ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
February 14, 2002
3:02 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Chair
Representative Peggy Wilson, Vice Chair
Representative John Coghill
Representative Vic Kohring
Representative Sharon Cissna
Representative Reggie Joule
MEMBERS ABSENT
Representative Gary Stevens
COMMITTEE CALENDAR
HOUSE BILL NO. 402
"An Act relating to diversion payments, wage subsidies, cash
assistance, and self-sufficiency services provided under the
Alaska temporary assistance program; relating to the food stamp
program; relating to child support cases that include persons
who receive cash assistance or self-sufficiency services under
the Alaska temporary assistance program; and providing for an
effective date."
- MOVED HB 402 OUT OF COMMITTEE
HOUSE BILL NO. 252
"An Act relating to the construction of certain statutes
relating to children; relating to the scope of duty and standard
of care for persons who provide services to certain children and
families; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 367
"An Act relating to coverage of children and pregnant women
under the medical assistance program; and providing for an
effective date."
- HEARD AND HELD
PREVIOUS ACTION
BILL: HB 402
SHORT TITLE:ALASKA TEMPORARY ASSISTANCE PROGRAM
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
Jrn-Date Jrn-Page Action
02/11/02 2205 (H) READ THE FIRST TIME -
REFERRALS
02/11/02 2205 (H) HES, FIN
02/14/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 252
SHORT TITLE:STANDARD OF CARE FOR CINA SERVICES
SPONSOR(S): REPRESENTATIVE(S)COGHILL
Jrn-Date Jrn-Page Action
04/23/01 1136 (H) READ THE FIRST TIME -
REFERRALS
04/23/01 1136 (H) HES
04/23/01 1136 (H) REFERRED TO HES
01/17/02 (H) HES AT 3:00 PM CAPITOL 106
01/17/02 (H) Heard & Held
MINUTE(HES)
02/07/02 (H) HES AT 3:00 PM CAPITOL 106
02/07/02 (H) <Bill Canceled>
02/12/02 (H) HES AT 3:00 PM CAPITOL 106
02/12/02 (H) Heard & Held
MINUTE(HES)
02/13/02 2257 (H) COSPONSOR(S): DYSON
02/14/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 367
SHORT TITLE:MEDICAL ASSISTANCE PROGRAM COVERAGE
SPONSOR(S): REPRESENTATIVE(S)COGHILL
Jrn-Date Jrn-Page Action
01/30/02 2098 (H) READ THE FIRST TIME -
REFERRALS
01/30/02 2098 (H) HES, FIN
01/30/02 2098 (H) REFERRED TO HES
02/04/02 2153 (H) COSPONSOR(S): OGAN, DYSON
02/12/02 (H) HES AT 3:00 PM CAPITOL 106
02/12/02 (H) Heard & Held
MINUTE(HES)
02/14/02 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
SANDIE HOBACK, Independent Consultant
American Institute for Full Employment
1030 Schurman Drive South
Salem, Oregon 97302
POSITION STATEMENT: Briefed members on provisions in HB 402.
JIM NORDLUND, Director
Division of Public Assistance
Department of Health and Social Services
P.O. Box 110640
Juneau, Alaska 99811-0640
POSITION STATEMENT: Presented the division's position on
provisions in HB 402; noted the division's support but expressed
concern about some provisions.
WILLIAM CRAIG
613 Degroff Street
Sitka, Alaska 99835
POSITION STATEMENT: Asked about the impact of HB 402 on
disabled people.
CYNTHIA EBELACKER
Alaska Nurse Practitioners;
Alaska Nurses Association
10251 Stewart Drive
Eagle River, Alaska 99577
POSITION STATEMENT: Testified in opposition to HB 367.
JACKIE SUNNYBOY
Fairbanks Community Mental Health Center
1716 University Avenue
Fairbanks, Alaska 99709
POSITION STATEMENT: Testified in opposition to HB 367.
CHARLES QUARRE
36525 Bradford Road
Sterling, Alaska 99672
POSITION STATEMENT: Testified in opposition to HB 367.
PATRICIA BOILY
Homer Medical Clinic
4136 Bartlett
Homer, Alaska 99603
POSITION STATEMENT: Testified in opposition to HB 367.
DONNA JORDAN
Governor's Council on Disabilities and Special Education
P.O. Box 876264
Wasilla, Alaska 99687
POSITION STATEMENT: During hearing on HB 367, presented a
mother's letter highlighting the importance of Denali KidCare to
her family.
SALLY BELTZ, MSN, RN, ARNP-C
Advanced Training Coordinator
Yukon-Kuskokwim Health Corporation
P.O. Box 528
Bethel, Alaska 99559
POSITION STATEMENT: Testified in opposition to HB 367.
JONALYN NAJERA
1731 Rierie Drive
Anchorage, Alaska 99507
POSITION STATEMENT: Testified in opposition to HB 367.
JAN LYNDES
57800 Stefin Trail
Homer, Alaska 99603
POSITION STATEMENT: Testified in opposition to HB 367.
DANA LEE HALL, R.Ph.
Village Operations Administrator
Yukon-Kuskokwim Health Corporation
P.O. Box 528
Bethel, Alaska 99559
POSITION STATEMENT: During hearing on HB 367, gave information
on Indian Health Service funding.
MARIE DARLIN
AARP
415 Willoughby, Suite 506
Juneau, Alaska 99801
POSITION STATEMENT: Testified in opposition to HB 367.
TONY LOMBARDO, Director of Advocacy
Covenant House
609 F Street
Anchorage, Alaska 99501
POSITION STATEMENT: During hearing on HB 367, discussed the
negative impacts of the bill to Alaska's teenagers.
SUSAN WOHGLEMUTH
5335 Pioneer Avenue
Homer, Alaska 99603
POSITION STATEMENT: During hearing on HB 367, highlighted
Denali KidCare's benefit to children in need of residential
care.
LYNDA THOMASSEN
P.O. Box 468
Wrangell, Alaska 99929
POSITION STATEMENT: During hearing on HB 367, testified that
Denali KidCare has provided necessary preventative health
coverage for her children.
SUSAN DRATHMAN
P.O. Box 12
Homer, Alaska 99603
POSITION STATEMENT: Testified in opposition to HB 367.
VALERIE DAVIDSON, Executive Vice-President
Yukon-Kuskokwim Health Corporation
P.O. Box 528
Bethel, Alaska 99559
POSITION STATEMENT: Testified in opposition to HB 367.
SUE ZAHND, Member
AARP; National Association for the Education of Young Children
(no address available)
POSITION STATEMENT: Testified in opposition to HB 367.
FAYE NIETO
1521 Elcadore Drive, Number 108
Anchorage, Alaska 99507
POSITION STATEMENT: During hearing on HB 367, testified as an
employer who is unable to provide health insurance benefits to
employees.
JOY LYON
Alaska Association for the Education of Young Children
5120 Blueberry Lane
Juneau, Alaska 99801
POSITION STATEMENT: Testified in opposition to HB 367.
NANCY KOON
P.O. Box 243903
Anchorage, Alaska 99524
POSITION STATEMENT: Testified in opposition to HB 367.
CAREN ROBINSON, Lobbyist
for Alaska Women's Lobby
P.O. Box 33702
Juneau, Alaska 99803
POSITION STATEMENT: Testified in opposition to HB 367.
SHAWNEE HART
P.O. Box 3307
Boniface, Number 3B
Anchorage, Alaska 99504
POSITION STATEMENT: Testified in opposition to HB 367.
CATHERINE BURGESS
3307 Boniface, Number 3B
Anchorage, Alaska 99504
POSITION STATEMENT: Testified in opposition to HB 367.
ELMER LINDSTROM, Deputy Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: During hearing on HB 367, drew attention to
information from the department in the committee packets.
