02/18/2025 03:15 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB73 | |
| HB70 | |
| HB27 | |
| HB14 | |
| Overview(s): Child Advocacy Centers | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 73 | TELECONFERENCED | |
| *+ | HB 70 | TELECONFERENCED | |
| *+ | HB 27 | TELECONFERENCED | |
| *+ | HB 14 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 18, 2025
3:18 p.m.
MEMBERS PRESENT
Representative Genevieve Mina, Chair
Representative Andrew Gray
Representative Zack Fields
Representative Donna Mears
Representative Mike Prax
Representative Justin Ruffridge
Representative Rebecca Schwanke
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 73
"An Act relating to complex care residential homes; and
providing for an effective date."
- MOVED HB 73 OUT OF COMMITTEE
HOUSE BILL NO. 70
"An Act relating to emergency medical services for operational
canines; relating to the powers, duties, and liability of
emergency medical technicians and mobile intensive care
paramedics; relating to the practice of veterinary medicine; and
providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 27
"An Act relating to medical care for major emergencies."
- HEARD & HELD
HOUSE BILL NO. 14
"An Act repealing programs for catastrophic illness assistance
and medical assistance for chronic and acute medical
conditions."
- HEARD & HELD
OVERVIEW(S): CHILD ADVOCACY CENTERS
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 73
SHORT TITLE: COMPLEX CARE RESIDENTIAL HOMES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/27/25 (H) READ THE FIRST TIME - REFERRALS
01/27/25 (H) HSS, FIN
02/06/25 (H) HSS AT 3:15 PM DAVIS 106
02/06/25 (H) Heard & Held
02/06/25 (H) MINUTE(HSS)
02/18/25 (H) HSS AT 3:15 PM DAVIS 106
BILL: HB 70
SHORT TITLE: EMERGENCY MED SVCS; OPERATIONAL CANINES
SPONSOR(s): SCHRAGE
01/27/25 (H) READ THE FIRST TIME - REFERRALS
01/27/25 (H) HSS, L&C
02/18/25 (H) HSS AT 3:15 PM DAVIS 106
BILL: HB 27
SHORT TITLE: MEDICAL MAJOR EMERGENCIES
SPONSOR(s): MINA
01/22/25 (H) PREFILE RELEASED 1/10/25
01/22/25 (H) READ THE FIRST TIME - REFERRALS
01/22/25 (H) HSS, FIN
02/18/25 (H) HSS AT 3:15 PM DAVIS 106
BILL: HB 14
SHORT TITLE: REPEAL CATASTROPHIC ILLNESS/MED ASSIST
SPONSOR(s): STAPP
01/22/25 (H) PREFILE RELEASED 1/10/25
01/22/25 (H) READ THE FIRST TIME - REFERRALS
01/22/25 (H) HSS, FIN
02/18/25 (H) HSS AT 3:15 PM DAVIS 106
WITNESS REGISTER
ROBERT LAWRENCE, MD, Chief Medical Officer
Office of the Commissioner
Department of Health
POSITION STATEMENT: Co-presented HB 73 on behalf of the bill
sponsor, House Rules by request of the governor.
EMILY RICCI, Deputy Commissioner
Office of the Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
73 on behalf of the bill sponsor, House Rules by request of the
governor.
REPRESENTATIVE CALVIN SCHRAGE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, presented HB 70.
JEREMY HOUSTON, Staff
Representative Calvin Schrage
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Gave the sectional analysis for HB 70 on
behalf of Representative Schrage, prime sponsor.
KERRY KIRKPATRICK
Southeast Alaska Dogs Organized for Ground Search
Juneau, Alaska
POSITION STATEMENT: Gave invited testimony in support of HB 70.
SEAN MCPECK, DVM
Tier 1 Veterinary Medical Center
Palmer, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
70.
KATY GIORGIO, Staff
Representative Genevieve Mina
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Gave the sectional analysis for HB 27 on
behalf of Representative Mina, prime sponsor.
GENE WISEMAN, Chief
Section of Rural and Community Health Systems
Division of Public Health
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
27.
REPRESENTATIVE WILL STAPP
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, presented HB 14.
BERNARD OTO, Staff
Representative Will Stapp
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Stapp, prime
sponsor, gave the sectional analysis for HB 14.
DEB ETHERIDGE, Director
Division of Public Assistance
Department of Health
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
14.
MARI MUKAI, Executive Director
Alaska Children's Alliance
Western Regional Children's Advocacy Center
Anchorage, Alaska
POSITION STATEMENT: Co-presented the Child Advocacy Centers
overview.
LEIGH BOLIN, Executive Director
Resource Center for Parents and Children
POSITION STATEMENT: Co-presented the Child Advocacy Centers
overview.
CATHY BALDWIN-JOHNSON, MD, Medical Director
The Children's Place
Wasilla, Alaska
POSITION STATEMENT: Co-presented the Child Advocacy Centers
overview.
