Legislature(2023 - 2024)DAVIS 106
01/25/2024 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Update from the Department of Health | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 25, 2024
3:02 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION(S): UPDATE FROM THE DEPARTMENT OF HEALTH
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
HEIDI HEDBERG, Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Co-presented the Update from the Department
of Health presentation.
EMILY RICCI, Deputy Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Co-presented the Update from the Department
of Health presentation.
DEB ETHERIDGE, Director
Division of Public Assistance
Department of Health
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding Medicaid
applications during the Update from the Department of Health
presentation.
ACTION NARRATIVE
3:02:38 PM
CHAIR PRAX called the House Health and Social Services Standing
Committee meeting to order at [3:02] p.m. Representatives Mina
and Prax were present at the call to order. Representatives
Ruffridge, McCormick, Saddler, Sumner, and Fields arrived as the
meeting was in progress.
^PRESENTATION(S): UPDATE FROM THE DEPARTMENT OF HEALTH
PRESENTATION(S): UPDATE FROM THE DEPARTMENT OF HEALTH
3:03:56 PM
CHAIR PRAX announced that the only order of business would be
the Update from the Department of Health presentation.
3:04:32 PM
HEIDI HEDBERG, Commissioner, Department of Health, began a
PowerPoint presentation [hardcopy included in the committee
packet], giving an overview of the State of Alaska Department of
Health. She showed slide 2, titled, "Promoting the Health,
Well-Being and Self Sufficiency of Alaskans." During her
introduction, she pointed out that the department was happy to
celebrate its one-year anniversary on July first. She explained
the department had a very busy year with an emphasis on
stakeholder engagement around health care, childcare, and
behavioral health. This included a focus on automation to
support staff processes and client experience. She pointed to
four major areas of effort: behavioral health; complex care;
childcare; and transformational care.
3:05:59 PM
COMMISSIONER HEDBERG moved to slide 3, which outlined the topics
of the presentation. She then moved to slide 4, titled, "SNAP
Updates: Backlog." She explained that when she started as
commissioner in November 2022 there was a backlog, and with a
change in leadership and system processing, the department was
able to remove that first backlog. Then in the fall of 2023,
there was a cascade of events that created the most recent
backlog. She discussed several causes and outlined the steps
the department took to deal with the backlog. She emphasized
the importance of preventing future backlogs. One step focuses
on staff training and maximizing staff resources.
COMMISSIONER HEDBERG continued the analysis of the Supplemental
Nutrition Assistance Program (SNAP) with slide 5, "SNAP Updates:
Path Forward," which detailed the six automations the Division
of Public Assistance will be implementing including online
applications, self-service portals, and client access to status
information. The department is currently on target to implement
the integrated eligibility enrollment program in 2025.
3:15:26 PM
EMILY RICCI, Deputy Commissioner, Department of Health, as co-
presenter, focused on the Department of Health beginning her
presentation with slide 6, "Medicaid Redeterminations," which
read as follows [original punctuation provided]:
Where are we at?
• Initiated over 90,000 redeterminations using ex
parte process
• Negotiated with CMS additional time for
redeterminations
• Implemented new mitigation strategies
• New access to data for partners
Ex Parte (Automated) Process
• Identified system errors impacting disenrollments
(Aug/Sep)
• Pause certain disenrollments until updates in place
• Working with federal data services to update and fix
system
• Updates will increase successful automated renewals
MS. RICCI explained that all states were required to review
eligibility determinations for Medicaid beneficiaries at the
beginning of 2023. She stressed the challenges of the process
and described some of the mitigation strategies including
automating processes; using data sharing; using texting for
renewal reminders; automating some of the renewal processes; and
analyzing system errors.
3:21:22 PM
MS. RICCI presented slide 7, "Medicaid Redetermination
Schedule." She discussed mitigation strategies the department
is implementing. She then moved to slide 8, "Medicaid Savings
and Tribal Reclaiming Initiative," which graphed General Fund
savings from 2017 through 2023 pursuant to reclaiming initiative
federal funds. The slide reads as follows [original punctuation
provided]:
• Tribal reclaiming allows states to submit claims for
100% federal match for services outside a Tribal
facility under certain conditions.
• The Tribal Reclaiming Unit works closely with the
Alaska Tribal Health System to maximize federal match.
3:24:20 PM
MS. RICCI moved to slide 9, "Medicaid Payment Changes," which
read as follows [original punctuation provided]:
• Comprehensive Medicaid rate review RFP released
• First round to focus on:
• Behavioral health
• Long-term care services and supports
• Federally Qualified Health Centers
• Nonemergent medical transportation
• Diagnosis-Related Groups (DRG) inpatient
reimbursement
• Went live 1/1/2024
MS. RICCI described the department's current work in analyzing
Medicaid rates; how the data is being collected; and what
Medicaid rate methodologies are being used. This work is being
done in phases, and the first review was recently released for
public comment. She also called attention to an inpatient
reimbursement program that went live on January 1, 2024.
3:26:15 PM
COMMISSIONER HEDBERG continued the presentation with slide 10,
"Child Care Updates." She focused on the funding and provided
an update on the Task Force on Child Care. She gave examples of
some child care innovations that have been implemented
throughout the state. She reviewed the work of the task force
and gave specifics regarding recommendations and the focus of
effort.
3:29:09 PM
MS. RICCI continued the presentation with slide 10, "Improving
the Behavioral Health Continuum of Care." She described the
department's goal to provide access to needed care as near the
communities as possible. Department staff visited five
different communities throughout the state to explore what
challenges are faced by providers, individuals, and communities.
