Good afternoon everyone. I call this meeting of the House Finance Department of Health subcommittee to order let the record reflect
it is
321 to be precise
Here in Juneau on Thursday February 10th, 2026 present today are representative schwonke
Representative mirrors representative Mina representative Gray
Rep. Prox was with us. He'll return and myself chair Josephson also present. Today our LIO moderator
Houdet Augustine, Jude, apologies, I took a chance.
From, didn't go over.
From the Legislative Information Office,
Valerie Rose Analysts from Legislative Finance Division
and Committee Aid Aaron Page.
As always, please remember to mute your cell phones.
In today's meeting, we will hear a budget presentation
from the Department of Health.
First up is the Division of Public Assistance
presented by Director Deb Etheridge
and Administrative Operations Manager, Sierra Meek.
A Director Etherige and Miss Meak,
please come to the table,
put yourself on the record and begin.
Thank you committee for the record. My name is Deb Etheridge. I'm the director for The Division of Public Assistance with me today
Is Sierra meek my administrative operations manager for someone to thank you for
the opportunity to present on the Division Public assistance FY 2027 budget as you know the division of public assistance is really the
front door to essential services for Alaskans to promote self-sufficiency
In fiscal year 2025, the division served more than 426,000 Alaskans,
which is nearly 58% of the state's population.
That scale underscores the importance of our work and the breadth of services we deliver.
At this point, I will transition to the budget portion of this presentation, and I'll turn it over to CRMEC.
Yes, all right, Ms. Meek.
For the record, my name is Sierra Meek and I'm the Administrative Operations Manager
for the Division of Public Assistance. And I apologize, I am having some technical difficulties
with the slide. I don't know how to advance right now. Okay, let's see if we can help. Here we go,
apologies. Fixed. This slide reflects the division's operating budget across fiscal years 2025 through
final authorized operating budget was 367 million. The fiscal year 2026 management plan is also
shown here with the addition of fiscal Year 20 26 supplemental items currently under consideration.
With those proposed supplemental included, the fiscal years 2027 total budget would be 376.2 million
The fiscal year 2027 governor's budget totals 340.4 million and includes 502 full-time positions.
When comparing the fiscal year 2027 governor's budget to the Fiscal Year 2026 management plan and
Excluding those fiscal Year twenty twenty six supplemental's the division's base budget remains essentially flat with a slight decrease of less than one percent
This change is primarily the result of one-time and temporary funding that was authorized in prior years and is now expiring
I will describe those items along with the FY26 supplemental request in more detail on future slides.
The division.
Ms. Meek, will those slides give us a sense of whether there's a reduction in need that reflects the reduction of benefits?
To the chair, yes.
Okay, all right, please continue.
The division's budget is primarily comprised of federal receipts and unrestricted general funds which support both direct benefits and
the required federal match, or sorry state match for federal programs.
Additional federal sources include designated general fund and
other receipts such as the permanent fund dividend hold harmless, statutory designated program receipts, and
Although the Senior Benefit Payment Program is a separate appropriation, it is administered
by the division and is included here to provide a complete picture of the Division's responsibilities.
A majority of division's budget supports outgoing grants and benefits that directly
address community needs.
Personal services make up the next largest category, which supports staffing required
to deliver benefits accurately and timely.
slide three, slide 3. First, I'd like to thank the legislature for the support of several
important fiscal year 2026 items. These investments have made an immediate and meaningful impact
on service delivery and system stability. The preschool development grant concluded in
Those funds strengthen Alaska's childhood system through workforce development, strategic
planning, and initiatives like Roots, which is retaining our outstanding teachers.
Building on that foundation, the legislature made significant investment directly into
allowing the division to modernize a funding structure that has not changed since 2012.
These investments are improving stability across child care system by giving providers greater predictability and
flexibility, particularly for infant toddler care and for new providers entering the field.
In parallel, Senate Bill 95 strengthened the childcare assistance program by expanding eligibility,
co-payments, and supporting employer-based childcare solutions.
Implementation is underway through staffing,
regulatory updates, public engagement,
to ensure these changes transform into real access
for working families.
Alongside the childcare investments,
the legislature also supported improvements
in core eligibility operations.
Funding for 15 new eligibility technician positions
is an investment in long-term service delivery.
One position has been recently filled
and recruitment is underway for the remaining positions.
As these positions come online,
they represent the division's off ramp
from reliance on contractors
by building permanent in-house capacity.
Following federal approval in October of 2025, the division began implementing the SNAP
new investment activities focused on staff tools, client systems, and quality assurance
to reduce error, improve timeliness, or modernize eligibility work.
These items reflect fiscal year 2026 actions that are already underway.
I'd like to ask a few questions, and I know Representative Gray has one.
First off, as to the last item, so to remind the members that they may very well see as soon as next week,
a supplemental budget bill on the House floor, but we will not have in our purview supplemental items.
So they have relevance to your lives, I think,
as legislators, not to budget action will take.
Now, my question to you, Ms. Meek, is this $5.9 million?
Was that taken from the Village Safe Water Program?
Are these the funds that were drawn during the federal government shutdown?
To the chair, no, these are not those funds.
These were appropriated last year.
Okay.
And I will be going over the supplemental items on the next slide.
Okay, just for your awareness.
I follow up to my own question.
There were an additional $5 million or something
taken from Village Safe Water for SNAP.
To the chair for the record, Deb,
Etheridge, we did receive disaster funds
during the federal shutdown,
and $ 5 million of those disaster
funds were distributed through the food bank,
and Food Bank of Alaska and Fairbanks, Food bank.
And their source was what?
To the chair, the disaster, it was through the Disaster Declaration.
And I'd have to call Lifeline to figure out exactly where that was appropriated from.
I can't, my apologies, I could come back.
Miss Meek.
To The Chair,
I believe it is the Disaster Relief Fund.
Thank you.
Okay, all right.
I'm going to go to Representative Gray.
We have a full committee now.
We've been joined by Representative Fields and Ruffridge.
We'll go ahead and represent Gray then Prox.
Thank you.
Through the chair, my question's also
about the Child Care Grant program.
So per, I am looking at the mid-year status report.
My understanding is that we appropriated 7.5 but then we went ahead and increased to 7,725 and then the governor vetoed 1.857.9 million out and it said it's a quote, setting the base increment below historical funding levels.
So I'm just curious if there were any impacts from from that.
To the chair, Representative Gray, I'm hoping that I can answer this question correctly.
I was remiss.
I do have a lifeline in the audience.
Lea Van Kirk with the commissioner's office is here and available to respond and maybe
I should.
For the record Leah van Kirk health care policy advisor for Department of Health
Through the chair to representative gray. I think that reference is to the FY 24 and 25
One-year increments of 7.5 million and then the fy 26 allocation allocation was just below that amount
Follow-up groups no great. Thank you through the Chair.
I just I'm it's just a curious way that you you're like, you know that the department itself
Remarks that you that it was setting the base increment below historic funding levels
So I understand that. It may have just been
Less than what you've done in the previous couple of years, but I'm curious about
Did that have an effect that did having child grant care grant programs funded less than they had been in
The past what affected that half
For the record leave in Kirk through the chair to representative gray
One item that I'd like to just escalate and note is that the $5.9 million that was added
was an added to the base rather than a one-year increment, and so the Child Care Program Office
Department of Health is very thankful because then as we move forward, we can implement
It was a decrement but we are redesigning the child care grant program in order to care
for some of the recommendations in the governor's task force on child
care. Thank you. All right. I see representative Prox and then
Chair Mina.
President Proxx. Yes.
Thank You. Through the chair to follow up just on
came from the state budget somewhere as opposed to the 5 million bucks disaster relief did
that come out of the State funds or the federal funds.
Director Etheridge.
Through the chair, Representative Prox, the five million was through the
are federally funded.
So the state does not fund the SNAP benefit.
Those are federal dollars.
OK, so it through the chair is that money expected
to come back from the feds to replenish what was
drawn from disaster relief fund.
