Legislature(2023 - 2024)ADAMS 519
02/06/2023 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Mental Health Trust Authority | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
February 6, 2023
1:34 p.m.
1:34:47 PM
CALL TO ORDER
Co-Chair Johnson called the House Finance Committee meeting
to order at 1:34 p.m.
MEMBERS PRESENT
Representative Bryce Edgmon, Co-Chair
Representative Neal Foster, Co-Chair
Representative DeLena Johnson, Co-Chair
Representative Julie Coloumbe
Representative Mike Cronk
Representative Alyse Galvin
Representative Sara Hannan
Representative Andy Josephson
Representative Dan Ortiz
Representative Will Stapp
Representative Frank Tomaszewski
MEMBERS ABSENT
None
ALSO PRESENT
Steve Williams, Chief Executive Officer, Alaska Mental
Health Trust Authority
PRESENT VIA TELECONFERENCE
Anita Halterman, Chair, Board of Trustees, Alaska Mental
Health Trust Authority
SUMMARY
PRESENTATION: ALASKA MENTAL HEALTH TRUST AUTHORITY
Co-Chair Johnson reviewed the meeting agenda.
^PRESENTATION: ALASKA MENTAL HEALTH TRUST AUTHORITY
1:36:32 PM
STEVE WILLIAMS, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL
HEALTH TRUST AUTHORITY, introduced himself.
Representative Stapp welcomed visitors from the North Slope
in the audience.
ANITA HALTERMAN, CHAIR, BOARD OF TRUSTEES, ALASKA MENTAL
HEALTH TRUST AUTHORITY (via teleconference), introduced a
PowerPoint presentation titled "Alaska Mental Health Trust
Authority: House Finance Committee," dated February 6, 2023
(copy on file). She provided prepared remarks:
The trust has a unique place in state government. We
are a funder, but we also apply our resources in a
catalytic fashion to help improve Alaska's system of
care. We do this by supporting partners and bringing
on new lines of services by supporting capacity
building, workforce development, and capital projects
and through policy and planning activities. As we
share in the upcoming slides, we do this in a way that
prudently and carefully manages trust resources.
Ms. Halterman acknowledged that the Alaska Mental Health
Trust Authority (AMHTA) was aware the system was currently
not meeting the needs of the trust's many beneficiaries.
The trust was aware of waitlists, increasing costs, and
other challenges, but trustees were proud of the work AMHTA
was engaged in with state, local, tribal, nonprofits, and
provider partners to support meaningful change and a robust
continuum of services for vulnerable Alaskans.
Ms. Halterman introduced the rest of AMHTA board members on
slide 2:
• Anita Halterman, Chair
• Rhonda Boyles, Vice Chair
• Brent Fisher, Secretary, Finance Committee Chair
• Verné Boerner, Program and Planning Committee Chair
• John Sturgeon, Resource Management Committee Chair
• Kevin Fimon, Audit and Risk Committee Chair
• Agnes Moran, Trustee
Ms. Halterman relayed that the board of trustees was an
independent board that provided governance and fiduciary
oversight and direction in achieving the mission for the
trust. Trustees were appointed by the governor and
confirmed by the legislature. The trust anticipated the
legislature would be considering appointments for two of
the board's seven members in the current year.
1:40:08 PM
Representative Coloumbe looked at the list of trustees on
slide 2. She thought individuals came from different boards
and were nominated for the governor's consideration. She
was interested in how the board members were selected based
on their background and experience.
Mr. Williams replied that the nomination process for
trustees was outlined in AMHTA statute and involved a six-
member panel including representatives from AMHTA and the
Alaska Native Health Board, Alaska Mental Health Board,
Advisory Board on Alcoholism and Drug Abuse, Alaska
Commission on Aging, and Governor's Council on Special
Education and Disabilities. The trust advertised for open
trustee seats and the panel received applications from
boards and commissions for review as a panel. The panel
conducted interviews and sent the governor a list of
recommendations for consideration. He offered to give the
background of the current members. He asked Ms. Halterman
to speak to her background.
Ms. Halterman answered that she had a background in program
and planning for Medicaid. She had 25 years of experience
working in the Alaska and Iowa Medicaid programs (with over
20 years in Alaska). She had a masters in business
administration and had served the AMHTA beneficiary
population primarily working with government programs in
the Department of Health and Social Services (DHSS) and
briefly in the Department of Corrections (DOC). She had
been on the board for four years and had served as the
chair since January of 2022. She was going through another
upcoming confirmation and would be talking with legislators
in the near future.
