This hearing of the Senate Health and Social Services Committee will now come to order.
Today is Tuesday, February 3rd, and the time is 331.
We are in butchered of its room 205.
Members present are Senator Meyers, Senator Klayman,
Senator Tobin, Vice Chair Geesele, myself, Chair Dunbar.
Let the record reflect that we have a quorum to conduct business.
Before we begin, I would like to thank Mary Glenn Kawakami,
the senate health and social services recording secretary,
and Kyla Tupo from the June LIO for staffing the committee today.
Today, we have an overview from the Department of Health, which will include updates on
SNAP and Medicaid related to the passage of HR1.
So in the room, We have Commissioner Heidi Hedberg, Deputy Commissioner Emily Ritchie.
On the phone,
we are Chief Medical Officer of the department of health, Dr. Bob Lawrence, as we do.
In addition,
Carson. She's here in person. The director of Division of Public Assistance, Deb Etheridge,
also in-person. And online, we also have the health care policy advisor, Leah Van Kirk. So
we have a great team here today. Commissioner Woodju and the deputy commissioner like to come
For the record, my name is Heidi Hedberg,
Commissioner for the Department of Health.
And so we will start on slide two.
So July 1st, 2022 is when there was the department
reorganization and that formed the
Department Of Health, and so I think of the
Department Health as a system, so systems that
support Alaskans across the state.
And it is made up of five divisions, seniors
and disabilities, public health, behavioral health.
health care services that includes our management operations of our Medicaid program and licensing
and background checks and then public assistance. Our mission is to promote the health, the
wellbeing and sole sufficiency of Alaskans. On slide three, so in 2022 as we stepped into these
we went out to communities and we listened and really heard what the needs were as we formed this
new department and that really created these four arcs of effort and over the past three years we
have provided updates to you as a committee on the four arc of efforts and I think this
weaves very nicely into the work of the rural health transformation again it's like how are
So the transformation of care is one of those arcs of effort and we have a contractor that has
been working with our providers looking at the rate methodology for four different groups.
It's behavioral health providers, ground transportation, long-term supports
two of those reports were posted on our website and then the other two are near finalization.
On child care, we had the childcare task force that wrapped up and there was about 55 different
recommendations from the Childcare Task Force. 56 recommendations, excuse me. And of
or complete. There's been a huge amount of effort into increasing access to quality child care.
And actually on slide 10, I'll do a deep dive into what those efforts were over the past year.
Protect rescue and restore life. That's all about preventing overdoses. And there has been
With the opioid settlement funds that have come in,
we have used that funding to grant out
to organizations across the state
around interdiction, how do we keep the drugs out
of the community prevention treatment and recovery.
In addition, from 2023 to 2024,
we did see a 5% decrease in overdose deaths.
So clearly the work that we are doing,
we're trending in the right direction.
And then finally, our strengthening the behavioral health system a couple of years ago, we did a pretty intensive focus on youth behavioral
health.
And we created a road map, we have a lot of the work that has been identified and we
have been working through shoring up so that our youth have access to services.
And so what we've seen is we fewer adolescents that are going out of state for care, which
is good news.
for crisis support and then referrals
for additional supports.
So again, I think that our trending is going well
for strengthening our behavioral health system.
Thank you, Commissioner.
Now, just note, we can pause anytime for questions.
We have a question from Senator Tobin.
Thank You, thank you Mr. Chairman.
And I'm really curious as you both know
that Safe Gun Storage is something I am really passionate
and reducing suicide and self-harm in our rural communities.
I know as part of the FY26 budget,
DOH chronic disease, and health promotion had requested money
for a gun safe storage media campaign that unfortunately had been vetoed.
Was the campaign able to find additional funds or resources
where there an ability to bring information to our communities about safe gun storage?
Through the Chair, Senator Soben Tobin, I would have to follow up.
I don't know off the top of my head.
Okay, Senator Keasler.
Commissioner, where do you get your data about behavioral health and drug overdoses and things like that?
Through the chair, senator Keisler, I would actually refer that question to Dr. Lawrence.
Dr Lawrence, if you're online, did you hear that, question?
Yes.
Sorry, they just unmuted the Chairman for the recognition of Dr. Robert Lawrence, Chief
my officer at Florida Department of Health, and I'm sorry, I was the question was broken
up a little bit, but I couldn't hear Dr., Senator Jason's question.
Senator Geese, so would you repeat the questions, please?
Yes, Dr Lawrence. The Commissioner commented that we're seeing less overdose deaths.
Where are you getting that data from? Perhaps it's from emergency rooms. I don't know.
Are you also getting behavioral health outcome data and from whom?
So, for the record, this is Dr. Robert Barnes,
good chair of the Center of Diesel, the data regarding the overdose deaths
who come through our state medical examiner's office.
And that's a number of deaths, something that we follow each year.
There was a 5% drop between 2023 and 2024, and so that's information that will continue to track through the Division of Public Health.
Regarding the second question, we'll have to get back to you on the connection between that and behavioral health data.
Thank you, Senator Giesel, senator Tobin.
Thank you. Thank You, Mr. Chairman. And this question is probably for Dr. Lawrence. Once again, good to hear from you
I see that the dashboard for the Alaska opioid data dashboard was last updated May 3rd 2025
I'm curious if there has been anything in the last eight months trends that we should be aware of or information that
Might be worthy of highlighting here
The trend that we see in 2025, that data is not finalized and actually,
unfortunately, because of the lag in data, we'll have final numbers towards the end of
the year. But the preliminary data shows that the trend is still in the positive direction.
Very good. We have a question from Senator Klayman.
This is a follow-up on the question Senator Giesel asked,
how are we doing on overdose deaths compared to national statistics in other states?
So again, for the record, this Dr. Robert Lawrence,
through the chair, Senator Klayman,
Alaska in general has higher rates.
And I believe you were asking about the overdose death rates
or overdose deaths rates remain higher
than the national average.
And while we've seen those numbers fall
in the rest of the country over the last several years,
Alaska, thankfully, is now starting to see
that downward trend.
Oh, go ahead, Commissioner.
For the record, Heidi Hedberg,
through the Chair, Senator Clayman.
So nationally, they've seen a 27% decrease,
and Alaska has seen five percent decrease.
And when we look, we take a step back
and we'll look at our data.
Alaska typically trends.
Um, after the lower 48, when we start to see some of these changes with overdoses or some
of the other public health initiatives.
And so, um, it's an aggregate number of 27%.
It does vary between each state.
And then go ahead.
So same, same question for Dr.
Lawrence about behavioral health outcomes, how we,
how were doing in comparison to other states.
Yeah, through the chair of Senator Kleinman. I'm not prepared to answer the question on behavioral health
I would defer to either of my colleagues there or we can get back to you
In the room we have Jen Carson director of the Division of Behavioral Health
Would you like to ask them that question senator claiming whoever's best whoever is best able to answered? I don't
I'd actually know, I don't know who's best able to answer.
Deputy Commissioner Ricci, would you like to
answer that?
Through the Chair, Senator Clement, for the record,
this is Emily Ricchi, Deputy commissioner
with the Department of Health.
I think it depends on how you measure it.
We were looking at some kind of measures
from that Medicaid released at a national level
a few years ago, and in some of the key measures,
particularly follow up.
access to a behavioral health provider following an emergency room visit or something like that.
We were actually trending faster and higher than other Medicaid states.
But when you looked at statistics related to one week, we were below other states and had not moved the needle yet.
But if you look at some of the changes that have occurred over the past two or three years,
we are starting to see improvements, at least from that measure.
If youth who are in out-of-state facilities, we track that very closely.
We track it on almost a monthly, if not weekly basis.
