Legislature(2015 - 2016)HOUSE FINANCE 519

01/27/2016 01:30 PM House FINANCE

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

Audio Topic
01:32:00 PM Start
01:32:43 PM Fy 17 Budget Overview: Alaska Mental Health Trust Authority
02:53:15 PM Fy 17 Budget Overview: Department of Health and Social Services
03:33:02 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Scheduled but Not Heard
Scheduled but Not Heard
Scheduled but Not Heard
+ FY17 Budget Overviews: TELECONFERENCED
- Alaska Mental Health Trust Authority
- Dept. of Health & Social Services
                  HOUSE FINANCE COMMITTEE                                                                                       
                     January 27, 2016                                                                                           
                         1:32 p.m.                                                                                              
1:32:00 PM                                                                                                                    
CALL TO ORDER                                                                                                                 
Co-Chair Neuman  called the House Finance  Committee meeting                                                                    
to order at 1:32 p.m.                                                                                                           
MEMBERS PRESENT                                                                                                               
Representative Mark Neuman, Co-Chair                                                                                            
Representative Steve Thompson, Co-Chair                                                                                         
Representative Dan Saddler, Vice-Chair                                                                                          
Representative Bryce Edgmon                                                                                                     
Representative Les Gara                                                                                                         
Representative Lynn Gattis                                                                                                      
Representative David Guttenberg                                                                                                 
Representative Scott Kawasaki                                                                                                   
Representative Cathy Munoz                                                                                                      
Representative Lance Pruitt                                                                                                     
Representative Tammie Wilson                                                                                                    
MEMBERS ABSENT                                                                                                                
ALSO PRESENT                                                                                                                  
Russ Webb,  Chair, Board of Directors,  Alaska Mental Health                                                                    
Trust  Authority;  Jeff  Jessee,  Chief  Executive  Officer,                                                                    
Alaska  Mental   Health  Trust  Authority;   John  Morrison,                                                                    
Executive  Director, Trust  Land  Office; Valerie  Davidson,                                                                    
Commissioner,  Department  of  Health and  Social  Services;                                                                    
Sana  Efird, Assistant  Commissioner,  Department of  Health                                                                    
and Social Services.                                                                                                            
FY 17 BUDGET OVERVIEWS:                                                                                                         
          ALASKA MENTAL HEALTH TRUST AUTHORITY                                                                                  
         DEPARTMENT OF HEALTH AND SOCIAL SERVICES                                                                               
Co-Chair Neuman discussed the meeting agenda.                                                                                   
^FY  17   BUDGET  OVERVIEW:   ALASKA  MENTAL   HEALTH  TRUST                                                                  
1:32:43 PM                                                                                                                    
RUSS WEBB,  CHAIR, BOARD OF DIRECTORS,  ALASKA MENTAL HEALTH                                                                    
TRUST AUTHORITY  (AMHTA), introduced other  AMHTA directors.                                                                    
He relayed that  he was pleased to present  to the committee                                                                    
in  his  role  and  he   believed  the  trust  was  a  great                                                                    
organization. He  added that he  would be much  more pleased                                                                    
if the  price of oil was  high. However, he did  recall that                                                                    
when he had  been the deputy commissioner  of the Department                                                                    
of Health  and Social Services,  oil had been under  $20 per                                                                    
barrel,  but there  had  been a  lot of  it.  He provided  a                                                                    
PowerPoint  presentation  titled "House  Finance  Committee"                                                                    
dated January  27, 2016  (copy on  file). He  introduced his                                                                    
colleagues (listed on slide 2):                                                                                                 
     · Russ Webb, chair                                                                                                         
     · Mary Jane Michael, vice chair                                                                                            
     · Larry Norene, secretary                                                                                                  
     · Laraine Derr                                                                                                             
     · Paula Easley                                                                                                             
     · Carlton Smith                                                                                                            
Mr. Webb  acknowledged AMHTA's new trustee  Jerome Selby. He                                                                    
provided   background    information   about    Mr.   Selby.                                                                    
Additionally,  he  introduced  executive  directors  of  the                                                                    
trust's advisory boards that included  the Advisory Board on                                                                    
Alcoholism and  Drug Abuse, the Alaska  Commission on Aging,                                                                    
and  the  Governor's  Council on  Disabilities  and  Special                                                                    
Education.   He   turned   to    slide   3   titled   "Trust                                                                    
     Approximate Number of Trust Beneficiaries                                                                                  
     Mental Illness: 34,000                                                                                                     
     Developmental Disabilities: 13,000                                                                                         
     Chronic Alcoholism/Substance-Related Disorders: 20,000                                                                     
     Alzheimer's disease and related dementias: 6,000                                                                           
     Traumatic Brain Injury: 11,000                                                                                             
Mr.  Webb   added  that  the  number   of  individuals  with                                                                    
Alzheimer's  and  related   dementia  was  probably  growing                                                                    
Representative  Gattis asked  if the  categories on  slide 3                                                                    
