ALASKA STATE LEGISLATURE  SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  April 10, 2025 3:31 p.m. MEMBERS PRESENT Senator Forrest Dunbar, Chair Senator Cathy Giessel, Vice Chair Senator Matt Claman Senator Shelley Hughes MEMBERS ABSENT  Senator Löki Tobin COMMITTEE CALENDAR  SENATE JOINT RESOLUTION NO. 16 Urging the United States Congress to pass the Ensuring Lasting Smiles Act; and urging lawmakers to advocate for policies that guarantee equitable access to vital healthcare. - HEARD & HELD PRESENTATION(S): CITIZEN'S REVIEW PANEL - HEARD PRESENTATION(S): OFFICE OF CHILDREN'S SERVICES RESPONSE TO FY 2024 CITIZEN REVIEW PANEL REPORT - HEARD SENATE BILL NO. 45 "An Act relating to medical assistance services; relating to parity in mental health and substance use disorder coverage in the state medical assistance program; and providing for an effective date." - SCHEDULED BUT NOT HEARD PREVIOUS COMMITTEE ACTION  BILL: SJR 16 SHORT TITLE: FEDERAL ENSURING LASTING SMILES ACT SPONSOR(s): SENATOR(s) GRAY-JACKSON 04/02/25 (S) READ THE FIRST TIME - REFERRALS 04/02/25 (S) HSS 04/10/25 (S) HSS AT 3:30 PM BUTROVICH 205 WITNESS REGISTER SENATOR ELVI GRAY-JACKSON, District G Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Sponsor of SJR 16. EMILY BRUBAKER, representing self Anchorage, Alaska POSITION STATEMENT: Testified by invitation on SJR 16. RETCHENDA GEORGE-BETTISWOTH, Chair Citizen Review Panel Anchorage, Alaska POSITION STATEMENT: Offered the presentation Citizen's Review Panel. KIM GUAY, Director Office of Children's Services (OCS) Alaska Department of Family and Community Services Anchorage, Alaska POSITION STATEMENT: Offered the Office of Children's Services Response to the FY 2024 Citizen Review Panel Report. KIM KOVOL, Commissioner Alaska Department of Family and Community Services Anchorage, Alaska POSITION STATEMENT: Provided comments on the Citizen Review Panel presentation. ACTION NARRATIVE 3:31:28 PM CHAIR TOBIN called the Senate Health and Social Services Standing Committee meeting to order at 3:31 p.m. Present at the call to order were Senators Giessel, Hughes, Claman, and Chair Dunbar. SJR 16-FEDERAL ENSURING LASTING SMILES ACT  3:32:22 PM CHAIR DUNBAR announced the consideration of SENATE JOINT RESOLUTION NO. 16 Urging the United States Congress to pass the Ensuring Lasting Smiles Act; and urging lawmakers to advocate for policies that guarantee equitable access to vital healthcare. 3:32:45 PM SENATOR ELVI GRAY-JACKSON, District G, Alaska State Legislature, Juneau, Alaska, sponsor of SJR 16. She introduced the resolution, Ensuring Lasting Smiles Act, which urges Congress to require private health insurance coverage for the diagnosis and treatment of congenital anomalies and birth defects. She said coverage would include medically necessary services and items that improve, repair, or restore normal bodily function or appearance, as determined by the treating physician, with cost- sharing and coverage limits no more restrictive than those for other medical and surgical benefits. She stated that although rare, Hypohidrotic Ectodermal Dysplasia (HED) affects approximately 1 in 20,000 newborns worldwide and nearly 200,000 individuals in the United States. Treatment often requires both medical and dental care, yet many medically necessary dental services are inadequately covered, placing a significant financial burden on families. She said by passing this resolution, the Alaska Legislature would stand with families affected by congenital conditions and urge the Alaska congressional delegation to champion this legislation, affirming that access to essential medical and dental care is a right, not a privilege. 3:35:12 PM SENATOR HUGHES asked whether Medicaid covers these medical services. 3:35:51 PM SENATOR GRAY-JACKSON replied that she wasn't sure. 3:36:06 PM CHAIR DUNBAR asked Ms. Brubaker to answer the question and offer testimony. 3:36:16 PM EMILY BRUBAKER, representing self, Anchorage, Alaska, testified by invitation on SJR 16. She answered that Medicaid does not cover the specific medical services for rare congenital anomalies. She said these services are viewed as cosmetic and unnecessary. She continued with her testimony stating that at the age of two she was diagnosed with a genetic condition that affects teeth, hair and skin. 3:37:17 PM At ease. 3:37:26 PM CHAIR DUNBAR reconvened the meeting. 3:37:43 PM MS. BRUBAKER stated that she will require numerous dental procedures, with estimated out-of-pocket costs of approximately $100,000. The Ensuring Lasting Smiles Act (ELSA) would amend federal law to require private insurers to cover medically necessary procedures for individuals with rare congenital anomalies, significantly reducing this burden. She said that she has actively advocated for ELSA since childhood, traveling to Washington, D.C. multiple times and engaging with Alaska's congressional delegation. The legislation passed the U.S. House with a bipartisan supermajority in the 117th Congress and did not advance in the Senate. She said she hopes for reintroduction in the 119th Congress. She said with growing national and local support, including the Anchorage Assembly, ELSA would have a profound impact on families across Alaska and the nation. 