Legislature(2023 - 2024)SENATE FINANCE 532
03/02/2023 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Snap and Medicaid Eligibility Redetermination | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
March 2, 2023
9:01 a.m.
9:01:29 AM
CALL TO ORDER
Co-Chair Stedman called the Senate Finance Committee
meeting to order at 9:01 a.m.
MEMBERS PRESENT
Senator Bert Stedman, Co-Chair
Senator Jesse Kiehl
Senator Kelly Merrick
Senator David Wilson
MEMBERS ABSENT
Senator Lyman Hoffman, Co-Chair
Senator Donny Olson, Co-Chair
Senator Click Bishop
ALSO PRESENT
Heidi Hedberg, Commissioner-Designee, Department of Health;
Emily Ricci, Deputy Commissioner, Department of Health;
Josie Stern, Assistant Commissioner, Department of Health.
PRESENT VIA TELECONFERENCE
Deb Etheridge, Director, Division of Public Assistance
Department of Health, Juneau; Nick Faulkner, Project
Manager, Division of Public Assistance, Department of
Health.
SUMMARY
PRESENTATION: SNAP and MEDICAID ELIGIBILITY REDETERMINATION
Co-Chair Stedman discussed the agenda. He explained that
the committee would consider the backlog for the
Supplemental Nutrition Assistance Program (SNAP) as well as
Medicaid redeterminations. He asked the testifiers to
provide background as to how the state ended up in its
current position and why the matter was not highlighted
earlier.
^PRESENTATION: SNAP and MEDICAID ELIGIBILITY
REDETERMINATION
9:03:11 AM
HEIDI HEDBERG, COMMISSIONER-DESIGNEE, DEPARTMENT OF HEALTH,
introduced herself and department staff.
Commissioner Hedberg discussed a presentation entitled
"SNAP Backlog and Medicaid Redeterminations," (copy on
file). She looked at slide 2, which outlined the positions
and programs within the Division of Public Assistance
(DPA). She highlighted that the divisions mission was to
promote self-sufficiency and provide for basic living
expenses to Alaskans in need. She cited that the division
had 458 permanent employees and 65 long-term non-permanent
employees which oversaw 18 different public assistance
programs. The two largest programs were Medicaid, for
262,000 Alaskans; and SNAP, which had 92,000 Alaskans.
Co-Chair Stedman asked about the number of qualifying
recipients.
Senator Wilson asked if the number was the total number of
recipients or the total number of enrollees.
EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH,
relayed that the number on the slide was specific to
recipients across all programs. She highlighted there were
about 263,000 Medicaid beneficiaries, 72 percent of which
were recipients that were utilizing services.
9:05:12 AM
JOSIE STERN, ASSISTANT COMMISSIONER, DEPARTMENT OF HEALTH,
spoke to slide 3, which reflected DPAs budget from FY 22
actuals to the FY 24 governors amended budget released on
February 14.
Ms. Stern continued to address slide 3 and highlighted that
the notable increases from FY 22 to FY 24 were in the
Unrestricted General Fund (UGF) section shown in blue. The
amount increased by about $7.2 million. The federal funds
reflected in yellow had increased by $22.2 million. The
increment requests would be addressed in a later slide.
9:06:21 AM
Commissioner Hedberg referenced slide 4, which focused on a
timeline of the SNAP backlog and illustrated a three-year
lookback. She underscored that the global Covid-19 pandemic
and a cyber-attack had significant impacts to the planned
upgrades to the Legacy IT systems. In 2020 there were new
federal relief programs that were disseminated to states -
the emergency allotments and the Pandemic Electronic
Benefits Transfer (EBT) to support kids lunches. The
department's IT systems were so old they were not able to
absorb the new relief programs from federal partners and
required manual monthly processing by eligibility
technicians for over two years. She emphasized that the
public health emergency had dominated much of the human
resources (HR) and procurement time in the department
through emergency contracts, procuring supplies, getting
vaccines. She explained that the work had negatively
impacted the other divisions within the Department of
Health (DOH).
Commissioner Hedberg continued that there had been a five-
milestone road map to addressing DOHs IT Legacy systems,
and some of the work had not been accomplished due to HR
and procurement staff being solely focused on the public
health emergency. Further, DPA had not been able to do some
of its contracts. She cited that there was a cyber-attack
in May of 2021, and at the time DOH did not fully grasp the
impact to IT systems. The IT systems were taken online, and
many staff reverted to manual processes. Many IT staff were
re-directed to focus on the forensics analysis as there was
priority on protection of Alaskans personal health
information. She emphasized that the divisions experience
with lack of integrated IT systems, lack of efficient
workflow processes, and being overtaxed was not new and
impacted the timeliness of application processing.
Commissioner Hedberg continued and expressed that she felt
she was in a better position because of the department's
reorganization. She posited that with the departments more
narrow focus and span of control, she had been able to
spend most of her time focusing on DPA since she started in
November. She mentioned that there was new leadership
within DPA. She identified the goal of having a functioning
and integrated IT system, and more efficient workflow
processes to benefit staff and provide more timely
benefits.
