Legislature(2023 - 2024)ADAMS 519
01/31/2024 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB270 | |
| Overview: 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
| *+ | HB 270 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
January 31, 2024
1:37 p.m.
1:37:50 PM
CALL TO ORDER
Co-Chair Johnson called the House Finance Committee meeting
to order at 1:37 p.m.
MEMBERS PRESENT
Representative Bryce Edgmon, Co-Chair
Representative Neal Foster, Co-Chair
Representative DeLena Johnson, Co-Chair
Representative Julie Coulombe
Representative Alyse Galvin
Representative Sara Hannan
Representative Andy Josephson
Representative Dan Ortiz
Representative Will Stapp
Representative Frank Tomaszewski
MEMBERS ABSENT
Representative Mike Cronk
ALSO PRESENT
Anita Halterman, Chair, Alaska Mental Health Trust
Authority; Steve Williams, Chief Executive Officer, Alaska
Mental Health Trust Authority.
SUMMARY
HB 270 APPROP: MENTAL HEALTH BUDGET
HB 270 was HEARD and HELD in committee for
further consideration.
OVERVIEW: ALASKA MENTAL HEALTH TRUST AUTHORITY
Co-Chair Johnson reviewed the meeting agenda.
HOUSE BILL NO. 270
"An Act making appropriations for the operating and
capital expenses of the state's integrated
comprehensive mental health program; and providing for
an effective date."
1:39:01 PM
^OVERVIEW: ALASKA MENTAL HEALTH TRUST AUTHORITY
1:39:03 PM
ANITA HALTERMAN, CHAIR, ALASKA MENTAL HEALTH TRUST
AUTHORITY, introduced herself and opened with prepared
remarks about the Alaska Mental Health Trust Authority
(AMHTA):
We appreciate the opportunity to present to the
committee today. The Alaska Mental Health Trust
Authority is a state corporation that administers the
Alaska Mental Health Trust. We are a grant maker, an
advocate for vulnerable Alaskans, and a systems change
agent. By working with state and local governments,
tribal, nonprofit, and provider partners we endeavor
to improve the outcomes for our trust beneficiaries
and to continue to build the continuum of care that
meets the needs for Alaskans. I hope that through our
presentation today we illustrate that as a board and
an organization, we prudently and carefully manage and
apply trust resources.
Ms. Halterman introduced AMHTA trustees shown on slide 2 of
a PowerPoint presentation titled "House Finance Committee"
dated January 31, 2024:
• Brent Fisher, Vice Chair
• Agnes Moran, Secretary, Program & Planning Committee
Chair
• John Sturgeon, Resource Management Committee Chair
• Kevin Fimon, Audit & Risk Committee Chair
• John Morris, Finance Committee Chair
• Rhonda Boyles, Trustee
Co-Chair Johnson welcomed the trustees to House Finance.
Ms. Halterman relayed that the AMHTA Board of Trustees was
an independent board that provided governance, fiduciary
oversight, and direction to an organization in order to
achieve the mission of the trust. Trustees had five-year
terms and were appointed by the governor and confirmed by
the legislature. She reviewed trust beneficiaries on slide
3:
Trust beneficiaries include Alaskans who experience:
• Mental illnesses
• Intellectual and/or developmental disabilities
• Alzheimer's disease and related dementia
• Traumatic brain injuries
• Substance use disorders
Ms. Halterman elaborated on trust beneficiaries with
prepared remarks:
We recognize that many of our beneficiaries fall into
more than one group. We support both youth and adult
beneficiaries and we prioritize individuals whose
behavioral health condition or developmental
disability place them at risk of institutionalization
if they don't have proper community-level services and
supports. We also consider prevention, one of these
conditions, when possible, to be part of our mandate.
1:42:29 PM
Ms. Halterman turned to slide 4 and read the mission of the
trust:
• Administer the Mental Health Trust, a perpetual trust
• Improve lives and circumstances of Trust beneficiaries
• Protect and enhance value of Trust lands while
maximizing revenues from them over time
Ms. Halterman elaborated on slide 4 with prepared remarks:
The Alaska Mental Health Trust Authority, the Trust,
is a state corporation that administers the Trust
perpetually to improve the lives of beneficiaries. The
Trust operates much like a foundation, using its land
and cash assets to help ensure that Alaskans have a
comprehensive suite of mental health and disability
services that meet the needs of our beneficiaries in
their own communities. The Trust Land Office is
contracted exclusively by the Trust to manage its
approximately 1 million acres of land and other non-
cash assets in order to generate revenue over time to
serve our beneficiaries.
1:43:27 PM
STEVE WILLIAMS, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL
HEALTH TRUST AUTHORITY, introduced himself and thanked the
committee for inviting AMHTA to present. He turned to slide
5 titled "Financial Position." A bar chart on the slide
showed AMHTA's financial position over time through the end
of 2023. The trust's invested assets totaled approximately
$818 million at the end of 2023, reflecting an increase
from $809 million the previous year. The corpus of the
trust was approximately $538 million (reflected by the
green portion of the bars), which was an increase of about
$7 million from the previous year. He explained that the
increase was largely attributable to the principal revenue
generated from the Trust Land Office (TLO). The trust
budget reserves totaled about $218 million (reflected by
the light blue portion of the bars) and commercial real
estate equity totaled about $61 million (shown in dark
blue). The chart showed the AMHTA financial position had
grown steadily since 1997 as a result of prudent management
by the board, TLO, and Trust Authority Office (TAO). He
noted several dips in the trust's invested assets,
specifically in 2008 through 2010 due to the national
economy. He noted that the $818 million of invested assets
did not include the 1 million acres of land managed by the
TLO.