overlapped.  She  asked  how   many  people  the  trust  was                                                                    
actually serving.                                                                                                               
Mr.  Webb answered  that the  figures (on  slide 3)  were an                                                                    
estimate of  the number of beneficiaries  in the population.                                                                    
He detailed  that each  of the  programs served  a different                                                                    
number.  He agreed  that many  of the  trust's beneficiaries                                                                    
had co-occurring conditions,  but he did not  have a precise                                                                    
JEFF JESSEE,  CHIEF EXECUTIVE OFFICER, ALASKA  MENTAL HEALTH                                                                    
TRUST AUTHORITY, agreed that the  trust did not know exactly                                                                    
how many people there  were with co-occurring disorders, but                                                                    
there  was definitely  overlap  between  the categories  (on                                                                    
slide 3).                                                                                                                       
Representative Gattis asked  if any of the  numbers shown on                                                                    
slide 3 were overlapping. She  noted that the slide showed a                                                                    
total  of 84,000  individuals. She  wondered if  there could                                                                    
possibly  be  far fewer  individuals  because  they had  co-                                                                    
Mr. Jessee answered that there  could be overlap, but it was                                                                    
not substantial.  He detailed  that the  numbers on  slide 3                                                                    
were  categorized by  the  primary  diagnosis. He  continued                                                                    
that it was synthetic national data  and there was not a way                                                                    
of actually counting beneficiaries in Alaska.                                                                                   
Representative Gattis would follow up  on how the number had                                                                    
been arrived upon.                                                                                                              
Mr.  Webb  addressed  slide   4  titled  "Established  Focus                                                                    
     1. Disability Justice                                                                                                      
     2. Substance Abuse Prevention & Treatment                                                                                  
     3. Beneficiary Employment & Engagement                                                                                     
     4. Workforce Development                                                                                                   
     5. Housing and Long-term Services & Supports                                                                               
1:39:13 PM                                                                                                                    
Co-Chair Neuman asked members to  hold their questions until                                                                    
after the presentation.                                                                                                         
Co-Chair   Thompson   asked   how  many   of   the   trust's                                                                    
beneficiaries were currently incarcerated.                                                                                      
Mr. Webb replied  that on any given  day trust beneficiaries                                                                    
could  account for  up  to 65  percent  of the  correctional                                                                    
population. Over the  course of the year  they accounted for                                                                    
about 40 percent.                                                                                                               
Mr.  Jessee  moved to  slide  5  and discussed  the  trust's                                                                    
current  priorities   to  help   the  legislature   build  a                                                                    
sustainable  budget.  The  trust's beneficiaries  were  very                                                                    
impacted  by  the legislature's  action  on  the budget.  He                                                                    
stated   that  if   the  legislature   could  not   build  a                                                                    
sustainable budget the trust's  beneficiaries would not have                                                                    
access to needed  services. The two primary  areas the trust                                                                    
saw tremendous  opportunity for savings and  partnering with                                                                    
the   legislature  were   Medicaid   redesign  and   justice                                                                    
reinvestment.  He elaborated  that  the  trust believed  the                                                                    
areas were interrelated in a  significant way. He pointed to                                                                    
a  bubble chart  on slide  5 and  indicated that  behavioral                                                                    
health  system  reform  and Medicaid  expansion  provided  a                                                                    
significant  opportunity  from  a  programmatic  and  budget                                                                    
standpoint to do the necessary  redesign and reinvestment in                                                                    
order to bring the budget areas under better control.                                                                           
Mr.  Webb addressed  slide 6  titled  "Why is  the Trust  so                                                                    
Engaged with Medicaid Redesign?" He  shared that when he had                                                                    
worked  for DHSS,  the  department had  already  begun -  at                                                                    
$8.00  per barrel  oil -  pursuing a  strategy to  refinance                                                                    
services  funded   with  General   Funds  (GF)   only,  with                                                                    
Medicaid, in part  to gain the benefit of  the federal match                                                                    
and cut down with GF costs.  It was a strategy the state had                                                                    
continued  to pursue  with what  he believed  was everyone's                                                                    
blessing.   He    stated   that   systems    serving   trust                                                                    
beneficiaries  were   currently  funded   primarily  through                                                                    
Medicaid.  He furthered  that Medicaid  services represented                                                                    
the largest portion of  the trust's comprehensive integrated                                                                    
mental health  system of  care. He  stressed that  AMHTA was                                                                    
committed to the sustainability  of the Medicaid program. He                                                                    
emphasized that  it had  to be  sustainable or  services for                                                                    
trust beneficiaries  would fall apart. There  were currently                                                                    
opportunities,  which had  not existed  when the  department                                                                    
