Legislature(2007 - 2008)HOUSE FINANCE 519

02/08/2007 01:30 PM House FINANCE


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Audio Topic
01:37:41 PM Start
02:56:20 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation by Alaska Mental Health TELECONFERENCED
Board of Directors
<Teleconference Listen Only>
                  HOUSE FINANCE COMMITTEE                                                                                       
                      February 8, 2007                                                                                          
                         1:37 p.m.                                                                                              
                                                                                                                                
 CALL TO ORDER                                                                                                                
                                                                                                                                
 Co-Chair Meyer called the House Finance Committee meeting to                                                                   
 order at 1:37:41 PM.                                                                                                         
                                                                                                                                
 MEMBERS PRESENT                                                                                                              
                                                                                                                                
 Representative Mike Chenault, Co-Chair                                                                                         
 Representative Kevin Meyer, Co-Chair                                                                                           
 Representative Bill Stoltze, Vice-Chair                                                                                        
 Representative Harry Crawford                                                                                                  
 Representative Richard Foster                                                                                                  
 Representative Les Gara                                                                                                        
 Representative Mike Hawker                                                                                                     
 Representative Reggie Joule                                                                                                    
 Representative Mike Kelly                                                                                                      
 Representative Mary Nelson                                                                                                     
 Representative Bill Thomas, Jr.                                                                                                
                                                                                                                                
 MEMBERS ABSENT                                                                                                               
                                                                                                                                
 None                                                                                                                           
                                                                                                                                
 ALSO PRESENT                                                                                                                 
                                                                                                                                
 Jeff Jesse, Executive Director, Alaska Mental Health Trust                                                                     
 Authority; Dr.  William  Doolittle, Chair,  Alaska  Mental                                                                     
 Health Trust Authority; Laraine Derr, Board Member, Alaska                                                                     
 Mental Health Trust Authority                                                                                                  
                                                                                                                                
 PRESENT VIA TELECONFERENCE                                                                                                   
                                                                                                                                
 None                                                                                                                           
                                                                                                                                
 GENERAL SUBJECT(S):                                                                                                          
                                                                                                                                
 OVERVIEW: Presentation by the Alaska Mental Health Board of                                                                  
                         Directors                                                                                            
                                                                                                                                
The  following  overview was  taken  in  log  note  format.                                                                     
Handouts will be  on file with the House  Finance Committee                                                                     
through  the 25th  Legislative Session,  contact  465-6814.                                                                     
After the 25th  Legislative Session they will be  available                                                                     
through the Legislative Library at 465-3808.                                                                                    
                                                                                                                              
                                                                                                                                
                                                                                                                                