TODD KEARNS
Anchorage, Alaska
POSITION STATEMENT: Co-presented the Child Advocacy Centers
overview.
ACTION NARRATIVE
3:18:41 PM
CHAIR GENEVIEVE MINA called the House Health and Social Services
Standing Committee meeting to order at 3:07 p.m.
Representatives Gray, Fields, Mears, Prax, Schwanke, and Mears
were present at the call to order. Representative Ruffridge
arrived as the meeting was in progress.
HB 73-COMPLEX CARE RESIDENTIAL HOMES
3:19:19 PM
CHAIR MINA announced that the first order of business would be
HOUSE BILL NO. 73, "An Act relating to complex care residential
homes; and providing for an effective date."
3:19:48 PM
ROBERT LAWRENCE, MD, Chief Medical Officer, Office of the
Commissioner, Department of Health, co-presented HB 73 on behalf
of the bill sponsor, House Rules by request of the governor. He
reviewed that the bill would establish a new residential license
type for complex care residential homes. The homes would
provide long-term residential care in a home-like setting for
those with complex behavioral and/or co-occurring medical and
disability-related needs.
3:20:40 PM
CHAIR MINA opened public testimony on HB 73. After ascertaining
there was no one who wished to testify, she closed public
testimony.
3:21:16 PM
REPRESENTATIVE PRAX asked for confirmation that the proposed
legislation would apply to facilities - not to the people
working within them.
3:21:43 PM
EMILY RICCI, Deputy Commissioner, Office of the Commissioner,
Department of Health, provided information and answered
questions on behalf of the sponsor of HB 73, House Rules by
request of the governor. She responded to a series of questions
from Representative Prax related to the function and timing of
the proposed complex care facilities. She spoke about the need
for legislation to be passed prior to creating regulation and
the expressed need for the facilities prompting efficiency of
putting those regulations in place get the facilities running.
3:25:18 PM
MS. RICCI, in response to Chair Mina. She said she does not
think there are specific care facilities that would convert to
complex care facilities under HB 73 even if they may be doing
their best currently to provide needed complex care. She
speculated that some of them may modify a portion of a building
or home to meet these needs. She further speculated that new
facilities may be built as a result of the proposed legislation.
3:26:52 PM
The committee took a brief at-ease at 3:27 p.m. [to address
technical issues].
3:27:46 PM
MS. RICCI, in response to Chair Mina, explained that the 15-
person limit per Alaska complex care residential home (CCRH)
[proposed in Section 4 of HB 73 reflects federal law that
establishes an institute for mental disease (IMD) exclusion
limiting use of Medicaid dollars. She clarified, "So, that
institute for mental disease prohibition against using Medicaid
funds to provide long-term care residential services does not
apply to facilities that are 16 beds or less."
3:30:26 PM
DR. LAWRENCE, in response to Chair Mina, said the vision is to
have multi-disciplinary services on site.
3:31:27 PM
MS. RICCI, in response to a question from Representative
Schwanke as to what would be gained with the proposed new
license type when facilities are already treating patients with
multiple conditions, proffered that the current mode of
operation may not be the most effective. For example, she said,
"We have this gap with individuals who need consistent support
in a way that is not available through an assisted living home
that is not funded or staffed at the levels of need that these
individuals require, or they are receiving care or treatment in
in-patient settings that are overly restrictive and are beyond
what they may need." She said HB 73 would create a facility
type that could be crafted for patients with specific needs.
She offered further examples.
3:35:03 PM
REPRESENTATIVE FIELDS recalled two individuals in that past that
were murdered by people who likely should have been in a CCRH.
He emphasized the urgency in getting this legislation passed in
response to the public safety aspect of the issue.
3:35:53 PM
REPRESENTATIVE MEARS moved to report HB 73 out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, HB 73 was reported out of the House
Health and Social Services Standing Committee.
3:36:14 PM
The committee took an at-ease from 3:36 p.m. to 3:39 p.m.
HB 70-EMERGENCY MED SVCS; OPERATIONAL CANINES
3:39:14 PM
CHAIR MINA announced the next order of business would be HOUSE
BILL NO. 70, "An Act relating to emergency medical services for
operational canines; relating to the powers, duties, and
liability of emergency medical technicians and mobile intensive
care paramedics; relating to the practice of veterinary
medicine; and providing for an effective date."
3:39:43 PM
REPRESENTATIVE CALVIN SCHRAGE, Alaska State Legislature, as
prime sponsor, gave the sponsor statement [included in the
committee file], which read as follows [original punctuation
provided, with some formatting changes]:
House Bill 70 empowers Emergency Medical Services
(EMS) personnel to deliver on-scene point-of injury
(POI) emergency care and transport for operational
canines (OpK9s).
Operational canines are essential members of law
enforcement, other government operations, and search-
and-rescue teams. These courageous animals amplify the
success of countless military, law enforcement,
search-and-rescue, and humanitarian missions. Their
roles even extend to police or fire chaplaincy during
crises.
