HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE April 1, 1997 3:03 p.m. MEMBERS PRESENT Representative Con Bunde, Chairman Representative Joe Green, Vice Chairman Representative Al Vezey Representative J. Allen Kemplen Representative Tom Brice MEMBERS ABSENT Representative Brian Porter Representative Fred Dyson COMMITTEE CALENDAR HOUSE BILL NO. 170 "An Act relating to interference with the rights of physically and mentally challenged persons; and relating to service animals during their training period." - MOVED CSHB 170(HES) OUT OF COMMITTEE HOUSE BILL NO. 197 "An Act relating to libraries." - MOVED HB 197 OUT OF COMMITTEE HOUSE BILL NO. 153 "An Act relating to the eligibility of aliens for state public assistance and medical assistance programs affected by federal welfare reform legislation; and providing for an effective date." - HEARD AND HELD (* First public hearing) PREVIOUS ACTION BILL: HB 170 SHORT TITLE: PHYS/MENTALLY CHALLENGED/ SERVICE ANIMALS SPONSOR(S): REPRESENTATIVE(S) BRICE JRN-DATE JRN-DATE ACTION 03/05/97 545 (H) READ THE FIRST TIME - REFERRAL(S) 03/05/97 545 (H) HES, JUDICIARY, FINANCE 03/25/97 (H) HES AT 3:00 PM CAPITOL 106 04/01/97 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 197 SHORT TITLE: PUBLIC LIBRARIES SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES BY REQUEST JRN-DATE JRN-DATE ACTION 03/14/97 668 (H) READ THE FIRST TIME - REFERRAL(S) 03/14/97 668 (H) HES 03/25/97 (H) HES AT 3:00 PM CAPITOL 106 03/25/97 (H) MINUTE(HES) 04/01/97 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 153 SHORT TITLE: ALIENS AND ASSISTANCE PROGRAMS SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR JRN-DATE JRN-DATE ACTION 02/24/97 442 (H) READ THE FIRST TIME - REFERRAL(S) 02/24/97 442 (H) STATE AFFAIRS, HES, FINANCE 02/24/97 442 (H) 3 FISCAL NOTES (DHSS) 02/24/97 442 (H) 2 ZERO FISCAL NOTES (DHSS) 02/24/97 442 (H) GOVERNOR'S TRANSMITTAL LETTER 03/11/97 (H) STA AT 8:00 AM CAPITOL 102 03/11/97 (H) MINUTE(STA) 03/13/97 (H) STA AT 8:00 AM CAPITOL 102 03/13/97 (H) MINUTE(STA) 03/15/97 (H) STA AT 11:00 AM CAPITOL 102 03/15/97 (H) MINUTE(STA) 03/17/97 690 (H) STA RPT 4DP 2NR 03/17/97 690 (H) DP: JAMES, ELTON, BERKOWITZ, DYSON 03/17/97 690 (H) NR: HODGINS, VEZEY 03/17/97 690 (H) 3 FNS (DHSS) 2/24/97 03/17/97 690 (H) 2 ZERO FNS (DHSS) 2/24/97 03/17/97 690 (H) REFERRED TO HES 03/25/97 (H) HES AT 3:00 PM CAPITOL 106 03/25/97 (H) MINUTE(HES) 04/01/97 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER JAY LIVEY, Deputy Commissioner Office of the Commissioner Department of Health and Social Services P.O. Box 110601 Juneau, Alaska 99811-0601 Telephone: (907) 465-3030 POSITION STATEMENT: Testified on HB 153 RICK TESSANDORE, Director Disability Law Center 615 East 82 Street, Number 101 Anchorage, Alaska 99518 Telephone: (907) 344-1002 POSITION STATEMENT: Testified in support of HB 153 SUZANNE GOODRICH, Executive Director Catholic Social Services 225 Cordova Street Anchorage, Alaska 99501 Telephone: (907) 277-2554 POSITION STATEMENT: Testified in support of HB 153 JANET OATES, Representative Providence Health System P.O. Box 196609 Anchorage, Alaska 99519 Telephone: (907) 261-4946 POSITION STATEMENT: Testified in support of HB 153 ACTION NARRATIVE TAPE 97-25, SIDE A Number 0000 CHAIRMAN CON BUNDE called the House Health, Education and Social Services Standing Committee meeting to order at 3:03 p.m. Members present at the call to order were Representatives Bunde, Green, Kemplen and Brice. Representative Vezey joined the committee at 3:05 p.m. Representatives Dyson and Porter were absent. This meeting was teleconferenced to Anchorage. HB 170 - PHYS/MENTALLY CHALLENGED/ SERVICE ANIMALS Number 0050 CHAIRMAN BUNDE announced the first item on the agenda was HB 170, "An Act relating to interference with the rights of physically and mentally challenged persons; and relating to service animals during their training period." He stated that the committee had adopted a committee substitute the last time the bill was heard. Number 0089 REPRESENTATIVE TOM BRICE said CSHB 170(HES) addresses a need. People in the disabled community, who rely on service animals for their independence, need to have properly trained service animals. Number 0133 CHAIRMAN BUNDE commented that these animals are worth $50,000 a piece and stated that he is sure they will be carefully cared for by their trainers. Number 0154 REPRESENTATIVE BRICE made a motion to move CSHB 170(HES) with individual recommendations and zero fiscal notes. Hearing no objection CSHB 170(HES) was moved from the House Health, Education and Social Services Standing Committee. HB 197 - PUBLIC LIBRARIES Number 0231 CHAIRMAN BUNDE announced the next item on the agenda was HB 197, "An Act relating to libraries." He noted that Representative Vezey had joined the committee meeting. Number 0305 REPRESENTATIVE BRICE made a motion to move HB 197 with individual recommendations and accompanying fiscal note. Hearing no objection HB 197 was moved from the House Health, Education and Social Services Standing Committee. HB 153 - ALIENS AND ASSISTANCE PROGRAMS Number 0363 CHAIRMAN BUNDE