1:43:26 PM
Mr. Williams reviewed the professional backgrounds of the
other AMHTA trustees. He relayed that Rhonda Boyles was a
businesswoman from Fairbanks who had a family member with a
condition related to dementia. Brent Fisher was from
Anchorage and had a healthcare background in private
business. Verne Boerner was formerly the CEO of the Alaska
Native Health Board. Ms. Boerner is Alaska Native from the
Kotzebue region who brought a wealth of knowledge on the
state's healthcare system from inside and outside the
tribal health system. John Sturgeon was the resource
management chair with extensive experience in the timber
industry and other resource development. Kevin Fimon lives
in Anchorage and had previously lived in Nome for several
years bringing experience from the rural part of the state.
Agnes Moran was the newest trustee and is from Ketchikan.
Ms. Moran was the executive director of WISH and had
extensive experience addressing issues related to
homelessness. Additionally, Ms. Moran had a financial and
business background.
Representative Ortiz asked if all of the trustees were
subject to confirmation by the legislature in the current
session.
Mr. Williams answered that Ms. Halterman and Ms. Boerner
were up for confirmation currently.
1:45:46 PM
Representative Hannan surmised that Ms. Halterman had
previously been confirmed by the legislature and was up for
reconfirmation. She thought it was unique. She asked if she
was up for reconfirmation because she was serving as the
chair of the board or for another reason.
Mr. Williams explained that Ms. Halterman had been filling
out the remainder of a previous member's term. He
elaborated that trustees were appointed and confirmed for
five-year terms. At the end of the five-year term, a
trustee was eligible for another five-year term and had to
go through the same application, appointment, and
confirmation process. The process was outlined in statute
and was the result of a litigation settlement of the trust
in 1994.
Representative Hannan remarked that a five-year term meant
that no executive in one term appointed the entire board.
She asked if there were terms expiring the next year and
year after. She asked if the terms were staggered so they
did not expire at the same time.
Mr. Williams confirmed that terms were staggered over the
course of several years so there was not a cohort of
trustees with terms expiring at one time. He believed one
trustee may be completing their first five-year term in the
coming year; if the member wanted to continue on, they
would have to go through the process again.
1:48:26 PM
Mr. Williams turned to slide 3 and briefly highlighted that
trust beneficiaries included adolescents and adults who
experience:
• Mental illness
• Intellectual and/or developmental disabilities
• Alzheimer's disease and related dementia
• Traumatic brain injuries
• Substance use disorders
Mr. Williams turned to slide 4 titled "Video- about the
Trust." The video provided a brief history about AMHTA. He
explained that the history was complex and there was
nothing like the trust anywhere else in the country. He
showed a three-minute video that was also available on the
trust website.
Representative Ortiz remarked that the first scene showed
an image of the Russian leader Vladimir Putin. He asked for
the reasoning.
Mr. Williams answered that the image that popped up was not
part of the presentation [note: the video was shown on
YouTube and the image referenced by Representative Ortiz
was not associated with the presentation].
Representative Galvin thanked Mr. Williams for the history
included in the video. She stated that dealing with mental
health and addiction seemed to be one of the biggest
puzzles in the state. She appreciated that AMHTA was an
independent entity raising funds to address the issues. She
asked how the $20 million in grants were directly impacting
the outcomes of drug and alcohol addiction. She wondered if
more Alaskans were being connected to more services
resulting in more results. She remarked that the committee
had been hearing a lot about unfilled positions in recent
weeks. She stated that one of the greatest challenges
seemed to be filling the positions of mental healthcare
providers. She knew many individuals who were unable to get
help for their children and elders with mental health
needs. She asked if there were specific successful
programs. She remarked the programs needed to be built upon
by the legislature in terms of growing more of its own
providers, in addition to other things that had been done
such as adding in telehealth.
1:54:41 PM
Mr. Williams replied that he would address the questions
later in the presentation.
Representative Coloumbe was concerned about the recent
Department of Justice (DOJ) report that the state was not
providing services to children and children were being over
institutionalized. She noted a large percentage of the
children were Native. She found it a little ironic because
it was the reason AMHTA had been created because the state
was not providing services for Alaskans and the state had
been sending residents to institutions in the Lower 48. She
understood it was an issue to find the community wrap
around services; however, she stated the federal government
had threatened to sue if the state did not fix the problem.
She wondered how AMHTA would pivot to make large
improvements in a short amount of time.
Mr. Williams answered that the serious concerns raised in
the DOJ report released in December 2022 were to the point
of the trust and its role in helping the state ensure there
is a system of care for children and adolescents to access
early intervention and prevention to eliminate the need for
higher levels of care and sending children out of state.
The trust would work with the Department of Health (DOH)
and the Department of Family and Community Services (DFCS).