 TIME        SPEAKER        DISCUSSION                                                                                      
 1:37:46 PM JEFF     JESSE, Introduced the members of the Board.                                                              
            EXECUTIVE                                                                                                           
            DIRECTOR,                                                                                                           
            ALASKA MENTAL                                                                                                       
            HEALTH    TRUST                                                                                                     
            AUTHORITY                                                                                                         
1:39:27 PM DR.      WILLIAM Introduced members of the advisory                                                                
            DOOLITTLE,      group.                                                                                            
            CHAIR, ALASKA                                                                                                       
            MENTAL HEALTH                                                                                                       
            TRUST                                                                                                               
1:40:47 PM Mr. Jesse        Referred to a handout entitled "Alaska                                                            
                            Mental Health Trust Authority" (copy on                                                             
                            file.) He  addressed the key  terms of                                                              
                            the   Mental    Health   Trust   Lands                                                              
                            Settlement, as shown on page  2 of the                                                              
                            handout.  He  explained that the trust                                                              
                            resources act as a catalyst for change                                                              
                            to improve  the mental  health system.                                                              
                            There was a separate appropriation bill                                                             
                            as a  result  of the  settlement.   He                                                              
                            stated   that    the   Trust    is   a                                                              
                            comprehensive plan  for  mental health                                                              
                            programs.    The  settlement  released                                                              
                            Mental   Health   Trust    Lands   for                                                              
                            development.     He   encouraged   the                                                              
                            legislature to look at the terms of the                                                             
                            settlement with  a  fresh  perspective                                                              
                            this session.                                                                                     
1:45:51 PM Mr. Jesse        Refreshed the committee as to the                                                                 
                            Trust's beneficiaries as listed on page                                                             
                            3.   He  reviewed  the  makeup of  the                                                              
                            advisors to the trust on page 4.                                                                  
1:46:11 PM Mr. Jesse        Explained who the advisors to the Trust                                                           
                            are:    Alaska  Mental  Health  Board;                                                              
                            Advisory Board on  Alcoholism and Drug                                                              
                            Abuse;    Governor's     Council    on                                                              
                            Disabilities  and  Special  Education;                                                              
                            Alaska     Commission    on     Aging;                                                              
                            Commissioners of  the  Departments  of                                                              
                            Health  and  Social  Services, Natural                                                              
                            Resources,   and    Revenue;    Alaska                                                              
                            Traumatic Brain Injury  Board, Suicide                                                              
                            Prevention Council.   He explained the                                                              
                            guiding  direction for  Trust  program                                                              
                            investment and  shared  successes from                                                              
                            the Therapeutic  Court System  seen on                                                              
                            page 5.                                                                                           
1:49:24 PM LARAINE DERR, Referred to page 8 and explained the                                                                 
            BOARD MEMBER, Trust      distributable   income    and                                                              
            ALASKA MENTAL expenditure recommendations for Trust                                                                 
            HEALTH    TRUST Funds.                                                                                            
            AUTHORITY                                                                                                           
1:51:38 PM Ms. Derr         Returned to page 6 to explain the land                                                            
                            and resources FY06 principal and income                                                             
                            revenue by resource.                                                                              
 1:52:35 PM  Representative Spoke to controversial issues regarding                                                           
             Stoltze        land development and wondered about                                                                 
                            improving  public relations surrounding                                                             
                            that matter.                                                                                      
 1:54:12 PM Mr. Jesse       Agreed that there are often clashes                                                               
                            surrounding  development projects.   He                                                             
                            related    a   timber   situation    in                                                             
                            Petersburg  and  how an  agreement  was                                                             
                            worked out.  There needs to be a public                                                             
                            relations  campaign regarding the  land                                                             
                            development and  the connection to  the                                                             
                            beneficiary   that  it  will   benefit.                                                             
                            Representative  Stoltze  thought  there                                                             
                            would continue to be a clash of values.                                                             
                            Mr.  Jesse opined that  the Trust is  a                                                             
                            good mechanism for the dialogue needed.                                                           
 1:56:32 PM Ms. Derr        Addressed    Representative   Stoltze's                                                           
                            concern.   The emphasis from  the board                                                             
                            is on the benefit to the beneficiaries.                                                           
 1:57:25 PM Ms. Derr        Referred to page 7 - Spendable Income                                                             
                            From Trust Land.  It is a review of the                                                             
