Legislature(2025 - 2026)DAVIS 106
04/15/2025 08:00 AM House TRIBAL AFFAIRS
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Tribal Health Contracting, Compacting & Consulting | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE SPECIAL COMMITTEE ON TRIBAL AFFAIRS
April 15, 2025
8:01 a.m.
DRAFT
MEMBERS PRESENT
Representative Maxine Dibert, Chair
Representative Ashley Carrick
Representative Robyn Niayuq Burke
Representative Andi Story
Representative Jubilee Underwood
Representative Elexie Moore
MEMBERS ABSENT
Representative Rebecca Schwanke
COMMITTEE CALENDAR
PRESENTATION: TRIBAL HEALTH CONTRACTING~ COMPACTING & CONSULTING
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ALBERTA UNOK, President, CEO
Alaska Native Health Board
Anchorage, Alaska
POSITION STATEMENT: Co-presented the PowerPoint, titled "Alaska
Tribal Health Compacting."
MONIQUE MARTIN, Vice President
Intergovernmental Affairs
Alaska Native Health Consortium
Anchorage, Alaska
POSITION STATEMENT: Co-presented the PowerPoint, titled "Alaska
Tribal Health Compacting."
JACOLINE BERGSTROM, Executive Director
Health Services
Tanana Chiefs Conference
Fairbanks, Alaska
POSITION STATEMENT: Co-presented the PowerPoint, titled "Alaska
Tribal Health Compacting."
ACTION NARRATIVE
8:01:44 AM
CHAIR MAXINE DIBERT called the House Special Committee on Tribal
Affairs meeting to order at 8:01 a.m. Representatives Moore,
Story, Carrick, and Dibert were present at the call to order.
Representatives Underwood and Burke arrived as the meeting was
in progress.
^PRESENTATION: Tribal Health Contracting, Compacting &
Consulting
PRESENTATION: Tribal Health Contracting, Compacting & Consulting
8:03:04 AM
CHAIR DIBERT announced that the only order of business would be
a presentation on tribal health contracting, compacting, and
consulting.
8:03:58 AM
ALBERTA UNOK, President, CEO, Alaska Native Health Board,
introduced herself, sharing that she is a tribal citizen of the
Native Village of Kotlik, located in the Yukon Kuskokwim region.
8:04:12 AM
MONIQUE MARTIN Vice President, Intergovernmental Affairs, Alaska
Native Health Consortium (ANTHC), introduced herself, sharing
that she was born and raised in Wrangell, and she is a tribal
member of the Tlingit and Haida Indian Tribes of Alaska.
8:04:23 AM
JACOLINE BERGSTROM, Executive Director, Health Services, Tanana
Chiefs Conference, introduced herself.
8:04:35 AM
MS. UNOK co-presented the PowerPoint, titled "Alaska Tribal
Health Compacting" [hard copy included in the committee packet].
She thanked the committee for hearing the presentation and began
on slide 2 with an overview. She stated that the presentation
would explain the Alaska Tribal Health System (ATHS). She
stated that the Alaska Native Health Board (ANHB) is the
statewide voice for ATHS, with the mission to promote the
spiritual, physical, mental, social, and cultural wellbeing and
pride of Alaska Native people. She stated that in 1994 the
Indian Health Service (IHS) had approved the Alaska Tribal
Health Compact (ATHC). She noted that this was the first multi-
party compact in the nation, and it serves all 229 tribes in
Alaska.
MS. UNOK moved to slide 4 and provided a timeline of the history
of Alaska Native health care. She pointed out that Native
Alaskans had used traditional healing methods until the U.S.
purchased Alaska, and at that time, military doctors began
providing some services, along with missionary medical
personnel. She stated that in 1931, the Bureau of Indian
Affairs took over the responsibility of health care for Native
Alaskans, and then the U.S. Public Health Services took over.
She stated that this year is the 50th anniversary of the Indian
Self-Determination and Education Assistance Act (ISDEAA), which
began the work that Native Alaskans are doing today.
MS. UNOK moved to slide 5 and spoke about the Alaska Native
Services Hospital, which was built to care for Native people
suffering from tuberculosis, a huge epidemic around 1953. She
directed attention to a picture of the hospital's Alaska Native
Health Campus, which is owned by Alaska Natives. She moved to
slide 6 and emphasized the importance of tribal self-governance
in health care, as it would ensure an effective voice in the
implementation of programs that respond to the real needs of the
people. She stated that ISDEAA backs the idea that if the
people served are involved in the decision-making process,
health statistics would improve. She asserted that this
reflects the true meaning of self-determination.
