I call this meeting of the House Finance Department of Health Subcommittee to order.
Let the record reflect that it is 3.34 p.m. on Tuesday, January 27th, 2026.
President, today, our representatives, Schwanke, Representative Ruffridge,
Representative Meers, representative Mina,
Representative Gray, and Representative Fields,
Representative Prox,
and myself, Chair Josephson.
Also present today are Aaron Page, our committee aide, moderator Renzo Alexis from the Legislative Information Office and Valerie Rose Analysts from The Legislative Finance Division.
As always, please remember to mute your cell phones before we begin our presentation today.
Note that binders have been provided to all committee members.
Hopefully, there are no questions about the binder contents.
I don't see any.
Okay.
In today's meeting, we will hear the Department of Health present its FY27 departmental budget
overview, including updates on FY26 budget items.
One housekeeping note, to accommodate members of the minority, who will need to leave early
for a meeting with the governor, after constantly you could have a meet with anyone.
It doesn't matter.
After consultation with their offices, I'm just having some fun.
After, after consultation, with our offices we've asked the department to rearrange the
presentation to front load areas of particular interest.
We will start with the Departmental Overview and then move to Public Assistance, Behaviour
Health and the Rural Health Transformation Program.
After that we will circle back to page three and go through the rest of the presentation
in order.
We appreciate the departments' flexibility in accommodating this late breaking change.
I look forward to a lively discussion, but for purposes of time, please keep in mind we
will have later opportunities to dive more deeply into each division.
With us today from the Department of Commissioner Heidi Hedberg, Deputy Commissioner Emily Ritchie,
and Assistant Commissioner Pam Halloran,
please the three of you come forward, put yourselves on the record and begin your presentation.
Good afternoon for the record. My name is Heidi Hedberg commissioner for The Department of Health
And you want to skip directly to public assistance
For the
Record my name, is Pam Haller and I'm the assistant Commissioner for
the Department Of Public Health
For this record today, we are reviewing three aspects for the Department of Health's budget.
We're looking at FY 25 final authorized, which includes all actions from July 24 to July 30, 2025,
such as veto, supplemental, fiscal notes, and carry forward balances.
Then we're look at the FY 26 management plan,
which reflects the current budgetary authority,
which is just over $3.9 million, or billion.
as a true-up of the enacted FY26 budget.
The FY27 governor's proposed budget released December 15th,
totals just over $3.8 billion.
The slight decrease between FY25 and FY 26 is driven
by the spenddown of pandemic-related federal funds,
the end of multi-year appropriations, and reductions
in DGF and other fund sources based on realized revenue.
The FY27 proposed budget reverses multi-year items that may carry forward with a modest
increase in other authority reflecting interagency receipt authority for implementing the IT classification
study to modernize IT job classes.
To move down and to spend a little bit time on the fund sources at the bottom of the chart,
The slight decrease reflects two budget actions within Medicaid services and the Division of Public Assistance, which we will explore on a later slide.
The orange represents designated general fund.
This includes program receipts, tobacco, education and cessation fund, tax revenue,
the alcohol and drug treatment prevention fund the recidivism fund and
the marijuana education treatment fund
The gray represents other, which represents interagency receipt authority.
The slight increase in the gray section covers the IT personnel surfaces related
to the classification study implementation.
The solid yellow represents federal and this increase is primarily due to an increase
within the Division of Public Health, but we will speak.
about later.
The gradient yellow represents pandemic era funding.
The remaining valences will carry forward into FY 27.
Overall, the FY27 proposed budget for the Department of Health
totals just over 3.8 billion.
Assistant commissioner, which multi-year appropriations
have been eliminated?
Do you know that offhand?
Within the Division of Public Assistance,
there were two multi-year appropriations which ended
at the end of FY 25, within the division of public assistance
related to Medicaid, re-determination,
and SNAP eligibility.
Okay, but there's a change from FY26 management to FY27.
I know one of them is behavioral health.
To the chair there's a couple others one of them is in the division of public assistance and that is related to the snap
New investment monies those term at the end of FY 26
There's also another appropriation which ends and thats related
to inter-eye that those monys within the Division Medicaid services and within division
of Public Assistance also term of the End of
FY26
term meaning they and they expire. They expire got it represent gray. Thank
you I'm through the chair I just wanted to
make sure that I understood that the reason why there's less money being spent this year than
there was in 2025 is because there is no more COVID money. It's not because we have less costs,
it's because it has been deflation, it is not that we don't need more money,
it simply doesn't have the money so therefore we need to make due with less.
small document that you're seeing, or a decrease that
you are seeing between FY26 management plan and FY27
governors is related to the to these spend down of the
COVID era appropriations. It's also related
to end of multi-year appropriations as well as a few
other changes which we will discuss later in the slides.
All right I think we're going to jump to slide 11.
Okay so let's go to Slide 11 because we think that's where
excitement lies. For the record Heidi Hedberg. So the division of public
assistance has gone through significant changes over the past three years since
I have been in this role as Commissioner and Deb Etheridge has been
in her role.
Director for the Division of Public Assistance, so we're going to provide a high-level overview today
But we do have a division update budget update and she will be able to go into much more detail during that presentation
But high level I just want to kind of draw your attention
You know we
Three years ago we entered our roles and there was the pandemic. There's a lot of
flexibility that ended. The office were closed. We had a
lot staff turn over and work for shortages. And we came in with new
leadership and a real big focus on how do we support our staff.
Fast forward today, we really appreciate the IT modernization appropriation that the legislature
appropriated a couple of years ago because we are starting to see the fruits of those
funds come into action.
And so we're seeing that our IT modernization is on target and continues to roll out to
benefit clients.
And what we are seeing is that we
are reducing the, or I should say,
we're increasing our timeliness.
We submit a monthly report to the courts.
And that monthly reported in January
reflected that our timeliness is down to 43 days.
That is the average time that it takes for a SNAP application.
30 days is what the.
the our federal partners are requesting and so you can see that that gap is
continuing to shrink as we are focusing on training our staff as
we're implementing our new IT modernization efforts.
So it's kind of a like high-level situational awareness of what's
focusing specifically on the budget updates specific to child care last year
the legislature appropriated five point nine million dollars and we are thankful
for those fundings to support the childcare grant program so those grant funds
have been deployed we effective November 1st we increased the base grant amount
In addition, we are piloting a funding model that increases grant support for program-serving
infants and toddlers. What we see is that there is a gap in infant care, so really pilotting
for a short period of time to see if that additional funding will help increase the capacity for
infant-care. We are also going to be continuing to focus on startup grants for our new licensed
for child care workforce subsidies.
So if you are a parent, you have children in child
care, there would be a subsidy for that child.
So really looking holistically at that support.
Representative Fields for the commissioner.
Thank you through the chair.
Well, thank you for all your work to make this program work
better and better every year in November.
I think it's the earliest that the department's gotten
the funds out.
So thank for you, for this efficient administration.
I was curious that a lot of providers are both working within this program and also looking at rural health transformation.
