Legislature(2023 - 2024)BUTROVICH 205

01/24/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES

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03:30:10 PM Start
03:31:26 PM Overview State of Alaska Department of Health
05:02:53 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Department of Health - Overview TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                        January 24, 2023                                                                                        
                            3:30 p.m.                                                                                           
 MEMBERS PRESENT                                                                                                              
 Senator David Wilson, Chair                                                                                                    
 Senator James Kaufman, Vice Chair                                                                                              
 Senator Löki Tobin                                                                                                             
 Senator Forrest Dunbar                                                                                                         
 Senator Cathy Giessel                                                                                                          
 MEMBERS ABSENT                                                                                                               
 All members present                                                                                                            
 OTHER LEGISLATORS                                                                                                            
 Senator Claman                                                                                                                 
 COMMITTEE CALENDAR                                                                                                           
 OVERVIEW STATE OF ALASKA DEPARTMENT OF HEALTH                                                                                  
      - HEARD                                                                                                                   
 PREVIOUS COMMITTEE ACTION                                                                                                    
 No previous action to report.                                                                                                  
 WITNESS REGISTER                                                                                                             
 HEATHER CARPENTER, Deputy Director                                                                                             
 Office of the Commissioner                                                                                                     
 Department of Health (DOH)                                                                                                     
 Juneau, Alaska                                                                                                                 
 POSITION STATEMENT: Co-presented an overview of the State of                                                                 
 Alaska Department of Health.                                                                                                   
 ANNE ZINK, Chief Medical Officer/Director                                                                                      
 Division of Public Health                                                                                                      
 Department of Health (DOH)                                                                                                     
 Juneau, Alaska                                                                                                                 
 POSITION STATEMENT: Co-presented an overview of the State of                                                                 
 Alaska Department of Health.                                                                                                   
EMILY RICCI, Deputy Commissioner                                                                                                
Health Care Services                                                                                                            
Department of Health (DOH)                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:  Co-presented an  overview  of  the State  of                                                            
Alaska Department of Health.                                                                                                    
HEIDI HEDBERG, Commissioner-Designee                                                                                            
Office of the Commissioner                                                                                                      
Department of Health (DOH)                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT: Answered  questions  during  the overview  of                                                            
the State of Alaska Department of Health.                                                                                       
ACTION NARRATIVE                                                                                                              
3:30:10 PM                                                                                                                    
CHAIR DAVID  WILSON called the  Senate Health and  Social Services                                                            
Standing Committee  meeting to order  at 3:30 p.m. Present  at the                                                              
call to order  were Senators Giessel, Dunbar, Tobin,  Kaufman, and                                                              
Chair Wilson.                                                                                                                   
^OVERVIEW State of Alaska Department of Health                                                                                  
              STATE OF ALASKA DEPARTMENT OF HEALTH                                                                          
3:31:26 PM                                                                                                                    
CHAIR WILSON  announced the  consideration of  an overview  of the                                                              
State of  Alaska Department  of Health  and invited  Commissioner-                                                              
Designee Heidi Hedberg to begin.                                                                                                
3:33:38 PM                                                                                                                    
At ease.                                                                                                                        
3:34:00 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
3:34:04 PM                                                                                                                    
HEIDI   HEDBERG,  Commissioner-Designee,   Department  of   Health                                                              
(DOH),  Juneau,   Alaska,  expressed  her  appreciation   for  the                                                              
Department of Health's leadership team.                                                                                         
3:34:51 PM                                                                                                                    
ANNE ZINK,  Chief Medical  Officer/Director, Department  of Health                                                              
(DOH),  Juneau,  Alaska,  stated  she  is  honored  to  work  with                                                              
professionals within  and outside of  the Department of  Health in                                                              
 serving the  needs of Alaskans.  She said  factors outside  health                                                             
 care determine  80  percent  of  an  individual's  health.  Mental                                                             
 health, economic  stability, cost  of health care,  and access  to                                                             
 health care  play  a phenomenal  role  in an  individual's  actual                                                             
 health, which  is  why DOH  works  with other  state departments,                                                              
 tribal partners,  health  care  providers,  and  the legislature.                                                              
 Alaskans' healthcare  needs are  diverse.  It is  important to  be                                                             
 person-centric and  having whole  systems that  serve Alaskans  is                                                             
 the mission of  DOH. DOH seeks  to serve Alaskans  and ensure  the                                                             
 promotion and protection  of their health,  well-being, and  self-                                                             
 3:35:51 PM                                                                                                                   
 DR. ZINK turned to  slide 3 and stated  that the health and  well-                                                             
 being of Alaskans  is often defined in  terms of life expectancy,                                                              
 cost of care, and  why people become ill  or die. The graph  "Life                                                             
 Expectancy at  Birth  vs.  Health Care  Expenditures  per  Capita:                                                             
 Comparison Across  States" was updated  in 2020.  She stated  that                                                             
 the data  shows  Alaska is  the  second most  expensive  place  to                                                             
 obtain health  care in  the country  when looking  at health  care                                                             
 expenditures per capita. Alaska  is slightly behind New York.  She                                                             
 stated  that  Alaska  is  placed  29th  in  the  nation  for  life                                                             
 expectancy.  Hawaii  has  the   highest  life  expectancy,   while                                                             
 Mississippi and  West Virginia  have the  lowest.  Health care  is                                                             
 complex. One way  to determine what  is needed is  to look at  the                                                             
 leading causes of  death. The graph, "Leading  Causes of Death  in                                                             
 Alaska vs.  US  (2021),"  shows that  cancer,  heart  disease  and                                                             
 COVID are the top  three causes of death  for Alaska and the  U.S.                                                             
 Previously COVID  was not  a leading  cause of  death,  and it  is                                                             
 hoped that it will cease  over time. Statistically, Alaska  stands                                                             
 out in  three  areas suicide,  liver  disease, and  diabetes.  The                                                             
 department is often asked what  is being done to improve  Alaska's                                                             
 3:38:06 PM                                                                                                                   
 DR. ZINK moved  to slide  4 and said  Alaska's health improvement                                                              
 plan  has  been  in  place  for  decades.  It  is  called  Healthy                                                             
 Alaskans and  was  created  in partnership  with  tribes  and  the                                                             
 state.  The  plan  identifies  measurable,  actionable   items  to                                                             
 improve  Alaskans'  health.  Goals  are  set  for  ten   years.  A                                                             
 strategic plan for 2030 has  been created with an outline for  the                                                             
 changes to be made every year. Areas of the plan include:                                                                      
   • Healthy Weight and Nutrition                                                                                               
   • Environmental Health                                                                                                       
   • Healthcare Access                                                                                                          
   • Alcohol, Tobacco and Substance Misuse                                                                                      
   • Mental Health and Suicide                                                                                                  
   • Injury and Violence                                                                                                        
   • Infectious Disease                                                                                                         
   • Cancer and Chronic Disease                                                                                                 
   • Social and Protective Factors                                                                                              
She stated  that the 2020  final report  card and the  2022 update                                                              
would be released soon.                                                                                                         
3:39:11 PM                                                                                                                    
COMMISSIONER-DESIGNEE  HEDBERG moved  to slide  5 and stated  that                                                              