He informed the committee that both of the departments were
engaged with DOJ and looking at the system to determine how
it could be changed for the better moving forward. There
were some things the trust was currently doing that should
have an impact on some of the issues raised. He highlighted
work by the Crisis Now Initiative (HB 172 had passed the
legislature the previous year) to stand up mobile response
teams and access to care at lower levels for shorter
periods of time in crisis stabilization centers and
residential centers. The trust was actively working with
Bartlett Hospital in Juneau to stand up chairs for
adolescents at the hospital. The items reflected some of
the ways the trust was working to help improve some of the
systems of care identified in the DOJ report.
1:58:16 PM
Representative Coloumbe asked if the trust board had
addressed or discussed the idea of redirecting grants in a
different way to address the specific issue identified in
the report.
Mr. Williams replied that the board had not engaged in
discussion directly related to the report that contained
findings for DOH and DFCS.
Representative Josephson stated that had not read the
report but speculated that it talked more about the state's
obligations rather than those of AMHTA. He asked if his
understanding was accurate.
Mr. Williams confirmed that Representative Josephson was
correct.
Mr. Williams spoke about the history of the trust on slide
5. The history of the trust went back to territorial days
when the federal government was managing a health and
social services system for the territory. At the time, if a
person did not have access to care or family or friends to
care for them and their needs were too high, the individual
could be charged with a crime of being an insane person at
large. He elaborated that frequently individuals had been
sent to institutions out of state. As the state
transitioned to statehood, the federal government
transferred one million acres of land through the Mental
Health Trust Enabling Act for the sole purpose of helping
the new state stand up a health and social services
continuum of care. The legislature had been designated the
trustee of the lands and the funds generated from the lands
were to be the revenues for a system of care.
Mr. Williams continued to review the trust history on slide
5. In 1982, a man by the name of Vern Weiss had a son with
a severe mental illness and was unable to get care. Mr.
Weiss recognized the state had breached its fiduciary
responsibility associated with the one million acres of
land and had filed litigation. The litigation was settled
in 1994 and resulted in several key pieces. First, about
half of the one million acres of land had been sold off and
the state had to determine how to identify new acreage to
reconstitute the original acreage. The effort included the
participation of the environmental and conservation
communities, resource development, local governments, and
others. Second, to account for the value of the lost lands
the state had to pay $200 million into a trust deposited in
with the Permanent Fund that served as the corpus of the
trust through present day. Third, the oversight of the
trust was established through a seven-member board of
trustees. Additionally, the board had to approve a budget
for the use of trust funds by September 15 for the use of
trust funds (only the board of trustees could approve the
use of trust funds). By statute, the board needed to
include recommendations to the governor and legislature on
how the state should spend general fund dollars on a
continuum of care for beneficiaries.
2:02:39 PM
Mr. Williams turned to slide 6 titled "Legislative Audit
(2021) Update." The audit of the trust was a follow up to
an audit completed in 2018. The 2021 audit had five
recommendations, some of which pertained to the trust's
commercial real estate assets. In November of 2022, the
trust had provided an update to the legislative auditor who
had presented them the Legislative Budget and Audit
Committee. He shared that no additional recommendations for
action were necessary as reported by the legislative
auditor.
Mr. Williams turned to a chart on slide 7 showing the
trust's financial position from 1996 to 2022. He
highlighted the overall growth of the trust over time. He
stated that in spite of the national recession in 2008
through 2010, the trust had sustained itself, continued its
grant making, and continued to grow moving forward. He
explained that much of the success had to do with how the
trust managed its assets and the draws taken from its
assets invested at the Permanent Fund and the Department of
Revenue (DOR), in addition to the work of the Trust Land
Office to consistently work to increase the revenue
generated for the principal and income of the trust. The
chart reflected that real estate investment equity had
grown over time as well. The top right box showed the
amounts reflected in the FY 22 column including $531
million in the Mental Health Trust Fund (shown in green),
restricted and unrestricted reserves of $204 million (shown
in light blue), and the real estate investment equity at
$73 million (shown in dark blue).
Representative Ortiz asked if the lighter blue section of
the bars reflected the amount of money the trust
appropriated for programs.
Mr. Williams replied in the negative. He clarified the
light blue section of the bar reflected the trust's budget
reserves. The trust targeted a reserve of 400 percent of
the payout from the Permanent Fund and DOR. He explained
that if the economy took a huge dip, the cushion enabled
the trust to maintain its current grant making obligations.
Representative Ortiz asked about the difference in
management between the green portion of the bars on the
chart reflecting the corpus and the blue portion of the
bars reflecting trust reserves.
Mr. Williams answered that the corpus of the trust was
managed by the Alaska Permanent Fund Corporation (APFC) as
part of the overall APFC investment. The trust paid its
portion of the management of its fund to APFC. The reserves
were a combination of the 400 percent he had previously
mentioned. He detailed that 200 percent was managed within
DOR and the other 200 percent was managed outside of the
fund corpus by APFC. He explained that Callan had looked at
how the trust's assets were invested and managed over time
and the trust followed the recommendation that had been
brought forward and confirmed.
