This meeting of the House Health and Social Services Committee will now come to order.
It is 3.15 p.m. Tuesday, February 3, 2026, and Davis 106.
Members present are representatives Schwonke, Ruffridge, Prox,
and myself, Representative Mina Chair.
Let the record reflect that we have a quorum to conduct business.
Please take this time to silence your cell phones for the duration of
the meeting. Staffing the committee today, we
have Andrew Gianati as Health & Social Service's recording secretary,
Chloe Miller, our LAO moderator.
and Katie Giorgio, my committee aide.
If you need anything during the meeting,
please don't hesitate to get her attention.
The recently released legislative audit of the Office
of Children and Services provides a critical look
at the systems intended to protect children in our state.
We acknowledge the incredibly difficult
and complex work performed by OCS staff every day,
and we thank you all at The Division and also at
the state for all of work that you do.
This committee's priority is clear.
in sharing that when the state intervenes in the life of a child, it does so with the highest
standard of care, urgency, and oversight. And we really appreciate all the work that's being done
to help care for many of our vulnerable children in this state. Just a few housekeeping items,
and I'll repeat this if we have other members come in during the meeting, we will start off
Department of Family and Community Services.
There are many slides and information,
so I will ask members to hold questions
for specifics, pauses, as we go along the presentation.
We will save the last 15 minutes of our committee time today
to hear a brief introduction of Senate Bill 83
by Senator Clayman related to telehealth services.
I would like to invite Department
of family and community services,
Acting Commissioner Tracey Donpling
and OCS Director Kim Guay to the presenters table.
And in addition to our presenters, we have several other people available for questions.
OCS Deputy Director Kim Swisher and Social Services Program Director Brooke Katasi.
From the Legislative Audit Division,
we've Chris Curtis in the room and Christine Lumba available on the phone.
Please put yourselves on record and begin your presentation.
Hi, good afternoon committee members.
For the record, my name is Tracy Dompling and I'm the acting commissioner for the Department of Family.
While I've been in this acting commissioner role for about five weeks now, I did want
to point out that in the department, either between the stand-alone department or as
part of the Department of Health and Social Services,
I have about 27 years' worth of experience.
I also worked for two years at the
Department
of health as the director for the Division of Behavioral Health.
I came back to this department last year in August as
Acting Commissioner Rold. So I'm going to I actually am joined today by
Director Office of Children's Services Director Kim Guay
We want to thank you for the opportunity to present on House Bill 151 an overview
implementation workforce challenges and solutions and I am going turn it over to director Gwen
Good afternoon for The Record. My name is Kim Guey. I've been with OCS for approximately 26 years
And I have been in this role for five years
I'm going to start off talking about a high level overview of House Bill 151,
which is titled, Children Deserve a Loving Home Act.
We often refer to it as HB 151.
First, I want to express my gratitude.
This bill passed in 2018, this legislation supported.
resource families, children, office of children services, it had a wide breadth of
items underneath it that really were intended to reduce casework, improve the
training, and increase stability for children. I'm going to dive a little bit
And as we transition to this slide, I want to recognize that representatives fields,
gray, and column all joined us at 3.19 PM.
So on this side, you will see various requirements that were passed under HB 151.
Those green check marks on there are ones that we have implemented throughout OCS
over the last six years of this bill.
Some folks have described this law as the gold standard in child welfare.
However, this Law has not fixed the aisles of child
welfare in the state of Alaska.
As a matter of fact, there is no state that is passing the federal reviews,
and there's no law that has been created that's going to fix the complexities of
child warfare.
With that said,
there are a lot of opportunities for growth, and we're going
to get into that a little bit later.
On this slide, I'm going to point out, highlight a few, and then I am going
to punt a couple of the topics to a little bit later into the presentation.
The ones I will address later are caseworker training, the mentor program,
and caseload averages.
With that said, some of
the items that we have implemented on here, foster care licensing, for example,
we've decreased the amount of time it takes to be licensed.
currently takes 43 days when an applicant has turned in their application to licensure.
The licensing packet back in the day, 2018, 2019 was 33 pages, is currently 13 pages.
possible foster parents if they have background barriers that need
variances. So we work with that person to help navigate the system because it
can be complex. Family connections under here, family connections, what we did is
we updated our policy and our training to strengthening the understanding and
the importance of sibling contact and family
In 2025, our quality assurance team assessed that cases reviewed were rated as a strength across all areas of Alaska.
As a matter of fact, 88% of the cases review made concerted efforts to ensure visitation between children, parents, and siblings.
Was sufficiently sufficient frequency and the quality to promote child relationships.
As far as relative placements, the Quality Assurance Team.
last year, 2025, indicated that 98% of the cases reviewed made concerted efforts to
place children with relatives, and our data reports from part two of
the legislative audit shows less than 2%
of children out of home and out-of-home placement do not have relatives
documented in NORCA. So what that tells me is 98 percent of our cases have
relatives documented at NORECA, in addition to that we are partnering
which are our tribes that are part of the tribal, Alaska tribal child welfare compact.
They also help with the relative search.
One of continued challenges of HB 151 is the technical aspect note of supervisors certifying relatives have been entered.
And you'll see this on the bottom of this slide titled Supervisor Relative Search Certification.
This is one area that we have failed to implement successfully and is a continued challenge, although that,
without said, the intent behind HB 151 was to make sure relatives were entered and relatives are entered, and that is what it says.
We just don't have a supervisor that's going in and documenting that within the orchestra, so I'm going to talk a little bit
Another topic under here is transition aged youth.
And what this means is involving children, youth,
14 and older in their own case plans,
and their permanency plans.
It's making sure that we are helping youth collect and gather
the documents needed when they exit foster care
or when need them for a driver's license or a job.
We are working, we are doing that fairly successfully.
We're having some hiccups with our Social Security Administration, with the federal government on some of the delays there.
The next one, foster parent decision making.
This was already, this is a federal law, and then HB 151 came after that federal
law.
What this means is it includes foster parents in a day to day decision
making of children, the foster children in their home.
It encourages children and youth to participate in normal activities and should use the parenting
standard and considering the child's age, developmental level, and particular abilities.
Back in the day, for an example, when I was a caseworker, we didn't want foster children
Or they couldn't travel outside of Anchorage to go keen eye to
go fishing without getting permissions and notes.
That is no longer the case.
Reporting requirements, one of the checkboxes here.
Since the passing of this bill, we are continuously reporting as
appropriately to the legislative auditors.
We have mentioned.
As I will mention, we're going to talk about some of our data and our methodologies.
But we take the feedback, recognize when we make mistakes, and we are nothing but transparent.
We are not a perfect system.
We're a broken system, but I'm going talk some solutions and some ideas moving forward.
So the two bullets at the bottom we'll address throughout the slides.
Next slide. Do we have any questions from the committee?
Representative Prox
Thank you through the chair
Actually, maybe the first one will wait until we're done
relative placement
How's that going through? The chair representative Proxx
We're pretty we're on par where we have been. I think we dropped one percent
I I Think we were 49 percent of our children placed are with relatives at this time
We would like to see that higher especially with our disproportionate number of Alaska native children in care
So I thing that is a goal of ours is to increase relative placement
And so that's kind of where were sitting at at the moment
and will you be getting into things you've thought about to improve it?
Through the chair. Yes, sir. Thank you.
Representative Gray.
Thank y'all. Thanks for being here. So through the Chair.
You were just talking about always being transparent and on page nine of the audit and report conclusions
It says high vacancies and turnover led to excess excess budget authority
Which was used in part for other purposes and so I think a lot of people have had questions what the other
purposes were
Through the chair representative gray
I believe you're talking about recommendation number seven on the legislative audit part three. Is that correct? So
My staff printed off the entire audit and I'm on page nine of whatever is printed of for me
So the title at the top of the page is report conclusions
Is it excuse me is it ten million dollars that they're
Discussing in there there's 20.7 million of additional funding and authorizing 110 new frontline caseworker positions for high vacancies
So the 20 point seven million that was for
authorizing the 110 casewer care positions
But then there was a lot of vacancies so that money wasn't used and so it just it says that
The money was therefore used for other purposes
Through the chair representative gray without specifics well, I can tell you is the money is used
to run child welfare.
And so when we don't have positions
as we got within Health Bill 151,
what that usually means,
we're spending a lot of that money
and overtime for our staff.
Or we looking at trying to do contracts
or hire long-term non-perms or on-call staffing.
So that is typically where we try to get creative
on how to serve our families and our youth
with the budget that we are allocated.
Did that answer your question or do you have a?
Thank you.
Follow up.
Oh, follow up?
I would just, I wish that it said that.
I wished that, it's said, high vacancies in turnover
led to the money being used for over time, you know,
something like that because I think the use of,
you other purposes,
I just it makes you wonder where the
money was.
And if I may add, so if you continue on reading
talks about some of those funds and how they've been used related to paying a fine from the 2021
cyber attack that's on page 12 of the audit where there was $2 million of these funds.
We do have Chris Curtis here. I wonder if you could come to the presenters table and also
Certainly for the record, I'm Chris Curtis. I am your State Legislative Auditor.
So the paragraphs you're reading from are summary paragraphs, and so if you go into the audit,
like you mentioned on page 11 and 12, we explain what those other purposes are.
As mentioned by Director Guey, overtime is part of the solution.
Also, the division has a lot of flexibility to use...
to transfer funds or authority between allocations.
And so they have like six or seven allocations
within the appropriations.
So they move that around for like foster care payment rates.
That's not often what I see.
Also the legislature during the budget process has moved some
of the authority in a very transparent way
that was originally appropriated for this purpose
for other purposes.
In addition, the cyber attack,
This has been a pot of money, 11 million of it, has
been used over the years to fund the tribal compact.
So all the details are listed on pages like 9 through 12.
Follow up.
Follow-up.
Thank you.
So there's lots of things that can be done with that money.
But could it be to increase the pay of case workers?
Through the chair.
