SB 266 - MEDICAID COVER/HEALTHY FAMILIES AK PROGRAM CHAIRMAN WILKEN asked Jay Livey to continue the presentation on SB 266, beginning with page 4, Chapter 19 (Section 9). JAY LIVEY, Deputy Commissioner of the Department of Health and Social Services (DHSS), asked Karen Pearson to address the section on the Healthy Families Alaska Program. KAREN PEARSON, Division of Public Health, DHSS, stated Chapter 19 contains two parts. The first part establishes the Healthy Families Alaska Program in statute and describes the program's operations. SENATOR GREEN asked if the Healthy Families Alaska Program has been a one year program in the past. MS. PEARSON responded the program has existed through appropriations. MS. PEARSON explained the Healthy Families Alaska Program has one main goal: to prevent child abuse and neglect. DHSS knows that most families function at the level they can and nurture and care for their children, but some families have certain stresses that place them at risk for abuse and neglect. Healthy Families, in the geographic areas that it serves, screens families for those risk factors. If a family chooses to accept services from the Healthy Families Program, a worker will discuss with the client the stresses that can lead to abuse and neglect, such as substance abuse, domestic violence in the home, a history of abuse of any kind in the family, and/or financial stresses. If the family chooses to enroll in the program, the family determines its goals and what services and assistance it needs from Healthy Families. Services available include assistance in getting substance abuse treatment, counseling, access to housing services, or a number of other things. Healthy Families Program workers simultaneously teach families appropriate expectations for young children so that parents use appropriate child rearing techniques. The program is geared to the individual family's needs and to help the family develop skills and abilities to deal with crises. The program is available to pregnant women and parents of newborns (AS 47.19.030) who can receive services for up to three to five years. Research has shown that lasting outcomes do not occur when programs are designed to help families deal with an immediate crisis. Families need help dealing with several crises until they develop their own coping mechanisms. MS. PEARSON explained Section 47.19.040 describes the duties of DHSS. It ensures that local agencies get the training and support they need to run a good program. The program is based on service delivery by paraprofessionals with the belief that people respond better to a worker who has the same experiences and cultural background. The most important characteristics of paraprofessionals are empathy and support. The paraprofessionals do not provide specialty counseling; they help the family access the professionals they need. This section also requires DHSS to establish screening and evaluation methods, and to ensure that all service providers work together to prevent duplication of services, to deal with problem resolution within the program, and to monitor and evaluate services for the sake of accountability. Section 47.19.050 pertains to the individualized support plan in which the family sets its own goals. The plan is reviewed and updated with the family on an ongoing basis. Section 47.19.900 addresses confidentiality and mandates that no records on any individual family ever be released. The only types of data that would be compiled by the program are aggregate numbers. Number 167 SENATOR GREEN asked if any place already exists where a person can receive the same services, in whole or in part, as those offered by the Healthy Families Alaska Program. MS. PEARSON replied some similar programs exist. The Head Start Program is a home-visit based program that provides services to children ages birth to three but its focus is on child development and school readiness. Other programs exist but use a different approach. The Healthy Families Alaska Program is specific to child abuse and neglect prevention. Head Start provides services to clients who are low income. The Healthy Families Program is not income based. SENATOR LEMAN asked whether the confidentiality section provisions would preclude a court order to provide records. MS. PEARSON said it would not. SENATOR LEMAN asked if existing DHSS regulation provides for that exception. MS. PEARSON said it does. Number 200 SENATOR GREEN asked if churches and synagogues are considered to be culturally appropriate and community based, and could provide services according to the language on page 5, lines 12 - 15. MS. PEARSON stated if Senator Green was questioning whether DHSS could give a grant to a church or synagogue to provide services, she could not answer at this time. She pointed out that several churches and synagogues have been involved because they are partnered with local agencies. DEPUTY COMMISSIONER LIVEY stated that DHSS does have the ability to give grants to religiously affiliated organizations because it already gives grants to Catholic Community Services in Juneau to provide various kinds of social services. SENATOR GREEN commented that churches were included, in the welfare reform legislation, as entities to provide services in places where no other agencies existed. She noted she would like to see religious organizations included in this bill as well. DEPUTY COMMISSIONER