                            income  generated from the  lands.   In                                                             
                            FY06  the  projected  income  was  $2.6                                                             
                            million  and   the  actual  income  was                                                             
                            $3.546  million,  as  corrected.    The                                                             
                            projected income for FY07 is again $2.6                                                             
                            million    but  the expectation  is  to                                                             
                            exceed $3 million.                                                                                
 1:58:19 PM Mr. Jesse       Reminded the committee to keep the                                                                
                            operational environment in mind.   With                                                             
                            the  addition of  Medicaid, the  mental                                                             
                            health program is  nearly $300 million.                                                             
                            The challenge is to  use $23 million to                                                             
                            enhance  a $300  million program.   The                                                             
                            trustees  decided  to   focus  on  five                                                             
                            areas.    He  reviewed the  five  focus                                                             
                            areas shown on page 9.                                                                            
 1:59:11 PM Mr. Jesse       Turned attention to Bring the Kids Home                                                           
                            (BTKH) depicted on page 10.   Mr. Jesse                                                             
                            maintained that this issue is  the most                                                             
                            complex  area of  the  Trust.   A  work                                                             
                            group  was convened between the  Trust,                                                             
                            DHSS, and the Tribes to deal with BTKH.                                                             
                            It  is essential  to engage the  tribal                                                             
                            entities in  order to partner and  keep                                                             
                           costs down.                                                                                        
 2:02:20 PM Mr. Jesse       Shared the Seven Indicators of Progress                                                           
                            on  BTKH -  page 11.   These strategies                                                             
                            are frequently re-evaluated.                                                                      
 2:03:16 PM Mr. Jesse       Pointed    out   that   building    the                                                           
                            infrastructure to  serve kids  in-state                                                           
                            takes time.  Page 12 shows the progress                                                             
                            of  Medicaid RPTC  Recipients: Custody                                                              
                            vs. Non-Custody.                                                                                  
2:04:44 PM Mr. Jesse        Explained the graph on page 13                                                                    
                            depicting Existing and  Projected Out-                                                              
                            of-State (OOS)  Non-Custody Youth  vs.                                                              
                            In-State Bed Capacity.  The bottom line                                                             
                            shows that RPTC bed capacity will begin                                                             
                            to increase in FY07.  The next step is                                                              
                            to plan  for home-based and community-                                                              
                            based out patient support systems.  An                                                              
                            education subcommittee  was formed  to                                                              
                            address this issue.  He blamed "family                                                              
                            issues" for the  reason behind needing                                                              
                            these  beds,  so  services  are  being                                                              
                            planned to deal with those issues.                                                                
2:08:31 PM  Representative  Expressed concern about poor parenting                                                            
            Kelly           and early preventative measures.  Mr.                                                               
                            Jesse  related  the   substance  abuse                                                              
                            treatment program solutions  and spoke                                                              
                            about  a  housing trust  to  alleviate                                                              
                            homeless  situations.    He  suggested                                                              
                            other training programs that may help.                                                            
2:11:46 PM Mr. Jesse        Highlighted Trust Beneficiary Projects                                                            
                            shown on page 14.  The goal is to build                                                             
                            up    grass    roots   projects    and                                                              
                            beneficiary-focused      organizations                                                              
                            through grants,  technical assistance,                                                              
                            and supports.                                                                                     
2:12:56 PM  Representative  Spoke of  a program in  Fairbanks that                                                            
            Kelly           was very effective.  He wondered about                                                              
                            the  small  numbers   handled  by  the                                                              
                            Therapeutic Courts.    Mr. Jesse  said                                                              
                            that the  numbers are  increasing, but                                                              
                            reminded the  committee that  they are                                                              
                            "frequent fliers"  and  have committed                                                              
                            the majority of the offenses.                                                                     
2:15:07 PM  Dr. Doolittle   Shared    statistics     related    to                                                            
                            Therapeutic Courts.                                                                               
2:15:52 PM Mr. Jesse        Shared an overview of the programs and                                                            
                            services  of   the  Trust  Beneficiary                                                              
                            Projects - page  15.   These are early                                                              
                            intervention programs.                                                                            
2:16:53 PM Mr. Jesse        Addressed Justice for Persons with                                                                
                            Disabilities - page 16.  The Department                                                             
                            of Corrections  is the  largest mental                                                              
                            health provider.  He  shared the goals                                                              
                            of the programs for incarcerated Trust                                                              
