Legislature(2021 - 2022)BY TELECONFERENCE

03/02/2021 03:00 PM House HEALTH & SOCIAL SERVICES

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Audio Topic
03:03:37 PM Start
03:04:35 PM Executive Order 119 - Dhss Reorganization
04:29:39 PM HB76
05:02:34 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Executive Order 119 - DHSS Reorganization TELECONFERENCED
-- Testimony <Invitation Only> --
- Lynn Biggs, Casey Family Programs
- Ryan McKee, Americans for Prosperity, Alaska
- Trevor Storrs, Alaska Children's Trust
- Chief PJ Simon, Tanana Chiefs Conference
- Amanda Metivier, Facing Foster Care in Alaska
Heard & Held
-- Testimony <Invitation Only> --
- Commissioner Adam Crum
- Dept. of Health & Social Services
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 2, 2021                                                                                          
                           3:04 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Liz Snyder, Co-Chair (via teleconference)                                                                        
Representative Tiffany Zulkosky, Co-Chair (via teleconference)                                                                  
Representative Ivy Spohnholz (via teleconference)                                                                               
Representative Zack Fields (via teleconference)                                                                                 
Representative Ken McCarty (via teleconference)                                                                                 
Representative Mike Prax (via teleconference)                                                                                   
Representative Christopher Kurka (via teleconference)                                                                           
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
EXECUTIVE ORDER 119 - DHSS REORGANIZATION                                                                                       
     - HEARD AND HELD                                                                                                           
HOUSE BILL NO. 76                                                                                                               
"An Act  extending the January  15, 2021,  governor's declaration                                                               
of a  public health disaster  emergency in response to  the novel                                                               
coronavirus   disease  (COVID-19)   pandemic;  providing   for  a                                                               
financing  plan;  making  temporary   changes  to  state  law  in                                                               
response  to  the  COVID-19  outbreak  in  the  following  areas:                                                               
occupational and  professional licensing, practice,  and billing;                                                               
telehealth;   fingerprinting   requirements   for   health   care                                                               
providers; charitable  gaming and online ticket  sales; access to                                                               
federal  stabilization funds;  wills; unfair  or deceptive  trade                                                               
practices;  and meetings  of shareholders;  and providing  for an                                                               
effective date."                                                                                                                
     - HEARD & HELD                                                                                                             
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: HB  76                                                                                                                  
SHORT TITLE: EXTENDING COVID 19 DISASTER EMERGENCY                                                                              
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
02/18/21       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/18/21       (H)       HSS, FIN                                                                                               
02/19/21       (H)       HSS REFERRAL REMOVED                                                                                   
02/19/21       (H)       BILL REPRINTED                                                                                         
02/26/21       (H)       FIN AT 1:30 PM ADAMS 519                                                                               
02/26/21       (H)       -- MEETING CANCELED --                                                                                 
03/01/21       (H)       HSS REFERRAL ADDED BEFORE FIN                                                                          
03/01/21       (H)       BILL REPRINTED                                                                                         
03/02/21       (H)       HEALTH & SOCIAL SERVICES at 3:00 PM BY                                                                 
WITNESS REGISTER                                                                                                              
LYNN BIGGS, Senior Director/Strategic Consultant                                                                                
Casey Family Programs                                                                                                           
Yakima, Washington                                                                                                              
POSITION STATEMENT:  Testified in support of Executive Order 119                                                              
and shared a PowerPoint presentation on Casey Family Programs.                                                                  
RYAN MCKEE, State Director                                                                                                      
Americans for Prosperity                                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Provided testimony on Executive Order 119.                                                               
TREVOR STORRS, President and CEO                                                                                                
Alaska Children's Trust                                                                                                         
Anchorage Alaska                                                                                                                
POSITION STATEMENT:  Provided testimony on Executive Order 119.                                                               
CHIEF "PJ" POLLACK B. SIMON, JR., Chief and Chair                                                                               
Tanana Chiefs Conference                                                                                                        
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified on behalf of the Tanana Chiefs                                                                 
Conference on Executive Order 119.                                                                                              
ADAM CRUM, Commissioner                                                                                                         
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented HB 76 on behalf of the bill                                                                    
sponsor, House Rules by request of the governor.                                                                                
HEIDI HEDBERG, Director                                                                                                         
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the hearing on HB
ACTION NARRATIVE                                                                                                              
3:03:37 PM                                                                                                                    
CO-CHAIR  TIFFANY ZULKOSKY  called  the House  Health and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:04  p.m.                                                               
Representatives  Fields,  Kurka,  Snyder,  Spohnholz,  Prax,  and                                                               
Zulkosky were present (via teleconference)  at the call to order.                                                               
Representative  McCarty  arrived   (via  teleconference)  as  the                                                               
meeting was in progress.                                                                                                        
^EXECUTIVE ORDER 119 - DHSS REORGANIZATION                                                                                      
           EXECUTIVE ORDER 119 - DHSS REORGANIZATION                                                                        
3:04:35 PM                                                                                                                    
CO-CHAIR  ZULKOSKY announced  that  the first  order of  business                                                               
would Executive Order (EO) 119  - Department of Health and Social                                                               
Services reorganization.                                                                                                        
3:05:55 PM                                                                                                                    
LYNN BIGGS,  Senior Director, Strategic Consultant,  Casey Family                                                               
Programs,  testified in  support of  EO  119.   She introduced  a                                                               
PowerPoint presentation on  Casey Family Programs.   She began by                                                               
outlining  her  presentation  and  described  the  PowerPoint  as                                                               
discussing   the  pros   and  cons   of  various   organizational                                                               
structures  and reorganization.    She  commented that  committee                                                               
members should  have access  to the  Alaska Tribal  Child Welfare                                                               
Compact  technical  assistance,   findings,  and  recommendations                                                               
regarding the  compact.   She also noted  that she  would provide                                                               
information on staff turnover, and  that committee members should                                                               
have a related information packet.                                                                                              
MS.  BIGGS  stated  that  Casey Family  Programs  (CFP)  is  very                                                               
committed to  Alaska and improving outcomes  for Alaska children,                                                               
teenagers,  and  families.    She explained  that  CFP  has  been                                                               
working  with  the  compact  and  with  tribal  state  groups  on                                                               
disproportionality and  prevention.  She offered  some background                                                               
information  about CFP  from slide  2 of  her presentation  which                                                               
read as follows [original punctuation provided]:                                                                                
     ? The nation's largest operating foundation focused on                                                                     
     safely reducing the need for foster care and building                                                                      
     Communities of Hope for children and families.                                                                             
     ?  We work  to influence  long-lasting improvements  to                                                                    
     the safety  and success  of children, families  and the                                                                    
     communities where they live.                                                                                               
       Operating in all 50  states, DC, Puerto Rico, and the                                                                    
     Virgin Islands.                                                                                                            
       Direct agreements with 16 tribes.                                                                                        
       9 field  offices provide direct services  to youth in                                                                    
MS. BIGGS  added that  in Alaska CFP  has agreements  with Tanana                                                               
Chiefs  Conference, Tlingit  and Haida  Indian Tribes  of Alaska,                                                               
and Kawerak, Inc.                                                                                                               
3:08:09 PM                                                                                                                    
MS. BIGGS  continued to slide  3 in her presentation,  which read                                                               
as follows [original punctuation provided]:                                                                                     
     Casey Family Programs' Work with Alaska                                                                                    
     ? Casey Family Programs  has been working and investing                                                                    
     in Alaska since the year 2000.                                                                                             
     ? We have worked  with the State, Tribes, philanthropic                                                                    
     organizations, the University of  Alaska, and others to                                                                    
     effect   positive,   improved  outcomes   for   Alaskan                                                                    
     children and families.                                                                                                     
     ?  We  have  sponsored  statewide  efforts  to  address                                                                    
     Adverse Childhood  Experiences in Alaska and  to safely                                                                    
     reduce the need for foster care.                                                                                           
MS. BIGGS commented  that one of CFP's biggest  concerns has been                                                               
disproportionality.   She  shared that  despite numerous  efforts                                                               
there  has  not been  a  reduction  in disproportionality.    She                                                               
resumed presenting with slide 4,  which read as follows [original                                                               
punctuation provided]:                                                                                                          
     An Alaska  Native infant (age  1 or younger) has  a 15%                                                                    
     chance  of  being the  subject  of  a child  abuse  and                                                                    
     neglect investigation.  An Alaska  Native child  has an                                                                    
     80% chance  of being the  subject of a child  abuse and                                                                    