No, it cannot under my authority, right?
We would have to, we're all unionized,
we have go through a classification study.
Now if I got something back that said I could increase
their salary schedule or I can change their job description
to something else where they had higher steps,
then we could use that money to do that.
But I do not have the authority as the director
to change the salary for my staff.
I saw rep fields and then reps one K after through the chair. I mean, that's technically true, but you can just do a letter of agreement with the union, right? I
mean it's not. Yeah, you
can't change the salary technically,
but
you
can change
the amount of money that employees get through this chair
We can do letters of agreement and we have had layers of
agreement in this last six years.
During this, we had letters
of agreements, for example,
for retaining retention bonuses
for our frontline case-working staff.
We have tried different methods of retention and that was
one of them. I will say that-
The job classes, the staff are called
Protective Services Specialists 1, 2, 3.
We are not the only division that has PSS 1-2-3s,
and we have run into union issues
when we try to do something specific
with some of the class that they're representing, right?
So for example, even supervisors,
if we wanted to give them retention bonuses,
the ideas went for all and all for one.
So we occasionally run
Pushback from unions or higher-ups as far as getting the L.O.A.'s approved or are authorized.
Okay.
Representative Schwenke.
Thank you, through the chair.
I'll add on to a representative field's question.
Can you describe the bonus program a little bit more?
What size bonuses type of thing?
And did you have to have an LOA to give bonuses?
Through the chair represent swanky. Thank you for the question first
Yes, we had to have LOAs to give bonuses and I had
to get an LOA from the GGU and
I have to given get a LOa for those supervisors unions because the bonuses were for staff
That had been here. So their retention bonuses, and it was a 10% of their
Annual salary split over two years so the first year if you were here for a year year or longer, you got six percent
the following year you would get 4% and then when it concluded it
concluded they were done and so there are no more retention
bonuses that was a something that we are doing right
close to the pandemic or right after the
pandemics quick follow follow and
so they did the union push back on those
Eloise are they like holding on do they have to sign off
on an Elaway that you do with an individual
Through the chair, yes, they have to sign off on any yellow ways that we push through or
Get approved and so there is a process to the state that
We submit it up to The department the department sends it out to a believe Department of law
Department law then goes to governor's office
OMB we also have the funding to do that so they're layers and then it also goes through the union as well
Okay, thank you
Representative great
Thank you, through the chair, back to the cyber fine, the $10 million.
So it's my understanding that the 10 million dollars was put aside to pay the fine.
But then we never got contacted to paid the fines.
So where's the ten million?
Through the Chair, my background is not necessarily in finance.
What I understand is we did not have to be the find.
But I believe that that money is where.
I have a statement I can read, let me read the statement so I don't misrepresent what I do know.
A re-appropriation period, the Department of Health and Social Services Commissioner exercised their transfer authority to reallocate excess funds from multiple divisions to the department social services.
The transfer was executed for two specific purposes, addressing a probable fine resulting from an unavoidable cyber attack and
covering the costs associated with the Office of Inspector General Audit.
This reallocation did not impair the department's ability to deliver services and
was conducted under the guidance of the agency's audit coordinator based on their findings of a GASB requirement for
cost to be recognized in the year the obligation is identified and measured.
The cyber attack and comorance has been liquidated.
That's what I've got on that one.
Sorry, quick follow-up.
Follow-ups.
Thank you through the chair.
So you just said the unavoidable cyber attack, we were fined for an unavoidable
cyber, what we're going to be fined, for unavoidable
cyber-attack. So we put, they took the 10 million out,
and it can't be put back in, and we didn't get fined
for the un-avoidable cyberattack, I just want to make sure that I understood
the statement. Through the chair,
The acting commissioner doppling may have more to add on that.
Or to the chair to can the auditor.
Certainly.
One thing that department has and has been granted over the years.
Authority to transfer money revenues or unexpended revenues through across appropriations.
And we've advised the finance committees that this can create issues.
And this is one of them to where.
Authority, unused authority could be transferred over to for some other purpose.
So to pay, say a fine, you may, maybe the legislature would never know what the fine happened because the money was transferred
over it.
And so our issue with this was that there was never a find and it was just based on an expectation that
there could that the authority was transfer instead of lapsing and so the
money when it doesn't lapse, it hasn't become available for other uses.
At one point of follow-up, the finding really is directed to Department of Health to where
the authority was transferred before the split, then Department
of health had that, so the recommendations directed
to the Department
of
Health.
Representative Prox.
I hate to get into the details because of time, but find for something that was unavoidable.
A rock rolled down the hill and fell on my car.
That was
Why would I get fined for something that is unavoidable?
That's questions to me, Chair.
I believe the is possible, possible violation of HIPAA.
Correct.
Right.
But the only reason, excuse me follow up to the chair,
the reason I would think somebody would get
fined is because it was avoidable.
As opposed to an unavoidable fine that is an oxymoron, I guess
Through the chair representative Prox I believe
It's hard to protect cyber attacks
Anywhere these days and I and i think that that's we have a responsibility
As a state agency to to detect information and when that information
Was hacked then that I'm not a lawyer, but I believed that when then fall upon us
for due diligence and making sure that that shouldn't have happened or if it
did what we're going to do to remedy that.
Yeah. Okay. Never mind. Well, we can't spend time. That's okay.
Yeah, thank you. I have one quick question and then we
can move on to the next slide. Just related to
the reporting requirement. So page 20 of the audit talked about how
the five-year recruitment and retention plan, it doesn't update every five years.
Looking prospectively it looks at the 2019 plan and then just gives updates on on
annual updates, on it
So i'm just wondering just your response to that feedback for the rear recruitment and retention plan
Chairman on the recruitment retention, plan we have
Have had and we continue to have a forward-looking recruitment every tension plan
our understanding of the law
was that we had to have a five-year plan. It didn't say if I update 2026, I should be planning
2031, right? So we always have the forward-looking plan and so that was some misunderstanding of
what the law was stating compared to what we were doing. I will say one of our number one priorities
at OCS is our recruitment and retention and we do have plan, and will continue to
Presentation, okay, thank you. We'll move on to the next slide. Okay, that was about page 20, but
We're moving on till the Next slide
All right, should I move back? That sounds good. Thank you
All Right
So as we are looking at HB 151 I would be remiss if I did not discuss the
pandemics and the impacts it had in the child welfare system as a whole. The
pandemic changed our landscape. It is not an excuse, it is our reality.
OCS, Experience Recruitment Retention Issues, that works exacerbated, and many of those
issues well before HB 151.
OGS, Stave Alaska, is not alone in our struggles of recruitment and retention of child welfare
staff.
One of the things that O CS, one thing about O C S and I think you all know this, but I
just want to state it because it's important.
We don't turn off our phone.
If I have one person, we continue to do our job as best as we can.
We do not have a capacity and then we stop building our widgets, right?
We continue do the best we do with the staff that we have.
And so what that means is it's often, people are often overwhelmed.
have too much to do the job that they came to OCS to
do, which was to really work diligently with children and
families. But I am proud that we do not, we don't just
try off our phone because we've reached our caseload cap,
which we have, don' t have a case load cap. We have to
continue serving. And this isn't OSCS, this is also our
entire department. One of the reasons that were split into a
different department from Department of Health is because
On those snow days, where everyone gets to work from home, we don't work
from Home.
We show up, knock on doors, and we do what has to be done for children and families.
OCS was identified by the Department of Personnel as a division that needed
to pilot competency-based hiring in 2019.
This was to address the lack of applicants that we were seeing to fill the many PCNs
that came with HB 151.
There was such a non-slot of PCN's we could not find the people to take the jobs.
So we started this new pilot of competency-based hiring.
And as you know, competencies- based hiring became a statewide initiative through the
governor, I believe, in 2021.
As a result, our applicants look different.
They are coming with less education,
less social services experience.
I myself have a master's degree in social work
and I recognize the importance
education brings to our field.
But I will also say we have some wonderful staff
that have experience and do great casework.
And they show up every day and they meet families
where they're at and have all sorts of experience
that they are bringing in.
It also allows us to bring in the lived experience folks it allows
us bring people in from rural Alaska that often that sometimes don't have
had the educational requirements that were needed before we moved to competency
based hiring. What we've had to do with the new staff and who are coming to our
door is we had pivot and change how we train them.
how we supervise them. There is a whole lot of nuances that had to pivot very quickly
during COVID when we started seeing new staff, remote learning, and those nature and things of
that nature. Also during the pandemic, we had pivot to online training. However, in 2023,
we went to a blended model, which is both in-person virtual classrooms and online.
This is now a practice across the country.
Fun fact, hundreds of colleges for social work programs
deliver full online bachelor's degrees.
During the past several years, we have struggled
to get our campus based training
to align with our vision of field based
training for practical applications of child welfare.
but this past year we've had some success in shifting our training to include more field-based
transfer of learning opportunities where classroom knowledge is applied and we begin to build worker
capacity to do the work. We will never stop evaluating and improving our trainings.
We'll always be working to improve as the social situations of our parents and youth
We pride ourselves and really being a agency of continual quality improvement and looking to make edits and changes as we go
Another one on this list of
Impacts, I don't want to go in too much because you all know this
Foster families many of our foster families closed the door during the pandemic
And we have been working except
Excuse me exceptionally hard to get those numbers back up
Some of the things that we have done is we
have centralized, we'll let me back up.
We started with foster care forms.
We were holding virtual foster-care forms,
what can we do?
What do you need from us?
We heard them and they wanted a centralized call line.
We stood up our special needs call-line.
They wanted us to be available till later into the evening.
We shifted our hours to eight o'clock at night for them.
They wanted respite, they're burned out, right?
I understand it, we set up a respit program.
So we are trying to hear where people are at
and then make those changes.
In 2024,
we increased the foster care base rate by 30%.
So there is a lot that we're doing
and we trying make things better.
We're trying get more folks to the table.
Just a quick little data.
Let's see, oh, let me tell you, in 2025, we had 84 recruitment events across all five regions.