2:08:07 PM
Representative Galvin referenced Mr. Williams mention of
APFC, DOR, and Callan. She asked if Callan was the trust's
consultant.
Mr. Williams agreed.
Representative Galvin asked for verification the entities
were giving the trust the suggestion of what the trust
should be spending on grants based on the reserves the
entities recommended the trust maintain.
Mr. Williams answered that Callan looked at the trust
fund's 4.25 percent payout of the market value of the
previous four years. Callan had determined the percentage
and the calculation method allowed for sustainability and
equity over time for current and future beneficiaries. He
explained that the trust had to ensure it was maintaining
assets to provide equity over time.
Representative Galvin thought it appeared the trust had
been very successful and had managed to get through some
tough times better than other funds in the state. She asked
if there was any sense that the 4.25 percent could be
bumped up to 5 percent. She thought it could be fuel for
conversation given Mr. Williams' earlier statement that the
system was not meeting the needs. She wondered if there had
been a conversation about the topic in order to be mindful
of important investments ahead while maintaining the long-
term goal of sustaining the fund for future generations.
Mr. Williams answered that the topic had been revisited the
prior spring in a presentation by Callan to the trust's
finance committee on how the trust assets were invested and
the 4.25 percent. Callan had looked at the entire picture
and presented it to the board. The trust was maintaining
its current structure. He noted that the need would always
be greater than the trust. He explained that the settlement
did not abdicate the state of responsibilities to providing
the funding and services necessary to meet the needs of
Alaskans experiencing any of the health conditions listed
at the beginning of the presentation [slide 3].
2:11:45 PM
Representative Coloumbe asked if real estate equity
included commercial real estate. She thought the audit
seemed to indicate the trust should not invest in
commercial real estate.
Mr. Williams answered that real estate investment equity
included the seven commercial real estate properties owned
by the trust.
Mr. Williams turned to slide 8 titled "FY24 Available
Funding." He addressed how the board calculated the
available funding for an upcoming fiscal year for
allocation in a variety of ways. He directed attention to
the table on the left and highlighted four different
revenue streams. He began with the investment portfolio
payout and relayed that the 4.25 percent for the investment
portfolio payout was taken off the average of the previous
four years. The four-year timeframe allowed for smoothing
of the numbers to provide more predictability and stability
in the available trust funds. The second revenue stream was
prior year funds carried forward, which also included a
four-year lookback. The category included balances from
grants that were not expended or not fully expended. The
$2.9 million in funds shown on slide 8 reflected an average
of the prior four years. The third source was spendable
revenue generated from the Trust Land Office. The office
resided with the Department of Natural Resources (DNR) and
was responsible for managing the one million acres of land
and working to maximize the revenue from the land. The
office projected it would generate about $4.3 million for
use in FY 24. The fourth category included low interest
General Fund and Other Non-Segregated Investments (GeFONSI)
accounts/checking accounts, which contained an estimated
$254,100.
Mr. Williams highlighted a table on the right of slide 8
showing the available funding for the previous five years.
Generally, there was some growth that happened, anywhere
between $1 million and $2 million over the previous five
years. He noted the projected increase between FY 23 and FY
24 was about $300,000 due to market volatility.
2:15:00 PM
Representative Hannan asked if the land office had started
to look at carbon sequestration value. She remarked that
the trust's one million acres contained some of the largest
stands of commercially viable timber remaining in the
state, especially from Icy Cape to southern Prince of
Wales. She elaborated that AMHTA owned larger swaths of
land than the State of Alaska. She stated that when there
had been discussions on carbon sequestration, examples had
been Sealaska Corporation and the Huna Totem Corporation.
She wondered if the land office had broached the topic as a
value to pursue or whether the trust viewed the issue as
needing enabling legislation. She had heard in numerous
discussions about trust lands that the trust did not have
to follow all of the state policies; therefore, access and
notification could be done much more rapidly and
responsively to markets. She surmised the trust had the
trees that may be a commercially viable product to sell.
Mr. Williams answered that the Trust Land Office looked at
all options to maximize revenue off its lands. He clarified
that the trust followed processes in place with the state
in terms of how revenue or development off of the lands
occurred. There were times when the trust had the ability
to do it in a more expeditious way than others. The trust
was looking at carbon sequestration and it would be weighed
against all of the other available opportunities for
maximizing revenue off of trust lands.
2:17:38 PM
Mr. Williams discussed FY 24 spending on slide 9. The slide
included a pie chart showing how the $37.9 million was
approved by the trustees for expenditure. The top right
quarter of the pie showed agency budgets. The Trust
Authority Office resided under DOR and the Trust Land
Office fell under DNR. The overall operating cost of both
organizations was about 25 percent of the overall projected
FY 24 spend. The Trust Authority Office was largely focused
on policy work, grants administration, advocacy, catalytic
system change (e.g., the Crisis Now Initiative), and
focusing on meeting beneficiary needs. The Trust Land
Office was responsible for managing the trust's one million
acres of land to ensure it maintained value and to maximize
revenue off of the lands when opportunities arose.