9:10:23 AM
Commissioner Hedberg continued to address slide 4 and
discussed steps taken in the previous three months. She
characterized the current situation as crisis management
and considered that the department was in triage. She
relayed that several strategies had been started and were
outlined on the slide. She cited that DOH had applied for a
federal waiver to waive the interviews and provide time
savings for staff. At the end of November there was a
dedicated team that focused on processing the
recertifications. Additionally, IT staff had been able to
focus on reprogramming the IT Legacy system known as the
Eligibility Information System (EIS) and roll the SNAP
benefits for February, March, and April. The action had
allowed for a stop-gap.
Commissioner Hedberg explained that the recertification for
November, December, and January constituted the current
backlog, and represented about 5,000 recertifications. She
reiterated that the dedicated team was processing the
applications, which was estimated to take two months. She
emphasized that DPS was doing everything it could to get
through the applications, which took approximately one hour
to process individually.
Commissioner Hedberg mentioned a third strategy and noted
that Alaska had a six-month certification period. She
mentioned that one of the federal recommendations was to
move to a twelve-month certification period. There were
contractors in place working on reprogramming the IT
systems to implement the change. She summarized that all of
the multiple strategies were in progress.
9:13:43 AM
Senator Kiehl appreciated slide 4 and thought there might
be some points that might not have been included in the
summary. He mentioned the 2018 Ombudsman report, and
thought there was nothing surprising being presented. He
asked if the one hour taken to process the SNAP
applications were completed by an Eligibility Technician I,
II, or III. He asked how many of the positions DPA had.
Commissioner Hedberg listed that DPS had a little over 130
Eligibility Technician 2 and Eligibility Technician 3
positions, which could process the applications. She
continued that the Eligibility Technician I positions were
receiving the paper applications and scanning them to a
document management system.
Senator Kiehl asked if the number of current positions was
the target or if the goal was to work towards a higher or
lower number.
Commissioner Hedberg thought Senator Kiehl was asking if
DPA had a sufficient workforce.
Senator Kiehl said he would not mind an answer to both
questions.
Commissioner Hedberg noted that the next slide would
address workforce issues and relayed that the department
was actively recruiting eligibility technicians. She
recounted that in 2018, she had worked with the Ombudsman
to review the report over several meetings. She had reached
out to many direct providers and had spoken with
individuals affected by the backlog. She had been to a DPA
office and seen the work of an Eligibility Technician. She
extended the invitation for members to be able to sit with
an Eligibility Technician and receive a tour.
Commissioner Hedberg continued that that the issues raised
in the Ombudsman report in 2018 had not been fully
addressed. She noted that in 2018 there had been a backlog
of paper applications, after which an online document
management system was implemented as a solution. The
technicians endeavored to scan the applications into the
system, which would then connect to another system called
Workflow Management. She qualified that the systems were
not all integrated, which contributed to the problem. To
reduce error rates and increase timely applications, the IT
systems needed to be integrated.
Commissioner Hedberg noted that in 2018 there had been many
complaints with regard to the fact the DPA did not have a
physical office, and cited frustration regarding a lack of
communication. She mentioned the implementation of the
Virtual Contact Center (VCC) and discussed equity issues.
She thought that VCC was a great idea but noted that it was
not fully staffed. She noted that the VCC was successful in
the early months until the backlog happened, and mentioned
a short-term contract for answering phones and to help with
process applications. She commented that she could not
change the past, but could own what would happen in the
future.
9:19:00 AM
Commissioner Hedberg turned to slide 5, which listed
immediate efforts to address the public assistance backlog.
She noted that there were four strategies already in place,
two strategies that would be implemented in the following
90 days, and a third strategy implemented in the next year
or so. She highlighted the importance of recruitment and
retention of employees, and cited that since November 2022,
the department had filled 71 vacant positions. As of
February there were 31 new employees in various stages of
training. There were a remaining 55 vacancies, with
positions posted on Workplace Alaska. She thought there
were large volumes of applicants due to media attention on
DPS. She noted that the division was staggering review,
hiring, and onboarding of new employees.
Commissioner Hedberg continued that in the governor's
amended operating budget, DOH had requested 30 additional
long-term non-permanent positions specifically for
supporting the redetermination process. She qualified that
when talking to Alaskans, an eligibility technician would
address all applications at once, and the new positions
would have positive impacts on all the programs.
Commissioner Hedberg addressed workplace safety and relayed
that due to public frustration there had been threats to
DPA staff. The department had hired security guards under
contract for DOHs four largest offices, that were able to
deescalate clients and engage in medical emergencies.
Additionally, there was a small contract to do a security
assessment for DOHs 11 offices to ensure safety for
clients and employees. She mentioned a contract for crisis
communication contractual support, which would help with
messaging regarding the backlog.
Commissioner Hedberg noted that Monday it had been
announced that there was $1.68 million granted to food
banks. She explained that in the 2021 capital
appropriation, there was $6 million given to the Department
of Fish and Game, which had utilized a reimbursable
services agreement (RSA) for $1.68 million to Homeland
Security and Emergency Management to purchase shelf-stable
food. She continued that Homeland Security and Emergency
Management had not purchased the food because of a lack of
storage. Because of the imminent food insecurities faced by
Alaskans, there had been conversation about using an RSA
for the funds to go to DOH. She explained that DOH had two
existing grants that were able to be amended to get the
food out to food banks.
Commissioner Hedberg explained that food banks had a "hub
and spoke" system, whereby the grant would go to Food Bank
of Alaska, and then on to partner with local food banks.