announced the next item on the agenda as HB 153, "An Act relating to the eligibility of aliens for state public assistance and medical assistance programs affected by federal welfare reform legislation; and providing for an effective date." Number 0421 JAY LIVEY, Deputy Commissioner, Office of the Commissioner, Department of Health and Social Services, said he was here to answer any questions. RICK TESSANDORE, Director, Disability Law Center, testified next via teleconference from Anchorage. He was in support of HB 153. The Disability Law Center provides legal services to people with disabilities. There are approximately 800 individuals who are scheduled to lose their benefits sometime between now and the beginning of the fiscal year. Many of these people have worked and lived in Alaska for many years. Some are now so disabled that they would not be able to pass any type of citizenship exam, using the same process people are accustomed to seeing during naturalization. For those who may be able to pass the test, it is not a speedy process. It takes a number of weeks, sometimes longer, to conduct all of the different background checks for these individuals so that they can become naturalized if they are eligible. It is difficult to find everyone because of geographical conditions and the language barriers. The center has been trying to identify individuals who are going to lose their benefits. MR. TESSANDORE explained that the Disability Law Center is partnered with the Catholic Social Services organization here in Anchorage, the Department of Health and Social Services (DHSS) through the Division of Public Assistance and with the Mental Health Trust Authority to try to help those people who are considered eligible for Supplemental Security Insurance (SSI) and are scheduled to lose those benefits. Many of those people are elderly people with dementia as well as other vulnerable adults who are attempting to become naturalized and need our help. The center is searching assisted living homes and nursing homes in order to find people who are incapacitated and unable to pass the civic or English exams. The center will help those individuals become naturalized using a waiver process, which was only approved last week. The center is struggling with a timeline and a crunch to get people naturalized whenever possible and to get waivers for those people who cannot pass the same naturalization test. Number 0601 MR. TESSANDORE referred to articles from the Anchorage Daily News explaining the plight of some of these people. He encouraged the committee to contact him if they had any questions. The center will continue to find people and get them through this process. The greatest fear of those people and families, who are going to lose their benefits, is the loss of the Medicaid benefits. People are relying on Medicaid for their essential health and are frightened that they will not receive it. This is especially true for family members who are incapacitated and possibly living in facilities now who wonder what they will do after the date passes. He urged support for HB 153. Number 0670 REPRESENTATIVE AL VEZEY asked for an explanation of the Disability Law Center. Number 0687 MR. TESSANDORE said the center is a statewide organization created in federal law in the 1970s to provide legal services to people with disabilities throughout Alaska. They can receive this legal assistance when one of the problem legal areas is based on their disability. Number 0704 REPRESENTATIVE VEZEY stated that he did not think anybody had the desire to take away a benefit available to most citizens just because a person becomes, through mental incapacitation, unable to meet current citizenship requirements. He asked how many of these people have family of the first or second degree of kindred which is part of their extended family here in Alaska. Number 0751 MR. TESSANDORE did not know the answer to this question. He has not talked to the family members. The center is searching out the individuals with disabilities in hopes that their family members have either contacted the immigration lawyers at Catholic Social Services or contacted the center. Number 0773 CHAIRMAN BUNDE questioned why the center was searching for those individuals. He thought that those people, scheduled to lose their benefits, would be proactive. Number 0798 MR. TESSANDORE explained that it is a combination of both. Those people are contacting the Division of Public Assistance and nursing home case managers who are then contacting the center. The center has recently spoken with Providence Extended Care who has indicated that a number of people have come to them with concerns. Number 0820 REPRESENTATIVE VEZEY asked him how he would feel if HB 153 were amended to exclude persons who have family members of the first degree of kindred. One of the things our welfare program assumes is that it is the government's responsibility to take care of our elders, rather than the family's responsibility. He reiterated the question that if people who had family of the first degree of kindred, who were capable of