Those recruitment event were working with tribes, churches, medical communities,
and organizations throughout the state. Just this morning, there were numerous OCS and
tribes in the Tribal State Collaboration Group. We just celebrated our 32nd year together.
and we spent a good portion of this morning's four hours talking about
resource family crisis. We broke into groups, we talked about barriers, ideas,
we had community cafes, so this is an area that we are we
are concerned about and were continuing to work on.
Lastly on this slide community resources, community
resources during the pandemic
were extremely difficult. A lot of places closed their doors, limited their hours,
moved to virtual themselves. We lost a lot community providers. Some are coming back online,
obviously. But some of the things during the pandemic that we didn't anticipate was the
struggles and the special needs that our youth and children would have and
the costs that were associated with those. So I will pause here for questions.
Thank you through the chair. I'm still puzzled of this assertion that unions get in their
way of pay raises.
I've never actually heard that before. And maybe, Ms. Quay, you could write us an email
explaining all the different ways that you can implement bonuses. Pay raises through
LOAs, every possible tool in the midst of a collective bargaining agreement. Maybe the
committee could also ask for the same information from ASEA and APEA, just to make sure we're
all on the
Sounds good
Representative reference. Thank you chair Mina through the chair
We have been in this committee now for over 30 minutes
And before I say what I'm gonna say I must say some of the dearest friends
I have in the whole world work in
This very important area, and I appreciate very dearly the work that's being done here
I'm frustrated that we have not gone over, I don't think, anything in here that is relevant
to discussing the very serious document that I have in front of me.
I appreciate Representative Fields' question.
I think that's very appropriate.
But some of these recommendations are really serious.
I've read a lot of audits.
exceedingly poor. This is talking about our hiring process, very simply, and our
training process. We just went over some of these things in implemented HP 151
requirements. I've obviously read this slide deck.
I don't see how we're going to go into
things that I think is what the public wants to hear and what I want to
hear. So I may be giving, I know you probably can't go
away from your notes, but I am going to encourage you to do so
because I wanna hear how this report has changed how you are doing work
inside of your department. What you need from us, because under my
you and the department, every single tool available to make this process be better.
This report came out three months ago, so I know that everything that you've been doing
for two years is probably in this report.
Would it read differently?
I think I know the answer to that question and the answers to
that is no.
We know you have workforce shortages.
We've heard about it.
This is my fourth year hearing about
it to representative fields this point.
I run a business.
If I have a workforce shortage,
there's literally a slew of things I do to fix that.
I pay people differently, I make their working environment better,
I made their training better. The consultant recommend that OCS conduct a re-engineering
of their business processes.
Impacts from pandemic and your recruitment and retention framework is not a
We have a little bit of time left in this presentation. I
Really hope that we're gonna we were gonna actually address this thing this audit in front of us
I haven't heard it yet
This side wasn't it the slide before it wasn' it?
I don't know I and I'm sorry madam chair.
I know there's not a question in there, but I really hope we get to it. It's really important to me
I'd like to think outside the box because we would like
to give you the tools that are necessary to fix this.
Because it actually is both people that have good hearts
that want to do this work well and we know that,
you know, that and it's about kids.
I worked through here.
I don't see kids, I say this every year.
I won't say kids in this report.
But what the report from, or I'm sorry, from the slide deck,
what report our auditor says is that kids are in foster care
for three years on average.
That's what reports says before they have permanency of any type.
That is actually against the law.
Not having caps is against law, it's not a law I passed.
It was passed before me.
But our division right now is not following the law that was set.
And to me, this is a serious hearing, and I want to hear serious answers.
And that's it.
I have another question.
I'm going to Representative Gray.
Thank you, through the chair, I heard you talk about a 30% increase to the stipend for foster families.
And that's interesting to me.
I was a foster parent.
I didn't care about the stipend.
I don't want to speak for my colleague.
But from my perspective, you did what you had to do
to try to get more foster parents.
But then I heard you talk earlier about with caseworkers.
We never turned anyone away.
So no matter how few employees we have,
they're just going to have to take care of more people.
mean not to be a dead horse the unions are standing in the way of us offering any more money to our employees and
I just think when I what I watched the hearings for House bill 151 I watch the Senate floor session
I've watched The Debate they really believed that they were going to
massively improved the system because they were going to increase the number of caseworkers and caseworkers would have manageable workloads.
They would a better quality of life, they would better hours, and they will be able to focus on the cases in front of them.
And I think the mistake that was made in 2018 was that in order to fill those vacancies,
they needed to pay a lot more money so that folks would apply for those jobs.
And that's what we haven't done.
I'm sorry. I think it was a mistake to say, well, the only thing we can do is just take away all
standards and we'll hire anybody to do this job. And Amanda Mativier has said it on the record
that when she was the trainer, that people showed up who thought they were going to be security
guards, who though they're applying for childcare positions, they are showing up to
do a job that was to go into people's homes and decide if that child should be removed from his
family forever. They didn't know how to it and they didn t know what they was signing up for.
The thinking that we need to be talking about
is how we never implemented House Bill 151.
We never implement it.
We need talk about how to implement the law
that have in front of us.
And I actually had a question.
Social worker programs are now online, and you mentioned that by going online you're able to train workers in rural Alaska.
I'm curious about whether we've increased the number of rural employees working for OCS thanks to this online...
what this more online system.
Through the chair, Representative Gray, thank you for what you were saying there.
I wanted to correct one thing.
It's not just unions that are blocking raises, right?
Stable Lask is an entire system.
I do think in 2018, they missed thinking about
how are we going to get experienced people to the table.
But here's what I know is everywhere in the country
is struggling to find people
to do child welfare.
It is very difficult, heart-wrenching, trauma-induced work.
That's a reality.
We don't have the UAA system, UA system does not produce enough social workers for our state.
If we paid people more, maybe we would get different people to the table.
But at the time when we switched to competency base, I'm thankful for that because we were not getting anyone during COVID, right?
People were wanting to go knock on doors and sit in the cars with kids that had COVID.
We had to do that.
Some people to do the job is better than no people
to the do job.
I would love to see a bunch of very experienced child
welfare workers or people who have social services
experience doing this work.
That's not the reality that we live in.
And again, I, from all my understanding,
do not have the authority to change the salary for my staff.
I bring up all sorts of questions
and push the box all the time trying to
change child welfare.
a stagnant leader. I am not someone who sits here for 26 years and does not take my job seriously.
Asked us, everyone else at OCS. Because this is what we get when we come out and talk about
the problems with child welfare is finger pointing that we're not doing our job correctly. And you
know what? It needs to be done better. We need help. That is why I try to
And I want to do better, we want
to better.
We need, our families need us to
do, better our tribes need
us, to to be better so as far
as your question goes, I'm
going to backtrack on that one.
No,
we are still struggling in
rural Alaska to get people to
the table to hire.
I will say when we talk to our
staff about moving to more in
person,
our workforce is predominantly
female.
They do not want
to away from their home for
six weeks for $26 an hour.
They don't want to, they do not want
to leave their families and their communities
for six weeks a year to be trained to do this job.
So what we have done is we've created a model
that folds in online training, synchronous,
and asynchronous, transfer of learning, Zoom calls,
and in person, and then our mentors go
into the field with our staff.
So we are trying to blend the best we can with what
we had.
So I hope that answers your question.
One more follow-up and we'll go to the next slides.
Okay, so really fast, speaking of the case worker workloads,
it seems that what's being reported in the audit,
and this might be a question for the auditor,
is the caseloads are being spread out among supervisors
and specialist positions that are not carrying cases.
is making the caseload problem look not as dire as it actually is.
And I couple that with on page 20, with the OCS reported of 81 vacancies,
but then the auditor finds 93 vacancies.
And, I'm just curious why there's a discrepancy in the number of vacancies being reported.
That's great question through the chair, Representative Gray.
It's sometimes difficult and right now I have 99 vacancies
So there are times where it is hard to figure out where our vacancies where are positions are right?
I've I was out without an admin manager for seven months. I couldn't find couldnít fill the position right there
Was their job to kind of help manage some of this stuff?
Itís not an excuse that that's our reality
What ends up happening is I'm going to move a PCN that I haven't filled out of
Craig Alaska, and I'm going to move it to central office,
and they're going do a specialized job.
That takes us a while.
Things get lost in the process, right?
So I think that was, there was some discrepancy in
the data that we have resolved, because we
have smart sheets where we're monitoring all this stuff now,
so it's not on someone's Excel that has left the shop.
So that is definitely helping navigate some of these lost PCNs.
Because sometimes there's a misnomer that we're hiding cases and we are not hiding
cases by any sense in the means.
The problem is I have an antiquated 25-year-old system that doesn't accurately count cases.
And so I'm going to talk a little bit about what that looks like because it's complex.
which makes it really difficult for us to report and the auditors to really line up on the same page.
So, for example, if I'm a family that's in Anchorage and gives birth to a child but I live in
rural Alaska, Anchorage may take that case as a primary because maybe the abuse occurred in
Anchorage. Well, the baby stays in the Anchorage because it needs medical treatment. The family is
And I have to sign a secondary worker in rural Alaska
to work with the parents in their location.
So who has more work to do?
It depends on the case, right?
Some cases I've eight kids.
Some case I'll have six parents.
Some of the cases have one mom, one kid.
So no one case is the same,
right, if I had my
My wishes we would have a system that weighted cases right because that way you would be able to assign
You would really know what a case is so a caseworker may have
15 cases, but five of their cases
are out of the region, and they don't even see those families, right?
They're working with the secondary worker on those cases.
Supervisors, there's a slide on here where it talks about healthy turnover.
You'll see that we are promoting a lot of our staff into different positions.
Sometimes it's best for families to stick with
the worker that they had as they move into supervisors.
And so maybe they're close to permanency.
Maybe they are close for reification or close adoption.
We're not going to transfer that case to a new worker
because it delays permanency.