When does the rural Health transformation grant open for those who have been reviewing it and want to submit an application?
So we are going to be announcing a webinar soon so that we can make sure everyone has the same base understanding of how to
submit a letter of intent and then we will be opening up that portal in the coming weeks.
Okay, and just to make through the chair just make sure thank you chair
Just to be sure I've missed it. There's not like a template that's out there for an application. Yeah
Through the Chair Representative Fields. No, there is no template yet. That's another follow-up on the child care
Yes, the four point through to the 4.9 million that you got out in November. How was that broken down among I know in the past it's been
Waging permits for workforce retention was this primarily waging permits or what was the division across that 5.5 million?
Through the chair representative fields. We would have to get back to you. I don't have that breakdown on the monetary
Between those elements that I had just communicated. Okay. Thank you
Representative gray.
Thank You through the Chair to Commissioner Hedberg there was reporting in the 80 in in December about
Persistent snapback log and I understand that you guys are
Working on it and getting better
But they reported that there were
that the legislature approved and that only in 2025 only 218 of them were filled so it was like
we were missing a hundred technicians. I assume that that may have played a role in the snapback
log and I'm just curious about how we hire those missing 100 technicians through the chair
We can get you an update on our workforce.
We actually have a dashboard that shows the total number of PCNs that we have and where
they're at in the various stages of recruitment.
There's a lot of effort that went into streamlining the process so that
we could fill positions and eligibility technicians are not subjected to the hiring, the administrative
order.
have a vacancy. We can post it and we can recruit. And actually which draws me back to the other
budget update. Last year the legislature appropriated or provided 15 additional eligibility technicians.
We created those positions. One is filled. The other 14 are in the process of being filled and
those 15 are going to support our virtual contact center. So we actually are seeing really good,
of our employees, I think that's part of changing the culture and the environment
and getting the tools to the staff so they can do their work efficiently.
And part it was streamlining the hiring process.
I could not tell you today where we're at with our vacancies.
I know a couple of weeks ago that they were decreasing now.
We were trending down.
Follow-up. Yes. Representative Gray.
Thanks. Through the chair.
I think when you have a lot of vacancies that one solution is to offer more money to do that job,
and I don't know if the current budget would allow for that, but that's something that
comes to my mind. Yeah, through the chair representative, great. That's actually another
great prompt because what you can, well, not on this slide, it is one of our talking points.
worked with the Department of Administration.
They're a classification unit and we are doing,
they're actually started in August of 2025,
an eligibility class study for eligibility technicians.
And so what we hear is it takes about a year,
they are actively in the process of interviewing,
looking at the work that they do,
and so we're waiting for that study to be completed.
Thank you, Commissioner, you mentioned
You called it the virtual contact center.
There's also something called a virtual call center,
I'm gonna hope that those are the same thing.
But I think you said that you hoped
these 15 eligibility texts would go there,
but we didn't fund the Virtual Contact Center,
or call Center.
Over my objection, I would have gladly supported it.
I am sure I did support it, it was 4.1 million,
GF 4,1,000, million match.
last year and I don't see that ask this year unless I missed it. Do you need
4.1 million dollars for the virtual call center? To the chair we will
definitely get back to you next week to answer your question. Okay.
Representative Mina. Thank you chair Josephson. Through the
chair to Commissioner Heverick. thank you for being here today. When will that
class study for that eligibility text be finished?
Through the chair, Representative Mina, what we hear is it takes about a year, so what I
would assume this summer.
Thank you.
Related to this issue of the virtual contact center, only in their title, they're very
different.
For us to approve an increment to the Mental Health Trust
request for a crisis call center, we didn't do that.
And I'm wondering if you have anything you'd like to say
about that, whether that's,
we should look to The Mental health Trust
to make the ask again, I don't know.
I defer to.
Anything that says center we did an approve.
For the record, Pam Haller and Assistant Commissioner Department of Health, I'm going
to answer and then defer to Emily Rooki, D.C.
Ragman, Emily Ricki if she wants to jump up as well.
The crisis call center has been determined to be a priority for the Division of Behavioral
Health.
And so there were a couple, we were moving around a little bit, that's fine.
There were couple items that impacted funding for the crisis contact center,
related to the designated general fund reductions.
If you remember the tobacco, the marijuana, and the alcohol revenues were declining.
And there was a reduction.
And then there's also the $750,000 general
fund mental health increase that didn't make it to
the final enrolled budget.
The Division of Behavioral Health determined that it was a priority.
It serves a lot of people, and so they did a couple things.
One, they combined funding sources, so what they refer to as braided funding,
and they to come up with the money,
and then they also had to make a difficult decision to reduce grants in their division.
Well, I know these are tough times, and I see that in the overall budget, but at least I'm here to help.
I like to march down the field until I am tackled,
and not nearly tackled yet,
and, not even a football fan, mind you,
but that's my approach, so.
All right, we're still on slide 11.
Is there more to tell us about?
For the record Heidi Hedberg, I just want to acknowledge that
we have seen an increase in qualified applicants for senior benefits and
And that is outpacing the budget and so effective February 1st
We did
Decrease the senior benefit so that we could continue to support all of the applicants
Riverland Fields through the chair I see FY 27 budget changes and one thing I was
curious about I think you all have been trying to address this issue of making
sure qualified Alaska families seek to enroll their children in child care
assistance and do you have any update on has there been success what are we
learning what else can we do to make sure that qualified individuals take
advantage of that program following SB 95 changes commissioner
Yeah, for the record through the chair, Representative Fields, we have had
some preliminary conversations with some associations about creating a
communication campaign and partnering with, as an example, like the Alaska
Chamber to get the word out. The two positions that were funded in Senate Bill
The position one position is created one is being created we need to fill those positions
and then they are really focused on the business sector in educating business partners about
on-site or near-side child care and make that connection between a business sector and child
care to be that liaison between both of those. So that is very much still under development right
now. Any other questions? Commissioner, can you tell us briefly about the last bullet on the right
Yes, in the budget throughout the for the record. This is Pam Haller an assistant commissioner for The Department of Health in
the
In the Budget throughout all of our components which have personal services and staff
There were entries related to Alaska care and insurance increase. I believe it was about forty six dollars per member
And there was an increase for basically bargaining unit related salary adjustments.
And so both of those items for the division of public assistance,
the increase in the salary adjustment was $2.5 million.
And the increased for
the Alaska care health benefits was a $161,400.
Wouldn't that just show up in a DOA budget?
And I don't know, am I going to see this in every subcommittee?
To the chair, yes, okay
As long as I see it in every second
All right, I think we're going to
Miss pay dr. Page are we going into slide seven or?
Yeah, the next slide on public assistance slide 12
All right slide 12. Okay
We're providing here a budget again the comparison from FY 25 into the FY 27 governor's proposed request
The slight changes we see here are primarily related to the items that we've discussed which is child care the snap new investment
Which is rolling out of the budget at the end of FY 26 and the and of
The multi-year funding which we're seeing between FY25 and FY26 related
To the Medicaid return and it returned my nation backlog and this nap
backlog. The multi, um, that's it. Questions. Representative Gray,
it's like, well, thank you. Um, through the chair, Um to deputy director
Halloran. All right. Hallarin Hallaren. Sorry. Okay.