     neglect investigation by age 18.                                                                                           
     ? Casey Family Programs  has actively supported efforts                                                                    
     to  reduce  disproportionality  of Native  children  in                                                                    
     foster care in Alaska.                                                                                                     
       We  have sponsored  Alaska's Strategic Plan  of 2016-                                                                    
     2020 to  'Transform Child  Welfare Outcomes  for Alaska                                                                    
     Native Children.                                                                                                           
     ?  We are  strong supporters  of Alaska's  Tribal State                                                                    
     Child Welfare Compact and its full implementation.                                                                         
     ? We participate in  Alaska's longstanding Tribal State                                                                    
     Collaboration Group.                                                                                                       
3:09:42 PM                                                                                                                    
MS. BIGGS  continued to slide  5 in her presentation,  which read                                                               
as follows [original punctuation provided]:                                                                                     
     Casey  Support  for  the Alaska  Tribal  Child  Welfare                                                                    
     ?  Tribes   know  the  needs  of   their  children  and                                                                    
     families, their culture and traditions.                                                                                    
     ?  Tribes are  best  suited to  administer and  deliver                                                                    
     ? Casey  Family Programs  currently funds  two contract                                                                    
     positions: a project manager and a Tribal liaison.                                                                         
     ?  Casey   is  committed  to  supporting   the  Compact                                                                    
     implementation  and  sustainability through  consulting                                                                    
     and  technical assistance,  regardless of  state agency                                                                    
MS.  BIGGS  shared  that  in  support of  the  compact,  CFP  had                                                               
contracted with a project manager and tribal liaison.                                                                           
3:10:42 PM                                                                                                                    
MS.  BIGGS  turned attention  to  on  data  slides  6 and  7  and                                                               
paraphrased the  information on the  slides.  She  explained that                                                               
the information  on the slides  underscored the  racial disparity                                                               
in Alaska.   She pointed out  that Alaska Native children  are 17                                                               
percent of  the child  population, but  when looking  at poverty,                                                               
the  number  rises to  35  percent.    When looking  at  children                                                               
screened for investigation  50 percent are Alaska  Native, and 57                                                               
percent are confirmed as maltreated, she stated.                                                                                
MS. BIGGS then addressed the graphs  on slide 7.  She again noted                                                               
that the  child population [is]  17 percent [Alaska  Native], but                                                               
they  are entering  foster  care  at a  rate  of  47 percent  for                                                               
American Indian  or Alaska Native.   She continued,  stating that                                                               
45 percent  of kids in care  are Alaska Native; children  in care                                                               
for two  years or longer is  48 percent Alaska Native,  and youth                                                               
aging out of care is 51 percent Alaska Native.                                                                                  
3:12:03 PM                                                                                                                    
MS. BIGGS  moved onto  slide 8,  which displayed  a graph  of the                                                               
rate of children  entering care from 2010-2019.   She pointed out                                                               
that the  rate of children  entering care  was very high  at 21.2                                                               
per 1,000 children for Alaska  Native children, far exceeding all                                                               
the other groups.  All of  that, she explained, was to underscore                                                               
how pervasive the disproportionality issue  is.  She said that is                                                               
why CFP  feels so strongly  about the  compact as a  very hopeful                                                               
and helpful strategy to improve outcomes.                                                                                       
3:12:51 PM                                                                                                                    
REPRESENTATIVE PRAX  interjected to ask if  the committee members                                                               
can ask questions now.                                                                                                          
CO-CHAIR ZULKOSKY  asked for questions  to wait until the  end of                                                               
the presentation.                                                                                                               
3:13:08 PM                                                                                                                    
MS. BIGGS continued  to slide 9, which read  as follows [original                                                               
punctuation provided]:                                                                                                          
     Alaska Tribal Child Welfare Compact                                                                                        
     What is the Compact?                                                                                                       
     ? Groundbreaking  opportunity: Government-to-Government                                                                    
     ?  A contractual  agreement to  transfer State  general                                                                    
     funds to  Tribal Co-signers to provide  select services                                                                    
     on behalf of the State.                                                                                                    
     ? 18 Co-signers representing  163 Tribes throughout the                                                                    
     ? Took effect January 1, 2018                                                                                              
     ?  State continues  to  have decision-making  authority                                                                    
     over child welfare cases.                                                                                                  
     ?  Addresses  mutual  vision  of  success,  information                                                                    
     sharing, shared responsibility and liability.                                                                              
MS. BIGGS skipped slide 10 and  read from slide 11, which read as                                                               
follows [original punctuation provided]:                                                                                        
     Challenges to Compact Implementation & Sustainability                                                                      
     ? Lack  of existing systems to  support implementation:                                                                    
     Referral process  and tracking outcomes is  complex for                                                                    
     State and Tribes.                                                                                                          
     ? High caseloads and turnover  of local OCS caseworkers                                                                    
     may make local or regional referrals impossible.                                                                           
     ? Lack  of adequate State staff  and Tribal Co-Signers'                                                                    
     staff dedicated to manage Compact.                                                                                         
       State  funding for one  staff per Co-Signer  does not                                                                    
     account for varying capacity among Tribes.                                                                                 
     ? Lack  of staffing  that will  promote sustainability:                                                                    
     including   development  and   monitoring  of   quality                                                                    
     improvement measures.                                                                                                      
3:14:52 PM                                                                                                                    
MS.  BIGGS moved  to  slide 12  and  paraphrased the  information                                                               
listed,  which  showed examples  of  how  some states  administer                                                               
child  and  family services  through  a  continuum of  structural                                                               
configurations.   She said one is  through multiple cabinet-level                                                               
agencies, one is a single  consolidated health and human services                                                               
agency,  and  then  one  other  way  is  through  various  agency                                                               
combinations  of  child   welfare,  early  childhood  [programs],                                                               
juvenile justice, and so on.                                                                                                    
MS. BIGGS  paraphrased slide 13  which read as  follows [original                                                               
punctuation provided]:                                                                                                          
     No  Research   Evidence  of  an   Ideal  Organizational                                                                    
     Governors and state  legislatures have long reorganized                                                                    
     state  agencies in  an effort  to improve  outcomes and                                                                    
     Research   is  lacking.   The   limited  research   and                                                                    
     extensive state experiences tell us:                                                                                       
     ?  No  ideal structure:  Every  approach  has pros  and                                                                    
     ?  Positive   child  and  family  outcomes   cannot  be                                                                    
     attributed to a particular model.                                                                                          
     ? No  research evidence  of improved  accountability or                                                                    
     service quality with reorganization.                                                                                       
     ?  Organizational climate  and  culture (low  conflict,                                                                    
     cooperation,  role  clarity)  may  contribute  more  to                                                                    
     outcomes than interagency coordination structures.                                                                         
MS.  BIGGS  moved  to  slides  14 through  17  and  informed  the                                                               
committee  she wouldn't  go  through them  [in  detail] but  said                                                               
committee  members  could  see  the   pros  and  cons  from  each                                                               
3:16:56 PM                                                                                                                    
MS. BIGGS  moved to slide  18 and explained her  reasoning behind                                                               
using the State of  Washington as an example.  She  said it was a                                                               
more recent  example of  the organization and  it shows  how much                                                               
went into  that as  far as  background and  planning, stakeholder                                                               
engagement, and  inclusion of tribes  and communities  which were                                                               
all part of [Washington State's] structure.                                                                                     
MS.  BIGGS  quickly  ran  through slides  19  through  21,  which                                                               
continued to outline the example  of Washington State and lessons                                                               
that can be learned  from it.  She noted that the  use of data is                                                               
extremely  important to  determine priorities,  and that  desired                                                               
outcome  should  drive the  structure.    She said  inclusion  of                                                               
tribes, communities,  people with lived experiences,  and as many                                                               
stakeholders  as  possible  ensures  that  agency  resources  are                                                               
aligned with  desired outcomes.   Transition  to a  new structure                                                               
usually  takes  two   to  five  years:  one  year   or  more  for                                                               
planning/preparing and up to five  years for implementation.  She                                                               
shared that implementation  science has been utilized  in many of                                                               
these, because it usually takes a  long time and is disruptive to                                                               