She described the intense logistics of the process. The
food banks were currently working on a bulk food purchase
plan in order to assist Alaskans affected by the backlog,
as well as the purchase of food cards for purchase of goods
at local grocery stores. She cited a strong connection
between the SNAP program and local economies.
9:24:49 AM
Senator Kiehl asked about applicants on Workplace Alaska.
He asked Commissioner Hedberg to discuss the constraints on
the hiring effort.
Commissioner Hedberg relayed that there was continuous
recruitment and large volumes of applications for three
current job postings: a fraud investigator, an Eligibility
Technician 1, and an Eligibility Technician 2. She
discussed training and ongoing efforts to expand capacity
for increasing the training program.
Senator Wilson asked if the change in department
organization had been translated to the hiring process.
Ms. Stern explained that the department had been delegated
authority for recruitment the previous week. After human
resources consolidation to the Department of Administration
(DOA), DOH had received one recruitment position back and
was taking over recruitment efforts with assistance for
recruitments under Range 16.
Senator Wilson asked if DOA had offered to provide
additional assistance in light of the situation.
Commissioner Hedberg relayed that DOA had been very helpful
in getting procurements and HR matters through. She offered
to circle back to the department for more information.
Senator Wilson asked how long it took to train an
Eligibility Technician II to be able to certify eligibility
for SNAP beneficiaries.
Commissioner Hedberg explained that the training took two
years, and training covered 18 different public assistance
programs. She noted that there was a staged process due to
the complexity, and SNAP was one of the most complex. The
training team had been able to compress the SNAP training
to two months. She noted that there was a lot of room for
improvements and a lot of need in the area.
Senator Wilson asked to discuss the minimum qualifications
and range of pay for an Eligibility Technician position. He
pondered that two years of training was a long period of
training.
Commissioner Hedberg noted that the DPA director was
present to discuss minimum qualifications for eligibility
technicians.
9:29:32 AM
DEB ETHERIDGE, DIRECTOR, DIVISION OF PUBLIC ASSISTANCE
DEPARTMENT OF HEALTH, JUNEAU (via teleconference), relayed
that the minimum qualifications for the eligibility
technician position included a high school diploma and
years of experience.
Senator Wilson asked about the range of pay for the
Eligibility Technician 2.
Ms. Etheridge offered to get back to the committee with the
information.
Senator Wilson asked about the $1.6 million that was going
to be redistributed by DFG. He asked if the amount was the
total or a portion of the total funding.
Commissioner Hedberg understood that $1.6 million was the
total amount.
Senator Wilson asked about the total monthly cost of SNAP
benefits.
Commissioner Hedberg thought that Director Ethridge could
address the question and noted that she was only in week
seven in the position.
Ms. Etheridge cited that the average benefit per household
for the SNAP program was $559.49, with an average benefit
per person of $242.21. There was an average monthly
recipient number of 94,645 individuals. The average monthly
benefits for all recipients was $29,605,934.
9:32:03 AM
Senator Wilson calculated that less than 10 percent of SNAP
beneficiaries would benefit from the funding to food
pantries. He thought that the legislature should look for
more opportunities to address the problem sooner.
Senator Kiehl was glad to hear about the security
contracts, which he thought addressed a major retention
issue. He asked Commissioner Hedberg to discuss when the
department started hearing from staff about feeling unsafe
at work.
Commissioner Hedberg relayed that she had started her
position on November 16. She referenced recordings. She
thought the problem had started in August and was related
to the SNAP backlog. She had asked staff for information,
and whether safety concerns had been an historic problem.
Staff had indicated that it was not an historic problem.
She noted that the division had the highest turnover rate
in the department, and there had been a lot of virtual work
during the pandemic. There had been an increase in threats
since August, which was the reason for engaging the
security assessment and security guards.
Senator Kiehl thought the department staff had been
speaking about feeling unsafe for a couple of years.
Senator Wilson asked if the SNAP backlog had caused any
other issues with other programs such as the Special
Supplemental Nutrition Program for Women, Infants, and
Children (WIC) Program.
Commissioner Hedberg affirmed that there were other public
assistance programs that were negatively impacted because
of the prioritization of the SNAP backlog.
Senator Wilson asked if there was anything the committee or
legislature should be aware of in terms of system failures.
Commissioner Hedberg mentioned the departments capital
request to address the IT Legacy systems. She thought slide
8 would address milestones and the direction of the
department. She mentioned recruitment and retention of
staff, and building staff morale. She mentioned holding
three staff town hall meetings with DPA. She emphasized the
importance of hearing and addressing staff concerns. She
cited that the department was working through multiple
strategies.
9:35:20 AM
Co-Chair Stedman asked about a future request that would be
addressed in the presentation, as well as a supplemental
request. He asked why the responses were coming in as
supplemental requests rather than being in the budget
submitted in December. He thought it appeared as if the
collapse in the system had happened slowly.
Commissioner Hedberg thought there had been deficits in
communication and realizing the total impacts. She noted
that when Alaskans had started reaching out to the
department there had been a change in commissioners. She
had learned about the backlog on her first day of work.
Co-Chair Stedman understood Commissioner Hedberg was new to
the position and emphasized that the program had been
around for decades. He expressed concern that the agency
had not provided the information to the legislature prior
to having a virtual collapse of the system. He asked the
commissioner to assure the committee that additional
assistance would not be needed after redirecting resources
to the SNAP backlog. He relayed that the legislature wanted
to see the matter holistically. He expressed that the
committee wanted to work through the problem. He wondered
if the current proposal would address the problem fully.