1:46:24 PM
Mr. Williams turned to slide 6 titled "Commercial Real
Estate." The trust owned seven properties including two
properties in Alaska, one property in Washington, one
property in Utah, and three properties in Texas. The
occupancy rate for all seven properties was 98 percent,
which exceeded the current national average of
approximately 80 percent. Additionally, the portfolio
performance currently exceeded the national average by
about 6 percent. The TLO had experienced staff tasked with
ensuring the properties were occupied, high quality,
retaining their value, and generating revenue. The assets
were in the 7 to 20-year mark in their lifespan and the
board's Resource Management Committee directed the TLO to
continue active and prudent management of the assets and to
provide recommendations for the board to consider regarding
disposal of the assets when financially prudent.
Representative Tomaszewski thanked the presenters. He
relayed that the Legislative Budget and Audit Committee had
recently seen information about some commercial property
the trust had purchased without proper authority. The
committee had been told the properties should be divested.
He asked if the trust had divested in the properties. He
asked for additional details.
Mr. Williams answered that the properties referenced by
Representative Tomaszewski and discussed in a previous
Legislative Budget and Audit report were the seven
properties discussed on slide 6. He explained that the
properties had been acquired in the mid-2000s. During that
time period there was a question about whether trust
principal could be used to purchase commercial real estate.
In 2021, the trustees transferred trust income of
approximately $39 million back to the corpus of the trust
to repay the principal.
Representative Tomaszewski asked if the recommendations
from the audit had been satisfied.
Mr. Williams answered that the trust was following the
audit recommendations. He explained that when financially
prudent, AMHTA would look at disposal of each of the
properties.
1:50:13 PM
Representative Coulombe looked at the trust's financial
assets shown on slide 5 and observed that restricted and
unrestricted reserves reflected a substantial amount of
money. She asked if the funds were reserved for operations
or grants.
Mr. Williams replied, "Both." He explained that AMHTA's
asset management policy had a budget reserve target of 400
percent of the payout amount for the previous four years
from the Alaska Permanent Fund. In a period of [economic]
downturn the reserves would enable the trust to ride out
the dip without any impact to grants or TLO and TAO
operations.
Representative Coulombe asked if Mr. Williams was referring
to the restricted and/or unrestricted reserves.
Mr. Williams responded that the restricted and unrestricted
reserves were both used in the calculation of the 400
percent.
Representative Josephson referenced management of real
estate income that should have been managed by the Alaska
Permanent Fund Corporation (APFC). He noted the issue had
received broad coverage and was the subject of an audit. He
asked if the issue had been resolved.
Mr. Williams replied that he was not certain he understood
the question. He stated that originally when the commercial
real estate properties were purchased there had been a
question about whether trust principal could be used for
the purchase. The AMHTA trustees used income to repay $39
million to the principal of the trust that a legislative
audit specified should have been invested in the Permanent
Fund.
1:53:10 PM
Representative Josephson stated procedurally it had been
unclear whether AMHTA would pivot back to allowing APFC to
have its statutory role in managing the funds. He sensed
that APFC had been acquiescent about the situation, but
that there was a rule that was not being complied with. He
asked if the issue had been resolved.
Mr. Williams replied that APFC actively managed the corpus
and principal of the trust. The $39 million was invested
and actively managed by APFC along with all the other
financial assets.
Representative Hannan asked for verification that the real
estate investment equity shown on slide 5 was not
restricted or unrestricted but was shown on the slide as a
percentage of assets.
Mr. Williams replied affirmatively.
1:54:45 PM
Mr. Williams moved to "FY 25 Available Funding" on slide 7.
The slide depicted the trustee's approval of the use of
trust funds for FY 25. The trust generated revenue in four
ways and used a calculation to determine available spending
for the future fiscal year. The investment portfolio payout
shown on the top row of a table titled "Trust's Estimated
Available Funding FY 25" represented the Permanent Fund. He
reminded committee members that figures shown in each of
the rows in the table were based on an average of the past
four years. The first row showing approximately $32 million
reflected 4.25 percent of the average of the previous four
years of the Permanent Fund [investment portfolio payout]
at the close of each fiscal year. The second row showed
$2.2 million in prior year funds carried forward. He
explained that the funding reflected grant funds from
previous years that were not fully expended. The third line
showed projected TLO spendable income at $3.7 million and
the fourth row showed interest earnings of $189,500
(interest on funds in the checking account). The total
projected available funding for FY 25 was $38.5 million,
reflecting a slight increase from FY 24. He noted that the
investment portfolio payout funding was based on APFC's
midrange return projection.
Representative Galvin asked about the 4.25 percent. She
recalled that when Callan came to present to the committee
the previous year, they were proud of how well the fund was
doing. She asked for details on the board's discussion on
growing the corpus versus ensuring the trust got as much
money as possible out for services. She observed that the
trust had been very conservative. She remarked that the
fund was doing very well, and she wondered whether the
board had considered a payout at a different percentage.
She also asked whether the $2.2 million in carried forward
funding would go straight into grants out the door. She
asked if an effort had been made to ensure the grant funds
were spent rather than carrying over into the future.
Mr. Williams shared that AMHTA had contracted Callan to
look at the 4.25 percent payout in the spring of 2022.