some extent.                                                                                                                    
MS.  BIGGS continued  to paraphrase  from slide  21 sharing  that                                                               
another lesson  was to plan  carefully for the separation  from a                                                               
single consolidated  agency to a separated  or bifurcated agency,                                                               
to  ensure  that the  resources  are  adequate, and  that  strong                                                               
leadership,  continuous improvement  systems, and  accountability                                                               
mechanisms are important regardless of structure.                                                                               
3:19:08 PM                                                                                                                    
MS.  BIGGS turned  to  slide  22, "High  Costs  of Child  welfare                                                               
Workforce  Turnover  for  Children  & Families,"  which  read  as                                                               
follows [original punctuation provided]:                                                                                        
     ?  Studies in  Colorado and  Wisconsin found  that case                                                                    
     worker  turnover  dramatically  increases the  time  to                                                                    
     achievement  of  a  permanent family  for  children  in                                                                    
     foster care.                                                                                                               
     ? A study by the  U.S. Government Accountability Office                                                                    
     (GAO   03-357)    found   that    caseworker   turnover                                                                    
     contributed   to  states'   failure  to   meet  federal                                                                    
     performance standards including:                                                                                           
       Timely response in child protection investigations,                                                                      
        Timely  closure   of  investigations  (an  important                                                                    
     factor  in   both  workload  and  families'   need  for                                                                    
       Frequency of caseworker contact,                                                                                         
       Maltreatment recurrence, and                                                                                             
       Timely  attainment of permanency for  children in out                                                                    
     of home care.                                                                                                              
MS. BIGGS read from slide 23, "Other Costs of Child Welfare                                                                     
Workforce Turnover," which read as follows [original punctuation                                                                
     ?  Direct costs  of  overtime,  worker separation,  and                                                                    
     hiring/training new staff.                                                                                                 
     ?  Domino Effect:  Remaining staff  are more  likely to                                                                    
     ?   Indirect  costs   for   other  workers   (increased                                                                    
     paperwork  and case  management, emotional  exhaustion,                                                                    
     supervisors  redirecting   time  to   providing  direct                                                                    
     ? Financial costs: Every time  a caseworker leaves, the                                                                    
     cost to  the child  welfare agency is  30200  %  of the                                                                    
     exiting employee's annual salary.                                                                                          
MS. BIGGS next shared slide 24, which read as follows [original                                                                 
punctuation provided]:                                                                                                          
     What Causes Caseworkers to Leave?                                                                                          
     ?  A   meta-analysis  of   22  studies   identified  36                                                                    
     variables that most affected caseworkers' intention.                                                                       
     ?  Factors  that  have  the  greatest  effect:  Stress,                                                                    
     emotional  exhaustion,  organizational commitment,  job                                                                    
     What   are  the   Essential  Foundational   Steps  that                                                                    
     Agencies Need to Take?                                                                                                     
     ? Conduct  their own outreach and  inquiry to determine                                                                    
     the  causes  of   their  workers'  dissatisfaction  and                                                                    
     ?  Develop  and  implement  a  comprehensive  workforce                                                                    
     development plan  that responds to the  state workforce                                                                    
     ?  Build a  supportive  agency  culture, regardless  of                                                                    
     agency structure.                                                                                                          
MS. BIGGS  moved to  slide 25, "What  Works to  Reduce Turnover?"                                                               
and presented a list which  read as follows [original punctuation                                                               
     What Works to Reduce Turnover?                                                                                             
    1.    Analysis   of    turnover   and    organizational                                                                     
     environment; assessment of caseload/ workload.                                                                             
        2. Building, leading & elevating a comprehensive                                                                        
     workforce development plan.                                                                                                
      3. Identifying the right competencies: Job analyses,                                                                      
     specialized positions to support best practices.                                                                           
     4. Educating/preparing the right students: University-                                                                     
     agency partnerships, financial supports for students &                                                                     
     existing staff.                                                                                                            
     5. Finding/hiring the best applicants.                                                                                     
     6. Onboarding and welcoming new staff.                                                                                     
      7. Providing incentives and a range of supports for                                                                       
     8. A comprehensive training system.                                                                                        
     9. Effective management and supervision.                                                                                   
     10. Healthy agency climate and culture.                                                                                    
MS. BIGGS concluded the presentation and asked for questions.                                                                   
3:22:39 PM                                                                                                                    
CO-CHAIR ZULKOSKY  noted that there  are many others who  want to                                                               
testify, and they only have time for a couple of questions.                                                                     
REPRESENTATIVE  PRAX recollected  that  Ms.  Biggs had  mentioned                                                               
that 80 percent  of Native children end up  in abusive situations                                                               
but offered  his understanding that  the Native culture  is built                                                               
upon raising  children.  He  commented that he  didn't understand                                                               
that,  because it  was an  inherent  contradiction and  suggested                                                               
there  must be  more to  it than  that.   He asked  Ms. Biggs  to                                                               
elaborate on that.                                                                                                              
MS. BIGGS  asked Representative  Prax to  clarify whether  he was                                                               
asking why  there is  an 80  percent chance  of an  Alaska Native                                                               
child being the subject of child abuse.                                                                                         
3:24:13 PM                                                                                                                    
CO-CHAIR  ZULKOSKY interjected  that  "this is  probably not  the                                                               
environment  for  that  conversation,  and  any  questions  about                                                               
disproportionality and cultural impacts  are probably best suited                                                               
for additional testifiers  at another time."  She  said the focus                                                               
of the  meeting was on  the structure  of the department  and not                                                               
the  disparities that  are identified.   She  told Ms.  Biggs she                                                               
didn't have  to spend her time  talking about the impacts  or the                                                               
specifics of  cultural implications  but asked  her if  she could                                                               
talk about "any contributing factors to disproportionality."                                                                    
MS. BIGGS said  one of the contributing  factors is institutional                                                               
racism.   She argued that  sometimes the questions of  safety and                                                               
risk are complicated and should  be separated to determine if the                                                               
child is  unsafe or at risk.   She also suggested  that sometimes                                                               
social workers don't  have a lot of experience  and are sometimes                                                               
REPRESENTATIVE  PRAX   asked  if  the  study   is  something  CFP                                                               
conducted for the state, or if it was general theory.                                                                           
MS. BIGGS  responded that  these statistics  came from  data that                                                               
showed  how Alaska  Native  children  were disproportionately  in                                                               
foster care.                                                                                                                    
REPRESENTATIVE PRAX  asked if Ms.  Biggs looked at  Alaska's care                                                               
system specifically.                                                                                                            
CO-CHAIR ZULKOSKY  clarified for  Ms. Biggs  that there  were new                                                               
members on  the committee since  the last time she  presented, so                                                               
it could be helpful to discuss  CFP's work with the Department of                                                               
Health and Social Services (DHSS).                                                                                              
MS. BIGGS  responded that the  organization has worked  in Alaska                                                               
since  2000 with  both the  state  and tribes.   The  goal is  to                                                               
improve  outcomes  for children  in  foster  care and  to  reduce                                                               
disproportionality.   She said  that more  recently CFP  has been                                                               
focusing on prevention and strategies like in home services.                                                                    
3:28:41 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ asked  about the  challenges in  tribal                                                               
child welfare compacting and asked  if there is a specific driver                                                               
that challenges that, or if there are a series of factors.                                                                      
MS.  BIGGS  responded  that  she   thinks  there  was  a  series,                                                               
including  a  lack  of staff  dedicated  to  implementation,  the                                                               
complexity  of  some  of  the  scopes of  work,  and  a  lack  of                                                               
processes in place to successfully implement it.                                                                                
REPRESENTATIVE  SPOHNHOLZ  agreed  that one  staff  doesn't  seem                                                               
enough to  support the work.   She discussed the  lessons learned                                                               
from  Washington State  and asked  about  the two  to five  years                                                               
necessary to implement a complex transition.                                                                                    
MS.  BIGGS responded  that  there needs  to  be more  stakeholder                                                               
engagement.   She argued more time  needs to be spent  with those                                                               
most impacted  by a transition to  create buy-in and input.   She                                                               
said  this   included  current  staff,  community   members,  and                                                               