strong  families are  the foundation  of a healthy  society  and a                                                              
vibrant  economy.  There  are three  fundamental  pillars  to  the                                                              
Healthy  Families  Initiative:  Healthy  Beginnings,  Health  Care                                                              
Access,  and  Healthy  Communities.   Healthy  Beginnings  is  the                                                              
cornerstone  of  healthy  families. It  prioritizes  maternal  and                                                              
child health  and emphasizes preventive  measures for  youth, such                                                              
as  a  healthy  diet  and  physical  activity.  It  works  towards                                                              
expanding childcare and after-school programs.                                                                                  
The  second  pillar,  Health  Care   Access,  addresses  improving                                                              
access  to mental  and  physical health.  This  pillar focuses  on                                                              
working   with  partners   to  create  a   robust  and   resilient                                                              
healthcare workforce.  It is about  supporting aging in  place and                                                              
aligning how  health care is paid  to reflect better  outcomes and                                                              
higher value for whole-person care.                                                                                             
The  third  pillar,   Healthy  Communities,  builds   on  existing                                                              
efforts to  create healthy workplaces.  It works with  partners to                                                              
increase safe  and affordable housing.  Launching the  Fresh Start                                                              
Campaign  will  reduce  the  burden  of  infectious  diseases  and                                                              
address  chronic  conditions. The  Fresh  Start Campaign  aims  to                                                              
connect  Alaskans  to  prevention  programs and  is  supported  by                                                              
ongoing federal and  general funds. She acknowledged  that many of                                                              
these  strategies   exist,  so   this  initiative  would   elevate                                                              
existing  programs,  promote expansion,  and  bring  new ideas  to                                                              
fruition.  She  stated  that  the   initiative  is  a  partnership                                                              
between departments,  communities,  businesses, and Alaskans.  She                                                              
reiterated that  health is not just  the Department of  Health; it                                                              
is  the  collection  of  all  state   agencies,  communities,  and                                                              
businesses working together.                                                                                                    
3:41:19 PM                                                                                                                    
Dr.  Zink  advanced to  slide  6  and said  the  Healthy  Families                                                              
Initiative includes  the Office of  Health Savings. The  Office of                                                              
Health Savings  is concerned  with healthcare  dollar savings  and                                                              
 saving people's  health. Healthy  people are  cheaper and  healthy                                                             
 economies are  built  with  healthy  people. It  is  essential  to                                                             
 consider  the   cost  of   care  and   how  to   improve   health,                                                             
 particularly  through  prevention.  She  said  the  office   would                                                             
 initially be  positioned  within the  DOH  Commissioner's  Office.                                                             
 Initial savings  will  focus on  the  Medicaid program  and  later                                                             
 consider innovative payment models  to determine how payments  are                                                             
 made.  Also, the  office  will  look  at  how  the  department  is                                                             
 building  across  payer  types.   Providers  want  to  know   that                                                             
 provider and payer  types are aligned  in a way  that allows  them                                                             
 to provide  care  without  thinking about  how  Medicaid  operates                                                             
 differently than the Division  of Insurance. Also, pharmacy  costs                                                             
 continue to  be  a  driving sector  of  the  healthcare  industry.                                                             
 Therefore, the  office will  investigate what  can  be done  about                                                             
 pharmacy  costs and  improving  access  to  clinical medications.                                                              
 Access to Paxil  during the COVID  pandemic demonstrated what  can                                                             
 happen when agencies work  together. The Office of Health  Savings                                                             
 (OHS) wants to look at what  can be done to work with the  federal                                                             
 government  across   agencies  to  ensure   key  medications   are                                                             
 available to people in Alaska,  regardless of cost or the  ability                                                             
 of  insurance  stipends  to   pay.  She  referred  to  the   chart                                                             
 "Healthcare Expenditures  per  Capita,  Alaska vs.  United  States                                                             
 (1991-2020)," which  shows that Alaska's  healthcare expenditures                                                              
 over time have diverged. Alaska has much work to do.                                                                           
 3:43:04 PM                                                                                                                   
COMMISSIONER-DESIGNEE HEDBERG reminded committee members that on                                                                
 July 1, 2022, the Department of Health and Social Services was                                                                 
 split into the Department of Health and the Department of Family                                                               
 and Community Services. Slide 7 shows each department's  assigned                                                              
 Department of Health                                                                                                         
 Commissioner's Office                                                                                                          
 Finance & Management Services                                                                                                  
 Health Care Services                                                                                                           
 Behavioral Health                                                                                                              
 Senior & Disabilities Services                                                                                                 
 Public Assistance                                                                                                              
 Public Health                                                                                                                  
 Department of Family and Community Services                                                                                  
 Commissioner's Office                                                                                                          
 Finance & Management Services                                                                                                  
 Alaska Psychiatric Institute                                                                                                   
 Juvenile Justice                                                                                                               
 Alaska Pioneer Homes                                                                                                           
Office of Children's Services                                                                                                   
3:44:39 PM                                                                                                                    
COMMISSIONER-DESIGNEE  HEDBERG moved  to slide  9 and stated  that                                                              
the Finance  and Management Services  (FMS) Division  supports the                                                              
work  of  the Commissioner's  Office  and  the  five  programmatic                                                              
divisions  of the department  by providing  essential services  to                                                              
special  sections, such  as the  Medicaid  Program Integrity,  the                                                              
Office of Rate  Review, Health Information Systems,  and Medicaid,                                                              
Allocations and  Audit Services (MAAS).  It also  handles budgets,                                                              
grants,  contracts,  revenues, finances,  facilities,  and  audits                                                              
for  the  department.  FMS  is  the  backbone  that  supports  the                                                              
department. In the  grants and contracts section,  FMS coordinated                                                              
over $173  million in FY 22  to over 500 grantees,  which included                                                              
nonprofits  and  municipal  government.   The  Medicaid  Integrity                                                              
program recovered $7.8 million in FY 22.                                                                                        
3:46:05 PM                                                                                                                    
EMILY  RICCI, Deputy  Commissioner,  Department  of Health  (DOH),                                                              
Juneau,  Alaska, stated  that slides  10 and  11 briefly  overview                                                              
the  key  divisions  that  combined   make  up  Alaska's  Medicaid                                                              
program.  She  said  the  Senior  and  Disability  Services  (SDS)                                                              
division  is focused  on serving  Alaskans  with disabilities  and                                                              
those   who  are   elderly  or   vulnerable.   The  division   has                                                              
approximately  170 staff that  provide a  wide range of  services.                                                              
Some  of the  more well-known  programs  offer a  snapshot of  the                                                              
   • Home and Community-Based Services (HCBS)                                                                                   
   • Adult Protective Services (APS)                                                                                            
   • Infant Learning Program                                                                                                    
   • General Relief program                                                                                                     
MS. RICCI  said Alaska has  a long-standing position  of assisting                                                              
individuals  to   remain  independent  and  in  their   homes  and                                                              
communities  as  long  as  possible. One  of  the  most  important                                                              
things the  division does is  administer home and  community-based                                                              
waivers.  These programs  allow  for Medicaid  to  cover home  and                                                              
community-based  services for individuals  who would  otherwise be                                                              
served  in   institutions  or  nursing   homes.  There   are  five                                                              
different waivers  that the division manages. Each  waiver focuses                                                              
on different  categories  of needs  and care services.  In  FY 22,                                                              
approximately  5,500   Alaskans  were  served  by   these  waivers                                                              
covering  nearly $281 million  in total  services. Other  programs                                                              