3:40:20 PM SENATOR GRAY-JACKSON thanked the committee for hearing the resolution. 3:40:38 PM CHAIR DUNBAR held SJR 16 in committee. 3:40:44 PM At ease. ^PRESENTATION(S): CITIZEN'S REVIEW PANEL PRESENTATION(S): CITIZEN'S REVIEW PANEL    3:42:05 PM CHAIR DUNBAR reconvened the meeting and announced a presentation Citizen's Review Panel of the State of Alaska, presented by Dr. Retchenda George-Bettisworth. 3:43:24 PM RETCHENDA GEORGE-BETTISWOTH, Chair, Citizen Review Panel, Anchorage, Alaska, offered the presentation Citizen's Review Panel. She said she is in her fifth year on the Citizen Review Panel and her second year as chair. She currently serves as a faculty member in the Social Work Department at the University of Alaska Fairbanks. 3:44:16 PM MS. GEORGE-BETTISWOTH moved to slide 2, Purpose, and read the following: [Original punctuation provided.] PURPOSE Congress created Citizen Review Panels (CRPs) as part of the Child Abuse Prevention and Treatment Act (CAPTA) to help child protection systems be more responsive to community needs. A CRP is a mechanism for public participation in child protection. It should facilitate robust and meaningful participation by citizens to promote a healthy and collaborative child protection system 3:44:46 PM MS. GEORGE-BETTISWOTH moved to slide 3, Mandates, and read the following: [Original punctuation provided.] MANDATES Federal Mandate 42 U.S.C.§ 5106a.(c) Examine the policies, procedures, and practices of state and local child protection agencies and evaluate the extent to which these agencies are effectively carrying out their child protection responsibilities. Conduct public outreach both to assess the impact of current policies and procedures, and to solicit public comment on the panel's recommendations. State Mandate AS 47.14.205 The state Panel shall evaluate the extent to which the department is effectively carrying out its child protection responsibilities under (1) the state plan submitted to the United States Department of Health and Human Services under 42 U.S.C. 5106a(b); (2) child protection standards under federal and state laws; and (3) any other criteria that the Panel considers important to ensuring the protection of children 3:45:37 PM MS. GEORGE-BETTISWOTH moved to slide 4, Principal Functions of the CRP, and discussed the following: [Original punctuation provided.]   EVALUATION    The Panel will evaluate OCS compliance with federal and state laws, examining policies and procedures for consistent statewide implementation while still being responsive to the diversity of needs across the state PUBLIC OUTREACH  The Panel will identify and implement means to gather feedback on procedures and practices for delivering child protection services in Alaska. As specified above, the information thus collected will be utilized in its evaluation function. ADVOCACY  The Panel will conduct appropriate actions to help improve Alaska's child protection services system. MS. GEORGE-BETTISWOTH said CRP does not lobby; it educates others about its activities and priorities as a state board. 3:46:40 PM MS. GEORGE-BETTISWOTH moved to slide 5, Annual Report FY 24 OCS Recruitment Practices, and stated that the Citizen Review Panel's fiscal year begins July 1. The panel sets annual priorities, meets monthly, and issues recommendations each May in an annual report, to which OCS must provide a written response. She said that the 20232024 report focused on a healthy CPS system, particularly workforce recruitment and retention. While OCS's new centralized hiring system has improved efficiency, staffing challenges remain. The panel recommends greater flexibility in HR policies, a more attractive hiring process, and expanded flexible work options within OCS. 3:49:09 PM MS. GEORGE-BETTISWOTH moved to slide 6, Annual Report FY 24 Prevention Efforts, and stated that the CRP examined prevention by reviewing OCS policies and data related to intake screening and referrals to support services. She said child welfare reports are assessed and either screened in for investigation or screened out if they do not meet criteria; nationally, 74.3 percent of screened-in cases involve neglect, often after multiple reports. She stated that the panel focused on what occurs after reports are screened out and identified barriers to connecting families with prevention services. The panel found that greater collaboration with community organizations is needed and recommended learning from other states, strengthening partnerships, and improving review of screened-out case data to better connect families to supports. 3:51:14 PM MS. GEORGE-BETTISWOTH moved to slide 7, Two Phase Work Plan Cycle, and stated that the panel has adopted a new structured two-year work plan, updated annually, to prioritize key focus areas for improving child welfare services in Alaska. She said each priority is addressed through a two-phase work plan cycle. 