Legislature(2023 - 2024)BUTROVICH 205
01/24/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| Overview State of Alaska Department of Health | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
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
OVERVIEW
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-
sufficiency.
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
situation.
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
divisions:
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
division:
• 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
include:
• 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
as:
• $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
Medicaid
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
assistance.
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
solutions.
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
backlog.
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
callers.
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
technicians.
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
disruptions.
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
programmers.
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
signed.
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
work.
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
licensing.
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
presentation.
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 |