the  division  manages  include  Adult  Protective  Services,  the                                                              
Infant  Learning   Program,  and   the  General  Relief   Program.                                                              
 Division employees work hard  to ensure that the programs  offered                                                             
 are robust.                                                                                                                    
 MS. RICCI  said one  of  SDS's accomplishments  was a  10  percent                                                             
 Medicaid rate  increase for  home and  community-based providers,                                                              
 which was  included  in the  FY  23 operating  budget.  These  new                                                             
 rates took  effect  on  July 1.  The  department  appreciated  the                                                             
 support  received   from  the  legislature.   The  division   also                                                             
 leveraged $8  million  in  federal  funds for  two  projects.  The                                                             
 first focused  on  providing  short-term relief  to  providers  to                                                             
 cover recruitment and  retention costs.  The second established  a                                                             
 training   and   certification   program   for   direct    support                                                             
 professionals  through  the   University  of  Alaska,  Anchorage.                                                              
 Approximately  225   providers  benefited   from  the  short-term                                                              
 relief, and 115 direct support  professionals are enrolled in  the                                                             
 UAA program. The  division learned from  the pandemic and  adopted                                                             
 regulatory  changes  focused   on  promoting  safe  and   flexible                                                             
 options. These include allowing  first aid training for providers                                                              
 to  be completed  online  and  expanding  the  use  of  video  and                                                             
 teleconference services for care coordination.                                                                                 
 3:48:35 PM                                                                                                                   
 MS. RICCI said that  the Division of  Health Care Services is  the                                                             
 heartbeat  of   the  Medicaid   program.   It  is   staffed   with                                                             
 approximately 180 positions and  is responsible for most  Medicaid                                                             
 services' claims,  processing, and  payment system.  The  division                                                             
 manages weekly  check writes  between $45  and $50  million  while                                                             
 processing nearly 6.3  million claims in FY  22. In addition,  the                                                             
 division  manages  several  units   with  functions  that   impact                                                             
 healthcare services  and  providers around  the state.  The  units                                                             
   • Background Check                                                                                                           
   • Residential Licensing                                                                                                      
   • Facilities Licensing                                                                                                       
   • Pharmacy Program                                                                                                           
   • Transportation                                                                                                             
   • Tribal Reclaiming                                                                                                          
 MS. RICCI stated that staffing  was one of the largest challenges                                                              
 for healthcare services  this year.  It was felt  most acutely  in                                                             
 the background  check unit,  which experienced  high absences  and                                                             
 staff vacancies.  This was  coupled with  the manual  process  and                                                             
 cleanup  project  from  the  cyber-attack  and  the  addition   of                                                             
 behavioral health  provider types  which increased  the number  of                                                             
 applications being processed  in the fall of  FY 22. While  having                                                             
 different  provider   types   was  good   for   the  department's                                                              
behavioral health  system, it ultimately  resulted in  longer than                                                              
standard turnaround  time and  processing delays. Since  December,                                                              
the unit has been  back to full capacity, and  the processing time                                                              
has  returned  to the  previous  standard  of four  business  days                                                              
following  receipt of a  complete application.  The department  is                                                              
committed to continual improvement  of the process for providers.                                                               
MS.  RICCI said  that  Healthcare  Services had  some  substantial                                                              
successes, including  the procurement and award of  a fiscal agent                                                              
contract.  Installation  services  are  a core  component  of  how                                                              
Health Care  Services processes  claims. Rebidding  services  is a                                                              
highly  complex and  challenging process.  The division  completed                                                              
the  procurement,  and  a  contract   was  awarded  to  Healthcare                                                              
Management  Solutions (HMS) this  fall, which  means a  portion of                                                              
the work  currently performed  by conduit  will transition  to HMS                                                              
on  April  1, which  is  something  that  the division  is  highly                                                              
focused on.  Other successes focused  on meaningful  savings, such                                                              
   • $155 million in claims recovery                                                                                            
   • $45 million in pharmacy savings                                                                                            
   • $74 million in tribal reclaiming                                                                                           
   • 22K+ determinations issued on background check applications                                                                
MS. RICCI stated the department expects  the low savings to grow.                                                               
3:51:10 PM                                                                                                                    
SENATOR GIESSEL arrived at the meeting.                                                                                         
3:51:18 PM                                                                                                                    
MS. RICCI  advanced to slide  12 and stated  that the  Division of                                                              
Behavioral  Health   is  responsible   for  the  publicly   funded                                                              
behavioral  health continuum of  care. It  has 123 physicians  and                                                              
an  annual budget  of about  $96  million. The  division has  five                                                              
operational sections that manage various programs, including:                                                                   
   • Tobacco Enforcement,                                                                                                       
   • Alcohol Safety                                                                                                             
   • Treatment and Recovery Coordination and Support                                                                            
   • Suicide Prevention.                                                                                                        
The division also  manages a collection of treatment  and recovery                                                              
grants to  community providers.  The treatment  and recovery  team                                                              
within the  Behavioral Health division  managed roughly  180 grant                                                              
awards in  FY 22. It is an  important component of  the behavioral                                                              
health system.                                                                                                                  
 MS. RICCI  explained that  the division  provides  a continuum  of                                                             
 statewide  behavioral  health  services  for  mental  health   and                                                             
 substance use  ranging  from  prevention and  screening  to  brief                                                             
 intervention  and  acute  psychiatric   care.  One  of  the   most                                                             
 important  initiatives  that  Behavioral  Health  manages  is  the                                                             
 expansion  of  covered  behavioral  health  services  through  the                                                             
 implementation  of   the  Medicaid  Section   1115  Waiver.   This                                                             
 innovative Medicaid  demonstration  project  allows the  state  to                                                             
 bill Medicaid for  services that would  otherwise not be  covered.                                                             
 The purpose of  the 1115 Waiver  was to establish  a continuum  of                                                             
 behavioral health services  at the community  and regional  levels                                                             
 by allowing  providers  to  bill  Medicaid  for  new  or  expanded                                                             
 service types,  including  crisis intervention  and  peer  support                                                             
 services. In FY 22, nearly  $190 million dollars in waiver  claims                                                             
 were paid  and  processed. The  waiver  was fully  implemented  in                                                             
 2020 and is  currently in  the process  of renewal. Additionally,                                                              
 the division has  proposed a  4.5 percent rate  increase for  1115                                                             
 Waiver services which is currently in the regulatory process.                                                                  
 In collaboration with  the Alaska Mental  Health Trust Authority,                                                              
 the  Division  of  Behavioral   Health  continues  to  work   with                                                             
 community   providers    to    support   the    development    and                                                             
 implementation of the  Crisis Now model. The  Crisis Now model  is                                                             
 a  systemic  approach  to  building  a robust  behavioral   health                                                             
 continuum of  care. The  Crisis Now  model has  been an  important                                                             
 part of the department's conversations.  Over the next two  years,                                                             
 the  Behavior  Health   division  will   organize  and  implement                                                              
 technical  assistance for  organizations  across  the  state  that                                                             
 expressed  interest  in  building  and  providing  23-Hour  Crisis                                                             
 Observation  and   Stabilization  Services.   The  department   is                                                             
 looking forward to the build-out  of the Crisis Now model and  the                                                             
 services it will offer.                                                                                                        
 3:53:55 PM                                                                                                                   
 DR. ZINK  moved  to  slide 13  and  stated that  the  Division  of                                                             