Commissioner Hedberg appreciated Co-Chair Stedman's
comments. She considered that her current job was to gather
information for triage and problem assessment, in order to
address problems and identify resources. She was aware of
the need to address IT systems and support staff. She
thought the operating request in the governor's amended
budget and the capital request in the amended budget would
address the majority of the issues. She acknowledged that
there could be unknown factors, and committed to ongoing
communication to work with the legislature to resolve
potential problems.
9:39:46 AM
Ms. Ricci mentioned the governors amended budgetand the
Medicaid redetermination process. She referenced the
timeline and the federal announcement through the
Consolidated Appropriations Act of 2023, which articulated
details about the redetermination process. She noted that
the information had come after the administration's first
budget was submitted. She noted that the federal guidance
was ongoing and included weekly updates from the Centers
for Medicare and Medicaid (CMS). She noted that there were
still outstanding questions in the department to ensure the
resources needed aligned with the level of effort that
would begin in April.
Co-Chair Stedman noted that the committee was starting the
budget subcommittee process, and wanted to ensure that the
department gave the subcommittees accurate information
without obscuring potential future cost issues. He thought
situations affecting the public, such as the SNAP issue,
were unacceptable. He thought the state had the financial
resources to resolve the problems and encouraged the
department to be forthright with the committee.
Commissioner Hedberg replied to a previous question about
the starting wage for an eligibility technician, which was
between $22.50 to $24.
Ms. Stern considered slide 6, which showed the budget
request associated with DPA. The December 15th budget had
requested a continuance of an FY 23 appropriation for 20
long-term non-permanent positions to support application
processing.
9:43:20 AM
AT EASE
9:44:19 AM
RECONVENED
Ms. Stern addressed slide 6, "Public Assistance Backlog:
Funding Requests":
December 15 FY24 Governor (in thousands):
• $1,331.9 for 20 positions to support application
processing (FY2023-FY2024)
- $679.2 Federal
- $652.7 in GF Match
- 10 IT positions
February 14 FY23 Governor Amend Supplemental (in
thousands):
• $3,088.7 UGF transfer from Medicaid Services to
Public Assistance for Medicaid eligibility
redetermination processing
• $3,733.0 Federal for Medicaid eligibility
redetermination processing
February 14 FY24 Governor Amend (in thousands):
• $54,234.2 capital request for full mainframe system
replacement
- 56% ($30,152.72) funded through federal awards
- $17,181.5 GF Match, estimated $6,900.0
reappropriation
Ms. Stern explained that slide 6 showed the budgetary
requests for DPA. The department had also added 10 IT
positions in departmental support services, to support
reprogramming efforts. She noted that the funds in the FY
23 governors amended supplemental would also go toward 30
long-term non-permanent positions to support application
processing.
Co-Chair Stedman noted that the capital budget chairman was
not present, but affirmed that he would examine the
information. He asked the testifiers to discuss how soon
the funds were needed, excepting the capital request.
9:46:39 AM
Ms. Stern explained that the funding for the supplemental
would be needed before the end of the fiscal year.
Co-Chair Stedman relayed that the committee would work with
the department and the Office of Management and Budget
(OMB) on the funding. The committee had not decided if it
would do a streamlined fast track supplemental, but hoped
it could be avoided.
Senator Wilson thought it looked as though the capital
request would have a five-year timeline to complete. He
thought the timeline was missing a funding request to look
at a systems re-design for the training and application
process. He thought the same problems would reoccur with
the current system. He thought the state was a horse and
cart system that focused on a point-to-point journey. He
shared concern that there was not a redesign of workflow to
make the staffing and application process easier.
Co-Chair Stedman thought the matter could be addressed in
the subcommittee.
Commissioner Hedberg addressed Senator Wilson's concern.
She listed that in 2017, the department engaged with
federal partners for a technical plan that provided a
roadmap. The had five milestones that laid a foundation for
moving off the main frame and addressing system issues. She
addressed workflow processes and mentioned a workflow
management system that supported the eligibility
technicians in application processing. The system had not
been fully implemented during the pandemic. She mentioned
the state of Nevada, which had embraced the technology and
had seen great improvement. She thought the department had
some tools to address problems mentioned by Senator Wilson.
She mentioned an upcoming meeting to work on steps to
utilizing the new system. She reiterated that the
department was triaging multiple scenarios simultaneously.
Senator Wilson mentioned the systems needed for eligibility
technicians to process applications. He asked if the
presentation would address the time frame of simplifying
the process.
Commissioner Hedberg deferred the question to staff that
would present slide 8.
9:51:53 AM
Commissioner Hedberg displayed slide 7, which showed a
timeline of items in the IT project funding history. She
wanted to discuss the three appropriations DPA had
received, the intent of the funding, and who it served. She
deferred financial questions to other staff. She noted that
slide 8 would go in-depth on milestones, which would
directly link to funding in the appropriations.
Commissioner Hedberg recounted that in FY 13, the
legislature had appropriated $8.7 million UGF, and through
the appropriation the department had leveraged $65.8
million in federal funds, both of which to create the AIRES
system. In 2014 the AIRES system went live and supported
the 2,000 Alaskans that were on Medicaid. She cited system
flaws in AIRES and mentioned the issue of having a single
contractor. After requesting federal support, the road map
had been created to address the issues with AIRES and
create a path forward to getting off the main frame.