LIVEY responded that DHSS might be constrained by the requirement that the organization receiving the grant must be an organized, non-profit, social service organization. SENATOR GREEN asked Mr. Livey to develop language to provide for that ability. Number 236 CHAIRMAN WILKEN asked for information about the Healthy Families Programs in operation today. MS. PEARSON informed committee members that eight local agencies are operating in Alaska today. Seven of the programs are delivered through local agencies, the Kenai program is operated by DHSS staff. The Juneau program is administered through Catholic Community Services; DHSS funds one staff person in the Southcentral Foundation; there is a program in the Mountainview community of Anchorage, the Mat-Su Valley, Fairbanks; a program in the Bristol Bay area which combines funding with the ICWA program and provides services in some of the villages; and a program in Bethel. CHAIRMAN WILKEN asked the amount of the program's funding. MS. PEARSON replied the amount is $1.4 in grant monies, and about $270,000 for running the Kenai program. CHAIRMAN WILKEN asked if the program leverages any federal money. MS. PEARSON responded it does, but not in terms of the local agencies, except for the Southcentral Foundation. That foundation has a federal grant from the Maternal Child Health Bureau. Number 261 DEPUTY COMMISSIONER LIVEY made the following remarks about SB 266. DHSS's major focus in SB 266 is to ensure that children have good health care. The bill expands medicaid coverage for children whose family's income is up to 200 percent of the poverty level, and maintains the expansion for pregnant women at that same poverty level. DHSS believes that expanding health care coverage to 200 percent of the poverty level will complement the welfare reform program because a lot of welfare recipients returning to the work force will not have health care coverage. DHSS does not want people to quit jobs and apply for public assistance to get medicaid coverage for their children. By providing this program through a medicaid expansion, more federal money will be leveraged. SB 266 is a relatively inexpensive investment on behalf of the state in order to receive a lot of federal money. That money will help to build a health care infrastructure in rural Alaska. Deputy Commissioner Livey reminded committee members that something needs to be done this year or the state will lose its federal allotment of $5.6 million. DHSS believes this program is a good investment in terms of the benefits it will provide in the future. SENATOR GREEN asked what amount 200 percent of the poverty level equals. DEPUTY COMMISSIONER LIVEY replied for a family of three, the level of income would be about $33,000 per year, or about $16 per hour. Number 297 SENATOR GREEN asked if any thought has been given to using the same income guidelines in the eligibility requirements for all programs so that children at age 17 would be eligible at the same income level as children at age 7. DEPUTY COMMISSIONER LIVEY stated that approach makes sense because under the current guidelines, a 14 year in a family might not be covered by medicaid while a younger sibling is. Those eligibility requirements are complicated for the families and for program staff. DHSS wants all programs to set the eligibility requirement at 200 percent of the poverty level, regardless of the child's age. SENATOR GREEN asked if DHSS has determined the number of people who will be eligible at the 200 percent level, 175 percent level, 150 percent level, etc., and whether using the 200 percent income guideline will increase the number of eligible applicants to the point to where services cannot be provided to all. DEPUTY COMMISSIONER LIVEY explained that at the 133 percent level, DHSS could serve about 1600 additional children and no additional pregnant women because that group is already being served at that level. At the 200 percent level, DHSS could serve an additional 4,000 children and 781 pregnant women. At that level, DHSS estimates that coverage could be provided at a cost of $4 million in general funds which would leverage about $11 million in federal funds. Number 315 SENATOR GREEN questioned whether DHSS would eliminate some of its current programs because they will no longer be necessary and whether an overall reduction in costs might occur. DEPUTY COMMISSIONER LIVEY said the different programs are really parts of one program. The difference between them is the level of coverage a person qualifies for depending on his/her income. DHSS would wipe out the different income levels for eligibility determination and use one level. BOB LABBE, Division of Medical Assistance, DHSS, added that the current levels are the federal required minimum levels that all states must have. One of DHSS's goals is to have a common standard which will require a statutory change. DHSS believes that the 200 percent level is the most advantageous to maximize federal funds because Alaska's population is not that large. If any lower level is used, the state will not be taking full advantage of the federal block grant. He noted he provided an analysis of the numbers to Senator Parnell. Number 360 SENATOR GREEN questioned whether it is possible that this program will provide a disincentive to employers to provide health care coverage for employees. DEPUTY COMMISSIONER LIVEY replied that the question