Legislature(2003 - 2004)
01/30/2003 03:03 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
January 30, 2003
3:03 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Carl Gatto, Vice Chair
Representative Cheryll Heinze
Representative Paul Seaton
Representative Sharon Cissna
Representative Mary Kapsner
MEMBERS ABSENT
Representative Kelly Wolf
OTHER LEGISLATORS PRESENT
Representative John Coghill
COMMITTEE CALENDAR
CONFIRMATION HEARING
Commissioner, Department of Health And Social Services
Joel Gilbertson - Juneau
- CONFIRMATION ADVANCED
OVERVIEW: DEPARTMENT OF HEALTH & SOCIAL SERVICES, COMMISSIONER
DESIGNEE JOEL GILBERTSON
- HEARD [See 3:45 p.m. minutes for this date]
PREVIOUS ACTION
No previous action to record
WITNESS REGISTER
JOEL GILBERTSON, Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified as appointed commissioner of the
Department of Health and Social Services.
ACTION NARRATIVE
TAPE 03-5, SIDE A
Number 0001
CHAIR PEGGY WILSON called the House Health, Education, and
Social Services Standing Committee meeting to order at 3:03 p.m.
Representatives Wilson, Gatto, Heinze, and Seaton were present
at the call to order. Representatives Cissna, and Kapsner
arrived as the meeting was in progress. Representative Coghill
also attended.
CONFIRMATION HEARING
Commissioner, Department of Health And Social Services
Number 0090
CHAIR WILSON announced that the committee would consider the
appointment of Joel Gilbertson as the commissioner of the
Department of Health and Social Services. Chair Wilson asked
Commissioner Gilbertson to give a statement and tell the members
the direction he plans to lead the department.
Number 0190
JOEL GILBERTSON, Commissioner, Department of Health and Social
Services (DHSS), told the members that for the past four years
he had the privilege of serving as legislative director and
staff representative for the United States Senate Finance
Committee for Governor Murkowski during his term in the United
States Senate. During that time, he said, he worked on issues
such as Medicaid, Medicare, community access hospitals, and
community health centers. He explained that a huge number of
the federal programs that he worked on are handled at the state
level by the Department of Health and Social Services. He told
members what a tremendous task it will be to carry forward
Governor Murkowski's agenda for DHSS because of the broad scope
of services.
COMMISSIONER GILBERTSON told the committee that in reviewing the
needs throughout the state, he finds that needs are being met in
some areas, and not in others. He cited the ongoing lack of
primary health care access in a lot of Alaska, and the problems
faced by many individuals who cannot access the health care
insurance market. Even those who can access insurance find the
cost is very high. He mentioned the need for greater assistance
and more cooperation from the Departments of Health and Social
Services and Labor and Work Force Development to provide job
training and child care assistance to help individuals who are
trying to transition from welfare to work.
Number 0317
COMMISSIONER GILBERTSON talked about the Division of Family and
Youth Services' recent [during prior administration] federal
review, which showed that it is not meeting the national
standards. He stated there are areas within that review which
are simply unacceptable for this state, and it will be the task
of the commissioner and new director of the Division of Family
and Youth Services to lead the division forward, restore morale,
and provide good management. Commissioner Gilbertson summarized
the primary goal of the department, which is to provide services
and to meet the needs of Alaskans.
Number 0435
COMMISSIONER GILBERTSON expressed his view that the state does
not always have to be the actual provider of services. He said
that sometimes a facilitator can deliver the services and the
state can provide the seed money so that entities can be the
service provider. He explained, however, that there will still
be some cases, particularly in some areas, for which the state
will continue to be the provider. He emphasized that it is the
responsibility of the Department of Health and Social Services
to do everything as efficiently as possible.
COMMISSIONER GILBERTSON told the committee that the governor has
asked Lieutenant Governor Leman and him to work in pursuing a
faith-based agenda and to ensure that the Department of Health
and Social Services is maximizing and facilitating the social
services networks throughout the state. He said many of these
organizations have a tremendous ability to provide care for
those who need it. To facilitate this, the department will work
to provide access to information on questions such as how it can
deliver the service, where the populations are located, or where
there is a gap in coverage. He stated that wherever there are
needs not being met, it is going to be the department's task to
build the partnerships and facilitate the collaborations that
allow these services to be provided. Commissioner Gilbertson
emphasized that this is going to be particularly important at a
time when the state is facing considerable financial challenges.
