ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  January 25, 2024 3:02 p.m. DRAFT MEMBERS PRESENT Representative Mike Prax, Chair Representative Justin Ruffridge, Vice Chair Representative CJ McCormick Representative Dan Saddler Representative Jesse Sumner Representative Zack Fields Representative Genevieve Mina MEMBERS ABSENT  All members present COMMITTEE CALENDAR  PRESENTATION(S): UPDATE FROM THE DEPARTMENT OF HEALTH - HEARD PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER HEIDI HEDBERG, Commissioner Department of Health Anchorage, Alaska POSITION STATEMENT: Co-presented the Update from the Department of Health presentation. EMILY RICCI, Deputy Commissioner Department of Health Anchorage, Alaska POSITION STATEMENT: Co-presented the Update from the Department of Health presentation. DEB ETHERIDGE, Director Division of Public Assistance Department of Health Juneau, Alaska POSITION STATEMENT: Answered questions regarding Medicaid applications during the Update from the Department of Health presentation. ACTION NARRATIVE 3:02:38 PM CHAIR PRAX called the House Health and Social Services Standing Committee meeting to order at [3:02] p.m. Representatives Mina and Prax were present at the call to order. Representatives Ruffridge, McCormick, Saddler, Sumner, and Fields arrived as the meeting was in progress. ^ PRESENTATION(S): UPDATE FROM THE DEPARTMENT OF HEALTH    3:03:56 PM CHAIR PRAX announced that the only order of business would be the Update from the Department of Health presentation. 3:04:32 PM HEIDI HEDBERG, Commissioner, Department of Health, began a PowerPoint presentation [hardcopy included in the committee packet], giving an overview of the State of Alaska Department of Health. She showed slide 2, titled, "Promoting the Health, Well-Being and Self Sufficiency of Alaskans." During her introduction, she pointed out that the department was happy to celebrate its one-year anniversary on July first. She explained the department had a very busy year with an emphasis on stakeholder engagement around health care, childcare, and behavioral health. This included a focus on automation to support staff processes and client experience. She pointed to four major areas of effort: behavioral health; complex care; childcare; and transformational care. 3:05:59 PM COMMISSIONER HEDBERG moved to slide 3, which outlined the topics of the presentation. She then moved to slide 4, titled, "SNAP Updates: Backlog." She explained that when she started as commissioner in November 2022 there was a backlog, and with a change in leadership and system processing, the department was able to remove that first backlog. Then in the fall of 2023, there was a cascade of events that created the most recent backlog. She discussed several causes and outlined the steps the department took to deal with the backlog. She emphasized the importance of preventing future backlogs. One step focuses on staff training and maximizing staff resources. COMMISSIONER HEDBERG continued the analysis of the Supplemental Nutrition Assistance Program (SNAP) with slide 5, "SNAP Updates: Path Forward," which detailed the six automations the Division of Public Assistance will be implementing including online applications, self-service portals, and client access to status information. The department is currently on target to implement the integrated eligibility enrollment program in 2025. 3:15:26 PM EMILY RICCI, Deputy Commissioner, Department of Health, as co- presenter, focused on the Department of Health beginning her presentation with slide 6, "Medicaid Redeterminations," which read as follows [original punctuation provided]: Where are we at? • Initiated over 90,000 redeterminations using ex parte process • Negotiated with CMS additional time for redeterminations • Implemented new mitigation strategies • New access to data for partners Ex Parte (Automated) Process • Identified system errors impacting disenrollments (Aug/Sep) • Pause certain disenrollments until updates in place • Working with federal data services to update and fix system • Updates will increase successful automated renewals MS. RICCI explained that all states were required to review eligibility determinations for Medicaid beneficiaries at the beginning of 2023. She stressed the challenges of the process and described some of the mitigation strategies including automating processes; using data sharing; using texting for renewal reminders; automating some of the renewal processes; and analyzing system errors. 3:21:22 PM MS. RICCI presented slide 7, "Medicaid Redetermination Schedule." She discussed mitigation strategies the department is implementing. She then moved to slide 8, "Medicaid Savings and Tribal Reclaiming Initiative," which graphed General Fund savings from 2017 through 2023 pursuant to reclaiming initiative federal funds. The slide reads as follows [original punctuation provided]: • Tribal reclaiming allows states to submit claims for 100% federal match for services outside a Tribal facility under certain conditions. • The Tribal Reclaiming Unit works closely with the Alaska Tribal Health System to maximize federal match. 3:24:20 PM MS. RICCI moved to slide 9, "Medicaid Payment Changes," which read as follows [original punctuation provided]: • Comprehensive Medicaid rate review RFP released • First round to focus on: • Behavioral health • Long-term care services and supports • Federally Qualified Health Centers • Nonemergent medical transportation • Diagnosis-Related Groups (DRG) inpatient reimbursement • Went live 1/1/2024 MS. RICCI described the department's current work in analyzing Medicaid rates; how the data is being collected; and what Medicaid rate methodologies are being used. This work is being done in phases, and the first review was recently released for public comment. She also called attention to an inpatient reimbursement program that went live on January 1, 2024. 3:26:15 PM COMMISSIONER HEDBERG continued the presentation with slide 10, "Child Care Updates." She focused on the funding and provided an update on the Task Force on Child Care. She gave examples of some child care innovations that have been implemented throughout the state. She reviewed the work of the task force and gave specifics regarding recommendations and the focus of effort. 