Again, it, It's a related question, but when we talk about senior that there
wasn't, there were too many people applying for senior benefits. So we had to
reduce the benefit. I don't know, like there's part of me that thinks,
Or maybe we would increase the budget to pay for those extra seniors.
And so again, I just, when I see the bars going down as the, you know,
and I think about inflation and the need for increased benefits,
I worry that the way we solve the problem is to provide less benefit
rather than increase
the budgets to give people the benefit that they were depending on.
Through the chair representative Gray, there is a request in the FY 27 budget to increase
senior benefits the amount of four hundred and eighty thousand dollars
All that yes, thank you. So what was the senior benefit?
What was it reduced to and then would the four-hundred and eight thousand dollar take it back up to where it was?
Through The Chair Representative Gray the
The decrease impacted only the highest benefit category.
That category would have originally received $125 per individual per month.
That was reduced to $76 per individuals per months between the month of February and the end of the fiscal year.
Through the chair, I represent I'm Gray.
I believe that would be a good question
for the division of public assistance.
I would take to get ahead of that.
Representative Fields.
Through it, Chair, could you remind me
what is the threshold for
the highest benefit level, please?
Ms. Halloran, if you know that?
Through that chair representative Gray,
I am going to call on a lifeline
and see if the commissioner might know.
Yeah.
We'll have to follow up.
We don't know if.
Okay, thank you.
Okay.
All right, we'll go to slide.
For the record Heidi Hedberg, so you know, I started off just talking about where we were three years ago and where
We are today. We're definitely improving and in improving our timeliness
And I just wanted to kind of highlight the significant work that's happening within the Division of Public Assistance
So last year we launched the Alaska Connect Portal. So Alaskans can
upload their application and make some basic updates. Phase two is going to be launching this
spring and it will have the ability for clients to actually track where their
application is at and I think that will reduce the volume of calls to the virtual contact center.
In addition, moving Medicaid off the legacy system,
again, this was an appropriation by the legislature,
which we're very thankful for,
and that kickoff HAP started in October,
and our contractors are in place.
They're working on that IT modernization project
as we speak, and we are still on target
for implementing in 2027.
The SNAP Modernization module will be kicking off this spring and it has the same timeline
in completion of launching in 2027 and both of those are really creating that integrated
eligibility enrollment platform.
Part of the new investments funding that we received is going
to be paying for that work assist tool.
Think of it as a virtual assistant
for eligibility technicians, they have a question there.
It has all of policies and procedures and so it provides
them with a consistent answer across the hundreds
of eligibility technician.
Our data modernization office is working
on rolling out that tool this spring.
In addition, we did launch the brand new Alaska Child Care Information System last April,
and that was what we have seen. Well,
The issues was that it was taking months, if not years, for an application to proceed.
Now we are seeing applications be processed within 28 days.
So that system modernization for child care has really helped the providers.
In addition we did procure the digital fingerprinting equipment and right now we are working to
train our staff and to implement the fingerprint again this was a recommendation out of the child
care task force committee. And then finally the other two areas DPA in a box you know what we hear
from communities that do not have a division of public assistance office is that there's difficulties
to try to have the virtual options and the call in
and you can upload applications,
having that face-to-face contact is really helpful.
So we call it DPA in a box.
It was a pilot.
We had an eligibility technician that went out
to Kotzebue and Delta Junction,
and they were there and
helped individuals complete their applications,
completed the interview,
and make determinations right there.
And it was very successful.
And so we are partnering with communities
who want to have DPA in a box go out to their community.
Again, as a community that does not have a DPI office.
And then as I had mentioned,
the eligibility class series study did launch last August,
and it will take about a year.
So.
There's a lot of irons in the fire, a
lot great work that's happening within
DPA.
Okay.
Representative Lina.
Thank you, Chair.
Josephson, through the chair, I love hearing
about the updates related to D.P.A.'s modernization.
I'm curious what feedback you're getting from
clientele about these new updates and what is
the best way for Alaskans to provide feedback as
these changes are being implemented.
Commissioner.
Yeah, through the chair representative Mina, thank you for that question. I would say first anyone can go to our department of health website and there is a little feedback icon and they can click on it and
they provide any feedback that they want and our communications team will triage that and make sure that it gets over to the DPA office to
I would say based off of the emails that I'm receiving,
you know, I started in this role with a lot of complaints
and a lotta just horrific stories,
and it was pretty heart wrenching.
And now what I am saying is there's still tension,
like we are still, it's not all fixed.
We're still improving, but we're heading
in the right direction.
But there is just a lots of appreciation.
We have eligibility technicians that go every week
down to the navigation center in Anchorage
experiencing homelessness and they are there again to help Alaskans process
their public assistance applications and we hear genuine appreciation for just
the ability to like meet Alascans where they're at.
Okay I think we can return to a normal course of business here and look at
Good afternoon
Good to see you
Good Afternoon good afternoon
For the record my name is Emily Ritchie, and I'm deputy commissioner in the Department of Health and
Today we're going to start with the largest budget component
Or I guess we will move to the Largest budget Component on slide 3 in The Department's budget and that is Medicaid Services
And I know that the committee is well aware of this,
but just for anyone listening from home,
Medicaid is a joint program between the state
and the federal government that is intended
to provide health insurance to Alaskans based on income
or categorical eligibility.
As of December 2025,
Alaska's Medicaid program covered 210,000 Alascans,
and that's about one in four Alasans.
The department, specifically the Division of Health Care Services, that we will talk about
a little bit later on in the presentation, processed about 10 million claims in FY 25,
and that with an average weekly payout to providers of around $59 million.
And that is an increase from last year where the average monthly payout was about $52.7
million, so we are seeing that increase throughout FY25, and you'll see that again in FY26 and
27.
But in FY 25, that accounted for about $3 billion in Medicaid spend.
What do you attribute that to?
That's a considerable increase in weekly claims.
It is, it is considerable.
We are seeing more acute services and we are
seeing higher utilization of services kind of across the board.
We're also seeing an aging population, right?
So that tracks a little bit with our population.
is something that continues to rise.
And I know the Medicaid program is not alone in this.
If you track insurance, which I do to a certain degree,
you, I have seen the highest increases
in employer-sponsored insurance rates in the US
that I've seen in about 15 years.
So I think across the board.
we are seeing increased utilization
and kind of an increased disease burden
and need for medical care across our population
and Medicaid tracts in the same direction.
Okay, if you go to the right side now.
Sure, I'm going to just touch on that last bullet
on the left.
very quickly because something that we follow very closely is the percentage of charges or the
percentage a program costs that is paid by the federal government versus state general funds.
We call this the Federal Medical Assistance Percentage or
the F-Map and an FY 25 kind of the total amount of costs was paid
by federal Government versus the state was 76%.