                            beneficiaries.     He   explained  how                                                              
                            incarcerated  beneficiaries  are  pre-                                                              
                            qualified for services upon release.                                                              
2:20:17 PM Mr. Jesse        Spoke to the accomplishments of the                                                               
                            Trust  as  listed  on  page  17.    He                                                            
                            discussed  the process of  developing a                                                             
                            Mental Health Court in Palmer.                                                                    
 2:22:49 PM Mr. Jesse       Shared the Critical Next Steps - FY08                                                             
                            for  the  Justice Initiative, shown  on                                                             
                            page 18.                                                                                          
 2:24:07 PM Mr. Jesse       Talked about Affordable, Accessible,                                                              
                            Safe Housing - page 19.  The goal is to                                                             
                            increase   the    availability  of    a                                                             
                            continuum    of   affordable    housing                                                             
                            options.   The  strategy is to  improve                                                             
                            housing and  support services models to                                                             
                            assist   beneficiaries  in  maintaining                                                             
                            stable housing.                                                                                   
 2:26:01 PM Mr. Jesse       Addressed programs and services for                                                               
                            affordable, accessible, safe  housing -                                                             
                            page  20.  Predevelopment services were                                                             
                            pooled and partnerships developed.                                                                
 2:27:25 PM Mr. Jesse       Noted the policy and data agenda for                                                              
                            housing on page 21.                                                                               
 2:27:55 PM  Representative Asked  how  much of  the Mental  Health                                                           
             Gara           Court is funded by the Trust.  Mr.                                                                  
                            Jesse replied that the Anchorage Mental                                                             
                            Health Court is funded by state general                                                             
                            funds.   The Palmer Mental Health Court                                                             
                            is funded by the Trust.                                                                           
 2:28:43 PM  Representative Asked  if  housing  is  analyzed  on  a                                                           
             Thomas         regional basis.  Mr. Jesse replied that                                                             
                            it  is.   He explained an  example with                                                             
                            regard   to    regionalization.      He                                                             
                            described  how SEARHC and  Juneau Youth                                                             
                            Services partnered to fund  beds in the                                                             
                            correct amount and location.                                                                      
 2:31:31 PM Co-Chair        Asked how many beds have been built.                                                              
             Chenault       Mr. Jesse referred to page 13 and said                                                              
                            "200 in  the pipeline".  There were 520                                                             
                            in FY06 and  there will be about 800 by                                                             
                            FY09.   Co-Chair Chenault  restated the                                                             
                            question  as  to  how many  beds  exist                                                             
                            today  and  how  many  kids  have  been                                                             
                            "brought home".   Mr. Jesse  said close                                                             
                            to  30 lower level beds.  He  could not                                                             
                            put a number on how many kids have been                                                             
                            brought   back.     Co-Chair   Chenault                                                             
                            maintained that the number of kids sent                                                             
                            "outside"  has not  been reduced.   Mr.                                                             
                            Jesse agreed.                                                                                     
 2:33:13 PM Mr. Jesse       Reported that the governor established                                                            
                            a  Council on  the Homeless to  address                                                             
                            homelessness in Alaska.  He referred to                                                             
                            a  report called "Keeping  Alaskans Out                                                             
                            of  the Cold"  - page 22.   Nearly  all                                                             
                            dollars  spent for housing  are federal                                                             
                            dollars,   which   end  up   going   to                                                           
                            individuals or families at  70 percent                                                              
                            of average median income or above.  He                                                              
                            discussed how  the funding  is graded.                                                              
                            The homeless do  not fall into  the 70                                                              
                            percent area,  so money  is  not being                                                              
                            directed effectively.  He explained the                                                             
                            difficulties associated with addressing                                                             
                            homelessness.   He  reported  that  in                                                              
                            Anchorage in some  Title I classrooms,                                                              
                            more than half of  the kids that start                                                              
                            the year will be gone by the end of the                                                             
                            year.                                                                                             
2:37:23 PM Representative Noted that the school dropout rate                                                                  
            Thomas          seems to be the same number as the                                                                  
                            number of kids moving frequently.  Mr.                                                              
                            Jesse  pointed out  that  the  fastest                                                              
                            growing   segment  of   the   homeless                                                              
                            population is  families with children.                                                              
                            He reported  that over 30  states have                                                              
                            created housing trusts to help address                                                              