MS. UNOK explained the difference between contracting and
compacting, as seen on slide 7. She stated that contracting is
the first step for tribes in exercising self-determination in
health care, but this would be limited, while compacting gives
tribes' full autonomy on programs and services. She noted that
tribes can contract, compact, or do both with the IHS. She
noted that the IHS provides less than 50 percent of funding for
services, and the tribes provide the rest.
8:09:57 AM
MS. UNOK directed attention to the 26 co-signers of ATHC, as
seen listed on slide 8. She stated that these represent a
single compact covering multiple tribes and tribal
organizations. She described ANHB's process in the compact, as
it helps set up the negotiations with IHS. This includes
looking at funding agreements and common language to create a
unified approach. On slide 9, she described ATHS as a statewide
coordination of care, forming an integrated statewide network,
which provides health care services at village clinics, regional
hubs, and the Alaska Native Medical Center (ANMC). She pointed
out some of the regional and local providers listed on the
slide, and she noted the partnerships.
MS. UNOK, on slide 10, displayed a map of the regional tribal
organizations. She stated that the tribal management of health
care prioritizes local decision making, as each region has its
own challenges. She moved to the next slide and displayed a map
showing the specific referral pattern of tribal care. She
addressed the "hub and spoke" model, which keeps care "as close
to home as possible." She noted that telehealth is highly used
in ATHS. She pointed out that the map emphasized the size of
Alaska compared to the contiguous U.S. She added that it shows
ATHS covering the entire state. She moved to slide 12 and
emphasized the importance of ATHS, both economically and
culturally. She pointed out that ATHS is a large part of the
state's economy, as it is larger than the retail trade,
construction industry, and manufacturing. She stated that ATHS
is responsible for over 24,000 jobs in the state. In
conclusion, she stated that this is all guided by the voice of
Alaska Native people, who set the direction of programs and
services. She expressed appreciation to the committee.
8:15:49 AM
MS. UNOK, in response to a question from Representative Story,
explained that IHS covers 50 percent of the need; therefore,
ATHS must seek additional revenue to provide the full spectrum
of services. She pointed out that IHS has had some funding cuts
to its budget, with not many increases. She stated this would
be discussed later in the presentation. In response to a
follow-up question, she pointed out that the national need from
IHS is $60 billion, and it is only funded at $6 million. She
stated that she would follow up to the committee with the
numbers statewide.
8:18:19 AM
MS. MARTIN added to Ns. Unok's response, stating that ANMC is
required to seek third party reimbursement. On average at the
ANMC, Medicaid makes up about 40 percent of the revenue at the
center. She stated that IHS provides about 12 percent of the
revenue. She noted the different third-party entities that
could be billed for reimbursement. She stated that the
Southcentral Foundation has been able to help connect people to
services.
MS. MARTIN co-presented the PowerPoint and moved to slide 13.
She explained the uniqueness of ANTHC, which was created in
1998. She noted that ANTHC supplies many of the statewide
services. She pointed out that 99 percent of functions that
normally would have fallen under IHS, have been assumed by
tribal health organizations through compacting, which is unique
in the state.
MS. MARTIN moved to the next slide and stated that ANTHC is
divided into four areas: support services, community health,
environmental health, and ANMC. On slide 15, she overviewed the
consortium's business support services, as it has enabled ANTHC
to support many different programs. On slide 16, she overviewed
ANTHC's Community Health services, and labeled it a "prevention
arm." She noted that it provides preventative care and is
almost entirely grant funded. She stated that ANTHC provides
training programs for health aides through its Community Health
services. She added that these services also include prevention
and research.
8:24:16 AM
MS. MARTIN, in response to a question from Representative Burke
concerning federal funding, stated that because of the funding
freezes, ANTHC's Community Health services is facing issues.
She noted that ANMC has been affected, along with some of the
water and sanitation projects. She explained that there has
been a lack of communication and information from the federal
government, and this has created angst for staffing who work in
grant-funded positions. She stated that as an organization, it
is navigating this uncertainty by taking steps to continue to
provide services and secure employees.
MS. MARTIN moved to slide 17 and continued to overview ANTHC's
Community Health services. She spoke about the first Integrated
Health Aide Forum, stating that this was important because it
brought aides together to speak about their different issues.
She noted the creation of the Alaska Tribal Cancer Advisory
Network and the sixth annual Alaska Indigenous Research Program.
MS. MARTIN, in response to a question from Chair Dibert,
expressed uncertainty concerning the dates of the first
Integrated Health Aide Forum. She stated that she would follow
up with this information.
8:29:20 AM
MS. MARTIN moved to slide 18 and slide 19 and discussed ANTHC's
"construction arm." She stated that, in partnership with rural
communities, ANTHC's Department of Environmental Health and
Engineering builds a variety of sanitation systems. She
discussed ANTHC's utility management support. She highlighted
some of the department's successes in 2024, including the
utilization of local hires, the installation of septic systems,
and water testing.