Callan had looked at the percentage to determine whether
the 4.25 percent payout should be increased or decreased
based on a number of different scenarios. He highlighted
that one of the trust's responsibilities was to ensure
there was parity and equality for current and future
beneficiaries. He explained that AMHTA was tasked with
ensuring the percentage payout did not put the trust at
risk for future beneficiaries. He reported that Callan had
determined 4.25 percent was currently the appropriate
payout. He added that the analysis was done every few years
and AMHTA took growth of the fund and the fiscal
environment into account.
2:00:08 PM
Representative Galvin remarked that in the current
environment people could get 4.5 percent [interest] in a
bank account. She thought it sounded like AMHTA waited a
substantial period of time before making changes, which she
could appreciate. She considered that the number
recommended by Callan for the Permanent Fund was higher.
She commented on the desperate need for behavior health
services supported by the trust and vocalized support for
considering the marketplace in more real time.
Mr. Williams asked for a reminder of the rest of the
question.
Representative Galvin complied.
Mr. Williams answered that the prior year funds carried
forward represented the previous four-year average of grant
funding that was not fully expended. He explained that the
trust would identify and expend the funding on grants in FY
25.
Representative Galvin asked whether the amount [of carried
forward funds] was an industry standard. She asked if the
number was not unexpected given the magnitude of funding
dispersed by the trust.
Mr. Williams replied that he did not know whether it was an
industry standard, but AMHTA tried to make certain that no
less than 10 percent of its awarded grants lapsed.
Representative Stapp asked if the board had always
recommended a 4.25 percent draw since the fund's inception.
He asked if the draw had been higher or lower in the past.
Mr. Williams replied that the draw had not been 4.25
percent since the fund's inception. The number had grown
since 1997. He did not have the year when the increase was
made, but he could follow up with the information.
Representative Stapp was satisfied with the answer and did
not need additional information.
2:03:15 PM
Mr. Williams advanced to a pie chart showing FY 25 spending
on slide 8. The TAO and TLO shown in green and blue,
respectively, represented the agency budgets. The TAO had a
staff of 17 and the TLO had a staff of 19. The slide showed
the agency budgets, which had been kept relatively flat for
the past several years. The trust had been attentive to the
allocation and needs for each agency budget. Additionally,
AMHTA wanted to ensure the TAO had adequate staff to ensure
grant funding got out the door to communities and that it
was able to monitor and manage grants and work with
agencies if they had any challenges with implementation of
projects. Trust Land Office work was about generating and
maximizing revenue off of trust lands in addition to acting
as good stewards of the land and mitigating any liabilities
in order to maximize revenue in the future.
Mr. Williams pointed to the yellow portion of the pie chart
on slide 8 reflecting Mental Health Trust Authority
Authorized Receipts (MHTAAR). The trustees approved $10.2
million in trust funds for 11 departments in different
amounts to support trust and state programs, services, and
initiatives. The legislature provided receipt authority for
the departments to expend the funds similar to federal
receipt authority. The dark green portion of the chart
reflected authority grants. The grants were made directly
from the trust office to local governments, nonprofits, and
tribal organizations that provide services to trust
beneficiaries. He explained that the House Finance
Committee saw the $10.2 million in MHTARR funds in the
state budget, but it did not see the $19.4 million in
authority grants provided directly from the trust to
organizations. The authority grants supported the state
system by ensuring organizations had funding available for
things like deferred maintenance, new programs, and capital
needs such as updates to financial software.
2:06:54 PM
Representative Tomaszewski stated that the legislature
often got questions from constituents about why they were
not getting paid on time by other departments. He asked if
AMHTA used a set of metrics to determine whether it was
getting payments for services rendered from grantees. He
asked how AMHTA ensured everyone got paid on time.
Mr. Williams replied affirmatively. He explained that after
a grant was approved, the trust tried to get the first
payment out within 30 days.
Representative Coulombe asked if the amount shown for
MHTAAR grants was more or less than the previous year. She
asked if the amount was typically around the same annually
and how AMHTA determined the amount.
Mr. Williams answered that the FY 25 MHTAAR amount was
about $500,000 higher than the FY 24 amount. He explained
that when staff developed budget recommendations that were
presented to trustees in the summer and the legislature and
administration by September 15, they looked at priorities,
needs, and capacity for the individual departments to
distribute the funding. He noted that the number
fluctuated. He added that part of the trust's consideration
when bringing forward MHTAAR increments was whether there
was any state match. He explained it was not a requirement
and the majority of the grants did not have a state general
fund match.
2:09:42 PM
Representative Coulombe asked how AMHTA prioritized its
authority grants. She thought the trust likely received a
substantial number of requests from across Alaska. She had
looked at an AMHTA pamphlet and observed that the trust
appeared to have several priorities based on the numbers.
She asked if the trust focused on a particular area of the
state when deciding how to distribute the $19.4 million in
grants in FY 25.
Mr. Williams requested to answer the question on a future
slide.
Mr. Williams moved to slide 9 titled "MHTAAR Grants, FY
25." A pie chart on the slide showed the 11 departments
receiving MHTAAR grants in FY 25. There were 63 grants and
the majority did not have a state general fund match;
however, there were several in the budget approved by the
trustees that should have a match. Approximately 40 percent
of the MHTAAR total was directed to the Department of
Health (DOH) and the Department of Family and Community
Services (DFCS).
2:11:38 PM
Mr. Williams turned to a table on slide 10 showing FY 25
GF/MH recommendations and associated MHTAAR grants
recommended by the trustees. He reminded committee members
that the board of trustees was required by statute to make
state general fund/mental health increment recommendations
for how the state should be funding its comprehensive
integrated mental health program plan. The inclusion of the
trustee's recommendations in the state budget varied over
time. He detailed that in some years a majority of the
trustee's recommendations were included in the final budget
and in other years a portion of the recommendations were
included. The governor's proposed FY 25 included about 36
percent of the trustee's recommendations. He relayed that
it had to do with priorities at the time and the state's
fiscal situation. He stressed that when trustees made state
general fund recommendations and approved them in the AMHTA
budget, the trustees were paying attention to the state's
fiscal climate. He explained that the trust's recommended
budget prioritized what it believed to be the most critical
things that were necessary.