Number 0684
COMMISSIONER GILBERTSON stated to the committee that the State
of Alaska's Medicaid program has a mission, a purpose, and an
obligation under federal law to cover low-income individuals who
cannot access health care insurance, and who need services. He
expressed his commitment to identifying [those people],
delivering [those services], and ensuring that those individuals
who need services and coverage get it. He emphasized that as a
state, Alaska has an obligation to make sure it is managing
these programs in a fiscally prudent fashion.
Number 0738
COMMISSIONER GILBERTSON said the governor wants him to find a
way for the state to protect services while trying to bring
fiscal stability back to the programs. He said he wants to work
with the legislature to protect programs, not just this year or
next year, but into the future. Commissioner Gilbertson told
the committee it will be essential to work together with
communities, facilities, and providers to find solutions.
COMMISSIONER GILBERTSON told the committee that he accepted this
job with a firm commitment to work as hard as he can every day
to ensure the department is maximizing services for the dollars
that are invested in the programs. He sees that as essential,
he said, since there are needs that are still not being met, and
the state simply does not have the resources to invest
additional funds into the Medicaid program. He said this year
the department will work aggressively with providers to make
sure it is maximizing other revenue streams. Those sources will
be federal funding, and the DHSS will be working closely with
the congressional delegation to push for additional federal
medical assistance percentage (FMAP) adjustments to draw down
additional federal resources. The department will also be
working aggressively and cooperatively with its grantees to find
ways to refinance some of its grants in order to maximize
federal dollars.
COMMISSIONER GILBERTSON explained that the Department of Health
and Social Services is currently spending 100 percent of general
fund dollars to fund grants. The department will be working to
find ways whereby the state can continue that same level of
service, but with less general fund commitment. He explained
that it will be essential to work cooperatively to identify
inefficient systems where care is being delivered that does not
maximize federal revenues. Federal medical assistance
percentages are determined by who the beneficiary is and where
the service is provided. In some areas there is 60 percent, in
other areas there is 71 percent, and in some areas there is 100
percent federal reimbursement. The commissioner said the
department must maximize those dollars so that services will be
protected.
COMMISSIONER GILBERTSON stated that the Murkowski Administration
is putting together a good team that is committed to working
with the legislature, cooperatively and in partnership as they
develop the budget and shape the missions for the Department of
Health and Social Services and the State of Alaska. He
expressed his commitment to always be available whenever the
committee asks for assistance, or whenever the committee sees a
need for dialogue about issues. He said he believes the
Department of Health and Social Services and the legislature can
work together to find solutions to maintain services, and that
it is not all about the budget or fiscal problems, but he
believes it is key to start there to bring financial stability
back to the department. He said that it is essential for those
individuals who interact with the Department of Health and
Social Services to have predictability in the services and
funding they receive, and that [the department] meet those
unserved needs in both health and social services.
Number 0777
CHAIR WILSON noted that Representatives Kapsner and Cissna had
joined the committee meeting. Chair Wilson opened the meeting
to questions of Commissioner Gilbertson.
Number 0784
REPRESENTATIVE GATTO said that in reviewing the organizational
chart of the Department of Health and Social Services he had
noted that there are six vacant senior management positions that
need to be filled to complete the team. Representative Gatto
asked whose responsibility is it to make those appointments.
Number 0809
COMMISSIONER GILBERTSON responded that today Governor Murkowski
announced the appointment of six individuals to the Department
of Health and Social Services. Those individuals include Bob
Labbe, Deputy Commissioner, an individual who has served as the
director of the Division of Medical Assistance. The
commissioner said he is a national expert on Medicaid financing
and Medicaid issues, an invaluable resource to the state and
legislature, and a wonderful asset to the commissioner's office.
Number 0844
COMMISSIONER GILBERTSON said another wonderful individual is
Karleen Jackson, Deputy Commissioner, an individual who has
served for the last few years as the executive director of
Catholic Social Services. He said she brings tremendous
experience and is by far the most highly recommended individual
he has ever seen, and he believes she will be a great asset to
the department and the committee in the coming year.
Number 0874
COMMISSIONER GILBERTSON told the committee that Doug Bruce, the
former chief executive officer (CEO) of Providence Health
System, has been appointed the director of the Division of
Public Health. He said Mr. Bruce has led one of the largest
health care systems in Alaska through change and has led it
well. The commissioner said he will be a tremendous asset as
the leader of the largest division in the department, which
provides health care services throughout the state and helps in
many areas including epidemiology, maternal child services,
nursing, and other areas. He will be a tremendous resource
within the department, he concluded.
Number 0907
COMMISSIONER GILBERTSON stated that the governor also appointed
Bill Hogan as the director of Mental Health and Developmental
Disabilities. Mr. Hogan is currently serving as CEO of Life
Quest, a mental health provider in Wasilla, and the current
chair of the Alaska Mental Health Board.
