ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  May 8, 2025 3:23 p.m. MEMBERS PRESENT Representative Genevieve Mina, Chair Representative Andrew Gray Representative Zack Fields Representative Donna Mears Representative Mike Prax Representative Justin Ruffridge Representative Rebecca Schwanke MEMBERS ABSENT  All members present COMMITTEE CALENDAR  PRESENTATION(S): ALASKA MENTAL HEALTH TRUST AUTHORITY - HEARD SENATE CONCURRENT RESOLUTION NO. 4 Designating May 2025 as Mental Health Awareness Month; and designating May 4 - 10, 2025, as Tardive Dyskinesia Awareness Week. - MOVED SCR 4 OUT OF COMMITTEE SENATE JOINT RESOLUTION NO. 15 Calling on the state's congressional delegation to oppose cuts to federal spending on Medicaid. - HEARING CANCELED PREVIOUS COMMITTEE ACTION  BILL: SCR 4 SHORT TITLE: MENTAL HEALTH MONTH; TARDIVE DYSK WEEK SPONSOR(s): SENATOR(s) GRAY-JACKSON 04/15/25 (S) READ THE FIRST TIME - REFERRALS 04/15/25 (S) HSS 05/01/25 (S) HSS AT 3:30 PM BUTROVICH 205 05/01/25 (S) Moved SCR 4 Out of Committee 05/01/25 (S) MINUTE(HSS) 05/02/25 (S) HSS RPT 5DP 05/02/25 (S) DP: DUNBAR, HUGHES, CLAMAN, TOBIN, GIESSEL 05/02/25 (S) RULES TO CALENDAR PENDING HSS RPT/REF 05/02/25 (S) TRANSMITTED TO (H) 05/02/25 (S) VERSION: SCR 4 05/05/25 (H) READ THE FIRST TIME - REFERRALS 05/05/25 (H) HSS 05/08/25 (H) HSS AT 3:15 PM DAVIS 106 WITNESS REGISTER MARY WILSON, MD, Executive Director Alaska Mental Health Trust Authority Anchorage, Alaska POSITION STATEMENT: Gave the Alaska Mental Health Trust Authority presentation. KATIE BALDWIN-JOHNSON, Chief Operating Officer Alaska Mental Health Trust Authority Anchorage, Alaska POSITION STATEMENT: Provided comment and answered questions during the Alaska Mental Health Trust Authority presentation. SENATOR GRAY-JACKSON Alaska State Legislature Juneau, Alaska POSITION STATEMENT: As prime sponsor, presented SCR 4. ANN RINGSTAD, Executive Director NAMI Alaska Anchorage, Alaska POSITION STATEMENT: Gave invited testimony during the hearing on SCR 4. ACTION NARRATIVE 3:23:40 PM CHAIR GENEVIEVE MINA called the House Health and Social Services Standing Committee meeting to order at 3:23 p.m. Representatives Schwanke, Ruffridge, Mears, Gray, Prax, and Mina were present at the call to order. Representative Fields arrived as the meeting was in progress. ^PRESENTATION(S): Alaska Mental Health Trust Authority PRESENTATION(S): Alaska Mental Health Trust Authority  3:24:17 PM CHAIR MINA announced that the first order of business would be the Alaska Mental Health Trust Authority presentation. 3:24:40 PM MARY WILSON, MD, Executive Director, Alaska Mental Health Trust Authority (AMHTA), began the Alaska Mental Health Trust Authority presentation via PowerPoint [hard copy included in the committee file]. She began by sharing her work background. She brought attention to slide 3 of the PowerPoint, "Trust Beneficiaries," which read as follows [original punctuation provided]: Trust beneficiaries include Alaskans who experience: • Mental illnesses • Intellectual and/or developmental disabilities • Alzheimer's disease and related dementia • Traumatic brain injuries • Substance use disorders DR. WILSON then clicked on the link on slide 3 to play a video. 3:29:16 PM DR. WILSON moved to slide 4, "Creation of the Alaska Mental Health Trust Authority," which read as follows [original punctuation provided]: • Prior to statehood, few mental health services available in the territory • Mental Health Trust Enabling Act, 1956 • Legislature was fiduciary, but mismanaged assets • Weiss v State of Alaska, 1982 • Final settlement creating the Trust Authority, 1994 • Trust was reconstituted, resulting in 1M acres of land to be managed by the Trust Land Office • $200M in cash (origin of our corpus), managed by APFC • Independent board of trustees • Trust established in Alaska Statute, 1994 Morningside Hospital, Oregon Historical documents and more available on our history webpage • UAF's Project Jukebox Oral History Project DR. WILSON turned to slide 5, "The Trust Today," which read as follows [original punctuation provided]: • Oversees management of Trust assets and administers the Trust • Spends Trust income • Ensures the State has a Comprehensive Integrated Mental Health Program Plan • Serves as an advocate for beneficiaries and a Change Agent • Is required to recommend to the Governor and Legislature how the State of Alaska should spend general fund resources (GF/MH) to support a mental health program (AS44.25.270) • The Alaska Permanent Fund Corporation and the DOR Treasury Division to manage Trust financial assets, and the Trust Land Office within DNR to manage Trust lands. Mission: to improve the lives and circumstances of Trust beneficiaries DR. WILSON noted she would not be addressing trust land during the presentation but members are welcome to reach out to the office. 