 Public Health is like the  brains and hands of healthcare.  Public                                                             
 Health is like  a chief strategist  that thinks about prevention,                                                              
 promotion,  and  keeping  health  moving  upstream  while  working                                                             
 closely with  communities.  While many  states have  local  public                                                             
 health jurisdictions,  Alaska  has  a  centralized  public  health                                                             
 section, allowing  epidemiologists to  work across  the state  and                                                             
 through public health nursing centers.                                                                                         
 DR. ZINK  said there  are over  500 people  in the  Public  Health                                                             
 division  and eight  distinct  sections  within  the  division  do                                                             
 creative, exciting,  and meaningful work.  This division  includes                                                             
 a team  that  focuses on  chronic  disease prevention  and  health                                                             
promotion.  Chronic  disease continues  to  be  one of  the  major                                                              
driving forces  of cost  to healthcare,  as evidenced by  Medicaid                                                              
and  overall healthcare  expenditures. Healthy  Alaskan goals  and                                                              
the work  done within  the Chronic  Disease Prevention  and Health                                                              
Promotion team  are now  built into the  MESA report  on Medicaid.                                                              
This helps the divisions work together.                                                                                         
3:55:05 PM                                                                                                                    
DR.  ZINK  stated  that the  epidemiology  program  is  well-known                                                              
after the  pandemic. It is  concerned with disease  investigation.                                                              
The  section's  current  major  hurdle   is  a  rise  in  sexually                                                              
transmitted diseases,  especially syphilis and  tuberculosis (TB).                                                              
Alaska's  Health Analytics  and Vital Records  help to  understand                                                              
data  and  include birth  certificates,  death  certificates,  and                                                              
death  reviews. Although  the  cyber-attack  heavily impacted  the                                                              
team, it has  fully recovered. However, it still  faces challenges                                                              
due to the limitations of IT and data systems.                                                                                  
DR.  ZINK said  the State  Public Health  Laboratories program  is                                                              
vital  to Alaska's  entire health  care system.  The labs  provide                                                              
certain  services to  Alaskans  that other  healthcare  industries                                                              
cannot  provide.   Alaska  did  not  have   commercial  laboratory                                                              
testing   for  COVID-19   when   the   pandemic   began  and   was                                                              
deprioritized  in all the  commercial labs in  the Lower  48 based                                                              
on population  size. Therefore, Alaska's  local public  health lab                                                              
filled that  gap for multiple  months until the  commercial sector                                                              
could  take  over. The  labs  also  do a  significant  portion  of                                                              
Alaska's  HIV testing,  genomic sequencing,  Hepatitis C  testing,                                                              
and  many  other infectious  diseases.  Labs  are  a key  part  of                                                              
surveillance and understanding disease mitigation within Alaska.                                                                
DR.  ZINK  said  Public  Health  Nursing  is  the  hand  within  a                                                              
community  and  expressed  thanks for  the  nurses'  on-the-ground                                                              
support  and  work.  She  emphasized   that  the  age  restriction                                                              
previously  in  place  has been  removed.  Public  Health  Nursing                                                              
Centers are now open to serve people of all ages.                                                                               
3:57:03 PM                                                                                                                    
DR. ZINK stated  that Rural Community Health Systems  are a catch-                                                            
all,  overseeing  the  EMS system,  rural  systems,  and  hospital                                                              
capacity.   Currently,  the   program   is  looking   to  hire   a                                                              
Homelessness  Data Coordinator.  Rural Community  Systems is  very                                                              
involved  in   ensuring  hospital   systems  are  connected.   For                                                              
example,  during COVID and  more recently,  hospital systems  have                                                              
been overwhelmed.  Rural  Community Health  Systems runs a  huddle                                                              
with hospitals  and  has a clinician  that helps  to support  back                                                              
transferring,  moving  patients,  and working  with  the  Medicaid                                                              
 team to ensure payments  occur. Alaska must  use all resources  as                                                             
 it has  limited  healthcare  capacity.  Examples  of successfully                                                              
 utilized resources  are  Fairbanks  and Mat-Su,  which  now  offer                                                             
 dialysis.  Support  from  Rural   Community  Health  Systems   has                                                             
 allowed for expanded  capacity when hospitals  carry a burdensome                                                              
 load. Being able to expand support helps keep people in Alaska.                                                                
 3:58:05 PM                                                                                                                   
 DR. ZINK  said  that instead  of  county coroners,  Alaska  has  a                                                             
 State Medical Examiner's  Office, which  helps to identify  causes                                                             
 of death. The office  plays a critical  role in understanding  the                                                             
 opioid  epidemic  and   the  reasons  for   people's  death.   She                                                             
 expressed gratitude for the team.                                                                                              
 DR. ZINK said the Women's  Children's and Family Health unit  also                                                             
 does amazing  work  thinking  about family  partnerships  and  how                                                             
 women and  children can be  supported. The  unit will  play a  key                                                             
 role in the Healthy Families Initiative.                                                                                       
 3:58:35 PM                                                                                                                   
 COMMISSIONER-DESIGNEE HEDBERG stated she oversees the Division  of                                                             
 Public Assistance  and  would discuss  its programs,  the  backlog                                                             
 with the  Supplemental  Nutrition Assistance  Program  (SNAP)  and                                                             
 answer questions.  She  highlighted that  the Division  of  Public                                                             
 Assistance promotes  self-sufficiency  and provides  basic  living                                                             
 expenses to Alaskans  in need. The  division oversees 18  programs                                                             
 and provides public assistance  to one out of three Alaskans.  She                                                             
 named the categories and programs as follows:                                                                                  
 Food and Nutrition Assistance Programs                                                                                       
 Supplemental Nutrition Assistance Program, SNAP                                                                                
 SNAP Education Program, SNAP-ED                                                                                                
 Women Infant Children, WIC                                                                                                     
 Breastfeeding Peer Counseling Program                                                                                          
 Commodity Supplemental Food Program                                                                                            
 Farmers Market Nutrition Program                                                                                               
 Senior Farmers Market Nutrition Program                                                                                        
 Pandemic Electronic Benefit Transfer, EBT                                                                                      
 COMMISSIONER-DESIGNEE HEDBERG stated  that the Electronic  Benefit                                                             
 Transfer  program  was  administered   in  partnership  with   the                                                             
 Department of Education during  the pandemic to children  eligible                                                             
 for the free lunch program.                                                                                                    
 Primary Medical Programs                                                                                                     
 Chronic and Acute Medical Assistance (CAMA)                                                                                    
Senior and Disabilities Programs                                                                                              
Adult Public Assistance                                                                                                         
Senior Benefit Program                                                                                                          
Heating and Water Programs                                                                                                    
Heating Assistance Program                                                                                                      
Alaska Affordable Health Program                                                                                                
Water assistance Program (Started December 2022)                                                                                
Assistance for Families with Dependent Children                                                                               
Alaska Temporary Assistance Program                                                                                             
Childcare Assistance Program                                                                                                    
General Relief Assistance Program                                                                                             
Offers  emergent   basic  needs  for  shelter,   utilities,  food,                                                              
clothing,  or  burial.  Requests   are  predominantly  for  burial                                                              
COMMISSIONER-DESIGNEE  HEDBURG stated that  in addition to  the 18                                                              
programs  that the division  operates, it  also distributed  $95.5                                                              
million in  COVID relief funds  for childcare and  provided public                                                              
assistance to approximately 300,000 Alaskans per month.                                                                         
4:01:39 PM                                                                                                                    
COMMISSIONER-DESIGNEE  HEDBERG said  she assumed  the position  on                                                              
November 16,  2022. She stated that  she recognizes the  impact of                                                              
the  SNAP delays  on Alaskans  and  is focused  on solutions  that                                                              