children   with   lived    experiences,   other   agencies,   and                                                               
philanthropic organizations.                                                                                                    
3:32:33 PM                                                                                                                    
RYAN MCKEE, State Director, Americans  for Prosperity, shared his                                                               
testimony  regarding  EO  119.   He  stated  that  Americans  for                                                               
Prosperity did not have an official  stance on EO 119 but did see                                                               
some benefits to  bifurcating DHSS.  He pointed out  that it is a                                                               
large department  with over 3,400  employees, and  that splitting                                                               
it up  would help focus  on more specific portions  of everything                                                               
that  is in  DHSS.    He argued  that  with  more specific  tasks                                                               
assigned to employees,  they would have a better  chance to excel                                                               
at their jobs rather than  trying to tackle everything that comes                                                               
at them.   He noted that the Office of  Children's Services (OCS)                                                               
has roughly  a 50  percent turnover rate,  which costs  about $13                                                               
million  a  year.    He  also  argued that  a  lot  of  work  and                                                               
improvement needs  to come from  the Medicaid sector and  that is                                                               
why the  organization would support  DHSS's employees  being able                                                               
to focus more on those specific tasks.                                                                                          
MR.  MCKEE said  that  from a  fiscal  standpoint, Americans  for                                                               
Prosperity realizes that there will  be added costs, specifically                                                               
the  13 new  positions and  the  15 declassified  positions.   He                                                               
noted  that   the  organization  is  opposed   to  any  duplicate                                                               
positions.   it does not see  any doubling of efforts  in EO 119,                                                               
but sees it as focused on alignment of current operations.                                                                      
3:36:01 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  asked Mr.  McKee about  how simplifying                                                               
workloads would  reduce turnover  in OCS.   She observed  that EO                                                               
119 doesn't simplify OCS, but  instead creates new administrative                                                               
executive  positions,  which  she   argues  wouldn't  change  the                                                               
workload.    She  asked  if  Americans  for  Prosperity  supports                                                               
creating  more  administrative  overhead without  providing  more                                                               
simplicity or frontline workers.                                                                                                
MR. MCKEE responded  that Americans for Prosperity  has not taken                                                               
a position  on EO 119 yet.   He said the  organization thinks the                                                               
additional  positions  are necessary  to  split  [DHSS] into  two                                                               
different groups, but it is  not supportive of a blanket increase                                                               
in  administrative  positions.    He commented  that  while  more                                                               
information is needed, the organization does see some benefits.                                                                 
REPRESENTATIVE  SPOHNHOLZ   argued  that  the   proposal  creates                                                               
additional  executive leadership  positions and  doesn't simplify                                                               
front line  workers' duties in  any way, in effect  creating more                                                               
bureaucracy and overhead.                                                                                                       
3:38:28 PM                                                                                                                    
CO-CHAIR  FIELDS  stated  that  for a  long  time  Americans  for                                                               
Prosperity did  not acknowledge  the beneficial  economic impacts                                                               
of public employment.  He asked  about the change in its approach                                                               
to economic development in Alaska.                                                                                              
MR. MCKEE  responded that  the organization  has not  changed its                                                               
stance on certain issues.   He clarified that the organization is                                                               
not opposed to public employees, who  he said play a crucial role                                                               
in Alaska.   However,  he argued that  the organization  does see                                                               
that [EO 119]  could be beneficial and is willing  to explore the                                                               
opportunity.  He indicated the  organization is interested in the                                                               
discussion surrounding  this issue and  to see how it  would play                                                               
out to separate the two divisions.                                                                                              
3:40:41 PM                                                                                                                    
TREVOR  STORRS,  President  and  CEO,  Alaska  Children's  Trust,                                                               
stated that his testimony would focus  solely  on 119 and not the                                                               
potential bifurcation of  the Office of Children's  Services.  He                                                               
stated that  as the statewide  leader in the prevention  of child                                                               
abuse  and neglect,  the Alaska  Children's Trust  (ACT) applauds                                                               
the  commissioner  [of  the  Department   of  Health  and  Social                                                               
Services  (DHSS)]  for  challenging  how the  current  system  is                                                               
functioning.   He  informed the  committee members  that ACT  and                                                               
DHSS  have teamed  up to  host discussions  with leaders  serving                                                               
children and families  and to co-host a townhall  meeting for the                                                               
public.  However, he noted, (ACT)  is neither for nor against the                                                               
bifurcation.  He said the goal  of his testimony was to share the                                                               
questions and concerns that ACT  and its partners have related to                                                               
the bifurcation, which have been shared with DHSS.                                                                              
MR.  STORRS said  the most  important questions  are whether  the                                                               
bifurcation  would improve  supports  and services,  and how  [it                                                               
would achieve  that].  He shared  that according to the  Annie E.                                                               
Casey Foundation,  overall, Alaska is  ranked 36th in  the nation                                                               
for  children's wellbeing.   He  said that  nearly 15  percent of                                                               
Alaska's children  live at or  below the national  poverty level,                                                               
only  one third  are  kindergarten ready,  and  most are  reading                                                               
below  proficiency at  the  third  and fourth  grade  level.   He                                                               
continued and pointed out that  Alaska has the third largest rate                                                               
of uninsured  children and  annually over  3,000 children  in the                                                               
foster  care  system.   He  also  noted that  even  pre-COVID-19,                                                               
suicide ideation was  up for children in Alaska.   He argued that                                                               
it  is  important that  DHSS  outline  how the  bifurcation  will                                                               
empower children and families to thrive.                                                                                        
MR. STORRS said  a question he has heard  from many organizations                                                               
and individuals is "Why now?"   He pointed out that in two weeks,                                                               
it  will have  been  a  full year  since  COVID-19.   People  are                                                               
overwhelmed and exhausted,  he said.  He defined  toxic stress as                                                               
prolonged  activation of  stress responses  in the  absence of  a                                                               
protective relationship,  which he argued captured  the impact of                                                               
COVID-19.   He explained  that toxic stress  response can  have a                                                               
huge toll on people's physical and mental health.                                                                               
3:44:57 PM                                                                                                                    
MR. STORRS stated that the  proposed bifurcation is a huge change                                                               
that individuals in and outside of  DHSS will have to manage.  He                                                               
opined that  so much has  been asked of these  organizations over                                                               
the past 12  months, and Alaska needs them to  remain strong.  He                                                               
asked if  the change was so  imperative that it needed  to happen                                                               
now,  or  if it  could  wait.   He  further  asked,  if this  was                                                               
imperative, what steps are being  taken to ensure individuals and                                                               
organizations   receive  the   support  needed   to  manage   the                                                               
additional anxiety it is causing.                                                                                               
MR.  STORRS said  a major  complaint shared  has been  a lack  of                                                               
shareholder engagement, and again noted  that ACT will be hosting                                                               
discussions    regarding   the    bifurcation,   although    some                                                               
stakeholders find  this late in  the process.  He  explained that                                                               
waiting to engage  with stakeholders within days  of the deadline                                                               
has caused trust issues with community partners.                                                                                
MR.  STORRS said  an additional  concern is  how the  bifurcation                                                               
will be  cost neutral.   He said  there will be  additional costs                                                               
that will  have to come  from existing  funding.  He  asked where                                                               
this funding will  come from and how it will  impact the programs                                                               
it is being taken from.   He explained that the greatest fear for                                                               
organizations is  that a greater  burden will be put  on families                                                               
and organizations.   He argued that community  partners want DHSS                                                               
to  be  successful, but  they  cannot  help without  being  truly                                                               
invited to the  table.  He concluded that Alaskans  all share the                                                               
same  goal  of wanting  families  and  children  to thrive.    He                                                               
challenged  the  committee  members  to imagine  the  outcome  if                                                               
[stakeholders and government] were to  join forces to make Alaska                                                               
the best state to grow up in.                                                                                                   
3:47:39 PM                                                                                                                    
CO-CHAIR SNYDER  asked about the  upcoming town hall and  who can                                                               
MR. STORRS responded that there are  two town halls and the first                                                               
is  specifically targeting  community partners.   He  said anyone                                                               
who provides  services is welcome,  although this is  targeted at                                                               
executive level [individuals] who deal  with policy changes.  The                                                               
second  will be  broadcasted for  anyone in  the public  to join,                                                               
hear about the bifurcation, and ask questions.                                                                                  
3:49:40 PM                                                                                                                    
REPRESENTATIVE  MCCARTY asked  about the  workforce and  caseload                                                               
