HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE January 19, 1994 3:00 p.m. MEMBERS PRESENT Rep. Cynthia Toohey, Co-Chair Rep. Con Bunde, Co-Chair Rep. Gary Davis, Vice Chair Rep. Al Vezey Rep. Pete Kott Rep. Harley Olberg Rep. Irene Nicholia Rep. Tom Brice MEMBERS ABSENT Rep. Bettye Davis (excused) OTHER LEGISLATORS PRESENT Rep. Jim Nordlund COMMITTEE CALENDAR Overview: Department of Health and Social Services Commissioner Margaret Lowe Jay Livey, Deputy Commissioner Kim Busch, Director, Division of Medical Assistance Jan Hansen, Director, Division of Public Assistance WITNESS REGISTER COMMISSIONER MARGARET LOWE Department of Health and Social Services P.O. Box 110601 Juneau, Alaska 99811-0601 Phone: (907) 465-3030 DR. PETER NAKAMURA, Director Division of Public Health Department of Health and Social Services P.O. Box 110610 Juneau, Alaska 99811-0610 Phone: (907) 465-3090 KIM BUSCH, Director Division of Medical Assistance Department of Health and Social Services P.O. Box 110660 Juneau, Alaska 99811-0660 Phone: (907) 456-33552 JAN HANSEN, Director Division of Public Assistance Department of Health and Social Services P.O. Box 110640 Juneau, Alaska 99811-0640 Phone: (907) 465-3347 SUZANNE PERRY, Regional Program Coordinator Division of Alcoholism and Drug Abuse Department of Health and Social Services P.O. Box 110607 Juneau, Alaska 99811-0607 Phone: (907) 465-2071 SHARON LOWE, Admistraive Officer Division of Public Health Department of Health and Social Services P.O. Box 110610 Juneau, Alaska 99811-0610 Phone: (907) 465-3090 ACTION NARRATIVE TAPE 94-02, SIDE A Number 000 CHAIR TOOHEY called the meeting to order at 3:03 p.m., noted the members present, announced the calendar, and introduced the Department of Health and Social Services members. (NOTE: Due to accidental erasure, tape count numbers 036- 199 have not been transcribed. This portion of the meeting contained testimony from Commissioner Margaret Lowe, whose prepared statement is on file. Her testimony has been pieced together from the prepared statement.) Number 200 COMMISSIONER MARGARET LOWE, Department of Health and Social Services (DHSS), read a prepared statement to the committee. (Attachment 1). In it, she informed the committee of legislation that the Department of Health and Social Services (DHSS) supports and also a summary of status in regards to specific programs within the department. She stated that health care reform, alcohol and tobacco excise tax, Governor Hickel's crime package, and senior services legislation were of particular interest to the department at that time. COMMISSIONER LOWE said that the Division of Mental Health and Developmental Disabilities (DMHDD) Medicaid refinancing for mental health services had proven successful. As of January, Medicaid revenues collected by grantees were greater than the entire previous year, and through Medicaid all grantees will have made up for funding cuts in fiscal 1994. Also, programs such as Project CHOICE waivers and Tax Equity Fiscal Responsibility Acts of 1982 (TEFRA) will help to reduce costs for facility or in-patient treatment by increasing home-based and community services for clients. COMMISSIONER LOWE said that the DHSS (the department) endorsed Governor Hickel's legislation to increase the excise tax on alcoholic beverages by 50%, expressing that the increase would reduce alcohol consumption among youths and not affect Alaskans who do not drink alcohol. She also supported the automatic waiver of juveniles 16 and over and stated that all five juvenile correctional facilities had been accredited. COMMISSIONER LOWE stated that protection and licensing for adults and children has been reorganized. The Division of Family and Youth Services (DFYS) will be responsible for protection and licensing for children, and adult concerns will be handled by the Division of Senior Services. COMMISSIONER LOWE talked about the replacement of Alaska Psychiatric Institute (API) in Anchorage. The plan is to provide designated treatment beds in existing facilities around the state and to replace API with a 90-bed facility and a 24-bed forensic facility. COMMISSIONER LOWE felt, in the area of public assistance, that the recipients were the result of the of lack of other preventative and supportive programs that prevent people from initially entering into the system. She suggested that they needed more staffing to assure containment and payment accuracy. COMMISSIONER LOWE commented on various successful programs and programs in need. Women, Infants, and Children (WIC) is expected to bring more federal funds into the state as the program grew by approximately 50%. Through