SB 98-ADULT HOME CARE; ADULT ADOPTION  4:12:42 PM CO-CHAIR ZULKOSKY announced that the next order of business would be SENATE BILL NO. 98, "An Act relating to medical assistance for recipients of adult foster care services; establishing an adult foster care home license and procedures; and providing for the transition of individuals from foster care to adult foster care homes." [Before the committee was CSSB 98(FIN), reported out of the Senate Finance Committee on April 12, 2022.] 4:13:29 PM JOHN LEE, Director, Division of Senior and Disabilities Services, Department of Health and Social Services, presented CSSB 98(FIN) on behalf of the bill sponsor, Senate Rules by request of the governor. He thanked the committee for considering the bill. He stated that he would be available for any question. 4:14:10 PM REPRESENTATIVE SPOHNHOLZ stated that she had supported the original version of the bill; however, she expressed concerns in the latest version about the inclusion of a new licensure category. She shared her understanding that the intent behind creating adult foster care is to establish continuity of care for adults aging out of their foster-care placement. She reported that a typical stipend for foster care is between $40 and $60, with a slight increase for foster children with disabilities. She expressed concern that a proposed stipend of $200 per day for adult foster care, combined with lower licensure requirements, could provide a monetary incentive for people to get licensed as a workaround of formal assisted living facilities. MR. LEE deferred to the deputy director. 4:17:58 PM TONY NEWMAN Deputy Director, Division of Senior and Disability Services, Department of Health and Social Services, answered questions on CSSB 98(FIN), on behalf of the bill sponsor, Senate Rules by request of the governor. He explained that the estimated stipend would be about $349, and this number was given to the committee to encompass all the possible services which would need to be compensated for, including the daily rate of $115, the costs of transportation, day habilitation, and other services the providers would be providing. He offered to provide the committee with a written breakdown of the different service rates and how the division arrived at the larger daily number. He reported that the division had consulted with the Office of Child Services (OCS) on appropriate stipend amounts, and the division had learned that a foster child could be eligible for other waiver services, for which the state would need reimbursement. REPRESENTATIVE SPOHNHOLZ expressed appreciation for the corrected stipend amount and pointed out the rate is five times higher than the child foster-care rate. 4:20:39 PM REPRESENTATIVE SNYDER expressed support for expanding care for the state's elders and those with disabilities; however, she pointed out the pushback on HB 292, which focuses on providing the lowest cost for health insurance for individuals receiving in-home care services. She reported that the concerns about HB 292 were in regard to maintaining and monitoring eligibility. She posited that the creation of a new category in CSSB 98(FIN) would introduce the same challenges. She requested clarification from the department. 4:22:21 PM MR. LEE explained that the two bills addressed completely different issues, which explains the different responses from the department. He stated that the full rates for adult foster care would need to be decided, but the proposed daily stipend is $115, which is not three to four times higher than child foster care. He stressed that the bill would allow certain seniors to transition from an institution to a home-like setting, and this would open options for individuals to return to or remain in their communities near loved ones while still receiving the services and supports they need. He opined that it would be an important option for the state to help manage costs as Alaska's population continues to age. 4:24:50 PM REPRESENTATIVE FIELDS shared his confusion about how the rates would compare to rates in other settings. He questioned whether the new setting would divert existing services from assisted living facilities or provide additional services. He expressed indecision on the breadth of the bill. 4:25:32 PM REPRESENTATIVE SPOHNHOLZ expressed reticence concerning the proposed legislation bill because of the fiscal note. She questioned how home-care homes would fit into the spectrum of service options. She expressed the need for more stakeholder feedback. She reiterated her support for the "lighter" version of the bill which focused on extending foster care services to adults and allowed for the adoption of adults. She expressed opinion that there is not enough understanding and stakeholder engagement to make a decision on the creation of a new care category. She opined that the fiscal notes were "a little light," considering the higher daily rate. She suggested that a more "granular" understanding of the issue is needed before pushing to move people from formal assisted living into home- care homes. She referenced conversations with professional care providers and foster parents who had questions which required very detailed answers. She stated that she is not prepared to dig into the answers two weeks before the end of session. She expressed appreciation of the intention of diversifying the spectrum of care available; however, she would only be comfortable with passing the House version of the bill which focused on adult foster care. She surmised that creating a new category requires more stakeholder alignment, along with a better understanding of the fiscal impact, of which, there is not time for this session. 4:29:10 PM REPRESENTATIVE PRAX expressed agreement with giving consumers another choice. He posited that creating a setting with lower licensure requirements may lead to a "lower level of care," but this could also be more affordable, create more business, relieving the pressure on assisted living facilities. He said he was in favor of additional options for care and offered support for the proposed bill. 4:31:19 PM CO-CHAIR ZULKOSKY announced that SB 98 was held over.