Director of Etheridge.
Thank you through through
the Chair again, Deb Etherich sorry to representative
We did not replace SNAP benefits with state funds.
We provided the federal funds, the Federal SNAP funds as soon as they were available
from the state government.
And a different question related to what representative Gray was talking about, child?
Yes, I will tell you, though, Director Etheridge.
Meeting with the Food Bank today, they said that I'm going to recall Ms. Durer, who I
'm sure you've heard of, noted that indeed funds were spent from a different source because
of the federal government shutdown.
I mean, that was the essence of what she said, which suggested that something needs replenishment.
And maybe there's some confusion here.
I'm aware that some communities provided financial support to members of their community
to address the gap in SNAP benefits that was created by the shutdown.
However, those were not provided by this state, if that makes sense.
I believe there was a trial entity.
There was, according to the press, there
was clearly, in October, the governor, as he maybe should have, took five million dollars
from an irregular source to fund SNAP, because those dollars were not forthcoming from Washington.
And it remains a mystery wrapped in enigma for me, and I don't understand it.
appreciate the complexity because I live through it. We did issue full snap
benefits to all individuals who are impacted and the issuance of those full
snap benefits occurred in increments and finally making them whole at the end of
the government shutdown.
Okay, I interrupted you, Representative Prox.
It's okay, thank you.
We're resolving that same subject to that, that was good to you
So, back to child care, representative Gray was talking about, uh, through the chair,
do we have any information, the starting point,
the situation was x.
and either the problem got better or worse.
Do we have some measurable goals and objectives
for those funds?
Please, Ms. Kirk.
For the record, Leah van Kirk,
Department of Health,
through the chair to Representative Prox.
So the Governor's Task Force on Child Care identified many recommendations with a premise that our focus was to increase affordability, accessibility,
and quality, and so those are represented in the Governor's Task Force recommendations.
So one way that I would respond to increasing affordability is the work that we have done
around increasing the eligibility requirements for parents to qualify for a subsidy.
Task force and the passing of SB 95.
Thank you.
Our state median income requirements for income were 85%
of the state meeting income is what qualified a family
for those benefits.
that increases to 105% of the state median income now.
That's one measure of increasing affordability for child care.
The other component was that we did an assessment around the cost of care,
the costs of providing childcare.
In order to understand if our rates fit a business model that supported child
What we found is that the cost of care is higher than what child care rates can support in terms of business modeling.
Through that, there will be a regulatory package that you will see that addresses some of those components and
integrates the use and considers the costs of providing childcare.
I was looking for something like X number more family served X
number of child care providers that either opened up or didn't go out of
business or something that we quantify. Do we have something
like that? Ms. Kirk.
We have had to focus hard on stabilizing the child care sector.
And so we've done that through many ways, increasing our child
care grant, um,
increasing affordability, looking at our rates, reducing barriers.
And, so, we're at a place where we are stabilising and over the next year,
we expect to see an increase in our childcare supply.
One of those strategies is also introducing a new provider type
called Families, Friends, and Neighbors.
which might meet the needs of rural communities better because it supports grandparents, relatives,
friends in your neighborhood and being able to pass those health and safety requirements,
get startup support and then provide care in smaller settings.
Okay. If it's brief, it is brief. Do we have some way of quantifying that or will we
Is it Ms. Kirk or Van Kirk?
Uh, Ms Van Kirk.
Van kirk, Miss Van Kirk.
Thank you through the chair to Representative Prox. Yes, we do look at licensed capacity in
our state. So the number of licensed child care spots that we currently have. We also look
at the numbers of providers licensed, unlicensed military families and other accredited organizations
or tribally exempt organizations. so we can look
at those pieces as data markers to indicate if we are increasing our supply.
Thank you. I would appreciate if you do that and come back with numbers.
It's a relatable question for me.
I think we want the satisfaction of seeing that progress.
Represent Mina.
Thank You.
I have two different questions.
So the first is on the full-time eligibility position.
So I'm trying to remember this correctly, but it was in starting in FY 23,
where the division started to.
add on more like the long-term non-perm positions to DPA and so it's great to see the transition
to those positions, to be full-time and, so, at this point, are there any more temporary
positions that are at the division or have we fully transitioned back to full time eligibility
positions?
Director.
Yes.
Through the chair, Representative Mina, we have 11 non-permanent positions,
so we've dramatically reduced the reliance on non permanent positions.
Most of our positions within the Division of Public Assistance are permanent
positions."
Thank you, and just to follow up, thank you.
Thank, you through the Chair.
Could you talk a little bit more on the SNAP new investment?
Is that related to the FNS fine or call centers and what was being done with that?
Director.
Yes, through the chair, Representative Mina, yes, the investment is on a quality investment,
quality improvement plan investment.
It is negotiated with food nutrition services.
We developed a plan that was in compliance to improve our quality, our QC error rate,
our Quality Control error rates.
The plan has three buckets, if I can put it fairly simple.
One is focused on our tools for our eligibility technicians,
including a worker assist tool, a centralized technician repository,
so information can be provided easily in our policies,
and then a policy tracking tool.
is our client facing improvements, which includes improvements to our
client portal. I'll talk a little bit about that later in developing that
recertification e-form for SNAP, making enhancements to
our notices, and validation of a client Portal. And what that is important is
because what we've heard right now
Our portal lives behind my Alaska.
And some Alaskans do not have an email address.
And so we want to have a tool that they can use without that.
And then the last is to improve our quality assurance checks
and have the system to record them and go full circle
to make improvements.
And that's all in the plan with FNS.
Yes, follow-up representative Mina. Thank you through the chair just a quick follow up
I have the DPA modernization timeline in front of me
And so this just partially funds some components of the different milestones
Is that correct because my understanding is that you know worker experience, etc
Those are a little bit of a years out in terms of that entire modernization process
Through the Chair, Representative Mina, the milestones, they're noted in the
milestones and they are happening simultaneously. Last month we implemented
analytics for our document management, which is the next step to having the
available information in our client portal, so it's incremental and happening at
Representative reference
Thank You chair josephson through the chair. I still had a question on the child care component
This has been I think the second or third year
We've kind of had this lingering out there and each time and it to represent of Josephson represent Proxis question
The intent originally if I remember the language correctly was that we could serve approximately 12 to 1,300 more children
or they would have access to child care.
It was approximately that number.
Is there a way to determine whether or not the number of
children that have the access
to quality child has gone up?
Director.
Yes, through the chair, representative Ruffridge.
Yeah, we absolutely do keep statistics on the
number children served and the licensed providers.
And I.
I believe it would do us well to provide that in writing to the committee.
Okay, thank you. Representative Fields.
Well, through the chair, as you might guess, I'm interested in that. But I was going to say, in the years since the legislature
started appropriating funds first to support the workforce.
Then as fiscal notes for legislation, my observation as the department has gotten better and faster every year.
getting the maximum benefit.
It's exciting to see this program go into effect.
So I just, you know,
you all went through a lot of organizational learning
and I realized you'll have a lotta other demands,
snap backlog and so on.
So just appreciate the sustained effort on childcare.
And I also wanted to thank you for your report
and the letter on Medicaid and schools.
That is really exciting
to the see the progress there.
So, I think those are two areas that are.
really encouraging in terms of the work the department is doing and I do want to learn
more and if there's there are things we can do in
terms making sure parents are aware that they might be eligible for child care
subsidies, I want know that as we talk to providers. Thanks.
My last question before we finally flip to slide four is about these
Things that we heard is that
Wages were inadequate to be competitive. Is there any way to know whether these dollars are translating into increases in pay?
To the chair Deb Etheridge director of public assistance
The intention is to increase the base grant for providers and then also remove the
of her child cap, which allows, it's dependent on cost
in the school district, the cost to allow increase
to the base grant for a child.
And so, I might have to call the up
if you have another question.
And I can answer that.
If you were a substantial they have.
Do you agree at math and intent?
To the chair I do agree.
That's what I needed.