of how to prevent employers who are currently providing coverage from discontinuing that coverage has been considered by Congress and by this Legislature. The Robert Wood Johnson Foundation has studied other states who have established similar expansions. The Foundation concluded that if the expansion deals primarily with children then that kind of "crowd out" does not occur, nor does it occur until eligibility includes people above the 200 percent of poverty level. He noted DHSS has also looked at ways to put barriers up to keep individuals from crossing over from employer coverage to medicaid coverage. CHAIRMAN WILKEN welcomed Senator Ward. He then informed committee members that written testimony sent by people from Fairbanks had been placed in committee packets. Number 386 MARGO WARING, staff to the Alaska Mental Health Board, made the following comments. The Board has spent a fair amount of time discussing SB 266 and is very supportive of the expansion of medicaid coverage for children and pregnant women. The Board hears frequently, in discussions with parents, about the difficulty of accessing mental health coverage for children, particularly for low income families. The Board believes that access to early intervention services provided through Medicaid could make significant differences in the lives of children with emotional disturbances. Whatever costs are incurred through medicaid will be offset by preventing children from becoming involved with the state juvenile justice and other systems later on. Regarding the Healthy Families Program, the Board is cognizant of the importance of identifying high risk families and providing them with needed services. Reduction in the rates of abuse and neglect is essential to any kind of prevention and early intervention strategy of serious emotional disturbance in children later in their lives because abuse and neglect are one of the strong environmental factors that create serious emotional disturbances in children. SB 266 is a very cost effective intervention strategy because it targets those at risk families. Intervention will occur at birth, before children experience the traumas that can lead to later psychiatric difficulties. SENATOR GREEN asked whether the Alaska Mental Health Board has given direct grants to the Healthy Families Program from the Mental Health Trust. MS. WARING stated she did not believe so but would defer to someone else from the Trust for that answer. Number 427 TANA BULKLEY, a Healthy Families Alaska Program client, gave the following testimony. She is the mother of four children, ages 15, 13, 7, and a newborn. She was young when she had her first two children and did not have much of a family support system. She had a lot of trouble parenting at that young age, especially with her daughter, who was neglected and has been in treatment for several years. Ms. Bulkley was forced to do a lot of things on her own with her first two children. She finished her GED and returned to school in an attempt to succeed, but it was a struggle. She was not aware of any help available until her children were four or five years old. When her newborn was born, she was given a questionnaire at the hospital that asked her whether she wanted help through the Healthy Families Program. A worker comes to her home, provides her with reading materials, and offers child development tips. She emphasized the most important factor in the success of the Healthy Families Program is that the worker comes to the client's home, which is extremely important to mothers with newborns and infants. KIM CHAMPNEY stated she is completing her MSW by doing field work with the Healthy Families Program in Juneau. She felt strongly about coming to the hearing today because she has seen the impact the program has had on families she has worked with. Ms. Bulkley represents a group of parents who are not receiving home visiting services because the program is full right now but her situation is valuable to share because she has raised children with and without aid from the Healthy Families Program. Had Ms. Bulkley received services from the Healthy Families Program for her first two children, she would have been matched with a home visitor who would have helped her to identify her immediate needs such as adequate housing, child care, job training or employment opportunities among other things. Ms. Bulkley's daughter was involved in a serious accident when she was 18 months old. Had a family support worker been involved, the worker could have advocated for services such as physical therapy or respite care. The family support worker would have helped Ms. Bulkley learn effective parenting skills and the support could have lasted until her children were five years old. Her children entered the state system at about the age of five which could have been avoided had Ms. Bulkley had help from a family services worker. Ms. Bulkley's family is beating the odds and pulling together which is what the program is about. Ms. Champney stated it is important to establish the program in statute so that it can be implemented statewide in a uniform manner and be accountable to the public. CHAIRMAN WILKEN noted no one else was present to testify on SB 266. He informed committee members that a companion bill, HB 369, is moving through the House and he planned to see how the committee can help the efforts of that bill, or vice versa.