ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
April 19, 2001
3:07 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Chair
Representative John Coghill
Representative Gary Stevens
Representative Sharon Cissna
MEMBERS ABSENT
Representative Peggy Wilson, Vice Chair
Representative Vic Kohring
Representative Reggie Joule
COMMITTEE CALENDAR
HOUSE BILL NO. 197
"An Act relating to directives for personal health care services
and for medical treatment."
- HEARD AND HELD
HOUSE BILL NO. 180
"An Act requiring child services providers to obtain criminal
background checks for child services workers."
- HEARD AND HELD
HOUSE BILL NO. 65
"An Act relating to a new optional group of persons eligible for
medical assistance who require treatment for breast or cervical
cancer; and providing for an effective date."
- MOVED CSHB 65(HES) OUT OF COMMITTEE
HOUSE BILL NO. 209
"An Act directing the Department of Health and Social Services
to establish a foster care transition program; relating to that
program; and providing for an effective date."
- MOVED CSHB 209(HES) OUT OF COMMITTEE
HOUSE BILL NO. 84
"An Act relating to civil liability for emergency aid."
- BILL HEARING CANCELED
HOUSE BILL NO. 173
"An Act relating to establishing a screening, tracking, and
intervention program related to the hearing ability of newborns
and infants; providing an exemption to licensure as an
audiologist for certain persons performing hearing screening
tests; relating to insurance coverage for newborn and infant
hearing screening; and providing for an effective date."
- SCHEDULED BUT NOT HEARD
HOUSE BILL NO. 112
"An Act relating to information and services available to
pregnant women and other persons; and ensuring informed consent
before an abortion may be performed, except in cases of medical
emergency."
- SCHEDULED BUT NOT HEARD
PREVIOUS ACTION
BILL: HB 197
SHORT TITLE:HEALTH CARE SERVICES DIRECTIVES
SPONSOR(S): REPRESENTATIVE(S)HUDSON
Jrn-Date Jrn-Page Action
03/19/01 0649 (H) READ THE FIRST TIME -
REFERRALS
03/19/01 0649 (H) HES, JUD
03/28/01 0762 (H) COSPONSOR(S): KERTTULA
04/10/01 (H) HES AT 3:00 PM CAPITOL 106
04/10/01 (H) <Bill Postponed to 4/17>
04/17/01 (H) HES AT 3:00 PM CAPITOL 106
04/17/01 (H) Heard & Held
MINUTE(HES)
04/19/01 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 180
SHORT TITLE:BACKGROUND CHECK OF YOUTH WORKER
SPONSOR(S): REPRESENTATIVE(S)MCGUIRE
Jrn-Date Jrn-Page Action
03/13/01 0560 (H) READ THE FIRST TIME -
REFERRALS
03/13/01 0560 (H) HES, JUD
03/13/01 0560 (H) REFERRED TO HES
03/16/01 0636 (H) COSPONSOR(S): DYSON
04/10/01 (H) HES AT 3:00 PM CAPITOL 106
04/10/01 (H) <Bill Postponed to 4/19>
04/19/01 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 65
SHORT TITLE:MEDICAL ASSISTANCE:BREAST/CERVICAL CANCER
SPONSOR(S): RLS BY REQUEST OF THE GOVERNOR
Jrn-Date Jrn-Page Action
01/16/01 0099 (H) READ THE FIRST TIME -
REFERRALS
01/16/01 0099 (H) HES, FIN
01/16/01 0099 (H) FN 1: (HSS)
01/16/01 0099 (H) GOVERNOR'S TRANSMITTAL LETTER
04/19/01 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 209
SHORT TITLE:PROGRAM FOR FORMER FOSTER CHILDREN
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
Jrn-Date Jrn-Page Action
03/23/01 0706 (H) READ THE FIRST TIME -
REFERRALS
03/23/01 0706 (H) HES, FIN
03/27/01 (H) HES AT 3:00 PM CAPITOL 106
03/27/01 (H) Scheduled But Not Heard
04/17/01 (H) HES AT 3:00 PM CAPITOL 106
04/17/01 (H) Scheduled But Not Heard
04/19/01 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
PAUL MALLEY, Program Manager
Aging with Dignity
(No address provided)
Tallahassee, Florida 32302
POSITION STATEMENT: Testified on HB 197.
REPRESENTATIVE LESIL McGUIRE
Alaska State Legislature
Capitol Building, Room 418
Juneau, Alaska 99801
POSITION STATEMENT: Testified as sponsor of HB 180.
JACK BOWEN
11224 Via Balboa
Anchorage, Alaska 99515
POSITION STATEMENT: Testified on behalf of himself on HB 180.
DICK BLOCK
Christian Science Committee Publication of Alaska
360 West Benson
Anchorage, Alaska 99503
POSITION STATEMENT: Testified on HB 180.
KAREN PERDUE, Commissioner
Department of Health & Social Services
PO Box 110601
Juneau, Alaska 99811
POSITION STATEMENT: Testified on HB 65.
MARY DIVEN
Alaska Breast and Cervical Cancer Early Detection Program
Maternal, Child & Family Section
Division of Public Health
Department of Health & Social Services
PO Box 110601
Juneau, Alaska 99811
POSITION STATEMENT: Answered questions on HB 65.
BARBARA DuBOIS
2500 Curlew Circle
Anchorage, Alaska 99515
POSITION STATEMENT: Testified on behalf of herself in support
of HB 65.
MARCIA HASTINGS, Women's Health Director
Young Women's Christian Association
7136 Candace Circle
Anchorage, Alaska 99816
POSITION STATEMENT: Testified in support of HB 65.
CARLA WILLIAMS
13001 Norak Place
Anchorage, Alaska 99516
POSITION STATEMENT: Testified in support of HB 65.
CAREN ROBINSON
Alaska Women's Lobby
PO Box 33702
Juneau, Alaska 99811
POSITION STATEMENT: Testified in support of HB 65.
JENNIFER RUDINGER, Executive Director
Alaska Civil Liberties Union
PO Box 201844
Anchorage, Alaska 99520
POSITION STATEMENT: Testified in support of HB 65.
SHARON YERBICH
6114 Prosperity Drive
Anchorage, Alaska 99504
POSITION STATEMENT: Testified in support of HB 65.
ROBIN SMITH
14100 Jarvi Drive
Anchorage, Alaska 99515
POSITION STATEMENT: Testified in support of HB 65.
COLLEEN MURPHY, M.D., Obstetrician-Gynecologist
3260 Providence Drive
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 65.
NANCY WELLER, Manager
State, Federal and Tribal Unit
Division of Medical Assistance
Department of Health & Social Services
PO Box 110660
Juneau, Alaska 99811
POSITION STATEMENT: Testified on HB 65.
MELANIE LESH, Staff
to Representative Bill Hudson
Alaska State Legislature
Capitol Building, Room 502
Juneau, Alaska 99801
POSITION STATEMENT: Testified on behalf of the sponsor of HB
197.
MARIE DARLIN
AARP
415 Willoughby Avenue
Juneau, Alaska 99801
POSITION STATEMENT: Testified in support of HB 197.