And so those numbers are data that is coming from youth that are tracked in our system
where we can see the decrease over time.
Thank you.
Good.
For the record Emily Rachey deputy commissioner with the Department of Health
So we're going to highlight in the next few slides some of the operational updates within each of
The divisions as well as what they are looking at for next year as we move forward
So, for the Division of Senior and Disability Services, the NRI implementation has been
a core focus of the division for several years, and we appreciate the support from the legislature
and stakeholders.
We think about this as kind of a foundational change to how individuals on waiver are able
to direct services themselves.
So this NRA tool is an assessment that will allow individuals to move towards something
care where they can use the funds that are available to them through waiver
services and decide kind of how best they could use those what services can
best meet their needs. Debbie Commissioner for the viewing public and
for forgetful legislators, can you remind me us what Inter-I stands for?
Through the chair, Inter I is actually the name of an assessment tool. It does not,
to my knowledge it does, not stand for a higher level acronym.
So, in order to move to a system where an individual can effectively engage in person-directed care or person centered care,
it requires a different type of assessment tool for what those needs are than what we have in place today and what our current assessment
tool is.
that allows for almost like a modernization of how we conduct our assessments.
So we intend to roll this out over all of our five home and community based waiver services.
And again, we have appreciated support from the legislature in helping fund both positions and
the capital necessary to support this tool.
conducting the procurement and working with CMS and engaging with a contractor that can
start to build out the software so that we can apply this tool for different waivers.
That contractor was selected in the fall and they began a kickoff.
They're called Monami.
And they're working within 15 other different states on similar projects right now.
As we look ahead to what the work the division will be doing in 2026,
they're really working to begin implementing kind of a soft launch of the inter-I assessment tool for two of different waivers.
Again, part of their strategic plan is to implement a Soft Launch with the Inter-Is assessment at the same time they are maintaining ongoing assessment tools.
If there's a change or a difference, we understand what that is, what
that means for the individual, and if the tool needs to be tweaked a little bit.
So, but you will see that soft launch happening this year,
and that's the big step for The Division.
One of the other items that The division focused on this
year was working with the Commissioner's office and our contractor
guide house, as Commissioner mentioned earlier, to complete a rate methodology study.
Again, we heard that long-term care services and support rates didn't always match the evolving
need that we see within our state, particularly related to individuals who have more acute or
complex care conditions.
So that study was completed this fall, and the Division is working with Guide House and
working stakeholders to understand how to think about the findings of that Study.
really lay out a series of different policy considerations and financial considerations
that can be developed or can
be implemented over a
series
of years. And so I think about this as providing the framework that the department and stakeholders
and the legislature can have over the next several years about how to think
about implementing different recommendations to achieve the goals of the system that we want.
And then finally, the division has worked very hard on implementing changes to help meet the needs of individuals with complex care.
I think that is an area within our state that we are really seeing an emerging need and a gap in kind of both an adequate continuum of care and services to address.
So the Division worked to make adjustments to create more flexibility for
different kind of flexible arrangements for individuals who may need two staff
to support them during some periods of the day versus 24 hours. So those are
some of changes that we're underway. I'll just pause note for my colleagues. We
will be hearing from Guide House, I believe next week. And we'll have a
hearing with Guide house next we can ask questions about these studies.
To the chair for the record, this is Emily Ricci moving forward.
One thing that I wanted to highlight for
the committee is that we have five home and community based waiver services.
And those are on a five year renewal period with the centers for Medicare and Medicaid services, and we are at the end of the renewal
period for four of those five waivers.
So the division has been undertaking the process over the last several months of renewing those waivers?
Everything is on schedule and going is planned.
I think the public comment period for those waiver renewal periods just wrapped up either
last week or this week, those will all be summarized, it will be published, and the
division will work with CMS to complete renewal by the end of June 2026.
But that represents a significant amount of work within the division that's critical,
so I wanted to highlight that.
I also wanted to highlight one last item on this, which is that the division is always
looking for ways, again, that it can help meet some of the needs of people it serves.
And so they started a pilot project.
This is only 60 days old working with a company called RingMD.
And Ring MD provides telehealth or virtual services that are specifically focused on
And so this is a service that providers or individuals or family members can access again 24-7 to receive specific advice or care for what their needs are.
Again, it's a pilot project and it is new, we're not even 60 days in yet.
So far about 51 people have signed up for it in January, but we will be reviewing this pilot over the next 12 months and then evaluating what next steps are
So, moving on to slide five, the Division of Behavioral Health has also been very busy this year.
As we talked about earlier, we completed the rate methodology study for behavioral health services.
And again, will be talking about that with the legislature in more depth next week.
But that was a large work of effort.
And when I step back and think about the behavioral system and what we heard when we started into these positions.
is we heard a lot of frustration with the Medicaid program and
the inability of providers to fully realize the services that were available under the 1115 behavioral health reform waiver.
So we identified three different approaches that we thought could be foundational to helping that.
The first was to ensure that our claims were being administered timely.
So, we transitioned claims systems to a new transition claim systems back into the MMIS last fall.
The second was to look at how behavioral health services are being paid.
Is the underlying methodology, does that make sense?
Does that support what the providers need and the outcomes we want to see?
And then the third is to support technical assistance.
So you'll see this year in our operational update.
We've addressed the rate methodology study and we will be working to implement those recommendations.
At the end of this here in the beginning of next year, we are also working
to build out technical assistants this
year and into next-year.
Another area of focus for the division is preliminary implementation for
a certified community behavioral health clinics.
This is an area focused for us and I know the committee has been interested in that in the past.
We received a $1 million planning grant from Sam Shell last year to begin the planning for
implementation of these clinics and we worked with Alaska Behavioral Health and Fairbanks and Jammy here in Juneau.
application to be part of the next cohort for the demonstration beginning
July 1st so that application is due April 1 and if we are elected to
be a part that cohort then we will begin the implementation. We will start with
two organizations and build out from there. It is a five-year demonstration but
we're excited to see this work move forward.
And then finally, the division has also been focusing on building out the crisis continuum.
There was a study that was completed earlier this year about different ways that we could
continue to build out, that crisis is continuum, and the Division is working to implement
that.
We also completed our subacute licensing regulations.
It took a long time.
We know getting it right is important, so I think we went through three rounds of public
comment.
before we finalize those, and those will be taking effect
either last month or this month.
So we will now be working with at least two providers
that we know are interested in opening up
these sub-acute facilities in Anchorage.
Those are both crisis stabilization
and crisis residential services.
Just to pause for a second.
Is that the facility that's opening at or near ANMC,
South Central Foundation, is that?
Into this category or is that a different kind of service through the chair senator Dunbar?
We are to a chair Senator Dunvar. We're speaking with
South Central Foundation and both providence who have expressed interest in standing up these facilities in the past and I
Have received legislative support from that in past years. So these regulations were critical to being able to move forward
I would also say we've incorporated crisis recommendations into the behavioral health rate methodology study as well,
because that was something that we heard, was that the crisis rates that were developed didn't necessarily match the needs and the expenses.
Now the providers were working on building out the model further.
So we worked, we made sure that Guide House worked and met very closely with some of these crisis providers,
so they could incorporate that in their rate recommendations.
Okay, moving to slide six. We're going to move into the I'm sorry deputy commissioner
I thought you were going through the next the moving forward
Yeah, I have a question there after you've gone through those bullets
To the chair moving, forward we're working to implement the behavioral health rate recommendations
And we are also looking to apply for
Certified community behavioral Health Clinic demonstration. So again, the application would be April
first, and we would begin the demonstration July 1st.
We are looking to expand provider technical assistance.