All right, let's go to slide four.
for the record CRM make administrative operations manager.
I will now turn to the governor's fiscal year 2026 supplemental requests.
The first item is a $0 request to extend the SNAP nutrition assistance program new investment.
This timeline will extend from June 30th of 2026 to June
30 of 28.
This extension allows contractor sufficient time to complete
implementation and ensures ongoing hosting, maintenance
and operational support for the systems being deployed.
The next item addresses the systems that underpin nearly all of our eligibility determinations.
The division relies on several mission-critical eligibility systems to deliver benefits across
Medicaid, SNAP, and other programs.
This supplemental request reflects rising operational and maintenance costs as systems
move from development into state operations.
The division is also maintaining reliable access with client seeking assistance.
The Virtual Contact Center supports timely communication with Alaskans while eligibility
staff focus on application processing and casework.
It manages approximately 20,000 to 24,00 calls per month, helping ensure timeliness and maintaining
federal compliance.
The next supplemental is requesting additional federal authority for food costs related to the women infants and children program better known as WIC
These funds are needed due to rising food prices and the expiration of prior multi-year authority
This ensures benefits remain sufficient to meet participant needs without service disruption
The final supplemental request for senior benefits reflects higher participation levels, which aligns with Alaska's growing senior population.
All right, and as I said, this is not in the preview of the subcommittee, but I'm going to go ahead and quickly ask something.
The item on number two, is that related to HR 1?
Is that an increase in administrative costs due to H.R. 1.
To the chair, Deb Etheridge, no, those are not related to HR1.
Okay, and then as to the senior benefit payment program,
Representative Gray had asked about getting back to
the full statutory allowance, is this the cure for that?
To The Chair,
Deb, Etherich, this is the care for them.
All right, let's go to slide five.
Sorry, I apologize and potentially I mean it is on the slide.
I guess, Mr. Chair, is it okay to ask questions about the supplemental in this?
No, it's not for the F. Please go ahead.
Let's just, we won't get too bogged down and understood.
So I had a question on a virtual contact center through the chair.
I recall that this was I believe not funded in last year's budget.
Well, and it sounds like it's still working
Was there a transfer of funds from another source to keep that operational if so what source was that?
It seems like this is
Unusual
Yes
To the chair, I would like to see if I can get some support from Pam Halloran sure miss Hallarin
Good afternoon for the record, Pam Halloran, Assistant Commissioner for
the Department, through the chair of Representative Reffridge.
The virtual concept center was maintained because it was basically crisis time for
the division.
Go into our budget and leverage money from other places in the budget.
The primary source of that was Medicaid.
We were able to identify eligible costs through the division's random moments time study and
charge that to Medicaid
Follow up, Mr. Chairman.
Yes, follow up.
I guess I was not aware you had the ability to do that.
Is that something new that I missed?
A.C. Halloween.
And through the Chair of Representative Ruffridge, we do that throughout our department.
We have contracts that are managed, that entirely serve the Medicaid population.
That are charged in Medicaid services, so this was just another one of those items.
We're trying to be more consistent across the division by charging items like contracts.
That serve solely the Medicare population to Medicaid Services.
Okay, and then final yes final. Yeah. Thank you, mr. Chair
So I mean did that in any way?
Diminished our ability to provide some of those services and if so how much money was leveraged?
out of Medicaid services for the contact center
Through the chair I
would have to remember exactly, there were a number of other smaller sources too that we
leveraged throughout the department. So I would remember the exact money that
we leverged. The reason why it's complex, and I'm pondering, my answer is because
there's a member of different enhanced federal funding sources for that,
and speaking now, I am speaking to the eligibility systems too, different items in our budget are
Come up with that exact number for you right now, but we can follow up.
Okay. Representative Schwonke.
Thank you through the chair. Director, I'm not sure who to direct the question to,
but I guess I am a little bit confused on the eligibility system's line item.
to maintain upgraded operations.
Why is this not in the operating budget?
Director.
For the record, this is Deb Atridge
through the chair to Representative Swanky.
What we discovered is that as the division
has transitioned from a capital project to operating,
those weren't reflected in our operating budgets.
And what you're seeing here is a correction of that.
Follow up. So this is a one-time thing or it will be in the operating budget going forward
Through the chair representative, this has added to the base
Okay
Okay
Were you in a queue?
Please go ahead. Thank you chair dresses in through the chairs
Could you talk a little bit more about those the eligibility systems funding and what that one?
towards.
Absolutely.
Of course, I didn't bring my cheat notes up here through the chair representing Amina
for the record, Pam Halloran.
So I might allow Etheridge to speak to the actual system.
She probably has that in her notes.
But as far as the cost, it was primarily we dove into the division of public assistance
We looked at FY 23 actual costs and we looked
at 20, 2026 actual cost.
And this request is almost the difference,
less what we leveraged Medicaid for.
So we've seen a significant cost increase
and the primary driver in that has been Aries.
And I'll let Director Etheridge speak
to the actual systems.
Director.
Deb Etherige, for the record,
Deb Ethridge to The Chair Representative.
When you hear ARIES, I think you think of it as this monolithic system that hasn't changed
its Alaska's resource for integrated eligibility.
eligibility system. In fact, it's become our platform for all of our modernization.
And so if you can think of it like building the foundation. And
so we leveraged the technology that was built into Aries to make it a
Azure on-prem, cloud-based, and so that we can start to build modules on top of
capital production, and we go into operating, that's when we have to shift from our capital
budget into our operating budget. And that is happening, which I think we all
That's just what we pray happens that we finish our capital projects and we go into
operations but that's what this is reflecting. And so even while it says
Aries and that sounds like a monolithic one system, it's really a platform.
Okay, I represent the fields quickly and then we're going to move to slide five and I
assume the eligibility systems through the chair you want to get this right
have high error rates, you're actually subject to even larger penalties under HR1, is that right,
like maybe 10 to 40 million dollars if I'm like very large penalties if i'm remembering correctly?
Director. Through the chair, Representative Fields, there are in HR 1,
there is penalty related to our error rate in out years if we maintain an error
If we do that, then we have to pay a portion of the SNAP benefit.
Right, okay.
Thank you.
And if I could ask another question.
Yes, follow it quickly.
The virtual contact center is run by an out-of-state contractor.
Is that right?
Director.
Through the chair, representative, this is a great opportunity to sort of...
Put on the record what the virtual contact center is.
The virtual context center, is general, like it's a phone line.
It's what people call into.
And then it is staffed by both state staff and contracted staff.
And the duties that are performed on
the Virtual Context Center vary by the staff person that's
working on a virtual content center at the time.
Employees answering and working the calls that come in for, for example, Medicaid.
Follow-up.
So what did the contracted staff do then?
Thank you through the chair, Deb Etheridge, Representative Fields.
The contracted staff right now are the ones who are
the first answer, so they do the initial screen,
they'll answer the phone.
They can also receive applications and take an electronic signature.
They do data entry into our area system for Medicaid.
They also are responsible for doing some import of our documents,
they register and import documents, all of it is designed in order to keep the
division timely. If you can imagine, receiving a document is step one, and if
it doesn't get into our workflow, days later, then we become untimely.
Okay, I think final follow-up through the chair if that's okay.
Go ahead. What is the plan to ultimately
insource these jobs? I assume that ultimately it will be more efficient to
Thank you. Ms. Etheridge. Through the chair.
Representative Fields, you're exactly right.
There is a plan to exit the virtual contact center contractual support that we receive.
One of the steps is, of course, the eligibility technicians having a dedicated team of eligibility
technicians trained on working the Virtual Contact Center, but it's really braided with
our technology and our milestones and ability to enhance tasks so that
clerical tasks and automate them and then leverage the eligibility technician ones to
do more case specific work.
Okay.
Thank you for the additional details.
Let's go to slide five.
For the record, Sierra Meek, administrative operations manager.
I'll now shift to the fiscal year 2027 budget changes, which fall into three main categories.