ACTION NARRATIVE
TAPE 02-10, SIDE A
Number 0001
CHAIR FRED DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:02 p.m.
Representatives Dyson, Wilson, Coghill, and Kohring were present
at the call to order. Representatives Cissna and Joule arrived
as the meeting was in progress.
HB 402-ALASKA TEMPORARY ASSISTANCE PROGRAM
Number 0259
CHAIR DYSON announced the first order of business to be HOUSE
BILL NO. 402, "An Act relating to diversion payments, wage
subsidies, cash assistance, and self-sufficiency services
provided under the Alaska temporary assistance program; relating
to the food stamp program; relating to child support cases that
include persons who receive cash assistance or self-sufficiency
services under the Alaska temporary assistance program; and
providing for an effective date."
CHAIR DYSON stated that Sandie Hoback would be presenting the
bill [which was sponsored by the HHES] to the committee. She
oversaw changes to Oregon's public assistance program. Public
assistance funds in that state were redirected to subsidize
wages for workers.
Number 0422
SANDIE HOBACK, Independent Consultant, American Institute for
Full Employment, testified via teleconference. She indicated
that the American Institute for Full Employment conducted the
assessment of Alaska's welfare-reform efforts at the request of
Senator Lyda Green and Representative Fred Dyson. The report
outlines five legislative recommendations, which are
incorporated into HB 402. The first recommendation is to amend
the state statute to allow for use of the full flexibility
permitted under federal law to extend benefits to some long-term
recipients. She explained that rather than having an arbitrary
20 percent cap, the department should use narrow criteria to
extend benefits to people beyond the 60-month time limit.
MS. HOBACK offered that the second recommendation changes the
way in which sanctions are imposed upon people who fail to
comply with the program. The report advocates a progressive
sanction system that includes different stages, but allows the
state to close the case when clients are noncompliant. The
current system takes 40 percent of the grant away from the
family. She said that the first instance of noncompliance
allows for immediate restoration of funds upon compliance. The
second instance of noncompliance, under the current system,
automatically imposes a 6-month waiting period after compliance
before the restoration of funds. The third penalty is a 12-
month waiting period. She noted that this current system does
not provide incentive for cooperation. The 60-month "time clock
continues to tick" while the adult is noncompliant. The system
proposed in HB 402 stops the time clock during noncompliance; it
also calls for immediate restoration of benefits upon
compliance. She added that she thought this to be a more
family-friendly sanction system.
Number 0639
CHAIR DYSON requested examples of compliant and noncompliant
behaviors.
MS. HOBACK responded that a noncompliant client would be one who
did not attend assigned work activities. Each client receives a
plan that includes "showing up". A client who does not follow
this plan is subject to sanctions. She pointed out that the
department might provide more examples of behavior that invokes
sanctions.
Number 0708
MS. HOBACK said the third recommendation is to enable the
provision of services to working families whose income may not
be enough [to meet the family's needs]. Except for the time
limit, these families would still be eligible for some benefits.
The time limit would prevent the family from receiving those
benefits and could therefore destabilize the employment
situation and could subsequently result in job loss. House Bill
402 addresses self-sufficiency services and allows for the
services to be provided to low-income, working families to
enable them to stay at work.
MS. HOBACK furnished that the fourth recommendation is to
strengthen the diversion program. Currently, the division can
give up to two months' worth of benefits upfront, rather than
put the person on full cash assistance. This allows people to
receive extra help in securing a job, and it keeps them out of
the public assistance program. She stated that the
recommendation is to increase this to three months' worth of
benefits. She noted that division staff had indicated two
months' benefits might not be enough incentive in many
situations; the diversion program is currently used very little.
She offered that her work with the division on implementing
management recommendations would couple with this fourth
recommendation to strengthen "that upfront process". She said,
"From the very first day a client walks into the office, they
begin in a concerted employment strategy, and diversion becomes
a real key to that." Many people's employment needs can be met
early on, and they never need be enrolled in the program.
Number 0874
MS. HOBACK stated that the fifth recommendation is to authorize
a more complete wage-subsidy program that targets the private
sector. This worked successfully in Oregon when the state
cashed out the food stamp and cash benefits and used them to
reimburse private-sector employers. These employers hired
clients in training positions and, in many instances,
subsequently hired them into the business. She said this worked
well for clients, and it became an economic stimulus piece for
small businesses. This program allowed small businesses to test
expansion plans; businesses often expanded after the wage
subsidy was terminated. She concluded, "It really became a win-
win [situation]. ... I think it's a really important piece to a
comprehensive program".
Number 0977
CHAIR DYSON asked Ms. Hoback about proposed changes to the 20-
percent cap on benefit extensions. He then added:
I have some small concern that ... if there's not
enough industry in the small community where those
people live to give a reasonable expectation of a job,
that we ought to be doing something to encourage - or
even enable - the folks to move where there are more
employment opportunities. Did you ... run into that
in Oregon?
MS. HOBACK responded, "Not nearly to the extent that you have
that issue in Alaska." She noted that rural pockets in Oregon
do have some similarities, and people were encouraged to move.
She added that Alaska has complex cultural issues. She agreed
with Chair Dyson, saying, "Everything possible should be done to
encourage people to move where there is ... employment."
Number 1029
REPRESENTATIVE WILSON asked whether assessments to measure a
client's job strengths and interests were administered.
MS. HOBACK offered that one of the tenets of the "work-first"
approach is that the labor market is the best determinant of a
client's employability. She indicated that administering many
"high-intensity, paper kinds of assessments" has been shown by
research to be an inaccurate indicator of employability; she
advocates using the labor market as an employability indicator.
It is important, she acknowledged, to assess what people want to
do and then place them in the most appropriate job. She
summarized by saying:
People should be consulted, and they should be able to
look for jobs that they really want to do. At the
same time, I think, you really need to shy away from
doing extensive kinds of vocational assessments, at
least at the beginning of this process until the
person really has had a chance to test the labor
market and learn from that experience.
Number 1126
REPRESENTATIVE JOULE inquired whether Ms. Hoback worked with
other departments, such as the Department of Education and Early
Development, to coordinate [these proposed changes]. He
mentioned that this would give young people a chance to see
potential opportunities.
Number 1150
MS. HOBACK explained that in Oregon, a more holistic approach to
the family was taken. "We were very much involved with K-12
education, involved with making sure that the children were
attending school, those kinds of things," she said. The Oregon
program included special activities targeting children in these
families. She observed that she had not witnessed as many of
these kinds of activities in Alaska.
Number 1187
CHAIR DYSON requested a "snapshot of success" of the work-first
initiative in Oregon.
MS. HOBACK reported that Oregon's program was studied by
Manpower Demonstration Research Corporation, an employment and
training research group. This study found that, for a statewide
program, Oregon produced some of the best results in helping
people obtain and keep jobs and increase their wages. Oregon's
has become known as the best welfare-reform program in the
country, she said; she speculated that this was due to the work-
first approach and bringing in the right kind of partners.
Oregon reduced its [public assistance] caseload by 65 percent,
she supplied.
Number 1263
CHAIR DYSON inquired how the Oregon program recruited businesses
to participate as employers.
MS. HOBACK replied that the Oregon program had a private-sector
"champion". This business encouraged other businesses to become
involved in the program. Utilizing this business as the
private-sector outreach proved to be very effective, she pointed
out. Prior to their involvement, many of these employers
disliked and distrusted government-subsidy programs. The Oregon
reform workers adopted the perspective of the employer to make
the program as simple as possible.
Number 1330
CHAIR DYSON asked, "Did organizations like the chambers of
commerce ... work with you?"