It has all sorts of research-based effects
that does not look good.
So they will keep thatcase sometimes on purpose
and sometimes because I just don't have the staff to assign
and we do try to do gradual assignments
when workers first start.
So in the first six months,
we are trying to guard them as much as possible
to make sure they have time to learn and grow.
and move into knowledge of working cases.
So our supervisors and our managers sometimes carry those cases,
it's not hidden,
it just not tracked on here because there's no way to track it in our orca system.
And that's the reality. And I will tell you for us to
track this data is a huge administrative burden.
It's important and we're going to do it,
but it takes hours upon hours to go through this and do this.
That's just a reality,
Next slide.
I, Brooke Chunky, has a question.
And then I'll hold questions for a few slides.
And don't we get to the end of the case slide?
Yes.
Representative Chucky?
Thank you, through the chair.
I'm going to kind of go back just a little bit kind
of an overarching question here.
So I would like to know from you a bit more
about how the Tribal Compact works and how you work with that.
Process I am a little confused.
I saw in the governor's budget, 5 million for travel
compacting for child welfare.
And then I see an audit, 11 million was spent on tribal
compactings.
So I'm very curious about the discrepancy there.
The hiring, is that done by tribes?
Do you include those numbers throughout the audit?
There are numbers on overtime.
There's numbers, on caseloads.
cases that went up or down, especially, there's a table in particular that references
2015 to 2023 numbers. So the tribal compacting came in in the middle. I'm kind of curious, is it
all lumped together in this? Do you have oversight over all of that? Just kind
of help me understand that a little bit better would be really helpful. Yeah.
Through the chair, Representative Swanky, the Alaska child welfare compact actually came
tribes co-signers. So it's a government-to-government agreement that we have with 18 co signers,
which equates to around 170 of the 229 tribes. This government to government agreement has
all sorts of documents to help us navigate child welfare. And so we started off
really building the infrastructure back in 2018-19,
ironing out confidentiality issues, things of that nature.
And then we started working in what we call scopes of work.
And so one of the first things that we did with the tribal
compact is they took on what
we called initial and ongoing relative search.
So when children come into care,
we have 30 days to do a relative
search on that family.
So we were giving that information to the tribes
They're contacting families, finding relatives,
entering them to our ORCA system,
and then they are sending out notices to request placement.
So we do that in the first 30 days, and then we
do it through the life of the case specifically if children are
not placed with a relative.
So as I mentioned, 170 tribes, 18 co-signers,
are doing initial and ongoing relative searches.
Over the years, we have expanded the dollar amount
into the compact.
So currently we're at $5 million annually,
GF.
We started off...
under a million. I can't remember how much it was in 0.6. Yeah, and then we've gone up and gone
up. And so there are five different scopes of work. Besides the initial
ongoing relative search, they also do family contact. They also
do licensing assist. So they'll go out and license homes and it could be
Alaska native homes or it can also be a non-Alaska native in one of their
locations. Right, so whether it's like a family living in known, for example,
but their family is willing to be licensed last year parents, so they'll go license them.
The fifth scope of work that they do is call a day safety walk through.
So if we have a grandma who lives in rural Alaska and they have boots on the ground
They will go out to the grandma's house and do a walk through to see if the home is safe
Who's in the Home? Do they? Have exits they, have fire extinguishers fire alarms?
They go do all of that and then they give us the information back so it saves us having to fly out there and
Do all that travel time so those are the five scopes the work they do and in addition to that they also do
primary and secondary prevention and so secondary
prevention is working they get all of our screen out
protective services report so someone calls the agency
and says I've got a you know this child has showed up at
school for eight days in the same close.
Um, we'll give them that information.
That's not something that we're probably going to go investigate,
but the tribes can call them and say, hey,
can we show up? Can we come talk to you?
What's going on, right?
So they do high risk work,
uh, secondary work tertiary work to try to prevent
Alaskania families, uh from coming into care.
Quick follow-up. Quick, follow up.
Okay. So, they obviously, um,
fill a tremendous number of gaps in rural Alaska and I-
I'm extremely grateful for that my curiosity still comes back to budget and spend and and if they are
operating somewhat independently on some of this activity how is the state of Alaska able to kind of control the scope of the additional spend
and it's does it come back in the supplemental when it is over the appropriated amount
I think it's the last three years,
it spent $5 million every year.
Sometimes it goes under, but it never goes over.
Where's 11 million come in?
I thing that was year after year, okay, cumulative.
Thank you. That's what I'm looking for.
Thank-you. Next slide.
All right. So this slide just highlights some data points.
It is a six-year look at our turnover data on the-
left slide there and then on the right side is our bi-region of turnover data and again it does
highlight what we call healthy turnover so for example Anchorage had a 42% turnover rate in
November of 24 to the October 31st 25 but if you take out promotions and folks that have
It's actually 27.3%.
So every region is seen a has some healthy turnover
with the exception of Western region.
Next slide.
So this just shows a little bit about the caseloads
and our struggle to meet HB 151, case load averages.
It shows the six year look about where the averages are.
These are a little deceptive, right?
Because what Representative Gray said about our cases
that are being held by supervisors
or specialty positions.
It's an average so I could have a brand new worker in here that started last week and has two cases and I
Could have worker and Anchorage that has 29 cases right now
So it's in average when I show this to staff. They don't like the slide because it doesn't show their reality either
But right. Now, it is as good as we can get with our aging
data system
Obviously one of the issues that we've had specifically in Anchorage
and western region. Western region has been a region, I'm going to say 15 years at this
Notoriously on Western Region on keeping that office staffed for years.
Anchorage is a new one.
We have never had issues with keeping Anchorage staffed.
We're not getting the applicants, we're seeing high turnover.
And some of the issues that we have in Anchorage and Western specifically
is our investigations,
we call them investigations and assessment, is pulled into here.
So we count that case once.
But what ends up happening is the numbers get inflated because we're not closing the case down
So we are screening an investigation in. We're going out to see if the children are safe
Doing our cursory look at what's going on and we moving to the next case
And so that case is staying open and were not
Closing it down because if we don't have enough workers right now
So, we were prioritizing the work that is getting done. So that's one of the reasons
that we're seeing some elevation and anchorage in western and frankly the
job market and Anchorage is harder for people to want to come where there's
more opportunity to do other things and then to work for OCS. Next slide I'll take
a pause here to see people have questions. I have a quick question about the previous
I know that you're working with an antiquated system that makes it difficult for you to pull
out supervisors who are carrying cases and it's an average, you have newer workers who might have
two cases. But I think that there's probably a way to have the new worker slide and then to
have experience worker slides and to then have a slide that shows how many cases the supervisors
And that it wouldn't, we're not dealing in the numbers
of like 10,000s of people.
We're dealing, and we were hundreds of
people, this could be done in a few hours.
You could actually have slides that are more accurate
about the caseloads,
and that's what people are concerned about.
And you said that your employees don't like the slide.
You can probably make slides
that you're employees feel are
more accurately.
Through the chair we do have a report that we have turned in every year and
It makes the slide look nice the side before and this is what our data looks like and it's very you got to be pretty skilled in
What it says and we've been looking at this and thinking that does need some editing and changing because it does break it down by
If you're a new worker if you've in here one to three months four to six months seven plus months
So there is quite a bit of data on here.
And so what I've shared here is high-level overview.
But I do have, and we can submit this, too, if you'd like it.
But we are talking about changing what this looks like.
I would say the narrative, though, is the caseloads
are too high, except for in southeast.
South Central right now they they do have manageable caseloads and Northern has also had manageable case loads in the last year or two
We really seem to be struggling the most in Anchorage and the Western region
Quick follow-up. Thank you. I so I appreciate that you have the data in a hard-to-read
Format, I think that that could be converted into an easier to read graph
And I thank using this general high-level graph. That's not really
giving an accurate picture of what the PCNs have,
you know, what actual caseload carrying caseworkers have
would just be more honest.
Through the chair, yeah, I didn't know how detailed
you all wanted, we will be back.
So we can definitely get more information
and highlight that for you.
At OCS, we have been working, as I mentioned, on workforce and recruitment retention issues
for years.
We adopted the U.S. Surgeon General's workforce framework approximately four years ago.
And you'll see at the center of this is the worker voice.
And so we really try to listen to what our staff are telling us.
And there's a variety of ways to put our stuff in the Center of the Circle.
We have a staff advisory board.
We have a supervisor leadership council, we have management group,
we a change management groups, so we really try and we just launched
an anonymous online suggestion box for staff to submit ideas and solutions.
So we try to put them at the center of all this so
we can hear their ideas, their solutions,
problems that are out there. So, through all this, we have been doing quite a bit of work
trying to improve the culture within OCS so people believe that they're at the right
place because there is a lot of burnout that can happen doing the job and so we need to
make sure that we're caring for employees as much as possible. Next slide.
These next two pages, two slides, are on recruitment retention strategies.
Many of these are redundant. You have all seen them before.
I do want to highlight just a few that...
of ways that we're trying to be innovative.
We developed a mentor program before 151,
but 151 allowed us to expand our mentor
program.
Our mentor Program receives rave reviews
from our supervisors, our case workers.
It was studied through the UAA School of Social Work.
They wrote research articles on it.
It's a great process.
We expanded, I think we currently have seven mentors
Currently that travel around the state and help all new staff within the first six months of their job
They develop staff development plans and work on how to engage with children and families looking at what data they need to understand
To try to be good caseworkers
We also have launched reflective supervision two years ago. We have been investing in our supervisors understanding and education on
Things that we do things that are important
And so we are seeing, we initially launched it with our case carrying supervisors,
and it's been so popular we have moved it to the entire state.
The last bullet on here that I wanted to address, which I've kind of already talked
about was competency-based, value- based hiring.
We worked with the University of Colorado.
We also worked in conjunction with Oklahoma, the State of Oklahoma.
Other states across the country have gone to more competently-base value based
And so we are trying to work to make the most that we can
with the situation we have.