Mr. Williams reviewed the table on slide 10. The left side
showed the project title and department receiving the
operating funds. Most of the projects were related to DOH
but they also included increments for the Department of
Revenue (DOR), Department of Education and Early
Development (DEED), Judiciary, and the Department of
Administration (DOA). The second column reflected trustee
approved recommendations shown in yellow. The third and
fourth columns indicated whether there was an MHTAAR
increment or other funding increment (e.g., Alaska Housing
Finance Corporation dividend) associated with the
recommendation. He noted that slide 10 showed operating
recommendations and slide 11 showed capital
recommendations.
Mr. Williams pointed to the columns on the right of the
slide showing trustee recommendations included in the
governor's proposed FY 25 budget. The differences were
shown in the second to last column. He highlighted the
impacts of some of the recommended operating items. He
highlighted that the increment of $50,000 for the
Governor's Council on Disabilities and Special Education
(GCDSE) was critical for the advisory boards to determine
the statewide need for adults and children experiencing
intellectual and developmental disabilities. He explained
that without the increment the council would not have the
ability to fulfill its mandate to report on the needs and
successes related to the population statewide. The second
row showed a $75,000 increment for the comprehensive
integrative mental health program plan manager position;
funding of the position was a shared responsibility. He
detailed that the departments were statutorily required to
have a comprehensive integrative mental health program
plan. The position was tasked with updating the plan, which
was currently at its five-year renewal cycle. He stressed
that the position was critical for the departments to do
the work and monitor the progress on the plan once
finalized.
Mr. Williams addressed the $133,000 increment for the long-
term care ombudsman office. The office was housed within
DOR and the trust was statutorily required to oversee the
administration of the long-term care ombudsman. The funding
was for a position within the office. The office was tasked
with investigating complaints at assisted living homes and
skilled nursing homes statewide. There were over 600
assisted living homes in the state with over 5,700
residents between skilled nursing homes and assisted living
homes located in Ketchikan, Bethel, Utqiagvik, Nome, and
everywhere in between. He stated the continued work was
critical. Historically, when the office received complaints
from a resident, a family member, guardian, power of
attorney, or someone in the community, they investigated
the situation and resolved it to the satisfaction of the
complainant close to 80 percent of the time. He added that
the office made unannounced visits as well.
2:17:55 PM
Mr. Williams continued to review AMHTA recommended
operating budget increments on slide 10. He addressed
increments of $1.5 million and $500,000 for Start-up Crisis
Now grants. He highlighted that the governor's proposed
budget included a reduction to the items and MHTAAR
increments that were not included in the trust approved
budget. The governor's budget reduced the $1.5 million
request by $1 million and added $500,000 in MHTAAR trust
funds that were not approved by the AMHTA trustees.
Additionally, the governor's budget reduced the $500,000
increment recommended by trustees by $250,000 and added
$250,000 in MHTAAR trust funds that were not approved by
the trustees. He was working with the Office of Management
and Budget (OMB) to hopefully rectify the issue perhaps in
the governor's amended budget. He elaborated that there was
no MHTAAR funding associated with the two increments in the
trust's recommendations; however, the trust was heavily
invested in the [Crisis Now] initiative and provided
funding largely through AMHTA authority grants. He
explained that trustees had approved over $4.6 million in
trust authority grant funds outside the state system for
the initiative. He reminded people not to assume the trust
was not invested in something if it was not shown in the
state budget because AMHTA may be providing funding
directly to agencies through its authority grants. He added
that over time, the trust had invested over $14 million in
the Crisis Now initiative.
Representative Josephson stated his understanding that the
governor's budget indicated that he did not support using
general funds on the trustees' recommended increments but
was amenable to using trust funds. He asked for
verification that the trust was not entirely in favor of
the change.
Mr. Williams surmised that the governor's proposed budget
did not want to include the full $1.5 million [for the
first increment for Crisis Now grants shown on slide 10] in
state general funds. The proposed budget reduced the amount
of general funds by $1 million and added additional trust
funds that were not approved by the trustees.
Representative Josephson recalled that the prior year there
had been a number of legislators who wanted to follow the
trustees' recommendations and had offered [budget]
amendments to that effect. He asked how successful the
effort had been.
Mr. Williams replied that he would follow up with a
comparison between the trustee recommendations and the
enacted budget. He recalled that a significant amount of
the trust recommendations had been included in the
governor's budget and the majority had made it through the
process. He clarified that the trust was appreciative of
the increments included in the governor's proposed FY 25
budget. The trust also wanted to move forward and hopefully
include some of the increments that were critical to
meeting the needs of beneficiaries.
Representative Josephson asked for verification that the
AMHTA authority grants were entirely within the trust's
purview and could not be vetoed.
Mr. Williams responded affirmatively.
2:23:23 PM
Mr. Williams clarified that only the board of trustees had
the authorization to expend trust funds. He explained that
when it came to MHTAAR, the legislature provided receipt
authority for trust funds to be expended by the state
department or division as approved and intended by AMHTA
trustees.
Representative Hannan stated her understanding that the
legislature did not have the authority to spend AMHTA
funds. She understood that the AMHTA board had to authorize
expenditures.