3:51:38 PM MS. GEORGE-BETTISWOTH moved to slide 8, and discussed the following: [Original punctuation provided.] Phase one: Education and Knowledge Building -Focus Area Selection: The cycle begins with the Panel selecting key focus areas that will guide its efforts over the next two years. -Expert Engagement: The Panel identifies subject matter experts in the focus areas and requests data and presentations. -Knowledge Development: The Panel dedicates time to in-depth discussions and expert consultations specific to each focus area. -Synthesis and Planning: As each focus area progresses through Phase 1, the Panel reviews the information to inform planning for Phase 2. Phase two: Action and Implementation. -Translate Knowledge: This phase focuses on translating knowledge into actionable strategies and initiatives to address identified issues within the focus areas. 3:52:42 PM MS. GEORGE-BETTISWOTH moved to slide 9, CRP Current Focus Areas, and stated that the Panel's current focus areas are mandatory reporting and out-of-home placements. Mandatory reporting has been a cornerstone of child abuse and neglect prevention for decades and is particularly significant in Alaska, where rates are among the highest per capita. She said in phase one, the Panel has worked with OCS to review data on reporting volumes, outcomes, compliance, and training for mandatory reporters, while engaging experts and the public to identify challenges and improvements. In Phase two, the Panel is exploring screened-out reports, resource allocation, and expanded community involvement in reporting. She stated that out-of-home placements involve temporary care for children who cannot safely remain at home and include kinship care, therapeutic homes, foster homes, and residential services. She stated that the Panel will analyze data on placement stability, timeliness, and long-term outcomes; collaborate with OCS and providers to assess placement types; identify system strengths and gaps; and emphasize cultural and community connections. She said phase two focuses on action and implementation. 3:56:00 PM MS. GEORGE-BETTISWOTH moved to slide 10, Recommendations for FY 25, and read the following: [Original punctuation provided.] In spring 2025, the Panel will develop a set of recommendations based on findings from its focus areas to be included in an annual report. This will include actionable steps for the Office of Children's Services (OCS) to consider, such as: -Enhancing the mandatory reporting process to ensure timely, accurate reporting and effective use of resources. -Advocating for ongoing training and education for mandatory reporters and caregivers MS. GEORGE-BETTISWOTH said the Panel will continue engaging experts in subject matter to develop recommendations for its annual report. She said improving the well-being of Alaska's children and child welfare workforce requires collaboration beyond OCS and a shared statewide effort. 3:56:56 PM SENATOR GIESSEL referred to slide 9 on mandatory reporting and asked how much the Panel interacts with the child advocacy centers. MS. GEORGE-BETTISWOTH replied that the Panel does not directly interact with the child advocacy centers. 3:57:50 PM SENATOR GIESSEL asked what impact the CRP anticipates if the child advocacy centers were too close. MS. GEORGE-BETTISWOTH replied that if the centers closed it would be a major setback to the child welfare system. 3:59:47 PM SENATOR GIESSEL asked whether CRP discussed or considered whether the child advocacy centers (CACs) would be better positioned under the Department of Public Safety rather than the Department of Family and Community Services. MS. GEORGE-BETTISWOTH replied that the CRP has not had any discussion regarding what department CACs should belong to. 4:00:41 PM SENATOR GIESSEL suggested the panel give more attention to CACs, hence discussion about ongoing funding that would result in closure. 4:00:55 PM SENATOR HUGHES stated that there is concern about a potential sudden loss of federal funding for child advocacy centers. She also asked whether the panel is aware of the ROCK (Raising Our Children with Kindness) program in the PalmerWasilla area, which supported families with screened-out reports to prevent system involvement. She asked whether the program was considered successful, remained ongoing, and whether the Citizen Review Panel has considered recommending replication of that model. 4:02:08 PM MS. GEORGE-BETTISWOTH replied that The Citizen Review Panel may recommend replicating best-practice models statewide, however it does not evaluate or review individual programs. She said that she is professionally familiar with the ROCK Mat-Su organization. She values the organization's work; however she cannot speak to how the Citizen Review Panel (CPR) would address this specific situation. 