MS. HOBACK said:
They absolutely did. We made a real effort to reach
out to the chambers and to the various business
organizations within communities. And many of them
embraced this totally and did a lot of the marketing
for us.
Number 1346
REPRESENTATIVE JOULE inquired whether these business
partnerships were established before or after the legislation
was submitted.
MS. HOBACK answered, "Both." Groundwork had been laid before
the legislation, and then the legislation was a catalyst to "get
on with it."
Number 1400
REPRESENTATIVE COGHILL stated that Alaska has many nonprofit
organizations that depend heavily on federal and state monies.
"This would be one more subsidy," he offered. He asked how
Oregon had dealt with this issue.
MS. HOBACK replied that Oregon might not have comparable numbers
of private nonprofits. Oregon did, however, use this program
with its nonprofits. The Oregon program targeted the small-
business sector, because this is where people would find jobs.
Alaska, on the other hand, must assess this as a "situational
issue".
Number 1469
CHAIR DYSON asked about labor unions as partners.
MS. HOBACK answered that labor unions did not initially
understand the program and were concerned it would replace
existing labor. After program workers clarified that this
program was about new work opportunities, labor unions were
predominantly supportive, she stated.
Number 1511
CHAIR DYSON inquired whether jobs created in the Oregon program
were primarily low-skilled, low-paying jobs.
MS. HOBACK replied, "Actually, it ran the gamut." Employers
were reimbursed at the minimum-wage level; Oregon's minimum wage
is $6.50, the highest in the nation. Employers could supplement
that amount and often paid workers significantly higher than
minimum wage. The average wage for program workers was about
$8.25 an hour, she furnished; some were making $12.00 to $14.00
an hour, and some were paid minimum wage.
Number 1571
REPRESENTATIVE COGHILL requested her perspective on the
program's inclusion of workforce development or "career-ladder"
strategies.
MS. HOBACK replied that the Oregon program included workforce
development. She noted the need to integrate funding sources.
"We did a fair amount of experimentation around the career-
ladder idea, she said. "How do you bring somebody in[to]... a
nursing home position, and then ... move them up into a higher
professional sort of a nursing situation?" Program managers
worked with community colleges and industry to develop those
career ladders while keeping a client on the job. She
acknowledged that Oregon is still working on this facet of the
program; it is a complex component, but must be part-and-parcel
of this whole agenda.
Number 1650
REPRESENTATIVE WILSON inquired whether the Oregon program paid
for schooling, such as training a nurse's aide.
MS. HOBACK responded that the program allowed for short-term,
targeted vocational training. She explained that specific
training was provided upon assurance of employment in that
field. Research has shown it is important to get people
employed as quickly as possible; long-term training programs
generally don't work as well for this population. She reported
that the most effective approach included providing minimal,
necessary training for entry-level positions and then augmenting
a client's work experience with training designed to upgrade
his/her skills.
Number 1717
CHAIR DYSON asked about the time limit for subsidized employment
for an individual.
MS. HOBACK replied that six months was the limit for training
positions.
CHAIR DYSON asked, "Did you find [that] many employers at the
end of the six months ... eliminated the position?"
MS. HOBACK answered that most of the employers hired their
employees after the subsidy expired. The placement rate,
including clients who stayed in the same position and those who
applied their skills to a new position, was over 80 percent, she
offered. "I think that's even more impressive when you realize
the folks that we put into those jobs ... were the folks that
had ... the most challenges [and] the most barriers to
employment," she added.
Number 1769
CHAIR DYSON commented that many Alaskan jobs are seasonal in
nature. He asked about Oregon's experience with seasonal work.
MS. HOBACK answered, "Yes. We have a fair amount of seasonality
in the employment here." She recounted her experience in Sitka,
where she received feedback indicating that this type of program
might serve as a "bridge" for employers in the off-season.
Employers, enabled by the wage subsidy, could train workers
during this time and prepare them for the summer season.
CHAIR DYSON asked whether clients in Oregon worked in
agriculture or fish processing.
MS. HOBACK said yes; clients were placed in any kind of work,
including agriculture, food processing, and fishing.
Number 1855
REPRESENTATIVE COGHILL asked if Oregon's program included
accountability measures and progressive sanctions, and he
inquired about the incidence of the sanctions' imposition.
MS. HOBACK affirmed that Oregon's program did use both of these
elements. She explained that the sanction rate decreased in
most parts of Oregon. She ascertained that this was because "we
were able to get people's attention much quicker."
Number 1906
JIM NORDLUND, Director, Division of Public Assistance,
Department of Health and Social Services, offered the division's
perspective on the proposed legislation. He thanked the
committee for sponsoring HB 402 and noted the division's support
of it. However, the division does have some concerns about some
of the provisions. He recounted that the division personnel did
have some initial apprehension about the assessment of the
welfare program; they are, nonetheless, pleased with the
results. He offered that this success was largely due to Ms.
Hoback's knowledge and expertise. "In the end, what we thought
was going to be a bad thing, frankly, turned out to be a good
thing," he said. "And the recommendations have a lot of
veracity." He noted that many of the proposed changes are
operational; the division has hired Ms. Hoback as a consultant
to assist in the implementation of these changes.
Number 1985
MR. NORDLUND observed that last year the division was advocating
for the change recommended in the first provision. He stated
that this provision is the most important to the division.
Victims of domestic violence, families with disabled children,
or parents with disabilities often need extended benefits. He
predicted that in the next two years, the number of families
needing assistance beyond the 60-month time limit will exceed
the 20-percent cap. Objective, strict criteria would instead be
used to identify families needing extended benefits.
Number 2051
CHAIR DYSON expressed his concern that people without the
aforementioned hardships and who are able to work, but who are
living in places without employment, could have a taxpayer-
subsidized lifestyle. He said, "How do we go about making that
judgment, of finally, when we say, 'No more living at taxpayer
expense; you need to relocate where there's some job
opportunities.' How do we make that call?"
MR. NORDLUND replied that protections against that were the time
limit and the requirement that clients participate in work
activities. People who might qualify for a subsidy extension
aren't necessarily exempt from work activities. People with
disabilities who are able to work are expected to pursue work
activities. Sanctions would be imposed if they failed to do so,
he stated.
CHAIR DYSON asked, "Do you, in your policy, say that a bona fide
work activity is to move where there's a job?"
MR. NORDLUND responded that the division has helped people to
relocate to find employment.
Number 2112
REPRESENTATIVE JOULE noted his concern with forcing people to
move. He pointed out that hub communities offer more employment
opportunities. "Would job-sharing work?" he asked. "That would
enable people to live in their community but work in another
community and still bring that income back." He stressed the
need to look beyond simply moving people and to seek ways to
help people "have value" and bring that value back to their
community.
MR. NORDLUND agreed that this was an excellent idea and a way to
take advantage of seasonal employment opportunities. This could
be made a part of a family's self-sufficiency plan.
Number 2175
CHAIR DYSON said, "There's no way that anyone's in favor of
forcing somebody to move." He acknowledged the need, however,
to address the issue of people wishing to live at taxpayer
expense and unwilling to relocate to gain employment. He
queried, "What's the administration's policy? How do we go
about making those decisions?"
REPRESENTATIVE JOULE suggested that HB 402 is a step in the
right direction. Similarly, people receiving services need to
change their thinking. People living near hub communities
should be looking for opportunities in these hubs, he offered;
employers also need to look at job-sharing opportunities for
employees.
Number 2236
MR. NORDLUND added that the wage subsidy would provide employers
with incentive to hire people off the public assistance rolls.
He then continued with his analysis of the bill's provisions.