So within the right methodology study, there were some areas where I think our contractor
identified opportunities for, I
think, a little more support with some of the billing practices that would allow providers
to be able to receive income for services that they are owed.
things that you need to do to take care of that. So, for example, updating your rate charts to
make sure that those reflect the updated amounts, things like that, so a guide house will be reaching
out and working with some of kind of a targeted approach initially to work with
some those entities where they identified immediate opportunities, but we will
be broadening that over the next year. And then I've talked a little bit about the crisis
Thank you. I have a question, Deputy Commissioner. So, you know, I I
have bill and we've had an active conversation about mental health or
behavioral health parity in billing. And that's not parity
in the amount, but rather in The Administrative burden.
And so I'm wondering which of these points, if any, speak to that, or if there are any
other efforts to move forward towards a more streamlined
traditional health services.
Chair Dunbar for the record.
This is Emily Ritchie.
Yes, it is not a bullet on this slide, but it should be.
I don't want to say we ran out of room because we could have made the font smaller.
But that is an area of focus for
the Division of Behavioral Health.
And some of it ties into the AO 360 regulations project where we want
to see if there are opportunities within our regulations.
to streamline or remove some of those particularly because when we have conversations with behavioral
health providers, I think a significant amount of concern is actually with how the regulations
are written and the level of detail that is contained in those regulations.
So that's an area that we are actively looking at.
In the next slide I'll talk a little more about service authorizations in general and
but the Division of Health Care Services will be working
to implement a new service authorization module,
and that is an opportunity for us to review all
of our service authorizations and evaluate what is appropriate
to maintain, what we may need to change,
and what might be able to reduce.
So I see those two as aligned.
Very good.
Senator Kleinman.
Going back to the discussion about crisis continuum.
Besides Anchorage, are there some efforts going on in the Matsu Valley and other parts of the state to implement some of those facilities?
Through the chair, Senator Clayman, there are, and one of
the aspects of The Crisis continuum that emerged in some
of contractual work that the division did last year is that we
need to build out maybe a better system for how to support place-based crisis services.
So not every community and not any type of crisis service will occur in kind of a sub-acute facility.
We know that there are community organizations and
there're entities that are able to provide crisis
services,
of a slightly different type in different settings.
So how do we build that out over the next year
and how did we align that with the reimbursement framework
so that we have the full continuum of crisis services?
Yes, I thought the Juno and the Matsu
and maybe Kotzebue at all were all taking steps
to at least bring in crisis, crisis intervention
as opposed to crisis residential
and checking where you are on that.
through the chair, Senator Klayman, yes,
those conversations are happening,
and I think that's part of the work
that the division wants to do,
is to make sure that we've really built those out thoughtfully,
because right now we have been so focused
on kind of a crisis stabilization
and crisis residential from a facility perspective.
We know that need to build out kind
of in between levels of crisis services
for some of those communities that you mentioned as well.
Thank you.
Moving to slide six, we're going to talk about the Division of Health Care Services.
They have also been busy.
Again, I think about them as kind of the heart of Medicaid program.
They kind keep the blood flowing, and in this case, the
They manage what is now a $59 million average weekly check right for the Medicaid program,
so weekly payments to providers, and nearly 10 million annual processing, nearly ten million claims annually.
So they are a small but mighty division.
Over the past two years we've really focused on increasing retention within the division.
In July of 2023 we had a 31 percent vacancy rate and as of last month that vacancy
rate was down to 8 percent.
So we have been successful in addressing that and that's important because they're
working to do a lot.
We know that we need to modernize our systems in a way that is not disruptive,
but allows us to move from technologies where we're still relying on people to push the button and move the things forward.
And we have to bring in some of the new systems where
we both have automation and self-service capacity.
So we are taking a modular approach to doing that.
and we are starting with the provider enrollment portal.
So we know the Provider Enrollment has been a pain point
operationally for several years now.
We are planning to begin implementation and go live
of a Provider enrollment Portal that will allow people.
the ability to self-service, upload documents, see where their application is at, and have that work in a different way than we do today.
Today, the system we have relies a lot on email boxes, even behind the scenes, going from person to person,
physically going in and checking national databases for certain information,
and a lotta that can be automated now.
So, in the next year, we'll be going live with a new provider enrollment portal.
We are also in the same vein, we are looking at launching our mobile app in
the next, I think, two to three months where individuals will be able to have
their Medicaid ID card on their phone, so it will
be a digital Medicaid I.D. card.
We are also, at the same time, we're looking at provider enrollment portal.
We need to do the thing for service authorizations.
These are all so prior authorisations for anyone outside of the Medicaid program.
We have federal requirements that align with some of
the legislation that I think was passed last year regarding prior authorization requirements and
timeliness from the legislature.
There's federal requirements that align very closely to those, and we are working to implement those federal
requirements, but to do that we need to bring in a new service authorization portal.
So our team is getting, I think, the final blessing from CMS right now,
and then we will be issuing an RFP so that
we can procure a service authorisation portal and work to
implement that.
So these are...
I get excited about this because I think these are core to when things work well it allows
us to focus on the bigger picture versus the daily operations and we need to make sure
that our technology is supporting us.
Another kind of in the weeds but core issue that we have heard for years is something
called multi-rendering provider enrollment and what does that mean?
system is structured right now, it's very difficult for you to also provide a different
category of service.
And that can be a problem, particularly in some of our rural communities, where individuals
may be providing personal care assistance, but they may also be doing other work.
And so this has been a longstanding issue we've heard about from many of the providers.
To make changes to this, I think about like our Medicaid system as like a house.
And this kind of change involves, like, knocking down a structural wall and moving a fireplace
and, you know, creating a new room.
It is a foundational change to the structure, which is why it hasn't been fixed for a while.
But our team has been working over the last year.
to make those changes and those fixes, they're doing it very carefully because you don't want
to mess anything up. And those are beginning to roll out. In the last three months, I think there
was a soft launch with phase one and phase two will be rolling out in the next few months. So
again, long-standing operational items that we're hoping kind of eases the friction. Sometimes it
And then finally, background check efficiency, we have managed to increase our background
check-efficiency, and we've dropped our provisional time to just over one business day.
And so that's almost a four-day reduction in that time period.
So again, this always fluctuates, some of it is staff dependent,
some is dependent on other variables, but it's headed in the right direction.
Thank you, Senator Giesel.
Is it still a paper process, or are you using electronic fingerprinting?
Through the chair, Senator Geesele, for the record, this is Emily Ritchie.
Right now, healthcare services for medical services, it is still paper.
I know that we are working on the digital approach with child care providers.
And I think depending on how that works, we will be able to pull it into the healthcare side.
Moving on to the right side of this slide, moving forward,
I've talked about the provider enrollment portal.
I talked
about implementing the service authorization portal,
I would love at some point in my time with the Department
of Health to move away from paper travel vouchers
or coupons to a digital format.
So that is next on our list.
I don't have information on exactly what that looks
like right now, but that
is a priority for the division.
And then we also really want to improve our analytics.
Including analytics for fraud, waste, and abuse reporting, but also better insight into the spend that is happening within our Medicaid systems.
We have teams of incredibly dedicated individuals with a lot of subject matter expertise and
knowledge that we rely on to understand what is happen with our spend.
With the evolution of technology and analytics, I think there are some ways where we could have faster,
better access to our data that's maybe more comprehensive than what we're able to do today.
So, our focus next year, again, is going to be on moving away from paper travel vouchers and
really looking at how we can incorporate better analytics.
Senator Tobin.
You piqued my interest when you talked about moving away from paper travel vouchers as obviously growing up in rural Alaska
I'm often surrounded by folks who still really appreciate their Nokia flip phones
So I am curious about some of the
Understanding a research that you have done as a department around
Would this actually save costs or would you only be moving a very small amount of folks to some sort of digital application and still have to maintain the paper?