Staff looked at what solutions were in place and how issues
might be addressed. The department reviewed the information and
discussed a continuum of care as it relates to behavioral
health.
3:32:55 PM
COMMISSIONER HEDBERG moved to slide 12, "Division of Public
Health Fresh Start Program." She described the free program,
how Alaskans have responded, and the subsequent improvements in
health.
MS. RICCI presented slide 13, "Person Centered Care & InterRAI
Tool." She described a system of care that features person-
centered care as well as collaborative work the department has
done with stakeholder groups. She briefly outlined the goals
for the next three years.
3:35:46 PM
REPRESENTATIVE FIELDS brought up a recent discussion he had with
behavioral health providers, and he was told that Medicaid rates
are insufficient to provide services. He asked whether the
11/15 waivers would help. He also asked whether autism services
are being looked at during the department's rate reviews.
MS. RICCI replied in the affirmative, saying it was one of the
department's priorities.
3:36:51 PM
REPRESENTATIVE RUFFRIDGE referred to slide 5 regarding online
applications and asked whether there is a mobile application.
COMMISSIONER HEDBERG explained that a person can use a phone to
access my.alaska.gov and complete an application.
REPRESENTATIVE RUFFRIDGE asked about Medicaid renewals and their
time frame.
MS. RICCI replied that Medicaid eligibility is reviewed
annually.
3:38:18 PM
REPRESENTATIVE MINA expressed her thanks to the department for
dealing with the application backlog and for the work on
providing online access. She asked about the language
accessibility of online applications. In addition, she inquired
about the differences in applications being completed through
the online platform versus the paper application.
COMMISSIONER HEDBERG responded that in terms of processing
applications, one team is focused on current work coming in, and
another team is focused on the backlog of applications older
than 30 days. Regarding the online platform, the department is
seeing more completed applications, but not enough time has
transpired for specific data.
3:40:05 PM
DEB ETHERIDGE, Director, Division of Public Assistance,
Department of Health, explained that the applications are
available in a variety of languages. In addition, the online
applications are fully accessible per the requirements of the
Americans with Disabilities Act. She would get back to the
committee regarding what languages are available on the online
application.
3:40:33 PM
REPRESENTATIVE MINA requested information regarding what type of
assistance is available for people who are doing the online
application but who do not have a lot of digital literacy.
MS. ETHERIDGE explained that the Division of Public Assistance
uses people from several divisions who can assist in completing
applications. They also use a Fee Agent program.
3:41:49 PM
REPRESENTATIVE MINA acknowledged that the online application
just launched but asked if Ms. Etheridge knew the average length
of time to complete the online application versus the paper
application.
MS. ETHERIDGE explained the online application was a "smart
form" and only takes about 20 minutes. The paper applications
take longer because people generally give information they don't
need to provide.
3:42:53 PM
CHAIR PRAX asked for clarification regarding Ms. Etheridge's
remark about SNAP that "all you need is your name and a
signature and an address."
MS. ETHERIDGE explained that when you fill out the initial SNAP
application, it secures the date of application and requires a
phone follow-up.
CHAIR PRAX requested information about the error rate for both
SNAP applications and Medicaid redetermination and asked how
much that contributed to the backlog.
MS. ETHERIDGE described the methods for dealing with the backlog
including extending the certifications for six months without an
application. That process technically contributed to the error
rate which is anticipated to last until 2025. However, as the
division reviews those earlier cases, the actual error rate is
5.6 percent. Typically, the division has a low error rate.
CHAIR PRAX commented that he has tried out the online form and
it seems like a step in the right direction.
3:45:27 PM
REPRESENTATIVE FIELDS brought up the Fresh Start program and
questioned how this program is addressing chronic diseases. He
asked whether the department has engaged with the Department of
Transportation and Public Facilities (DOT&PF)regarding expanding
places for people to use wheelchairs and to walk safely. He
pointed out that simply being able to walk safely positively
impacts the health of people with certain chronic conditions in
addition to creating healthy outdoor opportunities.
COMMISSIONER HEDBERG responded that the Division of Public
Health, Chronic Disease Prevention and Health Promotion does
have a working relationship with the DOT&PF and does provide
feedback.
3:47:05 PM
REPRESENTATIVE MCCORMICK explained that constituents and non-
profit organizations in his district have expressed concerns
that the state is not paying grants in a timely manner.
COMMISSIONER HEDBERG said that prior to the department
reorganization, the Department of Health and Social Services
experienced a cyber-attack that impacted all Information
Technology systems in addition to the grant management system.
On-time payment to grantees has significantly improved since
that time.
3:49:21 PM
CHAIR PRAX inquired about the results of a program that received
significant funding the previous year and which concerned
identifying pregnant women who had syphilis.
COMMISSIONER HEDBERG provided an update on the program
addressing congenital syphilis and tuberculosis. The funding
went out to communities and focused first on communication and
education on awareness of syphilis followed by testing of
syphilis. There has been an increase in identification and
treatment.
3:50:52 PM
REPRESENTATIVE FIELDS expressed interest in restoring funding
for the infant learning program. He would like to see the
funding restored so children who have been screened as being
eligible can get these services.
MS. RICCI shared the news that the department is going live with
the post-partum extension program.
CHAIR PRAX observed that the Division of Family Services and the
Department of Health are moving in the right direction.
3:54:00 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 3:54 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DOH HHSS Department Overview 2.25.24.pptx.pdf |
HHSS 1/25/2024 3:00:00 PM |
DOH |
| HHSS response 1.25.24.pdf |
HHSS 1/25/2024 3:00:00 PM |
DOH Follow Up 1.25.24 |