The second provision changes how sanctions are imposed. He
noted the general agreement that the current system offers few
incentives for compliance; an immediate reinstatement of
benefits upon compliance is the best incentive. He noted that
some concern exists in the division pertaining to the complete
family sanction for noncompliance; this program benefits poor
families - the children are most harmed when benefits are
completely taken away. He said:
We feel that we have worked with you, Mr. Chairman,
and think we put some provisions in the legislation
that would provide ... adequate protections to make
sure that a family isn't inadvertently cut off because
of poor casework, that there's proper review to make
sure that if a family is completely cut off, that we
know the circumstances of the family and,
particularly, what will happen to those children, and
if it's determined that ... the children truly could
be harmed if the benefit is completely cut off, that
we would take measures to help protect those children,
one of which could be ... making direct payments to
landlords to pay the rent. ... That's the apprehensive
side.
MR. NORDLUND continued:
The positive side is ... that without being able to go
to a full-family sanction, ... our own workers ...
have seen situations where there are some clients, and
not very many, who ride those sanctions out, and just
say, "We're not going to have anything to do with you.
Don't bother me." And there's really nothing more we
can do about it. We think we need to be able to do
more to help bring families into compliance. ... We
didn't propose to have in here the full-family
sanction. But we would not necessarily oppose it, as
long as those protections are in the bill.
MR. NORDLUND noted that the third thing that Ms. Hoback brought
up was the ability to continue to provide work-related services
to families.
TAPE 02-10, SIDE B
Number 2445
MR. NORDLUND said:
We have thought about putting this kind of language in
legislation before. And now, particularly, as we ...
get closer to the 60-month limit, we see that we might
want to provide work-related [support] to families
that does not trigger the clock. We thought that that
would be a good thing to do.
MR. NORDLUND continued:
The bill does go on; the bill is quite thick, and one
of the reasons is that ... every time that we
reference "assistance" in the statute, we had to make
the distinction between what is ongoing, cash
assistance, i.e., the welfare check, versus self-
sufficiency services, which is helping with
transportation, with child care, those kinds of things
that help the family stay on the job. So, we think
that's an important provision of the bill.
MR. NORDLUND offered that the fourth change is relatively minor.
It allows a diversion payment of up to three months' benefits
instead of two months' benefits. He emphasized that the real
issue is how the department will "operationalize that taking
advantage of the diversion program." The department is working
with Ms. Hoback on this matter to ensure a strong, "work-
oriented, upfront process" is in place. He acknowledged that
the department currently has an eligibility focus upfront. He
said, "We want to make sure ... that all of our staff is asking
the question when somebody comes in for assistance: 'Why are
you really here? Do you really need to go on assistance? Is
there some way we can help you to move down the road and not go
onto the program?'" He offered that before welfare reform, a
client coming in due to car trouble, for example, would be put
on the program to help him/her fix the car. Currently, the
diversion program helps keep them off the program.
Number 2278
MR. NORDLUND stated that the department supports the fifth
provision, providing for a wage subsidy. He pointed out that
provisions in the law already exist to authorize "work
supplementation" with the temporary-assistance benefit. House
Bill 402 additionally allows food stamp benefits to be converted
to cash for a wage subsidy. He added that the department needs
to do a better job "operationalizing" this; it cannot be
completely solved with legislation. He expressed concern
regarding the use of food stamps, because the federal agency
administering this program is very restrictive. "It's, frankly,
a bit of a nightmare to work with those folks," he said. Food
stamp benefits cannot be taxed; if the benefit is paid to the
client in the form of wages, that income cannot be taxed. He
noted that there are some administrative problems with this.
But he added that Oregon was able to accomplish this, and the
division is willing to make these changes.
Number 2207
CHAIR DYSON asked Ms. Hoback about how to measure the
department's success in using the work-first subsidized-
employment model.
MS. HOBACK replied, "I don't know that you'd want to
specifically put that measurement in the statute. I think the
important things are the ... hard outcomes that you are putting
in there, and this program should just be another tool in order
to accomplish that." She added that the Oregon legislature
required her to report annually on the subsidy program. An
annual report by the department to the legislature could provide
members with information such as the number of people in the
program, types of employers being used, average wage, and how
many people received jobs as a result of the program.
Number 2142
REPRESENTATIVE WILSON asked Ms. Hoback whether seasonal workers
who applied for unemployment following the work season were
counted as a success in the program.
MS. HOBACK responded that the client's initial placement would
have been counted a success. She noted that once a client was
earning minimum wage at a full-time position, he/she was
ineligible for cash-assistance benefits in Oregon. If that job
is lost, the client becomes eligible for unemployment insurance,
which is administered by another system. She said, "Unless they
exhaust those benefits and then come back to us and are eligible
for our program, we probably wouldn't have any involvement in
that family."
Number 2072
REPRESENTATIVE COGHILL asked Mr. Nordlund about the effect of
the subsidized work program on the 60-month benefit limit.
MR. NORDLUND replied that he believed that if the benefit is
being paid out in the form of a subsidy, and if the portion of
HB 402 passes that distinguishes between cash and self-
sufficiency services, it would be considered self-sufficiency
services and the "clock would not be ticking."
MS. HOBACK agreed that this is indeed true.
Number 2026
REPRESENTATIVE COGHILL expressed his concern regarding
nonprofits and that this might become a "make work" program that
will extend the program beyond control.
MR. NORDLUND answered, "The very fundamental thing that we're
trying to do with families is not to 'make work.'" He noted
that this work might be an entry-level job, and it will have a
six-month limit on it. The department wants to see a
progression from a temporary, entry-level job to higher-paying
jobs that do not require a subsidy. He referred to performance
measures developed with the finance committee which ensure that
progression and said, "Frankly, we'd be failing in one of our
performance measures if we took too much advantage of that
program and just made it ... 'make work' opportunities."
Number 1971
CHAIR DYSON pointed out that he has worked with Ms. Hoback to
put those kinds of performance measures into the missions and
measures.
REPRESENTATIVE COGHILL asked about ways in statute to encourage
the development of the career-ladder idea. He noted that many
employers are in need of employees; he acknowledged that
Representative Joule's idea of job sharing is one creative
solution to address the issue of getting people into the
workforce.
Number 1930
MR. NORDLUND suggested that the members should "feel some
comfort" that performance measures are now in place to show wage
progression, which is tantamount to career progression.
Number 1920
WILLIAM CRAIG asked what will happen to disabled people [as a
result of HB 402].
CHAIR DYSON responded that a disabled person who is able to work
would have a better opportunity to gain employment through
subsidized employment.
Number 1873
REPRESENTATIVE JOULE asked about the intent to move HB 402.
CHAIR DYSON indicated that it is his intention to move HB 402.
REPRESENTATIVE JOULE also asked about the next committee of
referral. He pointed out that when HB 402 was noticed, it had
no number designation. This may have impeded communication
about the bill to constituents.
Number 1822
CHAIR DYSON responded that the bill will go to the House Finance
Standing Committee next. He added that members saw the bill
before it was filed; there is a companion bill in the Senate, SB
293, which is an identical bill. It is scheduled to be heard in
the Senate Health, Education and Social Services Standing
Committee on February 22.
Number 1782
REPRESENTATIVE COGHILL moved to report HB 402 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 402 moved out of House
Health, Education and Social Services Standing Committee.
CHAIR DYSON extended his appreciation to Mr. Nordlund and Ms.
Hoback.
HB 252-STANDARD OF CARE FOR CINA SERVICES
CHAIR DYSON announced that the next order of business would be
HOUSE BILL NO. 252, "An Act relating to the construction of
certain statutes relating to children; relating to the scope of
duty and standard of care for persons who provide services to
certain children and families; and providing for an effective
date." [Version J, 22-LS0454\J, Lauterbach, 2/11/02, had been
adopted as a work draft and amended on February 12, 2002.]