3:33:38 PM DR. WILSON moved on to slide 6, "Trust Authority: Frequently Asked Questions," which are listed as follows [original punctuation provided]: • Is the Trust supposed to fund all public mental health and disability services in Alaska? • Why doesn't the Trust spend more? • Why is the Trust asking for general funds (GF/MH)? • Is the Trust improving mental health in Alaska? DR. WILSON answered each question on the slide. To the first, she said the answer is no because of insufficient funds. She explained that there had been concern that the legislature may cut funds to mental health with the existence of the Trust; however, there are records that state that the money will continue to come from the general fund (GF). The role of the Trust fund is to support but not replace state spending. To the second question, she said the Trust manages its assets for today's beneficiaries and those in the future and has a formula in its budget. She said the largest portion of the Trust's annual spend is funded through a withdraw from its invested assets at a rate of 4.25 percent of the average value from the previous four years. The payout started at 3 percent, and trustees could determine whether to increase the current 4.25 percent. Given the increase in value of the Trust's invested assets, the Trust is seeing larger payouts. To the third question, she said the Trust must, under statute, ask for GF by recommending to the state the use of GF dollars to support beneficiaries. To the fourth and final question, she said data shows there is a lot of work to be done in Alaska to improve the mental health of its population. She said mental health challenges faced by Alaskans have many contributing factors, and the Trust has been making advancements by focusing on systems change and prevention, as well as improving access to health care. She put particular emphasis on prevention and "looking upstream." She further emphasized focus on individuals and the grants used to that end. 3:37:52 PM DR. WILSON, in response to Representative Fields' mention of $13.75 million in legislative funding, an infant program, and investing upstream, said data always shows that prevention is less expensive than responding to crisis. She talked about lag time and sustained effort. She indicated that the Trust has a veteran staff that can make a sustained effort. She said there need to be partners and investment in the right place. Progress, she said, may be slow, but it will take place. In response to a follow-up question regarding the resistance to spending on prevention to save in the long run and how prevention could be supported statistically, she agreed that there need to be markers of success. She deferred to Ms. Baldwin-Johson for further comment. 3:41:39 PM KATIE BALDWIN-JOHNSON, Chief Operating Officer, Alaska Mental Health Trust Authority, added that the Trust, along with many of its partners, would be interested in helping with this issue. DR. WILSON, to an inquiry from Representative Fields regarding a possible shift from primarily short-term programs to a more balance mix of long- and short-term programs, said it is possible and indicated an upcoming slide addresses this topic. 3:43:15 PM DR. WILSON, in response to a two-part question from Representative Prax, said she would get back to him with an answer regarding the land trust and what it is producing versus what is not in production. Regarding the evolution of the focus and priorities of the Trust, she noted that the Trust has recognized that people with mental health problems end up in the corrections system; therefore, "something before and after that will be critically important to crisis management in the state." 3:49:45 PM MS. BALDWIN-JOHNSON added that part of the responsibility of the Trust is to work with the Department of Health (DOH) to ensure a comprehensive, integrated mental health program addressing a variety of issues. The Trust works collaboratively with a variety of stakeholders, has statutory advisors, partners with tribal health partners, listens to its beneficiaries, engages with state partners, and work prioritize effort and focus. 