So 76% of our Medicaid spend was covered through federal dollars.
Looking ahead to FY27, there are a number of different changes, and this presentation
was put together before some of the information was released, I think, yesterday related to
the Medicaid component.
But one of largest changes that you'll see in FY 27 is that the FMAP decreased by about
And every year, the F-Map is recalculated and adjusted.
And this is based on a number of factors,
including per capita income in states
compared to other states or the national average.
So over the last two years, Alaska
had experienced small increases in our regular F map.
And those were 1.53% and 0.88% respectively.
This is the first year where that regular F map has dropped by 1,05%.
And we can, you can kind of expect these variations to occur on an annual basis.
I think in the past we were kind
of at that base 50% level for a regular f-map.
So we didn't see these variation, but we are now slightly higher than that.
So, we see this on a annual bases.
Again, that 51.37% of regular F map,
that will take effect at the beginning of federal fiscal year 27.
So that'll take affect in October of this year.
But that is included in the FY27 budget.
And that ends up representing about a $13.6 million reduction
in federal funding that end up shifting to the state,
just with that, you know, 1% a drop.
Question from this and great.
Thank you through the chair
Miss Ritchie. Thanks for being here
I
Just have a math question. So it was 76 percent was paid for by the federal government
And now it's 51 percent, but it is a reduction of 1 percent and I'm just curious if you can explain the math to me
Through the Chair of Representative Gray for the record. This is Emily Richey. I skipped over some important talking points, which is that
The F map can actually vary depending on the category of coverage for an individual as
well as the services that are being provided.
So the F-Map can vary from a base of about 50%, in this case that 50% is really around
51% for Alaska and it can go as high as 100% of charges being covered by being eligible
for federal funding.
And it just really depends again on this situation.
The F map is kind of the lowest percent of cost for any service or person that the federal government will cover through Medicaid, and so that changes every year, but there's a, I mean, there is a table with about 10 to 12 other federal match rates that
the state can draw down or receive for charges, again, depending on the activity or the person covered.
I'm guessing the 76% number is how much the federal government reimbursed us last year. Is that correct?
Through the chair representative Gray, that is the total amount of
federal dollars versus state dollars that that made up the entirety of the Medicaid program for fiscal year 25
So I think what I am concerned about is
that we are going to get a lot less federal dollars
and that the lot
less Federal dollars is not being really reflected
when we say the 1% change.
But maybe I'm wrong.
D.C. Ritchie.
Through the Chair, Representative Gray.
So the 76% of total costs includes a blend
of all of the different kind of F map
matches that can occur across these programs.
So for example, when we talk about,
later on with the Division of Healthcare Services,
implementing a new provider enrollment system,
we can actually receive 90% federal match
for those charges, right?
There's other individuals like if an individual
is Medicaid eligible and goes to a tribal health organization.
facility, we can receive 100% of federal match for those. So those matches do not change
based on this decrease, but they are part of what makes up that blended F map of 76%.
So there are certain activities that will be affected by that regular F-map, that does
not make up the full portion of the state's federal
For example, if you're in the expansion population,
let's say you make 32,000 a year,
probably in that range,
the state may get 90% of the cost of a $100 visit
would be $90, for example.
Whereas if your not working poor, but just poor
the State might get less for that same visit.
Through the chair, to the Chair of Representative Josephson, that's correct.
So if you are an individual who's receiving a service through, and you qualify for the Medicaid expansion category,
then that service, the state would be eligible to receive 90% federal funding for
the cost of that services and would responsible for that 10% of the costs.
Whereas if are covered through another type of Medicaid category.
They tend to receive the regular F map, so the state would receive 51.37% of the cost
from the federal government and would be responsible for the other half.
So that's kind of how to think about it.
Refills?
Well, I just wanted to note the typographical error and one-time funding for behavioral health services,
which was actually a multi-year appropriation that passed.
do the budget. I would be supportive of just having that in the base, which is how it passed
last year. But I wanted to ask through the chair, one effect I think of Congress ending
the enhanced premium tax credits is that families who need health coverage and can't afford
insurance anymore are just going to stop working and become eligible for Medicaid,
which will be a call shift from the federal government onto the state. And I just hope
continue working and roll the dice, but there are going to be people who need healthcare who have to stop working
and go on Medicaid because it will be the only health coverage they can access.
That is an unfortunate effect, I think,
but one that I hope we track and try to understand.
Thank you.
Okay, so we're at,
wherever you want to
be, D.C. Bridgette on page three.
You said we have a question from
Repzmina.
Thank you, Chair Josephson, through the chair to D.C. Ritchie.
I just wanted to talk about what Ripfield just mentioned,
just for some clarity in terms of the 10 million dollars with behavioral health for Medicaid
that was put in the budget last year. Then there was the behavioral
health rate study, and then I know there is language in
language that's related to the base for fiscal year 27.
So can you just walk us through what's going on with that money?
D.C. Ritchie through the chair representative Mina.
So there was a increment a temporary increment passed by the legislature as you're well aware
last year that was about 13 million that ended up being vetoed a portion of that with the budget
passing at 10 million dollars. You know the
specific rates beyond what would have been allowable, but we knew that the overall intent
was to stabilize the behavioral health system, and so we were working through the right methodology
and appreciate the cooperation from everyone and looking at how we could...
implement those, the results of the behavioral health rate
methodology that was released in the fall and we are working to
promulgate regulations right now that will begin to implement
the recommendations from that study, specifically the
rebasing recommendations, that kind of increased areas where it
looked like our rates were low and held harmless areas, where the
rates are maybe higher than they need to be, until they,
kind of catches up with them.
At the same time, and again, this is before the information
that was released yesterday came out, there is an increase built into
our Medicaid projections for the annual behavioral health
inflationary adjustment.
And so as we think about implementing the results of the
behavioral-health rate study, we're also looking.
at how that ties into the inflationary adjustment.
But we are working to promulgate those regulations now
so that they can take effect
and we can work through those rates.
Thank you.
And the Medicaid mentioned in supplemental
is just standard Medicaid.
It's not about behavioral health dollars per se.
That's 35 million that your department has sought
for FY26 or 36 million.
To the chair for the record, this is Emily Regie.
Yes, that is accurate. However that amount includes the, I think I'm sorry,
I apologize. I
think i'm mixing up my supplemental and my FY 27. So yes, the supplemental includes
the unanticipated costs that we're seeing with higher, higher check right, but the FY27
projections that were released prior include that behavioral health annual rate adjustment
Okay.
Into the chair, one thing I would add, thinking about the supplemental for FY26, just to put
it into context.
Right and you're trying to predict out for the full federal fiscal year of 26 kind of what you think the cost will be
That's notoriously difficult with health insurance, right?
Thats why we hire actuaries or others to do that and
You want to have as much information as possible to inform those costs so that you can be as accurate as
Possible we had some really
Really unusual activity with our our weekly check right and by unusual I just mean we have five check rights
So we're over 70 million dollars between the beginning of federal
of State Fiscal Year 26 and October when we developed those projections.