MS. MARTIN transitioned from slide 20 to slide 23 and discussed
ANMC. She explained that it is Alaska's first level two trauma
center, and it treats non-beneficiary patients, such as non-
Natives. She explained that this is because it is a trauma
center, providing care to burn patients, for example. She
discussed the post-COVID-19 pandemic return of services. She
concluded by pointing out that part of ANMC's mission is to
serve traditional food to patients and in the cafeteria. She
noted that this helps with the healing process.
8:34:34 AM
MS. BERGSTROM co-presented the PowerPoint and moved from slide
25 to slide 28. She pointed out to the committee that the
presentation began at the state level, with the focus narrowing
to the regional perspective. She stated that the Tanana Chiefs
Conference (TCC) provides health and social services for members
in its region. It is a tribal consortium with 42 members, and
it strives to advance tribal self-determination, while enhancing
Native unity. She stated that it is one of the 26 co-signers on
ATHC, serving around 12 percent of the total Alaska Native
population. She directed attention to TCC's vision of having
healthy people across generations and its mission of partnering
with the people it serves, as seen on the slide. She explained
that in 2019 the board adopted the guiding Athabaskan principle
of ch'eghwtsen', which means "true love." She stated that the
corporate values are based on this principle, as seen on the
next slide. This slide showed a picture of Andy Jimmie, who was
the second traditional Chief for TCC. She expressed gratitude
for Mr. Jimmie's dedication.
8:38:50 AM
MS. BERGSTROM transitioned to slide 29 that displayed a map of
TCC's region in Alaska, which covers more than one third of the
state. She continued that 39 regions are covered, and this
represents 37 federally recognized tribes. She noted that it is
divided into six subregions. She stated that because of the
vastness of the region, different partnerships have come about.
She moved to slide 30 and discussed TCC's board structure. She
explained the board structure and funding for TCC, stating that
every tribe has one seat on the board of directors. She stated
that TCC is partially funded through IHS, and it relies on state
and federal grants. She noted that IHS is the "payer of last
resort" after third party collections, such as Medicaid,
Medicare, and private insurance. She expressed the
understanding that around 30 percent of TCC's budget comes from
IHS and 40 percent comes from Medicaid.
MS. BERGSTROM moved to slide 31 and discussed TCC's Board of
Directors. She stated the tribal leadership oversees the
organization, and the executive board and chief chair provide
oversight. She noted that Brian Ridley is the chief/chairman
and noted his guidance, as seen on slide 32. She discussed the
remote communities, as seen on slide 33. She stated that there
are 11 remote communities with limited road access. She noted
that many of the rural patients rely on airplane travel for a
higher level of care. She pointed out that there are 13
communities with limited sanitation facilities and no running
water in the homes. She noted that limited broadband in the
rural communities has implications on rural telehealth
capabilities.
MS. BERGSTROM moved from slide 34 to slide 36 and discussed the
challenges of the TCC region. For social determinants of
health, she listed water and sanitation needs and food security.
She noted the salmon crisis and the climate crisis. She pointed
out the effects of historical trauma, such as the loss of
language, culture, and the experience of boarding schools, as
Elders are now "opening up" about this. She added that the
limited access to education security also effects health. She
pointed out the lifestyle indicators of health, such as tobacco
and substance use, obesity and diabetes rates, and cancer rates.
She noted the high rates of colon cancer among Alaska Natives.
MS. BERGSTROM moved to slide 37 and slide 38 and reiterated that
TCC is tribally driven. Looking at strategic planning
initiatives, she stated that there is significant input from
tribes, patients, staff, and data. She pointed out that the
elder population has been growing, and it will not plateau until
2045. She noted the use of data concerning the population, as
the birthrate for Alaska Natives is higher than the rest of the
state; however, life expectancy for Alaska Native people is 10
years less than the average Alaskan. She expressed this is
because of the COVID-19 pandemic and the death from drug
overdoses. She addressed the concerns of tribal communities,
noting drug usage, violence, food security, and others.
8:50:04 AM
MS. BERGSTROM transitioned to slide 39 and explained the
strategic initiative to increase health care within Alaska
Native communities. She pointed out that this includes
finishing the Chief Andrew Isaac Health Center, improving
wellness, prevention, and behavioral health, addressing water
and sanitation needs, and achieving the re-accreditation of all
services.
MS. BERGSTROM moved from slide 40 through slide 42, and she
pointed out that there are still health care impacts from the
COVID-19 pandemic. She noted that TCC learned to be adaptable
on delivering services during the pandemic, such as with
telehealth; however, the challenges from the pandemic continue
to affect the workforce, supply chain, and inflation. She
pointed out that many people in remote Alaska have been leaving
the workforce, and the cost to hire a new workforce has risen.