for OCS.  He  asked if there was a point when  ACT will be taking                                                               
a position,  and if the committee  members would be able  to hear                                                               
back on what the position is.                                                                                                   
MR.  STORRS  explained  that he  did  not  address  [bifurcation]                                                               
purposefully, since it was not part of  EO 119.  He said that ACT                                                               
has  similar  concerns [about  OCS].    He commented  that  [DHSS                                                               
Commissioner  Crum]  has been  working  with  the [Alaska  Tribal                                                               
Health  Compact]  tribal  caucus   and  will  be  having  further                                                               
discussions  with ACT  around  [OCS].   He  said  ACT is  putting                                                               
together a  letter and  getting different  partners to  review it                                                               
and sign  on to bring the  commissioner and his team  up to speed                                                               
on where [ACT and its partners]  as community leaders are at, and                                                               
how they can help DHSS be successful.                                                                                           
MR. STORRS  mentioned that he  had testified before  the previous                                                               
legislature's  House  Standing  Committee on  Health  and  Social                                                               
Services, and  he offered  to forward  that testimony  to current                                                               
3:52:36 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  shared  that   her  office  will  share  that                                                               
REPRESENTATIVE MCCARTY asked if  Mr. Storrs could share solutions                                                               
for this issue.                                                                                                                 
MR.  STORRS said  he would  be happy  to, but  there wasn't  time                                                               
today.  He  stated that everyone is correct that  OCS is overrun.                                                               
He  said to  see  fewer  families in  the  childcare system,  "we                                                               
really need to  work upstream."  He argued that  data needs to be                                                               
used to have  an authentic conversation about what  the state can                                                               
be  doing.   He offered  examples of  working with  youth, making                                                               
sure  that   the  school  systems  have   a  comprehensive  human                                                               
development  curriculum [which  teaches] how  trauma impacts  the                                                               
brain, and  how the  brain develops, because  all the  kids going                                                               
through K-12 are the future parents.                                                                                            
MR. STORRS  shared that 7075   percent of  the kids in  the child                                                               
welfare system  were unplanned and  unwanted, which puts  them at                                                               
the  highest  risk  level.    He  argued  for  making  sure  that                                                               
contraceptive  family  planning [is  available]  in  Alaska.   He                                                               
acknowledged  how that  could  be a  challenge  to some  people's                                                               
personal values, but  good family planning is very key.   He also                                                               
pointed out  that poverty puts  families at greater  risk because                                                               
they have less access to  support services, resources, and skills                                                               
and  knowledge needed  to be  successful.   He explained  that if                                                               
families can space out their  children, their level of poverty is                                                               
decreased.   He  again said  the problem  is upstream,  mentioned                                                               
shortening "the line,"  and indicated that would  result in fewer                                                               
cases going through the child welfare system.                                                                                   
3:56:07 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ thanked Mr. Storrs  for his work and the                                                               
work of his  team at ACT in keeping families  together.  She also                                                               
thanked him  for bringing  up the  issue of  toxic stress  in the                                                               
middle of  COVID-19 and agreed  that employees in  the department                                                               
of Health and  Social Services were also  experiencing this level                                                               
of  stress.    She  thanked   him  for  facilitating  stakeholder                                                               
engagement  through  townhalls.    She raised  concern  that  the                                                               
public townhall  was scheduled  after the  legislature's deadline                                                               
to act on EO  119.  She stressed that DHSS  is a large department                                                               
and  many individuals  and private  businesses  across the  state                                                               
will be impacted by this.   She asked what meaningful stakeholder                                                               
engagement would look like.                                                                                                     
MR.  STORRS responded  that partners  feel same,  and that  there                                                               
should have  been a better  plan after the announcement  was made                                                               
for  these  kinds  of  conversations  to happen.    He  said  ACT                                                               
understood  why DHSS  may not  have  done stakeholder  engagement                                                               
with the question of bifurcation,  since it is a big organization                                                               
and internal  experts may best  be able to answer  that question.                                                               
He  suggested that  the  big question  is how  to  make sure  the                                                               
services are  consistent.  To  do that [would  require] listening                                                               
sessions [with partners], synthesizing  the information and going                                                               
back to  providers with a  proposal, and then asking  for further                                                               
feedback, he  said.   He commented  that he  is excited  that the                                                               
commissioner  is  looking  into  having  a  key  liaison  between                                                               
partners and  stakeholders.  He  said that there are  issues with                                                               
trust   with  DHSS,   but   the   stronger  the   [stakeholders']                                                               
relationship [with DHSS], the more successful they will be.                                                                     
REPRESENTATIVE  SPOHNHOLZ  said  stakeholder  engagement  sounded                                                               
like a  very complicated  process and  probably needed  more than                                                               
one or two listening sessions.                                                                                                  
MR. STORRS  agreed and said  it would be  better to sit  down and                                                               
discuss this topic.   He said he didn't want it  to seem like ACT                                                               
was coming  up with [an answer]  and suggested that a  small task                                                               
force would need  to come up with  a plan and find  ways to enact                                                               
that plan.                                                                                                                      
4:02:14 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  asked  if  ACT  was  engaged  in  substantive                                                               
conversations about  the concept of  splitting DHSS prior  to the                                                               
announcement in December.                                                                                                       
MR. STORRS  responded no.  He  shared that he was  not contacted.                                                               
He said  it was  indicated that  he was  on a  list to  have been                                                               
given a heads up prior to  [the announcement], but he was the one                                                               
who made the initial contact.                                                                                                   
4:03:23 PM                                                                                                                    
CO-CHAIR ZULKOSKY acknowledged that  discussion was running long,                                                               
but she felt it was an important topic.                                                                                         
CHIEF  "PJ" POLLACK  B. SIMON,  JR., Chief  and Chairman,  Tanana                                                               
Chiefs  Conference  (TCC),  shared  that TCC  is  an  intertribal                                                               
consortium  that provides  health and  social services  to 16,000                                                               
Alaska  Natives living  Fairbanks and  the surrounding  villages.                                                               
He  mentioned  that  TCC  is  a cosigner  to  the  Indian  Health                                                               
Services Compact, the agreement which  gives TCC the authority to                                                               
provide  health  services to  tribal  members  on behalf  of  the                                                               
United States Federal Government.   He explained that TCC is also                                                               
a member of  the Alaska Native Health Board which  is a nonprofit                                                               
that  assists  in  implementation  of  tribal  self-determination                                                               
through advocacy.                                                                                                               
CHIEF  SIMON  stated  that  TCC   utilizes  services  from  every                                                               
division  of  the  Department  of   Health  and  Social  Services                                                               
(DHSS),and is disproportionately  represented as beneficiaries of                                                               
these programs.  He shared that  TCC is a co-signer to the Alaska                                                               
Tribal  Health  Compact  and  the  Alaska  Child  Tribal  Welfare                                                               
Compact  and  has  worked  along-side   the  state  through  many                                                               
administrations on various work groups and collaborations.                                                                      
4:06:01 PM                                                                                                                    
CHIEF  SIMON said  TCC does  not support  the bifurcation,  as it                                                               
would create a separation between  programs and services that are                                                               
necessarily intertwined.  He stated  that the proposed separation                                                               
of  the Office  of  Children's Services  (OCS),  the Division  of                                                               
Public  Assistance,  and the  Division  of  Behavioral Health  is                                                               
baffling,  because  OCS  couldn't   support  families  in  crisis                                                               
without  working  with  the  other divisions.    He  argued  that                                                               
similar comments  could be  made about  the Division  of Juvenile                                                               
Justice because  of the need for  behavioral health intervention.                                                               
He continued,  asking the justification  of splitting  the Alaska                                                               
Pioneer  Homes  from  the  Division   of  Senior  and  Disability                                                               
4:07:42 PM                                                                                                                    
CHIEF.  SIMON stated  that  TCC is  both a  health  agency and  a                                                               
social services  agency.  He  argued that one system  makes sense                                                               
because  they  are  able to  provide  holistic,  wraparound,  and                                                               
patient centered  services.  He  said TCC achieved  less overhead                                                               
and a reduction in positions  by keeping services under one roof.                                                               
He offered an example wherein  patient presents at the clinic and                                                               
has a food security issue, and  a case manager is able to contact                                                               
the client  services division  and connect  the patient  with the                                                               
necessary  services.    He continued  listing  the  benefits  for                                                               
tribal members of the interconnected design of TCC.                                                                             
CHIEF  SIMON   said  DHSS's   frequently  asked   questions  page                                                               
indicated  that this  change  is being  made  to "streamline  the                                                               