Number 1659
REPRESENTATIVE COGHILL, sponsor of HB 252, referred to Amendment
1, 22-LS0454\J.1, Lauterbach, 2/14/02, which reads:
Page 1, line 5 - 13:
Delete all material and insert:
"* Section 1. The uncodified law of the State of
Alaska is amended by adding a new section to read:
LEGISLATIVE INTENT. By the amendment of AS
47.10.005 in sec. 2 of this Act, the legislature
intends to express its recognition that parents
possess inherent, individual rights to direct and
control the education and upbringing of their
children.
* Sec. 2. AS 47.10.005 is amended to read:
Sec. 47.10.005. Construction. The provisions of
this chapter shall be liberally construed to the end
that a child coming within the jurisdiction of the
court under this chapter may receive the care,
guidance, treatment, and control that will promote the
child's welfare and the participation of the child's
parents in the child's upbringing."
Renumber the following bill sections accordingly.
Page 2, line 1:
Delete "Section 1 of this Act takes"
Insert "Sections 1 and 2 of this Act take"
REPRESENTATIVE COGHILL said Amendment 1 takes the language out
of the construction section and puts it into an intent section.
It leaves the participation of the child's parents in the
construction section.
Number 1645
REPRESENTATIVE COGHILL moved to adopt Amendment 1. There being
no objection, Amendment 1 was adopted.
Number 1629
REPRESENTATIVE CISSNA referred to Amendment 2, "Amendments for
HB 252," which reads [original punctuation provided]:
1. Sec. 3: AS 47.10.086 (a) (3) following "or
available" insert "and enumerating the reasons
specific to the case for providing Intensive Family
Preservation Services"
2. Sec. 6: AS 47.10.520 (2) (c) change "family
conflict" to "any mitigating factor that could lead to
out-of-home placement not already covered under (A)
and (B)"
3. Sec. 6: AS 47.10.520 (b) (5) delete "unduly"
4. Sec. 7: AS 47.10.990 (28) (A) following
"competence" delete "and by solving" and insert ",
solve day to day"; following "stress" insert ",
identify the factors which created the risk of out-of-
home placement and assist in the development of a case
plan"
["Sec. 3" should read "Sec. 2"; it refers to Section 2 of the
amended CS, Version J.]
REPRESENTATIVE CISSNA offered that the rationale for the
proposed change in Section [2] is to "conform with other
divisions' concerns." She said, "Everything we're doing here is
trying to 'marry' everybody in this building and every other
building in town, so that everyone's happy."
Number 1546
REPRESENTATIVE CISSNA referred to the proposed Section 6 changes
in Amendment 2. The first change is proposed due to the
ambiguity of "family conflict"; she said, "This really says it
the way it needs to be said." She stated that the reason for
the second change to Section 6 is because "threatened is
threatened."
REPRESENTATIVE CISSNA explained that Section 7 changes are
intended to more clearly define "solving". "We're solving the
small ... problems, and ... helping to work out a plan for the
future for this family, because they will be working out ...
their case plan for some time," she concluded.
Number 1398
CHAIR DYSON asked Representative Cissna if she had discussed the
aforementioned changes with the Department of Health and Social
Services.
REPRESENTATIVE CISSNA replied that she had.
CHAIR DYSON noted that Theresa Tenoury, Director, Division of
Family and Youth Services, Department of Health and Social
Services, indicated that she had no objections to Representative
Cissna's amendments.
Number 1387
CHAIR DYSON asked if there were any objections to [Amendment 2].
There being no objection, Amendment 2 was adopted.
CHAIR DYSON announced that HB 252 would be held by the House
Health, Education and Social Services Standing Committee.
HB 367-MEDICAL ASSISTANCE PROGRAM COVERAGE
CHAIR DYSON announced that the next order of business would be
HOUSE BILL NO. 367, "An Act relating to coverage of children and
pregnant women under the medical assistance program; and
providing for an effective date."
Number 1297
CYNTHIA EBELACKER, Alaska Nurse Practitioners; Alaska Nurses
Association, testified via teleconference in opposition to HB
367. She is a nurse practitioner, and she owns a small clinic
in Eagle River. She referenced written testimony that she
submitted pertaining to HB 367. She acknowledged the importance
of fiscal responsibility and offered to clear up misconceptions
about who qualifies for Denali KidCare. She noted that her
experience has been that "people aren't flooding in to get on
Denali [Kid]Care." Some who do qualify are not aware that the
program exists. She furnished that parents who qualify for the
program are not white-collar workers with access to other
insurance; they are blue-collar and self-employed workers.
Eagle River is not an affluent community, she noted. At least
65 percent of her patients are able to see her only because they
have Denali KidCare insurance. She indicated that her clinic
staff members are well aware of their patients' economic status.
These patients usually do not have other insurance, she added.
MS. EBELACKER said:
These families ... are working hard; they are the
builders, ... the plumbers, ... the fast-food workers,
and the Wal-Mart workers. They do pay taxes and they
do vote. The difference is that three years ago,
their children would almost never have received any
preventative care, and they would have had to go to
the emergency room when their kids were really ill.
If their Denali [KidCare coverage] goes away, they
will once again be forced to utilize the emergency
room and their local "doc," and that's a much bigger
financial burden to the state.
MS. EBELACKER stated that she has spoken with people who work
with insurance and Medicaid fraud, and they have indicated that
evidence bears out the fact that not many people are abusing the
system by concealing additional insurance coverage.
Number 1126
JACKIE SUNNYBOY, Fairbanks Community Mental Health Center,
testified via teleconference in opposition to HB 367. She
reported that she works with the children's program at the
center and pointed out that 44 of the center's 205 clients are
covered by Denali KidCare; of the 50 clients on the waiting
list, 11 have this coverage. These families and children, she
noted, have severe emotional disturbances. Clinic staff is
concerned that many of these families will not receive service
without Denali KidCare insurance. These clients suffer from
severe emotional, physical, and sexual abuse issues, she
offered. The clinic also sees many children affected by fetal
alcohol syndrome; they need all the assistance they can get,
because these disabilities do not simply go away. These
children have a right to services [through Denali KidCare] that
they would otherwise not qualify for.
Number 1084
CHAIR DYSON asked about the number of clients Ms. Sunnyboy
referenced that would not qualify for Denali KidCare [under
provisions in HB 367].
MS. SUNNYBOY said, "It's not that they wouldn't qualify, but
without Denali KidCare, it would be very difficult to get
services."
Number 1084
CHAIR DYSON asked, "Does it mean that they wouldn't qualify for
Denali KidCare if the threshold was lowered?"
MS. SUNNYBOY replied that she had not had time to calculate the
number of clients [whose income is] 150 to 200 percent [of
poverty level].
Number 1043
CHARLES QUARRE testified via teleconference in opposition to HB
367. He cited statistics indicating that 3,821 children and
722 pregnant women will lose health care coverage should HB 367
be passed. He noted that if HB 367 passes, the state will save
$5 million, but it will lose $11.9 million in federal funds. He
stated that he applauds the effort to reduce state spending, but
he believes this cut would be near the bottom of the list if the
cuts were prioritized. Parents might wait until the last minute
to seek treatment when the problem is serious and requires a
trip to the emergency room, which will cost much more, he
concluded.
Number 0977
PATRICIA BOILY, Homer Medical Clinic, testified via
teleconference. She stated that she has been involved in health
care since 1980. She said:
My feeling is that HB 367 is wrong-headed and should
not be passed. Its target is pregnant women and
children. They are the only direct beneficiaries of
the Denali KidCare program. I was somewhat taken
aback by [Representative] Coghill's sponsor statement
because there were some errors in it. Denali KidCare
does not base anything on 250 percent. Those figures
are 150 to 200 percent of the federal poverty level,
depending on whether or not you have primary health
care insurance.