This bill is named "Rico's Law" in honor of Alaska
State Trooper K9 Rico, whose end of watch occurred on
March 26, 2017. Rico was fatally shot while heroically
attempting to apprehend a suspect after a lengthy
pursuit on the Parks Highway in Wasilla, Alaska.
K9 Rico, like all operational canines, demonstrated
unwavering dedication, protecting, and defending his
community. These animals are more than just assets or
propertythey are teammates, partners, and family
members who deserve emergency care and transportation
rights. Operational canines, especially those deployed
in tactical or high-threat situations, face
significant risks of injury or preventable death.
Currently, Alaska lacks statutory authority allowing
EMS personnel to apply life-saving care to these
animals. Under current law, providing such care could
be deemed "practicing veterinary medicine without a
license," a violation under AS 08.98.120, carrying
severe penalties. The super-rural nature of Alaska
adds another dimension of acuity for our operational
canines outside of Alaska's major urban
centers.
Alaska's EMS professionals already possess the
equipment, supplies, and medications needed to adapt
existing prehospital standards of care for human
patients to operational canines. Training programs
like the K9 Tactical Emergency Casualty Care (K9 TECC)
course provide additional training for clinicians to
confidently manage operational canine emergencies. The
passage of this bill would eliminate legal barriers,
allowing EMS personnel to administer life-saving care
and transport injured operational canines to emergency
veterinary facilities.
With minimal investment by our participating EMS
services, Alaska EMS can ensure that our operational
canines have a fighting chance at survival when
injured in the line of duty.
3:42:32 PM
JEREMY HOUSTON, Staff, Representative Calvin Schrage, Alaska
State Legislature, on behalf of Representative Schrage, prime
sponsor, gave the sectional analysis for HB 70 [included in the
committee file], which read as follows [original punctuation
provided, with some formatting changes]:
Section 1: Amends AS 08.98.125 exempts emergency
medical technician or mobile intensive care paramedic
from penalty for practicing veterinary medicine
without a license when providing emergency medical
services to an operational canine as provided under AS
18.08.093.
Section 2: Amends AS 18.08.075(a) to authorize
emergency medical technicians and mobile intensive
care paramedic to enter a building or premises where a
report of an injury or illness has taken place or
where there is reasonable cause to believe an
operational canine has been injured or is ill to
render emergency medical care and direct the removal
of a motor vehicle or other thing determined necessary
to prevent further harm to operational canines.
Section 3: Amends AS 18.08.086(a) to provide for civil
liability protection to providers, or a director of a
provider licensed under AS 18.08.082 who administers
emergency medical services to an operational canine
within the scope of the person's certification or
licensure and if the operational canine reasonably
seems to be in immediate danger of serious harm or
death.
Section 4: Amends AS 18.08.087 to remove language
limiting physicians, advanced practice registered
nurses, or physician assistants' permission to
disclose medical information of a patient to emergency
medical technicians and mobile intensive care
paramedics when the information is not for the purpose
of evaluating the performance of an emergency medical
technician, mobile intensive care paramedic or
physician.
Section 5: Adds two new subsections to AS 18.08.087.
The first allows licensed veterinarians to disclose
medical or hospital records of an operational canine
to an emergency medical technician or mobile intensive
care paramedic for the purpose of evaluating the
performance of an emergency medical technician or
mobile intensive care paramedic. The second adds
language restricting physicians, advanced practice
registered nurses, or physician assistants' permission
to disclose medical information of a patient to
emergency medical technicians and mobile intensive
care paramedics when the information is not for the
purpose of evaluating the performance of an emergency
medical technician, mobile intensive care paramedic or
physician.
Section 6: Adds one new section to AS 18.08 with two
subsections. Subsection (a) allows for an emergency
medical technician to provide emergency medical
services to an operational canine if 2 Tuesday,
February 4th, 2025 a veterinarian is unavailable to
provide emergency medical services in a reasonable
amount of time, the emergency medical technician or
mobile intensive care paramedic has received training
on providing emergency medical services to operational
canines, is trained to provide comparable medical
services to humans, is authorized to provide the
comparable medical service to a human under the scope
of their license or certification, and has informed
consent from the owner or someone authorized to make
medical decisions about the operational canine or is
providing medical service in accordance with a written
protocol developed by a veterinarian. Subsection (b)
requires the emergency medical technician or mobile
intensive care paramedic to transfer the operational
canine to a licensed veterinarian at the earliest
practicable opportunity and comply with all laws
governing the administration of drugs or biologics to
a human when administering a drug or biologic to an
operational canine.
Section 7: Amends AS 18.08.100(b) to clarify that if
individuals licensed under this chapter determine,
during a telehealth encounter, that the encounter will
extend past their scope of practice they shall advise
the person who is authorized to make medical decisions
for the operational canine that they are not
authorized to provide the services needed, provide
recommendation for an appropriate provider, and limit
the encounter to the services they are authorized to
provide.