providing support, could be excluded from this program through an amendment to HB 153. Number 0855 MR. TESSANDORE responded that, not really knowing everyone's situation, he would make the assumption that families are doing all they can now. One of the areas which is of great concern, is that even those resources which are currently being used by the families are going to be cut more than in half because they will lose their federal cash assistance benefits. If HB 153 is passed, at least those who were here prior to August 22, 1996, will receive their medical benefits which are the most expensive benefits and would probably not be able to be provided by family members. He reiterated that losing these benefits has been the greatest concern to those people scheduled to lose their benefits. Number 0911 SUZANNE GOODRICH, Executive Director, Catholic Social Services (CSS), testified next via teleconference from Anchorage. She explained that there are two distinct groups of immigrants who are affected by welfare reform. The first group are those who are currently receiving some form of public assistance and whose benefits will be cut off. The second group includes those people who may have entered the country after August 22, 1996, and will not receive any assistance from federally funded health aid programs for five years. It is important to note that the immigrants being cut off assistance are lawful, permanent residents. They are in the country lawfully, they may have worked in the United States for many years, they may have families here, paid into social security and taxes. The immigrants affected are those who are lawful, but are not yet citizens of the United States. MS. GOODRICH said there may be many reasons why a lawful, permanent resident has not become a citizen. Citizenship is an emotional, lengthy and difficult process, especially for someone with a language barrier, a disability or another challenge. MS. GOODRICH stated there are 2,105 individuals who are currently receiving assistance, but are being cut off by the federal government. Within this group are 439 children under the age of 18, 641 over the age of 64. There are 801 aged, blind or disabled individuals. Number 1048 MS. GOODRICH explained that CSS has been assisting municipalities with a survey of immigrants who will be losing their assistance. The survey is not completed, but among those who have been spoken: a young man from Nicaragua with a wife and two children who are United States citizens; a 77-year-old woman from Poland who has not yet become a citizen although she has lived here many years; a young woman from Cambodia who has lived in the country 17 years; another from Tonga; and a 70-year-old woman from the Philippines who volunteers in a senior companion program in Anchorage. Number 1086 MS. GOODRICH commented that the second group includes those who will be coming into the country, who would have previously been eligible for assistance. One of the CSS programs is a shelter for women and women with children. Previously, when a young mother arrived at the shelter and was in need of some form of assistance in order to move into housing, obtain a job or receive food stamps, she would be referred out to the various federal or state agencies who could be of assistance to her. Under the new laws that are coming into play, CSS will no longer have those options available to them as a resource for referral. This creates a significant concern, especially among those agencies who provide shelter. In addition, there are those individuals who will be coming into the country now, or are in the country now but have not lived here for five years. Number 1162 MS. GOODRICH said the committee is considering legislation affecting immigrants. It is critical to consider the overall impact of welfare reform. At CSS, there is a commitment to doing more; to raise more money, to increase the amount of volunteers in order to pick up some of the responsibility in local communities, but they cannot do it all. In addition to the immigrant provisions mentioned, the total welfare reform package from the federal government affects an unduplicated 4,805 individuals. In addition to those 4,805 individuals who will lose some form of assistance across the state, we will have the responsibility to place in a work or work-related activity over 7,000 individuals in the next two years. Correspondingly, we will have a responsibility for the associated child care. Number 1210 MS. GOODRICH explained that time was needed to transition the myriad of changes as a result of the federal welfare reform and the current state reform. It is important to point out that CSS recognizes that some of the immigrants and others will find jobs, some may leave the state and some will have no resources. In order for our local communities to transition into the full impact of welfare reform, the state should consider its option to continue benefits for our Alaskan immigrants. MS. GOODRICH referred to an article written by Robert Karacker (Ph.) in the New York Times National, Sunday, February 23, 1997. This article