MS. BOILY continued:
The program is supported by more than 70 percent in
federal dollars, and the state picks up the remainder,
but we're talking about our children. The future of
this state is its children. Since the state has
failed to take any proactive movement towards
affordable health insurance for its residents, it has
an obligation to make sure that at least the children
are healthy. Keep in mind that Denali KidCare is only
for health-related coverage; it doesn't provide money,
food, household expenses. Its purpose is only to
ensure that pregnant women and children are getting
whatever health-related needs they have attended to.
MS. BOILY added:
[Representative] Coghill stated that our unemployment
rate is 5.8 percent; he must realize that not everyone
employed in Alaska makes a living wage. There are
many people holding down two or more jobs just make
ends meet. And not all employers are inclined or can
even afford to provide health insurance coverage to
its employees. I have what's considered a good-paying
job in the private sector. Yet my monthly premium
[for] health insurance for me and my husband are in
excess of $690 per month. And we have a thousand
dollar deductible each. My employer contributes 18
percent, and the rest of it comes out of my paycheck.
I pay more than $8,300 a year just for premiums. Then
I have a thousand dollar's deductible before the
insurance even takes effect. Then I still have 20
percent. If I still had dependent children, my
premiums would be over [$]900 per month.
MS. BOILY concluded:
It's time for the legislators to recognize that
affordable health insurance is just not available to
the majority of Alaskans. Instead of focusing your
energy on our most vulnerable citizens, you should be
looking for solutions ... for the uninsured or
underinsured working class. Also, if everyone had
adequate health insurance, there'd be far fewer women
and children on Denali KidCare. Thank you.
Number 0841
CHAIR DYSON suggested that the 250 percent figure is based on
Alaska's poverty rate, which begins with a 25 percent cost-of-
living adjustment over the federal standards. The Denali
KidCare qualifications set the income level at 200 percent of
Alaska's poverty standard. The result is 250 percent above the
national poverty level. He said, "I don't think it was the
intention of the sponsor to be deceptive."
Number 0793
DONNA JORDAN, Governor's Council on Disabilities and Special
Education, testified via teleconference. She read a letter from
a parent she has worked with. She read as follows:
We are raising six children, four of which are adopted
and prenatally exposed to alcohol and drugs. Our
adopted children all receive Medicaid, for which we
are extremely thankful, as their medical [and]
psychological needs are many. Much to our surprise,
our youngest child, born to us five years ago, has a
speech delay. We thought, "No problem, the husband
works for the school district; we have great
insurance." What a shock to find out that private
insurance only cover $400 maximum for speech for our
son.
MS. JORDAN continued to read:
Basically, $400 covers the evaluation and two speech
sessions. We applied for Denali KidCare for our
child, ... [and] within a few weeks received the card
and immediately were able to get the speech therapy
our child needed. Denali KidCare had an extremely
positive impact on this family by providing what our
private insurance would not provide. I am pleased to
say that our son's speech has greatly improved. He is
not, at this time, requiring speech [therapy]. We
feel that the early ... intervention of speech
services at age four years has saved us in many ways
for a long run, and our family is very thankful for
Denali KidCare. In closing, let me share: If it
works, do not fix it. For families who may not
otherwise have coverage, Denali KidCare does work.
MS. JORDAN added that she works with families in the Matanuska-
Susitna area. There are many seasonal workers for whom Denali
KidCare has been extremely beneficial. Several of these
families have children with disabilities, and the costs
associated with these disabilities are numerous. She stated
that cutting the Denali KidCare program would create a problem
by discouraging families from using preventative services;
emergency medical bills would increase as a result. She
expressed her opinion that bringing the permanent fund dividend
(PFD) into the discussion is unfair; the PFD is not a
consideration for Denali KidCare eligibility.
Number 0616
SALLY BELTZ, MSN, RN, ARNP-C, Advanced Training Coordinator,
Yukon-Kuskokwim Health Corporation, testified via
teleconference. She paraphrased from a prepared written
statement that reads as follows:
My name is Sally Beltz, and I live in Bethel. I work
for the women and children in the Yukon-Kuskokwim
Delta. I work to ensure that, no matter what their
income, they receive the best health screenings
available in their home villages. I do this by
training the health aides in 48 tribal villages to
provide women's preventive health screenings and well
child periodic examinations through the Denali KidCare
Program. As I am sure you know, this program was
created to provide health care insurance to uninsured
children and pregnant women in working and non-working
families.
MS. BELTZ said:
The price of ensuring that our children have health
insurance coverage is relatively cheap - only $552 per
year, per child in state funds. This program ensures
that the children of Alaska can have a health and
developmental screening and a head-to-toe physical
examination. It also provides for a dental and vision
screening; a hearing screen done by audiometer; a
developmental assessment for gross and fine motor
development; and an evaluation of self-help and self-
care skills. They are also screened for social and
emotional development and receive a determination of
immunization and nutritional status. Their vital
signs are checked and a hemoglobin, hematocrit,
urinalysis and PPD are done. A pap smear and pelvic
and breast exam are also performed if needed. All
children are also screened for behavioral health
issues such as tobacco, drug, or inhalant use and
child abuse. All of these screens are performed
during the examination that is provided through Denali
KidCare.
MS. BELTZ continued as follows:
This program also ensures that pregnant women have the
opportunity to have prenatal care. It is well-known
that prenatal care is one of the most cost-effective
health care dollar expenditures. Prenatal care
increases the chance of a healthy pregnancy and
ensures the best chances for the delivery of a healthy
baby. Prenatal care is also the best method of
assuring that the children of Alaska have a healthy
start in life.
If this bill is adopted by the legislature, it will
cause approximately 3,821 children and 722 pregnant
women to lose their health care coverage. That means
3,821 children will not be offered the opportunity to
live their best lives. It means that 722 women and
722 unborn babies will not be offered the opportunity
to have the best health outcomes possible.
I ask that the legislature seriously consider the
potential negative health outcomes for the women and
children of Alaska if they are denied access to health
care. Aren't our women and children worth $552 per
year? I respectfully ask you to consider if Alaskans
are really willing to be guilty of leaving 3,821 of
our children behind?
Number 0470
CHAIR DYSON said, "Many of those children in your area would ...
still be covered under Indian Health Service, would they not?"
MS. BELTZ replied, "Yes, some would."
Number 0404
JONALYN NAJERA testified via teleconference. She is a parent on
Denali KidCare. She offered a statistic from the National
Alliance for the Mentally Ill: between 375 and 400 children
will lose care if HB 367 passes. She indicated that her
daughter, who suffers from early-onset bipolar disorder, would
be among these. The cost for her daughter's mental health care,
excluding hospitalization, was about $25,000 a year. Ms. Najera
stated that she would not know how to help her daughter [without
Denali KidCare insurance]. She offered that 25 percent of
bipolar children commit suicide each year. Denali KidCare is
very helpful, she said. She would be unable to get insurance,
and if she did have insurance, she could not afford the co-
payments.
Number 0333
CHAIR DYSON asked about Ms. Najera's income.
MS. NAJERA replied that her family of four's income is about
$42,000 a year. Her husband has insurance through work, but to
add herself and their children, the cost would be $800 a month
in addition to the co-payments and deductibles, she said. The
insurance, however, does not have much mental health coverage.
Number 0273
JAN LYNDES testified via teleconference. She stated that she
works with people covered by Denali KidCare. She was covered by
the program for her pregnancy. She received ongoing care and
education throughout her pregnancy due to the coverage.
Delivery complications necessitated a Caesarian-section
delivery; she offered that the decision to have a C-section may
have been delayed due to expenses incurred without Denali
KidCare coverage. This delay could have meant a long-term
disability or death for her son. She said, "I feel like Denali
KidCare allowed me to have a birth complication not affect my
physical or mental health [or] my son without causing my family
to live under the poverty level while paying for the birth."