Number 932
COMMISSIONER GILBERTSON said the governor appointed Ron Adler to
replace Randall Burns, who is retiring as superintendent of
Alaska Psychiatric Institute (API). He said Mr. Adler has
served as the executive director of the Gateway Center for Human
Services in Ketchikan.
Number 0943
COMMISSIONER GILBERTSON stated that the final appointment
Governor Murkowski made today is Rebecca Parker, Special
Assistant for the commissioner's office. Ms. Parker has served
as the president of Providence Alaska Foundation and as the
Director of Public Affairs of Providence Health System, and has
also worked in several positions in the Public Affairs
Department of ARCO [Atlantic Richfield Company]. He stated that
she will be an invaluable resource serving the Department of
Health and Social Services as the community coordinator,
constituent services coordinator, and event organizer in
Anchorage. She will be a partnership builder as the state works
to find ways to involve the private sector, specifically,
nonprofit organizations.
Number 0989
COMMISSIONER GILBERTSON specifically addressed the question by
Representative Gatto, saying the governor makes all appointments
and those appointees serve at the pleasure of the governor. He
added that the Department of Health and Social Services has an
excellent team coming on board, and that the administration is
moving forward aggressively on a number of remaining vacancies.
He said the governor is pleased to have these individuals on
board. The commissioner told the committee he believes they are
going to be a wonderful asset to the state.
Number 1010
CHAIR WILSON noted for the record that Representative Coghill
had joined the meeting.
Number 1026
REPRESENTATIVE CISSNA inquired about the Department of Health
and Social Services' support of legislation regarding breast and
cervical cancer.
Number 1047
COMMISSIONER GILBERTSON responded that he is aware that
legislation has been introduced, but has not personally reviewed
the language. He added that he was privileged to work for
Governor Murkowski, then United States Senator, to pass the
Medicaid expansion option. The commissioner said that Governor
and Mrs. Murkowski are supportive of the program, and he
believes the governor is examining the legislation. He said the
Department of Health and Social Services will also be looking at
it, but that process has not begun yet.
Number 1075
REPRESENTATIVE HEINZE asked Commissioner Gilbertson about the
statement in his resume that he worked on Governor Murkowski's -
then United States Senator - Alaska-specific Medicaid program
that increased federal support to the program by $300 million
over eight years. Representative Heinze asked how he was able
to do that.
Number 1094
COMMISSIONER GILBERTSON clarified that it was Governor
Murkowski, then United States Senator, who accomplished it. The
governor was able to pass through the United State Senate
Finance Committee an FMAP adjustment in 1997 and again 2000. In
1997 there was a statutory change of the FMAP formula. At that
time Alaska's FMAP percentage was 50 percent. What that meant
was that the state was paying 50 cents on every dollar and the
federal government was paying 50 cents on every dollar. During
the change for 1997 through 2000, the state's FMAP percentage
was fixed at 59.8 percent, and was a large increase in the
Medicaid appropriation. The result of that change was about
$100 million additional dollars over the three-year period for
Alaska's Medicaid program. In 2000, as part of the Benefits
Improvement and Protection Act of 2000 (BIPA), the governor,
then United States Senator, was successful in getting an
adjustment in the formula through the United States Senate
Finance Committee.
COMMISSIONER GILBERTSON explained, without getting too
technical, that the formula basically looks at the per capita
income of a state and compares that with the per capita income
of the national average. States that have a lower per-capita
income pay a smaller percent, and the reverse it true, wealthier
states pay the highest percentage. The most a state can pay is
50 percent, so Alaska was paying as much as any state towards
its claims. He said the lowest state was Mississippi, with the
federal government picking up about 73 percent of the costs.
The logical predicate for that adjustment is that the cost of
delivering care in Alaska is a lot higher. Per-capita income is
not a good marker in delivering care in Alaska.
COMMISSIONER GILBERTSON told the committee that in 2000 Governor
Murkowski, then United States Senator, won an additional change
in the formula. He said he was privileged to work on this for
the governor, then United States Senator, when the United States
Senate Finance Committee adjusted Alaska's per capita income
down by 5 percent before it is entered into the formula. The
resulting adjustment was an increase in Alaska's federal medical
assistance percentage. The end result of that is scheduled to
sunset on October 1, 2005.
COMMISSIONER GILBERTSON concluded by saying that from 2001 to
2005 there will be an increase of about $40 million dollars a
year or $200 million over five years for the State of Alaska.