focus  of  the Department  of  Health"  and to  "make  meaningful                                                               
interventions for  those Alaskans who are  experiencing crisis or                                                               
supporting their loved  ones."  He argued that it  is unclear how                                                               
the proposal  will meet  either objective,  especially in  a time                                                               
when the state budget  is in crisis.  He argued  that there is no                                                               
data or  information on  how this  new unit  will lead  to better                                                               
healthcare  delivery.   He  said  the data  did  not justify  the                                                               
creation  of   a  new   department,  which   would  mean   a  new                                                               
commissioner, staffing, facility, and other costs.                                                                              
CHIEF SIMON  argued this is  money the state  does not have.   He                                                               
recounted that over  the past few years, the state  has been in a                                                               
crisis due  to declining  oil revenue,  and the  insufficiency of                                                               
other  revenue  sources to  support  basic  state services.    He                                                               
argued  that there  have  been  annual budget  cuts  that led  to                                                               
reduced services  championed by  the current administration.   He                                                               
opined  that   in  the  midst  of   this  financial  environment,                                                               
splitting DHSS did  not make sense and would lead  to larger cuts                                                               
in services down the road.                                                                                                      
4:12:04 PM                                                                                                                    
CHIEF  SIMON said  CCT seeks  to  work with  the commissioner  to                                                               
ensure  any  reorganization  of   DHSS  benefits  Alaskans.    He                                                               
disagreed   with    the   administration   that    the   proposed                                                               
reorganization would  amount to  minimal additional  costs, since                                                               
the units  already exist.  He  then challenged the idea  that the                                                               
reorganization  would provide  services  to  Alaskans better  and                                                               
more efficiently.   He questioned  how this would lead  to better                                                               
services  if   funds  were  diverted  from   actual  services  to                                                               
CHIEF SIMON observed  that the programs in the  new Department of                                                               
Family  and Community  Service are  those the  administration has                                                               
tried  to privatize.    He said  it  was time  for  the state  to                                                               
provide these  programs with  the support they  need and  to stop                                                               
expecting a private operator to do better.                                                                                      
CHIEF SIMON  said that in  conclusion, TCC does not  support this                                                               
proposal and  believes it would  lead to worse outcomes  than the                                                               
status quo.  He reiterated that  TCC is happy to collaborate with                                                               
the state on ways that improve  outcomes.  He added that he hopes                                                               
TCC  and  other tribes  around  the  state are  consulted  before                                                               
future  proposals are  announced.   He requested  more engagement                                                               
and  more tribal  leaders at  the table.   He  shared that  2,800                                                               
Alaska Native children  were currently in foster  care, making up                                                               
64 percent of  all Alaska children in foster care.   He said that                                                               
an  investment in  children's services  is an  investment in  the                                                               
future of Alaska.                                                                                                               
4:15:36 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  commented that Chief  Simmon's insights                                                               
were  very important  and asked  him what  meaningful stakeholder                                                               
engagement  would look  like, and  whether  he felt  like it  had                                                               
taken place.                                                                                                                    
CHIEF  SIMON responded  that TCC  would like  more Alaska  Native                                                               
leaders meeting with DHSS, and  to be more involved in decisions.                                                               
He  said they  were not  engaged  before the  governor made  this                                                               
proposal.   He  commented that  being in  children's services  is                                                               
very tough,  and family separation is  hard.  He argued  that the                                                               
children's safety is jeopardized by the proposed structure.                                                                     
REPRESENTATIVE SPOHNHOLZ asked Chief  Simon what would meaningful                                                               
stakeholder engagement about splitting DHSS  look like, and if he                                                               
had a  sense of what  a process would  look like before  he would                                                               
feel comfortable supporting a potential split of DHSS.                                                                          
CHIEF  SIMON  replied  that  TCC  was  not  engaged  before  this                                                               
decision was  made by  the Office  of the Governor.   He  said he                                                               
felt [splitting the department]  was not very helpful, especially                                                               
not while the state was in  decline over oil revenue and during a                                                               
4:18:50 PM                                                                                                                    
REPRESENTATIVE PRAX asked  about how TCC works.  He  asked if TCC                                                               
provides services or refers to other service providers.                                                                         
CHIEF SIMON answered that TCC  provides services and described it                                                               
as a "one-stop-shop."                                                                                                           
REPRESENTATIVE PRAX asked if TCC  is encouraging more involvement                                                               
by the tribes.   He asked if children are being  taken out of the                                                               
Native culture through OCS.                                                                                                     
CHIEF SIMON said that it is  all about service, regardless of the                                                               
children  going to  different types  of  families.   He said  the                                                               
children  and  their   safety  were  of  upmost   priority.    He                                                               
emphasized  the  committee  members  were  discussing  children's                                                               
lives.   He again  noted that  64 percent  of children  in foster                                                               
care are Alaska Native.                                                                                                         
REPRESENTATIVE  PRAX replied  that  he would  like  to chat  more                                                               
CHIEF SIMON  said that this  is no  disrespect to lawmakers.   He                                                               
explained that TCC  is trying to deliver a high  level of service                                                               
in remote  locations in a  nonstandard fashion.  He  restated TCC                                                               
felt  strongly that  DHSS splitting  would only  impede services.                                                               
He said that  when families are split up it  is traumatic for all                                                               
involved, and TCC strives to make it less traumatic.                                                                            
4:22:59 PM                                                                                                                    
REPRESENTATIVE KURKA  said he appreciated Chief  Simon's comments                                                               
and concerns about the trauma being  done to children.  He shared                                                               
that he  has not decided  if is  for or against  the bifurcation,                                                               
but the current system does not  work.  He said the statistics he                                                               
was hearing were  horrible, and something was broken.   He shared                                                               
that several of his family members  are foster parents and he had                                                               
heard case workers speak positively towards the change.                                                                         
4:25:27 PM                                                                                                                    
CO-CHAIR ZULKOSKY asked  Ms. Biggs if she can  help the committee                                                               
identify  with  Representative's  Kurka's  comments if  it  is  a                                                               
structural issue  with the department,  or if  it is an  issue of                                                               
the culture and environment of the department.                                                                                  
MS. BIGGS  responded that what  Co-Chair Zulkosky said  was true,                                                               
and it  was an issue  of caseloads and  high turnover.   She said                                                               
this  is why  Casey  Family  Programs is  a  proponent of  having                                                               
tribes increasingly take care of  their children with support and                                                               
services  so  that  these  outcomes  improve,  which  would  also                                                               
alleviate stress on OCS.                                                                                                        
4:26:50 PM                                                                                                                    
CHIEF SIMON  commented that it  isn't about culture; it  is about                                                               
providing a  high level of  service.   He said all  the employees                                                               
with  TCC   are  doing  the   very  best  they  can   to  provide                                                               
opportunities for children.                                                                                                     
4:28:41 PM                                                                                                                    
CO-CHAIR ZULKOSKY announced that EO 119 was held over.                                                                          
          HB 76-EXTENDING COVID 19 DISASTER EMERGENCY                                                                       
4:29:39 PM                                                                                                                    
CO-CHAIR  ZULKOSKY announced  that  the final  order of  business                                                               
would be  HOUSE BILL NO.  76, "An  Act extending the  January 15,                                                               
2021,  governor's   declaration  of  a  public   health  disaster                                                               
emergency in  response to the  novel coronavirus  disease (COVID-                                                               
19) pandemic;  providing for a  financing plan;  making temporary                                                               
changes to state law in response  to the COVID-19 outbreak in the                                                               
following   areas:  occupational   and  professional   licensing,                                                               
practice,  and billing;  telehealth; fingerprinting  requirements                                                               
for health  care providers; charitable  gaming and  online ticket                                                               
sales; access  to federal stabilization  funds; wills;  unfair or                                                               
deceptive  trade practices;  and  meetings  of shareholders;  and                                                               
providing for an effective date."                                                                                               
4:30:17 PM                                                                                                                    
ADAM  CRUM,   Commissioner,  Department  of  Health   and  Social                                                               
Services, presented  HB 76 on  behalf of the bill  sponsor, House                                                               
Rules by  request of the governor.   He explained that  HB 76 was                                                               
introduced  by  the  governor pursuant  to  AS.26.23.020  and  AS                                                               
26.23.025.   He explained that  these two statues provide  that a                                                               
disaster proclamation  may not  remain in  effect longer  than 30                                                               
days  unless  extended  by  the  legislature  and  provides  what                                                               