Medicaid, Alaska Youth Initiative serves 130 youths which previously accommodated 100. Decline in suicide is the most significant in the villages that have grants from the department's rural program, Commissioner Lowe stated. Also, she cited the decreased reliance of foster care due to serving children in their own homes and shortening out- placement length of stay. COMMISSIONER LOWE expressed concern for severely emotionally disturbed children statewide, as research proved that there was a "great unmet need for mental health services." Number 531 (Rep. Brice arrived at 3:07) Number 538 REP. BUNDE asked the department about the teen pregnancy problem. Number 554 COMMISSIONER LOWE stated that she did not know of a concentrated effort that was taking place to curb teen pregnancy and referred to Dr. Nakamura. Number 567 DR. PETER NAKAMURA, Director, Division of Public Health, DHSS, said that the department agreed that teen pregnancy was a major area of concern that could be addressed through family planning and family health education programs. Number 583 REP. BUNDE asked if the rate of teen pregnancy was slowing. Number 586 DR. NAKAMURA could not give accurate numbers, but volunteered the statistic that better than 10% of births in Alaska are born to teen parents. Number 605 REP. BUNDE asked if single, pregnant teens received a monthly stipend from the state. Number 617 DR. NAKAMURA stated that the Women, Infants, and Children (WIC) program supplied supplemental food for pregnant woman, and the program was not limited to teens. REP. BUNDE felt it was inappropriate to give a cash stipend to teens and encouraged a coupon of sorts (i.e., food stamps). He asked if the state paid for sonograms for teens. Number 643 KIM BUSCH, Director, Division of Medical Assistance, DHSS, stated that under the Healthy Baby Initiative teen pregnancies are considered high risk, and if the teen is on Medicaid she is eligible for certain services through the state. REP. BUNDE asked again if there was a stipend for teens. MS. BUSCH replied she was unaware of any stipend through the state. Number 718 CHAIR BUNDE asked again if there was a "financial reward" for teens getting pregnant. Number 720 JAN HANSEN, Director, Division of Public Assistance, DHSS, stated that there was no available cash stipend through DHSS until the third trimester when the teen meets the requirements through Aid to Families with Dependent Children (AFDC) and a grant is allowed. Number 737 CHAIR TOOHEY said that a teen would not automatically be sent a stipend; they would have to apply through Medicaid or AFDC. Number 749 In reply to Rep. Bunde's question, MS. HANSEN stated that a teen in her first or second trimester does not receive a cash stipend. Number 756 (Rep. Kott arrived at 3:25) Number 763 REP. BUNDE asked the department's reaction to legislation in other states regarding state funding for teens to live on their own away from their family. Number 782 MS. HANSEN said that a task force in 1988 recommended that Alaska not adopt the requirement for teens to live in the home of the parent; the mind-set being that the state would not force a teen to live in an abusive environment. She stated that the Clinton Administration was proposing legislation to make pregnant teens live at home, and subsequent to national debate, would look again at the issue. Number 856 REP. G. DAVIS asked Dr. Nakamura if there would be any cost reductions in services provided by the state upon completion of the new Native hospital in Anchorage. Number 864 DR. NAKAMURA felt there would not be any significant changes. Number 880 REP. G. DAVIS asked Ms. Hansen about her opinion on welfare reform in Alaska in regards to legislation in Wisconsin. Number 888 MS. HANSEN answered that whatever demonstration projects that were being tested in Wisconsin and other states that had merit would be seriously considered by the department. Number 939 REP. BUNDE inquired as to whether or not the DHSS had an opinion on "two years and out" for Alaska, referring to present legislation in other states that allows for recipients to participate in the system for two years, exit the system, and then after only a brief period rejoin the system. Number 950 MS. HANSEN answered that she felt Alaska would not "just put people out" after two years, stating as a supporting factor that there are 12,500 families on AFDC and that there are not 12,500 jobs available. She supported an expectation of a time limit in the form of a contract between family and state and the utilization of the JOBS program. Number 022 CHAIR TOOHEY reminded the department of her "HEALTHY STUDENT" bill, stating