LORILYN SWANSON, Manager
Fireweed Place
3101 Riverwood Drive
Juneau, Alaska 99801
POSITION STATEMENT: Testified in support of HB 197.
EUGENE DAU, Volunteer
AARP
PO Box 20995
Juneau, Alaska 99802
POSITION STATEMENT: Testified in support of HB 197.
LINDA FINK, Assistant Director
Alaska State Hospital and Nursing Home Association
426 Main Street
Juneau, Alaska 99811
POSITION STATEMENT: Testified on HB 197.
THERESA TANOURY, Director
Division of Family & Youth Services
Department of Health & Social Services
PO Box 110630
Juneau, Alaska 99811
POSITION STATEMENT: Testified on HB 209.
CHRIS CROMER
(No address provided)
Anchorage, Alaska
POSITION STATEMENT: Testified on behalf of himself on HB 209.
TIMOTHY SPENGLER
Division of Family & Youth Services
Department of Health & Social Services
PO Box 110630
Juneau, Alaska 99811
POSITION STATEMENT: Testified on HB 209.
AL SUNDQUIST, President
Alaska Chapter
Americans United for Separation of Church & State
3384 Mount Vernon Court
Anchorage, Alaska 99503
POSITION STATEMENT: Testified in opposition to HB 209.
RANDALL LORENZ, Staff
to Representative Fred Dyson
Alaska State Legislature
Capitol Building, Room
Juneau, Alaska 99801
POSITION STATEMENT: Testified on HB 209 in reference to
testimony on constitutional rights.
ACTION NARRATIVE
TAPE 01-46, SIDE A
Number 0001
CHAIR FRED DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:07 p.m.
Representatives Dyson, Coghill, Stevens, and Cissna were present
at the call to order. Representatives Kohring and Joule arrived
as the meeting was in progress.
HB 197-HEALTH CARE SERVICES DIRECTIVES
CHAIR DYSON announced that the first order of business would be
HOUSE BILL NO. 197, "An Act relating to directives for personal
health care services and for medical treatment."
Number 0086
PAUL MALLEY, Program Manager, Aging with Dignity, testified via
teleconference. He stated that [Aging with Dignity] is a
national nonprofit organization with offices in Washington
[D.C.] and Miami. The headquarters in Tallahassee, Florida, are
where the Five Wishes advanced directive is distributed
throughout the country. He explained that within two weeks of
Five Wishes being introduced in Florida in 1997, there were more
than 50,000 requests from people all over the country who wanted
a copy of the Five Wishes. So many people were interested
because it is easy to use and it includes many of the issues
that matter most to people, including some of the non-medical
issues.
MR. MALLEY stated that once [Aging with Dignity] started
receiving requests, it began to work with the American Bar
Association to make the document completely valid. It added a
commission dealing with legal problems of the elderly and
expanded the law of 50 states regarding advanced care planning.
He stated that when Five Wishes was introduced in 1998, it was
valid in 33 states. All of the 33 states had a suggested
advanced directive form, but the residents were given the
opportunity to put their wishes in their own words. Since then
it has become legally valid in an additional two states -
California and West Virginia. Both of those states enacted laws
in the past two years that made Five Wishes valid, but they did
not include Five Wishes in the state statutes. He noted that in
some cases it was a matter of changing one word, from "the
advanced directive must be in the following form" to "the
advanced directive may be in the following form."
MR. MALLEY said [Aging with Dignity] is now working with people
in several states who are trying to change their [state] laws to
make Five Wishes legally valid. [Aging with Dignity] is also
working with more than one million American families and 3,000
organizations, all of which have copies of Five Wishes and are
using it. The greatest interest is coming from some states
where Five Wishes is not legally valid. He stated, in closing,
that he would like to congratulate and thank the committee for
even considering this legislation, which [Aging with Dignity]
believes will greatly help the people of Alaska put their wishes
in their own words and therefore get the kind of care they want
at the end of life.
Number 0376
CHAIR DYSON asked what forces a hospital to comply [with the
advanced directive].
MR. MALLEY responded that [hospitals] are bound by the laws of
the state, which require that the advanced directive be followed
if it meets requirements in the state statute. He said counsel
for the Council of the American Bar Association believe that
Five Wishes would stand up in court in all 50 states because of
the so-called Patient Self-determination Act, which is a
national Act that requires health care providers to be involved
with individuals' wishes. He added that [Aging with Dignity]
has not had one instance in which an individual who filled out
Five Wishes did not have his or her wishes honored.
CHAIR DYSON asked what the penalty is if an institution does not
[honor the Five Wishes].
MR. MALLEY answered that he believes that would probably vary by
state.
CHAIR DYSON asked whether Mr. Malley knows of any states that
have criminal or civil penalties if the directives are not
followed.
MR. MALLEY responded that he knows there have been several
instances in which criminal suits have been filed against health
care providers who have not followed an individual's wishes that
were spelled out in a legally valid advanced directive.
CHAIR DYSON stated that it appears to him that this form is
directed to elderly people and not necessarily to those who are
facing life-threatening diseases earlier in life.
MR. MALLEY stated that this is good for anyone who is 18 or
older. He remarked that [Aging with Dignity] is working with
companies to institute a program that would provide Five Wishes
as an employee benefit. He said [Aging with Dignity] encourages
people to fill out Five Wishes, or any advanced directive,
before they get seriously ill.
CHAIR DYSON stated that in the first hearing of this bill [the
committee] discussed whether or not the form itself ought to be
put in state law, as opposed to being referenced in law.
MR. MALLEY stated that he thinks it would be better to reference
the form rather than including the actual document, word for
word, in the state's statute. He said there hasn't been a state
to do that yet. He explained that if there were any changes to
Five Wishes, [Aging with Dignity] would have to come back to
[the legislature] and ask for another statute to be passed for
the revisions.
[HB 197 was suspended temporarily in order to hear other
legislative business.]
HB 180-BACKGROUND CHECK OF YOUTH WORKER
CHAIR DYSON announced that the next order of business would be
HOUSE BILL NO. 180, "An Act requiring child services providers
to obtain criminal background checks for child services
workers."
Number 0735
REPRESENTATIVE LESIL McGUIRE, Alaska State Legislature, came
forth as sponsor of HB 180. She requested a motion to adopt the
committee substitute (CS), version 22-LS0642\P, Lauterbach,
4/9/01, as the working document.
CHAIR DYSON asked if there was any objection to adopting the
proposed CS as a work draft. There being no objection, Version
P was before the committee.
REPRESENTATIVE McGUIRE stated that HB 180 requires background
checks of volunteer child service workers. A man from her
district would share his story [with the committee]. Three of
his four children have been victims of sexual abuse while under
the supervision of volunteer child workers. This bill, she
said, is an attempt at trying to minimize the level of risk
children are exposed to when in the hands of volunteers. There
are many laws in [Alaska] statutes that regulate specific state
services such as foster care homes; however, the area of
volunteers is sort of vague. She stated that there are some
organizations such as the Boys and Girls Club that have
recognized a need for this and have taken it upon themselves to
require background checks of their volunteers. The cost
associated with that background check is a $20 fee, which can be
paid by the volunteer or by the organization.