Commissioner Hedberg recounted a $9 million UGF legislative
appropriation in FY 19, which leveraged $27.7 million in
federal funds. She explained that two of the associated
tasks were complete the unified search module and the
automated renewal functionality. The third element of the
appropriation was to draft a Request for Proposals (RFP)
for a contractor to use the remaining balance to migrate
Medicaid programs to the new eligibility enrolment system.
Additionally, the AIRES system would be moved into the
cloud with a completion date of June 2023.
Commissioner Hedberg continued to address slide 7, and
cited that there were two capital appropriations in 2023,
only one of which was listed on the slide. The legislature
had appropriated $4.7 million UGF (that leveraged $18.8
million in federal funds), and the funding to start
milestones 3, 4, and 5; which would be addressed on slide
8. The $8 million capital appropriation was to pay for the
E-forms for all public assistance applications, and would
also launch the online SNAP application by December 2023.
Some of the funding had already been used and was
encumbered for the projects.
Commissioner Hedberg discussed the governors amended
request for the department, which was for $17.1 million in
General Funds (GF) and a $6.9 million reappropriation to
leverage the $31.1 million federal dollars to finish
milestones 3 through 5. The funding would fully
decommission the mainframe eligibility system and would
migrate all of the public assistance programs into the
brand new eligibility enrollment system. In addition, the
funding provided secured access to a self-service portal.
She affirmed that there would always be DPA offices to
access, but in addition there would be self-service portals
to apply for public assistance. She noted that all the work
had been managed by a team of five state employees in the
project management office in DPA.
9:56:40 AM
Senator Wilson asked how much funding was left from FY 19.
Ms. Stern explained that the FY 19 appropriation had about
$20 million remaining unobligated, about $16.5 of which was
federal funds and the remaining $4.4 million was GF. For FY
23, around $23 million of the $27 million appropriation was
remaining.
Senator Wilson asked about the capital request for FY 24.
He asked if the amount was in addition to the previous
funds.
Ms. Stern relayed that the funds were in addition to the
prior year appropriations.
Senator Wilson thought it looked as thought there was
almost $200 million from FY 13 and roughly $130 had been
spent. He thought there was a large sum of money proposed
to spent on a system when there were still big problems.
Co-Chair Stedman commented on the large amount of funding.
Senator Wilson asked why there was $20 million unspent from
FY 19, when the state could have done more to fix the
problem. He thought the same was true for FY 23.
Commissioner Hedberg agreed with Senator Wilson. She
mentioned that the Department of Health and Social
Services role during unprecedented global pandemic had
greatly impacted procurement. She described that all of the
procurement staff had focused on procuring for Covid-19, in
addition to getting federal dollars to communities. She
cited the effects of not being able to procure contracts in
earlier years.
Senator Wilson understood that the pandemic had effects,
but thought some of the issue pre-dated Covid-19.
10:00:08 AM
NICK FAULKNER, PROJECT MANAGER, DIVISION OF PUBLIC
ASSISTANCE, DEPARTMENT OF HEALTH (via teleconference),
introduced himself and shared that he was the project
manager for the eligibility system roadmap modernization
effort. He highlighted slide 8, which showed a timeline of
long-term efforts to address the public assistance backlog.
He mentioned the EIS system, which went live in 1983. In
2014, the AIRES system was put into place and included a
Medicaid program. In 2017 another approach was identified
and the department worked with federal partners to develop
the roadmap, which had smaller more agile modular
procurement that lowered the risk as compared to larger
multi-year IT project timelines.
Mr. Faulker noted that the change was a multi-year effort.
The first two milestones involved enhanced and streamlined
worker experience and included enhanced search options and
the automated renewals functionality. He listed the
remaining milestones as migrating SNAP off of the existing
EIS, improving case processing and communication, and
migrating other programs off of the EIS. The goal of the
roadmap was to have all of the public assistance programs
out of the mainframe and into a modern, modular, and
flexible public assistance eligibility enrollment system.
10:04:21 AM
Senator Wilson mentioned the enhanced and streamlined
worker experience. He asked Mr. Faulkner to discuss when
workers would go from nine screens to one screen, and
whether the change would speed up the training experience.
Mr. Faulkner relayed that some improvements were already
available to workers. He discussed the challenge of using
multiple systems. He mentioned the new functionality of
gathering information on multiple systems in one
centralized place, which was already in use with positive
reports. He highlighted that the new automated renewal
process would allow for a certain amount of Medicaid
renewals without interaction from workers.
Senator Wilson referenced Nevada being number 14 in the
national ranking mentioned by Commissioner Hedberg, and
asked about the top three ranked states. He asked if any of
the top states were using AIRES.
Mr. Faulkner offered to look into the matter and get back
to the committee.
Senator Wilson asked if the state was at risk of federal
penalties for delays and loss of certifications. He
wondered where the penalties would appear in the budget.
Commissioner Hedberg relayed that the SNAP program had
sanctions that could be applied. The state was in a
corrective action plan and was meeting weekly with Food and
Nutrition Services. She did not anticipate the program
leveraging financial penalties. Medicaid was under
different rules.