Those two adjustments combined are about $300 million in
additional Medicaid funding that has come from the federal
government as a result of technical changes that Governor
Murkowski, then United States Senator, made in Washington, D.C.
to help improve services. Those federal dollars have been used
to expand health care services and strengthen the delivery
system to allow for a higher level of care and to provide a
better provider rate to ensure providers continue to keep
accepting Medicaid patients.
Number 1277
REPRESENTATIVE SEATON asked what he thinks of the draft change
in the budget for the Independent Living Centers. He stated
that the change will close Independent Living Centers in
Fairbanks, Kenai, and Ketchikan, and reduce the one in Homer to
one half. Representative Seaton said he understands that the
Department of Labor [and Workforce Development's] 10-percent
adjustment in the draft budget is all coming from that one area.
He asked the commissioner if he is aware of the draft budget
cuts and how that would impact Independent Living Centers.
Number 1331
COMMISSIONER GILBERTSON stated that both he and his director of
the Division of Administrative Services, Janet Clarke, have not
seen the proposal; however, he is aware there was some mention
of it in the media. He promised to look into the proposal and
get back to the committee.
Number 1365
REPRESENTATIVE SEATON offered to provide Commissioner Gilbertson
with some materials concerning the proposal. He added that it
would appear to be a huge impact on state dollars.
Number 1385
REPRESENTATIVE GATTO asked about breast and cervical cancer
treatment, saying these are gender-specific benefits. He asked
if females have a higher priority than males.
Number 1415
COMMISSIONER GILBERTSON explained that his background [master's
degree in public health] has trained him in a core tenet of
public health and, that is, do not produce a screening process
if there is not a treatment available. He stated that in 1990,
the federal government decided to establish a screening program
for breast and cervical cancer within the CDC [Centers for
Disease Control and Prevention] for low-income women. What they
came up with was a program that said, "Congratulations you've
got cancer; we'll try to work to find you some free treatment
options in the community." It took 10 years to add the
requisite insurance coverage to provide the care. The
commissioner said that when the governor was in the U.S. Senate,
he did not like it, so he co-sponsored and voted in favor of
language that would provide the associated treatment option to
go with that screening program. The Governor, then United
States Senator, made a strong statement that this should not be
a disease-by-disease or body-part by body-part expansion of the
Medicaid program, but there was a commitment made to women that
was not being fulfilled. He added that while it expanded the
Medicaid program to provide the associated coverage, it is a
very small population of women. There were legitimate concerns
made by some United States Senators that this may not be a wise
policy or a prudent way of expanding the Medicaid program. The
commissioner said that at the time, the facts that were in front
of Governor Murkowski, then United States Senator, were that
there was a screening program that was ongoing, with no
treatment options for these women. He said he believes the
decision to make that a Medicaid option was appropriate. He
pointed out that there have been tremendous differentiations
between men and women for years, including differences in the
way men and women are treated in clinical trials for drugs, and
access to health care. There are a number of differences in the
way men and women access health care services. For example,
women go to doctors more often than men do.
Number 1595
REPRESENTATIVE KAPSNER stated for the record that several years
back, then-Senator Duncan introduced prostate cancer legislation
that required insurance companies to cover prostrate cancer, and
the bill passed very quickly. Representative Kapsner said last
year a number of women legislators were wondering why prostate
cancer gets the green light, but breast and cervical cancer get
the red light. She said she sees differing opinions on the
anatomy and gender issues.
REPRESENTATIVE KAPSNER said the people of the Yukon-Kuskokwim
Delta, and all of Alaska, want to thank Commissioner Gilbertson
for his help in getting the Inhalant Abuse Treatment Center and
all the work he has done on Medicaid.
Number 1649
REPRESENTATIVE KAPSNER stated that in the national media there
has been a lot of coverage about family and youth services and
foster care. She noted that in Alaska there have been deaths of
young children in foster care. Representative Kapsner asked the
commissioner how he is planning on improving the Division of
Family and Youth Services.
Number 1665
COMMISSIONER GILBERTSON responded that there are good
professionals in the Division of Family and Youth Services.
However, there are serious problems, which were addressed in the
federal review, and the division's failure to meet a number of
those standards is reason for concern. He stated that the
federal standards are good, and the debate should not be about
whether or not the standards are appropriate for Alaska, but
that when standards deal with harm to a child, the department
will accept the highest standard. He told the committee the
first thing the governor did is initiate an aggressive search
for the best-qualified person to take over leadership of the
Division of Family and Youth Services. He said final interviews
will be conducted next week and an announcement of the person
who will lead children's services into the future should be
announced soon.