REPRESENTATIVE McGUIRE noted that it is mandated in the bill for
state background checks, as opposed to federal, in order to not
be too punitive as far as the cost. There are some exemptions
in the proposed CS such as Sunday school teachers; nursery
volunteers at a church; and a parent, guardian, or relative
participating in school-sponsored functions. She said this is
an attempt to try to narrow any unintended consequences that the
bill might have.
Number 0929
REPRESENTATIVE McGUIRE stated that she has some amendments she
would like to offer. The first amendment would be on page 1,
lines 11 and 12, and would delete any reference to current
offender information. This would make it so a report can only
note a conviction involving a serious offense. The second
amendment, on page 2, line 27, would add "parent, guardian, or
relative of a child". It would then read, "while a parent,
guardian, or relative of the child is in attendance at the
religious service".
REPRESENTATIVE McGUIRE stated:
I think the goal of the bill is very clear; we want to
try to protect our children in any way that we can.
... Statistics show that where there has been a
conviction in the past of sexual molestation, there is
a higher degree of risk. We cannot protect our
children 100 percent ... but we can as [legislators]
take steps to try to minimize those risks. This would
be one of those steps - requiring the background
checks. ... There are some due process aspects to the
bill that are important. If you notice, on page 2,
[lines] 16 and 17, the individual can challenge the
accuracy and completeness of the report.
Number 1060
REPRESENTATIVE STEVENS asked how much a federal background check
costs.
REPRESENTATIVE McGUIRE answered that it costs $99.00.
CHAIR DYSON stated that as he reads this, a babysitter would
have to get a background check.
REPRESENTATIVE McGUIRE responded that she has been trying,
through the use of amendments, to minimize the vagueness [of the
bill], and feels that the goal is relatively clear. She added
that she is amenable to any changes. She stated that this is
one of those difficult tasks as a lawmaker: to recognize a
problem and then draft a bill to try to address the problem.
She said she looked at what other states are doing, and this
bill is pretty much in line with the other states.
REPRESENTATIVE CISSNA stated that page 1, line 6, says the
background check is required of a child services provider. If a
parent decides to act as the hiring agent for someone who comes
into his or her home, that's different than putting a child in a
situation in which [the parents] have the assurances that
someone has taken the same effort [that the parents] would take.
REPRESENTATIVE McGUIRE remarked that that was the intent.
Number 1308
REPRESENTATIVE STEVENS asked Representative McGuire to explain
who a volunteer child services provider would be.
REPRESENTATIVE McGUIRE responded that the definition section in
the bill [on page 3], states that "provider" means a business,
organization, or entity that provides child services.
CHAIR DYSON added that on page 3, line 2, it states, "child
service" means [the case] treatment, education, training,
[institution,] supervision, [or] recreation. On page 3, line
11, "provider" means a business, organization or other entity,
whether public, private, for profit, nonprofit, or voluntary,
that provides child services. He said he thinks this would
include Boy Scouts and "girls club."
REPRESENTATIVE STEVENS asked if that would, then, also include
arts or Native organizations that have summer camps.
CHAIR DYSON answered yes, and that it could also include the
local neighborhood babysitting cooperative.
Number 1421
REPRESENTATIVE CISSNA stated that this definition is a business,
which is different from a cooperative.
CHAIR DYSON disagreed and reiterated the definition on page 3,
line 11.
REPRESENTATIVE McGUIRE stated that there is a concern and a
debate on this. She said since a constituent of hers brought
this [concern] to her attention and she has drafted the bill,
she has received over 150 concerns from parents.
REPRESENTATIVE COGHILL said he thinks rather than mandating that
a person cannot be employed, people need to be encouraged to
check up on whomever they use as volunteers.
REPRESENTATIVE CISSNA asked if it would be too specific if it
were to say on page 3, line 2, "child services means the
professional care".
Number 1586
JACK BOWEN testified via teleconference on behalf of himself on
HB 180. He stated:
Around the middle of February, the first part of
March, I sent out an e-mail about a program that is
going to be on the Discovery Channel. Basically it
was about pedophiles [and] where they operate. One of
the things that they do is they associate themselves
with youth organizations as a volunteer and then they
groom the child so they can have access to them by
themselves. This is not excluding anybody. If you
look in the Anchorage newspaper and watch TV, there
[are such headlines as] "Anchorage Teacher: Sexual
Contact"; ...; "Fire Chief: Sexual Contact"; "Wasilla
Teacher: Sexual Abuse of a Miner"; "Fairbanks
Minister: 12 Counts of Sexual Abuse of a Minor,
Sexual Contact, Indecent Exposure"; "Anchorage Hockey
Coach: Drugs Possession"; "Boys and Girls Club
Employee Fairbanks: Sexual Abuse of a Miner"; "Murder
of a Little Girl in Sitka."
These things have got to be stopped. I work as a
volunteer for an organization that does a lot of work
with kids. I've worked for Little League and I work
for [the] Alaska (indisc.) Softball Association, and
we run background checks on everybody [who] coaches
with the kids. Some organizations do; some of them
don't.
My youngest daughter, unfortunately, came in contact
with a coach with an organization that did not run a
background check. He was a multiple convicted felon
in the state of Alaska and never had a background
check done. I think it's time that this ceases. The
state of Alaska has one of the highest rates of child
abuse in the nation; I don't think that's something we
should be proud of.
CHAIR DYSON stated that [the committee] is trying to figure out
where to draw the line with babysitters.
MR. BOWEN responded that he doesn't think neighborhood
babysitters apply. He said he thinks any of the organizations
that have volunteers working for them to officially provide
youth care services should be included.
Number 1738
DICK BLOCK, Christian Science Committee Publication of Alaska,
testified via teleconference on HB 180. He stated that his
concern when he first reviewed this legislation was that it
seemed to be broad enough to cover Sabbath schoolteachers and
those who are volunteering to work in a nursery during Sunday
services. He added that he is sure that is not the intent. He
said he would like to thank Representative McGuire and her staff
for accommodating [the Christian Science Committee Publication
of Alaska's] concern by already putting the amendment into the
proposed CS.
REPRESENTATIVE STEVENS asked Mr. Bowen whether his organization
pays [for the background checks] or if the volunteers pay for
them.
MR. BOWEN answered that the volunteers do. He said he has his
background check done once a year and also has a federal
background check. He noted that he keeps a copy of these and
that one background check is good for [more than one
organization].
REPRESENTATIVE STEVENS said he has made a list of what his
children have been involved in, which includes summer softball
camps, wrestling, piano, and dance. He asked if all of those
would be on [Mr. Bowen's] list of [activities for which] people
would be subject to this check.
Number 1852
MR. BOWEN responded that he would think if [a person] has many
children around him or her and is left alone [with the
children], parents would want to know that the person does not
have any convictions for assaulting a child.
REPRESENTATIVE STEVENS stated that he thinks Mr. Bowen is right;
however, he thinks it is necessary to know how extensive this
requirement will be.
MR. BOWEN remarked that he would tend to take a stand that would
be more rigid than some people's because of the experiences he
has gone through. He stated that his two oldest children were
assaulted by a physical education teacher. His oldest daughter
was [assaulted] from the time she was 10 till she was 16. His
son, and now his youngest daughter, [were assaulted] by a coach
who worked for one of the sports organizations in Anchorage.