Mr. Williams agreed.
Representative Hannan referenced the increment [on slide
10] for the long-term care ombudsman. She asked if the
position was existing or new. She asked how many long-term
care ombudsmen there were or had been. She referenced Mr.
William's statement about the critical nature of the
position and she reasoned it was likely the state needed
more of the positions based on its aging population.
Mr. Williams replied that the position was currently funded
with federal funds that were expiring soon. He explained
that without the state funds the position and capacity
would be reduced. He believed there were six or seven full-
time ombudsmen positions for the state. He would follow up
with specific information.
Representative Hannan requested information on the capacity
or workloads associated with the positions. She remarked
that in her experience with constituents, the ombudsmen
appeared to be working to full capacity. She presumed that
losing a position would lead to fewer investigations.
Mr. Williams agreed to provide the information.
Representative Tomaszewski thought it looked like a simple
.25 percent draw would cover the critical needs [listed on
slide 10]. He asked if there was resistance to increasing
the draw to 4.5 percent.
Mr. Williams replied that he did not believe there was
resistance. He explained that within the next 1.5 years or
so, the trust would have Callan or someone similar do an
analysis on the appropriate payout percentage for the trust
overall. He noted the analysis was done on a regular basis.
2:27:07 PM
Mr. Williams turned to slide 11 titled "FY 25 GF/MH
Recommendations (and Associated MHTAAR Grants)" and
addressed capital budget increments recommended by AMHTA
trustees. The slide showed the differences between the
governor's proposed budget and the trustees' approved
recommendations. He highlighted the first row [for
coordinated community transportation] and explained there
was no general fund/mental health fund difference; however,
the governor's proposed budget included $50,000 of
unauthorized MHTAAR trust funds. He highlighted there were
significant differences between the general fund/mental
health fund trustee recommendations and the governor's
proposed budget for the Special Needs Housing Grant and
Homeless Assistance Program. He emphasized that the items
were critical and had been in the budget for several years
to address capital and operating housing needs for unhoused
beneficiaries or beneficiaries needing access to low
barrier/low cost housing.
Representative Josephson shared that he had met with the
Anchorage mayor the previous week and he agreed with the
mayor's argument that Anchorage's homelessness problem was
the state's homelessness problem. He thought the mayor
would prefer for the governor to appropriate [include] the
$2.85 million [for the Homeless Assistance Program]. He
stated it was obviously something the trust cared deeply
about. He asked if he was correct.
Mr. Williams agreed that the increment was important, which
was the reason it had been included in the trustees'
recommendations to the governor.
Co-Chair Edgmon asked about the rationale that the
governor's budget would not include the trustees'
recommendations for the last three items [on slide 11].
Mr. Williams replied that he did not have the answer.
Co-Chair Edgmon asked if the components were matching funds
that were part of a larger package.
Mr. Williams responded that the trustees' proposed
increment for the special needs housing grant had been the
same for several years. There had been occasions where the
general fund/mental health increment was not included but
was added in the legislative process. He noted that the
increment reflected flat funding that would not meet the
total need because of the individuals and because the cost
of construction and operations had increased significantly
in the past couple of years. He stated he had the
same/similar response to the Homeless Assistance Program.
Co-Chair Edgmon believed that for the second year in a row
the conversation had come to the same intersection where
"we decide to move onto the next topic" because the
rationale [to exclude the funding in the governor's
proposed budget] escaped him.
2:30:56 PM
Co-Chair Johnson asked Mr. Williams to touch on legal
issues that had been resolved in the past related to
AMHTA's authority to control its own budget.
Mr. Williams answered that AMHTA had been established in
1994 due to a lawsuit against the State of Alaska. The
seven-member board of trustees was established to oversee
and have fiduciary responsibility for the cash and non-cash
assets of the trust. Under statute, the board of trustees
had the authority to expend trust funds on meeting the
needs of beneficiaries and to fulfill programs and services
for a comprehensive integrative mental health program plan.
The settlement also ruled that the board of trustees made
recommendations on how the state should be spending its
general fund dollars. He reiterated that the board of
trustees authorized expenditures for its funds and annual
budget process and making recommendations for how the state
could be and should be spending state general funds. He
explained it was up to the administration and legislature
to determine how to accommodate the recommendations.
Co-Chair Johnson asked if there was anything additional
ever defined for a situation where the legislature did not
follow the trust recommendations. She remarked that the
board of trustees had the authority to expend.
Mr. Williams did not know of any additional piece beyond
the board's statute.
Mr. Williams advanced to slide 12 titled "Trust Grant
Impacts." He highlighted that the AMHTA investment report
and annual report had been distributed to legislators at
the beginning of the week. The investment report included
details on the 190 trust grants [awarded in FY 23]
including a description, amount, and location. The slide
showed 14 different communities or areas where the trust
had directed grants. He clarified that some of the grants
had a statewide impact and were not limited to the
communities shown on the slide.
2:35:14 PM
Co-Chair Edgmon believed everyone would agree on the
importance of HB 172 [legislation related to mental health
facilities] that passed in 2022. He wondered how much of
the close to $23 million in grant awards was directed
towards crisis intervention. He asked if the amount
directed to crisis intervention would increase over 5 to 10
years based on the legislation.