3:29:09 PM MS. RICCI continued the presentation with slide 10, "Improving the Behavioral Health Continuum of Care." She described the department's goal to provide access to needed care as near the communities as possible. Department staff visited five different communities throughout the state to explore what challenges are faced by providers, individuals, and communities. Staff looked at what solutions were in place and how issues might be addressed. The department reviewed the information and discussed a continuum of care as it relates to behavioral health. 3:32:55 PM COMMISSIONER HEDBERG moved to slide 12, "Division of Public Health Fresh Start Program." She described the free program, how Alaskans have responded, and the subsequent improvements in health. MS. RICCI presented slide 13, "Person Centered Care & InterRAI Tool." She described a system of care that features person- centered care as well as collaborative work the department has done with stakeholder groups. She briefly outlined the goals for the next three years. 3:35:46 PM REPRESENTATIVE FIELDS brought up a recent discussion he had with behavioral health providers, and he was told that Medicaid rates are insufficient to provide services. He asked whether the 11/15 waivers would help. He also asked whether autism services are being looked at during the department's rate reviews. MS. RICCI replied in the affirmative, saying it was one of the department's priorities. 3:36:51 PM REPRESENTATIVE RUFFRIDGE referred to slide 5 regarding online applications and asked whether there is a mobile application. COMMISSIONER HEDBERG explained that a person can use a phone to access my.alaska.gov and complete an application. REPRESENTATIVE RUFFRIDGE asked about Medicaid renewals and their time frame. MS. RICCI replied that Medicaid eligibility is reviewed annually. 3:38:18 PM REPRESENTATIVE MINA expressed her thanks to the department for dealing with the application backlog and for the work on providing online access. She asked about the language accessibility of online applications. In addition, she inquired about the differences in applications being completed through the online platform versus the paper application. COMMISSIONER HEDBERG responded that in terms of processing applications, one team is focused on current work coming in, and another team is focused on the backlog of applications older than 30 days. Regarding the online platform, the department is seeing more completed applications, but not enough time has transpired for specific data. 3:40:05 PM DEB ETHERIDGE, Director, Division of Public Assistance, Department of Health, explained that the applications are available in a variety of languages. In addition, the online applications are fully accessible per the requirements of the Americans with Disabilities Act. She would get back to the committee regarding what languages are available on the online application. 3:40:33 PM REPRESENTATIVE MINA requested information regarding what type of assistance is available for people who are doing the online application but who do not have a lot of digital literacy. MS. ETHERIDGE explained that the Division of Public Assistance uses people from several divisions who can assist in completing applications. They also use a Fee Agent program. 3:41:49 PM REPRESENTATIVE MINA acknowledged that the online application just launched but asked if Ms. Etheridge knew the average length of time to complete the online application versus the paper application. MS. ETHERIDGE explained the online application was a "smart form" and only takes about 20 minutes. The paper applications take longer because people generally give information they don't need to provide. 3:42:53 PM CHAIR PRAX asked for clarification regarding Ms. Etheridge's remark about SNAP that "all you need is your name and a signature and an address." MS. ETHERIDGE explained that when you fill out the initial SNAP application, it secures the date of application and requires a phone follow-up. CHAIR PRAX requested information about the error rate for both SNAP applications and Medicaid redetermination and asked how much that contributed to the backlog. MS. ETHERIDGE described the methods for dealing with the backlog including extending the certifications for six months without an application. That process technically contributed to the error rate which is anticipated to last until 2025. However, as the division reviews those earlier cases, the actual error rate is 5.6 percent. Typically, the division has a low error rate. CHAIR PRAX commented that he has tried out the online form and it seems like a step in the right direction. 3:45:27 PM REPRESENTATIVE FIELDS brought up the Fresh Start program and questioned how this program is addressing chronic diseases. He asked whether the department has engaged with the Department of Transportation and Public Facilities (DOT&PF)regarding expanding places for people to use wheelchairs and to walk safely. He pointed out that simply being able to walk safely positively impacts the health of people with certain chronic conditions in addition to creating healthy outdoor opportunities. COMMISSIONER HEDBERG responded that the Division of Public Health, Chronic Disease Prevention and Health Promotion does have a working relationship with the DOT&PF and does provide feedback. 3:47:05 PM REPRESENTATIVE MCCORMICK explained that constituents and non- profit organizations in his district have expressed concerns that the state is not paying grants in a timely manner. COMMISSIONER HEDBERG said that prior to the department reorganization, the Department of Health and Social Services experienced a cyber-attack that impacted all Information Technology systems in addition to the grant management system. On-time payment to grantees has significantly improved since that time. 3:49:21 PM CHAIR PRAX inquired about the results of a program that received significant funding the previous year and which concerned identifying pregnant women who had syphilis. COMMISSIONER HEDBERG provided an update on the program addressing congenital syphilis and tuberculosis. The funding went out to communities and focused first on communication and education on awareness of syphilis followed by testing of syphilis. There has been an increase in identification and treatment. 3:50:52 PM REPRESENTATIVE FIELDS expressed interest in restoring funding for the infant learning program. He would like to see the funding restored so children who have been screened as being eligible can get these services. MS. RICCI shared the news that the department is going live with the post-partum extension program. CHAIR PRAX observed that the Division of Family Services and the Department of Health are moving in the right direction. 3:54:00 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 3:54 p.m.