will   address   the  immediate   crisis   and   mitigate   future                                                              
disruptions.  She has spent  two and  one-half months focusing  on                                                              
the  Division of  Public Assistance's  (DPA) programs,  workflows,                                                              
and  delays  to  identify solutions  to  immediate  and  long-term                                                              
needs. She  has listened  to clients,  agencies, unions,  advocacy                                                              
groups,  and  staff  to hear  their  frustrations,  concerns,  and                                                              
COMMISSIONER-DESIGNEE  HEDBERG stated the three  high-level causes                                                              
for the  backlog are  the Legacy IT  systems, a cyber-attack  that                                                              
delayed planned  improvements to  the IT  systems, and  the burden                                                              
of  the pandemic  that required  additional  manual processing  of                                                              
benefits using Excel documents.                                                                                                 
4:03:46 PM                                                                                                                    
COMMISSIONER-DESIGNEE  HEDBERG  stated that  she  visited the  DPA                                                              
office in  Anchorage to thank  two employees who  administered CPR                                                              
 to a  client.  She  also shadowed  an  eligibility  technician  to                                                             
 understand processing  issues.  She stated  that  the eligibility                                                              
 technician was  hired during the  pandemic to  assist with  manual                                                             
 processes. The eligibility technician's  office had four  computer                                                             
 screens, two  keyboards, one  computer, and  a pad  of paper.  The                                                             
 demonstration began by  pulling up information  from the  workflow                                                             
 management system. Forty minutes  later, the technician was  still                                                             
 processing the  request using  nine computer  systems to  transfer                                                             
 data. One system,  the Eligibility Information  System (EIS),  was                                                             
 created in 1959 using COBOL.  This demonstration provided  insight                                                             
 into the reasons for the backlog.                                                                                              
 4:06:51 PM                                                                                                                   
 COMMISSIONER-DESIGNEE HEDBERG  moved to slide  17 and stated  that                                                             
 the  nine systems  to  process  a  client's  application  are  not                                                             
 integrated and require  a login and logout  for each system.  Copy                                                             
 and pasting  information  is used  to  verify or  issue  benefits.                                                             
 Some of the  systems are relatively  up to date.  However, EIS  is                                                             
 predominantly used for SNAP,  and the department is still  looking                                                             
 for programmers  who know  COBOL and  can update  the system.  The                                                             
 department is working  with the Office  of Information Technology                                                              
 (OIT)  to   locate  available   contractors  to   reprogram   EIS.                                                             
 Currently, the department  has one state  employee who can  manage                                                             
 the maintenance  of the  system, but  help is  needed to  progress                                                             
 through the reprogramming.  The department  is focused on  finding                                                             
 programmers  to   reprogram  the   mainframe   and  alleviate   an                                                             
 identified pinch  point.  Once EIS  is updated,  programmers  will                                                             
 migrate  it  into  the  Integrated  Resource  Information   System                                                             
 (IRIS). IRIS  is easier to  program and  is not  connected to  the                                                             
 mainframe. Moving  SNAP  and the  other assistance  programs  from                                                             
 EIS to IRIS is a long-term solution.                                                                                           
 4:09:10 PM                                                                                                                   
 MS.  RICCI   stated  she   became  Deputy   Commissioner  of   the                                                             
 Department of  Health (DOH)  in November  2023 and  began  working                                                             
 with DPA to form a group  of technicians specifically assigned  to                                                             
 work through  older SNAP  recertifications and  applications.  All                                                             
 September recertification benefits  have been issued. The team  is                                                             
 currently  working  through   October  recertifications  and   has                                                             
 noticed  a   substantial   increase  in   the  daily   number   of                                                             
 recertifications being  processed.  However, the  processing  time                                                             
 should be better  for Alaskans in need  and entitled to  benefits.                                                             
 DPA  understands  and  is  entirely  focused  on  addressing   the                                                             
 problem with efforts underway.  Although the focus is on the  SNAP                                                             
 program, the backlog has  impacted specific Medicaid applications                                                              
 and renewals.  The team  focusing on processing  outstanding  SNAP                                                             
 applications  is the  same  team  that  would  be  processing  the                                                             
Medicaid  applications. This  shift  in focus,  combined with  the                                                              
overall   backlog    of   applications,   means    some   Medicaid                                                              
applications    are   delayed,    such    as   applications    not                                                              
simultaneously  submitted  with  the SNAP  application  and  those                                                              
stored in EIS that are coded as requiring recertification.                                                                      
MS. RICCI  stated that a compounding  factor is the influx  of new                                                              
applications  from  the  annual open  enrollment  period  for  the                                                              
Federally Facilitated  Marketplace (FFM).  The FFM is  also called                                                              
the  Health  Care  Exchange.  Applications   deemed  eligible  for                                                              
Medicaid are sent  to DPA for processing instead  of FFM. Although                                                              
typical,  the influx  of applications  adds to  the volume  of the                                                              
4:11:20 PM                                                                                                                    
MS.   RICCI  said   the  system's   limitations  make   processing                                                              
applications  challenging. It  is difficult  to estimate how  many                                                              
applications  are  delayed  because the  system  cannot  determine                                                              
duplicate  applications,  applications  that have  been  processed                                                              
and  may still  be  listed  in error,  or  those which  have  been                                                              
submitted  in   error.  Generally,  Medicaid  enrollment   can  be                                                              
retroactive  90 days  past  the day  an eligible  application  was                                                              
received. If  an individual  submitted their Medicaid  application                                                              
in  January   but  received   services  in   December,  and   that                                                              
application  is   later  processed   in  February,  the   services                                                              
received  in December  would  be  within those  90  days, and  the                                                              
claims reprocessed, which can be beneficial.                                                                                    
4:12:05 PM                                                                                                                    
COMMISSIONER-DESIGNEE HEDBERG  moved to slides 19 and  20 and said                                                              
she would  discuss the intent and  challenges of the  Virtual Call                                                              
Center (VCC). One  in three Alaskans relies on  public assistance.                                                              
Since the  inception of DPA, the  division has struggled  to serve                                                              
all  Alaskans equitably  because there  are only  11 DPA  offices.                                                              
The  solution  was to  create  a  virtual  call center  to  ensure                                                              
equitable  access   and  address  the  overcrowded   offices  that                                                              
sometimes have  had unsafe situations  for clients  and employees.                                                              
VCC went  live on  April 2021. The  goal was  to allow  clients to                                                              
phone  in, talk  with an  eligibility technician,  and have  their                                                              
applications  processed during  the call.  Between April 2021  and                                                              
September  2022,   when  a  client   called  and  spoke   with  an                                                              
eligibility technician,  the application was processed  during the                                                              
call. That changed  in October 2022 when DPA was  overwhelmed with                                                              
4:13:26 PM                                                                                                                    
 COMMISSIONER-DESIGNEE  HEDBERG  said that  in  October,  when  the                                                             
 call volume peaked at  2000 calls a day,  a change was  instituted                                                             
 that placed  newer eligibility  technicians  on the  Virtual  Call                                                             
 Center  (VCC)   to  collect   basic  information,   and   seasoned                                                             
 eligibility technicians  processed the  applications. This  change                                                             
 has allowed  clients to talk  with an  eligibility technician  and                                                             
 have  basic  questions  answered.   More  calls  are  also   being                                                             
 answered. In addition,  on Wednesdays, some  staff are reassigned                                                              
 from VCC  to  process applications.  She  stated  she understands                                                              
 that people  are  frustrated  with  call center  hold  times,  but                                                             
 calls end at the end of the day, and the next day starts anew.                                                                 
 4:14:51 PM                                                                                                                   
 COMMISSIONER-DESIGNEE   HEDBERG   stated   that   five   immediate                                                             
 solutions are being focused on  to address the backlog. The  first                                                             
 is pursuing contractors  to reprogram EIS  because it is  critical                                                             
 to pursuing other updates.                                                                                                     