First, the budget reverses one-time funding,
expiring at the end of fiscal year 2026.
This includes the reversal of the American Rescue Plan Act,
Authority for the WIC program,
totaling 219.6 thousand in federal funds.
In addition,
the Budget also reversals 210.5 thousand
in unrestricted general funds
This is related to the maintenance of effort for the Alaska temporary assistance program
and tribal assistance.
For clarity, I have combined two separate items into a single line here.
The fiscal year 2027 governor's budget also includes an Alaska care rate adjustment totaling
161.4,000 and 2.5 million in salary adjustments aligning with the statewide labor agreements
to support recruitment and retention.
And for the mathematicians in the room, you may notice that the federal and unrestricted general fund amounts do not equal the total.
The difference is due to other fund sources which are included in total, but not individually broken out on this slide.
Finally, the fiscal year 2027 budget includes 480.3,000 unrestricted general funds.
This is an increment for the senior benefit payment program, representing the third year
of the Fiscal Note implementation.
This increase reflects what was anticipated when the legislation wasn't acted.
Okay, Representative Mina.
My understanding is that within House Resolution 1, that states have to pay the administrative fee from 50% to 75% between the state and federal match.
And that is supposed to start in federal fiscal year 2027.
So why is it not in this budget?
Ms. Meek.
Through the chair to the representative, Mina.
We are working with the governor's office to address that increase.
In the SNAP administrative cost and the governor amends budget will be released next week
Okay, thank you
representative reference
Thank you chair. I think I might have gotten the answer to my question with that last sentence, which was
Governors of men budget next we because when we went through the beginning
slide it looks like
the
intention of the Division of Public Assistance is to reduce state UGF spending
by a significant amount of money, approximately 8 million.
But then we just talk through some of these supplemental items that might be going into
the base, such as eligibility systems, amid rising costs.
But, then, in our fiscal year 27 budget changes, I don't see any of that.
Are those coming at a later date and is that number on slide one going to be different?
To the chair to the Chair Representative reference
Yes, we've been working very closely with the commissioner's office on the needs of the division and
Will we hope to have
More answers to your questions
Okay, let's go to slide six
And this concludes my portion of the presentation, and I will pass back to Director Etheridge.
Director.
Thank you for the record.
This is Deb Etherich, Director for The Division of Public Assistance.
I'm going to spend a little bit of time talking about our operational updates at the division over this past year.
made meaningful operational progress focused on really improving access,
stabilizing workforce and workload, and just strengthening our service delivery.
We are serving a growing number of clients across programs while improving overall
process timeliness based on our internal reporting and tracking.
That progress is driven by targeted operational changes including automated service
We are now text messaging, notifications of schedules.
We're doing systemic improvement to our in-person lobby flow.
We've enhanced our document management and workflow practice
to reduce the manual handling and delays.
And a few years ago, the legislature provided significant support for critical IT improvements.
I really want to thank the Legislature for that investment into the division's capital projects.
It's very timely right now.
With that support, we've continued to meet technology milestones that improve reliability on service delivery.
The Alaska Connect Portal provides important digital entry into four clients.
capabilities so that we can enhance that experience for the consumer. These are
really enhancing our ability to reduce alliance on paper, base processes, and
really lays the groundwork for our modernization. In parallel, initiatives
such as DPA in a box are improving access and role and remote Alaska
communities and really helping ensure that Alaskans can connect with service
Finally, I would be remiss if I didn't mention, we continue to manage ongoing federal program
changes and compliance requirements, particularly for SNAP and Medicaid, while maintaining service
delivery and timeliness as timeling expectations.
Director, just to repeat, and I think you, Ms. Meek answered this, if you look at slides
There must be lots of amendments coming, or you have programs that will expire in some cases.
So it sounds like the amendments are due, I think February 18th, somewhere in there.
It sounds we should anticipate quite a few additions to the FY27 budget for DOH.
See, I don't mean to.
This is Deb Etheridge.
As I said earlier, we're working very closely
with the commissioner's office on the needs of the division
moving forward.
OK.
Rip, Gray, thank you.
Through the chair,
I just want to say before I do this little line of questioning
that I think you guys do the very best you can.
So I'm not trying to beat up the people in front of me, but my
questions are going to be about the 5.9 million in UGF. Again,
I want to say you want reduce error rates to avoid federal
To put, you know, we had the worst error rate in the country for two years running,
we were short 100 eligibility tech positions last year, 100 positions short.
I can't imagine that we can improve our eligibility rates with 100 people missing.
So I guess I'm just curious if you can speak about how on track we are to avoid federal penalties.
And just for my own curiosity, what federal penalty have we have?
Deb Etheridge, for the record, through the Chair Representative Gray, that's a lot to
respond to.
We have seen tremendous improvement despite the fact, and I'm going to talk about staffing
on my next slide a little bit, despite that fact that we do maintain a vacancy rate.
to make systemic improvement and it's really beginning to show.
For example, we have automated the processing for receipt of verifications.
We have created a document upload so that we're getting verification back timely.
Just those little improvements have actually improved our error rate
and improved the timeliness significantly.
The struggle with the air rate is that, and the reason we have the compliance plan is
that we need to make some internal supports for eligibility technicians.
With the number of new staff, we do have to provide quality training and
the resources that need in order to prevent any kind of errors.
And I do believe our investment plan has directly pointed to that.
I have confidence.
Follow-up represented great
Thank you for the chair
I guess to go to the second part of my question and and again, it's partly curiosity. I've been reading the media coverage
I know that
Attorney General Steven Cox
tried to get
Some charges dismissed, you know, like I don't know there's a lot of federal action that's put that like on top of the snap stuff
What
Current penalties to be faced
Through the chair representative the
Penalty that we're we've been talking about is our error rate penalty
And we are investing in our air rate Penalty
There's of course future penalties that. We could face or we all are experiencing
Class-action lawsuit and the penalty associated with that has not been established at this time
Thank you, Chair Josephson. I believe Chair Mina might have been ahead of me in line,
so I'll defer to her.
Chair Meena?
No.
Thank you. Through the chair, I have a question. Well, first, just to answer
rep graze question, talking a little bit about the fines because I
have, from legislative finance, the list of the vacancies and the
fines going back to fiscal year 16. And so if we're talking about fiscal
year 2024, state received a fine of 11.9 million, and then fiscal
year 2025, it's 4.6 million. But I
Could you talk a little bit more about that because I know there's been conversations
in the past about reclassifying the eligibility text.
My understanding is that there was a re-classification in 2010 and then I think there might have
been some reclassified related to eligibility one's and I was curious about whether this
study would impact ET2s.
Director.
The class study, yes, our eligibility technician ones, the class they were previously in, was called an office assistant or an OA, and they
were reclassed to an eligibility Technician 1.
This current class Study includes all of the eligibility field services staff.
And so that does impact our eligibility technician one, two, three, four eligibility office
managers.
So it's the series and looking, I pride DPA in the fact that we create a career ladder
for individuals to stay within the division and so, that has an impact on all those classes.
Thank you.
So, this is going back to the virtual contact center, and I know that you all applied to
that federal waiver to have some of the contractors at VCC be able to do the interviews.
I've heard some anecdotal feedback from some folks that people have been having, not the
best experience with some the contractors.
I think everyone at DPA is doing, you know, the best that they can.
I don't know if you all have started to onboard those contractors to do the interviews, but what can we do to make sure that that public feedback is getting back into the division so that you are working with the contractors
to to making sure you're providing the best service for people who are waiting a long time for their benefits?
Director.
I'd like to answer that in a few ways.
The first is in negotiation for this non-merit demonstration.
We have a strict quality assurance oversight by the federal government, and we have
a sample plan where we do quality-assurance samples and outcomes,
and report that to the Federal Government.
That is one way.
Another way that we actually internally manage quality is that our eligibility technicians
send what's called FYI form.
And so we actually have people reporting
when they find an error and then the error
is getting corrected and we are,
that has been informally and through email
and now we're launching a system through Qualtrics
in order to track them and so I can measure
and tell when perhaps it's triggering a need for a training.