She discussed medical inflation in detail. Concerning the
workforce challenges, she stated that TCC is looking to "grow
our own," and she noted the health aide-training center.
MS. BERGSTROM moved to slide 43 and slide 44 and discussed the
Chief Andrew Isaac Health Center expansion project. She stated
that existing services are being expanded, along with the
addition of other services, such as an ambulatory surgery
center, cancer care infusion center, audiology services, and
ophthalmology services. She moved to slide 45 and discussed the
challenge and opportunities concerning behavioral health. She
noted that there has been an increased need for these services;
however, there has been a reduction in funding. She added that
other challenges include provider enrollment delays and
authorization requirements. She stated that recent legislation
could reduce the administrative burdens.
MS. BERGSTROM moved to slide 46 and provided positive examples
of improvement in Alaska Native health care. She pointed out
that the collaborative element with state and federal partners
is strong. She noted that there is a 100 percent match for
those who receive Medicaid services. She maintained that IHS
health care is not free, as it is a federal obligation to repay
for the past. Contrary to some beliefs, she asserted that
tribal health services are of the same quality or better,
compared to other entities. She maintained that tribal health
organizations provide quality health care, with strong quality
assurance policies and procedures in place. She discussed the
opportunity to expedite the patient and the provider enrollment
process and streamline the travel reimbursement process.
MS. BERGSTROM moved from slide 47 to slide 50. She pointed out
that in 2022 the TCC Cancer Care Committee received an award for
its work on colon cancer detection. It also received the
Patient Experience Award for timely response by staff and a
national award for a quality improvement study that focused on
accelerated Hepatitis C screening of patients. She stated that
the TCC pharmacy was recognized for its rapid response with
vaccines during the COVID-19 pandemic. She added that TCC's
clinical pharmacist specialist are providers with full
prescriptive authority. She noted that the Alaska Pharmacist
Association presented two awards to TCC pharmacists in 2023. In
conclusion, she noted the long-term staff who sit on state and
national committees.
9:04:05 AM
MS. BERGSTROM, in response to a question from Representative
Story concerning funding, stated that TCC gets its base funding
from compacting with IHS, which covers roughly 30 percent of the
need. She stated that the rest of the funding comes from
federal grants. She mentioned that there is a small amount of
funding from the state, but overtime grant funding has dwindled.
She added that for those with alternate insurance, that
insurance would be billed. In response to a follow-up question,
she stated that compacting consists of different groups coming
together. For the IHS compact, she stated that all the co-
signers are in one compact, but each would have its individual
funding agreement, and TCC would receive 12 percent of the total
share. She stated that TCC has existed for 30 years, so the
organization is strong, but it has not happened overnight. She
stated that TCC is a consensus-based organization, as 26 out of
the 29 co-signers must agree, and this is how it is able to
function.
MS. BERGSTROM, in response to a question from Representative
Carrick concerning access to more colonoscopy screenings, stated
that TCC would remind patients when they are on the 5-year
interval for screenings. She stated that if a family has a
positive history for polyps, the screening begins at age 40.
She expressed concern over the possible lack of federal funding
to continue this program.
REPRESENTATIVE CARRICK commented that not having federal funding
for preventative health care would cost the state, as the state
already has some of the highest colon cancer rates in the world.
9:13:01 AM
MS. UNOK, in wrap up, stated that even though a large amount of
information was presented, there is much more in the tribal
health story. She noted that many third-party sources do not
reimburse for preventative services, and the lack of funding for
preventative services is a major issue.
MS. BERGSTROM thanked the committee. She stated that with
further questions, the dialogue could be continued at another
time.
MS. MARTIN discussed the importance of prevention, emphasizing
that the barrier of travel plays into the issue. She suggested
that there should not be a centralized campus in Anchorage, but
a distributed healthcare network, so health care is "closer to
home."
CHAIR DIBERT commented on the quality of services provided at
ANMC, especially the pulmonology department. She commented on
ANMC's expansion project.
MS. MARTIN invited the committee members to visit ANMC and tour
the expansion project. She stated that ATHS serves 70,000 more
people than before compacting, and ANMC reflects this.
CHAIR DIBERT expressed appreciation for the traditional foods
served at ANMC. She thanked the presenters.
9:20:07 AM
ADJOURNMENT
There being no further business before the committee, the House
Special Committee on Tribal Affairs meeting was adjourned at
9:20 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Tribal Health Compacting - Tribal Affairs Committee April 2025.pdf |
HTRB 4/15/2025 8:00:00 AM |