Section 8: Amends AS 18.08.200 to define
"veterinarian" in this chapter the same as it is under
AS 08.98 and "operational canine" as a dog used by law
enforcement or other government operations; or in
search and rescue operations.
Section 9: Sets an effective date of January 1st,
2026.
3:47:41 PM
KERRY KIRKPATRICK, Southeast Alaska Dogs Organized for Ground
Search (SEADOGS), as invited testifier, introduced the committee
to Bizzy, an 11-year-old search dog [seated next to her at the
witness table] certified in multiple disciplines for search,
including avalanche, wilderness, cadaver, and water. She stated
that she has been doing this work for 30 years, often in remote
areas out of reach of communication where there is no access to
veterinarians. Sometimes, when working with Coast Guard or
National Guard, the search team has access to emergency medical
technicians (EMTs) or paramedics. She emphasized the importance
of having people working with the team that have the knowledge
to be able to, at the very least, stabilize an injured search
animal and get them to a veterinarian. She said she thinks that
whether a professional or a volunteer, anyone would do their
utmost to keep a dog alive, and she hopes that anyone who made
that effort would not then be held liable for attempting to
help.
3:50:06 PM
MR. HOUSTON, in response to Representative Gray, explained that
language from Section 4 was moved to Section 5 at the
recommendation of Legislative Legal Services.
3:52:10 PM
SEAN MCPECK, DVM, Tier 1 Veterinary Medical Center, in response
to a question from Representative Gray regarding when Section 7
"would come into play," surmised there could be a scenario in
which a doctor is speaking to someone telephonically and "going
off of the interpretation" of the person who is present [with
the injured animal]. Without diagnostics, x-ray, and hands-on
examination, the doctor on the phone is guessing at the best
course of treatment with limited information.
REPRESENTATIVE GRAY said he interpreted Section 7 as pertaining
to a situation in which a person who is not a veterinarian is
trying to provide medical advice to someone who is rendering
care to a canine. Under this scenario, the person would have to
disclose that they were not a veterinarian.
3:54:45 PM
REPRESENTATIVE SCHRAGE offered to get back to Representative
Gray and the committee with a specific example of when Section 7
would apply. In response to Representative Gray, he said he is
not aware of any case in which care was not rendered "as a
result of this concern." That said, he noted that there is
concern within the medical community about continuing to provide
care moving forward.
3:56:03 PM
REPRESENTATIVE SCHRAGE, in response to Representative Prax,
talked about the choice to call this "Rico's Law" and recognized
Brian Webb, a former legislative staff and emergency medical
services provider with experience with this issue, who brought
the issue to Representative Schrage.
REPRESENTATIVE PRAX expressed concern that the proposed bill
would open up "a can of worms."
REPRESENTATIVE SCHRAGE suggested the flip side is to question
whether not addressing the issue would result in failed care of
a canine in the future. The concern for this issue has already
been expressed, thus the can of worms has already been opened.
In response to whether he would consider expanding liability by
further clarifying the bill, Representative Schrage said he
worries about broadening the scope of the bill beyond "those who
are reasonably assumed to have the necessary medical skills to
provide care to an operation canine." He suggested his is a
policy question for the committee.
4:01:54 PM
REPRESENTATIVE RUFFRIDGE observed there seems to be a need for
definitions, including: what is a reasonable amount of time;
who trains; and what does that training look like.
REPRESENTATIVE SCHRAGE proposed to hold a dialogue between this
this bill hearing and the next to address those concerns.
4:03:15 PM
REPRESENTATIVE SCHWANKE noted that she has training in animal
welfare and immobilization training, and she talked about
varying schedules and reporting requirements. She noted her
question mirrored that of Representative Ruffridge and is
related to training.
4:04:33 PM
REPRESENTATIVE SCHRAGE referred again to Brian Webb as a source
for answering questions.
MR. HOUSTON noted that there is national training course
standard, called Canine TECC.
4:06:03 PM
CHAIR MINA announced that HB 70 was held over.
4:06:13 PM
The committee took an at-ease from 4:06 p.m. to 4:07 p.m.
[During the at-ease, Chair Mina passed the gavel to
Representative Mears.]
HB 27-MEDICAL MAJOR EMERGENCIES
4:07:32 PM
REPRESENTATIVE MEARS announced that the next order of business
would be HOUSE BILL NO. 27, "An Act relating to medical care for
major emergencies."
4:07:43 PM
CHAIR MINA, as prime sponsor of HB 27, gave the sponsor
statement [included in the committee file], which read as
follows [original punctuation provided]:
A coordinated statewide system of care enhances the
chance of survival in life-threatening, time-critical
emergencies in adults and children. Trauma and
specific medical emergencies addressed within this
system ensure that Alaskans receive care from the
"right person, at the right place, at the right time."
Trauma, strokes, and heart attacks represent the
leading causes of death in Alaska. In 2022 alone, 744
Alaskans died from trauma, 217 died from strokes, and
510 died from died from cardiovascular disease such as
a heart attack. By enabling a statewide systems of
care approach for major emergencies, death rates
caused by these time-sensitive emergencies can
improve. Importantly, these are conditions for which
interventions exist that can markedly alter their
otherwise dismal prognoses.