We had not experienced check rights at all in any prior year, so we experienced five.
Now following those, we saw a large decrease in our check right.
And so there's just a lot of volatility right now.
We don't know if some of that may have been the result of the federal shutdown with providers
make sure that their bills were paid faster.
Sometimes we see that where providers submit bills faster
than they normally would, and that can result
in some peaks and valleys.
But we're hoping that as we look at a few more check rights,
we'll get a better sense of kind of what that,
what the FY26 Medicaid budget will look like.
But I just want to say this year is the most volatile it's been
since I started in this position.
Just to put a finer point on it,
grants through clinical services were 10 million, spanning two years.
The governor has written the FY 27 budget to drop the second year of the two
years, as is his right. I get that. The other FY 26 expenditure was sort of held
up by an upper payment limit issue. Can it now be spent because of regulatory change?
To the chair, we are working through the regulatory process, but that does take time
And so you know I anticipate the earliest that would take effect would be towards the end of FY26 or the beginning of the FY27
Okay, good thing this is all simple
All right, and then I see a last bullet point on the inter I
Yeah, go ahead.
For the record, this is Emily Ritchie.
So the last point of the bullet is that there
was a multi-year appropriation associated
with six staff positions to support the NRI, which
is a assessment tool.
Oh, I apologize.
Oh OK.
Thank you.
I'm going to pass this off to Assistant Commissioner Halloran
to keep me straight.
Pam Haller, an assistant commissioner, Department of Health,
Emily, ROTC, Richie, had it just right, almost.
There's six positions within the.
division of senior disability services that are related to NRI and there's also a contract
for the software portion of the NRA which is in the Medicaid services budget.
That is on a multi-year appropriation which ends at the end of FY26.
The department is currently exploring whether it needs to extend that appropriation and
Right, so go to slide four on the big picture.
Slide four shows the Medicaid services budget from FY 25 through the FY 27 governor's proposal for the Department of Health.
The FY27 proposed budget largely mirrors FY 26 management plan with limited adjustments for
the behavioral health rates that we previously discussed as well as the inner eye assessment tool.
We will return after February 17th.
when the governor's amended budget is due to the legislature, and we'll share more.
Forward to it.
All right, so slide five, health care services.
For the record, this is Emily Ricci with the Department of Health.
So moving on to slide 5, as again this committee is well aware.
Health care services to me really represents kind of the heart of
the Medicaid program and with its 133 permanent full-time positions and
a proposed $27.3 million budget, they are responsible for many of
the core operational functions of a Medicaid Program.
So they manage claims payment, provider enrollment, service
authorizations, and when we talk about the $59 million weekly
check right, this is a team that is responsible
for getting that out.
Outside of the Medicaid program, they are also responsible for other activities,
including the background check unit, as well as licensing inspections required
for both Medicare and Medicaid through the health facilities licensing
and certification unit and the residential licensing unit.
Over the past several years, we talked about this last year, there were kind of challenges
with federal funding specifically related to the health licensing and facility licensing
and certification program.
Again, that team performs those certifications on behalf of both the Medicaid program but
also the Medicare program, and previously the division had kind
of covered those gaps on the federal side through a high vacancy rate.
kind of impacting operations throughout the entire division.
Over the past two years, we've really focused
on increasing retention within the division
because we wanna make sure that that division is strong.
And our vacancy rate dropped from a high of 31% in July
of 2023 to 8% as of this month.
So we have seen a significant drop that did, however,
require us to make sure that our budget reflected the realities of the cost that were underlined
the positions within the division.
So last year we requested about $962,000 with about 667,00 in general funds to offset
The legislature approved and the budget included a $481,000 increment in the final budget.
So we were able to use that to help cover the gap and we received some additional and
unexpected funding support from Medicare for that position at the same time.
So, we are stable right now within that unit.
The division also proposed a eight hundred and forty eight thousand dollar increment
align the divisions underlying costs with the positions that were supported because we had
been covering those frequently through vacancies.
And we received, the division received about $424,000 in the final budget from the legislature
last year.
We were able to leverage that to cover the gaps that we saw and then we were also able
to look at our contracts and we really made a push and you'll hear about this more in
to make sure that anything that is eligible
to receive federal Medicaid funding, that we are doing that.
So we found some additional opportunities to shift some
of the funding that was covered in contracts from general fund
to federal funds with the Medicaid program.
So, we have used that to cover the remaining gap.
And we're now in a stable position with HCS.
For the record, this is Pam Haller, an assistant commissioner for the Department of Health.
There were a couple budget changes on the right side of the past slide, were you interested
in hearing about them or should we move on?
Okay.
The only item I wanted to point out was the conditional language to carry forward programmer seats
that are received every other year related to licensing and certification for health facilities' licensing.
So that will allow us to use those funds to operate in the years that we're not receiving the funds by carrying them forward into the next year.
Okay.
This slide six shows the health care services budget from FY 25 through 27.
Between 25 and 26 general fund match associated with the increases we just discussed as well
as the salary adjustments and the Alaska care adjustments are reflected here.
The governor's proposed budget for the Division of Health Care Services is $27.3 million.
This is an increase of $812,500 over the FY26 management plan.
Again, this is primarily driven by the salary adjustments and the Alaska care increases, which we'll see throughout our budget.
Moving on to slide seven for the record, this is Emily Ricci with the Department of Health,
and we will talk about the Division of Behavioral Health.
So the division of behavioral health has a proposed $96.8 million budget, and that supports
about 101 permanent full-time positions.
And to, the provision provides a variety of services, I think one of the most, one
of those ones that I know this committee is very focused on is how to support Medicaid
But they also provide, they operate some of our largest behavioral health grants and other services including like the alcohol safety program.
Question from Representative Fields.
Through the chair, I think I could learn more about Medicaid behavioral services in schools.
Which schools have those through contractors maybe through ASD employees, and we just appreciate learning more and whatever format you think it's
Easy to educate me in the future. Thank you
DC
To the chair for the record. This is Emily Ritchie
We can follow up both in writing and then we can make sure that we
Can focus on that as part of our budget overview to with the division of that scenario of interest
Please continue
For the record, Pam Haller and Assistant Commissioner Department of Health will start with the budget updates.
In FY26, the governor's budget for the Division of Behavioral Health included two $750,000 requests.
One is for mental health.
Trust authority money and one was for general fund mental health.
We discussed that previously, so I'm going to skip over that.
In FY26, the governor's budget also proposed the designated program
receipt authority reduction to align with tax revenue projections by the Department of
Revenue for the division of behavioral health, that was over 3.7 million.
experienced some cost pressures, as I mentioned previously, because of the compounded effect of
the loss of determinated COVID grants that were terminated last March,
as well as a designated general fund,
as Well as the 750,000 mental health. Again, it was about 107 grants
that received reductions between the amount of 5% to 25% as result of that.
The division continues to prioritize the crisis contact center and it's fully operational.