Through the chair, Senator Tobin
I think there will always be a need for paper of some sort, I
think right now that we rely on it almost as a primary form for
people across Alaska, and I
think we would like to see that change.
We have been working on providing
some more flexibilities or changes.
Ways where administratively some of the things that we're doing don't make sense and they donít save money and we've been working with some
of our tribal health organizations to look at facilitating some
of those changes through their work.
And so I think to your point weíve been
working very closely with them and have
A state plan amendment right now that actually we're working on with CMS that would incorporate some new changes.
Again, recognizing things like Uber and Lyft are transportation options that people use.
So how do we make sure that we are leveraging those as options
that are available to our Medicaid population?
Now that doesn't address the needs of rural Alaska because not everyone will have Uber
and LIFT, but we kind of want to make
What's new but making sure we can maintain what works for people who don't have access to all of the the services that you would see in like Anchorage or Juneau
Thank you for your next slide deputy commissioner and we
If it's possible to move a little bit quicker through these cuz I would like to get to the conversation about HR 1 and its impacts that starts on slide 11
But please continue through here
to the chair. I believe Chief Medical Officer will be speaking to this.
Dr. Lawrence, are you there to speak to slide seven?
Good afternoon. For the record, this is Dr Robert Lawrence Chief
Medical officer for the Department of Health. That brings us to you the slide on the division of public health.
which is a division made up of just under 450 permanent whole-time staff led by Director
Lindsey Cato providing a wide array of services.
I'll be brief, but there are, by way of this operational update, just a couple of things
we wanted to highlight for you.
First is, while, as we said earlier, the overdose deaths have declined by 5% 2003-2024, and things
The division is not backing down on our prevention efforts until we continue with the distribution
of the overdose reversal kits, including the kits that are now stocked in each public school.
We're working with other departments on the expansion of
the prescription drug monitoring program, so the prescribers are alerted when individuals
present to an ER with non-fatal overdose, and the Overdose Fatality Review Committee,
which is now set up as generating actionable.
strategies. Second of all, we've upgraded our electronic laboratory information management
system and taking steps to modernize public health nursing. 80 percent of laboratory reports
are now generated and submitted to providers electronically, which is a welcome move out of
the paper-based system. The work of our public-health nurses is now documented on an electronic health
and excited to report that the TB program has adopted and implemented the use of an EDOT,
which stands for electronic directly observed therapy. It's technology that does not take
the place of a human being, but helps us with facilitating the connection between patients with
TB with providers who are overseeing their treatment. Finally, on that side of the slide,
we are connecting residents experiencing homelessness to services through a new mobile
that over the last year has been very well received.
If I can go ahead and just say looking ahead,
the division is strengthening out our capacity
for infectious disease surveillance and response,
particularly in the areas of TB and syphilis,
as well as other emerging infectious diseases.
And the Division is working with community
and tribal partners across the state
to ensure that people are connected to treatment
and outbreaks are prevented.
After hearing from our communities in a statewide effort, our public health centers are now
transforming to adapt to community needs, providing standardized services across the state while also
moving to co-locate multiple state services, preferably in the same location.
And then finally, we recognize that as an essential service to Alaska,
that provides critical data and information regarding the causes of death, the division is building out
advanced technology for state medical examiners in the process.
So in each of these ways, the division of public health continues to guard to help all of our communities.
Thank you, Dr. Lawrence, Senator Tobin.
Thank You, Mr. Chairman.
Dr Lawrence I'm curious to hear a little bit more about the state Medical Examiner's Office.
Dr. Cato and I have the opportunity to travel with the Alaska Mental Health Trust
to some rural communities and they brought up some of the barriers that they're experiencing particularly when someone in the community passes.
How has the work in that particular area been going especially to help folks in there in their most time of need?
Through the chair to Senator Tobin, thank you for highlighting that. The work of state medical examiners office is vital to
our neighbors across the entire state.
And as you mentioned, there can be delays when the person passes
and the state member needs to help with doing the post-mortem exam.
And there are can-be just times that are required for, you know,
transports of individuals' bodies and then also getting reports
back out to communities.
And so that work is ongoing and improving.
And I would say this last year because of upgrade.
Both technology and then, as I said, building out the work of the State Mokley-Bammers office,
your point both will take in, and I think in answer to that point, our goal is to make sure that every family
is able to reach closure regardless of where they are in the state as quickly as possible,
and that that State mokly-bammers offer truly as a service to the to state.
I would love to follow up offline as I know that there was some things identified by our tribal partners that I think we could continue to work upon.
Thank you, Senator Tobin. Dr Lawrence. I have a question. So we've seen in some other parts of the country.
falling rates of vaccination and rising vaccine skepticism,
partly driven by misinformation and disinformation on social media,
and sometimes even from officials.
I'm wondering, have we seen a concomitant fall in rates
of vaccinations here in Alaska?
answer the question is yes we see just as you see across the whole country there are particularly
in certain areas a reduction in the rates of vaccination coverage. The reasons for that are
multi-factorial and there many contributing factors but I would say the trends that you're
hearing about and seeing nationally we also see at Alaska. Well thank you and I mean
We've seen measles outbreaks now. There's one ongoing, I believe, in Texas.
I know there was a case of measles in Alaska,
I think.
What is a division doing to try to reduce that trend towards fewer vaccinations?
The vision of public health is focused on making sure at several levels that individuals
who are making decisions about vaccination have accurate information.
They also encourage individuals to speak to their healthcare provider.
And so we do a lot of work to educate our healthcare providers and provide recommendations
that are specific to Alaska.
It's important to know that while national guidelines will come out for national bodies,
vaccine policy and vaccine recommendations for the state really falls to us and the
state looking specifically as our history of infectious diseases and particular pressures
with ongoing transmission of disease.
And so all of that taken together is a way of saying that we recognize that there's
one particular effort or initiative that is going
to increase vaccination rates in any given area,
but rather it's about providing good information,
good support, and most importantly connecting people
to address the source of information
when they're making that decision.
Thank you for that answer, Dr. Lawrence.
I won't harp on this any further.
We can go on to the next slide, but I will say that I think
be thinking about I'm sure you are but redoubling efforts to address a change in the environment
that is to say we've been doing things one way and it's been relatively successful in getting
folks to get vaccinated we are in a different information environment now and
it seems like things are trending in their wrong direction and I don't think that
is because of the state of Alaska or the division I think there are external forces
that are convincing people not to get vaccinated
or have their children vaccinated.
And we should be thinking seriously about new strategies
to counteract those forces.
But I won't go any further.
If we could go on to the next slide, please.
for the record, Heidi Hedberg.
So on slide eight, I'm gonna talk about
the division of public assistance.
I'll provide just a brief overview on operational updates
and the focus for coming year.
The division has had a strong focus on streamline processes really leveraging our IT modernization
and we're starting to see the fruits of that. So we are now serving more Alaskans than we have
And we continue to improve our timeliness.
And so as you can see, as an example, last year we were at 60 days,
now actually as of last month, we're down at 43 days.
So serving more Alaskans, continuing to, improve
our timeliness.
Part of that is our IT modernization efforts.
And I will provide an overview in the moving forward and the next slide.
We are on track with all of our IT modernization efforts.
In addition, as an example, the Alaska Connect Portal we launched last year so that Alaskans
can complete an application, upload documents.
This spring, we will launch the second phase and that allows Alascans to actually track where their application is at.
if the division is waiting on additional documentation for their application or whether they need to
schedule an interview. So it's increasing that transparency. We should see a decrease volume
to the virtual contact center as Alaskans are leveraging more of the Alaska Connect Portal.