CHAIR DYSON stated that he doesn't think [the committee] is
ready to pass the bill out. He said two things to consider are
the organizations that have stature in government or have filed
as a nonprofit, and any organization that by its nature has to
have insurance. This could tell if there is a way to tailor the
law so that if [organizations] have background checks, their
insurance rates go down or, contrarily, if they don't, their
liability insurance doubles or triples.
MR. BOWEN stated that one of the ideas he had was if an
organization didn't perform background checks, it would lose its
limit of liability with the insurance company and the insurance
company would be forced to pay [the organization's] judgment.
He said this would make the insurance companies require
organizations to run background checks in order to get
insurance.
[HB 180 was held over.]
HB 65-MEDICAL ASSISTANCE:BREAST/CERVICAL CANCER
CHAIR DYSON announced that the next order of business would be
HOUSE BILL NO. 65, An Act relating to a new optional group of
persons eligible for medical assistance who require treatment
for breast or cervical cancer; and providing for an effective
date."
Number 2026
KAREN PERDUE, Commissioner, Office of the Commissioner,
Department of Health & Social Services (DHSS), came forth and
stated that in 1997, which is the last year [DHSS] has full data
for, there were almost 300 women who were diagnosed with breast
cancer in Alaska, and 41 people who died of breast cancer. 26
women were diagnosed with cervical cancer, and 4 of them died.
She said early detection and screening has dramatically improved
in Alaska and in the country, and early detection and early
treatment can reduce morbidity and mortality - it reduces
mortality by 30 percent. She said there has been a huge effort
on the part of the health community to provide both screening
for cervical cancer and mammography. She added that [DHSS] has
also been working on that, and offers a breast and cervical
[cancer] early detection screening program. The program, she
said, has been gathering "steam" across the state and is fully
funded by the federal government. Last year, about 15,000 low-
income women were screened under that program.
COMMISSIONER PERDUE remarked that this program is being used
nationally. Women were being diagnosed with treatment and not
having the ability to pay for treatment. Last year, Congress
made available as an option to the states the ability to provide
coverage for the treatment. She stated that last year the
breast and cervical cancer screening program in Alaska uncovered
about 39 breast cancers and 33 cervical cancers. It is likely
that about 41 of those women would have been eligible, if this
bill had been in place. The cost of this, she said, is being
borne to a great degree by the federal government. If this bill
were to pass, the cost is estimated to be about $175,000 in
state general funds and $413,000 in federal funds. The coverage
is only for the treatment phase of the program. She added that
the basic philosophy is that many of these women are getting
treatment, but that any day of delay once the cancer is
diagnosed can be very concerning.
COMMISSIONER PERDUE, in conclusion, addressed the concerns that
have come up nationwide. She stated that some of the issues are
"Why this disease?" and "Why this body part?" because there are
many constituents that don't have health insurance for many
diseases. She said her response would be that the system for
people who have no health care insurance is imperfect. When
there are opportunities to provide coverage for groups, it is a
valid public policy choice to determine whether or not to invest
in those coverages. She added that one of the problems with
anyone who has this cancer is that it is not possible at that
time to get private coverage, because at that point the person
has a preexisting condition.
REPRESENTATIVE COGHILL asked if this goes under the Children's
Health Insurance Program.
COMMISSIONER PERDUE answered no.
REPRESENTATIVE COGHILL stated that it is mentioned [in the bill]
that it is going to be under the same federal match rate as the
Children's Health Insurance Program.
COMMISSIONER PERDUE replied that he was correct, that it is an
enhanced match rate.
REPRESENTATIVE COGHILL asked what title it would be under.
COMMISSIONER PERDUE answered that it is an optional group under
Title 19.
Number 2268
REPRESENTATIVE STEVENS asked what the results are for not having
early detection.
MARY DIVEN, Alaska Breast and Cervical Cancer Early Detection
Program, Maternal, Child & Family Section, Division of Public
Health, Department of Health & Social Services, answered that
the later it is detected, the greater the chance for metastasis
- for it to spread to other parts of the body. The death rate
is much higher the later it is detected or if treatment is
delayed once it is detected.
CHAIR DYSON stated that he hears conflicting things from the
medical services providers. One says it is a myth that people
can't get care, and if a person has a serious illness and shows
up at the emergency room at the hospital, he or she will get
cared for. He said one of his constituents has cancer, and
although she is $380,000 in debt, she has the treatment. He
asked whether it is true in [Alaska] that if a person has a
serious illness and shows up at the hospital, he or she will be
treated.
TAPE 01-46, SIDE B
COMMISSIONER PERDUE answered that she thinks that is true. She
said this would not solve the problem of lack of insurance for
everyone who has cancer in the state. She stated that she
thinks it would be good to address that question to women who
have had the disease, and to hear how they have paid those bills
or how they were going to struggle along in terms of what they
could demand from the health care system if they did not have
insurance. She added that she does not think the medical
community in Alaska is insensitive, but the access issue is not
totally solved by saying, "Let's let the private sector carry
the burden."
Number 2313
CHAIR DYSON remarked that as he understands it, [the insurance
companies] charge "you and me" more in order to subsidize the
indigent people who can't or don't pay.
COMMISSIONER PERDUE responded that that is absolutely true.
REPRESENTATIVE CISSNA stated that she doesn't disagree with the
concern of encouraging people to be responsible, but on these
sorts of things, when people may hesitate because of the matter
of money, the public cost may go up. She said it does make a
difference in terms of how fast people respond.
REPRESENTATIVE COGHILL asked what the eligibility is.
MS. DIVEN responded that the eligibility for the screening
program is that women receive detection through this federal
program and they have an income less than 250 percent of the
poverty level. For the treatment program, the income
requirement is the same. She said one of the eligibility
criteria for the screening and the diagnosis program is that
[the women] can have insurance, but if the deductible is too
high, they are eligible. For the treatment portion, they would
not be eligible under this Medicaid option because their health
insurance would cover it. Therefore, she said, the treatment
portion is only for people with no other insurance coverage.
CHAIR DYSON asked what the annual figure is of 250 percent of
the poverty level.
Number 2197
COMMISSIONER PERDUE stated that she would suspect that a lot of
the individual women are not 65, but somewhat older in age than
30, and probably many of them are single, because they don't
have the ability to have insurance in the family.
MS. DIVEN stated that for a family of one [the annual figure] is
$26,000.
CHAIR DYSON asked if there is any qualification in terms of
their assets.
MS. DIVEN answered no. She said one of the main public health
goals is to get the early detection in order to reduce the long-
term cost for treatment.
REPRESENTATIVE COGHILL stated that federal funding is obviously
going to be a large part of this, and he asked what the
commitment to this is under this authorization.
COMMISSIONER PERDUE responded that this is an option that's been
created for the states under congressional law. She said she
has never seen [such a law] repealed.
REPRESENTATIVE COGHILL stated that his concern is that the
federal government says to do this and the state ends up with
that "ball in our lap." The other issue, he said, is
continually adding health care issues. He added that if the
federal government decides to change its mind, then this will be
in statute and it will be the state's responsibility to pay it.