She stated that she is now a full-time mother, which pays no
money and offers no health insurance; she is dependent on
[Denali KidCare] for the health of her son. She urged members
to reject HB 367.
CHAIR DYSON asked, "Is it true, then, that you wouldn't qualify
if this bill passed?"
MS. LYNDES replied that this was correct.
TAPE 02-11, SIDE A
Number 0001
DANA LEE HALL, R.Ph., Village Operations Administrator, Yukon-
Kuskokwim Health Corporation, testified via teleconference.
CHAIR DYSON noted that the committee had received the fax sent
by Ms. Hall.
MS. HALL stated that she wished to follow up her testimony of
February 12 by clarifying information on Indian Health Service
(IHS) funds used by YKHC in Bethel. These funds are minority
funding, she said, adding, "Last year they were 49 percent of
our funding. This year they're actually 43 percent." She noted
that this was less than the 60 percent indicated by Nancy
Wheeler, Unit Manager, State, Federal, and Tribal Relations,
Division of Medical Insurance, Department of Health and Social
Services. This money is leveraged with other money, Ms. Hall
stated. This has enabled YKHC to double its operating budget
and, in turn, double its services. She offered that with only
IHS dollars, staff would be forced to choose which services to
provide; this choice would limit services to those giving the
most immediate health benefit such as emergency-room services.
Essentially, YKHC would provide acute care services exclusively
and discontinue preventative care services.
MS. HALL turned attention to the fax sent to members entitled
"Price comparison between Anchorage and Shageluk." This chart
shows the higher costs of grocery items and gasoline in
Shageluk. Each grocery item identified is at least 2.4 times
more costly in Shageluk than in Anchorage. She said that a
household salary of $32,000 for a family of four does not go
very far when these are the prices paid.
CHAIR DYSON thanked Ms. Hall for the information.
Number 0201
MARIE DARLIN, AARP, referred to a February 14 fax from AARP
addressing HB 367. She stated that she was speaking in
opposition to HB 367 on behalf of Alaska's 112,000 AARP members.
She noted that AARP understands the legislature's need to
address fiscal problems, but it believes that HB 367 is poor
health policy and poor public policy. Most of Alaska's
uninsured, she said, are in working families whose employers do
not provide health insurance. "Denali KidCare is the only thing
that they can rely on," she said. "It ... is one of the best
preventative health programs that you can find."
CHAIR DYSON asked Ms. Darlin if many AARP members were pregnant
or had small children.
MS. DARLIN replied, "Not that many. ... However, we have a great
many grandparents and people who are taking care of children."
She indicated that some of these were using Denali KidCare. She
offered that the program increases the chances for good health
in families. She said, "We support any fiscal decisions that
the legislature might make that are fair and make sense.
However, we do not feel it makes sense to take these people off
of Denali KidCare. So we are recommending a nay vote."
Number 0402
TONY LOMBARDO, Director of Advocacy, Covenant House, testified
via teleconference. He noted that his remarks are based on the
statistics that he has received from Denali KidCare on Covenant
House's specific client population, teens 13-19 years old. He
noted that this information indicates that 3,319 teenagers will
lose coverage if this "rollback" of Denali KidCare occurs. He
said, "Covenant House always champions better health and living
conditions for all teens, but especially for homeless and at-
risk kids." The loss of this coverage will harm uninsured,
working families in Alaska; it will worsen the situation for the
children in Covenant House. Covenant House opposes the rollback
for this reason alone.
Number 0474
MR. LOMBARDO stated his understanding that Alaska pays $5
million in state funds to receive $12 million in federal funds.
He added his understanding that when the Native percentages are
factored in, 40 percent of that $5 million comes back to the
state. As a result, he offered that Alaska is spending $3
million to get $12 million of federal funding. Denali KidCare
is not a wasteful program, and Covenant House encourages members
to not cut this successful program.
Number 0565
SUSAN WOHGLEMUTH testified via teleconference. She pointed out
that even moderate-income families with health insurance
benefits have insurance that provides only limited benefits for
residential care for children with psychiatric disorders, eating
disorders, or behavioral health problems. She noted that she
knows a number of families aided by Denali KidCare who would
have been destroyed by catastrophic expense. "Denali KidCare
helped save my daughter's life, and it's a necessary and vital
institution," she concluded.
Number 0597
LYNDA THOMASSEN testified that her family commercial fishes and
Denali KidCare has been a "lifesaver" to their children. She
said, "I would hate to see us fall off the Denali KidCare if ...
the guidelines are lowered." She noted that her family's income
would put them "on the edge" of eligibility. Her son has
asthma; the preventative care has saved money, and it has saved
her son from more serious problems in the future. She noted
that she formerly had employment with insurance but has been
unable to work since the birth of her second son. "Denali
KidCare has been great for me," she concluded.
Number 0689
SUSAN DRATHMAN testified via teleconference. She urged members
to leave Denali KidCare eligibility guidelines untouched. She
said that she concurred with other witnesses' testimony. She
said, "Healthy children are the foundation of a ... successful
society, and it's about $500 per year per child. I can't think
of a better investment. It's incredibly ... cost-effective."
The program offers medical, dental, and mental health care
coverage; mental health care coverage is not available to many
families without Denali KidCare. Most insurance companies cap
mental health care at a low rate. She cautioned against looking
only at the eligibility income levels for families of 9 or 10;
she ventured that most Alaskan families are smaller than this.
Health insurance is out of reach for most people; a trip to the
emergency room is expensive - an appendectomy costs $15,000 to
$20,000 without complications, she stated. Health care
providers or the state will eventually incur these costs,
because people are unable to pay these large bills.
MS. DRATHMAN pointed out three inaccuracies she had heard at the
previous hearing on HB 367. She clarified that the Special
Supplemental Nutrition Program for Women, Infants, and Children
(WIC) does not offer medical care; it offers nutrition for
pregnant women. Second, Alaska Natives are not automatically
eligible for Medicaid; they must meet the same income guidelines
as others. And third, all Alaska Natives do not have ready
access to Native health centers: Homer Natives seeking services
must travel to Anchorage, where they must wait in line for care.
Number 0850
VALERIE DAVIDSON, Executive Vice-President, Yukon-Kuskokwim
Health Corporation, testified via teleconference in opposition
to HB 367. She said she would like members to remember as they
deliberate that "the need for medical care ... doesn't
distinguish whether a woman or a child is eligible for Denali
KidCare." This means that the population in greatest need of
medical care - low-income women and children - will be forced to
pay for their own care with dollars they do not have, she said.
MS. DAVIDSON pointed out the irony in the legislature's proposal
to reduce eligibility when our nation as a whole is expanding
services to women and children. She explained that 38 states
and the District of Columbia now have Children's Health
Insurance Plan (CHIP) coverage available to families whose
income is 200 percent or higher than the federal poverty level.
Before the CHIP program's inception, only 6 states offered
coverage for infants at this income level. She said that states
report that more than 75 percent of the children enrolled in
CHIP in 2001 were between the ages of 6 and 18. California sets
eligibility at 300 percent of the federal poverty level for
children under 2 and at 250 percent for children ages 2 to 19.
She noted that Minnesota sets the eligibility level at 280 and
275 percent, respectively. New York and Washington have an
income eligibility at 250 percent of the federal poverty level.
She added that other states that have the poverty level set at
200 percent offer other benefits; New Jersey covers both parents
of CHIP-eligible children. Studies indicate that racial and
ethnic minority groups are more likely than whites to be
uninsured and are less likely to have job-based health
insurance.