HB 27 seeks to expand the scope of the Section of
Rural and Community Health Systems within the
Department
of Health to include strokes and severe heart attacks
in:
• Developing training programs for ambulance and first
responder services on a standardized protocol.
• Communicating the urgency of the patient's condition
to the local receiving hospital or clinic.
• Assist in establishing statewide guidelines, helping
physicians and advanced practice practitioners
determine if local treatment is appropriate or to
expedite transport to the suitable treatment facility.
This legislation also focuses on expanding AS
18.08.010 and AS 18.08.200, allowing the Department of
Health (DOH) to replicate those systems and processes
that have improved trauma care and apply those
principles to stroke and severe heart attacks.
With the success of the Trauma Center program, HB 27
will ensure that the receiving specialty hospitals
meet DOH-adopted national criteria for being a
voluntary stroke or heart attack center. It also
establishes a registry specific to these major
emergencies, a means to measure outcomes, and guide
changes that will inevitably be needed.
The overall goal of HB 27 is that a trauma, cardiac,
or stroke patient returns home as a functional member
of the community and embraces life changes that will
improve their future health.
4:12:35 PM
KATY GIORGIO, Staff, Representative Genevieve Mina, Alaska State
Legislature, on behalf of Representative Mina, prime sponsor of
HB 27, gave the sectional analysis [included in the committee
file], which read as follows [original punctuation provided]:
Section 1. Amends AS 18.08.010
Section 1, subsections 1-3 adds "major emergencies" to
the existing emergency medical services (EMS) system.
Currently, only trauma care appears in statute, and
the addition of "major emergencies" will allow the
Department of Health (DOH) to include time-sensitive
emergencies such as heart attacks and strokes to their
EMS review system.
Section 1, subsection 4, addresses the trauma center
designation status for hospitals and clinics and gives
the statutory authority for DOH to adopt criteria for
those health centers to represent themselves as being
capable of treating major emergencies.
Section 2. Amends AS 18.08.200 by adding a new
paragraph:
This is the definition section for the chapter, and
"major emergency" is added and defined as heart attack
and stroke.
4:13:37 PM
REPRESENTATIVE MEARS invited committee questions.
4:13:52 PM
REPRESENTATIVE RUFFRIDGE said he understood why heart attack and
stroke were chosen as major medical emergencies, as they are
clear options. He then cited the current statutory definition
of medical care as "services utilized in responding to a
perceived need for medical care to prevent loss of life". He
questioned the need to define major emergency as being just two
types of medical situations.
CHAIR MINA replied, "My understanding is that what we have in
statute for the duties and responsibilities of the Office of EMS
is only situated to what is in statute. And so, to be able to
clearly define the different instances of major medical
emergencies, like strokes and heart attacks, I think we do have
to put that in statute clearly." That said, she deferred to
Gene Wiseman.
4:15:39 PM
GENE WISEMAN, Chief, Section of Rural and Community Health
Systems, Division of Public Health, Department of Health (DOH),
noted that AS [18.08.010] specifies "trauma" [in relation to
emergency medical services]. He stated, "At the time of the
writing of that statute, trauma had known outcome for
coordinated care." He spoke about the finite timeframes related
to heart attack and stroke "that require a higher level of
system coordination to occur." He offered further details.
REPRESENTATIVE RUFFRIDGE summarized that Mr. Wiseman had said
that because trauma care is specifically defined, then major
emergencies also must be specifically defined, which led him to
ask whether the statute could be broadened by replacing "trauma
care" and "major emergencies" with "plan and deliver emergency
medical services".
MR. WISEMAN responded that EMS responds to all emergencies. He
indicated that the statute facilitates the building of a system
of care that encompasses trauma, stroke, and heart attack. This
requires collaboration, subject experts, and monitoring. He
offered examples. He concluded, "Without it being in there, ...
potentially, it doesn't allow us ... that focus on the
collaboration."
4:22:08 PM
REPRESENTATIVE GRAY proffered that HB 27 is more of a "clean-up
bill," because it is proposing to put into statute "that which
we are already do." He remarked that he knows no one in the
field of medicine who will say, "Well, now that it's in statute,
we'll start taking strokes and heart attacks seriously." That,
he emphasized, has already been happening for decades.
4:23:26 PM
REPRESENTATIVE MEARS announced that HB 27 was held over.
4:23:36 PM
The committee took an at-ease from 4:23 p.m. to 4:24 p.m.
[During the at-ease, Representative Mears handed the gavel back
to Chair Mina.]
HB 14-REPEAL CATASTROPHIC ILLNESS/MED ASSIST
4:24:47 PM
CHAIR MINA announced the next order of business would be HOUSE
BILL NO. 14, "An Act repealing programs for catastrophic illness
assistance and medical assistance for chronic and acute medical
conditions."