He said he is always concerned about replacing the private
insurance market with public insurance for services.
Number 2080
COMMISSIONER PERDUE stated that with the issue of the private
market, it is important to remember that this could be
considered a preexisting condition and can be a barrier to
getting insurance. She added that by the time this will be
done, she imagines that about 20 states will have adopted this;
therefore, it will be difficult for Congress to retreat from its
commitment to the states.
MS. DIVEN added that even though it was passed under the last
president, President Bush and Tommy Thompson - the Secretary of
Health & Human Services - are calling and congratulating each
state that has passed this. She added that this was passed
unanimously by the [U.S.] Senate.
Number 2003
REPRESENTATIVE CISSNA stated that one of things [a woman] gets
told by health care providers is that as a woman over a certain
age, she is supposed to go in for her annual mammogram.
Representative Cissna said most of the people she knows have
taken that to heart. She asked Commissioner Perdue, in the
process of working on this, if she has figured out what
voluntary efforts there have been to comply with that
recommendation, because 40 people seems like a small amount.
She also asked if there really is a concern about people
quitting their jobs because they want to get this for free but
keep their "Cadillacs and palaces."
COMMISSIONER PERDUE responded that one of the things about an
asset test is that people can be very land-rich but cash-poor.
She said if a person is making $26,000 a year, he or she
probably is not able to make many payments on many things.
Number 1833
BARBARA DuBOIS testified via teleconference on behalf of herself
on HB 65. She stated that she is 51 years old, is uninsured,
and was diagnosed with inflammatory breast cancer in December.
She said she was diagnosed through the state screening program,
and if she had not had this program, she would not have gotten
early detection. She remarked that she was first diagnosed with
a stage-four cancer, which is the worst a person can get, but
because it was detected early and her treatment has been
successful, she has been downgraded to a stage two.
Unfortunately, she said, [the program] gave her the diagnosis,
but did not provide the funds for treatment. She explained that
women in her position have three options: they can go on state
aid by quitting their jobs and having only $500 in possessions;
they can seek substandard or no treatment, which could be fatal;
or they can get the recommended treatment and accrue a lot of
debt, which is what she chose to do.
MS. DuBOIS stated that the medical bills she accrued before her
surgery, which was a week ago, were upwards of $40,000. She
said her cancer is aggressive and expensive. She has had
chemotherapy for 12 weeks, has had a mastectomy, and has to go
back for more chemotherapy and radiation. She added that more
than likely she will file for bankruptcy. She said she chose to
continue working because she didn't want the state to pay for
her rent and her food.
MS. DuBOIS remarked that a woman shouldn't be penalized for
choosing to work and not choosing state aid. She said HB 65 can
actually save the state money by allowing women to continue to
work, not go on the state dole, and only receive the medical
assistance.
Number 1641
MARCIA HASTINGS, Women's Health Director, Young Women's
Christian Association (YWCA), testified via teleconference. She
stated that [the YWCA] has been providing outreach to medically
underserved women in the greater Anchorage area since 1994.
[The YWCA] has been referring women to screening through the
Breast and Cervical Cancer Early Detection Program. Nationally,
she said, [the YWCA] has a partnership with the federal
government and the Centers for Disease Control [and Prevention]
(CDC) to provide outreach services for these women. If [the
YWCA] did not have the financial resources of the screening
program, their community health educators would be finding women
who are without financial resources; telling them the message of
early detection and that they should have an annual mammogram, a
clinical breast exam, a pelvic exam, and a pap smear test; and
then saying "good luck" and walking away. She stated that
because of the Breast and Cervical Cancer Early Detection
Program, [the YWCA] has been able to refer [those women] and
help them navigate the health care system to receive screening
services at no cost.
MS. HASTINGS stated that her intent in speaking today was to put
a personal face on the problem of women refusing the screening
services because they don't have resources to pay for the
treatment. Beginning early on, she said, oftentimes women would
say, "I don't want to know; I don't want to be screened because
if I find something, I will have no way to pay for it." She
added that in the last six years [the YWCA] has had 3,500 women
who are actively enrolled in its program. In conclusion, she
stated that fortunately there are many physicians and medical
facilities that are helping women; however, this doesn't stop
women from accruing bills. For example, she said a woman who
was detected with breast cancer through the early detection
program did everything that was required. Every time a bill
came in the mail, she put it in a shopping bag because she was
busy keeping herself alive. Nine months after her treatment,
she came into Ms. Hastings' office with three trash bags full of
bills.
Number 1421
CARLA WILLIAMS testified via teleconference in support of HB 65.
She stated:
The first legislation was introduced in Congress [in]
1997 because back then, as we realize now, ... it
borders on inhumane to tell a women that she has
breast cancer through a free screening program and
then essentially leaving [her] on her own to find
treatment. The intention of the early detection
program was to reduce breast and cervical cancer
mortality in this country, but screening and diagnosis
alone do not prevent cancer deaths.
... The U.S. Senate gave their unanimous vote to this
federal legislation, and the House was 421 to 1. So
there was a lot of support. ... Even last night on
Channel 2 news the governor again expressed his
concern about this bill - that it wasn't moving
forward. His comments were that this is a "must have"
legislation. Some previous discussion has been
concerning the 250-percent-of-poverty funding level.
I have submitted written testimony to this office
today, which supports [that] the 250 percentage number
is reasonable and necessary. The figures I've used in
this cost analysis were moderate ... and in some cases
actually fairly low. ... I went to a Senate
presentation last week on Medicaid regarding this
issue about not having any assets. I remember the
Medicaid presenters saying that there is a trend away
from making people bend down with regard to the recent
actions added to the Medicaid program. Bending down
... is making sure that you don't have any money left
before you go into this program.
Number 1239
CAREN ROBINSON, Alaska Women's Lobby, came forth in support of
HB 65. She stated that the Alaska Women's Lobby has a
membership, men and women, of about 1,500 and a steering
committee of about 15. She noted that all of the 12 steering
committee members have lost a friend or family member to breast
cancer, and two of the members are going through chemotherapy
for breast cancer.
JENNIFER RUDINGER, Executive Director, Alaska Civil Liberties
Union [AKCLU] came forth and stated that [the AKCLU] supports HB
65 and urges the committee to move it out.
CHAIR DYSON asked if adding a particular disease - in this case,
cancer - to the list of things that are specifically cared for
opens up the possibility for actions that once one cancer is
treated, all cancers must be treated equally.
MS. RUDINGER responded that on the flip side of that,
historically there has been a lack of attention and research to
women's health care issues. She said she doesn't know if this
is opening a door. She added that there have been arguments
that there is discrimination; for example, in health coverage
for Viagra and not for contraception.
CHAIR DYSON said [Alaska Superior Court] Judge Sen Tan's
decision stated that if one service is provided in a particular
medical area they all have to be provided. He asked if, based
on the judge's decision, this would be in danger of that.
MS. RUDINGER stated that she doesn't see that the two are
directly analogous.
Number 1050
CHAIR DYSON asked, referring to the judge's argument [in the
funding case], whether services must continue to be provided,
once they have ever been provided.