The Division of Behavioral Health requested and received five million in federal authority
to support new grant programs.
These funds allow the division to support two new subrecipients in fully implementing a collaborative care model in primary care settings.
With the third sub recipient nearing full implementation very soon.
Moving over to the right side of the slide, the governor's budget.
proposes a transfer of $474,300 general fund from the Division of Behavioral Health to the
Division Of Family and Community Services. This funding supports grants to children's
emergency service providers. The services provided by these grants focus on safety and
supervision and are not clinical treatment services, so they align with the division
There is also a proposal for federal receipt authority in the amount of $585,000.
This federal authority aligns with allowable and eligible Medicaid costs for the crisis
contact center.
Finally, there's a small shift from the restorative justice account to general fund related to
Incarceration and the amount of the pfd assistant commissioner the 585 you mentioned for authority
I typically authority
Is matched by a state investment?
And we didn't provide the state
So are we still eligible to receive five hundred and eighty five thousand for a crisis call center when we're not
Investing in one so far. I I'm just
to the chair for the record, this is Emily Regie.
So again, kind of similar to what we've been looking at
with the Division of Healthcare Services,
we wanna make sure that anything that is eligible
for additional federal funding,
we are really leveraging that.
And so one area that the division of behavioral health
worked on was to look at the services offered
through the crisis call center.
And there's a rather convoluted process
that you can undertake to have CMS effectively review
the contract and the service and to identify
federal funding or essentially federal match, and they were able to identify a portion of
the call center services that would be eligible for Medicaid federal
match. And we will be using that in this next fiscal year in order to help cover some of
the costs for the crisis call Center.
Okay, I like your ambition. I think some departments, nothing comes to mind, but I
to use a common vernacular and trying to get everything you can.
I appreciate it.
I'm not hearing that all the time from other places.
All right, should we go to slide eight?
Slide eight shows the Division of Behavioral Health's budget.
Oh, for the record, this is Pam Haller,
an Assistant Commissioner for The Department of Health.
Slide 8 shows a Division
of Behavior Healths budget from FY 25 authorized
through the governor's proposal.
Between FY 25 and FY 26 management plan we wanted to point out the reduction in
the general fund authority to align with the projections which we've already
discussed as well as federal COVID-era funding also decreased during that time
due to the notice we received in March.
The FY 27 budget for the Division of Behavioral Health is $96,855,500.
The changes between FY 26 and is primarily related to the Alaska Care Adjustments and
For the record, this is Emily Ricci with the Department of Health.
So the next division is the Division of Senior and Disability Services.
And so this a critical division, they all are, but this one has 184 permanent full-time
The division undertakes a number of different activities.
One of those is to administer the Medicaid home
and community-based waiver services.
And there are about five different waivers
that make up that program.
This is not in the budget update, but just for awareness.
This some of kind of the quiet but heavy work that goes
on regularly within the divisions.
Four of these waivers are actually up for renewal this year.
So the division has been working over the last six
to eight months to make sure that we.
are going through the process of renewing those waivers,
and we're in the final stages,
and will have that done by the end of this fiscal year.
But I just wanted to highlight that
because it's quite a lot of work,
and it doesn't always get called out.
Looking at FY26, there are a couple of key budget updates.
So the legislature allocated $2.5 million in the FY26 budget for increased funding to support and stabilize senior centers.
And these include about 1.2 million nutrition, transportation, and supportive services.
Just over 300,000 for adult day services, about 460,00.
for senior in-home grants and 345,000 to centers for independent living.
This funding will benefit any senior who is eligible for those services,
so it's not tied to Medicaid eligibility, which is an important distinction.
And we anticipate that these funds will be distributed this month, well, next month in February.
Another key focus is the inter-I implementation and this is a tool, I know we've talked about
it before on the committee, but this a key tool for the division and for our Medicaid
recipients that will allow them to begin to establish a budget and provide for person
directed care.
So when I think about kind of transformational changes within a system, this one of those,
reshape how we think about providing these services, which is especially important given our aging population.
So that work is underway and we are beginning the implementation this year in
2026 however, I got ahead of myself in earlier slides
The legislature in FY 26 the legislature supported carrying forward funding of just over
$1 million in combined federal and GF Authority to support six positions for the inter-I implementation
that funding does end at the end of this fiscal year,
and we are still working through the implementation process.
Does implementation remind me how implementation of NRI could act
to reduce the IDD wait list and what the connection is there?
Yeah. Through the chair, you know, I know that the division
Rightfully so, is sometimes very cautious about tying the two together because it is
hard to predict, but the intent, one of the things that I think other states have experienced
with implementing tools like the NRI, and again, the NCRI is a...
Global tool that's used and can be kind of modified to meet state specific needs is that it allows us to be
It allows the program to to more effective with the funds and more efficient and in turn you can then use those funds to potentially serve more people
I would say the implementation of the inner eye is going to a multi-year process. So we are beginning in this year
in calendar year 2026
but
But, the division is doing so very cautiously because this really represents a new way to
assess an individual's needs.
And you really need to make sure that those assessments are accurate.
And a portion of that involves comparing the new assessment tool to the old assessment
tool, to makes sure it's calibrated right and you're identifying if there are any issues.
When I talk about MRI implementation, you'll be hearing about this for several more years
Okay, all right, so we'll go to the FY 27 budget changes.
For the record, this is Pam Halloran, Assistant Commissioner.
The FY27 budget proposal for the Senior Disability Services
includes two new mental health recommendations.
There's many older mental-health recommendations
which we'll leave for division to cover
in their presentation with you.
The first is an Alaska State Plan for Senior Services.
This is Mental Health Trust Funding
in the amount of $60,000.
Commission on Aging produces this plan every four years.
And it's to secure Federal Older Americans Act funding.
It addresses a number of things, and I'll name a few,
dementia care, housing, transportation, medical care
food security, homelessness,
and more.
The contract will support a contracted consultant
to draft the plan.
The second mental health recommendation
Our project search, the trust recommends funding,
temporarily funding $75,000 for FY27 through FY29.
This is a statewide employment program
that supports school-age children with disabilities
and is coordinated by the Governor's Council
on Disabilities and Special Education.
10 demonstrates three-year budget comparison, again from FY 25 into the FY 27 Governor's
proposed budget.
The increased in general fund between FY25 and FY26 reflects the legislative action adding
to $0.5 million to support and stabilize senior centers that we just discussed.
The slight decrease in other funds between the 24 and 24 is primarily related to mental
trust authority projects. The FY 27 governor's proposed budget for senior
and disability services is just over $77 million.
So that takes us to slide 10 or 14 skipping.
We'll go to public health.
For the record, my name is Heidi Hedberg.
The Division of Public Health has 449 employees
and about a $159 million budget.
And they truly are.
They're out in the field promoting and protecting
the health of Alaskans across the state
and they do a lot of great work.
I will just give you just a few highlights
Pam Halloran
The Director Kato has a lot of great updates in terms of just the system changes and how they are getting out in the community and truly supporting Alaskans.