information  is required  to the  legislature  when the  governor                                                               
declares a condition of disaster  emergency concurrently with the                                                               
issue of a proclamation.                                                                                                        
COMMISSIONER CRUM  said that  on January  15, 2021,  the governor                                                               
issued a  proclamation of a  public health disaster  emergency in                                                               
response to  the COVID-19  pandemic.   He noted  that a  bill was                                                               
transmitted  to  the House  on  January  21, 2021,  proposing  to                                                               
extend  the public  health disaster  emergency  to September  30,                                                               
2021, or until  the commissioner of DHSS certified  that there is                                                               
no longer an outbreak of COVID-19.   The bill also includes other                                                               
provisions  to protect  the  public and  economic  health of  the                                                               
state.  He  explained that absent legislative  action, the public                                                               
health emergency expired on February 14, 2021.                                                                                  
COMMISSONER  CRUM shared  that the  administration evaluated  the                                                               
current  COVID-19 response.   He  said  this involved  evaluating                                                               
previous response  efforts authorities provided under  the Alaska                                                               
Disaster  Act  and  the current  statutory  authority  under  the                                                               
Alaska Public  Health Emergency.   He shared  that DHSS  also met                                                               
with numerous  stakeholders and  providers to  discuss operations                                                               
and  response   efforts  if   the  disaster   declaration  wasn't                                                               
extended, and the department received feedback.                                                                                 
COMISSIONER CRUM  paraphrased the beginning of  subsection (e) of                                                               
AS 26.23.020, which read as follows:                                                                                            
     (e) A  proclamation of  a disaster  emergency activates                                                                    
     the  disaster  response  and recovery  aspects  of  the                                                                    
     state,   local,    and   interjurisdictional   disaster                                                                    
     emergency   plans    applicable   to    the   political                                                                    
     subdivisions or areas in question                                                                                          
COMMISSIONER  CRUM explained  this  allowed  for unified  command                                                               
structure  to  support  local  jurisdictions  and  the  statewide                                                               
public healthcare system and response to the pandemic.                                                                          
4:34:47 PM                                                                                                                    
COMMISSIONER CRUM  continued in explaining  the impact of  HB 76.                                                               
He paraphrased subsection (f), which read as follows:                                                                           
     (f)  During   the  effective   period  of   a  disaster                                                                    
     emergency, the  governor is commander  in chief  of the                                                                    
     organized  and unorganized  militia  and  of all  other                                                                    
     forces available  for emergency duty. The  governor may                                                                    
     delegate  or assign  command  authority by  appropriate                                                                    
     orders or regulations.                                                                                                     
COMMISSIONER  CRUM said  this allowed  the administration  to use                                                               
the National Guard for certain  response purposes such as contact                                                               
COMMISSIONER  CRUM  paraphrased  subsection (g),  paragraph  (1),                                                               
which read as follows:                                                                                                          
     (g) In addition to any  other powers conferred upon the                                                                    
     governor by law, the governor  may, under  AS 26.23.010                                                                    
     -  26.23.220,                                                                                                              
          (1)  suspend  the  provisions  of  any  regulatory                                                                    
     statute  prescribing  procedures  for  the  conduct  of                                                                    
     state  business, or  the orders  or regulations  of any                                                                    
     state agency, if compliance with  the provisions of the                                                                    
     statute,  order,   or  regulation  would   prevent,  or                                                                    
     substantially  impede  or  delay, action  necessary  to                                                                    
     cope with the disaster emergency;                                                                                          
COMMISSIONER  CRUM   explained  this   was  used   for  emergency                                                               
procurement  contracts  for  additional cold  chain  shippers  of                                                               
testing and  supplies and hiring  of personnel to  support public                                                               
health  plans.   He shared  that  it also  allowed for  increased                                                               
flexibility in how  the state cared for and  provided services to                                                               
populations in congregate settings and facilities.                                                                              
COMMISSIONER CRUM said  the state did not use  the authority from                                                               
paragraph (2) of subsection (g).   He drew attention to paragraph                                                               
(3), which read as follows:                                                                                                     
     (3) transfer personnel or alter  the functions of state                                                                    
     departments  and  agencies or  units  of  them for  the                                                                    
     purpose of  performing or facilitating  the performance                                                                    
     of disaster emergency services;                                                                                            
COMMISISONER  CRUM  explained  that   the  state  repurposed  the                                                               
Division of Public Health to respond to COVID-19.                                                                               
COMMISSIONOR CRUM skimmed through the  rest of subsection (g) and                                                               
highlighted  paragraphs   used  in   response  to   the  COVID-19                                                               
pandemic.   He  explained that  paragraph (7)  was the  authority                                                               
used to implement testing requirements  for travel.  He said that                                                               
paragraph  (9)  was  used  for  non-congregate  housing  for  the                                                               
homeless, for travelers that tested  positive, and for healthcare                                                               
workers.   He  said that  paragraph (10)  was used  to distribute                                                               
personal  protective  equipment   (PPE),  testing  supplies,  and                                                               
vaccines  and therapeutic  treatment.   He pointed  out that  the                                                               
administration  did not  use  paragraphs (4),  (5),  (6), (8)  or                                                               
4:38:13 PM                                                                                                                    
COMMISSIONER CRUM summarized that  not all these authorities were                                                               
used.   He noted  that of  the authorities  that were  used, they                                                               
were not  all necessarily  utilized at  the same  time.   He then                                                               
asked,  "How does  Alaska  proceed to  a  recovery phase,  moving                                                               
beyond  the disaster  and emergency?"   He  said the  state could                                                               
take a more limited approach.   He argued this will also help the                                                               
state's economic metrics.                                                                                                       
COMMISSIONER CRUM reiterated that  through the evaluative process                                                               
the administration  went through  after the  disaster declaration                                                               
expired  on February  14, 2021,  the  administration realized  it                                                               
didn't  need  all  the authorities  available  under  the  Alaska                                                               
Disaster Act.  He explained  that the administration hopes to use                                                               
a more  targeted approach  by using  uncodified law  to establish                                                               
the  needed  authorities.    He said  the  authorities  that  are                                                               
identified  as  important  include  allowing  the  Department  of                                                               
Health and Social Services (DHSS)  to manage vaccine distribution                                                               
and the  therapeutic response to  COVID-19, and to allow  DHSS to                                                               
cooperate with  the Federal Government,  with respect  to blanket                                                               
waivers, the 1135 Waiver, Appendix  K authorities, as well as the                                                               
application   and  distribution   of  Emergency   Allotment  (EA)                                                               
Supplemental Nutrition Assistance Program (SNAP) benefits.                                                                      
COMMISSIONER CRUM said  another part was to  allow the Department                                                               
of Military &  Veterans' Affairs (DMVA) to assist DHSS.   He said                                                               
the  DMVA would  receive  authority from  the  governor to  allow                                                               
activation of  the Alaska  Guard to respond  to the  pandemic and                                                               
coordinate with  the Federal Emergency Management  Agency (FEMA).                                                               
He said  there was also the  authority for the use  of telehealth                                                               
and telemedicine  for healthcare providers currently  licensed in                                                               
another state,  as well as  immunity for  employers, governmental                                                               
agencies, or persons engaged in the state response.                                                                             
COMMISSIONER CRUM  summarized his  presentation.  He  stated that                                                               
the  administration understood  Alaska's  need to  progress to  a                                                               
recovery phase, but  also to have the tools to  respond as things                                                               
change.  He said it is  possible to continue a safe response plan                                                               
without  providing  the  broad   authority  of  a  public  health                                                               
emergency disaster  declaration.  He noted  that standalone bills                                                               
had  been introduced  in the  other body  to address  changes for                                                               
shareholder meetings, licensing issues, and telemedicine.                                                                       
4:42:35 PM                                                                                                                    
CO-CHAIR SNYDER asked Commissioner Crum  if he had a presentation                                                               
to go with his testimony.                                                                                                       
COMMISSIONER CRUM said [there was no presentation].                                                                             
CO-CHAIR SNYDER asked if Commissioner  Crum's testimony meant the                                                               
administration was backing away from the need for HB 76.                                                                        
COMMISSIONER  CRUM   replied  yes.     He  said  that   when  the                                                               
declaration expired,  the administration had to  determine how it                                                               
would  maintain  the response.    From  that, the  administration                                                               
identified what was  needed to have legal  coverage going forward                                                               
and to make sure it  could continue distributing the vaccines and                                                               
therapeutics.    He said  that  from  public response  there  was                                                               