And we are seeing, you know, as an example, when we launched our SNAP online application,
well over a year ago, 80% of our applications are submitted online now.
So we have a decrease in paper submissions, which is a benefit.
It is a team of eligibility technicians that work with a community.
They go out and they help,
they meet Alaskans and help them complete their application,
whether they require to do an interview and make a determination.
So we launched to this last year,
we went out to contribute and to Delta Junction,
and it was very successful,
and so we are working with communities as the invite us out.
that do not have a DPA office. In addition, there has been a lot of federal changes.
And we'll talk about HR1 at the end of this slide deck,
but there's a lot of policy changes within CMS or within USDA
in addition to a federal shutdown.
And that had significant impacts to this division.
And I really appreciate the division and the leadership
and how they managed through those ever evolving changes
while keeping clients at center.
So clients where the impacts were minimized to the clients.
And then finally...
Eligibility technicians, that job class series, there is a study that was launched to evaluate
that series. It takes about a year to
evaluate that class Series, looking at the work that they do, the current pay structure,
and that's if it's commiserate with the
work duties that their doing. This has been a job
that it launched and this summer is when we should hear what's the goal the hope
is that this Summer we will see the completion of that study. Commissioner
I have a question before you go on to the next point. A few months ago there was
an article in the ADN about using out-of-state contractors to process snap
applications and I was wondering if you'd speak a little bit to that and then say
plans to do going forward? Is that an indefinite sort of plan or was it a one-time thing?
For the record, Heidi Hedberg, to the chair. So we were working with USDA, the federal agency.
on SNAP and looking at our contractors that support the virtual contact center in helping
with the SNAP application.
I do have Director Etheridge here so she can talk about the details, but the article was
talking about The Demonstration Project and that was, it's still in process with USDA.
I don't believe that it has been fully approved yet.
Yeah, um director if you could please come put yourself on the record. I'm also curious
what the time frame will be on that project and
You know generally we don't have
Out-of-state contractors doing what is kind of a core
Stave Alaska function, so can you speak to?
You Know is this going to cause any problems with our existing contracts
For the record, my name is Deb Atheridge, I'm the Director for the Division of Public
Assistance and to the chair.
I'll first talk about what's called a non-merit demonstration waiver, which we applied for
through Food Nutrition Services at USDA, and we received approval for that and signed
Through that contract, in terms and conditions,
we have phases.
We're currently in essentially phase zero.
And what that means, that's our planning phase
where we are identifying
stepping back in the terms and conditions they specifically they
specifically named our contractor public consulting group PCG who's
supporting the virtual contact center and so that becomes important because
that's how that individuals non merit staff were selected in order to work on
this demonstration project. In phase zero we are training those virtual PC G
staff, just like we change state staff on processing a SNAP case. And we are in
negotiation right now with FNS on our sample plan. There's a high level of
oversight for the state of Alaska. We're one of the first states to receive a
demonstration to use non-Marret staff to support the work of our SNAP program.
so we're in negotiations with them on our sample plan and our reporting so that I think we are
close to final and we've been training those I don't think 10 PCG staff to process SNAP.
Our goal was to begin the SNAP merit, non-merit work with, merit work
I can pause, but I'd also like to say that the plan is not to be ongoing and forever with this body of work.
My goal will always be that, the state of Alaska,
the Division of Public Assistance employees are processing snap cases.
This is really targeted in order to get the support in
order for us to address our untimely work at the division of public assistance.
And so while we've seen great improvements with SNAP,
we do know that there's other areas
that we require some improvement in timeliness.
And in order to, if we have support
in the SNAP processing,
then that allows my merit staff
to also work on those other
areas to see system improvement,
our timaliness improvement and those programs.
Through the legislature received appropriation
for an additional 15 FTEs.
and we're in the process of hiring those. We have the management portion, we've created them,
we are interviewing for them and the Management portion. Those are really designed to start the
transition from that contract or those contracted non-marid staff into a fully-state staffed program.
Very good. Thank you. Are there any follow-ups on that? Senator Tobin.
Thank you, Mr. Chairman.
I apologize, you use a lot of acronyms.
So I wrote down FNS, PCG, non-merit.
If you could please help break these down
so that the public can follow along.
Thank for that.
Again, this is Deb Etheridge through the chair,
Senator Tobin.
F&S is Food Nutrition Services.
They are under the U.S.
The Department of Agriculture.
Yeah, the Department Of Agriculture, thank you very much.
The PCG is public consulting group.
They are the contractor we've contracted with to provide
the support to our virtual context center.
So if I said VCC, that's what that stood for,
virtual contact center, I try really hard not to use acronyms.
But was there another one I feel like there was?
I think that what's a merit staff versus non merit
staff, it's in new term.
Sure.
through the Chair, Senator Tobin.
A merit staff is a person who is hired and supervised
by the state of Alaska,
and they have what's called merit principles.
So we have quality oversight in hiring practices
that we follow, and therefore the State of Alaska,
the staff that, we hire, meet those hiring principles
as far as merit and staff.
And then a non-merit staff would be someone
who was not an actual state staff employee.
And so what was really predicated on our ability
to get the approval is that public consulting group
hired the staff following the same merit-based principles,
but they're still considered non-merit staff
in that definition because they are not actual state
employees.
Is that helpful?
Do you have a follow-up Senator Tobin?
I just wanna make sure that I follow.
So with non merit staff, it would sort of like
be as though we hired someone from Idaho to provide support and services.
They don't live in the state, but they are supporting your department in this virtual contact center.
Am I getting any of this correct?
Yeah, through the chair, Senator Tobin, yes, they're hired through a contractor,
through contract, and we remain directly oversight and
supervision of the body of work that they conduct and do.
So they're responsible through a contract.
Very good.
Senator Klayman.
It's a lot of work and a
lot acronyms.
The question that I think the chair
asked was, do we have an
out-of-state contractor that's
processing the benefits?
And it sounds like the answer is
yes, but you're on a path to
bring all the effort back in
state.
Have I got that right?
Through the chair, Senator Klayman, yes.
And a short follow-up.
Thank you, go ahead, senator Kleyman.
What is your timeline on when it'll all be back in state?
Through the chair, Senator Cleiman, that's a good question.
I think my timeline is really predicated upon our ability to become timely and
get benefits out to Alaskans in a timely manner.
We have, it's multi-pronged approach, our timeliness is not just based on
leveraging non-merit staff.
We also have a number of technology improvements, which have already
us to become more timely. Thank you director and I apologize to the committee
for taking us down that road but there had been some news coverage of it and
it's good to get some more specificity thank you Director. I don't know if Deputy
Commissioner wants to continue or was it you Commissioner if you want to
continue with moving forward on slide eight. For the record Heidi Hedberg and
I know we're running out of time so I'll make it brief.
Just to share with you the division moving forward,
this spring they will be launching an all programs application.
So many of the programs will have a single application and that will,
it's easier for clients.
What won't be included is childcare burial assistance or heating assistance.
We have a contractor.
They are working on moving the Medicaid program off
of our legacy system, so that is underway.
Our SNAP modernization module, we're going to be launching,
we are issuing an RFP this spring.
And the work assistance tool is for our eligibility technicians.
It will have all of the policies and procedures with an agent,
a little chat bot, and so the eligibility technician will be able
their question, and then it will be able to pull from the policies and procedures.
So it's a tool to help our eligibility technicians with the consistency of the answer.
And then they're not having to flip through all of
the paper or legacy tools to find the information.
So again, it is a tools that help are eligibility technicians.
Very good.
Senator Meyer.
Thank you, Mr. Chair.
All program application are we concerned that we might see people applying for more programs
at once especially ones that they may not be eligible for hence taking up more time which
I mean having having a electronic tool I'm sure that's going to speed things up but then
might this be a little bit counterproductive at the same time?