4:25:06 PM
REPRESENTATIVE WILL STAPP, Alaska State Legislature, as prime
sponsor of HB 14, gave key points from the sponsor statement
[included in the committee file], which read as follows
[original punctuation provided]:
Although housed in Division of Healthcare Services,
the Division of Public Assistance (DPA) is responsible
for administering the Catastrophic Illness and Chronic
or Acute Medical Conditions program. In FY21, FY22,
and FY23, the DPA has collectively processed thousands
of applications and only two qualifying applicants
that did receive assistance within the year of 2021.
The program began in 1986. Recipients were mainly
those too young for Medicare and with incomes too high
to qualify for Medicaid. Those who were either not
covered by health insurance or whose insurance was
inadequate to brace a catastrophic illness event
without endangering their financial resources,
subsistence and essential assets. Due to the expansion
of Medicaid under the Affordable Care Act put into
effect within Alaska in late 2015, the increase in
coverage for Medicaid recipients grew nearly 145,000
people. Since that time, the number of qualifying
recipients has dramatically declined to the numbers we
see today. However, as a statutory program, the
division must administer it, which is costing the
state over $150,000 a year and countless hours of
administrative work that could otherwise be spent on
other such programs.
As a statutory program, the division was administering
[Chronic and Acute Medical Assistance] CAMA program
until FY 24 costing the state over $150,000 a year.
Funding for the program was discontinued in the FY25
budget and remains unfunded in the FY26 budget. The
division had also provided countless hours of
administrative work that would alternatively have been
used to process applications for more utilized
programs within their division such as Supplemental
Nutrition Assistance Program (SNAP) to prevent
backlogs in assistance funding. The Catastrophic
Illness and Chronic or Acute Medical Conditions
program has since become obsolete and House Bill 14
aims repeal the program from state statute.
4:26:47 PM
BERNARD OTO, Staff, Representative Will Stapp, Alaska State
Legislature, on behalf of Representative Stapp, gave the
sectional analysis for HB 14 [included in the committee packet],
which read as follows [original punctuation, with some
formatting changed]:
Section 1
AS 36.30.850(b)(11) amended
Deletes reference to Catastrophic Illness Assistance
from service providers
Section 2
AS 47.05.085 amended
Deletes reference to Catastrophic Illness Assistance
from evidence in connection with investigation under
the administration
Section 3
AS 47.05.200(d) amended
Deletes Catastrophic Illness Assistance from obtaining
payment from providers
Section 4
AS 47.05.210(a) amended
Deletes reference to Catastrophic Illness Assistance
from medical assistance fraud
Section 5
AS 47.05.240 amended
Deletes reference to Catastrophic Illness Assistance
commissioner excluding applicant from medical
assistance program
Section 6
AS 47.05.290(9) amended
Deletes Catastrophic Illness Assistance from the
definition of "medical assistance program"
Section 7
AS 47.05.290(10) amended
Deletes Catastrophic Illness Assistance from the
definition of "medical assistance provider"
Section 8
AS 47.05.290(17) amended
Deletes Catastrophic Illness Assistance from the
definition of "medical assistance services"
Section 9
AS 47.05.330(a) amended
Modifies reference to Catastrophic Illness Assistance
as "former"
Section 10(a)
AS 47.08.010 47.08.140 Repeal
Repels all references to Catastrophic Illness
Assistance within statute
Section 10(b)
AS 47.08.150 Repeal
Repeals reference to Medical Assistance for Chronic
or Acute Medical Conditions within statute
Section 11 Uncodified Law/Add new section
Allows the Department of Health to create an initial
case if fraud is found within previous program of
Assistance for Catastrophic Illness and Chronic or
Acute Medical Conditions
Section 12 Uncodified Law/Add new section
Allows the Department of Health to issue subpoenas and
further investigate with necessary records or evidence
4:27:42 PM
CHAIR MINA invited questions from the committee.
4:27:58 PM
REPRESENTATIVE FIELDS asked for confirmation that even if U.S.
Congress is successful in gutting Medicaid, "we would want to
then continue covering people under Medicaid and not CAMA."
4:28:26 PM
REPRESENTATIVE STAPP replied that it is hard for him to imagine
that "even if they did cost-shift 100 percent of the cost of the
Medicaid program back on to the state, that they'd still qualify
for CAMA." He deferred to Deb Ethridge.
4:29:16 PM
DEB ETHERIDGE, Director, Division of Public Assistance,
Department of Health (DOH), stated that the division does not
anticipate "any additional eligibility if there's any effect."
4:29:42 PM
CHAIR MINA asked if the funds would be returned to the
[undesignated general fund] (UGF).
REPRESENTATIVE STAPP answered yes, they would be available to
spend on other things because they would be returned to the
[general fund] (GF).
4:30:03 PM
CHAIR MINA announced that HB 14 was held over.
4:30:10 PM
The committee took an at-ease from 4:30 p.m. to 4:32 p.m.