3:52:54 PM DR. WILSON, regarding a question from Representative Ruffridge regarding Trust spending, confirmed that the Trust asset pool is approximately $800 million. 3:53:47 PM DR. WILSON returned to the PowerPoint, briefly mentioning slide 7, "Trust Spending," then moving on to slide 8, "Trust Grantmaking, FY 26," which shows authority grants of $19,119.3, designated grants to community provider, nonprofit organizations ("nonprofits"), local governments, and tribal organizations, including $1.9 million in mini-grants; and MHTAAR grants of $10,196.8, designated grants to state agencies, which require receipt authority. Also on slide 8 is listed "FY26 MHTAAR Grant Detail" reflecting 53 projects total [original punctuation provided]: • Department of Health ($4,413.9) • UAA ($1,870.0) • AHFC ($1,485.0) • Department of Corrections ($1,041.7) • Department of Family and Community Services ($587.0) • Department of Administration ($355.9) • Alaska Court System ($158.3) • Department of Public Safety ($130.0) • Department of Education and Early Development ($130.0) • Department of Labor and Workforce Development ($25.0) DR. WILSON moved to slide 9, "Longevity of Trust Grants to SOA Agencies," a pie chart showing fiscal year 2026 (FY 26) MHTAAR grants comprising 53 projects, totaling $10.2 million. 3:57:17 PM DR. WILSON turned to slide 10, "Trust Focus Areas," which read as follows [original punctuation provided]: The Trust develops its budget and engages in grantmaking and system improvement efforts around the following areas: Established Focus Areas (FY26 Grant Investment) • Disability Justice ($3.6M) • Mental Health & Addiction Intervention ($7.0M) -Includes Behavioral Health Crisis Response ($5.3M) • Beneficiary Employment & Engagement ($1.7M) • Housing and Home & Community Based Services ($4.3M) Additional Priorities • Workforce Development ($2.2M) • Early Childhood Intervention & Prevention ($3.3M) DR. WILSON next showed slide 11, "Disability Justice Focus Area," which read as follows [original punctuation provided]: Disability Justice reduces Trust beneficiary involvement in the criminal justice system by focusing on evidence-based practices, data, strong partnerships, and advocacy for systemic change. It also focuses on reducing Trust beneficiary recidivism rates and enhancing/expanding access to clinical and case management resources for incarcerated Trust beneficiaries. Grant Highlight Project: Mental Health/Therapeutic Courts Grantees: Alaska Court System/Partners for Progress 3:58:31 PM MS. BALDWIN-JOHNSON added that Trust support for therapeutic courts is also referred to as the Coordinated Resource Project. It provides an alternate to usual criminal case process for some offenders, the goal being to prevent recidivism in the court system. She said currently, the Trust supports training for court staff, and she reviewed the dollars spent and saved. 4:01:14 PM DR. WILSON returned to the PowerPoint, to slide 12, "Mental Health and Addiction Intervention Focus Area," which read as follows [original punctuation provided]: This focus area supports the entire continuum of care, ensuring beneficiaries have access to prevention, early intervention, ongoing community-based care, treatment for mental health and substance use disorders, and recovery support across the various care settings. And on improving the crisis system of care for individuals in acute behavioral health crises. Grant Highlight Project: 3.7 Care at the ARCH Youth Residential Treatment Facility Grantee: VOA Alaska MS. BALDWIN-JOHNSON highlighted one project for which the Trust awarded a $325,000 authority grants to Volunteers of America - Alaska to support the implementation of the American Society of Addiction Medicine (ASAM) level 3.7 care, including expanded psychiatric services and medication management. She discussed the expected outcomes. 4:02:55 PM DR. WILSON moved on to slide 13, "Beneficiary Employment and Engagement Focus Area," which read as follows [original punctuation provided]: This focus area works to improve outcomes and promote recovery for beneficiaries through integrated, competitive employment, and meaningful engagement opportunities. Grant Highlight Project: Microenterprise Grant Program Grantee: UAA Center for Human Development MS. BALDWIN-JOHNSON highlighted the microenterprise grant of $175,000, which goes directly to the University of Alaska Center for Human Development, through the University of Alaska Anchorage (UAA) to administer the direct microenterprise grants to beneficiaries. Uses for the grant monies include starting new businesses, expanding current businesses, or acquiring an existing business. She expounded on the topics of eligibility, coverage, and recipients. 