 The second solution  is to  hire a temporary  contractor to  staff                                                             
 the VCC  while  seasoned state  employees  determine eligibility.                                                              
 DPA has informed the  union of this plan  and is working with  the                                                             
 Department  of  Administration  and  the  Department  of   Law  on                                                             
 emergency contracting.  Many avenues were  explored. The  decision                                                             
 was not taken lightly;  DPA needs to  get benefits out quickly  to                                                             
 Alaskans that are hungry and malnourished.                                                                                     
 4:17:08 PM                                                                                                                   
 COMMISSIONER-DESIGNEE HEDBERG  said third is  the need to  improve                                                             
 crisis communication.  Many Alaskans  are frustrated  and want  to                                                             
 know  what  the  department  is  doing  to  address  the  backlog.                                                             
 Unfortunately, all  three of the  department's Public Information                                                              
 Officer  (PIO)   positions  are   vacant.  Being   proactive   and                                                             
 communicating the  status  of  applications and  how  clients  can                                                             
 assist the  department would  help alleviate  frustration,  reduce                                                             
 the backlog,  and  prepare  for the  redetermination  of  Medicaid                                                             
 funding in April.                                                                                                              
 The fourth  immediate area  of  focus on  is staff  safety.  There                                                             
 have been  many threats  to the  staff in DPA  offices.  Workplace                                                             
 safety  is  paramount.  Requests  for  two  contracts  have   been                                                             
 initiated. The  purpose of one  contract is  to evaluate  security                                                             
 at all DPA  offices. The other  is to provide  security guards  at                                                             
 four DPA offices.  Finally, the  fifth solution  is the  continued                                                             
 recruitment of permanent  and temporary non-permanent eligibility                                                              
 4:19:15 PM                                                                                                                   
COMMISSIONER-DESIGNEE  HEDBERG  advanced to  slide  22 and  stated                                                              
her role  is to  listen and  meet with  advocates, providers,  and                                                              
clients  to   solve  problems.   She  provided  the   department's                                                              
response to eight solutions people have suggested to DPA:                                                                       
[Original punctuation provided.]                                                                                                
     1. Lengthen certification periods                                                                                          
COMMISSIONER-DESIGNEE  HEDBERG said the  department agrees  and is                                                              
implementing Food  and Nutrition Services (FNS) options  to change                                                              
SNAP certification  periods from six  months to 12 months  for all                                                              
SNAP households,  except  where household  members are elderly  or                                                              
disabled  and  have  no  earned  income.  Those  individuals  will                                                              
continue  to be  certified at  24 months.  Once EIS  reprogramming                                                              
has  been  completed,  testing  and   training  will  follow.  The                                                              
timeframe   for    implementation   is   May-June,    pending   no                                                              
     2. Waive unnecessary interviews                                                                                            
COMMISSIONER-DESIGNEE  HEDBERG  said  the department  agreed,  and                                                              
Alaska  received  a  waiver  from  FNS  granting  flexibility  for                                                              
applications  and  recertifications   from  October  1,  2022,  to                                                              
September 30, 2023.                                                                                                             
4:21:47 PM                                                                                                                    
       3. Streamline the review of housing, utilities, and                                                                      
     dependent care costs                                                                                                       
COMMISSIONER-DESIGNEE  HEDBERG  said  the  department  agreed  and                                                              
amended the  shelter and utility  expense verification  process to                                                              
temporarily suspend  the requirement  for verification  and accept                                                              
the  client's statement.  The amendment  streamlines workflow  and                                                              
increases eligibility processing timelines.                                                                                     
     4. Implement broad-based categorical eligibility                                                                           
COMMISSIONER-DESIGNEE   HEDBERG   stated   that   the   department                                                              
previously put this  consideration on hold when  the prior federal                                                              
administration proposed  a rule that  would have  nationally ended                                                              
broad-based   eligibility.  DOH   will  review   this  option   to                                                              
determine if it would be useful.                                                                                                
      5. Extend one month of SNAP benefits for all who are                                                                      
     delayed because of agency fault                                                                                            
COMMISSIONER-DESIGNEE HEDBERG stated the department found that                                                                  
eligibility technicians could not enter an additional month of                                                                  
benefits to a person's case because of system limitations.                                                                      
         6. Establish a cost effectiveness threshold and                                                                        
      compromise overpayment claims                                                                                             
COMMISSIONER-DESIGNEE HEDBERG said the department would review                                                                  
its practices and options under federal program rules.                                                                          
      7. Recruit and train more fee agents                                                                                      
 COMMISSIONER-DESIGNEE  HEDBERG  said  the  department  agrees  and                                                             
 recognizes fee  agents  are  a valuable  tool  in  supporting  the                                                             
 efficient administration  of SNAP  benefits. One  of the  barriers                                                             
 to expanding the use  of fee agents is  a federal regulation  that                                                             
 limits the use of  fee agents to those  communities not within  50                                                             
 miles of a DPA office. DPA  plans to expand fee agents by  seeking                                                             
 a  temporary  waiver  of  the  federal  regulation,  and  it  will                                                             
 increase its  outreach to  find individuals  willing  to serve  as                                                             
 fee agents.  DPA  does  have a  staff  member who  is  focused  on                                                             
 recruiting fee agents.                                                                                                         
 4:24:28 PM                                                                                                                   
      8. Improve website capacity                                                                                               
 COMMISSIONER-DESIGNEE  HEDBERG  stated  DPA  developed  an  online                                                             
 application   that   allows    clients   to   submit   supporting                                                              
 documentation online.  It  is  queued to  be  reviewed by  the  IT                                                             
 security office to ensure  the system meets the required  security                                                             
 elements. It is one of  the division's pinch points because  there                                                             
 is a long  list of  elements to address,  but only  one person  is                                                             
 assigned to work on the list.  Although it is in the queue,  there                                                             
 is no timeframe for its review.                                                                                                
 COMMISSIONER HEDBERG asked if there were any questions.                                                                        
 4:25:25 PM                                                                                                                   
 CHAIR WILSON  stated that  he  would like  the committee  to  hear                                                             
 about Commissioner-Designee   Hedberg and  Ms.  Ricci's  years  of                                                             
 experience and accomplishments.  He announced  that the committee                                                              
 could ask questions about the SNAP program.                                                                                    
 4:26:39 PM                                                                                                                   
 SENATOR DUNBAR  stated he  is curious about  federal requirements                                                              
 for SNAP and  the degree to  which they limit  the state. He  said                                                             
it  was possible  for the  state to  have issued  benefits for  12                                                              
months instead  of six  months since the  change is happening.  He                                                              
is disappointed to  hear that the length of time  for benefits was                                                              
not already  12 months  because it  would have  prevented much  of                                                              
the backlog. He  stated that property tax exemption  is issued for                                                              
12 months,  and vehicle registration  is for two years.  He opined                                                              
that it  is disappointing  to hear  benefits were  only given  for                                                              
six  months  because the  extended  period  would have  helped  to                                                              
prevent  the  backlog.  He  mentioned  that  senior  citizens  are                                                              
issued  the  benefit  for  two years  and  asked  whether  federal                                                              
regulation prevents two years from being offered to others.                                                                     
COMMISSIONER-DESIGNEE  HEDBERG said  DOH is  limited to 12  months                                                              
by FNS rules and regulations.                                                                                                   
4:27:47 PM                                                                                                                    
SENATOR DUNBAR  asked how fast DOH  can switch from six  months to                                                              
12 months of issued benefits.                                                                                                   
COMMISSIONER-DESIGNEE  HEDBERG  replied  that  the EIS  system  is                                                              
supposed to be updated  and tested by June. If  that transition is                                                              