^OVERVIEW(S): CHILD ADVOCACY CENTERS
OVERVIEW(S): CHILD ADVOCACY CENTERS
4:32:25 PM
CHAIR MINA announced that the final order of business would be
the Child Advocacy Centers overview.
4:33:02 PM
MARI MUKAI, Executive Director, Alaska Children's Alliance
(ACA), Western Regional Children's Advocacy Center (WRCAC), as
co-presenter of the Child Advocacy Centers overview, brought to
the table the subject of child abuse. She began a PowerPoint
[hard copy included in the committee file], titled "Alaska
Children's Alliance & Child Advocacy Centers As an
introduction," on slide 2, stating that there are wide-ranging
consequences of child abuse, not only medical but also mental
illness, substance abuse, and [negative] socio-economic
outcomes. Added to that are the expenses related to those
outcomes. She reported that Alaska's rate of child abuse and
neglect is among the highest in the country.
MS. MUKAI discussed slide 3, "Child Advocacy Centers (CACs):
Frontline Coordinated Response to Child Abuse," which read as
follows [original punctuation provided]:
A CAC is a neutral, safe place where a child and non-
offending caregiver can receive comprehensive services
following a concern of abuse such as: sexual abuse
(including commercial sexual exploitation,
trafficking, and child sexual abuse materials),
physical abuse, witnessing violence (such as domestic
violence and homicide), and extreme neglect.
MS. MUKAI, while displaying slide 4, highlighted some of the
reasons CACs are critical. For children and families, CACs are
"the most trauma-informed way" to ensure they get access to
needed services and justice for crimes committed against them.
For professionals, CACs assist with coordinating services. For
Alaska, CACs provide a good return on investment. On slide 5,
Ms. Mukai showed a map with the locations of 20 CACs throughout
the state.
4:36:33 PM
LEIGH BOLIN, Executive Director, as co-presenter of the Child
Advocacy Centers overview, picked up the PowerPoint on slide 6,
which depicts a pie chart with the percentages of CAC funding,
the primary topic on which the presentation is based. Slide 6
shows that one half of the funding comes from a combination of
private/foundations [4 percent]; fundraising and earned income
[17 percent]; federal grants/"other" [15 percent]; and Victims
of Crime Act of 1984 (VOCA) [14 percent]. She said 50 percent
of funding to CAC comes from Temporary Assistance to Needy
Families (TANF) [31 percent] and a grant from the U.S.
Department of Justice (DoJ) [19 percent], and she emphasized
that both the TANF and DoJ funds will be gone in fiscal year
2026 (FY 26). She underscored how detrimental it would be
without CACs.
4:38:08 PM
MS. BOLIN responded to questions from the committee. To
Representative Gray, she explained the reasons that CACs do not
qualify for TANF. To Representative Ruffridge she said it looks
as though TANF funds are being "cracked down upon" nationwide,
and she mentioned there are four criteria related to TANF. Not
every state was using TANF; there has been funding through DoJ's
Office of Victim's rights.
4:41:15 PM
MS. MUKAI, in response to Representative Fields, remarked on the
topic of congressional support, noting that U.S. Senator Lisa
Murkowski has been an advocate in finding a fix related to the
VOCA grant.
4:42:10 PM
MS. BOLIN responded that "we" had met with Senator Dan Sullivan
last year, and Senator Murkowski is aware of the situation. She
explained that the DoJ funding was Alaska-specific.
4:43:42 PM
MS. BOLIN, in response to Representative Prax, offered details
related to VOCA, described the connection between the Alaska
Children's Trust and ACA, and clarified her affiliation.
4:47:44 PM
BOLIN returned to the presentation, to slide 7-8, which read as
follows [original punctuation provided]:
Imminent Funding Concern
ACA/CACs face a dramatic drop-off of federal funds in
FY26: $3.4M TANF + $2M DOJ = $5.4M
Alaska Children's Alliance sought and secured intent
language in the FY25 budget that directs the State to
"ensure CAC services are not interrupted due to the
loss of federal funds in FY26." Nevertheless, despite
legislative intent and Alaska Statute AS 47.17.033
that requires OCS to refer child abuse cases to CACs,
they were not included in the proposed FY26 budget.
ACA/CAC FY26 Request
Requesting operating funds to DFCS in the FY26 State
budget: $5.4M to the base
MS. BOLIN emphasized that the "ask" is not an increase but
merely to maintain current service levels.