4:05:06 PM DR. WILSON to slide 14, "Housing & Home and Community Based Services Focus Area," which read as follows [original punctuation provided]: This focus area concentrates on ensuring beneficiaries have access to housing and a continuum of services and supports that maximize independence in their home and community. Grant Highlight Project: Environmental Modifications Improvement Grantee: DOH, Senior and Disability Services MS. BALDWIN-JOHNSON highlighted the Environmental Modifications ("E-Mods") Improvement project, which is a $90,000 grant to Senior and Disability Services in FY 26 to create a position to remove systemic barriers to effective use of the Medicaid waiver environmental modification service. She talked about the improvements helping to delay or avoid assisted living of skilled nursing facility. The project was created in partnership with the Division of Senior and Disability Services in DOH and will terminate once system improvements are implemented, in approximately three to five years. DR. WILSON showed slide 15, "Workforce Development Priority Area," which read as follows [original punctuation provided]: The Trust utilizes workforce development strategies to support engaging, recruiting, training, and retaining healthcare employees across Alaska who provide residential and community-based services to Trust beneficiaries. Grant Highlight Project: Peer Support Certification Grantee: DOH Division of Behavioral Health MS. BALDWIN-JOHNSON highlighted the Peer Support Certification program, noting that peer support professionals are people who have experienced recovery from mental health, addiction, or other issues or have cared for people who have experienced those. She reported that $150,000, which includes $100,000 in FY 25 and $50,000 in FY 26, support the Division of Behavioral Health in administering the certified training, overseeing the Commission for Behavioral Health certification, executing a statewide conference, and recruiting and training a peer workforce. 4:08:31 PM DR. WILSON moved to slide 16, "Workforce Development Priority Area," which read as follows [original punctuation provided]: The Trust utilizes workforce development strategies to support engaging, recruiting, training, and retaining healthcare employees across Alaska who provide residential and community-based services to Trust beneficiaries. Grant Highlight Project: Peer Support Certification Grantee: DOH Division of Behavioral Health MS. BALDWIN-JOHNSON talked highlighted a $216,000 grant awarded to the Family Resource Center of Beacon Hill, a nonprofit organization that serves Alaska's children in foster care and those at risk of going into foster care. In response to 4:10:09 PM MS. BALDWIN-JOHNSON, responded to questions from committee members. To Representative Fields, she confirmed that the Trust has been a funder of the therapeutic courts for quite some time, although with varying start dates. To Representative Prax, she confirmed that the Trust receives performance reports from all the therapeutic courts, and there are evaluations conducted, which show that a high number of those who go through therapeutic courts do not recidivate. To Representative Ruffridge, she talked about meaningful engagement in the community. To a follow-up question, she talked about requirement for eligibility and the meaning of being a trust beneficiary. 4:16:15 PM DR. WILSON, in response to Representative Fields, offered to follow-up with information regarding Trust workforce programs. 4:18:44 PM MS. BALDWIN-JOHNSON, in response to Representative Schwanke, offered further information regarding Beacon Hill. She said the program helps those with financial need that may not necessarily have access to other help. 4:22:17 PM DR. WILSON added that the Trust seeks to develop data in grant making. To a question from Representative Fields, she further discussion strategic planning in partnership with others. 