Number 1743
COMMISSIONER GILBERTSON went on to say that person will be
tasked with developing and negotiating the program improvement
plan for the Division of Family and Youth Services. As part of
the federal review, the state is required to provide its program
improvement plan to document how it is going to meet the federal
standards. There will be a variety of issues addressed
including the review of caseloads for frontline social workers,
ensuring that the requisite clerical and managerial support is
available for frontline workers, ensuring they have the tools
they need, and that there are adequate resources in the division
to ensure that reports of harm can be investigated, and
implementing a new information system to better track cases.
The division will be working aggressively to make sure treatment
options are available to help families stay together, including
treatment options that ensure children are protected from abuse,
and vigilance that the Department of Health and Social Services
does not see patterns develop that one might see in the child
protection system. The commissioner asked that the committee
understand that he is not being specific, as the department is
still in negotiations on how to move forward in the program
improvement plan. He also does not want to be so specific it
would inhibit program development for the new director of the
Division of Family and Youth Services. He said the director
will be the individual who will be held accountable for the
results.
COMMISSIONER GILBERTSON explained that when the program
improvement plan is approved by the federal government, the
State of Alaska will have two years to implement that plan. He
told the committee this administration, this department, this
commissioner's office, and the new director of the Division of
Family and Youth Services are going to be committed to
accomplishing those goals. He emphasized his desire to see the
professionals in children's services have the flexibility and
tools to succeed.
Number 1840
CHAIR WILSON explained that Commissioner Gilbertson will be
giving an overview of the Department of Health and Social
Services later in the meeting and asked that, if appropriate,
questions be held until then.
Number 1854
REPRESENTATIVE GATTO expressed concerns he has heard from many
providers of Denali KidCare that the program is not adequately
covering costs and that the program has discrepancies. He went
on to say that Lieutenant Governor Leman has also expressed an
interest in revising some of the specifics in Denali KidCare.
He asked Commissioner Gilbertson what his plans are for the
Denali KidCare program?
Number 1898
COMMISSIONER GILBERTSON stated that the governor wants to
preserve Denali KidCare and wishes it to remain a viable
insurance product for the children of Alaska. Governor
Murkowski, then United States Senator, voted to create the state
option for the children's health insurance program at the
federal level. The commissioner said that states do retain
tremendous flexibility in the design, structure, and management
of their children's health insurance plan. In Alaska that is
Denali KidCare, and it has been a tremendous success. He said
the Department of Health and Social Services will be doing
everything in its power to protect services, but the department
stands ready to engage in any conversations that the legislature
wants to have on structure. He told the committee that they
will be meeting with the House Finance Committee tomorrow where
Denali KidCare will be discussed. He explained that at the
moment, the governor has not made any decision on how he wants
to proceed on eligibility, benefits, or payment rates. While
this is a program the governor supports, the program will be
completely reviewed by the department to ensure that it has the
resources to maintain it as a viable health insurance product
for Alaska's children.
Number 1942
REPRESENTATIVE HEINZE asked Commissioner Gilbertson his opinion
on certificate of need.
Number 1948
COMMISSIONER GILBERTSON replied that certificate of need is
state law in Alaska and that the executive branch carries out
the law. He said he is aware that some states have done away
with the certificate-of-need clause, and some states have
retained it. He explained that the certificate-of-need law's
justification is that the state has an interest and investment
in the health care system because the state is the primary payer
for health care services in Alaska. The state's interest in how
the health care systems are structured, designed, and positioned
is to identify and ensure that sufficient health care resources
and delivery needs of Alaskans are being met. If the
legislature wants to look at the certificate-of-need program to
see if this program is still important for Alaska, that is a
conversation the Department of Health and Social Services is
willing to have. He stated that it is the law now and that the
department will continue to administer the certificate-of-need
program as responsibly and efficiently as possible. He said the
department will work to clarify regulations; however, it has not
yet begun the review of them, so he cannot provide specifics.
He added that proposed regulations will be drafted, where
needed, to clarify the certificate-of-need law.
Number 2010
REPRESENTATIVE HEINZE made a motion to advance the confirmation
of Joel Gilbertson as commissioner of the Department of Health
and Social Services to the full body for confirmation.
Number 2076
CHAIR WILSON asked if there were any objections to
Representative Heinze's motion. There being no objection, the
confirmation of Joel Gilbertson was advanced.
CHAIR WILSON announced that at 3:45 p.m. there would be a brief
at-ease, after which the committee would hear an overview of the
Department of Health and Social Services. [For the overview,
see the 3:45 p.m. minutes for this date.]
ADJOURNMENT
The House Health, Education and Social Services Standing
Committee took an at-ease at 3:45 p.m. in order to prepare for
the overview. [For the overview by the Department of Health and
Social Services, see the 3:45 p.m. minutes for this date.]
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