Mr. Williams continued to review FY 24 spending on slide 9.
The bottom quarter of the pie chart (shown in yellow)
reflected MHTAAR grants, reflecting trust funds approved by
the board of trustees. The board had approved approximately
$9.8 million to state departments in FY 24. He explained
that the legislature provided receipt authority for the
expenditures in the budget. The remaining half of the pie
chart was comprised of authority grants (shown in green).
The trust had the authority to provide grants through the
state budget process to its state partners, in addition to
providing grants directly to communities, tribal
organizations, local governments, and nonprofits outside of
the budget process. For example, the trust could provide
grants directly to Juneau alliance and wellness, Alaska
behavioral health, and tribal health organizations such as
the Yukon Kuskokwim Health Corporation or Norton Sound
Health Corporation. The $19.7 million in authority grants
for FY 24 would go directly to the entities to provide
services and improved systems of care for beneficiaries. He
noted that $1.9 million of the total was designated for
direct grants impacting the lives of individual
beneficiaries. Individuals could apply for a mini grant up
to $2,500 for a variety of things (e.g., upgrading a
bathroom to be ADA compliant, purchasing clothes for a job,
and paying a housing deposit).
2:21:26 PM
Representative Coloumbe asked if the expenditures shown for
the Trust Authority and Trust Land Office reflected only
salaries or included leases, utilities, and other.
Mr. Williams replied that the Trust Authority had 17 full-
time employees and the Trust Land Office had 19 full time
employees. The budget increments [shown on slide 9]
represented the salary for employees, interagency charges
to DOR and DNR, trustee honorarium, travel, and other
services and contracts.
Representative Coloumbe observed that the agency budgets
were close to the MHTAAR spend reflected on the slide. She
asked if there was a limit on the amount the trust could
spend on administration.
Mr. Williams answered that there was not a cap. He
highlighted that the trust's agency budgets had remained
relatively flat over the past few years.
Representative Galvin looked at the yellow portion of the
pie chart on slide 9 reflecting MHTAAR funds. She observed
it was a significant amount of funding for state agencies.
She was interested in growing the workforce and ensuring
there were more care providers. She asked if the funds
filled the gaps where there had been cuts in state funds.
Alternatively, she wondered whether the funds were in
addition to state funding. She asked if there was a sense
that the number of care providers were growing in Alaska
because of the funding. She surmised if the funding was
filling in holes where there had been cuts that perhaps it
merely maintained the status quo.
2:24:21 PM
Mr. Williams answered that the trust did not backfill
reductions made to other services previously funded by the
state. He relayed there were a number of things the trust
was doing to try to grow the workforce for things like the
SHARP program providing loan repayment to AMHTA community,
tribal health, and state government partners. He elaborated
that API, DOC, and OCS used the loan repayment program as a
way to attract and retain a workforce serving trust
beneficiaries.
Mr. Williams turned to a pie chart reflecting a breakdown
of the $9.8 million in MHTAAR grants for FY 24 on slide 10.
The grants were going to 11 state agencies, 9 departments,
the Court System, and Alaska Housing Finance Corporation
(AHFC). He noted the largest portion of the funding went to
DOH and DFCS.
Mr. Williams advanced to a table on slide 11 titled "FY 24
GF/MH Recommendations (and Associated MHTAAR Grants)." He
explained that by statute, the board of trustees made
recommendations for how the trust spent its money and for
state general fund mental health expenditures. The three
columns in blue reflected recommendations approved by
trustees in August of 2022 and submitted to the legislature
and governor for state general fund spending. The yellow
columns to the right reflected funding that had been
included in the governor's proposed FY 24 budget.
Mr. Williams highlighted there were some places where the
[trustee] recommendations were not included in the budget
and other places where recommendations had been included.
He detailed that about 40 percent of the general fund
mental health recommendations were included in the
governor's proposed budget. He remarked it was not
necessarily uncommon. He elaborated that in the history of
the trust when AMHTA made recommendations for general fund
spending, governors had included all of the funding, some
of the funding, or somewhere in between. The trust was
appreciative of the funds that had been included in the
proposed budget and it was working with the administration
and legislature to try to get the recommendations included
in the budget.