The other assurance is that we have to train them as merit workers.
They go through the same training as our state staff to provide the service.
They receive 100% case review until they're released from training and feel confident.
And we've trained their supervisors before we train the actual staff.
And then the supervisors went through training with the staff, thank you.
Just one last follow-up.
Quickly.
Thank you through the chair.
I know that the waiver, was it for another four years?
I just wanted to get some certainty
with Rep Field's question about this transition back
to making sure that we're doing work within the division
when this contract ends and when does the waver end.
At the same time, through the chair representative Mina, the intention is to transition from the contract as soon as possible.
The standard waiver approval is four years, and I will make sure I correct that if I'm wrong on that.
It's just to allow us ability to to have that exit.
Thank you.
Slide six, if not through it, sorry.
Representative Ruffridge.
Thank you, Chair.
Yes, I just wanted to continue on just a couple of questions
on the snap timeliness and IT milestones.
I guess I want to know what snap timeliness means exactly.
That seems just to little vague to me.
And what milestones are specifically there for IT?
with that IT milestone from my perspective, it feels like we've appropriated in capital
expenditures a fairly large sum of money for IT and I always feel like were going to hear
like the we made it and we never quite get there so I'd really like to
hear what that what you mean by milestones. Director.
I'm going to start with your question about timeliness in processing any eligibility program,
any application. The federal government or the state sets a timeline for us to process that.
And for SNAP, there's two timelines that we have. If you're expedited, which means that you have
limited funds and access or you pay more in rent than income, we'll have seven days to
days is considered not timely. Right now, we're operating at 44 days on average processing.
It's taking us for our SNAP applications. So that's what timeliness means when I talk
about timaliness. The IT systems and the desire for the Big Bang is I see those internally
flashy, we implementing the document upload and transition automatically moving a piece
of paper and not having someone do it by hand is not something that's experienced externally,
but it's internally.
modified adjusted gross income category off of our legacy system.
That is, that RFP was awarded and we are in production.
They're doing their first test case now to move those categories,
sort of what that's going to look like and service.
And I'm going, I have space for that to talk about that in a future slide.
Okay, a follow up if I may, Mr. Chair.
Yes, follow-up.
Thank you.
That's helpful to understand both from the timeliness perspective, which was what I understood it to be.
And I was wondering if that was sort of an aggregate of timelingness, so that included both the sort
of more immediate need and then also the maybe less immediate, I think you answered that.
On the IT milestones component.
You know, I think a lot of us here as representatives of the people back home
We do hear about the papers that move and a lotta times we hear that they they don't move
And so it actually really I'm not looking for fireworks over the Capitol building
I am looking people that write me emails that say actually my
time to application to hearing from somebody and completing the process was
effective and reasonable. Um, I don't hear that yet. And I'm sure you know,
that that's true. I guess some of the features seem to me being a person of
the 21st century, like wild that we can't do it. Uh, things like we
can do a renewal online. When, when is that going to change?
Through the chair representative, two things with the renewal forms are being, so we have
to have federal approval for any kind of online or any type of application.
And so, we are ready to go a multi-program application, and we're waiting for CMS approval
out to the public. So some of our delays are really predicated upon us getting federal approval.
One of the items I hope you're starting to see is that we've implemented what's called
scheduled interviews for our SNAP program and remember our eligibility technicians work all
programs. And so now when a person is submitting their application we have automated the scheduling
two weeks ago. So like every day we're starting, it feels like a little bit of a domino. We're
really starting to see some improvements. And just a comment at the end. I guess I find it odd
that sort of the hand that's feeding us, if we are talking about the federal government for a lot
are that we have things ready to go, and then the federal government says,
you hold off, you can't implement it. And then we get to receive a fine to the
tune of some millions of dollars over the course of the last decade.
It's sort of like, that's odd to me,
that you would have that same entity that is delaying the implementation.
find you for timeliness. How are other states, I ask you this was not a comment, there is
a question at the end I'm sorry Mr. Chair, how are others this, because I feel like other
states have implemented some of these things when I talk to other people in my position
and other places. They have online things, interviews, seemed like they happen at a
faster rate. There's less delay in renewals. Are we just behind and now we're playing
Through the chair, representative, one of the things I want to be clear is that we're
waiting for CMS approval, Center for Medicare and Medicaid approval on our application,
and it's Food Nutrition Services that find us.
So that's a different connection.
They're not the same entity.
I think when you know one state, you only know what state and how they operate, Alaska,
My peers express struggles with workforce,
with timeliness, all of the same things
that Alaska struggles
with I think is across the nation.
I'm not alone, I meet with Hawaii and Washington.
The struggle for us is very similar in other states.
of administrative simplifications that was provided to us
from food nutrition services.
And we have done everything that they've offered us,
unless it's absolutely not something that can happen
in Alaska, you know, for one reason or another.
And so we are constantly leveraging everything
that we can in order to simplify how we're operating.
Seven if you're ready for that. Sure
Again for the record Deb Atridge many of you received the legislative finance overview eligibility technician PCN report and memo
And as outlined there our vacancy rate in 2025 peaked at about 34%
Re our recent vacancy is down to 23%
This slide really, what I'm trying to demonstrate with this slide is to show how our eligibility workers move over time.
In fiscal year 2025, we saw significant internal mobility with promotions and transfers as staff move up the career ladder.
Even with that movement,
we have ended up with a net gain in staff.
In fiscal year 2026 that movement has slowed as teams stabilize internal
transfers are down, hiring is outpacing separations and we're seeing a stronger
net staffing growth. The overall trend is positive and reflects a more stable
Thank you, Chair Josephson.
Through the chair, for this graph, is it just including your, like, your frontline eligibility
text?
Does it also include supervisors and managers?
Through, the Chair, Representative Mina, it does include that, managers.
It's the field staff.
Perfect.
Follow-up?
Follow up.
So it doesn't include them?
It does.
Okay.
Thank you through the chair.
It's not in this slide, it's in the other slide.
So this might be the best place to ask.
I've heard that with all of the cases that need to be processed,
there are some supervisors and managers that are also
processing cases.
Do you have an idea of percentage of cases within DPA
that a process between eligibility tech ones and twos
and then your supervisors in management?
Through the chair, Representative Mina, we keep what's called key performance indicators
and statistics on the casework that's happening both at all, at the individual staff level
and we can group that into the job class also.
I don't have that with me.
Perfect.
One last follow-up.
Last question.
Thank you.
Thank, through the Chair.
Yeah, I would really appreciate that follow up and also when you mentioned earlier that
these eligibility texts, you really do need more support from their leadership and I'm
just wondering, and by leadership I mean just support for their work and and
I am just curious when we have supervisors and managers who are also
processing the cases, knowing that the division has to process the case as much
as as fast as possible while trying to keep our error rates low, how does the
supervisors of managers doing that case work?
impact their responsibilities to support our eligibility
texts that are primarily doing a lot of this work.
So I guess the question is, how does that shift in the
managerial role impact, their work?
to support workers in DPA?
Director.
Through the chair representative, I feel like you're with me when I was writing my investment
plan because that really is we need to be able to leverage resources for eligibility
workers when they don't have access to a supervisor or to somebody when
they have a question.
And that's part of this growth in the division around technology and support to the eligibility
staff.
We also remember they're authorizing overtime.
Often, it's a supervisor who has opportunity to work over time to process cases.
We have scenarios where we have scheduled interviews and people on the phone and like
you said, we had to answer those phones and process those cases and that does lean into
all staff.
Thank you.
Representative Gray.
Thank You.
Again, on the mid-year status report, there was talk of the $1.6 million increment that
was to add 15 eligibility technicians.
And in your answer about whether they've been filled, you said that you were prioritizing
the ET4s, so the eligibility technician 4s which, and in it, your answers, with the
goal of filling all remaining positions by the end of January, that would have just
been recently.
Did you hire all those people, are those positions felt?