4:49:02 PM
CATHY BALDWIN-JOHNSON, MD, Medical Director, The Children's
Place, as co-presenter, gave the next portion of the Child
Advocacy Centers overview. She brought attention to slides 10-
11, which read as follows [original punctuation provided]:
Child Abuse and Health
• Multiple studies link poor health and social
outcomes for childhood adversity
• Landmark Adverse Childhood Experiences study
• >17,000 middle aged adults, most with college
education, most employed
• 10 categories: Before age 18 experienced sexual
abuse, physical abuse, emotional abuse, physical
neglect, emotional neglect, household member who
abused substances or went to prison or was mentally
ill, witnessed violence against mother, or lost a
parent
• "ACE Score" 0-10
• Higher the score, higher the risk of all of the
most common causes of adult illness and death in the
US
• Additional studies indicate onset of health problems
in childhood/adolescence
• It is never just one bad thing
• Multiple studies demonstrate polyvictimization
during childhood and extending into adulthood
• Resulting in higher and higher ACE accumulation
• And higher and higher costs for healthcare and
social ills
• CACs offer the opportunity to interrupt the cycle
DR. BALDWIN-JOHNSON concluded her portion of the presentation on
slide 12, which read as follows [original punctuation provided]:
The Medical Role in CACs
• It's never just one bad thing: research shows a
significant percentage of children presenting to CACs
for sexual abuse have multiple unmet health needs
• Medical providers at CACs work in partnership with
the rest of the multidisciplinary team:
• Gather pertinent health information from the
forensic interview and medical history
• Children may reveal more to a health
professional during an exam
• Provide medical evaluations as indicated
• Gather forensic evidence as indicated
• Diagnose and treat as indicated
• Differentiate between abuse and medical
problems or accidental injuries
• Provide reassurance for children and their
families
• Testify in court as needed
4:52:37 PM
TODD KEARNS, as co-presenter of the Child Advocacy Centers
overview, specified that he was not speaking on behalf of the
Anchorage Police Department (APD) but as an invited testifier
with experience working in a CAC. He covered slides 14-15,
which read as follows [original punctuation provided]:
MDT Partner Perspective: Law Enforcement
Child Advocacy Centers: national best practice model
provides a safe place for kids to talk
? Non-police facility
? Audio/Video recorded per Alaska Statute AS 47.17.033
? They receive a medical evaluation
? Mental health care available
? Advocacy from start to finish
? Disclosure to trial Build stronger cases with a
"team concept"
? Trauma informed trained investigators
? Advocates for the family
? Trained interviewers
? Medical experts in the child maltreatment field
? DNA evidence collection
? Sexual related injuries
? Expert courtroom testimony
? Allows LE to focus on the criminal investigation
while other team members focus on the other needs of
the victim: Hold offenders accountable
? CACs in Rural Alaska ? The child and family are
local ? The family does not have to travel ? Large
delay in treatment due to logistics ? Local follow up
and mental health treatment ? Cost savings of travel
4:57:12 PM
MS. BOLIN concluded the presentation with a recap of the deficit
going into 2026.
4:57:22 PM
DR. BALDWIN-JOHNSON, in response to Representative Schwanke,
explained why billing third-party payers for medical evaluations
is not a realistic way to support the medical aspect of these
programs. Some CACs are under the auspices of tribal entities
and their ability to survive in rural areas of the state is
limited by what the tribal entities are able to provide. To a
follow-up question regarding support from Native consortiums,
she offered her understanding regarding some support the
Southcentral Foundation through the Alaska Native Health
Consortium.
5:00:21 PM
MS. BOLIN, in response to Representative Mears, offered her
understanding that [CACs] are not included the current state
budget. In response to a follow-up question from Chair Mina,
she offered her understanding that CACs were funded by the State
of Alaska until FY 15 and have been under TANF for the past
decade. She surmised that the move to TANF was an "avenue" for
sustainable funding.
5:02:33 PM
MS. BOLIN, in response to Representative Prax, confirmed that
referrals can come from the Office of Children's Services and
the Department of Public Safety. In response to Representative
Fields, she confirmed that [CACs] gather information that helps
to apprehend more predators.
5:05:40 PM
MS. BOLIN, in response to Chair Mina, described the effects of
loss of funding, including diminished staffing.
5:06:23 PM
DR. BALDWIN-JOHNSON added that adequate funds allow for
providing on-site mental health services; many children seen are
in crisis.
5:08:04 PM
MS. BOLIN, in response to Chair Mina, talked about having a
neutral space, working with law enforcement, bringing families
in from remote areas, doing outreach and education,
collaborating with partners in community work, and providing
core services in response to child maltreatment.
5:09:14 PM
DR. BALDWIN-JOHNSON, in response to Representative Schwanke,
described the process before the advent of CACs and called it a
disservice to children. They were interviewed in interrogation
rooms by police. Regarding the attempt to coordinate mental
health services for these children, she stated that "people
weren't sitting down and talking to each other about these
cases; there was information that was lost; and families got
discouraged with the whole process and would just give up - not
follow through; and cases would just sit; and offenders went
unpunished; and kids ended up without the treatment that they
needed."
5:11:33 PM
SARGEANT KEARNS, in response to Representative Fields, said CACs
help because of the team concept involved where the team is
accustomed to working together; action is taking immediately
24/7; and information is received from the child, who has to
tell their story only once.
5:13:43 PM
CHAIR MINA thanked the presenters.
5:13:51 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:14 p.m.