Mr. Williams elaborated on slide 11. He pointed to the
second row reflecting a comprehensive program planning
position, which was jointly funded by the trust and the
department. The position served as the point person for the
department's comprehensive integrated mental health program
plan developed with the trust by statute. The position had
been incredibly valuable over the past several years. He
highlighted the trustee recommendation for two increments
for Crisis Now continuum of care grants of $1 million and
$500,000. He explained that DOH, DFCS, and AMHTA had been
engaged in the transformational initiative since 2018 and
significant headway had been made in the way the system had
traditionally responded to an individual in behavioral
health crisis. He pointed to the special needs housing
grant program that had not been included by the governor.
He explained that after talking with AHFC and others that
it had been an oversight; the trust was hoping the
increment would be included in the governor's amended
budget.
2:29:12 PM
Representative Josephson believed HB 172 had been about
helping people and saving money. He asked if his
understanding was accurate.
Mr. Williams replied that the bill could result in saving
money, but the primary goal was ensuring the available
resources were allocated and used the most appropriate and
effective way, specifically related to law enforcement. He
elaborated that law enforcement was the default response to
people in crisis, which meant officers did not have the
time to investigate crimes and work on reports. The
component could translate into savings, but the bill was
primarily about using the resources in the most effective
and efficient way.
Representative Josephson shared that he was thinking about
emergency room costs as well. He asked for verification the
Crisis Now model would require a large infusion of capital
funding. He believed structures were needed where people
would care for people in the 23-hour to 7-day window under
the Crisis Now model.
Mr. Williams answered affirmatively. There would be a need
for capital funding and startup funding to allow for an
organization bringing on a new service to have a transition
period. He explained the organizations would need time to
phase in a service, capture as much revenue as possible,
and move forward with a program or services that balances.
2:31:17 PM
Representative Hannan referred to the special needs housing
grant and the two Crisis Now continuum of care grants
[shown on slide 11] that were approved by the trustees but
not included in the governor's proposed budget. She asked
if the trust anticipated seeing the items in the governor's
amended budget. She referenced the Crisis Now center at
Bartlett Hospital in Juneau that was expected to be
operational in 2024.
Mr. Williams answered the items were recommendations for
the governor to consider and the trust was hopeful the
increments or a portion may be included in the governor's
amended budget. He relayed that AMHTA developed its
recommendations over the course of the spring and summer in
partnership with departments. The trust recognized the
departments could not commit during the process. He noted
it was the way the systems had operated over the past 25
years.
2:33:12 PM
Representative Hannan asked if the budget increments
recommended by the trustees would fully fund the Crisis Now
models coming online. She asked if additional money would
be needed.
Mr. Williams answered that the increments would not fund
the total need.
Representative Coloumbe believed the special needs housing
grant was included in the governor's supplemental budget;
however, she had not see the Crisis Now grants included.
She looked at slide 11 and saw that the trustee
recommendation of $1.5 million. She asked if the trust was
prepared to pay the amount if the governor did not include
the funding in the budget.
Mr. Williams clarified he had been referencing the
governor's forthcoming FY 24 amended budget and not the FY
23 supplemental budget. He hoped to see the funding in the
amended budget. The trust would continue to work through
the legislative processes to include the items in the
budget.
Representative Galvin thought Mr. Williams had stated the
comprehensive program planning position (shown on line 2 of
slide 11) was in statute. She asked for clarity.
Mr. Williams clarified that the plan was statutory; the
position was not.
Representative Galvin surmised the plan was in statute and
there may be a need to have a person help coordinate the
plan.
Mr. Williams agreed.
2:35:42 PM
Mr. Williams turned to slide 12 titled "Trust Grant
Impacts." He noted that committee members should have
received a copy of the AMHTA Annual Report and AMHTA FY 22
Investment Report in the past couple of weeks. The
documents included the 170 grants awarded in FY 22 and the
(state and non-state) organizations that received them. He
detailed that around 22 organizations had received grants
from AMHTA.
Mr. Williams turned to slide 13 and discussed the trust's
budget development process. Trust staff worked with
community partners, statutory advisory boards, and others
to develop budget recommendations that fell into AMHTA's
four focus areas outlined on the slide:
Established Focus Areas
• Disability Justice
• Mental Health & Addiction Intervention
• Beneficiary Employment & Engagement
• Housing and Home & Community Based Services
Additional Priorities
• Workforce Development
• Early Childhood Intervention & Prevention
Mr. Williams elaborated that the trustees had established
the focus and priority areas over time to channel AMHTA
staff and financial resources in a focused way to address
key issues impacting beneficiaries. The alternative
piecemeal approach was not holistic and did not result in
beneficial change over the long-term.
2:37:55 PM
Mr. Williams discussed slide 14 titled "Policy/Advocacy":
• Community based Services
o Housing and homelessness
• Workforce Development
• Medicaid
• Transforming behavioral health crisis response
Mr. Williams elaborated on slide 14. He elaborated that
early intervention and having available services meant that
hopefully individuals did not go into crisis or need to
access higher levels of care that were more costly,
traumatic, and could pull individuals out of their
communities and away from family. Additionally, the trust
worked to use peers in recovery as a part of the workforce
(part of the Crisis Now model) to get individuals in a
challenging time to engage in treatment services and a path
towards recovery. Medicaid was an important piece of AMHTA
advocacy because the majority of beneficiaries received
health insurance through Medicaid. The transforming of the
behavioral health crisis response system was the Crisis Now
model.