Through the chair, Representative Gray, I know that all of those
positions have been interviewed, and I
know the individuals who qualified for those
positions, have put forward for approval through our HR system.
Thanks.
Okay, last slide for this division.
Moving forward, I mean, looking to have the division is really focused,
I hope you hear it, on long-term modernization that improves the reliability,
reduces administrative work, strengthens the system both for clients and for staff
and really being person-centered.
For clients, the focus, again, is on a more streamlined multi-program application experience,
paired with continuing build out of our Alaska Connect Portal,
so clients can view their information.
track their status and see documents related to their case.
For staff, the focus is on reducing reliance on legacy systems
and modernizing how eligibility work gets done.
Again, right now we're working to move the modified
adjusted gross income Medicaid category out of our legacy system
with our SNAP program to follow
and then other cash assistance programs.
In parallel, we're investing in our workers and the tools that they need.
We have quality improvement committees.
We're improving our workflows and through the quality
improvement committee's we are receiving recommendations from the staff on how to make
our system better.
question and answer spot at our we're piloting a question answer at in our
lobbies in Kenai and Anchorage it's our eligibility technician ones that have
said I need somebody here who can actually answer these questions and just
resolve them immediately and so we are constantly making quality improvements
within the state. I would say that our current modernizations
Our current monetization efforts are allowing the
division to absorb through that appropriation for our capital.
It's really to observe the federal program changes in
SNAP and Medicaid using those existing capital investments
and then while continuing to deliver services on time.
Thank you, Chair Josephson, through the chair, just looking ahead and I gave
reference to my copy of the DPA modernization timeline but I would love
that to be included in the follow-up because I think it's helpful for all
members and for the public and so right now in 2026 concurrently there's a few
milestones and SNAP investment and HR1 so I'm just wondering with HR 1 there
Are you just, are you all focused on the good faith waiver, or are any of your staff involved at all in what's going to come to adapt to these significant changes to the division?
Director.
through the Chair Representative Mina and HR1 changes related to SNAP and the
Good Faith Waiver. Within the Good faith waiver that we received there was
planning phases for us in order to implement what we perceived as needed
to happen in inorder to successfully implement the requirements in HR 1 and
that's what the good faith waver is and so we're if you can say where we add is
Zero right we're doing internal capacity the data that we do have what can we track what system improvements?
Do we need to make just sort of doing the inventory in order to get us to a place where we can ensure that?
We have the communication plan in place
We, have, the population identified and so that, we know the water that
We're stepping into when we, do get into full compliance with hr one thank you you welcome
Thank you. Through the chair, I think going back to this being our budget subcommittee on some of these questions that are really helpful for me to understand both from a past perspective, which is how many dollars have we put into these modernizations.
because I think there's more of that coming.
Maybe that's waiting for the government, I don't know.
But I feel like I've seen a number of
supplementals and other things that I'm sort of maybe just
surprised by.
I I would think it would help me certainly, and maybe this
committee, to just hear generally if you have an idea of
how many more additional eases to the puzzle need to be
put in place before we feel we have
an all-program application and timeliness has been improved.
What do you think that costs?
Director
Through the chair representative rough Ridge
the timing is really
On our side as far as our our modernization for the division of public assistance
The changes that we're making and to move out of the legacy system into this module or platform for Medicaid
remember it
This is a platform that affects, it's not just a monolithic system.
We are making those in compliance with the federal regulations at the time.
And so we are not.
We're understanding the impact of HR1, we're leveraging our current capital budget in order to make a system that's compliant.
And so, as I said earlier,
we are in constant conversations with the commissioner's office on the needs of the division.
But right now we, are we assuming that with.
The capital funds,
we aren't going to implement a systems that is compliant with HR one.
Yeah thank you through the chair distilling that down to a sentence we have
what we need for now. Director. Through the Chair Representative
In good faith come into compliance with HR one with what we have in capital right now
but we are
Consistently analyzing one of the unknowns for the division is that their guidance from CMS
Continues to be forthcoming on compliance requirements for HR. One
Director when will we know
whether we've received the waiver and what will the extension of time be if we do receive it?
To the chair, I want to be clear. There's two impacts.
There is the Medicaid and SNAP and we already have the Waiver for the Good Faith Waver for HR1
The intention of the division is to become in compliance with HR1 for Medicaid and not have to request a waiver, although there is options, and we will be in constant communication with CMS on our coordination of that implementation.
Okay.
Great.
Very briefly.
Thank you through the chair.
The reporting that we have from the ADN in December said that you guys had
processed 18,755 snap cases in August, 19,000 in September, 23,00 in October, so
we were doing more and more cases. And I'm curious about if you've been able to
process more in more case since then and what the status of our backlog is
today.
Director, briefly, if
Through the chair representative, I've got my little court report, and I can follow up in writing with the exact number.
It's under, it's like right around 3,000 for our SNAP cases and
that are untimely right now with an average processing time of 44 days.
A significant improvement as when we can schedule an interview.
Then we know the person's calling in for the interview and we can talk to them.
And then we complete their application because right now with document upload they can take
a photo.
When we're on the phone with them they take a photos and upload that document.
It automatically gets registered now.
It doesn't have to get looked at by a person.
The person has it available to the them and process that case to completion.
That's all new.
So prior to that, we were doing coal calling,
which is what we could handle at the moment.
And now we've been able to shift to scheduled interview.
And so we're actually serving more Alaskans to completion.
But our scheduling time is out a little bit.
And, so, I have strategies to manage that.
OK.
I'm going to, with my apologies,
we are going do SDS, for sure.
We need to take about a five minute eddies, so we'll be at ease for five minutes and I'll
be back.
All right, thank you for letting me sponsor a bill down the hall.
I want to thank Director Etheridge and Ms. Meek, next we have the Division of Senior Disability Services presented by Director Tony Newman, Deputy Director Caroline Hogan.
It tells me how to pronounce Caroline.
Please come forward put yourselves on the record and begin
Good afternoon
Good Afternoon, Josephson and members of the subcommittee
My name is Tony Newman and I'm the director of a division of senior and disability services and
for the Recuror Nicole worry administrative operations manager for senior disability to services
please begin
Thank you for having us and giving us a few minutes to talk about the division our budget and our work
Our division as our divisions mission is to promote the health well-being and safety of individuals with disabilities seniors and vulnerable adults
By facilitating access to quality services and supports that foster independence personal choice and dignity
Another way to think of senior disabilities is the agency
that administers long-term services and supports for people
like these pictured in this slide.
These are photos of actual individuals who've been served
by our division and gave us permission to use their photographs.
And now I'm going to turn it over to Nicole
to introduce our budget.
Administrative Operations Manager, Senior Disability Services, and the slide before you,
is Fiscal Year 25, Final Authorized Fiscal year 2026 Management Plan,
and Fiscal years 2027 Governors for Senior and Disability services operating budget.
And while the division administers Medicaid waiver services,
the funding for these services are not reflected in this operating
Budget slide, but it is in the Medicaid Services component.
And the difference between fiscal year 25 and 26 is the $2.5 million that's a legislature
appropriated, which we want to say thank you for, to support and stabilize senior centers
and $100,000 for the Deaf Navigator Program which provides a range of resources and services
designed to improve long-term employment and housing outcomes for Alaskans who are deaf
And then the slight decrease between FY26 and 27
is primarily related to the mental health trust
authority projects that ended.
And I will now turn it back over to Director Newman.
Director Newman.
This is Director Neumann.
Senior and Disability Services is a complex agency, and we develop this chart as a way
to show the range of our services, our major program areas, the number of people who are
served by them and the breakdown between federal and state funding.
We update this graphic every year because it's the most concise way we've been able
Our stakeholders ask me for this slide so that they can view that range of services and I
myself pretty much refer to it almost every day.
And I'm going to break this side down into the major program areas to introduce them
to you.
So please feel free to ask questions as I go.
First up are our grant services.
We reach a lot of people through grants, 22,000 Alaskans, and these programs allow community
We divide our grant services into three components.