10:07:19 AM
Ms. Ricci addressed Senator Wilson's question and relayed
that there were certain requirements, some of which were
new, for redetermination efforts as well as general
Medicaid eligibility processing. She highlighted the need
for identifying where the state was unable to meet the
requirements, articulating a mitigation plan to CMS, and
demonstrating the state was taking serious action towards
the plan. She cited that there were 40 other states that
were also developing mitigation plans because the
requirements were challenging for most states. She
qualified that most of the requirements the state was
unable to meet were associated with the EIS system and
those Medicaid enrollments stored on the system. She
thought it was important to move the enrollments off the
EIS system and into an AIRES system, within a three-year
time frame. She reiterated that some of the guidance was
still forthcoming.
Senator Wilson referenced the one-vendor situation with
AIRES and the fact that the vendor sometimes failed to live
up to the guidance or contractual agreements. He understood
that there were multiple vendors for the integrated
enrollment system underway, asked if there was anything the
state could do to work with multiple vendors and speed up
the process.
Commissioner Hedberg relayed that the department was
engaged with multiple vendors, which included competitive
pricing and reduced the risk of single vendor failure. She
considered that the department had learned a lot from the
2014 AIRES roll-out and the failure of the contract. She
shared that there were vendors in place to present the same
thing from recurring. She mentioned Ms. Riccis experience
with contracts, and a dedicated project management team.
Co-Chair Stedman asked about the role of Mr. Faulkner.
Commissioner Hedberg relayed that Mr. Faulkner was a
contractor.
10:10:34 AM
Ms. Ricci explained that she oversaw the divisions and
sections that related to the Medicaid program, and that she
had started a week prior to Commissioner Hedberg. The
following two slides would address the Medicaid
redetermination process. She addressed slide 10, which
addressed the unwinding of the continuous enrollment for
Medicaid. She recounted that in 2020 the federal
governments response to the Covid-19 pandemic included
requirements (via the Family First Coronavirus Response
Act) that maintained continuous eligibility for Medicaid
enrollees rather than the standard 12-month redetermination
process.
Ms. Ricci continued that recognizing the need for
additional funds for increased enrollment, the federal
government had provided 6.2 percent enhanced federal match.
All states had been receiving the funding to help offset
the costs of maintaining enrollment. She continued that
because the funding had been tied to the ending of the
federal public health emergency, there had been much
speculation and concern about how much time the state would
have to prepare for the changes to Medicaid enrollment.
Ms. Ricci relayed that in late December 2022, the
Consolidated Appropriations Act was passed, which
effectively severed the ending of the continuous enrollment
requirements from the ending of the federal public health
emergency. There was also guidance provided, and a timeline
for what states could expect. The act also outlined a
phase-down approach for the ending of the enhanced federal
funding match, which would begin April 1, 2023. In order to
retain the enhanced FMAP, states were required to complete
redeterminations subject to certain requirements and
timeframes. The continuous enrollment period effectively
ended March 31, 2023, and on April 1, all states would
begin Medicaid eligibility redeterminations.
Ms. Ricci cited that there were currently about 263,000
enrolled beneficiaries in the Medicaid program, and Alaska
would have 12 months beginning April 1 to initiate
redeterminations for all active Medicaid cases. States
would have 14 months to complete the redeterminations. She
reiterated that there were additional requirements in the
Consolidated Appropriations Act that would be permanent for
states in how they managed eligibility and eligibility
systems.
Ms. Ricci shared that within the previous two to three
weeks, CMS had provided further guidance to states
outlining that states would have two years after the end of
the unwinding period to ensure systems complied with the
permanent requirements outlined in the act.
10:15:19 AM
Ms. Stern advanced to slide 11, "Medicaid Redetermination:
Funding Requests":
December 15 FY24 Governor (in thousands):
• $18,132.6 Medicaid utilization and inflation
February 14 FY23 Governor Amend Supplemental (in
thousands):
• $3,088.7 UGF Transfer from Medicaid Services to
Public Assistance for Medicaid eligibility
redetermination processing
February 14 FY24 Governor Amend (in thousands):
• $24,388.0 UGF Medicaid increases from eFMAP
stepdown and rate rebasing
• $17,834.5 for Medicaid and Public Assistance
program eligibility redeterminations (FY2024-
FY2025)
- $8,917.3 Federal
- $8,917.2 GF Match
Ms. Stern noted that the $17.8 million for eligibility
redeterminations would also come with 30 long-term non-
permanent positions in DPA as a carry-on from the FY 23
supplemental request.
Ms. Ricci looked at slide 12, which outlined the state's
redetermination schedule. She reiterated that the state
would have 12 months to undertake redetermination for
263,000 Alaskans, which was over a third of the states
population. She described requirements, including minimum
and maximum numbers of how many redeterminations states
could initiate in a month. The bar graph outlined a
schedule by month that indicated a slow ramp-up to full
capacity for redeterminations. She pointed out that in
April through June the department proposed about half
capacity, then reaching the mature redetermination effort
in September through March.
Ms. Ricci discussed reasons for the slow ramp-up for
eligibility redetermination. She mentioned Commissioner
Hedbergs comments about the department experiencing
impacts from the SNAP backlog, including in the Medicaid
program. She emphasized that the redetermination was a
large undertaking that would utilize new systems. She
thought the new systems could result in some helpful
automation, but noted that there were many outstanding
questions about how many of the redeterminations would be
processed automatically versus manually.