But what I want to highlight for you today before I transition over to Pam is that they launched a new electronic health record for public health nursing, so now they're all digitized.
80% of all test requests and results.
are electronically requested and transmitted.
All of that was paper-based, including during the pandemic.
So there's just been a lot of focus on public health
infrastructure, IT modernization, with our systems.
Public health is also working very closely
with the Department of Corrections,
again working on identification of infectious diseases
and supporting the department of corrections.
For the record, Pam Haller and Assistant Commissioner, Department of Health.
The FY26 budget for the Division of Public Health included a designated general fund
decrement in the amount of 1.7 million.
That was again based on Department or Revenue projections for tax revenue.
The tobacco tax revenues for
the division supported a tobacco control program and
the decision was able to absorb those costs.
and not reduce existing grant funding.
They were able to, they focused their priority
on new media and they reduced costs
associated with new-media campaigns
and prioritized established prevention campaigns.
The marijuana tax supported youth or supports youth after school programming aimed at reducing substance use risk by strengthening resilience and fostering connections between youth and adults.
No reductions were made to after-school program grants.
The FY26 governor's budget also proposed a $1.7 million increase in general fund program receipt authority for workforce recruitment known as a SHART program.
that that request did not make it into the final enrolled budget.
The funding, the receipt authority provided healthcare providers an opportunity to
leverage their funds to match federal funds, to provide incentive programs for recruitment purposes.
However,
recruitment program due to the delay of the federal revenues associated with that program.
Sliding over to right side of this slide, I am going to spend a little bit of time on
FY27 budget changes.
For the division of public health, there was a proposed increase in 2.7 million in federal
The authority enables the division to maximize federal funding for child development initiatives, mental health consultation services,
opioid crisis response activities, and systems that strengthen quality early learning.
The addition in federal authority also supports a procurement of a forensic evidence processing tool within the medical examiner's office.
trust request items within the budget and again these are new items only the
budget includes 151,000 that supports a position leading a statewide
implementation of an evidence-based framework that improves social emotional
development and reduces behavioral challenges for children birth to five.
The five-year investment strengthens early childhood systems and sustains
with the Department of Education as well as other partners.
The budget also includes 130,000 dementia education and prevention fund.
The funding will support a long-term non-perm position in FY27 and in FY28.
The position is for dementia coalition facilitation and replaces a contract.
The Division of Public Health will carry forward some COVID-era appropriations into FY27 using
remaining balances at the close of FY26.
As these time-limited funds conclude, the Division deliberately is integrating investments
into core public health systems and laboratory capacity to strengthen long-term operations
and avoid reliance on temporary funding.
The carryover of these funds is needed to finish out those enhancements.
$4.4 million in statutory designated program receipts from the opioid settlement.
This represents the third year of settlement funding for the division and supports an opioid
settlement community grant program, enhancements to the prescription drug monitoring program
including overdose alert modules for providers and statewide communication efforts.
Slide 15, again, provides the same comparison between FY 25 and FY 27.
The governor's budget proposal does not include multi-year-era appropriations.
Those remaining balances will be carried forward at the close of FY 26 into final authorized budget.
Slide 16 shows a department support services division, the backbone of the department as
well as Medicaid services.
The division includes public affairs, quality assurance and audit, our Medicaid audit and
cost allocation section.
The commissioner's office, or administrative support unit, which includes budget, human
resources, grants, and procurement and IT.
And now it has oversight of The Rural Health Transformation Program.
For FY27, there's two key changes.
Those we've lightly touched on already, that's the return of the shared services of Alaska
positions from the Department of Administration into our Division of Administrative Services.
Those positions will incorporate, integrate accounts payable and travel reconciliation
services back within the department.
The addition is the IT classification implementation program, which are implementation,
which will shift just under $1.2 million back into the department to cover those physician costs.
Slide 17, the FY27 governor's budget for the Department of Support Services Division is just
This slight decrease in undesignated general fund from FY 26 reflects $382,300,
which was transferred from the commissioner's office into the division of public health.
This moves the funding closer to the work and supports a statewide data sharing and
an integration project to expand data collection capacity related to homelessness.
Are we on 18?
Good afternoon again for the record. My name is Emily Ritchie deputy commissioner with the Department of Health and on slide 18
I'll be brief because I think we'll spend a lot more time talking about these within each different division
But I just always want to highlight the importance of our tribal reclaiming program
This basically this supports the Medicaid program
Alaska's medicaid program in the state and being able to receive a hundred percent federal funding for certain services
And we do this in partnership with our Tribal health organizations
Every year this is a really important area that we focus on and in state fiscal year 25
We had a total of a hundred and twenty seven million dollars in tribal reclaiming and so again
Those those are monies that would otherwise be paid for using general funds
So it's very important that. We maintain that
We are always looking at new opportunities to to expand that
The next item on the slide is just what we have done to implement system
improvements. You've heard a little bit about that regarding the Division of Public
Assistance. We are also looking to do the same thing within the division of
healthcare services, right? So we are continuing to build out our provider
services module this next year. This is an area where we want to leverage new
systems and modules so that people can interact more effectively with our
system. Again, we're moving away from systems that require people to push
Our contractors are a health care services team, and we're moving into something that is more automated.
We are also planning to implement and develop new service authorization modules,
so we can expand that to the prior authorization process.
And we will be implementing kind of a Medicaid digital card this February
through something called gain will go. I said February, but I think it's actually March or April.
Some of the other areas that we talked a little bit about,
Commissioner Smokbout earlier is just expanding access
in remote communities, and so we're trying to think
about different ways that, we can make sure
that were bringing our services to remote areas.
So we've talked about things like the division
of public assistance going out and meeting
with individuals in specific areas,
I know the Division of Public Health is also doing
that in different way, so just a couple of highlights.
And finally, a little program called the Rural Health Transformation Program.
Who, I bet Emily, that you want to describe this for us.
To the chair, for the record, this is Emily Ritchie, Deputy Commissioner with the Department
of Health.
Item is something called the Rural Health Transformation Program.
I know we've already talked with many of you here and I anticipate several hearings throughout
the session about this.
This is an opportunity that passed as part of HR1 or the budget reconciliation bill this
summer and it provides about $50 billion worth of federal funding over five years distributed
across states.
distribution period happened in a very short time frame.
So we received notice of our funding opportunity.
It is a one-time opportunity for states to complete an
application to receive funding in September.
We had six weeks to put together this one time funding
opportunity and a response.
We did that.
We submitted our application actually on November 3rd.
So, we were two days ahead.
We don't want to wait until the deadline for something like
We appreciated the support from legislative budget and audit, and we received $200 million
in federal receipt authority in November, which was kind of the base amount that all
states had submitted in their application.
We found out at the end of December that the amount awarded to Alaska was higher than that.
It's actually $272 million.
And we had a kickoff meeting with interested parties in Alaska, just what feels like two
I'm not sure it's actually been two weeks yet.
Rob Fields.
Thank you.