smooth,  then processing  will be  faster.  Reprogramming is  IT's                                                              
priority because  benefits issued for  12 months will  improve the                                                              
department's efficiency.                                                                                                        
4:28:42 PM                                                                                                                    
SENATOR TOBIN asked  why only one programmer is  available for DPA                                                              
and  what  needs to  happen  to  ensure  all systems  have  enough                                                              
COMMISSIONER-DESIGNEE   HEDBERG  stated   that  the   department's                                                              
budget  provides for  10 IT positions.  In May  2021, the  systems                                                              
were overrun,  and there  was an  IT deficit.  The bifurcation  of                                                              
Health and  Social Services  has made it  possible to  dive deeper                                                              
into  issues at  DPA, such  as having  only  one programmer.  Many                                                              
people work  for IT,  but only one  knows the antiquated  computer                                                              
language, which is why DOH is seeking a contractor.                                                                             
SENATOR  KAUFMAN  asked if  DOH  utilized  any of  the  integrated                                                              
resource  loaded scheduling  concepts he suggested,  or would  DOH                                                              
stick with the matrix system.                                                                                                   
4:31:24 PM                                                                                                                    
COMMISSIONER-DESIGNEE HEDBERG  stated DOH developed the  IT matrix                                                              
out  of necessity  after the  cyber-attack  took down  all its  IT                                                              
systems.  DOH  categorically  went  through  all  its  systems  to                                                              
identify  needs and establish  manual processes.  The process  for                                                              
 approvals of IT systems,  whether off the  shelf or created,  also                                                             
 needed to  be  more organized.  It  was a  significant  burden  to                                                             
 Alaskans and DOH.                                                                                                              
 4:33:07 PM                                                                                                                   
 SENATOR GIESSEL  stated that  budget cuts  are familiar  and  that                                                             
 one in three Alaskans  depend on DOH  services. She asked how  the                                                             
 legislature could help DOH obtain staff.                                                                                       
 COMMISSIONER-DESIGNEE   HEDBERG  replied   that   completing   the                                                             
 current  roadmap of  splitting  the  departments  needs  to  occur                                                             
 before that  conversation  can  happen. A  needs  assessment  must                                                             
 happen across DOH and DFCS,  so that separating staff, resources,                                                              
 and knowledge is  fair and equitable. The  needs of each  division                                                             
 are different, and IT is focusing on immediate solutions.                                                                      
 4:34:34 PM                                                                                                                   
 CHAIR WILSON  asked for  a  timeframe of  when the  backlog  would                                                             
 cease once the items on slide 21 are addressed.                                                                                
 COMMISSIONER-DESIGNEE HEDBERG replied  that  she  is  asked   that                                                             
 question multiple  times  daily. However,  she  does not  have  an                                                             
 answer. Eligibility technicians  are very focused and making  good                                                             
 progress; currently,  the  backlog is  less than  900 applicants.                                                              
 The  department  can  provide  an  estimate  once  contracts   are                                                             
 CHAIR WILSON  stated it  would  take time  to manage  the  backlog                                                             
 once  systems and  other  efforts  are  in  place.  People  should                                                             
 expect it to take  a few months.  He congratulated the department                                                              
 on fixing the  backlog with  background checks  and restoring  the                                                             
 turnaround to four days.                                                                                                       
 4:36:39 PM                                                                                                                   
 SENATOR DUNBAR  asked  if the  department  could hire  an  outside                                                             
 time-limited contractor to  assist the one  person who is  working                                                             
 on the website.                                                                                                                
 COMMISSIONER-DESIGNEE HEDBERG stated  that DOH has been exploring                                                              
 that idea.  DOH  also  partners with  the  Office  of Information                                                              
 Technology (OIT). DOH has  given OIT a list  of its needs. OIT  is                                                             
 analyzing  that to  determine  who  can  help  with  the  security                                                             
 reviews for each of the security plans.                                                                                        
 4:38:08 PM                                                                                                                   
CHAIR  TOBIN  said  she  has  several   constituents  who  receive                                                              
benefits  that have  expressed interest  in  assisting. She  asked                                                              
where people find information on applying for a vacant position.                                                                
COMMISSIONER-DESIGNEE  HEDBERG stated  that it  is fantastic  that                                                              
people  want  to  help. The  positions  are  posted  on  Workplace                                                              
Alaska. People  interested in  applying should  check back  as the                                                              
posting  is  not  continuous  enrollment.  The  jobs  are  posted,                                                              
applicants are selected,  interviews are held, and  candidates are                                                              
chosen before the positions are published again.                                                                                
4:39:39 PM                                                                                                                    
SENATOR  TOBIN stated  she would  promote the  PIO positions.  She                                                              
worked  in the  non-profit  sector of  communications  for a  long                                                              
time and is an  advocate of crisis communications.  It is critical                                                              
SENATOR  KAUFMAN asked  what the  state is doing  to minimize  the                                                              
statistic  that 1 out  of 3  Alaskans need  public assistance.  He                                                              
opined that  while DOH  can be  beefed up,  what would reduce  the                                                              
workload  is a focus  on reducing  demand. He  stated he  has some                                                              
ideas  to discuss  later, but  central  to the  project should  be                                                              
demand reduction.                                                                                                               
4:40:40 PM                                                                                                                    
COMMISSIONER-DESIGNEE HEDBERG  replied that DOH has  a partnership                                                              
with Nine Star,  funded through the Division of  Public Assistance                                                              
(DPA). She  stated that her  vision is to  create an  easy on-ramp                                                              
so that Alaskans  can receive the  services they need and  a quick                                                              
off-ramp  that will  meet them  where  they are  and connect  them                                                              
with meaningful employment.                                                                                                     
SENATOR GIESSEL  stated that with meaningful employment  comes the                                                              
need  to solve  childcare concerns.  She asked  why Department  of                                                              
Commerce,  Community  and  Economic  Development  (DCCED)  is  not                                                              
involved  in  doing  background checks  as  part  of  professional                                                              
4:41:37 PM                                                                                                                    
MS. RICCI  clarified that a  background check takes  four business                                                              
days from  receiving a complete  application. The  application has                                                              
multiple  parts:  the  application,  a fee,  fingerprints,  and  a                                                              
background  check.  The  goal  of  the  department  is  a  35-day                                                               
processing  time. In  the fall  of 2022,  processing times  became                                                              
longer due to  staffing vacancies, attrition, and  the 2021 cyber-                                                              
attack,  which  had  a  ripple  effect  through  the  department's                                                              
 divisions. Healthcare  Services has  addressed the  issues and  is                                                             
 back to a processing timeframe of four days.                                                                                   
 4:42:58 PM                                                                                                                   
 SENATOR GIESSEL  asked if  the division requires  fingerprints  to                                                             
 be submitted on paper.                                                                                                         
 4:43:25 PM                                                                                                                   
 MS. RICCI  stated  that fingerprints  must  be  printed. It  is  a                                                             
 manual  process. The  Division  of  Public  Safety  processes  the                                                             
 fingerprints. Manual  processing is necessary  because IT  systems                                                             
 need connectivity  and  coordination  to be  electronic.  Security                                                             
 issues are also starting  to be realized  in other states.  Better                                                             
 methods are being  sought, but prioritizations  must also be  made                                                             
 regarding  staffing   issues,   fiscal  agent   transitions,   and                                                             
 technology deficits.                                                                                                           
 4:45:08 PM                                                                                                                   
 SENATOR DUNBAR stated his belief  that it is possible to make  the                                                             
 filing of  fingerprints  electronic. He  asked if  the department                                                              
 could use some of  the $15 million set  aside for its bifurcation                                                              
 to accelerate and pay for IT assets.                                                                                           
 COMMISSIONER-DESIGNEE HEDBERG  asked  for clarification  on  which                                                             