Through the chair senator Myers that is a great question it's a smart
form, electronic smart form. So when you say yes, it's going to pull up the additional
questions to verify if they meet the eligibility for that application and it is going
to prompt people.
So if you're applying for SNAP, they're going ask, you know, maybe about Medicaid.
So there's gonna be some prompting that will happen. One is to ensure that the clients
are receiving all of the information. It's to help consolidate the amount of applications
that are coming through.
Thank you so much, thank you, commissioner. Please continue.
For the record, Heidi Hedberg.
I just want to draw your attention. We talk a lot about IT modernization within the division of public health.
So this is a visual representation of what the modernization office is working on.
So at the top, I want draw attention that orange banner lists all of the Division of Public Assistance programs.
You can see on the left-hand side, those are the families. Those are
connect portal, which is what I just talked about, or they can call the virtual
contact center. You can see down at the bottom there is our eligibility
technician. They are going to be having one area that they log into that will
be connected into all of the various programs that are represented in the
We're looking at just the conformity, the single, easy access point so
that our eligibility technicians are not toggling between various programs.
And we want to make sure that we have consistent information.
So there's just a lot of work that the division has been doing with the data
integrations and shifting off of these legacy platforms into a new modular
integrated eligibility program.
And finally, on this, we are not going to call it permanently
the integrated eligibility system.
There will be a naming contest, and so we will
be called something different in the future.
I propose not SAP.
Thank you.
Let's go on, Senator Tobin.
Thank You, Mr. Chairman.
May I ask, what is Spirit Web or current or Qualtrics?
There is just some words here that I don't know what they mean.
for the record, Heidi Hedberg, through the chair, Senator Tobin.
So just highlighting real quickly,
these are the names of the program.
So SpiritWeb is our family nutrition,
our energy cost offset system.
That's our heating systems.
Childcare is a child care program,
QualTrux, that is that,
is the system that tracks all of our corrective action plans.
It also has a survey tool.
Quality Assurance is a program that accesses this information.
You can see the EIS eligibility information system
and Aries.
Those are our two current legacy systems
that will essentially go away
as they're morphed into the integrated eligibility system.
Random moment sample, so all of the staff have to do,
if they working on multiple programs,
they have do timekeeping,
so they document if their working
on SNAP or Medicaid.
the Mobius view direct repository that has all of our warrants and some reporting in there.
Current is the name of the workflow system that tracks the work of
our eligibility technicians and iLings is our document management system.
And then the Instant Eligibility Verification System,
I-E-V-S, is connected into the Department of Labor,
the Social Security Administration.
It is checking and verifying income and employment.
Very good.
Thank you, Commissioner.
We'll go on to the next slide.
So, for the record, Heidi Hedberg, on slide 10,
there's been a lot of focus.
on child care and we really appreciate the legislature and the appropriation of funding
for childcare and
The passage of Senate bill 95 so just very quickly because I know we're short on time
Last year we did launch our new child care information system.
So that is for child-care providers and it is also for parents and is
also our staff and what we are seeing is some child
care providers are now able to get a license within less than 30 days.
and it used to take months, so we are seeing some really good progress.
There's a tool that if parents qualify it links them to
the assistance application for child care. So it's it is a user-friendly
system to support families. We did receive funding last year
to increase the base funding formula for our child-care grants.
The last time it was updated was in 2012,
we updated the base rates and we are also focusing in on our infant care so we have a pay
bomb for providers that will increase the number of infants and toddlers that they are caring for.
Senate Bill 95 passed, that increased the eligibility so more families qualify up to 105%.
It also capped the parent copay from 10% to 7% and it created two positions that are really
focused on supporting the business sector so that they can create on site or near site
child care.
for, to be posted for recruitment.
The, on the other side, the moving forward, I would just share with you, there is a new
provider type.
It does not exist in Alaska.
It's called Friends, Families and Neighbors.
I think this is going to
be a
a provider type that's really going to impact our most rural communities and so if a family
qualifies for a child care subsidy and they identify a
family friend or neighbor that then passes the safety requirements
we they are registered with the state essentially that they could receive that subsidy that
That means there's a lot of discussions to look at how we develop that provider type,
but that's going to be a focus of our child care program office.
Well, I'm sorry, Commissioner, will that require statutory change?
To the chair, no.
Okay.
And then childcare workforce subsidies, that is really targeting those child
care providers who have infants and toddlers in child
Looking at how we can provide a subsidy to augment how much they are paying for their own child care
Very good. Thank you commissioner
So for the record Heidi Hedberg
On page 12, we're going to transition and start talking
about HR1 that passed July 4th, and there are changes
to the SNAP and the Medicaid program.
So what I want to talk a little bit on slide 12 are some
of the changes that we are planning for.
So on SNAP, the work requirements
are changing so they the age range is changing and it's extending it from 55 years to 64 years
of age. So now anyone that is 18 years, just 64, years of
age will need to meet those work requirements. In addition there are state penalties for payment
And that is beginning in federal physical year 28.
So states that have a penalty of payment,
error rate above 15%,
will have to pay a percentage of the SNAP benefits.
For historical context, in Alaska, we had a high payment
error rate of 60%, and now it is down at 24%.
So we are improving and decreasing our percentage
and our goal is to get below 6%, so that we do not have
for a portion of those SNAP benefit rates.
For all of the states that goes into effect in 2028,
we are going to be applying for A waiver to extend that.
So it buys us more time while we work
on our IT modernization, our workforce,
and streamlining our process,
which I think we've discussed today.
And then finally, the administrative cost sharing for the state, it used to be 50-50
for paying for administration of these federal benefits within SNAP.
Now it is shifting to 75%, 25%.
Thank you, Commissioner.
I have two questions.
I think it's public actually we found it so that administrative cost shift they estimate
It'll be forty seven point five million dollars a year
And I'm wondering if that is in line with your own estimations
If not what is your estimate of what that cost?
Shift will be and is that cause shift built into our budget?
I suppose you say this isn't is this going to also not happen until 2028 or is just happening?
immediately
So to the chair the administrative cost shift does start in
For state year 27 so we're budgeting for right now
To the Chair for the record this is Emily Ritchie, so the Administrative cost Shift I think already
I have to pass it over.
We have a lifeline from the division director.
It's good.
For the record, this is Deb Etheridge, director
for the Division of Public Assistance.
To the chair, the administrative shift
occurs effective federal fiscal year 27.
OK, and so remind me, does that mean
it needs to be built into our state budget for 27?
Or are they on a different schedule?
For the record Heidi Hedberg, so we are currently working through that and we'll provide an update to the committee
Okay, and yeah, I'm very interested to know if it has been built into our budget or into the governor's request
and so
Is 47.5 million dollars is that in line with what your estimations are?
So for the Record Heidi headberg we will follow up with the Committee on what the amount is of the administrative
Cost shift impact that 25% a similar question. I'll turn it over to my colleagues
They want the food bank also estimates that between
4500 and 6900 so
About 4,500 in 7,000 Alaskans will lose their snap benefits because of HR one is
That a simpler projection to what the division is expecting
To the chair this is Deb for the record, this was Deb Etheridge director of public assistance
I would say no, that is not what we're estimating in loss of benefit.
The changes in HR1 for SNAP really to the able-bodied work requirements.
There's a number of exemptions.
The state of Alaska was able to apply for what's called a good faith waiver to those ABOD,
which we did apply and we have for one year, but we can have that good
faith waver exemption until October of 2028.
And through that process, we hope to be able to align our systems to make it simple for
individuals to verify their work requirements and really implement a robust ABOD program.