4:03:00 PM SENATOR HUGHES noted that ROCK Mat-Su partners with OCS and suggested it may fall within the panel's purview for potential recommendations. She asked whether the review panel has considered alternatives to removing children from homes, such as temporarily removing parents and placing a relative or caretaker in the home to minimize disruption to the child's life. 4:04:11 PM MS. GEORGE-BETTISWOTH answered that removing a parent from the home has not been discussed as a panel. She stated her belief that OCS does not have the ability to remove a parent from a home they may own. She agreed that less disruption in a child's life is best. 4:04:59 PM SENATOR HUGHES stated that removing the parent from a home would take statutory changes and would be a sensible approach. 4:05:14 PM CHAIR DUNBAR reflected on constituent complaints about OCS, noting that while improvements may be possible, the work is often inherently difficult. He asked whether the panel reviews comparative data from other states and how Alaska's child welfare system is performing relative to others, based on the panel's perspective and annual reports. 4:06:09 PM MS. GEORGE-BETTISWOTH replied that the panel has not conducted a formal comparison of Alaska's child welfare system with other states, noting that while all states operate under CAPTA, each implements it differently. She said based on national child welfare data, Alaska appears generally comparable to other states, though it screens out a higher percentage of cases than the national average. The panel does not conclude that any one state performs child protection significantly better or worse than Alaska. 4:08:05 PM At ease. ^PRESENTATION(S): OFFICE OF CHILDREN'S SERVICES RESPONSE to FY 2024 CITIZEN REVIEW PANEL REPORT PRESENTATION(S): OFFICE OF CHILDREN'S SERVICES RESPONSE to FY  2024 CITIZEN REVIEW PANEL REPORT    4:08:21 PM CHAIR DUNBAR reconvened the meeting and announced the Office of Children's Services Response to FY 2024 Citizen Review Panel Report. 4:08:59 PM KIM GUAY, Director, Office of Children's Services, Alaska Department of Family and Community Services, Anchorage, Alaska, offered the Office of Children's Services Response to the FY 2024 Citizen Review Panel Report. 4:09:34 PM MS. GUAY moved to slide 2, Recruitment, and referenced the bar graph. She stated that OCS is improving recruitment and retention through a talent acquisition team that has streamlined hiring and reduced onboarding time. She said while applicant education levels have shifted, training has been adjusted accordingly. Initial implementation challenges have eased. To retain staff, OCS is investing in paid internships and professional development, including partnerships with the University of Alaska to support child welfare certification. 4:11:48 PM CHAIR DUNBAR referenced prior data showing very short average tenure at OCS, with a small group of long-term employees and high burnout rates compared to other state departments. He asked whether burnout remains high and whether employee retention data has improved. 4:12:34 PM MS. GUAY replied that she would give information to the committee. She said at the height of the pandemic, OCS experienced a 51 percent turnover rate among case-carrying staff, which has since decreased to around 37 percent. Anchorage currently has a 45 percent vacancy rate for case-carrying positions, with statewide vacancies at 33 percent. She said to address staffing shortages, OCS has centralized tasks such as placement searches and support for foster families, however high turnover and difficulty filling positions continue to challenge service delivery. Many workers leave quickly due to the demanding nature of the work. 4:14:47 PM SENATOR CLAMAN asked for clarification regarding whether the previously mentioned percentages referred to turnover rates or vacancy rates. 4:15:09 PM MS. GUAY replied that both were discussed. The turnover rates measure how often case-carrying staff leave and was 51 percent at the peak of the pandemic and is now 37 percent. She said although vacancy rates reflect current unfilled positions, both metrics are important to assess staffing challenges. 4:15:41 PM SENATOR CLAMAN asked if the 37 percent turnover rate among frontline staff refers to annual turnover, meaning over one- third of staff leave within the first year on the job. MS. GUAY answered that is correct. 4:16:02 PM CHAIR DUNBAR stated that even though all agencies eventually experience full turnover, losing 3751 percent of staff within a single year makes it extremely difficult to operate effectively. SENATOR HUGHES asked whether reducing caseloads in the past helped lower turnover and requested information on the history and impact of that effort. 4:16:43 PM MS. GUAY replied that House Bill 151, passed in 2018, aimed to reduce caseloads for new OCS staff to allow for proper training and onboarding. While OCS tries to cap caseloads during the first six months, high turnover and staffing shortages make this difficult. She said caseloads often exceed national recommendations, some staff carry 33 cases versus the recommended 1213, forcing prioritization to ensure child safety. Despite these challenges, OCS strives to serve all families and children effectively. 