discusses 40 states who have submitted state welfare plans to the federal government, specifically about immigrants. She quoted the article, "A surprisingly large number of states, 37 out the 40 filing states, said they would continue providing cash, welfare benefits to impoverished legal immigrants who have not yet become citizens, but were in the United States before August 22, when President Clinton signed the welfare bill. Only Alabama, South Carolina and Wyoming said they would not provide benefits to immigrants already in the country. Those who arrive on or after August 22, are generally ineligible for federal welfare benefits for five years." Number 1287 MS. GOODRICH said, in closing, please consider the full impact of welfare reform as the committee considers the continuation of benefits for immigrants. Number 1300 CHAIRMAN BUNDE commented that the committee appreciated all the good work that CSS has done in the past and continues to do. The legislature wishes to encourage as much responsibility for family members and sponsors when possible. Number 1322 REPRESENTATIVE VEZEY asked if CSS worked directly with the immigrants who would be affected. Number 1338 MS. GOODRICH said CSS has a program, the Immigration\Refugee Program. It is a program which exists among many of the Catholic charities organizations nationwide. Number 1351 REPRESENTATIVE VEZEY asked what degree of family involvement was seen. He asked if the immigrants were without immediate family or was it that their family was unable to offer assistance. Number 1371 MS. GOODRICH agreed with Mr. Tessandore's remarks that generally the experience has been that the extended families are doing as much as they can in order to support family members who are here. Number 1395 REPRESENTATIVE GREEN expressed confusion that we are extending services that would otherwise be cut off, yet the fiscal note in every case shows a savings. He asked how long we would continue services to immigrants. Number 1418 CHAIRMAN BUNDE guessed that it was a decrease in the rate of increase. Number 1428 MR. LIVEY explained that the fiscal notes are negative because it looks over time. If this bill were to pass, no new immigrants would come onto these programs for at least five years. This creates a static pool of people from which some people, in future years, will come out by moving away, some may die, some may get a job or something might happen to them and they will no longer be in the program. There are some potential savings in the future as people come off. In addition, there is nobody new coming into the program. It is really a combination of those two things, but the numbers in the fiscal note are based on an established pool of people that through attrition will become smaller over time. Number 1466 REPRESENTATIVE GREEN asked how this would correspond to not passing the bill. Number 1472 MR. LIVEY suggested that if HB 153 did not pass and a substitute bill were not introduced and passed, in other words there was no legislation, then Adult Public Assistance benefits would continue to be paid for those currently on the program as well as those individuals who came into the country after August 22, 1996. This is because the state has to go in and affirmatively change the law under Adult Public Assistance because currently there is no eligibility criteria under current law regarding immigration status. Under Adult Public Assistance it would cost the state more money. MR. LIVEY explained that under Alaska Temporary Assistance Program (ATAP) the same explanation would apply. The state would have to continue to provide benefits to individuals who came into the country after August 22, 1996, as well as all those who were here before that date which would result in additional costs to the program because the state would be picking up all the new people coming in after August 22, 1996. There is a twist to this, because the federal government has placed a five year ban on paying for means tested programs. For five years all of the payments made to those ATAP recipients would be state general funds. The state could not use any federal funds to match it because the federal government has said this can't be done for five years. This would be an increasing amount of money also. Number 1543 MR. LIVEY stated that with Medicaid the situation is just the opposite. Under Medicaid, if no bill passed, the state would not be able to provide health care services to any of those legal immigrants for five years whether they were in the country prior to August 22, 1996, or whether they come into the country after August 22, 1996. This is because of the way the current eligibility is written in state law for the Medicaid program. The eligibility is one of inclusion, you have to be specifically written into the statute to get a service and the Alaskan statute does not currently have these immigrants listed as receiving a Medicaid service. On the Medicaid side there would be some cost savings because all the people currently on Medicaid would come off and no new people would receive Medicaid. MR. LIVEY stated that he