ABLE-bodied adults with dependent children, without dependent
children.
Senator Tobin.
Thank you, thank you Mr. Chairman and you know I.
I kind of bristle a little bit when we say able-bodied because there were particular
exemptions previously for folks with SNAP that now we're not allocated to this particular
dynamic.
So I'd love for you to talk a lot about that because I think it's helpful for the folks
to know.
I appreciate the application for exemption, however I still think the information should
be made public.
The removal of exemptions for veterans, for folks experiencing healthlessness.
For folks who are aging out of the foster care system, the 10% dynamic.
If our state has a higher rate of those who aren't unemployed and how we might be tracking that.
And additionally,
the removal the exemption for
folks that are caring for dependent children at all ages.
To the chair, again, this is for the record,
through the chair of Senator Tobin, you did list the groups that are no longer considered exempt.
We do have some capacity to have discretionary exemptions, but
that said, those are the removal.
What isn't there is what has been expanded in that Alaska Native, American Indian,
California Native are also exempt from those work requirements.
And that is current in our good faith waiver.
We have already exempted those groups
from the able-bodied work requirements.
So to.
to be clear about that and I think what you're saying is exactly why we applied for that
good faith waiver and i think that the administration understood that Alaska was going to experience
some unique circumstances that we had to have the time to care for in order to ensure that
The removal of the dependent care starts at age, I think it's 14.
And so anybody with a child under the age of 14 still has a dependent child and
is not required under their able-bodied work requirements.
And I can follow up with the committee on those specifics.
I I that would be better in writing.
Yeah, Senator Tobin.
Thank you, and just one follow-up as you mentioned that there is a new exemption for
folks who are American Indian, Alaska Native, California Native.
How is the department tracking that?
How, how do you go about determining that someone meets those exemption requirements?
Through the chair, Senator Tobin, right now we collect that information on our applications, but it's voluntary.
And so we do require, and we provide information to individuals that if you're
may be exempt from an able-bodied work requirement and they can voluntarily
provide that information to us and that is how we're collecting it right now.
We can't require that field.
Our federal oversight entities don't
require us to require the field, don' t allow us.
Last follow-up, I'm curious as someone who is experiencing
How would they provide that documentation to your department if they may not have their vital documents or tribal cards?
Through the chair, Senator Cholman, it is an attestation.
Very good.
Senator Klayman.
Just going back to the state payment errors and
the goal is to be under 6% brought it down significantly.
Is there any history for us ever having been below 6%.
Thank you very much. Through the chair, again, Deb Etheridge, Director of Public Assistance,
Senator Klayman. In years such as 2011, 2012, 2013, and 2014, we were as low as 0.76 percent.
In 2017 and 2018, were closer to 7 percent and then it rose post that.
Yes, thank you, Senator Klayman.
I'll just to put a pin in this, the food bank has their estimation.
I understand we're applying for a waiver, but I would like if you can provide in
writing the department's estimation, trying to be realistic about if there's
more administrative, as we are changing exemptions, rather as the federal
government has changed exemptions and some of them require.
More attestation you're going to end up having people slip through the cracks and then some folks
You know genuinely won't meet the new exemption. So I'd like a
A number if you were able to provide it
So we'll move on to if there are no other questions on snap we move onto the Medicaid portion in the next slide
For the record, my name is Emily Ritchie, Deputy Commissioner for the Department of Health,
and we are looking at slide 13.
So thinking about the impact of HR1, I really think about changes relative to the Medicaid
program in three different buckets.
The first bucket is changing financing mechanisms at the federal level, and that's really what
this slide speaks to.
The other two buckets include eligibility and enrollment changes,
which we'll talk about in the next two slides.
And then the third bucket is a number of other changes.
We did not include kind of that third
bucket in presentation materials for this committee,
but we're happy to follow up, of course, at any time
at the committee's convenience.
So one of the aspects that I think is really important for individuals to understand in policy makers is that the bill does make changes to different financing mechanisms that state use to fund their Medicaid program.
specifically two different financing mechanisms.
One is something called provider taxes, and I think many of you on the committee have been involved in debates
within the state about whether or not to establish a provider tax.
Alaska is the only state in the U.S. that does not have a
provider, tax, so these changes do not impact our
how our program is financed today.
The other financing change that occurred was something called state directed payments, and these are, this is a mechanism that states that have managed care organizations use to direct funding or payments towards specific entities or types of services.
Alaska as well does not have any state-directed payments. We do not. Have any managed-care organizations. So again, neither one of those funding mechanisms impact Alaska.
At a national level, some of those funding mechanisms were important to support other states in how they provide care to rural areas or to maternal and child health.
And so as states work through the impacts to their budget, I would anticipate that they are having some hard conversations in those areas.
It could be easy to kind of.
Confused what's happening in other states with Alaska's Medicaid program and we heard that initially from constituents who were concerned that there would be impacts to their services and so I just want to highlight that for this committee and for anyone listening.
Moving on to slide 14 and cognizant of the time.
I do want spend some time talking about eligibility and enrollment changes because those are areas that Alaska is working towards and that will impact Alaska.
So, there's new eligibility requirements and these are focused on the Medicaid expansion
population.
And so, these individuals who are eligible for Medicaid as a result of income and not
necessarily eligible through any other types of categorical eligibility.
calendar year 2026, these are individuals who are making about $26000 or
more if they are a single household or $35,000, just over $3,500 if
they're a household of two.
And so the bill makes changes to eligibility requirements and
requires that able bodied adults that are within the Medicaid expansion
population who were between the ages of 19 and 64.
complete 80 hours per month of work or other qualifying activities, and I will try to be really
clear. I know there are a lot of questions about this. It can be very complicated,
and we are working through getting answers to some of these questions, but everyone is
those qualifying activities can include job training, education, or volunteer service,
and again states are working with CMS to get more guidance in terms of details for what all
of those means. So we will share with you what we know today guidance will be forthcoming
and we'll have more firm guidance by June of this year.
The bill also allows for seasonal income flexibility.
I know this is something that our delegation worked really hard on, given the number of
Alaskans who have very seasonal jobs.
And so the bill, also, allows average income over a six month period to count as meeting
that 80 hours per month if that income is sufficient.
individuals will need to demonstrate that they have completed 80 hours per
month of these qualifying activities in the month prior to enrollment and in
the six-month period prior, to their redetermination. Another change that is
taking effect is that redeterminations for this population, for the Medicaid
expansion population will occur every six months instead of every 12 months.
So again, we have the addition of community engagement requirements, as well as more frequent eligibility determinations.
And again this is focused on the Medicaid expansion population.
I have two quick questions, Senator Meyer, and we'll get to you.
I know we've got a long list of exemptions on next page, but I want to stay here for a second.
The first is, I've heard from a provider that if someone under HR1,
not work required, but this engagement requirement.
They are then locked out of ACA exchanges.
Is that true?
Is there any interplay between this program and the ACA Exchanges?
To the chair, Senator Dunbar has written in the bill an individual who fails to qualify for Medicaid.
Because they did not meet the community engagement requirements would not be eligible for premium tax credits on the exchange.
So that is an element of the bill.
I know you can't really answer this, but why?
They seem like vastly different programs.
The ACA is more akin to a private market.
Why deny someone access to that?
To the chair, I can speak to it.
And we have no flexibility in that at the state level, is that correct?
To chair I would need to refer to the Division of Insurance
regarding the marketplace plans and restrictions there.
We'll go to you next, Senator Meyer, and have another question.
Thank you.
So you talked about six month rechex as opposed
to the standard yearly.
Do you anticipate a significant burden
on your eligibility technicians?
Are we talking about potentially changes to your budget
or having to hire extra people for that?