So I won't go too much more into that because we
have discussed that quite a bit.
The next slide on recruitment retention strategies.
Some other things that have done is the occupational
endorsement for an inner professional child welfare
certificate.
So we worked, sorry that was a lot of words and I'm talking
fast because I want to be mindful of time.
We work with UAA to develop a child welfare certificate and so what that means is people
are coming to the agency that do not have the education or people that are in a bachelor's
program but they're not quite sure what they want to do after they graduate.
You can get a certificate in child warfare and we have some of our staff that our faculty
staff members that have gone to and gotten their child welfare certificate, and we are paying for those costs.
Of those 44, 20 percent have been promoted at this point and are staying with the agency, so that's great news.
We also implemented paid internships two years ago, three years
ago and then we have some intern ships that they choose not to be paid, but they still want to work for us.
And so, that is a great avenue for
us to bring people in with some education.
hopefully they stay on with OCS or they get a greater understanding of what we
do. And then I talked, I'll talk a little bit more about the trainers, well I've
talked about, the train is six weeks. We have, it is a blending,
it does not just all online, there's some in person.
There's some where they're in a classroom together virtually and we also go out into
the field with them.
So, we really have and will continue to look at training, where in the process of revamping
it to launch a new launch out in July.
We're looking at more simulations, more in person.
We also do forensic interviewing training which is a week long in-person.
to really carve out the skills necessary for the job.
I'll pause real quick for questions.
Representative Prefridge.
Thank you, Chair Mina.
Director, wait.
You've read this audit, yeah. Oh, yes.
It seems like the words that you're saying and the slides that
you are presenting are not connected to this audit in any way.
So is this Audit wrong?
Through the chair and in what way is it wrong.
I mean like which part?
Okay, so you said that the mentor program was essentially a glowing success.
This audit says OCS's management structure found
The review of OCS's management structure found the new training program focused on the clinical
side of the work, the failed to incorporate practical aspects of
the job. In addition, interviewees describe training as taking place remotely, limited
mostly to remote delivered mentoring, and coaching by overburden supervisors and over
burden co-workers. Voluntary supplementary training was not helpful and was difficult
We recommend OCS consider implementing a more comprehensive training program that is grounded in practical applications.
Furthermore, this is strongly out of alignment with best practices and
is not realistic and leaves people with little to no understanding of what their job actually entails.
Through the chair, Representative Ruffridge, thank you for the clarification.
Yes, some of that was wrong.
First off, when the audit was done.
It was 2023, but they were at our door at 2024.
So there was a delay.
And it's not all wrong,
but there is parts of what you read that is incorrect.
They hired a contractor called PCG,
and I can't tell you what it stands for right now,
some kind of consulting group.
They came in and they did small focus groups with 200 staff.
There was no rhyme or reason how it was done.
My staff came back to me and said,
we don't even understand what just happened.
Like, that was the most unfocused group.
So we disagreed with some of the things
that PCG recommended in there.
With that said not all of it, was false.
We did need to change our training
and we had already started changing our trainings.
We knew it wasn't practical
and were working with our contractor
at the university at that time
to try to get to be more practical.
To be honest with you, got a lot of pushback because we wanted our trainers in the field
with our staff and they were, they did not want that to happen, right?
The risk management came back and said it's too dangerous.
They can't go into the fields with.
So we had to pivot and figure out how this is going to work.
How are we going get into a field?
Let's hire, put more people, move those PCNs from case carrying and have them be mentors
so they can help train people in field.
We knew there are problems, for sure, which the audit does say,
and we made modifications before this came out, right?
Okay, this 2023, they show up at 24 to do the thing,
to the, to, the
audit, thank you, and then we got this report in 2025.
We're not sitting around waiting for this
report, like we, we know where there're problems and
we are working on changing them.
This is,
we by no means are
going to wait for a report to tell us what we already know that we are missing the mark
when it came to training. We knew that. So some of it is true. Somehow they got there
we didn't agree with. But at the end of the day, we knew our training needed to be adjusted.
So follow up, Madam Chair.
Follow up.
So I asked a question in my first, I guess we'll call it a diet drive for lack of better
Would all these recommendations still be there?
There's a lot of recommendations through the chair. There are a
lot recommendations. Let me, uh, many of them would be, right? And I
think there is a slide on here talking about solutions.
Just passing 151 isn't going to change the child welfare system. OCS is one
piece of child warfare, and I think that there's the misnomer
that we are responsible for everything.
Everything falls on OCS's shoulders.
And if something isn't done right, it's O CS's fault.
And that is not the truth.
Now we're not perfect, we make errors,
we have problems, but we do a lot of things really well.
And, that's not highlighted,
it' not shared, and it not celebrated.
And it is a problem because that contributes
to our turnover, to burnout,
and to these sound bites that end up in the media.
that are attention seeking and do not help in the long run.
Maybe they do, they, we get 151, right?
I mean, there are things that happen that, and I understand, I appreciate the advocacy.
But I also would like to say there's things we do well.
And I don't think that that's often discussed or talked about.
Madam Chair,
I just want to clarify with your permission please.
I by no means.
I have contributed to any sound bites that I know of, nor have I engaged in finger-pointing.
I think that was your phrase a little bit ago.
And to your point, you said a a bit a go in that same sentence that you want to partner
with us.
And I hope you hear from me.
I would like to partners with you as well.
I've yet to hear what it is you need from Me or from any of the members of this committee.
We are appropriators and lawmakers.
I think we made a law that we liked to think maybe could help you.
Yep.
And then I'm pretty sure we funded it.
Your budget is 200 and some odd million in just OCS?
Is it more money that you need?
Is there more laws that's you needs?
What do you for me?
Through the chair, Representative Ruffridge, I love your question.
fast forward to the slide, there we go, what we need, we
need to come back to a table and reimagine what can be done.
And some of the things that we do,
we needed to have a competitive compensation and benefits.
We are not competitive in the market.
We're not.
I think that would help.
I don't know how to go about that, right?
I can't, I have enough positions,
I don't have people in the positions.
If my positions were full,
I would be at the caseload averages without a doubt.
I do need new positions
I need to think outside the box, right?
And so part of that is compensation and benefits.
I think, you know, our annual surveys,
our exit surveys they're all indicating.
competitive and compensation and benefits.
Madam Chair, if just on each of these points,
I'd like to ask a question, yeah.
I want to make sure other members have opportunity.
I sadly have to leave it for 30 and it has nothing to do with this presentation.
I just have a constituent meeting I have
to get to and I apologize for that.
But this competitive compensation benefits,
does the Office of Children's Services currently need additional money in your budget?
to do this or is there something else that needs to happen to feel like we're
dancing around that question? Through the chair, Representative Ruffridge, part of
the problem is services have gotten very expensive. Our children in care have
extreme needs and so we have we would probably need more money in our budget
initially, right? But we will then maybe be offsetting all the overtime.
if we had people there to do the job.
So eventually it could probably even out,
but I think that we would need additional funding
if were to have a higher salary or compensation.
Do you have that request in our budget books currently?
I do not.
Representative Green then Fields.
Thank you, through the chair.
What I heard was that 151
you know, wasn't going to fix the problems at OCS, but the reason why we passed it was such an
overwhelming margin is because it's based on New Jersey and New jersey did vastly improve
their child welfare system.
because they actually did hire lots more caseworkers
and they did reduce those caseloads
and the weren't losing people.
The turnover stopped.
Like they just vastly improved the system
and so we tried to do it like New Jersey.
And I just wanted to say if there was anything about,
anything that I've said at all in the last six months
that seemed like finger pointing,
what I tried do at every step of the way is say
so that caseworkers will do the job,
so we have more caseworks so
we can lower the caseloads.
And if that's finger pointing,
I just don't know what else to do.
I think I'm thankful for the work that you guys are doing,
and I don' think that we're paying you enough,
and we need to pay you more so
that can have some more of you
so you can do this job better.
And I guess I'll keep saying it,
but it just seems like
We're caught in this weird situation if we're going to say that what we did in 2018 wasn't going
to fix it. We never did that law. Like we just never executed it through the chair representative
of HB 151, the intention was magnificent, it was fantastic. The support it had was
fantastic, I will say New Jersey is so much different than Alaska, right? I mean they can pull from
eight universities that are within like a 50 mile radius, that's not what we have in Alaska.
work for Office of Children and Services.
So that is, I mean, there are some differences.
And I will add, and I think New Jersey has done great things.
They also do not pass the federal standards, right?
They, also, are failing child welfare.
And there could be all sorts of reasons for that.
So I just want to point that out.
They did start off going really well.
They are different than us, though.
And, what solutions that we have to have
have be unique for Alaska.
I've always appreciated your partnership.
You've been to our office and have been problem-solving by no means do I think that you're
finger pointing or anything like that.
I'm just frustrated because a lot of times our staff do not get acknowledged and we don't
talk about the great things that they're doing.
The good things don t end up in the press, right?
And it is, I have managers coming to my office saying again, like there's a lotta media and
It's just one more thing to add to the trauma that staff are feeling,
and I don't want to lose people because of media all the time, right?
So I apologize if that came off too strong.
So we bypassed a few other things and we'll just keep going from here.
Why wouldn't ask a question on this slide actually, Madam Chair?
Sure. Representative Fields?
Yeah, it's more a suggestion.
Through the chair the department has encumbered $10 million to pay fines.
I would use that money to raise wages and through the chairs I was curious if you met
with the head of ASEA, the employee union to talk about implementing pay raises through
LOAs and if haven't done that I recommend doing that because when you have a bunch of vacant
Below market rate pay the obvious thing to do is raise the pin you'll have fewer vacancies
I you won't actually spend more money. You will simply have more filled positions each at a higher
Pay rate and I guess I would ask if you met with the head of a SCA
And if not I wouldn't commend that to you and use some of that ten million to fill the vacancies
And then maybe we won t have as much exposure to fines. Thank you
Through the chair representing fields, I have not met
with a SE a I will say however, there are
rules on what I can and cannot do, right?