Co-Chair Johnson referenced the behavioral health crisis
response and asked if the trust had any information on the
number of response calls that had occurred.
Mr. Williams replied the trust could provide some data
related to the Fairbanks mobile crisis team that had been
operational for a little over a year. Additionally, he
would provide information from the Anchorage Fire
Department related to its paramedicine response that
included an EMS and social worker.
Mr. Williams looked at a timeline illustration of a
commitment beginning in 2018 between the department and
AMHTA to transform the system (on slide 15). He highlighted
that systems change did not occur over night. The work was
being done by AMHTA, DOH, DFCS, DOC, the Department of
Public Safety (DPS), tribal health organizations, community
partners, and trust beneficiaries. He stated for the system
to change everyone had to understand where it was going and
be a part of the change to the extent possible. The goal
was to create a system with parity when someone accessed
emergency response for a physical health condition.
2:41:04 PM
Mr. Williams highlighted the work of the Trust Land Office
on slide 16. He detailed that Jusdi Warner was the
executive director of the office with a staff of 18. The
table to the right showed FY 23 anticipated Trust Land
Office revenues from resources including coal, oil and gas,
minerals, timber, lands, real estate, and materials for
transportation projects around the state (e.g., sand,
gravel, and rock). He relayed the trust did an annual fall
land sale that generated $2.7 million in FY 23, which
exceeded the revenue the previous year. The trust was
exploring the ability to capture revenue through fees
related to public utility easements that existed currently
or easements in the future that would run through trust
land parcels. The revenues from the U.S. Forest Service
land exchange had generated roughly $7 million for the
trust with a projected $20 million to $30 million over the
life of the land exchange. The Icy Cape development was
AMHTA land located to the north of Yakutat where minerals
may generate revenue.
Co-Chair Edgmon thanked the trust for an excellent
presentation. He stated that annually the trust came before
the legislature and proved it was doing many things to help
programs in need in real time and was at the leading edge
in terms of innovation such as the Crisis Now centers. He
referenced HB 172 that had been passed the previous year.
He believed the potential associated with the bill was more
than the mind's eye could see, particularly if the mobile
crisis centers could be built out in the bush and other
places. He imagined the Trust Authority did not do a five-
year planning session to project forward. He elaborated
there were elements of the bill that went along at their
own pace. He invited Mr. Williams to provide additional
detail on where the program could go. He stated that if it
came together, its impact would be far reaching.
Mr. Williams answered the initiative to transform the
system to do better was spurred by a lawsuit against the
state by the Disability Law Center and Public Defender
Agency because individuals in behavioral health crisis had
been sitting in hospital emergency rooms or DOC without
committing a crime and waiting for access to care. When the
settlement occurred, the crisis had been used as an
opportunity to transform the response to Alaskans in crisis
healthcare conditions. The work had begun by conducting a
national review of what was being done in other states. The
research had landed on work being done in Phoenix, Arizona
with the Crisis Now model. The trust had then contracted
with RI International to do an assessment on Alaska's
system of care with an initial focus on Fairbanks,
Anchorage, and Mat-Su. The assessment looked at current
capacity, gaps, possibility, and what was needed to meet
the needs of the individuals without overbuilding. He
elaborated that a work plan was developed to look forward
on how to create a call center, mobile crisis response
teams, short-term crisis stabilization, short-term
residential up to seven days, and higher level beds
operated at hospitals such as Bartlett and API.
Mr. Williams continued that the work had resulted in mobile
crisis teams operating in Fairbanks and Anchorage. The
effort in Mat-Su was in the process of currently rolling
out the mobile crisis team. He elaborated that AMHTA was
partnering with other communities to help them gain a
foundational understanding to know what they could be doing
in their communities. He listed Copper Center, Ketchikan,
Kotzebue, and Juneau as examples. The systems in the
communities were looking at how the state could do better.
The goal was not to take the model working in Phoenix and
plop it into Ketchikan or Juneau because the community of
Phoenix was strikingly different from the two Southeast
Alaska communities. It was necessary to take the principles
and foundations of the model along with the capacities and
needs of the communities and align them. He stated the
process would take several years, but results were being
seen.
Co-Chair Edgmon believed it would be a transformation if it
all came together.
Mr. Williams agreed.