Through the chair, Senator Myers, that is one of the things that we are looking at throughout this whole process is what are the technical requirements?
What are going to be the staffing requirements, what're the communication requirements to implement aspects of this bill?
One thing that I have to put into context,
the changes in this Bill impact an estimated 71 to 72,000 Alaskans.
which is an important number, that's the size of our Medicaid expansion population.
When we started in these roles, we and all other states had to undergo a process of reviewing
redetermination or eligibility for every single Medicaid enrollee in the state.
And that was about 250,000 individuals.
And it took us about two years to get through that process we did.
is substantial work for the division, but it is not the same level of work as we undertook
the last two years where we were doing a review of kind of the entirety of
the Medicaid population. We also developed through that new tools.
And those tools are improving that allow us to leverage other data sources so
that we can automate, re-determination, and renewals as much as possible.
And we are actively looking at how we could use those
tools to help inform individuals ability or their qualifications for
exemptions which are on the next page.
And the exemptions become critical.
because they are very broad, I mean there are a number of different exemptions that could
cover a substantial portion of the Medicaid expansion population.
And I think Alaska, as well as other states, are looking to figure out how we can simplify
the process.
So we could very clearly understand who must meet these community engagement requirements
and who has an exemption.
It will increase workload, but to what degree really depends
on how much we can effectuate our technology
and our data sources to automate this as much as possible.
And that is what our focus has been on as we've been preparing
and building out for the last six months.
And we have had a really great team that has kind of been working
in the background for last 6 months tracking the guidance
that CMS has issued and meeting with different contractors
and different technologies to try to figure
out what's going to be the best approach for Alaska.
Thank you. A little bit different question. So education, you know, I'm thinking about,
you in college, the kind of the standard full-time workload is 15 credit hours a week. The university
still counts you as full time if you're all the way down to 12. But if your just talking
the 80 hours a month, that's going to be, if you're only at 12, you are at 64.
So are we telling people that they have to
be taking very heavy class loads or are they expecting, can we combine education hours with job hours or how does that work?
Through the Chair, Senator Meyers, those are all questions that states are working through with CMS right now because some of those details are really important to how we implement.
I will tell you when I worked in the.
In the division of retirement of benefits, the retiree plan was one of the few plans that still had a restriction on coverage for dependence up until age 26, unless you were a student.
So there aren't many plans to have had the experience of trying to understand those dynamics.
What exactly counts as part-time?
What counts is full- time in relation to different universities, different credit hours,
different semesters versus quarters?
Again, we are working through that with CMS and asking those questions.
We don't know what those answers are right now.
I do know that CMS is working to build out access to the national scholastic database,
I believe, so that states will be able to automatically connect to that database to know,
again, if an individual is considered a student where I suspect they will land.
Although, again we don t have full guidance on this, is that it will
It will be up to the University regarding how they define full-time or part- time student and that will probably flow into the
Whether or not they meet these requirements. Okay, thank you. Thank you, Senator Meyer if we go to
the next slide through the chair just one more point that these
requirements become effective December 31st
2026 but states may apply for a good faith waiver to phase in implementation through The End of 28
Are we going to do that?
Have we done that right now?
We are making a good faith effort to look at all of our systems and what the build up
will be.
And if we need to apply for that waiver, we plan on doing that.
So there are a number of exemptions in these bills.
And again, I know that our congressional delegation was very thoughtful about.
Trying to make sure that Alaskans had the exemptions that they needed to
make that these requirements are focused on people who are able-bodied and not on others.
So this bill provides a series of mandatory exemptions and
then optional exemptions, that we'll talk about in the next slide.
For mandatory exemption, you can see if an individual or
Pregnant women is, or a woman who is within the postpartum,
coverage period, they are exempted from these requirements.
Alaskan natives or American Indians
are exempt from this requirement.
Individuals who have a significant physical, intellectual,
or developmental disability are
exempt as are those who are blind and disabled.
Individuals experiencing substance use disorder
or disabling mental health condition are
exempted, as well as those
That also includes individuals who are medically frail, and I can tell you there's been a lot of time in the last three months spent at a national level.
Again, between Medicaid directors and CMS, as well as within different chief medical officers around the country to come up with a definition of what medically fral would mean.
There is the ability in The Bill for States to submit kind of a.
a variation of medical frailty to the Secretary for consideration, but right now I think CMS
is taking a relatively firm approach with looking at existing federal regulations for
that definition. So we'll see where they land,
but we are tracking it closely. We are also veterans with the total disability rating
are exempted as are those enrolled in Medicare, so anyone 65 or older or anyone who qualifies
individuals who are parents or caregivers for a child who's 13 years or younger are exempted,
as well as parents are caretakers caring for someone with a disability.
Individuals who have been recently incarcerated or released within 90 days are exempted,
as those under age 26, formerly in foster care.
And that last bullet, it is individuals whom meet, snap, or TANF work requirements.
I needed to update that a little bit.
One of the questions, again, states are looking at, and we are talking with CMS, is can we
provide for a self-attestation upon that initial review?
So if an individual believes that they meet any of these exemption requirements, can they
self attest?
And then in that redetermination period, six months later, could we either use
data that we have access to within our systems, with permission, of course, from the individual
or other national data to basically verify that exemption.
Again, we're trying to see if we can leverage as much as possible to make these systems
automated.
We'll be releasing more information, I think, later this month, but initially, in looking
Needing to require with community engagement requirements. I would say just about two-thirds of the population
We believe would qualify for an exemption and we would be able to potentially automate
That exemption following verification. So again, we are working to build that out more and will release more information as it becomes available
But we're really trying to take that approach so we were almost out of time. We were actually over time
I'll say this is sort of
the heart of the issue, is how do people prove this?
What kind of administrative burden is it to process this,
and so we will certainly have either you, Deputy Commissioner,
or whoever you feel is most appropriate come and speak to us again
in the near future, maybe when that information comes out in a month
or maybe sooner.
Senator Tobin has a question.
Thank you Mr. Chairman, and this is actually one that I think you
and I both are pretty interested in.
We know that one in 10 veterans is on Medicaid.
We now that they are not necessarily 65
and also accessing Medicare.
We also know
that a total disability rating is not
necessarily one that many veterans meet.
They might be at 60 percent or 70 percent.
So I'm very curious as we know
that as a population that often is overrepresented
in experiencing homelessness and healthlessness,
some of the suggestions you might have
on how we hopefully help this population
joint base on the door for Richardson and have many folks in my district who I'm deeply concerned about with this particular dynamic that is about to really wreak havoc in our state.
Thank you Senator Tobin, I think if we can briefly touch on a next slide and then, like I said, we're already over time.
We will hear from you again on this topic specifically.
Hi, the chair for the record, this is Emily Ritchie, so moving on to the next
There's a series, like I said, the prior slide was mandatory exemptions that all states must apply.
This slide is optional exemptions, that states can choose to apply, Alaska is choosing to
apply these exemptions as we move forward. That is part of our plan.
So individuals living in areas with high unemployment would be exempted, and that is defined as an unemployment rate
greater than 8% or 150% of the national average.
Those in federally declared disaster areas.
individuals receiving inpatient or residential care.
And then again, this was a kind of a, specifically for Alaska,
those traveling for medically necessary care that is not available locally.
We know that that's an issue in our state.
Very much so.
All right, thank you very much Deputy Commissioner, any final questions?
Again, Thank you everyone for staying late today.
Thank You Commissioner and your team.
Our next, let me see.
I seem to have misplaced my script here.
The next meeting of the Senate Health and Social Services Committee will be Thursday, February 5th.
We look forward to hearing HB 27 act relating to medical care for major emergencies.
It is now 5.05 p.m.
This meeting is adjourned.