MS. RUDINGER responded that the decision stated that
appropriations are up to the legislature and that the
legislature does not have to fund any health care. There is not
a constitutional right to funding; however, once the legislature
undertakes to do so, it cannot discriminate based on the
exercise of a constitutional right. For example, because
reproductive choice and reproductive freedom are given great
privacy protection, they are not analogous to other health care
issues that don't have the similar privacy issues associated
with them.
CHAIR DYSON remarked that one could argue that cervical cancer,
as well as prostrate cancer, is getting close to reproductive
services.
MS. RUDINGER remarked that privacy affects the choice; there's
no choice to get or to not get a disease.
Number 0912
SHARON YERBICH testified via teleconference in support of HB 65.
She stated that she is a [cancer] survivor and has four
daughters, one of whom was screened by this program several
years ago. She said that if at that time [her daughter] had
been diagnosed there would have been no treatment and she would
have been in a quandary.
ROBIN SMITH testified via teleconference in support of HB 65.
She stated that when there are federal matching funds, they
should be taken advantage of. She remarked that it is also
necessary to look at the impact [these cancers] have on
families.
COLLEEN MURPHY, M.D., Obstetrician-Gynecologist, testified via
teleconference in support of HB 65. She said she is currently a
participant in the CDC-sponsored Breast and Cervical Cancer
Early Detection Program. She stated:
I just want to tell you that this is real, this is
very real. ... As the women actually access the
screening services, we invariably will encounter the
abnormalities that they are intended to detect. I
cannot tell you how distressing it is for a woman to
find out that she has a precancerous process and then
not be able to afford the treatment. So, it makes
absolutely no sense for us to initiate an evaluation
process and not make the same eligibility criteria
available for us to treat the patient fully. I want
to mention that ... I have ... permission from a
patient that I saw, age 23, a Miss Ada Lee (ph) from
the Valley who is apparently a constituent to Lyda
Green. She gave me authorization with her signature
that says, "I authorize Dr. Colleen Murphy to use my
name during testimony at the HES committee hearing on
4/19/01. It is OK for her to describe my medical
condition and financial challenges."
This is a 23-year-old woman who delivered a baby three
months ago and is currently breastfeeding. She had a
pap smear abnormality during pregnancy that is a
[high-grade intraepithelial lesion]. Colposcopy,
which is looking at the cervix, was performed
approximately three weeks ago. The biopsy that was
done by Dr. Sivaly (ph) shows that she has severe pre-
cancer. If the patient is not treated in the next
several months, she has a 70 percent likelihood of
progressing to evasive cervical cancer. The
discussion we had this morning revolved around how is
she going to pay for further evaluation and treatment.
I want to let you know that the doctors in Alaska face
this every single day, where we see patients [who]
have diagnosable diseases, treatable diseases -
namely, breast and cervical cancer - and the patient
simply can't afford the care and follow-up that needs
to be done. I really want to encourage you to
complete the process to close the loop. Currently we
know cervical cancer, if people get adequate
screening, ... is 90 percent preventable. ... It is
not enough to get a pap smear; the pap smear is only a
screening technique. We have to do colposcopy, and
then we have to do treatment; and that treatment may
involve the treatment of cervical cancer. Same thing
with mammography. We know that if a women gets a
mammogram on a recurring basis, the likelihood of her
dying of breast cancer decreases by at least 30 to 40
percent. There is no point getting a mammogram if we
can't provide the treatment.
Number 0545
REPRESENTATIVE STEVENS referred to the fiscal note and stated
that of the four grantees who provided the testing, 61 percent
tested were Alaskan Native women who are not covered by this
because they are covered by the Public Health Service. He asked
if the 61 percent Native women are outside the facts and
figures.
COMMISSIONER PERDUE responded that the number she gave of the
300 women is for all women.
NANCY WELLER, Manager, State, Federal and Tribal Unit, Division
of Medical Assistance, Department of Health & Social Services,
came forth and stated that she thinks the high percentage of
Alaskan Native women is due to the fact that three of the four
grantees are Alaska Native health organizations that have CDC
grants. Anyone with credible coverage under the HIPAA (Health
Insurance Portability and Accountability Act) definition would
not be eligible for this option. That excludes people who have
military medical care, Indian Health Service, and any kind of
health insurance coverage.
REPRESENTATIVE STEVENS asked if the 300 women in Alaska would
include people who would not be covered under this.
MS. WELLER said yes.
Number 0411
REPRESENTATIVE COGHILL stated that he is nervous about adopting
the [U.S. code] because he thinks it could change and therefore
put [the legislature] under obligation. He asked if it would be
difficult to put what [the legislature] would expect the 250
percent of poverty to be.
MS. WELLER responded that in drafting the bill there was a lot
of discussion about whether or not to reproduce all of the
language from the federal law in the statute. She stated that
if Representative Coghill wanted to put specific language that
describes the [federal legislation] she could help with the
parts that are critical.
REPRESENTATIVE COGHILL stated that he thinks he would rather
have that in statute and then reference this as an authority,
rather than have it be encoded. He stated that he objects to
the direction [the committee] is going, but he also understands
that this is a highly sensitive issue. He stated that he would
like to put sideboards on [the bill] that say exactly what the
intent is.
Number 0141
REPRESENTATIVE COGHILL made a motion to adopt conceptual
Amendment 1, to only reference the U.S. code, which clearly
describes what the qualifications are.
MS. WELLER stated that individuals would be eligible if they
have not attained age 65; have been screened for breast and
cervical cancer under the CDC breast and cervical cancer early
detection program established under Title XV of the Public
Health Service Act, 42 U.S.C. 300k et seq; and need treatment
for breast or cervical cancer; and are not otherwise covered
under creditable coverage, as defined in section 2701(c) of the
Public Health Service Act.
CHAIR DYSON announced that there being no objection, conceptual
Amendment 1 was adopted.
Number 0010
REPRESENTATIVE CISSNA moved to report HB 65, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes.
TAPE 01-47, SIDE A
REPRESENTATIVE COGHILL objected.
REPRESENTATIVE KOHRING stated that he is going to vote no on the
legislation, but it doesn't reflect his opposition to women who
need care. He said this is mainly an issue of who should pay
for the service: the taxpayer or private funding. He remarked
that there are nonprofit [organizations] that could potentially
help.
REPRESENTATIVE COGHILL stated that he feels strongly about this;
however, he removed his objection.
REPRESENTATIVE KOHRING stated that he will remove his objection,
but will reflect his concerns [when signing the bill].
CHAIR DYSON announced that there being no objection, CSHB
65(HES) moved out of the House Health, Education and Social
Services Standing Committee.
HB 197-HEALTH CARE SERVICES DIRECTIVES
[CHAIR DYSON returned the committee's attention to HOUSE BILL
NO. 197, "An Act relating to directives for personal health care
services and for medical treatment."]
MELANIE LESH, Staff to Representative Bill Hudson, Alaska State
Legislature, stated that Representative Hudson, sponsor, would
like to continue to work on amending HB 197.