has not done a calculation which would generally sum up those two sides. The sum of the savings on the Medicaid side are mitigated because the state would still have to provide, under federal law, emergency medical services to all legal immigrants even if the Medicaid program hasn't picked them for all services. These services would include emergency room visits and hospital room stays. He said there would be an expectation of a cost shift from Medicaid to general relief medical which is the non-Medicaid health care program for indigents. Number 1643 CHAIRMAN BUNDE said that shortly before the last election there was a significant rate of increase for people becoming citizens. The election speeded up the process. He asked if there had been an increase in attempts or interest in becoming naturalized citizens. The federal reform bill passed August 22, 1996, and becomes effective in Alaska the beginning of fiscal year 1997. Number 1668 MR. LIVEY stated there have been nationwide stories in the news about the skyrocketing number of people applying for naturalization. They think that there will be a year waiting list before Immigration and Naturalization Services (INS) will even be able to get to applications. Number 1692 CHAIRMAN BUNDE referred to a newspaper article where some charitable program was working on citizenship. Number 1702 MS. GOODRICH explained that CSS is working with Disability Law Center and a number of grassroots organizations to help with naturalization classes. They are actually working with a program in Anchorage, they have also developed contacts and are developing outreach programs in Kodiak, Juneau, Fairbanks, and across the state. One of the challenges, specifically for the aged, blind, disabled group is the timeframe challenge in terms of helping individuals, especially those with disabilities, achieve their citizenship status. Number 1741 MR. TESSANDORE stated that it is true that the applications have increased dramatically. He added that INS travel to locales across the state as much as they can often isn't as timely as the applicants would wish. The Disability Law Center is trying their best to coordinate with INS to get as many people naturalized as possible during the visits. Number 1765 JANET OATES, Representative, Providence Health System, testified next via teleconference from Anchorage. She was speaking in support of HB 153. There are a number of individuals in the extended care facilities who are being impacted, about 11 people. Her organization is trying to assist them with obtaining citizenship. She talked with staff in the financial counseling area at the medical center who stated that there are two or three cases pending. It is hard for them to come up with dollar amounts and the implications. Her organization supports HB 153. It obviously has a time limit to it, so it is not an open ended expense. MS. OATES explained that her organization worked very hard at the federal level and was concerned, as a health organization, about the effects of welfare reform. They did their utmost to express their opinion there. In the future, her organization is going to be one of the recipients of that cost shifting. They are going to be people who fall through the gaps. This bill will help them a little bit. Number 1833 MS. OATES said that right now the involved people do not represent big dollars and they think that they will be able to deal with it. They are concerned that if these people aren't covered, then the families will be pushed into the Medicaid area anyway and it will be paid for in this way. Number 1892 MR. LIVEY referred to the kinship responsibility. If an amendment was added to HB 153 exempting those people who had a family member within the first degree of kinship, the family is going lose more than half of their current level of cash support even if this bill passes. They would also lose Medicaid. Even if family members in town could help them pick up some of the cash aspects or pay for some of the services that the cash would provide. Most of these individuals are disabled or elderly and it would be difficult for them to go out, get insurance or to be able to have someone purchase insurance on their behalf. The health care would still be a real problem. Number 1932 CHAIRMAN BUNDE asked if those people were not disabled when they came into the country, but have become disabled since they immigrated. Number 1943 MR. LIVEY answered that he could not tell him for a fact that everybody who was given immigrant status, prior to August 22, 1996, was not disabled. Those immigrants are certainly all disabled now and have passed the program criteria for disability or old age assistance. Number 1960 MS. OATES referred to a woman who had cancer, she did not have cancer as far as she knew when she entered the country. Number 1989 CHAIRMAN BUNDE said this bill would be heard again to allow input from Representatives Porter and Dyson. ADJOURNMENT There being no further business to conduct, CHAIRMAN BUNDE adjourned the meeting of the House Health, Education and Social Services Standing Committee at 3:40 p.m.