that the bill addressed all the aforementioned youth problems (i.e., teen pregnancy, alcohol and tobacco consumption, and an increase in HIV) and asked for support from the department. CHAIR TOOHEY asked why there was a 30% increase of women and children in Aid to Families with Dependent Children (AFDC). Number 040 DR. NAKAMURA stated that WIC was given an additional $1,000,000 last year to serve more individuals, and the program was serving 40% of the eligible population. Number 050 CHAIR TOOHEY was reminded that it was the rebate process discussed in the subcommittee that made the additional $1,000,000 of no cost to the state. Number 063 CHAIR TOOHEY questioned the department about the criteria for participating in TEFRA. MS. BUSCH said the eligibility criteria was based on the child's income, regardless of the parent's income. Number 090 COMMISSIONER LOWE stated that TEFRA only covered children 18 and under for mid-level to severe level care for the developmentally disabled. Number 100 CHAIR TOOHEY asked the cost of the outcome study. Number 104 SUZANNE PERRY, Regional Program Coordinator, Division of Alcoholism and Drug Abuse, DHSS, stated that the contract was for $150,000. Number 123 CHAIR TOOHEY asked if there would be chronic beds at the new API. Number 128 COMMISSIONER LOWE said that there would be no chronic beds at the new facility, but API 2000 would facilitate tertiary care (care for the most complex cases necessitating a staff of psychiatrists). Primary and secondary care would be provided in regional hospitals around the state. TAPE 94-02, SIDE B Number 006 CHAIR TOOHEY asked how many beds API presently has. COMMISSIONER LOWE responded that there were 130 beds. CHAIR TOOHEY asked if the other beds would be taken up by the surrounding hospitals (ANS, Providence, etc.). Number 015 COMMISSIONER LOWE replied that there were still a fair number of long-term psychiatric or "nursing home" type of dementia patients. The department was looking to place some of those patients at Harbor View Developmental Center. Number 080 REP. NICHOLIA asked if there was data that showed the impact of the Rural Human Services program (also known as Village Counsellor program). Number 091 COMMISSIONER LOWE stated that the training program at the University of Alaska, Fairbanks for Rural Human Services had moved up to the certification level, and as it continues to grow, it benefits the villages. She said the data clearly reflected changes in alcohol habits and a lower suicide rate within the villages involved in the grant program. Number 141 REP. NICHOLIA asked for comment on the length of time on waiting lists for the rural communities for infant learning programs. Number 152 COMMISSIONER LOWE explained that there were waiting lists and acknowledged that the department was not meeting the needs of the program with the current budget. Number 160 SHARON LOWE, Regional Program Director, Division of Alcoholism and Drug Abuse, DHSS, remarked that hopefully the waiting list was not increasing, and cited the need for grantees and third party payers to apply to Medicaid for reimbursement to offset the $200,000 program receipts. Number 200 CHAIR TOOHEY asked if it was a statewide program or a Native program only. She was told by a number of participants that it was statewide and that there were waiting lists virtually everywhere. Number 208 REP. NICHOLIA asked if there were other crime bills besides SB 54 that the department was supporting. Number 215 COMMISSIONER LOWE responded that the department was working specifically with Senator Halford on youth waivers. Number 231 REP. BUNDE inquired as to the success/failure rate of treatment centers for alcoholism and drug abuse, commenting that there should be effective documentation evaluating treatment performance. Number 259 COMMISSIONER LOWE said treatment evaluation research was a difficult study as it must be done over a long period of time and there is no existing funding presently to facilitate a study over the span of time required for accurate assessment. Number 145 CHAIR TOOHEY briefly related her childhood struggle with family dysfunction and growing up with Alcoholics Anonymous (A.A.). She stated that recovery is such an "ongoing" process that one could not qualify an outcome until they die sober or from alcohol abuse. She stated further that the $125,000 should be put towards A.A. meetings and counselling. Number 340 CHAIR TOOHEY reminded the department of the state's fiscal status and said there would be future input needed from the department. Seeing no further questions or discussion, Chair Toohey adjourned the meeting at 3:56 p.m.