                            this issue.  He described the logic for                                                             
                            establishing housing trusts  and their                                                              
                            goals.                                                                                            
2:40:02 PM Mr. Jesse        Spoke of the value of the Gates                                                                   
                            Initiative   and   the   process   for                                                              
                            establishing an Alaskan Housing Trust.                                                            
2:41:45 PM Mr. Jesse        Explained why a housing trust is needed                                                           
                            in  Alaska -  page  23.    The current                                                              
                            administration is  pursuing a  housing                                                              
                            trust.     He   spoke   about  funding                                                              
                            possibilities for a housing trust.                                                                
2:43:00 PM Representative Asked about the two groups of homeless,                                                             
            Gara            those with, and those without, mental                                                               
                            health  issues,  and   how  the  trust                                                              
                            addresses those  groups.   He wondered                                                              
                            how the housing trust works in Seattle.                                                             
                            Mr.  Jesse replied  that  the proposed                                                              
                            housing trust will be designed to serve                                                             
                            all of the  homeless and their various                                                              
                            needs.  He  agreed that some many need                                                              
                            continuous service,  others  may  not.                                                              
                            The Gates Foundation booked five years                                                              
                            of support services to the first year's                                                             
                            money.   That insures support services                                                              
                            in the case of declining funding.  Many                                                             
                            families  were   able   to  be   self-                                                              
                            sufficient in that time.                                                                          
2:46:29 PM Mr. Jesse        Turned   to   page  25   -   Workforce                                                            
                            Development.      He   explained   the                                                              
                            coordinated efforts across  the system                                                              
                            including    recruitment,   retention,                                                              
                            training,  and   Healthcare  Workforce                                                              
                          Development.                                                                                        
 2:48:28 PM Mr. Jesse       Concluded with page 26 - Maintenance of                                                           
                            Medicaid.  Medicaid funding is critical                                                             
                            to  beneficiaries of  the  Trust.   The                                                             
                            Trust  is  very  interested in  working                                                             
                            with  the  Legislature and  understands                                                             
                            that their beneficiaries will suffer if                                                             
                            a  sustainable Medicaid program is  not                                                             
                            achieved.                                                                                         
 2:49:41 PM  Dr. Doolittle  Noted that  there are common threads in                                                           
                           each area.                                                                                         
 2:50:01 PM  Representative Asked  if audits  were continuing.  Mr.                                                           
             Hawker         Jesse confirmed. He observed that the                                                               
                            Office  of Management  and Budget  does                                                             
                            not  support  increased  appropriations                                                             
                            and  that  there  could  be  structural                                                             
                            deficits   in  the   near  future.   He                                                             
                            questioned   how  interests  could   be                                                             
                            balanced.                                                                                         
 2:52:18 PM Mr. Jesse       Stressed the need for a long-term                                                                 
                            fiscal plan that does  not rely on oil.                                                             
                            As  the Medicaid study pointed out,  if                                                             
                            early  intervention  programs  are  not                                                             
                            invested  in, there  will be  increased                                                             
                            costs   down  the  line,  such  as   in                                                             
                            corrections.   The Trust  is attempting                                                             
                            to  meet  the  demands  placed  by  the                                                             
                            public and  the fiscal realities of the                                                             
                            state.                                                                                            
 2:53:48 PM  Representative Asked  if the missions  brought forward                                                           
             Hawker         by the Trust take into consideration                                                                
                            the   fiscal  situation.    Mr.   Jesse                                                             
                            stressed      that     the      Trust's                                                             
                            recommendations are conservative.                                                                 
 2:54:49 PM Ms. Derr        Agreed that requests are conservative                                                             
                            and are intensely scrutinized.                                                                    
 2:55:20 PM  Representative Noted that he would like to discuss the                                                           
             Kelly          Tribal   emphasis   made   during   the                                                             
                            Medicaid  presentation [2/7/07]  and  a                                                             
                            race-based system.  Mr. Jesse responded                                                             
                            that he would be happy to discuss those                                                             
                            issues.                                                                                           
 2:56:20 PM ADJOURNMENT     The meeting was adjourned at 2:56 PM.                                                             
                                                                                                                                
                                                                                                                                

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