CS FOR SENATE BILL NO. 57(FIN) am "An Act relating to home- and community-based services under the medical assistance program; relating to medical assistance for recipients of Medicaid waivers; establishing an adult care home license and procedures; providing for the transition of individuals from foster care to adult home care settings; and providing for an effective date." 2:11:25 PM Co-Chair Foster asked to hear from the Department of Health (DOH) on changes made to the legislation by the Senate. He noted the bill was the Senate version of HB 58 related to Medicaid assistance for adult homecare. TONY NEWMAN, DIRECTOR, SENIOR AND DISABILITIES SERVICES, DEPARTMENT OF HEALTH, thanked the committee for hearing the bill. The bill was the companion bill to HB 58, which he had presented to the committee the previous week. He reviewed the differences between the two bills. He explained that SB 57 included new language that would allow certain family members and others with a legal duty to support an individual to be allowed to be paid to provide personal care services to the individual under one of the Medicaid programs. The program was called Community First Choice (CFC) authorized under a subsection of the federal Social Security Act known as the 1915(k). Currently, under department regulations, certain family members including spouses, parents of minor children, and adult children of parents who were assigned guardianship, were prohibited from being paid to provide Medicaid funded personal care or home and community based waiver services unless a court order allowed it. He detailed that the prohibition had been lifted under the public health emergency out of concern that people would not be able to find caregivers during the pandemic. Mr. Newman continued to speak to the bill. He explained that the workforce shortages seen throughout the healthcare sector had been especially acute for providers of home and community based services. The experience the department gained offering the flexibility [under the public health emergency] as well as the findings from a provider survey, conversations with stakeholders, and national experience, had all suggested that with the proper safeguards the change could be continued on a permanent basis. The bill would allow a limited subset of people receiving Medicaid funded personal care to have a spouse or guardian be paid to help them with their bathing, feeding, or other activities of daily living. Mr. Newman relayed that if the bill passed and was signed by the governor, the department would write regulations that would enable it to ensure the program was done in a way that would ensure the safety and wellbeing of individuals receiving care. He emphasized that the original adult homecare aspects of the bill and the additional new pieces, would both be administered by the Division of Senior and Disabilities Services, but the bills did not directly impact each other otherwise. He detailed that adult homecare would be a waiver service, not a 1915(k) service; therefore, legally responsible individuals would not provide adult homecare to someone in their care. He stated that more details would have to be worked out through a careful regulatory development process that would include stakeholders. He noted an individual available online for questions and/or comment. 2:15:04 PM Co-Chair Foster stated his understanding that another bill had been rolled into the legislation. He which Senate Bill had been added to the legislation. Mr. Newman responded that SB 106 had been rolled into the legislation. Co-Chair Foster asked for verification that the fiscal notes had not changed. Mr. Newman replied that the fiscal notes had been prepared to reflect the new narrative, but there was no change to the amounts. Representative Josephson referenced Mr. Newman's statement that adult homecare would be a regular waiver and not a 1915(k). He asked for clarification. Mr. Newman responded that the original adult homecare bill referred to a Medicaid waiver service. The allowance for legally responsible individuals to provide personal care that had been added to the bill was not a waiver service and was referred to as a Community First Choice 1915(k) service. Representative Tomaszewski noted that Mr. Newman had used the term "legally responsible individuals." He asked for a definition of the term. Mr. Newman replied that Alaska regulations referred to individuals with a legal duty to support another individual. He detailed that it included a spouse of a recipient of services, the minor child of a parent, and an individual with the legal duty to support the recipient under state law (a guardian assigned by the court to an individual). He explained they were the three types of individuals needing care that would need to be amended under the regulation. Co-Chair Foster set an amendment deadline for Friday at 5:00 p.m. He requested any amendments to be sent to his office. Representative Josephson asked if the fiscal note was small because the cost would primarily be borne by the federal government. He noted he liked the bill. He asked how the state would pay the people who had not been paid before. He wondered if there would be additional fiscal notes forthcoming. Mr. Newman responded there were a couple of reasons there would not be an increase in the Medicaid services bill to the state. First, the bill would represent a very small number of individuals. Currently, the CFC program served around 850 people. He explained that a small subset of those individuals would be seeking to have care provided by a legally responsible individual. Second, the state was seeing a "slow bleed of providers" of home and community based services. There had been a decrease in the number of people served because of a loss of providers. He did not believe the bill would increase the pool of providers so much that it would stop the bleed of providers. He reported that the state had been offering the service under the pandemic and had not seen an increase in cost. The bill would mean maintaining flexibility for a small subset of people. Representative Josephson asked for verification that the slow bleed Mr. Newman was referring to meant that some of the non-familial providers were no longer providing the services and the bill would mean familial connections would get reimbursed for their good efforts. 2:20:50 PM Mr. Newman agreed. Co-Chair Foster noted that Co-Chair Edgmon joined the meeting. He remarked that Alexis Rodich was available online. He asked Mr. Newman if the individual was available for questions or had testimony to provide. Mr. Newman relayed that Ms. Rodich had worked closely with the sponsors in the development of the bills. He noted she may have a comment and was also available for questions. Representative Coulombe asked if the bill covered foster parents and adults taking care of their elderly parents. Mr. Newman replied that the bill covered adults taking care of their elderly parents if they were assigned guardianship of the parent. He remarked that the adults would currently be allowed if they were not assigned guardianship because they were not guardians. He noted it was not currently a prohibition in place. Under the regulation 7 AAC 127.015, a foster parent was not considered an individual with a legal duty to support a recipient. He noted it would remain unchanged. Representative Coulombe thought the bill aimed to fix a situation pertaining to disabled foster children through adulthood. Mr. Newman agreed that the original adult homecare bill was designed to provide better service to foster children aging out of foster care. The two bills were not connected in that way. He elaborated that the legally responsible individual portions of the bill would not be related to the adult foster care portions of the bill. Both would be administered by the Division of Senior and Disabilities Services, but they were two different services. 2:23:34 PM ALEXIS RODICH, SEIU-775, SEATTLE (via teleconference), relayed that she was available for questions. Co-Chair Foster restated the amendment deadline. CSSB 57(FIN) am was HEARD and HELD in committee for further consideration.