I have bosses who also put limits on
what can't and can do right.
I had to get approval through all sorts of people above me
to propose a letter of agreement or to do things.
You know, we did do the state salary study last year
and it's not really showing that job class is underpaid.
So that's problematic right,
so we are brainstorming on
what else we can
To increase compensation as far as the ten million dollars
My understanding is it's over with DOH and I'm not sure how that works
I think it might at this point have been back to the coffers on so
But that is not in my budget or anywhere near OCS at the point
Okay guys know
Jeremy and
When the state wanted to hire airport dispatchers
say raise or pay 25 to 30% and fill all the positions where there's a will there is a way.
Through the chair I would love to know more about that so we'll be looking that up.
So some other things on this slide the top part is kind of like things with that could really help
But you can come into OCS as a master's, a bachelor's are no education, you're getting
paid the same range as as starting case worker unless you have case experience.
And also, highlighting the good work that does happen at O CS and changing the narrative,
I think is important.
more upstream than that would be super impactful is really to improve the spectrum of services
across the state of Alaska. So I'm talking prevention intervention, like the whole spectrum
of early engagement, prevention, tertiary. We are a small piece of this giant spectrum
And we are seeing a deficit in families going into homes and helping children and families.
We are also seeing the deficit and affordable child care and early childhood intervention.
These things really do help families from entering the doors of OCS, which is what we want is people to help
families before they get to our doorstep.
We know that our lived experience, whether it's our parents or our youth,
they're asking for peer navigation.
People need peer navigations to understand how to access social services.
Typically, families are in crisis, and it is very hard to navigate these systems when you're in
crisis.
A broad spectrum of community-based services, especially in rural Alaska,
You just have to think differently when it comes to
rural Alaska than we do in urban Alaska.
And I think that asking our communities in rural
Alaska what this looks like would be important.
And the last one is just strengthen the continuum of
care.
We are optimistic and super hopeful about the
Rural Health Transformation Program.
We think it's going to bring a lot of opportunity for the state to
really look at getting us off on a better foot than
where we currently are.
We're excited about those opportunities and we look forward to seeing what's going to happen with those next slide.
I just want to leave off with some of the good stuff that we are doing.
I wanted to say again that, we really try to live by being transparent.
We are innovative.
I'm hoping you can see that through the slides and the number of things that we have tried
to stem the tides of our turnover and our vacancies and case assignments.
We are dedicated in the work that that do here in Alaska.
We're dedicated to our families and children and youth.
We were committed to working with the voices of lived experience.
This last year or two years ago now we've stood up a parent advisory committee and it
is powerful.
hearing their stories, hearing some of the parents have been reunified, some
of them have had their rights terminated, and they are coming forward saying we want to help.
So I do feel like we've got a lot of momentum through numerous partnerships and communities
to really try to transform child welfare. I would love to be sitting up here and saying that 151
changed everything. Um, I think it changed some things, right? But I
We changed policy, we changed training, but it's not changing the intent which was changing outcome for children, families, and OCS.
So we're not there yet.
I would like to say, I don't think that's because we have lacked trying.
I think it is because I haven't tried something.
We continue to try and we just are not getting those outcomes.
I wanted to end with this last slide and something I would love to see plastered somewhere.
We're one of the highest in the country with reunification of children in our state.
That's powerful.
Representative Reffridge said three years for permanence, it's actually 24 months.
But that is above.
the national average. The national
average is around 20 months. We're
around 24, 25 months to make
permanency. It looks different if
it's reification compared to
adoption, but the average
is 24 months and it takes us
longer to achieve permanacy here
in Alaska. But if that
permanence takes four more
months, and we're getting higher
numbers of reinification, maybe
that's good, right? I will also
add, when you're looking at
reunification what you want to
also double check is they're not
reentering.
right? Like you didn't reunify today and take the kids back out two months from now.
They're not. The children are staying home when they're being reunified,
which is great. Again, one of the best in the country as far as reunification goes.
So super impressed with where we're at. This is broken by Alaska Native and American Indian
versus not Alaska native American-Indian.
So I'll end with that and ask if there are any further questions.
Thank you and I know we skipped over a few slides. I don't know if either the presenters or the committee members were interested in those other slides
I'm hearing nothing. All right representative Parks
Yes, thank you
Through the chair
I might be the only member on this committee who was here
Was it five or six years ago when you gave a report on turn over and everything else and you almost broke down
We're on the TV screen, and the rest of us in here almost broke down.
And you've been in my office a couple of different times with what you call those community-based
groups saying, well, we'd sure like to have them show up there then with your office.
And today you are more positive than you were four or five years ago, whenever that
was.
I appreciate that and you said well the first thing that you
said is really what I agree with and how do we fix it but you
said no law can fix. It was kind of almost your opening
statement. Any suggestions? Well no let me
offer one first. I think what i need to do as a member of this
spend about six weeks at OCS to really understand how it works or doesn't work
or what the hell's going on and that has been difficult to do. And then I tried
to emphasize the process in the executive budget act that I've been
Well, we can't tell you what to do.
We have to figure out what you think you need to
do and just say, well, all right, set a goal.
Let's see if it works.
But anyway, so with that, what do you suggest?
No law can fix.
I agree, but.
There's a chair representing a Frux.
First off, I wish it was a law that could just fix it.
Because what I don't like to say is,
I'm not following the law.
I want to follow the Law.
We all do,
I think part of the problem is our workforce, right?
Workforce looks different in Alaska than it has years ago.
And so how do we pull the right people into the job
and pay them to do the work that's needed?
Saying that, we also need providers.
I need foster parents.
I needs these community providers to help services.
I needed a parent to get mental health services
or substance abuse services and so it's
We are a piece of this puzzle, but it can't just be on us to figure out how to implement
and do all these things.
And so I don't know that I have, like, if we just did this, I feel often like this is
a recipe, right?
It's a little bit of that, well, it didn't come out quite right.
So let's tweak the recipe again.
Is this really what we wanted?
And so I feel like we're still trying to evaluate
how to make this right,
how do make the system fit for our children and families and youth.
I think a lot of this needs collective input.
It needs to be collectively dialed in and presented in a way that
Change makers such as you all can hear and do and you know
I definitely have the the position of what my staff and what we are seeing in the OCS
But again, we're just a piece of the child welfare system
But I would say the biggest thing for O CS is our is a workforce if we had if I didn't have a 32%
turnover rate
We probably could be doing things a little bit better.
But with that said, we also are seeing higher numbers of reallification.
I'm seeing less children in care than we've seen in years and they're safely staying home.
So we're seeing we are making some incremental progress even with high high turnover 32 percent.
And if we didn't have HB 151, that would look even more bleak right now than it would have before.
This bill has contributed to a lot of great things. It just is not going to fix what ails the child welfare system
Unfortunately
Follow up yes, you mentioned that
OCS is broke
You should be in the legislature for a while if you want to see a process that's broke
But I'm a serious note. I wouldn't mind at all
Just spending time. It's across town in Fairbanks. I don't know if that's good enough, but I wouldn't mind at all
being invited to
Be there on the ground spend all day there at least all they there if not six weeks
Through the chair representative Prox. We would love to have you we have taken out legislators in the past.
We've taken our aides
We really think it's an important endeavor to see what it is that we're doing and
And you have full access to whatever staff you're out with for the day to really hear
unscripted what their thoughts and opinions are, right?
So we highly recommend and we invite people to come and partake in really talking to our
staff and learning more about what it is they're doing on a daily basis.
So please reach out to me and I would be happy to connect you with our Fairbanks manager.
Acting Director Dumpling, did you have something to ask for the record Tracy
Dummpling Acting Commissioner for The Department that's my totally fine
I bounced around in different jobs here in the last three years it's totally good
I did want to note you know I think that director Guey's really hit on the
fact that there I mean there's there is no silver bullet
what I have appreciated since being in this role is that OCS has made efforts
come up with ideas. Make changes. Change is to training. The mentoring program. What's important,
I think, is that we continue to review the effectiveness of those ideas, some are going to work and some
art. I am a leader who is never ashamed to say, you know what, that didn't work.
What I'm ashamed is when we keep doing the same thing over and over again and expect a different
So I have seen and it's only been a short while really coming in as Deputy Commissioner and but I
have see that work. I've seen us even recently as a month, actually two, three weeks ago reviewing
some of the efforts that have been underway and saying, okay, some
of these pieces aren't moving the needle where we want it to go. We need to
go back to the drawing board and we need figure something else out. So just I just wanted to add
You know, they have been making efforts that will continue to make efforts, and
we will continuing to evaluate the success of those outcomes.
Representative Gray.
Thank you.
Through the chair, I just disagree.
I disagree,
I think this talking about how there were a couple of things that worked in House Bill 151.
But overall, it didn't.
The heart of House bill 51 is caseload caps of 13.
per caseworker, we have never done that.
So when I hear of saying, well, it just didn't work,
we didn' t follow the law.
The law is an average of 13 cases per case worker
after their first year or whatever.
And so I think you say, like, oh,
we tried lots of different things
and we're not gonna keep beating our head against the wall.
We need to do something massively different to actually follow the law as it was past 2018, which we've never done.
And I think, I really do, think that if case workers only had 13 cases, they could focus on the children,
what Representative Ruffridge was talking about.
They would know their cases.
They'd be able to invest their time in that.
They will be really able do what's best for those cases."
There's another representative in the audience today who's had experience with the OCS system.
We all had experienced those of us who've been foster parents of not getting a call for months.
It's because I'm not blaming the OCS worker who has too many cases.
That's why I didn't get a Call for Months.
What I am saying is they need less cases so that they can do their job better.
The heart of 151 is the case load cap.
That is the heart of that bill that was never implemented.
So I would love it if we could experiment, just try it out for a year.
Let's try implementing the law that we passed in 2018 and
see if it makes a difference in turnover.