Number 0370
MARIE DARLIN, AARP (formerly the American Association for
Retired People), came forth and stated that AARP has been
interested in the additional help given to families by use of
the Five Wishes outline. She said it definitely helps in
planning for health care needs with more complete advanced
directives from the elderly or disabled person. She added that
she would also like to direct [the committee's] attention to
recommendation 10 of the January 1999 Long Term Care Task Force
Report, which speaks to the importance of advanced directives
and the need for public education regarding their availability.
LORILYN SWANSON, Manager, Fireweed Place, came forth and stated
that she is also a member of the Commission on Aging. She said:
I am here today to express to you, from the viewpoint
of a service provider, the importance of advanced
directives and how HB 197 will meet and assist
Alaskans in encouraging people to discuss with their
families and friends their personal wishes for care
prior to ... becoming incapacitated. I have watched
many families find it necessary to make decisions with
regard to loved ones and their care at a time when
they are not prepared to do so, due to death, due to
the imminent prospect of the loss, guilt, denial,
grief, or family dissention. Many times these
decisions needed to be made immediately or quickly
without knowing or having even spoken to the person
concerned because no one wanted to address the subject
or talk about [it]. It was just too difficult to
discuss. When it [it] almost too late and all the
forms [needed] to be found, it's extremely difficult
to find the forms in one place.
No one form or collection of forms at this time
addresses the directives as well as HB 197. It is
written and encourages discussions with families in an
open and dignified way, with options one might not
think of on one's own. It offers a clear
reconciliation at the close of life of one's wishes.
It prompts one to think of options and gives an
opportunity to express oneself.
Number 0612
EUGENE DAU, Volunteer, AARP, came forth and stated that every
time people talk about this, they think about money. He said he
thinks filling out the form will get more people to do what they
should do, instead of holding back because they think it will
cost them $300.
LINDA FINK, Assistant Director, Alaska State Hospital and
Nursing Home Association (ASHNA), came forth and stated that in
concept [ASHNA] supports the legislation but does not support
how it is drafted. She said [ASHNA] would like to work with the
sponsor over the interim in order for the bill to work for the
providers who have to deal with the forms as well as the people
who are filling the forms out.
[HB 197 was held over.]
HB 209-PROGRAM FOR FORMER FOSTER CHILDREN
CHAIR DYSON announced that the last order of business would be
HOUSE BILL NO. 209, "An Act directing the Department of Health
and Social Services to establish a foster care transitional
program; relating to that program; and providing for an
effective date."
Number 0794
CHAIR DYSON, speaking on behalf of the House Health, Education
and Social Services Standing Committee, sponsor of HB 209,
stated that the federal government has recognized that there is
a problem with kids who have spent their lives in state custody
and may be ill-equipped when they are 18 and take up independent
living. He said the federal government has developed a program
that includes funding for transition services for those kids.
[The legislature] will have to change its law in order to
comply.
THERESA TANOURY, Director, Division of Family & Youth Services
(DFYS), Department of Health & Social Services, came forth and
stated that HB 209 is needed in order for [DFYS] to accept some
funding through the federal bill - the Chafee (ph) bill - that
gives [DFYS] the authority to serve kids who have been in foster
care until they are 18. The Chafee bill requires [DFYS] to
serve kids ages 18 to 21 who are no longer in state custody.
Currently, under state statute [DFYS] does not have the
authority to spend money on kids who are not in state custody.
She added that HB 209 also codifies an independent-living
program for this certain population. She clarified that it does
not include kids who are being adopted, have a guardian, or are
returning home.
CHAIR DYSON asked when this has to be in place in order for
[DFYS] to get the federal money.
MS. TANOURY answered that there are no regulations in place for
the federal law. She stated that the federal government has
told [DFYS] that there will be a penalty, but didn't specify
what, and that [DFYS] must demonstrate that a certain percentage
of the money must be spent on kids not in foster care over age
18. She said [DFYS] can receive the funding now.
CHAIR DYSON asked, if [the committee] doesn't pass this law,
whether [DFYS] can receive the money.
Number 1000
MS. TANOURY responded that [DFYS] can receive it but will be
subject to a penalty unless it can prove where it can spend the
money. Right now, she said, it does not have the authority to
spend money on kids who are not in state custody. She added
that [DFYS] also went to the federal government with the idea of
extending custody, which is done occasionally for kids who are
in foster care and haven't completed high school. The federal
government had responded that those kids will not count for that
federal requirement; they have to be former foster care
children.
REPRESENTATIVE CISSNA asked Chair Dyson what his concern is.
CHAIR DYSON answered that he does not have a big problem with
[the legislation]. He said he wants to push [DFYS] to start
preparing these kids for transition when they are 16. He stated
that in theory there is nothing that is keeping [DFYS] from
doing that now, but this money is not available to do that. He
said he was also trying to inject a magistrate into that
decision. He added that given all that, some "neat" things are
happening: the universities have promised five scholarships for
these kids; virtually every labor union is going to offer a
couple of free apprenticeships; and housing, mentors, and health
care are being determined.
Number 1199
REPRESENTATIVE STEVENS remarked that when he thinks of an 18- to
21-year-old, he thinks of a person who is ready to leave as
quickly as he or she can. He stated that he needs to be
convinced that someone who is 18 or 21 is in a situation in
which he or she needs to have the state shepherd him or her into
life. He asked if a kid is having trouble at 18, whether [DFYS]
can get that person in better shape by the time he or she is 21.
CHAIR DYSON responded that some of these kids have prenatal
alcohol damage and other things. He said that [DFYS] is not
going to do this with every kid, and it is largely voluntary.
If the kid wants to avail himself or herself, and learn how to
get a driver's license or use a checkbook, he or she will have
those services available.
Number 1320
REPRESENTATIVE CISSNA stated that having worked with
adolescents, adolescents today are not the adolescents "we" used
to have. She said some of it is due to the kind of pressures
that kids have now that they didn't have 30, 40, or 50 years
ago; they mature more slowly. The average adolescent today has
not really taken on adult symbols of maturity. She stated that
the kids who have been in the foster care system oftentimes have
been in situations in which the people they were with weren't
professionals helping them develop full maturity as adults.
They have missed out on a number of the steps that normally a
parent is going to very deliberately have been working toward
for years. She remarked that these kids have "holes" in their
development, and this would pick up those missing pieces.
MS. TANOURY stated that this bill, as well as the federal bill,
tells [DFYS] to identify the kids who are likely to "age out" of
the foster care system. This creates a program around these
children that isn't there today, because there hasn't been any
funding. The focus has been to get kids with families; however,
there are some kids who aren't going to go back to the family or
be adopted. She stated that what happens to those kids is that
at age 18, or the day the custody ends, there is no support for
them. She said there is a feeling of obligation to these
children to make sure that they have the right start, given the
history that many of them have endured.
Number 1490
CHRIS CROMER testified via teleconference in support of HB 209.
He stated that he has been a foster parent for many years. He
stated that he heard Ms. Tanoury say that this does not have an
impact on children taken into the guardianship program; however,
he thinks that is a big population that is being left out. He
noted that 79 children this year taken into guardianship will
enter adulthood while still in high school. He asked if there
are any plans to add that into this.
MS. TANOURY responded that the federal bill refers to kids aging
out - those kids who are in foster care on their 18th birthday.