Ms. Ricci mentioned that the department was trying to find
how to work with external partners that engaged with
Medicaid beneficiaries in order to leverage work that was
already being done by those such as tribal health
organizations, the hospital association, and health
centers. The slow ramp-up would provide additional time to
highlight the partnerships and contemplate data sharing and
financing.
10:19:10 AM
Senator Kiehl referenced the slow ramp-up, and thought
there was a 145 percent increase in redetermination in
three steps. He estimated the amount of time needed, based
on one hour of worker time per application, and questioned
how the project was possible.
Ms. Ricci emphasized that the department would leverage
automation, and mentioned ex parte renewals that used and
matched information from multiple systems to achieve an
automated redetermination. She pondered what percentage of
determination would be possible for automation, and relayed
that the estimates varied widely by state. The department
estimated that about 40 percent of the applications in
AIRES would run through the redetermination ex parte
process. More information would be available in April, and
noted that the department would endeavor to match the
information to staffing needs.
Ms. Ricci explained that when Commissioner Hedberg was
talking about the hour to process applications, she had
been referring to the SNAP applications, which were
considered to be more complex. She understood that Medicaid
redeterminations would be faster or more streamlined. The
department was also looking at leveraging external
partners, including contractors, although always preferred
to use employees. She continued that federal requirements
stated that an actual employee of the state had to make the
determination. She pondered whether the department could
leverage additional support to gather information so that
the eligibility technicians had everything needed to
streamline the work.
10:23:00 AM
Senator Kiehl was concerned at the escalation of workflow,
and wanted more information on how the step-ups would
happen.
Co-Chair Stedman asked for the inclusion of a brief
highlight on how information would be shared about hitting
the numeric targets.
Commissioner Hedberg relayed that the group worked together
daily and affirmed that DOH could share information on
benchmarks with the committee as soon as it was known. She
reiterated that gathering the information was difficult so
DOH wanted to leverage its partners to maximize the
automation and the technicians. She emphasized that the
undertaking would be a large of effort. She agreed to
follow up with updates.
Co-Chair Stedman wanted to receive an update in May, to see
how the month of April went. He wanted to keep track of the
issue and know about any challenges in a timely manner.
Ms. Ricci added that there were very specific CMS reporting
requirements that began April 8, to include some of the
same information the committee would be interested in. The
information from the federal reporting requirements would
be made public.
10:25:39 AM
Ms. Ricci showed slide 13, which addressed ex parte
renewals for the redetermination approach. She reiterated
that about 40 percent of renewals in AIRES would be
processed as ex parte renewals. She thought it was
important to note that there were two systems, with the
vast majority of enrollees in AIRES, and those in long-term
programs with eligibility stored in the EIS system. It was
not possible to automatically process the Medicaid
enrollees in the EIS system, and she emphasized the need to
plan for manual redeterminations. She noted that the first
batch of redetermination notices that had gone through the
ex parte process would be mailed to beneficiaries April 15.
Ms. Ricci referenced slide 14, which addressed manual
processing for the redetermination effort. She noted that
she had addressed most of the slide already. She explained
that manual processing would be required for
redeterminations where insufficient data existed in the
database to complete the automated ex parte renewal, or if
the enrollee was no longer eligible through criteria.
Additionally, manual processing would be necessary for
enrollees whose eligibility was maintained through in the
EIS system.
Senator Wilson asked if the state had initiated any
contracts to help with redetermination.
Commissioner Hedberg answered affirmatively and relayed
that the contract to support the virtual contact center was
one of the contracts that would help with the backlog of
redeterminations. People with questions about eligibility
or redetermination could get calls answered by DPA staff
plus associates.
10:28:43 AM
Senator Kiehl thought he had heard that Ms. Ricci indicated
that a state employee had to process the redeterminations.
He asked if the department had gone through the process
that public employee contracts required.
Commissioner Hedberg relayed that she had engaged with the
union regarding the temporary contract with the virtual
contact center. The department had not been able to do a
feasibility study because of the timeline, but the
department was in active conversations with the union. She
pondered bulk of work that had to happen and considered
engaging partners that had direct contact with enrollees.
The application decision would not be contracted out per
federal law, but contractors and partners could assist with
the provision of information.
Ms. Ricci turned to slide 15, which addressed disenrollment
as part of the redetermination effort. Initial
disenrollment from the effects of the redetermination
effort could occur beginning June 1. She noted that the
process was complicated, with the end of the continuous
enrollment period was March 31. She cited that it was
possible that an individual could be disenrolled between
April 31 and May 31 when they may be interacting with DPA
for other programs. As a result of initiating
redeterminations on a monthly basis, the first
disenrollments would occur June 1, 2023. She pondered the
question of how many recipients were estimated to be
disenrolled, and did not have a firm number. She cited that
since 2020 there were 30,000 more Alaskans enrolled in
Medicaid than were three years previously.
Ms. Ricci continued that if an individual were disenrolled,
there were hearing rights. Most recipients that were
disenrolled would be transferred to the federally
facilitated marketplace in order to retain coverage and
sign up for coverage. The process was automated for
individuals that were enrolled in the AIRES system, while
those enrolled in the EIS system would receive notices.
Ms. Ricci affirmed that the department was working to make
sure it could support individuals that might be
disenrolled. She cited the goal of making sure everyone
stayed covered through the various health insurance options
available, and mentioned the need to work with external
partners. She thought some groups had set up health
insurance navigators, as well as the Division of Insurance.