4:25:00 PM DR. WILSON continued with the PowerPoint, on slide 17, "Crisis Now Community Implementation 2024/25," which read as follows [original punctuation provided]: Since the initiative's launch in 2019, the Trust has invested roughly $20M in planning and grantmaking around psychiatric emergency response. Crisis planning and implementation is underway in: Anchorage Mat-Su Fairbanks Juneau Ketchikan Kenai Peninsula Kotzebue Copper Basin Unalaska 4:26:51 PM [A video was shown regarding Crisis Now.] 4:31:33 PM MS. BALDWIN-JOHNSON moved to slide 19 to discuss House Bill 172, passed in 2022, during the Thirty-Second Alaska State Legislature, which established a statutory framework to bring on new crisis facility types and services. It aimed to reduce the need for hospitalizations. A report was submitted to the legislature October 2023. She reported on the progress of the Department of Health (DOH). The goal is to design and implement a behavioral health crisis response system analogous to the physical health system. 4:36:39 PM DR. WILSON, in response to a question from Representative Fields regarding issues at Providence Alaska Medical Center, said the Trust is concerned. She said not only is the use facility not moving forward, but the 23-hour stabilization center is also "on pause." She said the assumption is that the issue has to do with money and sustainable funding. In terms of whether Medicaid payment alone sustains mental health services in acute crises, she said there is usually a shortfall. She added that there are models that can make it work, but most of the time it is difficult. 4:39:23 PM DR. WILSON, in response to Chair Mina, said the Crisis Now model has to look different depending on its area of focus. She pinpointed areas of difficulty being the 23-hour holding area and access after that for short stay, along with intensive outpatient follow-up for any hospitalization or long-term stay. 4:41:37 PM MS. BALDWIN-JOHNSON added that each community needs to design its unique local response and coming up with solutions that work. 4:42:31 PM DR. WILSON, in response to Representative Schwanke's comment that the grant funding is not sustainable, agreed and said the Trust must work with communities to come up with something that works, is better than what they currently have, and is evidenced based. 4:45:24 PM DR. WILSON returned to the PowerPoint, to slide 20, "The Trust and the Comp Plan," which read as follows [original punctuation provided]: Per AS44.25.200, the Trust ensures an integrated comprehensive mental health program We do this through: • Supporting DPH/DFCS in the development of the plan - Latest 5-year plan was released in 2024 • Shared funding of a Comp Plan Coordinator in DOH • Coordination on Comp Plan implementation and progress with SOA partners 4:46:54 PM MS. B-J offered her understanding that the 2024 score card, which holds the results of the last comp plan, is soon to be posted on DOH's website. DR. WILSON moved to slide 21, "How the Trust Uses the Comp Plan," which read as follows [original punctuation provided]: The Plan and the Associated Scorecard are considered in the development of the annual Trust budget • All Trust grants are linked to Comp Plan Areas of Focus Strengthening the System II Areas of Focus: 1: Early Childhood and Youth 2: Healthcare 3: Economic & Social Well-being 4: Substance Use Disorder Prevention 5: Suicide Prevention 6: Protecting Vulnerable Alaskans 7: Services in the Least Restrictive Environment 8: Services in Institutional Settings 9: Workforce 10: Data 4:48:35 PM DR. WILSON directed attention to the final slide, "Wrap-up: The Trust Continues to Meet its Mission," which read as follows [original punctuation provided]: The Trust is a unique asset to our state's mental health system, supporting innovation and system-level improvements • Behavioral health crisis response • Access to treatment • Community-based services The Trust is completely self-funded, and awards grants to State, local, Tribal, provider, nonprofit, and other partners each year • Since inception the Trust has awarded more than $465M, supporting more than 5,000 beneficiary-focused projects The board of trustees prudently manages Trust assets • Continued growth in invested assets managed by APFC and DOR • Principal and income earnings generated each year from Trust-owned lands and non-cash assets 4:50:47 PM REPRESENTATIVE RUFFRIDGE made comments about the importance of mental health and the need for better mental health in Alaska and the role that the Trust plays. 