Through the chair, yeah, thanks for y'all's many hours
of hard work on RHDP.
The chair.
So I was talking to a nurse from Prague the other day
who said that infant mortality in the NICU
has doubled over the last year.
What's going on at Prague is, Prague
has increased the ratio of patients
to nurses, which is basically in response to cuts in HR1.
sense of prov as a multi-state network. They've also changed their management, other hospitals
are experiencing these staffing ratio changes. So I am interested and I know I've heard a lot
of good things that you are pursuing in rural health but you know looking at the devastating
effects and nurse staffing I'm curious is there a way, I don't know we can't backfill funding but is
stem the loss of life that's occurring
because of other cuts in HR1
because it's extremely concerning, you know.
Patients being held in hallways,
patients calling 911 from the ER
because they can't get care,
kids dying at double the rate.
So, we are seeing the effects of the HR-1 cuts
at the same time and obviously appreciate y'all's effort
to mitigate that through RHTP, thank you.
Thoughts or comments?
Through the chair of representative fields, I think I would just add that when you look at the investment that Alaska has made in in our hospital systems.
I, think Alaska's investment remains strong, and I
would want to ensure that that investment is reflected in the services that we receive within the state, kind of regardless of the other connections that they have.
For the record, Heidi Hedberg. Through, the Chair represented fields. I
as well. And so I think that is our desire when we listen to Alaskans and the Alasking
Voices are in the application that the system has to change.
And, so truly from, you know, healthy beginnings, which is focused on that maternal health and
There's staffing support, but there's technology that supports the staffing,
and then there is caring for the moms so that they do have those healthy pregnancies,
and I think that is a large focus. It's the first initiative and the
first goal that we have. In terms of strengthening the workforce, that
is absolutely a goal we got under Goal 3, is how do we grow our own? How do
But I'd also say that, you know, and we look back
and when we hear the life stories and
we see the statistics and
we looked at the system, I think that's where we have
such a great opportunity to build out services
that is really focusing in that prevention realm
so that we are decompressing the hospitals.
And so patients truly are only going to the hospital
if they need that surgery or that time sensitive event.
because there's a lot of care that can happen outside of the hospital.
And so I think this is the urgency that we feel in partnering with organizations
across the state so that
we can make these truly system level changes.
So we're going to wrap up.
But since I have you here and it's not even five,
I wanted to ask and I've asked you this before, but I I want to know.
So when I look at HR1 and I looked at the work requirements,
there's another term from community engagement, I guess.
I think the best that can be said about the policy from that July bill,
the Reconciliation Act, is to promote people to go to work who are able to do so.
And that's great.
It's hard to dispute that.
More than than concerned about people falling off the rolls in Medicaid and the impact on
everyone who's insured providers, etc.
And and separately the the SNAP issue is is it
Well, I view that somewhat differently than Medicaid of course because you're just talking about sustaining
Diet and food and all those things
I guess where I'm going with this is, if it's the will of the majority in both chambers,
what is the singular thing we could do to protect folks who might fall in the cracks?
Is it the virtual call center that we didn't fund?
Would that be helpful to reduce error rates and therefore keep our costs, our administrative costs down?
Because I almost look at the new requirements as sort of a labyrinth.
And if the poor can navigate that, they can stay in the roles.
They have to do it twice a year.
I'm just trying to see what mechanism this subcommittee and then other
committees above us could utilize to capture the most benefit we can from these programs.
Yeah, thank you chair for that
The question which is how to support constituents how do sport Alaskans and I would say you know on the Department of Health side
We're focusing on that foundational changes
Within our staffing and our IT modernization because that's been the biggest barriers to supporting Alascans
And I think all of you have a voice and you work with all your constituents, but the ask is the
messaging. I thank the Avenue, like, Contact Center. All of those mechanisms are very, very
helpful because they truly help manage and connect.
Alaskans to the resources and they help answer questions and
they move applications through the process.
But I would say that the messaging is really important because what I find
when I am out in the community is a lot of Alascans,
they don't know where to go and
they do not know how to get help or they
the changes and the change that are happening in impacting other states are not the
changes that impacting Alaska and I think that nuance is really important so we are going to be
in the coming months really focusing in on community engagement working with all of the
associations and we would ask that the legislature would help you know with the communication
and in what community engagements requirements are what they're not because there's a lot of
Confusion, confusion, but exemptions as well.
And I think that's going to be really important.
Is the messaging, to answer your question, is the
messaging.
But if we're talking about urban Alaskans, setting aside the
provider tax, which is really an administrative thing for
states to pay their Medicaid portion, so that is not really
where I'm going.
But, if you're
The change is the same, potentially, as the lower 48, isn't it?
Isn't the carve out for essentially Bush, Alaska, for most of these requirements?
To the chair for the record, this is Emily Ritchie.
I don't know that I would describe it that way.
I will say depending on the community characteristics, there may be individuals,
that meet different exemption criteria than others.
And I think it's really hard to compare us
to other states down south because our demographics
are really different.
One of the things I was on a webinar earlier today
talking about this, and one of things that I
think is going to be key is communication.
And we just went through
re-determination process and unwinding process within our Medicaid plan and I
remember at the time someone said this is going to be the biggest thing since
ACA like the big is undertaking the states
can have. And we did that, we got through it. It took us about two years. We took our
time to get through and we do that thoughtfully. But in some ways, the messaging there, while
that impacted 250,000 Alaskans, right? The messaging was the same or very similar for
what our challenge is going to be is that we are now speaking to a subset of Alaska
Medicaid recipients and we have some specific information that either we need to communicate
to them or they need communicate to us within a time period. And so we
need make sure that were targeted in who we reach and how we communicate because we don't
want people thinking that things apply to
our call center and our staffing structure can be fragile at times, so we want to make
sure that we're not communicating in a way that creates a lot of unnecessary incoming
communication into the division because people aren't sure whether or not this applies to
them and it, in fact, is not.
And so, we need to think about how we balance all of that, and so those are the conversations
that want us to start having in the next month or so.
six or seven months with a team on this topic working through the technical aspects of how
we build out what we need. And we're really going to be focusing on leveraging the communication
tools that people use now. So a lot of texting, a
lot mobile base, but we know that that doesn't work for everyone, particularly in some of our
more rural communities. We're going really need to work differently with our partners.
allowed us to start that process. We have worked differently with our stakeholder groups and partners
through that. And I we want to use that same foundation when we think about how to communicate
these in the coming months. Great. Well, I want
to thank the commissioner deputy commissioner and assistant commissioner Halloran.
This was a quick overview of a lot of important issues and divisions.
Our next House Finance Committee meeting is scheduled for Thursday, February 5th at 3.20.
We'll hear an overview presentation from a Department of Family and Community Services, two of its divisions, API and Pioneer Homes.
If you'd like to propose particular areas or topics for those presentations, please work with my aid, Aaron Page, by this Thursday January 29th.
If there's no other questions for these fine folk, we're going to adjourn this meeting at 5.04. Thank you.