Legislature(2023 - 2024)SENATE FINANCE 532

03/02/2023 09:00 AM Senate FINANCE

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

Audio Topic
09:01:29 AM Start
09:03:11 AM Presentation: Snap and Medicaid Eligibility Redetermination
10:47:23 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Presentation: SNAP & Medicaid Eligibility
Redetermination by Division of Public Assistance
+ Bills 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                                                                    
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                                                                    
^PRESENTATION:     SNAP     and     MEDICAID     ELIGIBILITY                                                                  
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
Commissioner  Hedberg  noted  that   the  DPA  director  was                                                                    
present  to discuss  minimum qualifications  for eligibility                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
9:43:20 AM                                                                                                                    
AT EASE                                                                                                                         
9:44:19 AM                                                                                                                    
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                                                                           
      $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                                                                    
     - 56% ($30,152.72) funded through federal awards                                                                           
     -    $17,181.5    GF    Match,    estimated    $6,900.0                                                                    
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                                                                    
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                                                                    
Senator Wilson  asked about the  capital request for  FY 24.                                                                    
He  asked if  the amount  was  in addition  to the  previous                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                           
         $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-                                                                         
          - $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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                                                        
Co-Chair Stedman thanked the testifiers. He discussed the                                                                       
agenda for the following day and upcoming subcommittee                                                                          
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