MS. DAVIDSON concluded by pointing out that President Bush's FY-
03 budget makes available $3.2 billion to states in unused CHIP
funds that would otherwise return to the federal treasury.
Alaska stands to benefit from these underutilized CHIP funds.
If Alaska underutilizes CHIP funds by reducing eligibility,
Alaska CHIP funds will be redirected to other states. She
requested that the Denali KidCare eligibility remain at the 200
percent of federal poverty level.
Number 1037
SUE ZAHND, Member, AARP; National Association for the Education
of Young Children (NAEYC), read from a written statement as
follows:
It is important to note that the people most affected
by the reduction of Denali KidCare would be those
families who provide stability and positive
contributions to our community. As often happens,
those with little, we care for, and those with much
are not in need. It is the parents who don't make
much money, who don't have access to group insurance,
who do not have large savings accounts, who suffer.
They work hard each day, keep this community
functioning, furthering their education, striving to
provide for their families as best they can.
These are the people who end up without the means to
care adequately for their family's health care needs.
Insurance is either not available for them, does not
provide for [preexisting] conditions, or is only
available at costs far and above what they can pay.
Individual doctor bills are problematic in the weekly
budget, and catastrophic illness, prohibitive. They
have the dilemma of whether to buy food, pay rent and
child care, or go to the doctor. They wait until the
need is severe, meaning that a minor illness may
become a serious one, and untreated conditions become
chronic ones with repercussions for the person in the
community.
MS. ZAHND continued:
These same children attend schools and child care with
other children, where they share play, learning, and
germs, thus further jeopardizing [the] health of the
community. Most importantly, when children aren't
well and safe, we risk their positive development that
could mean so much to the well-being of our whole
community.
At the present time we are quite conscious of the need
for safety and talk about it in expansive terms. We
need to be conscious that communal safety begins with
how we protect our children - all of them, not just
the very poor and not just the affluent. The
contribution of Denali KidCare to the health of
children in our community, and thus to the communal
safety, has been significant. It is my opinion that
families and their children will suffer if it is
reduced, and the negative effects on the community
will be long-term. Please keep your commitment to
children [and] families, and focus as you make this
decision and support Denali KidCare fully.
Number 1178
FAYE NIETO testified via teleconference. She encouraged members
to make a decision with their hearts as well as their heads.
She serves parents with children who have developmental
disabilities through Parents, Inc. As a nonprofit employer,
Parents, Inc. is unable to provide full benefits to its 25-plus
employees. Therefore, employees are needing to enroll [in
Denali KidCare to offset insurance costs]. These employees are
not making competitive wages in the nonprofit sector. She noted
the importance of considering employers and working families.
This proposed cut is a disincentive to former welfare recipients
who are working hard to provide for their families. She noted
her confidence that the House Health, Education and Social
Services Standing Committee will make the best decision for
Alaska's children.
Number 1350
JOY LYON, Alaska Association for the Education of Young
Children, noted the general agreement that health is critical to
a child's learning. Denali KidCare has been successful in
promoting children's learning through good health care. She
commended members on their efforts to save money; however, this
will not save the state money, she noted. She pointed out that
reducing the income eligibility for Denali KidCare will result
in a reduction of state expenditures only if the families
affected by the reduction purchase health insurance for their
children. If these families do not purchase insurance, higher
costs will result from the greater number of uninsured families
unable to pay hospital bills, she said.
MS. LYON stated that the 722 pregnant women who [will not
receive Denali KidCare coverage under provisions in HB 367]
could incur $8,300 to $9,600 for a basic C-section delivery.
[If these bills are unpaid] the costs will be transferred to
future patients, she offered. Children who do not receive
medical care eventually cost the state more through special
education and other services. She reiterated that the real
question at hand is whether the aforementioned families will
obtain private medical insurance.
Number 1400
MS. LYON indicated her first impression was that the $44,000
[income threshold for a family of four] sounded like a lot to
her, so she conducted some research. She pointed out that the
missing [expense] is the cost of child care. All of these
families are working families; this means that they have very
high child care costs, but are ineligible for child care
assistance. To be eligible for assistance at 25 percent of
child care costs, a family must be at 185 percent of the poverty
level. She expressed her belief that this threshold would be
reduced in the summer of 2002.
MS. LYON stated that her research indicates that average monthly
costs for a family of four are as follows: $424 for food
[according to the Alaska Cooperative Extension]; $1,464 for
rent, according to the Alaska Housing Finance Corporation; and
$1,100 for child care. She concluded that with these expenses,
there just isn't enough [money]. She offered her opinion that
[Denali KidCare] is a bargain for the state. On behalf of the
Alaska Association for the Education of Young Children, she
urged members to maintain the eligibility level at the 200-
percent-of-poverty level.
Number 1482
NANCY KOON testified via teleconference in opposition to HB 367.
She is the single mother of four children; her children receive
Denali KidCare benefits. She has a 10-year-old daughter in an
out-of-state placement. If HB 367 passes, Ms. Koon said her
children would be ineligible for coverage, her daughter would be
returned home, and she might need to quit her job to care for
her daughter. She speculated that this would counter the
state's goals. She offered her opinion that children around the
state deserve these benefits, and it saves the state money in
the long run. Her daughter's health care costs have exceeded
$100,000 in the last two years. She would be unable to meet a
co-payment of 20 percent; she would need food stamps [to make
ends meet]. Ms. Koon explained that her 11-year-old child needs
extensive back surgery in Seattle. She noted that she would be
unable to pay these "devastating" medical bills on her own. She
asked members to reject HB 367.
Number 1577
CAREN ROBINSON, Lobbyist for Alaska Women's Lobby, requested
members to reconsider the direction of HB 367. She reminded
members that Denali KidCare is not a long-term program. Most
women enroll in the program when they become pregnant; the
coverage lasts for one month after the birth. The children are
eligible for one year. She said, "Philosophically, we believe
very strongly that we need to do everything in our power to
assist pregnant women and children in getting the kinds of
medical care that they need."
Number 1624
SHAWNEE HART testified via teleconference, stating that she is a
single mother of two biological children and one adopted child.
She offered that she suspects that her adopted child is
emotionally disturbed. One of her biological children has
Aspbergers' Syndrome and the other is severely asthmatic. She
noted that their medical bills are beyond her ability to pay.
She has worked for four years since getting off welfare, she
indicated. Her income level disqualifies her for food stamps
and housing assistance. If she became ineligible for medical
assistance, she stated, she would most likely be forced to quit
her job or ask for reduced hours to keep her children covered.
She noted her concern for pregnant women who would not qualify
for Denali KidCare and would therefore lack necessary prenatal
care. She said, "I know that raising a child alone is very hard
work. I fear for the families that would ... be forced to
separate or divorce in order to ensure that their children can
receive medical coverage." She urged members to oppose HB 367.
Number 1684
CATHERINE BURGESS testified via teleconference, noting that she
is the single mother of four children; she is an Alaska Native
and her children do receive IHS care. Denali KidCare serves as
her secondary insurance. One of her children will require
surgery Outside this year. If this bill passes, she will be
unable to pay for insurance, she said. She opposes the passage
of HB 367.
Number 1730
ELMER LINDSTROM, Deputy Commissioner, Department of Health and
Social Services, pointed out that a memo dated February 14 is in
the committee packet. Attached to this memo is a matrix that
outlines income levels, disposable income, and the out-of-pocket
expenses for health insurance costs; these figures do not
include child care, rent, and other expenses. He stated that
Nancy Cornwell in the Anchorage office could answer any
questions pertaining to the matrix. Also attached to the memo
is a table showing the number of eligible children [whose family
income is] 150 to 200 percent of the federal poverty level, by
community.
CHAIR DYSON suspended the hearing on HB 367.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:08 p.m.