See if if makes the difference on our outcomes, because we've never done it.
Through the Chair, Representative Gray, how would you suggest that
Stick to the caseload caps if we don't have staff.
Should I stop screening reports or elect which families to stop serving?
I just, like how do we do it?
Yeah, follow up.
Follow up?
Thank you.
We need to massively increase your budget so that we can pay your workers properly so
that you can fill all those vacancies.
I mean, that is the solution.
The solution is that, we have to fill those vacancies, and
there is no alternative way.
to money. I think that's the thing is like we tried reducing the requirements for what
it takes to do that job. That did not work. We've tried the recruitment incentive like
giving them a one time cash thing that $26 an hour that twenty six dollars an
I'm not the first person to do this.
They're representatives who came years before me who said,
it is like a public safety officer, you know?
You are going into a dangerous environment.
You don't know what's behind that door
and it could be very dangerous.
And, straight up, we pay our police officers
and our troopers more than we POCS workers,
but they're putting themselves at risk
and the emotional toll is probably greater most of the time.
They deserve to be paid for what we're asking them to do and when we pay them appropriately
We will fill those vacancies and we can drop those caps and
We can achieve what with the intent of the original bill
Thank you
Representative Schonke, thank you through the chair I
See a similar response across
state employment agencies with people being burned out, 30 retirements a long time.
I know OCSK's workers have an unbelievably stressful job.
And I just, in not being as familiar with the bill that passed,
I will go back and I, will do some research and try to better understand that and where Ray's coming from on this.
I feel like there's some disjunct issues happening here though and when I see the overtime increasing drastically, that to me says we are pushing our caseworkers to quit.
and walking away from the job. So I look forward to future conversations. I have some ideas that
I've thought about for other departments and agencies and what when we do see burnout and
high staff turnover. And there might be some creative ways here that we can really try to tackle
that individual reason behind some of these individuals leaving OCS.
Thank you for your 26 years there's there is a level of dedication in an incredibly difficult field
Thank, you very much. I appreciate that. Appreciate your comments, too
I have a question actually and I had a questions for the legislative auditor for Miss Curtis
I wanted to get a more details for the record and for
the public just on the audit itself, the time span, it was done.
Who at OCS was engaged and then about PCG,
the contractor.
This is Chris Curtis, I'm your state legislative auditor.
So the background information provides some perspective.
This bill, HB 151, had.
multiple different effective dates, and so it spanned from 2018 to 2020, I believe.
So when it was passed, there was some concern about funding the positions.
And so there is requirement placed in the bill that the OCS can cooperate with an audit.
And, so we planned the audit in three separate parts because of the different effect of dates.
provisions that were effective. Then we we're going to do the second one but COVID hit and there
was no reason to look at an agency implementation of this bill when they're unable to to their
typical procedures so we put it off. So we did part two came out 2023 late 2022 and we immediately
There is some confusion about the periods that's covered so we did look at I think that some
in the audit talks about is through December of 2023 when we looked at training. The consultant
was in there in fall of twenty twenty three. So if there's anything I know they've talked about
in their response to the Audit the Talent Acquisition Team which I didn't hear much.
Okay. There are some other things they're doing with employment and recruitment that has happened since the time of our audit, so I'm sure that creates some confusion.
But yeah, that's the period is pretty much through 2023 and then working.
That was the consultants and the auditors doing their work in our auditor is doing there work and 2024.
Thank you. And just to follow up, I know PCG, the state uses them pretty often in different
departments, but they do have a pretty good familiarity of a lot of the states' systems.
I don't know, that's an appropriate question for you.
Yeah, well, it's a question about if you're
asking about the qualifications.
In the RFP, because it was a competitive procurement,
and so they did score the highest,
and they do have a cross-section of experience.
I dunno if it included in their bios and the report
and their appendix, but their actual full report
is in the appendix and includes the qualification
of those that conducted the work.
Thank you, and maybe connect it to the audit for director Guey.
So we do have three, a few recommendations, seven recommendations in the
audit and it has been some time.
So I could see a bit of confusion from the
audit that had been done a
few years ago in progress that's been
done now and so out of those seven new
recommendations and I don't have to go through all of them right now, do you want
what the department, the division has been doing in response to the audit.
Yes, thank you, Chairman.
I'd love to.
So, recommendation one, I'll just quickly go through each of them.
It was to ensure that procedures were in place for our annual staff and report being accurate.
I mentioned that we've had some turnover in our Minister of Manager, seven months vacancy,
couldn't hire many.
She was in charge of that.
When she left, we kind of had,
we dropped the ball, right?
So we now have this streamlined and in smart sheets.
So it cannot be if the next person departs.
We're still dialed in on that.
So that was on us.
We made some data errors there.
Number two, OCS director should implement procedures
to ensure annual recruitment retention report is accurate
and prepared in compliance with the state law.
Again,
we had data, data challenges.
It's hard sometimes to.
calculate who's got primary assignments, who got secondary assignments.
How many PCNs we have, especially when we do a lot of like, here we are now, and when
the auditors come in, they're saying, Here's 20, 24, right?
So sometimes we had to figure out where that position went in 24 and why it moved.
And so there was some discrepancies in there, but I think that we created a process so that
Number three, OCS director should consider implementing more comprehensive training program ground and practical applications.
We started this shift back in 23. We were already doing some in-person.
We're doing a week in person.
We are also doing the forensic interviewing, which was in the person,
and we have the mentors that were going into the field.
Now during COVID, there was more zooming.
rather than in the field but they have in
the end of 23 they move back to being in person and in 24 and we are in
the process of re-evaluating training yet again and enhancing it right now.
Recommendation four OCS director should continue to implement hiring best practices.
As Ms. Curtis mentioned we have our talent acquisition team.
We are a pilot through the Department of Administration to see if we could streamline some of the hiring to get people on board faster.
This is a newer program, I think it's been in place for two years.
It started off kind of strong, then we hit a bump where they had all vacancies, and then the hiring came back to us.
It's back the department now that's helping stream line this.
We're at the point of evaluating to figure out next steps if this is beneficial or not.
So, we are trying to streamline.
I will mention that hiring, there's a lot of things I believe in like there in the administrative
code.
This is not my expertise that make it very difficult for us to make hiring happen quickly.
For example, if I interview 30 people for two spots, I got a disco out with narratives
Not that that's, but it's very complex.
The workplace Alaska isn't always conducive for rural Alaska.
And so there's things I think that we could be done differently.
That's DOA, that not OCS.
More intentional recruiting, we've been at so many recruitment events these days.
We're at the City of Anchorage's recruitment event.
We are at South Central Foundation's Recruitment Event.
So we have been attending quite a few recruitment
events trying to solicit folks to apply for jobs with us.
One of the recommendations expand the use of creative models to fill space,
our fill offices in rural Alaska.
We have letters of agreement already in place with many role offices in Alaska
where they work a week on, week off, and so we haven't quite figured out what else to do
that's creative to meet those needs, but we're always, we are open to ideas and suggestions.
We do think housing would be a game changer for some of our role locations
because it is expensive to live in rural Alaska.
This one, why this one was, we created all new, brand new realistic job profile videos,
our staff advisory board did those, they're all posted on our website.
So this was completed back in 2024, end of 2024.
Recommendation 5, OCS Director should consider enhancing data to align with best practices,
making recruitment retention efforts more meaningful.
We this one's a little bit about our TA team trying to make sure that we're getting the right folks in the door
And we are doing the recruitment events
We are the first division that's doing this new candidates and trick streamline process
Time will tell if it's going to be
Morfed out other divisions or states entities
Recommendation 6, OCS Director should include a forward-looking plan addressing recruitment
retention challenges over the last, the next five years in an annual recruitment and retention
report.
We have a very robust recruitment retention plan and we have five-years forward looking.
I will say there was some discrepancy of what we believe HB 151 said compared to what
the auditor said, but we do have 5-year forward lookin' plan.
The last one is the ten million dollars, which we've talked about and that's the seven recommendations
Thank you. I really appreciate your time director Guey and also to
Chris Curtis our legislative auditor and for everybody at the Division in the department
I think it's pretty clear from the committee hearing and from my colleagues on the Committee
We want to help
We really, really want to do whatever we can to help OCS make sure that it's not just about caseload caps.
At the end of the day, it is about helping kids and children in this state.
And so the staffing needs, salaries, benefits.
We want help.
We're eager to hope.
I think this is such a strong bipartisan issue in the legislature.
And we're ready to continue this work.
In this subcommittee process and in upcoming hearings, so thank you so much for being here today to all of you.
Thank you all, I appreciate you
Lastly today we will hear a brief introduction of Senate Bill 83 by Senator Clayman on telehealth services.
If Senator clayman and staff Serena Hackenmiller could please come to the presenters table, put yourself on the record and introduce your bill.
And my goal is to end by 515 so we'll have a speedy introduction today.
Thank you, Madam Chair and members of the House Health and Social Services Committee.
For the record, I'm Matt Klayman, Senate District H in West Anchorage.
Senate Bill 83 is brought forward by healthcare providers in my district to provide both in-person and
telehealth services to Alaskans across the state.
Senate bill 83 will ensure pay parity for tele-health requiring health care insurers to reimburse at the same rate for
tele health services as in person care.
telehealth reduces barriers to care and allows patients to receive timely and
convenient care from the comfort of their own homes. In Alaska, barriers
to Care affect individuals in rural areas, those with disabilities, and those
with limited transportation options. Telehealth is especially important for
chronic disease management mental health services and preventive care.
The COVID-19 pandemic highlighted the critical need for telehealth access, prompting the
Centers for Medicare and Medicaid services CMS to temporarily implement tele-health
parity.
While this federal mandate has expired, some tele health provisions remain in place.
What was once a temporary need is now standard practice and
many states have made efforts to solidify permanent access to these services.
At least 28 states has enacted similar legislation to Senate Bill 83 to ensure fair reimbursement for telehealth services,
Alaska's Medicaid program already has tele-health pay parity.