First, our senior and disabilities grants.
These grant funds are distributed to non-profit
and municipal agencies around the state who in turn provide
direct support to individuals or their families.
We have about two dozen grant programs offering a variety
of different services, many of them to seniors.
Meals on wheels programs, caravan services.
Lunch is offered in senior centers.
These programs in your communities.
are supported, at least in part, by these grant programs.
And as Ms. Wary mentioned, last year,
the legislature and governor provided an additional $2.5 million
to go to grant program serving seniors to help stabilize them.
And this is where that money is hitting, as well as the $100,000
to the Deaf Navigator Program that was provided
and is operated by Hope Community Resources of Anchorage.
Next up on our grants is the general relief assisted living home program supported through state general funds and offering temporary housing for low income Alaskans who are at risk of abuse, neglect and exploitation and who need oversight and help in an assisted
living setting.
Just a reminder, the legislature has funded two rate increases to this program once in 2022, another in 2024.
of this program. We have, as of today, 293 assisted living homes actively participating
in the general relief program, compared with 274 last year, so that's about a 7% increase.
And then the Early Intervention Infant Learning Program, a supported through grants distributed to 15 programs around Alaska that are operated by non-profits or tribal health organizations.
This program is supported by both federal and state funds.
The InfANT Learning program supports services for children, birth to age 3, who experience developmental delays through home visits, parent coaching, other services like speech or occupational therapy.
Catching young children while their brain development is still rapid.
And data shows that the infant learning program reduces the need for
special education services because it results in improved language, nutrition, and health.
I've been looking at a lot of budgets and forgive me if I'm mistaken.
But is there a governor's ask related to the ILP and FY27?
Mr. Chair, an additional ask beyond the base?
No, okay, there's not.
Okay.
All right, pause.
Thank you through the chair.
Do you have a list of the different grants that are issued that you give out for the
seniors and disability grants?
Through the Chair, Representative Prox, we certainly do the department puts out an operating
budget book that names every grantee of a department and all of our senior disability
services grants are in there.
Okay, slide six.
Okay, next up, this slide shows services administered through our division and provided
through Alaska's General Medicaid State Plan.
These services and all home and community-based services are provided by private agencies
across Alaska.
Personal care services is administered here through both the regular state plan and also
through the Community First Choice Program.
The Community first choice program is offered under a provision under the Social Security
Act known as the 1915-K option.
This is for people who meet an institutional level of need.
And when we provide services through the community first choice program, the state gets to claim an additional 6% federal match.
Next.
Question from Representative Mina.
Thank you, Chair and Josephson.
Through the Chair, I've been loosely following a lot of the different guide house presentations.
So, specifically on LTSS, one of biggest areas that still got to me was the.
Need to increase the rate for personal care services. I know it's not in this budget, but could you just talk a bit about that?
Certainly, through the Chair Representative Mina, the Department contracted with the firm
Guide House to conduct an analysis of many of the Medicaid cost centers in the department,
including long-term services supports like those administered by senior disability services.
And they looked at the full range of our services, and one of their highest-need recommendations
they had was for personal care services to increase rates.
I think their recommendation was on the order of 34%.
Thank you.
Alright.
Slide 7.
If that's okay.
Next comes our Medicaid home and community-based waivers, which are a significant part of our
work at senior and disability services.
So under a Medicaid Home and Community-Based Waiver.
The federal government waves some requirements of regular Medicaid so states can offer services that allow people to remain in their homes or assisted living settings when otherwise they might only be able to be served in an institution such as a nursing facility or a facility for people with intellectual disabilities.
Alaska has five waivers aimed at different populations of vulnerable Alaskans from children with complex medical conditions to adults with developmental disabilities to seniors with functional challenges.
comes with a menu of potential services
that help address individual needs
ranging from habilitative care in someone's home
or an assisted living home to employment services
to help someone gain and keep job skills.
From meal services to modifications such as ramps
or rolling showers that can help people
live as independently as possible.
The home and community-based waivers are approved by the Centers for Medicare and Medicaid Services every five years.
And four of our five waivers going through the renewal process now to ensure the waivers continue without interruption come July 1st.
An aspect of the waiver renewal processes is a public review and comment period about our proposed waiver applications, and that has just closed on January 30th.
So now we will be waiting through those comments received to determine if we should make any changes to our waiver application.
Okay, all right
Next I
Include this slide to point out the cost savings that Alaska is able to gain thanks to the home and community-based waiver program
While we spend a significant amount of money on our home
And community based waivers that amount pales in comparison to what we would spend if we didn't have these waiver services
We estimate that Alaska would spend over a billion dollars in institutional care than if we did not have waiver services.
Meaning that thanks to having waivers, the state saves on the order of almost $700 million.
The best part is that waivers allow Alaskans to live in their own homes and communities with the lifestyle they live.
They choose and the supports that they identify.
In other words, waivers are savers.
There's a happiness index.
Okay, slide nine.
Here just a bit of information on the division's work with skilled nursing facilities and intermediate care facilities.
Our division does not oversee or operate these facilities, but we work closely with the staff at these
facilities to make sure residents meet admissions criteria and have safe discharges and services if they are able to return to their homes.
This slide shows the number of people and the spending for these intensive long-term care services.
Alaska has 19 skilled nursing facilities, also called nursing homes or long term care facilities.
But we currently have no intermediate care facility for individuals with intellectual disabilities.
So the six Alaskans listed here were in out of state facilities for at least some period of fiscal year.
2025. These would all be people who had needs that were unable to be met here in Alaska and our
goal is always to provide care for Alaskans in Alaska but when that's not possible our next goal
is to make sure transitions for those individuals are as smooth as possible. I guess what confuses me
about that is the term intermediate so I see intermediate care and suggest that disabilities are
Mr. Chairman, no, these are facilities that are specifically focused on services for people
with intellectual and developmental disabilities that have a level of professional support for
them.
Representative Prox.
Yes.
Thank you.
They're I guess the intermediate care facilities
Are not really
Comparable to nursing homes
Total different
Situation to address
through the
Noticing the difference in cost per person and
It really doesn't make sense to compare one to another we have to dress that
Director, through the Chair of Representative Prox, I think that's a good observation.
A nursing facility has obviously got 24-hour nursing care, devoted to medical needs primarily,
an intermediate care facility for people with intellectual and developmental disabilities
focused on those disabilities, focused upon habilitative care for those individuals, and
the professional needs that accompany those specific sorts of needs.
representative reference thank you through chair well I always appreciate
this presentation every year it's amazing the amount of different areas
that your department is our division is involved with I think the slides go
a long way in explaining the breadth of the services that you offer from a
from a, I mean, we deal with the general fund dollars
of which your division is 70 or 44 million approximately.
And so I think it would be helpful for me
to understand how much of the UGF component
of senior disability services is represented
in these slides, because a lot of this is just dollars
say over or you know participation in and so I think given our you
know jobs as appropriators or overseers of that my question would be kind of
how much of this 44 47 million somewhere in there is involved in this and kind
of where those dollars are going and maybe that's question for a different
Through the chair representative reference. No, that's a that is a fine question and and I'll refer you back to what Ms
Wary said at the start of her presentation the the budget that we presented to you earlier
Show the this the costs to the division personnel
the grant services we administer it didn't include the Medicaid services and
Everything that I've shared with you after the grants services slide was Medicaid
Sir it was housed in the medicaid services budget and the cost
there are on the order of, I think, about $660 million of combined state and federal funds.
Yeah, thank you.
Follow up, Mr. Chair.
I remember that.
That's exactly my question, is of the components that we're looking at here, what is the state
match component of that, and maybe that isn't a different presentation than I need to go
track down, but is it 90-10?
track down what that is director through the chair representative
reference it's primarily 50 50 general fund to federal match
uh like i pointed out earlier the community first choice program
allows us to enjoy a slightly higher
federal match of 56 percent, but generally these are people who are served, they enter
our system through long-term care Medicaid, which is funded primarily on a 50 basis.
