agreed  to continue to  pursue this.                                                               
She had a son who was one  of most disabled children in the state                                                               
of  Alaska.  He  passed  away  two  years  ago.  She  is  a  care                                                               
coordinator and works with children  on CMS waivers. She has seen                                                               
a need  for this for a  long time and  is hoping that it  will be                                                               
taken care of. As these children  turn 18, the important thing is                                                               
that  they not  lose  any of  their services.  They  turn 18  and                                                               
suddenly  they  have  to  live   in  assisted  living  where  the                                                               
expectation  is  that  they  will get  better.  All  the  in-home                                                               
supports  are taken  away, which  is the  only service  that they                                                               
need to  have. It is exhausting  to take care of  these children.                                                               
She did  it for 21  years all by  herself. The foster  parents of                                                               
these children have  to be aware of the children  24/7. The adult                                                               
foster  care license  has  been  needed for  many  years. She  is                                                               
praying that it  goes through this time and  it includes personal                                                               
care services.  They lose  all that because  they turn  18, which                                                               
doesn't make sense  because there is no other  change except age.                                                               
She hopes  the new  license permits families  to get  the in-home                                                               
support services. The waiver services  are meaningless unless the                                                               
in-home support piece is added.  There are many families who have                                                               
been in  the system for many  years, like Lois Epperson.  She has                                                               
such  admiration  for  them.  For  10 years  this  has  been  her                                                               
project. She  worked with the governor  for years on this.  It is                                                               
2:54:22 PM                                                                                                                    
VICE  CHAIR HUGHES  thanked  her for  all she  has  done for  the                                                               
precious, disabled  Alaskans and  her decade of  persistence. She                                                               
closed public testimony and held SB 98 in committee.                                                                            
SENATOR  BEGICH thanked  the members  for the  robust discussion.                                                               
That allows them to know what is going on with bills.                                                                           
VICE  CHAIR  HUGHES  said  it  was  informative  and  about  some                                                               
important matters.                                                                                                              
SENATOR REINBOLD said these are  important and interesting bills.                                                               
This is why there is Health  and Social Services, for when people                                                               
are truly in need and dependent on people.                                                                                      

Document Name Date/Time Subjects
SB 89 Version A.PDF HHSS 5/4/2021 3:00:00 PM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 Transmital Letter.pdf SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 Sectional Analysis Version GS 1675 A.pdf HHSS 5/13/2021 3:00:00 PM
SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 Fiscal Note 1 DHSS.PDF HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
HHSS 5/13/2021 3:00:00 PM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 FAQ on Final Rule prepared by Coalition for Community Choice.pdf HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
HHSS 5/13/2021 3:00:00 PM
SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 Final Rule 42 CFR 441.301c.pdf SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 One Page Summary.pdf HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
HHSS 5/13/2021 3:00:00 PM
SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 Settings Information webpage.pdf HHSS 4/29/2021 3:00:00 PM
SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 All Ways Caring Letter of Support.pdf HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
HHSS 5/13/2021 3:00:00 PM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 89 Letter of Support Samash_Redacted.pdf HHSS 4/29/2021 3:00:00 PM
HHSS 5/13/2021 3:00:00 PM
SHSS 3/18/2021 1:30:00 PM
SB 89
SB 98 Version 32 GS 1708 A.PDF SHSS 3/18/2021 1:30:00 PM
SB 98
SB 98 Transmittal Letter.pdf SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 98
SB 98 Sectional Analysis Version GS 1708 A.pdf SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 98
SB98 Fiscal Note 1 DHSS Medicaid.PDF SHSS 3/18/2021 1:30:00 PM
SB 98
SB98 Fiscal Note 2 DHSS Senior Svcs.PDF SHSS 3/18/2021 1:30:00 PM
SB 98
SB98 Fiscal Note 3 DHSS Health Care Svcs.PDF SHSS 3/18/2021 1:30:00 PM
SB 98
SB 98 Adult Foster Care for Disabled Graphic.pdf SFIN 4/7/2021 9:00:00 AM
SHSS 3/18/2021 1:30:00 PM
SB 98