concern  about using  the Disaster  Declaration Act  any further.                                                               
He said the  administration had been trying to  work with federal                                                               
partners to make  sure that any specific  language necessary gave                                                               
the administration the cover needed to continue the response.                                                                   
4:44:51 PM                                                                                                                    
REPRESENTATIVE MCCARTY  clarified that the  state felt it  was no                                                               
longer in  an emergency  status with COVID-19  and asked  if that                                                               
was the reasoning for changing the decision.                                                                                    
COMMISSIONER CRUM answered that it  has to do with the definition                                                               
of  the word  "disaster."   He said  the words  carry "a  certain                                                               
connotation."   He acknowledged that  there was a  current public                                                               
health emergency,  but said it was  "with a little 'e'  and not a                                                               
capital."  He stated that  the administration has identified ways                                                               
it can still access the necessary authorities.                                                                                  
REPRESENTATIVE MCCARTY  asked if  the state's  new status  of not                                                               
having an emergency  in place had any bearings  on federal COVID-                                                               
19 funds.                                                                                                                       
COMMISSIONER  CRUM responded  that the  two items  tied to  state                                                               
action were the non-congregate sheltering  order, which was being                                                               
worked on  with FEMA,  and the  EA SNAP benefits.   He  said this                                                               
could  be  tied  into  a  law  that  would  be  used  for  future                                                               
REPRESENTATIVE  MCCARTY asked  if this  has any  bearing on  data                                                               
collection to assess if COVID-19 is becoming better or worse.                                                                   
COMMISSIONER  CRUM  responded  that   data  collection  is  still                                                               
possible through standing authority.                                                                                            
4:47:47 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  asked how  this changed the  ability to                                                               
require testing for  non-residents who come into the  state.  She                                                               
noted that  much of Alaska  has limited healthcare, and  this had                                                               
been an important measure to prevent the spread of COVID-19.                                                                    
COMMISSIONER  CRUM  responded  that  the  authorities  the  state                                                               
requested  do not  include the  authority  to require  pre-travel                                                               
REPRESENTATIVE SPOHNHOLZ asked  for clarification if Commissioner                                                               
Crum didn't think it's necessary  for non-residents to get tested                                                               
if and when they come into Alaska.                                                                                              
COMMISSIONER CRUM said it is  important to identify who is coming                                                               
into the state and shared  that now the administration is working                                                               
directly with  the tourism industry.   He said the  barriers [for                                                               
testing] had been removed by  keeping the infrastructure in place                                                               
and removing the testing fee.                                                                                                   
REPRESENTATIVE  SPOHNHOLZ  commented  that  the  commissioner  is                                                               
trying to  adapt, and she  appreciated that.  She  expressed that                                                               
she thought it  in an important public health  measure to require                                                               
testing  for people  coming into  Alaska.   She pointed  out that                                                               
Alaska has a high number of non-resident workers and tourists.                                                                  
COMMISSIONER CRUM agreed that it has been an important tool.                                                                    
4:50:52 PM                                                                                                                    
CO-CHAIR SNYDER  brought up  that on January  14, 2021,  when the                                                               
last disaster  declaration passed, Alaska  had 193 [new  cases of                                                               
COVID-19], food insecurity at about  12 percent, and unemployment                                                               
claims remained  elevated.   She also pointed  out that  that day                                                               
Alaska had  124 new cases  with increasing food insecurity.   She                                                               
opined  that the  current statistics  were similar  [to when  the                                                               
last  disaster declaration  was issued],  but the  administration                                                               
was pursuing authority in a  more piecemeal fashion and asked for                                                               
explanation on Commissioner Crum's strategy.                                                                                    
COMMISSIONER CRUM responded  that DHSS is trying to  operate in a                                                               
timely manner, and that is why  there is a trimmed down response.                                                               
He  said they  had  to adjust  [without the  approval  for a  new                                                               
declaration]  on February  14, 2021.    He pointed  out that  the                                                               
distribution of  the vaccine has  been a priority and  has helped                                                               
reduce hospitalizations from COVID-19.                                                                                          
4:53:26 PM                                                                                                                    
REPRESENTATIVE KURKA  asked how  many positive cases  of COVID-19                                                               
were found  by testing travelers,  thus resulting,  in preventing                                                               
those  cases  from  entering  Alaska.    He  then  said  that  he                                                               
understood that  contact tracing  was possible in  the beginning,                                                               
but his perception  was that it fell apart because  there were so                                                               
many cases.   He  asked what  the point of  screening was  if the                                                               
state could no longer contact trace.                                                                                            
COMMISSIONER  CRUM  turned  to   Heidi  Hedberg  to  address  the                                                               
4:54:53 PM                                                                                                                    
HEIDI HEDBERG,  Director, Division  of Public  Health, Department                                                               
of Health  and Social Services,  answered questions about  HB 76.                                                               
She  said airport  testing  began on  June 6,  2020,  and it  has                                                               
screened  almost 500,000  travelers  and  identified almost  3000                                                               
positives.   She opined that  it had been a  successful endeavor.                                                               
In terms  of contact  tracing, she said  DHSS engaged  in contact                                                               
tracing  once  it  found  someone  was  positive  and  asked  the                                                               
individual to notify everyone that  he/she came into contact with                                                               
for more than  15 minutes within six feet.   She stated that that                                                               
had really helped to lower the number of positive cases.                                                                        
REPRESENTATIVE  KURKA   asked  what   percentage  of   cases  are                                                               
successfully tracked through contact tracing.                                                                                   
DIRECTOR HEDBERG  said DHSS  would have to  follow up  with that,                                                               
but  they  do use  a  database.    She  said they  could  compare                                                               
percentages  of where  individuals  were  exposed, although  that                                                               
varied through communities across the state.                                                                                    
REPRESENTATIVE  KURKA commented  that  it was  clear from  DHSS's                                                               
online information  dashboard how  many ICU  beds are  being used                                                               
for COVID-19 patients.  He asked  what the number of active cases                                                               
was, rather than new cases.                                                                                                     
4:58:52 PM                                                                                                                    
COMMISSIONER CRUM  shared that underneath  the dashboard  one can                                                               
download raw  summary data  to look at  patients on  the COVID-19                                                               
4:59:26 PM                                                                                                                    
DIRECTOR HEDBERG  responded that when  it comes to  active cases,                                                               
the Center  for Disease  Control (CDC)  said individuals  need to                                                               
quarantine for 10  days, but some individuals  can be symptomatic                                                               
for much  longer.   She said  during the  summer DSS  removed the                                                               
"recovered"  cases  from  the  dashboard  because  it  is  person                                                               
5:00:28 PM                                                                                                                    
CO-CHAIR  ZULKOSKY shared  that they  have  run out  of time  and                                                               
asked  if the  commissioner could  be available  during the  next                                                               
meeting for additional questions.                                                                                               
COMMISSIONER CRUM said he would be there.                                                                                       
5:01:14 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ clarified  a  misunderstanding that  64                                                               
percent of Alaska Native children  are not in foster care, rather                                                               
64 percent  of children in  foster care  are Alaska Native.   She                                                               
shared  that there  are  190,000 children  in  Alaska, and  about                                                               
38,000 of  them are Native.   Alaska  only has 2,800  children in                                                               
foster care, she explained.                                                                                                     
CO-CHAIR ZULKOSKY announced that HB 76 would be held over.                                                                      
5:02:34 PM                                                                                                                    
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:03 p.m.                                                                                                          

Document Name Date/Time Subjects
HB76 AEMA Letter of Support to HHSS.pdf HHSS 3/2/2021 3:00:00 PM
HB 76
HB0076-4-2-021821-MVA-Y.pdf HHSS 3/2/2021 3:00:00 PM
HB 76
HB0076-3-2-021821-DPS-N.pdf HHSS 3/2/2021 3:00:00 PM
HB 76
HB0076-1-2-021821-CED-N.pdf HHSS 3/2/2021 3:00:00 PM
HB 76
HB0076-2-2-021821-DHS-N.pdf HHSS 3/2/2021 3:00:00 PM
HB 76
HB 76 Sectional Analysis Version 32 GH1011 A.pdf HHSS 3/2/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
HB 76 AK ACEP Letter of Support HHSS.pdf HHSS 3/2/2021 3:00:00 PM
HB 76
HB 76 Transmittal Letter.pdf HHSS 3/2/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
HB 76 Version 32 GH 1011 A.pdf HHSS 3/2/2021 3:00:00 PM
HHSS 3/6/2021 3:00:00 PM
HB 76
21.02.26 ANHB to Commissioner Crum re. DHSS Reorganization - Final.pdf HHSS 3/2/2021 3:00:00 PM
SFIN 3/11/2021 9:00:00 AM
EO 119
HOUSE HSS memo.final 2.25.21.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
EO 119 Sectional Analysis.pdf HHSS 3/2/2021 3:00:00 PM
SFIN 3/11/2021 9:00:00 AM
EO 119
exor0119.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
Casey Family Programs - Signed Final 2.18.21 Compact TA Findings Recommendations.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
Casey Family Programs - HO_Turnover-Costs_and_Retention_Strategies-1.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
Casey Family Programs presentation 3-2-21 AK H&SS Comte.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
FFC Alaska - Preventing Early Departures Among the Child Welfare Workforce.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
FFC Alaska - NCWWI Caseload-Workload 2011 One Pager.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
FFC Alaska - Caseload briefing paper Multi-page NCWWI.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
FFC Alaska - 2020 HB 151 Report to the Legislature.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
Alaska Healthcare Transformation Letter - EO 119.pdf HHSS 3/2/2021 3:00:00 PM
EO 119
ACT OCS Proposed Restructure Testimony Jan 14 2021.pdf HHSS 3/2/2021 3:00:00 PM
EO 119