2:48:40 PM
Representative Stapp applauded AMHTA on its fiduciary
responsibility. He remarked on the trust's solid investment
portfolio that appeared to be well managed and had good
risk tolerance. He highlighted that the assets under
management had more than doubled since 2009. He observed
that outcomes were going the other direction. He referenced
scorecard information from the nonprofit Healthy Alaskans
reporting increases since 2009 in suicides, adolescents
experiencing feelings of hopelessness, and alcohol induced
mortality rates. He asked what legislators could do to help
the trust further its mission.
Mr. Williams stated the statistics were tragic and
alarming. He thought it was necessary to look at the system
as a whole and understand the myriad variables that were a
part of one individual's decision to attempt suicide for
example. He stated it was not only the health and social
services sector, it included economies, workforce, jobs,
sense of community, loss of sense of community. All of the
things could be a part of an individual reaching a place
that was so overwhelming that they were actually
considering taking their life. He stated that the trust,
communities, the legislature, and Alaskans had a role to
play. In order to turn the curve it was necessary to
understand when an individual was reaching out in need of
support in addition to funding services at the current cost
of providing the service. He highlighted the importance of
the ability to recruit and retain trained staff and in
making sure services were culturally appropriate. The
ability to change the statistics would require a sustained,
concerted, and comprehensive approach. He stressed that
there was not one individual thing on its own that would
solve the problem.
2:53:31 PM
Representative Josephson considered Representative Stapp's
question and Mr. William's response. He believed there was
almost a near perfect analogy involving funding for K-12
education. He explained there were people who believed the
value of the funding for K-12 education needed to be proven
with data and concrete accomplishments. He asked how AMHTA
responded to the idea. He asked if the trust made
adjustments to pivot and go a different direction when a
specific method did not work.
Mr. Williams answered that when AMHTA awarded grants there
was a grant agreement outlining the intended use of the
funds and expected outcomes. He explained that because the
trust was an innovative, catalytic fund, there would be
some things that did not play out in the desired way. He
noted the trust could learn from the outcome and pivot to a
different method. The trust viewed grant outcomes and
performance as a way to help guide it in directions that
prove to have positive impacts for trust beneficiaries. He
highlighted therapeutic courts as an example. He elaborated
that the trust, in partnership with the Court System, DOC,
and others, had invested heavily on in the early 2000s in
therapeutic courts. The investment had been made with the
idea of demonstrating the value, or not, of the program. He
relayed the value had not been demonstrated in one
particular project and the trust had discontinued its
funding.
2:56:20 PM
Representative Josephson noted that Senator Matt Claman had
filed a bill related to involuntary commitment. He noted
his office had been working intensely on the issue as well.
He asked if the trust had any internal meetings about
problems that exceeded the HB 172 "sphere" in that a
mentally ill person posed a real and palpable threat to
others and they were not chargeable because they were
incompetent to stand trial.
Mr. Williams answered there had been no discussion related
to Senator Claman's bill SB 53. He relayed that in 2015
AMHTA, DHSS, the Department of Law, the Public Defender
Agency, and other state and nonstate entities had looked at
the Title 12 statutes pertaining to legal competency to
identify how they could be rewritten and updated because
they were significantly outdated. The work had involved
looking at the interplay between Title 12 the criminal
statutes and Title 47 the civil commitment statutes. He
believed it was the interplay Senator Claman and perhaps
Representative Josephson were looking at. Specifically,
what happened when someone's charges were dismissed but
they had been evaluated to be a serious threat to
themselves or others.
2:58:45 PM
Representative Galvin referred to Co-Chair Edgmon's earlier
point about a gamechanger. She looked at systemic ideas
shown on slide 15. She referred to Mr. Williams' example
about Arizona. She asked if Mr. Williams could add more
context and color for individuals looking for tangible
changes in direction and possible outcomes in relation to
the data mentioned by Representative Stapp.
Co-Chair Johnson reminded members that Mr. Williams would
be available to elaborate on topics discussed in the
meeting in individual appointments as well.
Mr. Williams communicated the importance of ensuring
someone had immediate access to needed care. He pointed to
the crisis call center icon on slide 15 represented by a
headset. The call center was a place for individuals in
crisis to call where the staff were trained to address the
situation by helping the individual work through the
situation or by connecting them to the appropriate place to
address the acute need.
Representative Galvin asked if there were any concrete
examples of outcome differences after Arizona adopted a
similar approach.
Mr. Williams would follow up with the information.
Co-Chair Johnson thanked Mr. Williams for the presentation.
She reviewed the schedule for the following day.
ADJOURNMENT
3:02:14 PM
The meeting was adjourned at 3:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| AMHTA H FIN presentation 2023_Final.pdf |
HFIN 2/6/2023 1:30:00 PM |
HB 41 |
| AMHTA Responses to Commmittee Questions During 2.6.23 Hearing_Final.pdf |
HFIN 2/6/2023 1:30:00 PM |
HB 41 |