We serve virtually no individuals who find their pathway through Medicaid through expansion,
Okay understood. Thank you, and I guess final follow-up then representative reference
Do you anticipate? Thank You through the chair
Any adjustment to these rates as we kind of move through some of the changes that happened with Medicaid and
Accessibility to some these services with HR one
Director through the chair representative rough Ridge as director at the Ridge pointed out in the previous presentation
People with disabilities are primarily are exempted from many of the changes that are going to accompany house resolution one. Okay. Thank you
Okay
Slide 10 if you're there
Thank you.
I wanted to take note of three important areas of work at our division that are important and are often familiar to you as legislators because frequently you will get questions from constituents who are seeking help.
that touch on one of these services.
The Medicare Information Office is overseen by our division.
It's a mighty team of four staff and many volunteer counselors
that support Alaskans with their questions about Medicare,
not Medicaid, but Medicare the federal health insurance program,
primarily for seniors.
The Medical Information office provides one-on-one counseling
to Medicare beneficiaries, tips on how to spot
and report Medicare errors or scams.
Here we show the number of counseling sessions
And I'll note that this was an increase of about 300 from the previous year,
which we attribute to the growing number of seniors in Alaska.
One of our responsibilities at the division is to ensure the protection of vulnerable adults,
and we do that through a centralized reporting portal on our website, through which mandated
reporters, members of the public, can file reports about an adult they're concerned about,
and which our central intake team then can look at and assign for follow-up. One
of places that they will refer people to is Adult Protective Services. This is a unit of 16 staff.
charged with investigating those reports and making decisions about how to
assist people who are in vulnerable situations. They conduct investigations,
determine whether the adult has capacity to take care of themselves,
and depending on the need may do anything from refer them to a local non-profit for
more services to seeking a protective placement
or a guardian for that person.
Alaska law requires that protective services not interfere with the individual's desire, what they want, and if they
want to care for themselves. So the staff and adult protective
services walk a line between seeking to protect people and also respecting their autonomy and independence.
Okay, represent Prox then, Gray.
Quick one, not related to budget, but I have a couple of people that
Call me frequently and
They're getting hit by what I would say scams, but
Would I recommend them to adult protective services?
But they have to call you I can't right
Director through the chair representative Pax know you can file file a report to Adult protection services to our central reporting portal if they are
If they're interested in a scam involving Medicare, for instance,
I would suggest that they contact the Medicare Information Office.
But if there's a concern that there being scammed, yes,
yes you could refer it to our central reporting system yourself
and then we would follow up with the individual and investigate further.
Okay.
Representative Gray.
Thank you.
Through the chair to Director Newman.
So 7,895 reports.
received by Adult Protective Services and 1,261 investigations completed, so 16% of reports resulted in completed investigations.
Can you explain why so few of the reports result in complete investigations?
Director.
Through the Chair, Representative Gray, yes, a significant number of
the Reports of Harmony received when they're screened.
At first our referred for information and referral that is there they'll be directed to a nonprofit or another agency
They can assist without an investigation being deemed necessary
Yes through the chair, so you have 16 staff for the state are they spread out all over
Right through. The chair representative Gray right now
We have adult protective services staff in Anchorage and Fairbanks
We had one in Juneau, that person resigned and we have not
refilled that position in Julyau.
Follow up, follow up.
So do you fly them out to wherever they need to go to do the investigation?
Through the chair representative Gray, yes.
Follow, thank you through the Chair.
Do you think that you,
that Adult Protective Services adequately staffed and is able to
do that job that they're required to with this time?
Director.
Through the Chair Representative Gray, we are doing the very best with the resources we have.
We, as you may recall, an ombudsman's report gave us some policy ideas on where we might focus some of our efforts,
and we've been implementing some those to the best of the ability, and as our budget allows.
For instance, they recommended implementing a screening procedure to make it more efficient for us to manage our cases.
report was being finalized from the ombudsman.
Another recommendation they made was to establish more quality assurance oversight to assist investigators in making sure they're making the right decisions.
And I'm pleased that we are right now recruiting, I think we're in the recruitment phase for that position right
now.
So we doing the best we can with a variety of the needs they have, and I'll mention one more.
to involving community more often
in helping manage vulnerable adults
in their situations by establishing multidisciplinary teams,
law enforcement, health care providers, and others.
And through the good work of our adult protective services
team, we've been starting to get that process underway.
Final follow-up.
Final followed, yes.
Thank you.
So through The Chair, just a final comment,
as you mentioned earlier, that the law in Alaska
I will just say that as a
health care provider who's had to deal with adult protective services. It's been very frustrating
when there are folks who we know are harmed to themselves and should not be living independently and the result of the
investigation is that this person has food in the refrigerator and therefore they're fine to just keep doing whatever they are doing and
we will be holding hearing in judiciary about guardianship, conservatorship and about what what Alaska needs to do to
basically protect these people who
who currently, it sounds like our law is unable to protect and that APS is not able to intervene with.
Okay, Director Newman, Deputy.
What's that?
Sorry, final slide, go ahead.
Thank you, thank you Mr. Chair.
I wanted to share updates on three major initiatives going on under division.
And to start, I'd like to ask Deputy Director Caroline Hogan be permitted to approach the table and provide the first update.
Hi, yes.
Director Hogan.
Good evening.
Further record.
My name is Caroline Hogan, I'm the Deputy Director with the Division of Senior and Disability
Services.
So I am just going to give a very brief update on the inter-I project, our resource allocation
assessment instrument.
So this is an internationally recognized group of assessment tools that are used to determine
eligibility for home and community-based waiver services for community first choice
and for personal care services.
So the legislature approved three years of funding starting in FY24 and we're incredibly
grateful for that.
With that funding we were able to get a federal match of 90% towards planning, design, development
project. It's a multi-year project with several phases. We did just sign a contract with our
software vendor in December of 2025 following the pre-state procurement process and our system
design work has started. So our goal for phase one is that we will launch the first phase of
assessments by the end of this calendar year 2026.
This will better position the state to make systemic changes and give recipients more choice
and control over their services in time. Thank you. The idea is to be having a narrowly tailored
program that does not too little or too much, but it's the individualizes a program of care.
To the chair, yes, correct. This is assessment very much brings a more person-centered approach,
Just, all right, did you, the guide house matter we heard in finance, I'm very familiar with it.
Is the subcommittee familiar, with, it did, you get a report and standing committee?
All right so you did not.
Did you want to comment on the Guide House reports?
Mr. Chair, I was only going to take note of the guide house study and that the department had undertaken that study
and the Division the vision services were looked at closely and I just wanted to note that you have advocates
in the in capital this week and in weeks to come and it's of keen interest to them and
I Just wanted a just
Make you aware that we would be available to you if there were follow-up questions following those meetings with advocates and stakeholders
I encourage the chair to calendar some hearing time and then statewide
dementia training.
Mr. Chair, the division has been able to use American Rescue Plan Act funding for the last several years.
And we've done a variety of innovative projects, and I was going to point this one out.
Just because you may, it may be familiar to all of you a few weeks ago.
The Alzheimer's Resource Agency and the Alaska Training Cooperative were in Juneau providing statewide dementia training that we have been
able partner with them on.
They set up the virtual dementia tour in the belts building as part of that.
to attend it and I was just recognizing that partnership.
So that's basically all we have for you today.
Yes, Ms. Toussigno, I think, did you meet her?
Mm-hmm.
Okay.
I just wanted to show you that I knew
what you were talking about.
Director, that was a very fast presentation.
We know that you do a lot of good work.
You have a lotta supporters in the building.
That will wind up today's testimony,
or thanks to all presenters.
That goes for Deputy Director Hogan and Ms. Wierry as well.
Our next House Finance Health Subcommittee meeting
is next Tuesday, February 17th at 320.
We'll hear from DOH's Division of Behavioral Health
and Public Health.
health. This meeting is adjourned at 516. Thank you.