4:55:44 PM DR. WILSON concurred with Representative Ruffridge that this is a good time to make a contingency plan. 4:56:23 PM REPRESENTATIVE PRAX asked if the Trust is allowed to accept nongovernment contributions. MS. BALDWIN-JOHNSON noted that statute allows the Trust to receive funds. REPRESENTATIVE PRAX said he would like information about income- raising land development. DR. WILSON agreed to make that part of future presentations. 4:58:39 PM REPRESENTATIVE FIELDS mentioned a parcel of land in downtown Anchorage and wondered whether it would be developed with a lower rate of return than from other assets. DR. WILSON offered to update Representative Fields on that later. 4:59:26 PM REPRESENTATIVE GRAY concurred with the comments of Representatives Ruffridge and Fields. 4:59:44 PM CHAIR MINA thanked the presenters. SCR 4-MENTAL HEALTH MONTH; TARDIVE DYSK WEEK  4:59:59 PM CHAIR MINA announced that the final order of business would be SENATE CONCURRENT RESOLUTION NO. 4, Designating May 2025 as Mental Health Awareness Month; and designating May 4 - 10, 2025, as Tardive Dyskinesia Awareness Week. 5:00:28 PM SENATOR GRAY-JACKSON, Alaska State Legislature, As prime sponsor, presented SCR 4. She noted that in Alaska, there are more than 108,000 adults who live with mental health conditions. She explained that by designating May 2025 as Mental Health Awareness Month, SCR 4 "seeks to promote understanding and reduce stigma and support those effected by mental illness." She reported that Alaska continues to face a mental health crisis; the state ranks second in the nation for suicide rates, and 8,000 youth are currently experiencing depression. Mental health issues effects all communities regardless of age, race, or economic status. She opined that raising awareness and reducing stigma is the least the legislature can do. SENATOR GRAY-JACKSON pointed out that the second part of SCR 4 would recognize Tardive Dyskinesia Awareness Week, observed May 4-10, 2025. This is a side effect of long-term, anti-psychotic treatment that effects hundreds of thousands of individuals nationwide yet remains underdiagnosed and widely misunderstood. She concluded, "So, through this resolution, we aim to shine a light on these important issues and foster a culture of compassion, education, and support." She noted that Ann Ringstand was available to expound on the reasons to support SCR 4. 5:02:28 PM CHAIR MINA announced the committee would hear invited testimony and invited Ms. Ringstad to speak. 5:02:35 PM ANN RINGSTAD, Executive Director, National Alliance for the Mentally Ill (NAMI) Alaska, began her invited testimony in support of SCR 4 by explaining that established in 1949, Mental Health Awareness Month is observed every May to raise awareness about the importance of mental health and "to celebrate the recovery for individuals and families." She echoed the statement of the bill sponsor that mental health effects everyone regardless of age, background, or experience. She added that just like physical health, "mental health is essential to overall well-being in every stage of life." The two are "deeply connected," yet stigma regarding mental health prevents too many Alaskans from seeking needed care. MS. RINGSTAD talked about Tardive Dyskinesia, explaining that it causes involuntary movements of the face, limbs, and torso, and this is the eighth annual effort to raise awareness. She stated, "This resolution is a call to action for all of us to realize the impacts of mental health challenges, the importance of support and services, and the healing power of acceptance." She concluded by emphasizing, "There is no fiscal note, but the cost of inaction is great - socially, economically, and emotionally." She thanked the committee for its support and asked for expedient action to pass SCR 4 during the month of May. 5:04:36 PM REPRESENTATIVE PRAX, regarding the connection between anti- psychotic medications and Tardive Dyskinesia, asked whether the legislature should create further legislation to address the issue. 5:05:18 PM MS. RINGSTAD responded that she does not think the legislature needs to do anything besides supporting SCR 4 as a way to bring awareness of the issue to Alaskans. 5:05:54 PM CHAIR MINA opened public testimony on SCR 4. After ascertaining there was no one who wished to testify, she closed public testimony. 5:06:43 PM REPRESENTATIVE MEARS moved to report SCR 4 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, SCR 4 was reported out of the House Health and Social Services Standing Committee. 5:07:22 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 5:07 p.m.