10:33:24 AM
Senator Kiehl mentioned the challenge of contacting
recipients, which often had changeable work and housing
situations. He understood the department was working on a
dedicated way for Medicaid beneficiaries to update contact
information. He understood the federal government required
new and different ways of reaching out to those that did
not have contact information. He asked for more detail.
Ms. Ricci relayed that DPA had established a separate
option when calling into the virtual call center. The only
activity for the call center staff was to update
individuals contact information, and the goal was to make
the line available and ensure it did not get backed up. The
staff was not permitted to answer any other questions. She
detailed that the department would be sending postcards
encouraging Alaskans to keep contact information updated,
and that there was a full public communications plan that
would be rolled out.
Ms. Ricci continued that there were certain requirements in
the Consolidated Appropriations Act that dictated how DPA
systems needed to ingest updated address information from
the national change of address database as well as how
individuals can be disenrolled and what steps the division
must take before it could engage in disenrollment. She
listed working on access to the national change of address
database as one of the areas DOH was working on in the
mitigation plan with CMS. The database was not automated in
AIRES but she anticipated it to come online later in the
summer. She noted that Senator Kiehl was correct in that
there was a requirement to contact beneficiaries by other
means than a letter, and the department was working on ways
to collect other contact information and planned to make
phone calls.
Ms. Ricci considered slide 16, which listed federal
requirements that were outlined in the Consolidated
Appropriations Act of 2023. There were four major areas
that the department was addressing through CMS mitigation
plans, including connecting with the address change
database, ex parte renewals, transferring disenrollments to
the federal insurance marketplace, and developing the
online submission. She noted that the department was in
active conversations with CMS regarding mitigation plans,
timelines, and milestones.
10:37:46 AM
Ms. Ricci displayed slide 17, which had additional
information on federal requirements. She summarized that in
order to remain compliant for enhanced federal FMAP and
additional federal funding, DOH needed to demonstrate to
CMS an approved mitigation plan, set dates for reaching
compliance, and demonstration of working towards the plan.
She continued that CMS had developed a form that would be a
helpful tool in articulating compliance measures.
Co-Chair Stedman asked when the department was notified of
the redetermination requirement.
Ms. Ricci recalled that the requirements were released in
the Consolidated Appropriations Act at the end of December.
There had been ongoing national discussion about when the
public health emergency would end, but there was no
specific date until December.
Co-Chair Stedman asked if there was any lead time other
than the act being released.
Ms. Ricci answered "yes." She thought there had been
general awareness of what could be required by CMS or what
CMS would be looking for, which was why the division
engaged in programming necessary to start ex parte renewals
in the AIRES system. She believed the effort had started in
the fall.
Ms. Ricci highlighted slide 18, which showed a flow chart.
She reiterated that the department was working to identify
how to leverage external stakeholders to reach Medicaid
enrollees. She cited that DOH was working on financing,
data sharing agreements, and articulating which
organizations could help in different areas.
Ms. Ricci looked at slide 19, which outlined the
department's communication plan for the redetermination
effort. She anticipated that the communication plan would
change and flex within the next few months in response to
identified questions and needs. She highlighted the
importance and requirements to engage in broad-based
communications with Alaskans.
Senator Kiehl asked if the communication plan would be
public.
Ms. Ricci noted that the plan had already been shared in
certain meetings and would be meeting with stakeholder
groups to share an outline of the plan and receive guidance
from those engaging directly with enrollees.
Senator Wilson asked the department was offering
opportunities for overtime for SNAP and Medicaid
eligibility technicians.
Commissioner Hedberg affirmed that there were eligibility
technicians that were working seven days a week, and that
working overtime was optional.
Senator Wilson asked if the overtime would create an
increase to the operational budget for the positions.
Commissioner Hedberg did not anticipate an increase and
noted that the department had been using the balance within
the budget to manage the amount.
10:42:34 AM
Co-Chair Stedman asked to go back to slide 11, which showed
funding requests for Medicaid redetermination. He mentioned
the committees desire to help the department anticipate
problems. He cited a challenge with Medicaid projections
and information flow. He mentioned a request for more
information to flow to the Legislative Finance Division
(LFD).
Ms. Stern relayed that the department was in discussions
with the Office of Management and Budget (OMB) as well as
LFD to provide the projections. She referenced a meeting
the previous week and relayed that she would follow up with
OMB to see when the information could be provided to the
division.
Co-Chair Stedman asked if the request had been concluded so
that there would be a good flow of information to LFD.
Ms. Stern hoped to get the information to LFD in the
following two weeks.
Co-Chair Stedman emphasized keeping up the flow of
information so there were no surprises when the budget
season started. He was concerned about whether the
department would be hitting established targets and
emphasized the importance of hearing about issues sooner
rather than later. He recognized the size and complexity of
the department and trying to keep the growth of the
department reasonable. He encouraged the department to work
with LFD.
Commissioner Hedberg showed slide 20, "Questions?":
Courtney Enright
Legislative Liaison
Courtney.Enright@alaska.gov
907-269-7800
Co-Chair Stedman thanked the testifiers. He discussed the
agenda for the following day and upcoming subcommittee
meetings.
ADJOURNMENT
10:47:23 AM
The meeting was adjourned at 10:47 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 030223 DOH SNAP Backlog and Medicaid Redeterminations Presentation for (S)FIN 3.2.2023.pdf |
SFIN 3/2/2023 9:00:00 AM |