 funding he was proposing to use.                                                                                               
 SENATOR DUNBAR  replied  he was  not certain  of the  funding  and                                                             
 asked if either could be used.                                                                                                 
 4:47:08 PM                                                                                                                   
 HEATHER  CARPENTER,   Deputy  Director,   Department  of   Health,                                                             
 Juneau, Alaska, said that to  highlight how funding was spent  the                                                             
 department could  recirculate  last year's  funding  documents  to                                                             
 the committee members. She  clarified that the exact amount  given                                                             
 to the department  for bifurcation  was not $15  million. Most  of                                                             
 the funding was spent on  reclassifying positions. Two positions,                                                              
 Department Technology Officer  (DTO), and Administration  Services                                                             
 Director (ASD)  were added  to each  department.  There were  also                                                             
 strategic investments made that enabled work to be performed.                                                                  
 CHAIR WILSON asked her to define the acronyms.                                                                                 
 MS.  CARPENTER  explained  that  ASD  stands  for  Administration                                                              
 Services  Director.   The  position  is   also  called  Assistant                                                              
 Commissioner in  the  Department  of Health  because  it  oversees                                                             
 Finance and Management Services,  not just the budget. At DOH  the                                                             
 position is held by Ms. Josie Stern.                                                                                           
4:48:29 PM                                                                                                                    
CHAIR WILSON  said he  attended a  Medicaid Leadership  Conference                                                              
and heard  from the  federal director of  the Center  for Medicaid                                                              
Services  (CMS) and  others.  They discussed  how  it is  becoming                                                              
burdensome for CMS  to process 1115 Waivers. The  directors stated                                                              
it would  be faster and more  efficient to rewrite  state Medicaid                                                              
plans because of  the waiver's numerous legal  requirements. Also,                                                              
at  the federal  level, the  employees  who write  the state  plan                                                              
have  a lower  caseload than  those  who handle  1115 Waivers.  He                                                              
asked if  DOH has considered  rewriting Alaska's Medicaid  plan to                                                              
avoid the hurdles of the 1115 Waiver.                                                                                           
4:50:13 PM                                                                                                                    
MS. RICCI  stated she would follow  up with a more  robust answer.                                                              
However,  both processes  are  very intense.  Some  points in  the                                                              
state plan amendment  may be less intense. However,  it depends on                                                              
the page  because the  federal government  may review anything  on                                                              
the  same  page  as  the  paragraph   to  be  changed.  Therefore,                                                              
proposals are considered  carefully before requesting  a change to                                                              
the state plan.                                                                                                                 
4:52:25 PM                                                                                                                    
SENATOR DUNBAR  asked whether  the VCC system  that DPA  staff use                                                              
to enter  information and  process applications  could be  altered                                                              
so that clients could enter their own information.                                                                              
COMMISSIONER-DESIGNEE  HEDBERG  stated that  in  August 2022,  DPA                                                              
received  8000  SNAP recertifications  which  created  a  backlog.                                                              
That is  when the division  positioned new  employees at  the call                                                              
center to  take basic  information so  more experienced  employees                                                              
could process  the applications.  It is  the division's  intent to                                                              
return  to processing  applications through  the VCC,  once it  is                                                              
caught up.                                                                                                                      
4:56:20 PM                                                                                                                    
SENATOR  DUNBAR asked  if it  is  possible to  have clients  enter                                                              
their own  information into  the system,  so they  do not  need to                                                              
speak with the VCC.                                                                                                             
4:56:46 PM                                                                                                                    
COMMISSIONER-DESIGNEE   HEDBERG  said   that  having   eligibility                                                              
technicians  man the  VCC provides  equitable  access to  Alaskans                                                              
across  the state.  The forms  are  still paper.  The division  is                                                              
working  to  move the  application  process  online, but  all  the                                                              
pieces  of the  puzzle  must come  together  and fit.  There is  a                                                              
deficit  with  IT resource  and  IT  staff  so the  division  must                                                              
 prioritize what it  will work on first.  There are four  divisions                                                             
 within the department, and each  have priorities which is why  the                                                             
 department created a roadmap.                                                                                                  
 4:58:17 PM                                                                                                                   
 SENATOR TOBIN  said  that  Alaska is  diverse  geographically  and                                                             
 culturally,  so  it  is  important  to  provide  equal  access  to                                                             
 benefits by  providing  a variety  of ways  for people  to  apply,                                                             
 such as the  call center,  online, and paper.  She stated  concern                                                             
 about the  surge of  tuberculosis  (TB) and  sexually transmitted                                                              
 infections (STIs) in Alaska. She  asked if there is a correlation                                                              
 between the surge of TB and  the discontinuance of testing for  it                                                             
 in public schools.                                                                                                             
 4:59:18 PM                                                                                                                   
 DR. ZINK  replied that  DOH is  also concerned.  The epidemiology                                                              
 for TB cases  is primarily  in the  rural regions  of Alaska  but,                                                             
 more specifically,  the Yukon-Kuskokwim  Delta. Alaska  has had  a                                                             
 unique strand  of  TB for  a  long time.  From  the 1930s  to  the                                                             
 1950s, TB was the  cause of many deaths in  that area which had  a                                                             
 huge  historical  traumatic   impact.  She  stated  that   testing                                                             
 stopped   happening  at   schools   because   schools   were   not                                                             
 necessarily the best location.                                                                                                 
 5:00:00 PM                                                                                                                   
 DR.  ZINK  said   the  Center  for   Disease  Control  and   Curry                                                             
 International advised DOH  that TB testing  should be done in  the                                                             
 most  effective  way  possible.  For  instance,  directly  testing                                                             
 families upon  returning from fish  camp could  be more  effective                                                             
 than testing at  schools. The  reason for the  current high  rates                                                             
 of TB is multifactorial. First,  Alaska already had high rates  of                                                             
 TB. Then during the pandemic,  people were not being screened  and                                                             
 treated. TB  is a  disease that  is often  latent.  People do  not                                                             
 know they are  contagious and  spreading the disease.  It takes  a                                                             
 lot of time and  effort to identify those  cases and treat  people                                                             
 when they  are still  amenable.  The treatment  for TB  is  tough,                                                             
 which is a significant limitation.  Access to broadband so that  a                                                             
 patient has  direct  observational  therapy is  critical  for  the                                                             
 success and risk reduction of multi-drug-resistant TB.                                                                         
 5:00:49 PM                                                                                                                   
 DR. ZINK  stated  that  not  having broadband  or  a  health  care                                                             
 worker to  incentivize  patients to  take their  medication  every                                                             
 day for four to  nine months can  be problematic, particularly  as                                                             
 people  move  from  hubs  to  home.  Rural  communities  are  also                                                             
 congested,  which makes  for  easy  transmission.  Public  nursing                                                             
 positions  have  been   challenging  to   restaff  following   the                                                             
pandemic.  Partners have  been helping  DOH  by offering  leftover                                                              
COVID  funding   to  help  with  contact  tracing   and  strategic                                                              
planning. Funds  have been appropriated  in the governor's  budget                                                              
because TB  ravaged America  for years and  getting the  number of                                                              
cases in Alaska down is critical.                                                                                               
5:02:45 PM                                                                                                                    
CHAIR WILSON  said the DOH  would return  next week to  finish the                                                              
5:02:53 PM                                                                                                                    
There  being no  further business  to come  before the  committee,                                                              
Chair  Wilson adjourned  the  Senate  Health and  Social  Services                                                              
Standing Committee meeting at 5:02 p.m.                                                                                         

Document Name Date/Time Subjects
DOH Department Overview - DRP 01.23.2023.pdf SHSS 1/24/2023 3:30:00 PM
SHSS 1/31/2023 3:30:00 PM
SHSS Dept of Health Overview