Mr. Williams responded that he did not have the exact
amount. In FY 24, the trustees approved $4.6 million
towards Crisis Now related efforts and in FY 25 there was
roughly $4.7 million. He did not have the figures on hand
for FY 22 or FY 23, but he offered to follow up with the
information. The trust invested $14 million since the start
of the initiative with DOH. He stated as there were several
communities starting to have the conversations, the
legislation was critical to establish a system of earlier
intervention with someone experiencing a behavioral health
crisis. He anticipated that the trust would remain focused
on the issue and would be working with communities other
than the three that got started in Anchorage, Fairbanks,
and Mat-Su. He noted there were a couple of slides later in
the presentation with more detail.
Co-Chair Edgmon shared that he had met with a contingent
from the Northwest Arctic Borough earlier in the week and
the group had talked about crisis stabilization efforts at
the Maniilaq hospital and the challenges they were having
with travel from villages to a centralized location. He
underscored the importance of the [Crisis Now] effort and
expressed appreciation for the trust's work.
2:37:51 PM
Representative Galvin spoke about crisis care versus acute
care that was necessary based on what was learned from the
crisis care. She had met with providers earlier in the day
from Nome, Valdez, Ketchikan, and across Alaska who had
shared concerns that Crisis Care Now was starting to ramp
up in a great way but there was no place to put the
patients after receiving the immediate crisis care. She
observed that some of the capital components in AMHTA's
budget were to help with the issue. She did not know
whether it addressed the need for care providers. She
highlighted there was room for 10 beds in Nome; however,
the facility only had staff to serve five individuals after
receiving crisis care. She asked if there was a plan to
focus on ensuring there were spaces for the patients after
receiving crisis care.
Mr. Williams answered that crisis care was only one piece
of the continuum of care; it was a point in time where an
individual needed critical health immediately. Since
AMHTA's inception in 1997, the trust and its advisory
boards including the Governor's Council on Disabilities and
Special Education, Alaska Mental Health Board, Advisory
Board on Alcoholism and Drug Abuse, and the Alaska
Commission on Aging had always advocated for community-
based services. He spoke about the need for a community-
based service continuum in order to hopefully prevent
someone from going into a crisis. He addressed
Representative Galvin's point about continued care after
individuals left crisis care. The trust would always be
speaking to and looking to the community-based system to
ensure it could do and advocate for what it could to have a
robust system that met the needs of individuals. He
remarked that it was the same conversation when talking
about individuals coming in and out of the juvenile justice
system, the Office of Children's Services system, and the
Department of Corrections (DOC) system. He stated the
community-based system was needed to prevent contact with
those higher levels of care.
2:41:43 PM
Mr. Williams moved to "Trust Focus Areas" on slide 13. He
noted the slide may help with Representative Coulombe's
earlier question about how AMHTA prioritized authority
grant funding. He detailed that in the trust's early years
the grant making was a scattershot process. He detailed
that applications had come in, were considered, and grants
were awarded or declined. There had not been a connection
on how grants worked together and how they integrated with
the state system. He explained that it had not necessarily
been prioritized based on beneficiaries' needs. The
trustees had established focus areas:
Established Focus Areas
• Disability Justice
• Mental Health & Addiction Intervention
o Includes Behavioral Health Crisis Response
• Beneficiary Employment & Engagement
• Housing and Home & Community Based Services
Additional Priorities
• Workforce Development
• Early Childhood Intervention & Prevention
Mr. Williams elaborated on the focus areas on slide 13. He
detailed that disability justice was an umbrella for
contact with the juvenile justice system and the criminal
justice system. There was substantial work that needed to
be done to identify the needs of beneficiaries earlier so
they could be diverted out when appropriate and so
individuals did not pose public safety risks. The trust had
strategies under each of the focus areas with projects
identified through a robust conversation with state, tribal
health, and community partners, which were then brought
forward to trustees for allocation of resources. He noted
it included specific expenditures related to authority
grant funding as well as recommendations for MHTAAR funding
that went through the state budget process.
2:43:45 PM
Representative Coulombe asked if the current five-year
mental health plan (that was expiring) was integrated with
the established focus areas. She thought it sounded like
the trust had good communication with the health
departments.
Mr. Williams agreed that projects funded by AMHTA were
connected to the comprehensive plan. The trust would
continue to use the comprehensive plan once it was
"refreshed" for the next five years.
Mr. Williams turned to slide 14 showing high level policy
and advocacy issues tracked and monitored by AMHTA:
• Community-Based Services
• Youth and early childhood mental health
• Medicaid and provider reimbursement rates
• Dementia care
• Reentry supports
Mr. Williams stated that the trust and its partners were
working together to address needs associated with youth and
early childhood mental health, which continued to be an
issue. For example, getting access to mental health
services in schools and early intervention to address
conditions early to curtail impacts in adolescence and
adulthood. The Department of Health was looking at Medicaid
rate methodology for the mental health system and senior
and disability system to determine how rates compared to
where they needed to be and how to ensure rates kept pace
with the cost of doing business and inflation over time. He
pointed out that a flat rate was in essence a reduction
over time. Dementia care included work done by the trust
with senior and disability services and the Alzheimer's
Resource Agency on accessing and working to develop a
system for the state's aging population. Lastly, reentry
supports were critical to ensure planning for a person's
reentry into the community happened well in advance of
their date of release. He stressed the importance of
continuing gains and recovery that may have been made prior
to release.
2:47:32 PM
Mr. Williams turned to slide 15 showing an innovation
timeline on the Crisis Now initiative. In 2018, the trust
and the Department of Health and Social Services (now the
Department of Health and Department of Family and Community
Services) had embarked on the Crisis Now initiative to
transform the response to a person experiencing a
behavioral health crisis, which had been sparked by a
lawsuit against the state. He highlighted progress that had
been made in many communities. He noted Co-Chair Edgmon's
mention of Kotzebue and relayed that AMHTA was working with
Maniilaq to determine how it may be able to establish a
crisis stabilization center for the region. The slide
illustrated that what started as looking at Fairbanks,
Anchorage, and Mat-Su based on an analysis of the needs of
the state, had resulted in other systems of care in other
places to address needs. He remarked that the systems may
not all look the same as those in Anchorage and may need to
be adapted to meet needs in a better way.