This legislation builds upon that existing framework to require the same parity for private insurers.
passage of this legislation will expand access to care, improve, and maintain quality of care and incentivize continued to help you in utilization.
And my staff, Serena Hackenmiller, will now present a sectional analysis of the bill.
Good afternoon, good evening.
Chair Mina and members of The Health and Social Services Committee for the record.
My name is Serene Hackmiler, staff to Senator Matt Klayman.
This is a Sectional Analysis of Senate Health & Social services Committee, substitute version O.
Section 1 adds a new paragraph, number 3, to reference the definition of healthcare provider in AS21.07.
Section 2 is the meat of the bill, establishing a New Subsection C under Alaska Statute 2142-422,
requiring that healthcare insurers reimburse healthcare providers for telehealth services at the same rate as for in-person services.
Section three through six can form existing statutes to section two of the bill.
Section 3 adds a new paragraph, number 68, health care insurance plans to the list of provisions which apply to home rule municipalities.
Section 4 establishes a new section requiring a home rule or general law
municipality offering a group health insurance plan to meet the requirements
of section 2 and provides the definition of health care insurance
plan as given in AS 2152-500.
Sections 5 and 6 amend the statutes to conform with section
2 including the statues for group insurance plans covering state
employees and self-insured group
health-insurance plans, covering active state employees.
sections seven and eight repeal sunset language and session law pertaining to
meta-medicate telehealth parity and section nine this bill is from last year
has an effective date of January 1st, 2026 and that concludes the sectional
analysis. Thank you. We do have one invited testifier to hear from
Dr. Sarah Doherty, thank you for being patient.
Could you please put yourself on the record
and give your testimony?
Good evening.
Thank you, Senator Quayman, for the invitation
to testify in favor of Senate Bill 83
and to chair Mina on members of the Health, Health
and Social Services Committee for your time
and consideration of my testimony.
For the records, my name is Sarah Dody, I'm a physician
and I am speaking on behalf of myself.
My testimony today reflects my experience with providing in-person and telehealth services
in Alaska and represents my own views and opinions.
I do not speak on behalf of former current employees, including search and central peninsula
hospital.
I'm a clinical rheumatologist, and one of, I believe, currently only nine board-certified
r heumatologists in the state.
A r Heumatiologist, for those of you not familiar, is a physician who's completed four years
Three years of internal medicine residency and two years
of rheumatology fellowship training.
I diagnose and treat patients with autoimmune diseases,
including r heumatoid arthritis, lupus,
clairadorma, curdormas.
Children's disease, psoriatic arthritis and others,
stomach and pronatory disorders.
These conditions are chronic multi-organ system diseases
often striking in the prime of patients' lives.
and can lead to chronic pain, organ damage, disability, and death if not diagnosed and treated
appropriately. It's likely that many of you know someone affected by autoimmune disease and have
heard how difficult it can be to access rheumatology services in Alaska. I reside in Anchorage but I
travel throughout the state to provide care to Alaskans living in rural communities where access
I've worked in Alaska since 2013 as a hospital,
so later as the vernetologist,
and I have traveled from known to Kodiak,
Dillingham to Fairbanks,
possibly to catch a cannon beyond,
and have experienced first-hand, like many of you,
the challenges that travel across our state can pose.
For those suffering from inflammatory arthritis,
and other disabling autoimmune diseases,
many who are profoundly immunocompromised
and at risk for severe infection.
these challenges are greatly amplified.
Not only is it probably fitly taxing, but it's expensive and time-consuming
requires time away from family and employment.
It's these challenge that my patients have faced that inspired me to deliver
in-person and telemedicine services throughout Southeast Alaska
and the Keeneye Peninsula where I'm calling in from today.
which would require most commercial insurance plans
to cover telehealth services at the same rate
as in-person services.
While I prefer to see patients in person
when I can, it's not always possible,
especially in the case of bad weather
or when a patient is experiencing an acute flow of disease.
Cell medicine services allow me to extend my clinical reach
to address disease flares,
meaning acute symptoms of the disease
often severe pain, stiffness, or swelling,
can occur in bones, joints, or other organs.
And it also helps me to expedite care
that would otherwise take months
if in-person visits were required.
In just the past two weeks,
via telemedicine services to communities outside the city
where I was performing in person visits at the time,
I diagnosed and treated a flare of inflammatory muscle disease,
which prevented emergency air lift and vacation
to a local hospital.
I diagnosed acute pericarditis, a life threatening complication of rheumatoid arthritis, and
was there on the line via telemedicine to coordinate care with EMS when they arrived
on site to care for the patient.
I initiated treatment for another patient's arthritis flare, subsequently preventing
an ER visit and adjusted medications for a patient with lupus in order to hopefully
In each of these cases, the visit involves reviewing the patient's chart in recent study results,
taking a detailed history, examining the patients with a clinical staff member
on the other end of the call in some cases.
Ordering rods, coordinating care,
educating the person on their acute illness and treatment plans,
as well as documentation of visit.
In some cases, coordinating care of these patients required more work than if I'd actually
been seeing the patient in person.
And so, to suggest that these efforts should be valued or compensated at a lower rate compared
to an in-person visit, seems short-sighted, considering that reducing the reimbursement
for telehealth services may be reducing or cutting tele-health service from many practices
across the state.
When you consider the cost savings to the insurance companies that we had just in the
past two weeks by avoiding medical transport, avoiding prolonged hospitalization and ER
visit and in a long run, hopefully dialysis, it's clear that telehealth services really
do provide an outstanding return on investment.
I am an employee physician.
I do not have a direct financial incentive related to the passage of this bill.
I'm here today speaking with you solely for the purpose of advocating on behalf of my
patients.
My patients often have like I mentioned multi-organ disease and so even if I enable to provide
telemedicine services, if they have different specialists or a primary care provider that's
telemedicine services due to reduced reimbursement,
that's going to affect the care of my patients
across the state.
So passing Senate Bill 83 and requiring parity payments
for telehealth services, a commercial insurance plan
would help to ensure that the healthcare providers
in Alaska can afford to continue to offer high quality
life-saving and cost- saving tele-health
services that my patient will have access to when they need it.
where they need it, and no matter where we live.
Thank you very much for your time
and for you service to Alaska.
Thank You, Dr. Jody,
and thank you for Your testimony.
We are close to our closing time for the committee,
but I would love to entertain one committee question
if anybody has one question, each.
Each.
Reprox.
Thank-you Madam Chair.
I can't see anything wrong with this, but I want to find out.
So, have you talked, I'm guessing the insurance companies would want
to weigh in on this.
Have we checked with them or?
Through the Chair Representative Prox, we have communicated with the
insurance company and they are, they have no opposition to this legislation.
Can't think of anyone else is there any one else that I should call that
Save me some time
Through the chair ghost busters
Representative schonke and then great
Thank you through the chair, thank you Senator for being here.
I just have kind of one overarching thought on this initially from doing some research.
It looks like about half of the states have parity requirements and half don't.
And that goes for private internships as well as Medicaid.
And one of my biggest concerns here at initial blush is we worked for
many years to increase the capacity of healthcare in rural Alaska.
Offering telemedicine is generally considered to be lower,
a lower cost modality, and if indeed we are incentivizing a
lower-cost modality offered from an urban area,
would this not disincentivize actual in-person care
in rural settings?
I would actually, the best person, he's not here now, but if you go look at the testimony,
we actually had an economist that has written extensively about increasing access to healthcare.
Jim Reitzer, who's written a book called Why Not Better and Cheaper, and in his testimony
at prior hearings, He gave a better explanation than I can to say that it actually will increase
The challenge with telehealth is that without parity often,
tele-health has underpaid, and so you actually
start losing health care because you're not
creating those incentives.
But if you are interested, we can try
to get Dr. Reberts to testify at the next hearing
and answer that question in more detail.
Sure, quick follow up.
Quick follow-up.
OK.
I will absolutely go and review the testimony.
I'd appreciate that reference.
And it's just something to consider the fact that when you set
up an in-person health facility in a rural area
Create the disincentive to have that rural in-care facility
By creating parity with a lower cost modality of something offered from an urban area
It it does have a very significant effect on that in the future
And I I am very concerned that something like this actually will help dis incentivize point of care in rural areas
When it's in person when it is necessary, so thank you and in response to that
I would note that actually the example of what Dr. Dodie testified to is an example
of how having the facilities of care, the practical realities that somebody in a rural
a rheumatologist, the likelihood the r heumatologists will get to your community is quite low and
there's no chance you get the Rhematologist actually having their regular practice there and so
access to that specialty is actually improved through telehealth and their ability to deliver
that through Telehealth needs the clinic in the in your Community as well. We have nurses and
other professionals that are there can that can coordinate the care with the specialist.
Thank you through the chair to the sponsor.
I'm very excited about the bill.
I just wanted to make sure that with the rural health
transformation asking for the physician
compact to be passed, that if we do indeed
pass the Physician Compact,
that we would have access to hundreds of rheumatologists
across the country to able to provide telehealth appointments
to our Alaskans all over the state.
I mean, so that's part of it is that by.
This would allow telehealth providers outside of Alaska to be able to provide the care.
Okay, thank you.
Sure, absolutely.
Thank you, I didn't think it was a question.
I'm just making sure that there's nothing in the bill that would prevent it,
I guess, through the chair representing grade, not that I am aware of.
Thank you, and I didn't want to bring up a question just related to the Alaska Municipal
Leagues letter just really did a cost savings, but I will save that question for next time,
but maybe a follow-up or any additional documents related
to telehealth cost saving.
I know there's some concerns about employers or trusts and the rising cost of care,
Please note that Thursday, February 5th, there will be a Finance Subcommittee meeting at 3.20 PM.
The time is 5.18 PM and this hearing of the House Health, and before I do that,
Representative Meers did join us at three 20 PM, I didn't forget.
The Time is five 18 PM
and the hearing the the Health and Social Services Committee is now adjourned.