4:18:49 PM SENATOR HUGHES noted that House Bill 151 created additional positions. She asked whether filling current vacancies would bring caseloads closer to the national average and more manageable levels. 4:19:08 PM MS. GUAY replied yes, if all vacancies were filled, caseloads would be more manageable at 1014 cases per worker. However, challenges remain because applicants are scarce, staff turnover is high, and low pay and job difficulty contribute to short tenure. 4:19:41 PM MS. GUAY moved to slide 3, Employee Wellness and Retention, she stated that OCS has focused on staff retention using a framework adapted from the U.S. Surgeon General, emphasizing career development, emotional and psychological safety, and critical incident debriefings to support staff facing difficult situations. She said recent surveys show a significant increase in staff feeling valued at work, which OCS hopes will lead to improved retention over time. 4:21:09 PM MS. GUAY moved to slide 4, Workplace Communication, and stated that OCS is improving workplace communication through fireside chats, a monthly newsletter, a staff advisory board, and a supervisor leadership council. It is also prioritizing staff input and creating a supportive, valued work environment. 4:21:37 PM MS. GUAY moved to slide 5, Protective Services Reports (PSR) and Policies, and stated that OCS receives about 21,000 protective services reports annually, with 31 percent screened in for investigation and 69 percent screened out for reasons such as jurisdiction. She said reports outside the household are referred to law enforcement or other agencies. When appropriate, reports on Alaska Native families are shared with tribes under confidentiality agreements to support family services. 4:22:43 PM CHAIR DUNBAR referred to slide 5 and asked whether Alaska's 31 percent screened-in and 69 percent screened-out rate is typical compared to other states and whether Alaska screens in or screens out cases at a higher rate than the national average. MS. GUAY replied that Alaska screens out slightly more cases than the national average. She said differences in state laws, such as the number of mandated reporters required to file a report, affect these rates and the volume of calls received. 4:24:24 PM CHAIR DUNBAR asked how much a typical salary for a case-carrying employee is. MS. GUAY replied that starting salary is $25. CHAIR DUNBAR asked what the requirements are for the entry level position. MS. GUAY replied that OCS uses competency-based hiring for protective service specialists, focusing on key skills such as communication and critical thinking. Candidates are evaluated through interviews and reference checks instead of relying on minimum qualifications like a bachelor's degree or prior case management experience. 4:25:52 PM CHAIR DUNBAR stated at $25 an hour, or roughly $52,000 a year, protective service salaries in Anchorage are insufficient to afford housing. He said this makes recruitment and retention extremely difficult, especially without a pension. MS. GUAY said staff surveys indicate pay and job opportunities affect retention, with higher turnover in Anchorage due to other employment options. In Western Alaska, housing and lack of local hires are challenges, leading OCS to implement a week-on, week- off rotation for staff flying in to work. 4:27:24 PM KIM KOVOL, Commissioner, Alaska Department of Family and Community Services, Anchorage, Alaska, provided comments on the Citizen Review Panel presentation. She stated that OCS staff work hard and are committed to supporting families, while also improving customer service and ensuring access to needed services. Recruitment and hiring have been strengthened through the talent acquisition team, resulting in better staff stabilization, with legislative support aiding these efforts. 4:28:42 PM CHAIR DUNBAR asked about the potential impact on child advocacy centers if federal funding is lost and whether the state could continue supporting them, including the consequences of closure or reduced services. 4:29:17 PM COMMISSIONER KOVOL responded that OCS is exploring options for child advocacy centers (CACs), including whether they should move to DPS or remain with DFCS, while seeking additional federal funding and reviewing practices in other states. Despite bureaucratic challenges and new priorities, CACs provide specialized services and training for both custodial and non- custodial families, ensuring support even for families not involved with OCS. 4:30:40 PM SENATOR HUGHES asked for examples of CAC clients who aren't coming from OCS. COMMISSIONER KOVOL replied if a child's situation does not involve the family, the case is referred to law enforcement, as OCS's authority only covers familial cases. 4:31:50 PM There being no further business to come before the committee, Chair Dunbar adjourned the Senate Health and Social Services Standing Committee meeting at 4:31 p.m.