2:49:06 PM
Representative Josephson pointed to the reference to the
psychiatric patient rights report near the bottom of the
right column on slide 15. He pointed out that there was a
group of well intentioned people who were concerned that
Crisis Now was more involuntary commitment and drugging. He
stated that by definition the service was meant to be a
short timeframe, which he believed had to be an
improvement. He wanted to give Mr. Williams an opportunity
to respond to the criticism.
Mr. Williams answered that when the trust looked at the way
the behavioral health crisis system operated in 2018 and
how to transform the system, the trust had considered
individuals who may require an involuntary commitment for a
short period of time (because they present a danger to
themselves or others by the courts) and for individuals who
voluntarily needed access to care. The goal was to
intervene early to try to stabilize the individual and to
do an assessment to determine whether additional care was
needed at the appropriate level of care.
Mr. Williams advanced to slide 16 and shared that in an
effort to try to understand the beneficiary needs, the
trust conducted a rural outreach trip in the fall of 2023.
He relayed that Representative Coulombe had joined the trip
to the Bethel region. The trust appreciated the work with
the Yukon Kuskokwim Health Corporation, the Association of
Village Council Presidents (AVCP), and the AVCP Housing
Authority. He elaborated that the entities had hosted the
group and helped to identify the abilities and needs of the
communities to meet with AMHTA. The trip included 16 site
visits in Bethel and smaller teams had traveled to Toksook
Bay, Saint Mary's, Kwethluk, and Napaskiak. The trip
included legislators, commissioners, trustees, and AMTHA
staff. He added that people had visited the hub community
and villages with subregional clinics or health clinics.
The trust looked forward to doing another trip in the
future.
2:52:45 PM
Mr. Williams turned to slide 17 and discussed the Trust
Land Office. The TLO had a staff of 19 led by Ms. Jusdi
Warner and was responsible for overseeing the management of
the trust's 1 million acres. By statute and the settlement,
the trust was required to contract with TLO [housed under
the Department of Natural Resources] to manage the lands.
He highlighted that the TLO was tasked with maximizing
revenue off of the lands and to steward the lands for the
future. He pointed out that the lands were private lands
held in a trust and were managed differently than state
public lands. He noted the issue sometimes created
confusion for the public, but the trust worked to provide
education on the differences. The right side of the slide
showed the seven asset classes used to generate revenues
off the land including coal, oil and gas, minerals,
materials, timber, lands, and commercial real estate. The
bottom of the table showed the total anticipated FY 24
revenue of $12.6 million. He explained that about 50
percent of the generated revenue would go directly to the
corpus of the trust and the other 50 percent was income
that could be expended [shown on slide 7].
2:54:43 PM
Representative Tomaszewski looked at slide 7 with $3.7
million in Trust Land Office spendable income. He asked if
it was one-quarter of the anticipated TLO revenues.
Mr. Williams responded that the amount reflected one-
quarter of the roughly $6 million in spendable income
generated from the seven asset classes on slide 17.
Co-Chair Johnson noted there were a number of pieces of
legislation dealing with timber sales and carbon capture,
most of which were the governor's bills. She asked if the
trust was tracking the topics as potential revenue
generators on AMHTA land.
Mr. Williams advanced to slide 18 titled "Trust Land Office
Highlights" to answer the question. The slide showed ways
the TLO generated revenue for the trust. The trust held an
annual fall land sale, which generated about $2 million in
2023. The trust had only sold about 3 percent of its total
land. He elaborated that the trust did over-the-counter
sales. He detailed that an individual could approach the
TLO to purchase a parcel. He highlighted the trust's
forestry program, specifically the forest fuels mitigation
work in Tok. He expounded that the trust had done fire
mitigation work in Tok on trust parcels. He relayed that
the product resulting from the thinning of trees in the
area was used as biomass fuel for the Tok school.
Mr. Williams continued to review TLO highlights on slide
18. The trust leased some of its lands for wind and solar
energy. He elaborated that there were trust parcels on the
Kenai that were leased for solar energy. Additionally,
there were wind farms on parcels across the inlet and near
Healy that would tie into the Golden Valley Electric
Association, Chugach Electric, and the Homer Electric
Association.
Mr. Williams referenced Co-Chair Johnson's mention of
carbon sequestration. The trust was looking into the topic
and was assessing its lands to determine how it may fit in
the portfolio of activities. He addressed the fourth
category on slide 18: subdivision development. The trust
parcels could be large and located near communities. The
trust considered how the parcels could be subdivided to
create opportunities for commercial or housing development
in communities. Lastly, the Icy Cape project started in
2015 and was located on a parcel north of Yakutat that was
being assessed for gold and heavy minerals. The trust had
done some core sampling, which was currently being assessed
for value. The project started off as a heavy metals focus
that had transitioned into a gold-focused project. He
clarified the project was using placer mining, not hard
rock mining. He stated that AMHTA was hopeful the project
would generate revenue for the trust in addition to
building and growing an economy in the region.
Mr. Williams asked Co-Chair Johnson if his comments on
carbon sequestration and renewable energy had answered her
question.
Co-Chair Johnson responded affirmatively. She highlighted
Representative Jesse Sumner's lumber grading legislation.