She said [DFYS] has had three or four 17-year-olds this year who
were adopted. Most of the time a guardianship takes place
early; therefore, there is a significant adult in their life.
She stated that [DFYS] would like to see those kids in the
guardianship program get some independent-living skills, but
[DFYS] is trying to prioritize the population in order to
address those kids who have no adult [in their lives].
MR. CROMER stated that he can see the point. He said, in his
case, [he took a child in, under guardianship] after that child
was under his care for four years. By the time all of the
proceedings went through, the child was 17. However, regardless
of his age, that wouldn't have stopped the fact that he
graduated at 19. Mr. Cromer stated that if he were to have
taken this child at 5, 12, or 17, he still would have lost his
benefits at the age of 18 and would have had to complete his
entire senior year of high school without Medicaid and without
subsidies provided by the state.
CHAIR DYSON asked Ms. Tanoury if the federal law would
exclusively preclude children who had only been in guardianship
for a relatively short period of time from participating in this
transitional services.
MS. TANOURY responded that the federal law says, "children who
are likely to age out of the foster care system." She stated
that she thinks it is good practice - for any kid who is in
custody at 16, whether he or she is going to be adopted or have
a guardianship - for [DFYS] to be talking to them and the foster
parents about the preparation that the youth needs.
CHAIR DYSON asked when a guardianship ends.
MS. TANOURY answered, [when the young person is] 18.
CHAIR DYSON asked, "Can't we argue that these kids are aging out
as well?"
MR. CROMER responded that he thinks, parallel to this bill, the
federal government, through the Title IV-E, allows [protection]
until the age of 21; however, the state has put a limit on that
to the age of 18.
Number 1280
MS. TANOURY stated that [DFYS] has had many discussions about
extending the subsidy program as well as extending foster care.
REPRESENTATIVE CISSNA asked, if that population were added to
the guardianship population, whether there would be any fiscal
implications.
MS. TANOURY responded that she would have to look at the number
of kids being discussed. She stated that [DFYS] will get
federal money to do this program - $500,000 for approximately 50
kids a year. This was authorized to last for five years. She
clarified that [DFYS] can spend money on kids younger than 18,
and has to spend a certain amount of money on kids between 18
and 21 who are former foster kids.
REPRESENTATIVE CISSNA asked if it is $500,000 for as many kids
as can be covered.
MS. TANOURY answered, "That's correct."
Number 1900
REPRESENTATIVE COGHILL asked how many of these kids have mental
health issues.
MS. TANOURY referred to documents provided in the committee
members' packets and replied that [DFYS] had conducted a survey,
which found that about 52 percent did not have any disability.
REPRESENTATIVE COGHILL stated that [the legislature] is looking
at a significant cost in housing. He asked if this is going to
back up programs that are already working with people with
disabilities.
MS. TANOURY responded that those kids will probably transition
into the developmentally disabled programs or the mental health
programs.
REPRESENTATIVE COGHILL asked if any of this money will go with
them.
MS. TANOURY answered, no.
CHAIR DYSON stated that he and Representative Cissna are
thinking of one of three options: do nothing, have [DFYS] serve
some of the kids who are aging out of guardianship and have
needs, or put that in the bill.
REPRESENTATIVE CISSNA said maybe there should be some priority
for kids who really need what can't be provided.
Number 2025
TIMOTHY SPENGLER, Division of Family & Youth Services,
Department of Health & Social Services, stated that a good
portion of the $500,000 will be used for children who are still
in foster care - ages 16 to 18. It will not all be used for
those who are aging out of the program. He added that
guardianship of a DFYS child is considered a permanent plan,
like adoption or going home. Hopefully, someone who was
guardian to a child would continue to be involved in that
child's life, just as if he or she had adopted that child. He
stated that the money is limited, and if it is spread too thin
with youngsters who have significant people in their lives, it
will limit what can be accomplished with the youngsters who have
nobody in their lives.
REPRESENTATIVE JOULE asked what percentage of this money would
be for the kids [DFYS] would want to get ready prior to 18, and
if [any of that money] would go to training foster parents.
MS. TANOURY responded that [DFYS] has not specified that amount
but has talked about putting some money into foster parent
training. She added that when the guardianship takes place, the
case is closed. If the child has special needs, [DFYS] provides
the subsidy until he or she is 18, and annually reviews it. She
said this is a little different from having a kid age out and
keeping an open, monitored case.
REPRESENTATIVE CISSNA asked Mr. Cromer, in terms of the
guardianships, whether there are ways [DFYS] can provide
training or extended opportunities, but not "drain the bank"
specifically on [guardianship].
MR. CROMER responded that he has no desire to add guardianships
specifically to HB 209. He clarified that he is in full support
of this bill, but thinks there is a simple remedy for the
guardianship issue. The guardian should take on the
responsibilities as a standard parent; however, subsidies and
Medicaid should continue until the age of 18. If there is
school left, these [guardians] need to be supported.
Number 2201
CHAIR DYSON remarked that he has two proposed conceptual
amendments. The first one would allow [DHSS] to receive grants
as well as program money, and the second limits the age to under
21, instead of under 22.
REPRESENTATIVE JOULE made a motion to adopt the foregoing as
conceptual Amendment 1 and conceptual Amendment 2. There being
no objection, conceptual Amendment 1 and conceptual Amendment 2
were adopted.
Number 2299
AL SUNDQUIST, President, Alaska Chapter, Americans United for
Separation of Church & State, testified via teleconference in
opposition to HB 209 as it is currently written. He stated:
This bill is unconstitutional and should be amended.
Americans United is a national, nonprofit, nonpartisan
organization committed to preserving the
constitutional principles of separation of church and
state and religious liberty. ... In the definitions
section of this bill, "qualified entities" includes
churches and religious organizations. This is
unconstitutional. The first amendment of the U.S.
Constitution prohibits funding of [religious
organization.
TAPE 01-47, SIDE B
MR. SUNDQUIST continued, stating:
The Alaska constitution includes similar prohibitions,
also specifying churches, is evidence of
privatizations of one faith, which as additionally
prohibited. An amendment would easily remedy this by
changing the language on page 3 from "churches and
religious organizations" to religiously affiliated
organizations". If funding is provided through
religiously affiliated organizations, there will need
to be safeguards, as usual, so that indoctrination and
proselytizations of beneficiaries is prohibited; that
government funding precludes discrimination in hiring
on the basis of religion; and that no funds can be
used for religious purposes.
Number 2282
RANDALL LORENZ, Staff to Representative Fred Dyson, Alaska State
Legislature, speaking as the committee aide to the House Health,
Education and Social Services Standing Committee, stated that
what Mr. Sundquist is referring to comes under Article VII of
the [U.S.] Constitution, which dealt with the public school
system only. There were two arguments: one was direct and
indirect funding of a private or religious school. [Article
VII] only talked about direct funding of a school and did not
address indirect [funding]. Therefore, as long as a single
private entity is not directly funded, the constitution is not
violated.
Number 2207
REPRESENTATIVE JOULE moved to report HB 209, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 209(HES) moved
from the House Health, Education and Social Services Standing
Committee.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:32 p.m.