She asked if individuals could recommend/request that the
trust include a specific parcel in a land sale.
Mr. Williams recommended that an individual could call Ms.
Warner with the TLO to determine whether it was a
possibility.
Co-Chair Johnson clarified that she did not have a
recommendation.
Mr. Williams encouraged anyone with questions about trust
land to contact the TLO. He highlighted that the TLO
website included a GIS system showing the parcels and their
location.
3:01:17 PM
Co-Chair Johnson asked if the $2.8 million under the real
estate line on slide 17 reflected real estate sales.
Mr. Williams responded that the figure reflected revenue
generated from leases and rents on each of the seven real
estate properties.
Co-Chair Johnson asked about the lands category on slide
17.
Mr. Williams replied that he would follow up with a
specific answer in writing. He corrected his prior
statement about the $2.8 million in real estate revenue
line on slide 17. He clarified that the category included
other elements of revenue generated from other pieces of
real estate in addition to the trust's real estate assets
he previously mentioned.
Mr. Williams concluded with slide 19 titled "Looking
Ahead." He relayed that AMHTA looked forward to the growth
of the trust, and the ability to partner with the state to
continue its grantmaking to improve the lives of
beneficiaries and build out the Comprehensive, Integrated
Mental Health Program Plan. The trust held its first
Improving Lives conference in the fall of 2022 and the 2024
conference would be held on September 17 and 18 in
Anchorage. The trust would continue its work with
departments and other state agencies on the next five-year
comprehensive plan. He elaborated that the collaboration
with other agencies went beyond DOH and DFCS because the
beneficiaries' needs were not limited to those two
departments. He highlighted other departments including the
Department of Public Safety, DOC, and DEED. Lastly, the
slide showed the next land sale would be in the fall of
2024.
3:04:06 PM
Representative Ortiz thanked the trust for its work and
presentation. He thought it seemed like the demands on the
resources available to the trust were growing. He looked at
the trust's mission on slide 4. He asked if every
allocation was measured against the trust's mission to
improve the lives and circumstances of trust beneficiaries.
He thought the other two items shown on the slide were
easier to measure. He asked if there was an attempt to
measure the trust's success pertaining to the specific
goal.
Mr. Williams answered that the trust looked at the specific
portion of its mission in a couple of different ways. He
elaborated that the work of the trust to improve the lives
and circumstances of trust beneficiaries happened at the
individual beneficiary level, program or services level,
and at a systems change level. He explained that all of the
trust's funds had a grant agreement and performance
measures attached. He expounded that the trust tracked the
performance of its grants and the impact on beneficiaries
as reported back from grantees. He noted that the specific
portion of the trust's mission could be difficult to track;
however, the trust, departments, trust advisory boards, and
community partners engaged with AMHTA to identify gaps,
successes that could potentially be expanded, things that
were not working, and how the items would impact the lives
of beneficiaries.
Representative Ortiz looked at slide 9 related to MHTAAR
grants. He highlighted the segment of grants directed to
the Alaska Court System shown in the pie chart on the slide
as an example. He did not know how the court system used
the grants to promote the trust's middle goal [on slide 4:
improve lives and circumstances of trust beneficiaries]. He
asked if grants were always measured against the goal when
determining whether an agency would receive funding.
Mr. Williams replied affirmatively. He drew attention to
the comprehensive plan and the goal to ensure that a
project or initiative (1) connected to improving the lives
of beneficiaries and (2) was connected to the comprehensive
plan. The comprehensive plan contained higher level policy
direction for a robust system for the State of Alaska.
3:08:37 PM
Representative Coulombe asked if there was an approximation
of the land value of the trust's one million acres.
Mr. Williams responded that the land as a whole was valued
at $1 per acre; however, the amount changed over time when
looking at development or a resource on a particular
parcel. He explained that trying to assess the value of
each of the one million acres would be costly without some
type of end purpose or goal.
Representative Coulombe was trying to get her head wrapped
around the trust's assets. She thought that at some point
the trust would have to tell someone an approximation of
its land value. She considered that perhaps the land in Icy
Bay was valued at a much higher rate than a less desirable
parcel in another location. She thought much of the trust
land was located in Southeast and Southcentral.
Mr. Williams answered that the land was located in
Southeast, Southcentral, the Fairbanks area, and to the
west.
Representative Coulombe asked about partnership grants and
estimated the grants made up about $2 million of the
trust's awarded funds. She asked if partners matched the
trust money. She asked for a definition of a partnership
grant.
Mr. Williams answered that partnership grants was a
grantmaking category. The trustees approved around $2.5
million in a fiscal year in unallocated funds. He
elaborated that organizations could apply for a grant for a
program or service to meet the needs and improve the lives
of beneficiaries and was connected to the comprehensive
plan. Often there was no match requirement but grant
proposals listed other pending or secured fund sources,
which could include other foundations, state grant funding,
and federal funds.
3:11:37 PM
Representative Coulombe thanked Mr. Williams and AMHTA for
the trip during the interim, which she found insightful.
She appreciated the invitation.
Co-Chair Johnson thanked the presenters.
HB 270 was HEARD and HELD in committee for further
consideration.
Co-Chair Johnson reviewed the schedule for the following
day.
ADJOURNMENT
3:12:52 PM
The meeting was adjourned at 3:12 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HFIN AMHTA Trust Presentation 1.30.24.pdf |
HFIN 1/31/2024 1:30:00 PM |
|
| AMHTA Responses to H FIN Committee Questions 2.9.24.pdf |
HFIN 1/31/2024 1:30:00 PM |