had  first begun  Medicaid refinancing,  to  change the  way                                                                    
services  were  structured  to obtain  better  outcomes.  He                                                                    
discussed  that  there were  ways  to  gain greater  federal                                                                    
participation, which were part of the redesign process.                                                                         
Mr. Webb  stressed the importance  of making  Medicaid work.                                                                    
He furthered  that because  of the  way the  federal program                                                                    
was  structured  there were  a  number  of things  that  had                                                                    
prevented  the  state  from  making  the  best  use  of  the                                                                    
Medicaid funds.  For example, when the  state had refinanced                                                                    
services  with Medicaid  some individuals  became ineligible                                                                    
in  the behavioral  health system.  He  detailed that  there                                                                    
were critical populations  (i.e. young men at  high risk for                                                                    
involvement with criminal justice  system), in many ways due                                                                    
to  substance abuse,  traumatic brain  injuries, and  mental                                                                    
illnesses, who could not access  services because they could                                                                    
not get  through the Medicaid  door; therefore, some  of the                                                                    
services had fallen  off. He stressed that  the state needed                                                                    
to make the  system work for getting the  needed outcomes at                                                                    
a sustainable level.                                                                                                            
1:44:26 PM                                                                                                                    
Mr. Jessee addressed slide 7 titled "Medicaid Redesign":                                                                        
     · The Trust has invested over $600,000 this year on                                                                        
        various contracts to provide a strong base of                                                                           
        information and options to help the state make                                                                          
        strategic decisions regarding Medicaid redesign.                                                                        
Mr.  Jessee  relayed  that the  trust  understood  that  the                                                                    
effort  would be  a  long-term process.  He  added that  the                                                                    
department had  already been  in the  process of  looking at                                                                    
reforms and other ways of  transforming the state's Medicaid                                                                    
system.  He  noted  that  the   process  would  have  to  be                                                                    
accelerated going forward. He  furthered that the trust knew                                                                    
it was  a long haul, but  it was used to  that. He explained                                                                    
that  AMHTA bridged  administrations  and legislatures.  For                                                                    
example, the Bring the Kids  Home program had been an eight-                                                                    
year effort across three different administrations.                                                                             
Mr. Jessee turned to slide  8 and addressed that funding had                                                                    
been  used for  technical  assistance contracts  to look  at                                                                    
Medicaid reform  from a national perspective.  He elaborated                                                                    
that  AMHTA  had  retained the  services  of  Charles  Curie                                                                    
(former director  of the federal Substance  Abuse and Mental                                                                    
Health Services  Administration under  the [George  W.] Bush                                                                    
Administration)  who  had  taken a  particular  interest  in                                                                    
Alaska and had  spent time in its rural  areas. He furthered                                                                    
that Mr.  Curie was currently  a consultant for  many states                                                                    
going  through Medicaid  reform.  Mr.  Curie was  consulting                                                                    
with Alaska particularly in behavioral  health areas to help                                                                    
determine lessons  the state could  take from  other states.                                                                    
He noted that  Mr. Curie had been very helpful  to AMHTA and                                                                    
1:46:36 PM                                                                                                                    
Mr. Jessee  addressed slide 9 titled  "Redesign...Now and in                                                                    
the Future."  He noted  that just  because the  reforms were                                                                    
under consideration  did not mean  they would all  happen at                                                                    
once. He read from the slide:                                                                                                   
    A number of reforms are already under consideration                                                                         
     · 1915 (i)/(k) state plan options for Home-and                                                                             
        Community-Based services                                                                                                
     · Primary Care Access Initiative                                                                                           
     · Behavioral Health Access Initiative                                                                                      
     · Data Analytics/IT infrastructure                                                                                         
     · Pilot Accountable Care Organizations                                                                                     
     · Alternative Benefit Plans for Expansion Population                                                                       
Mr. Jessee  expounded that if  services could  be integrated                                                                    
into  primary care,  recipients  would  get better  service,                                                                    
sooner, and at a lower  cost. He stated that getting primary                                                                    
care on board with AMHTA  beneficiaries was a high priority.                                                                    
He stressed that access to  behavioral health services was a                                                                    
problem.  They  could  not  throw  money  at  the  services;                                                                    
therefore,  it was  necessary to  determine how  to increase                                                                    
effectivity  and efficiency.  He  stated that  it would  not                                                                    
work if AMHTA  could not collect and analyze  data about the                                                                    
reforms as they  were taking place. He cited  Bring the Kids                                                                    
Home as  an example and  stated that nothing  worked exactly                                                                    
how  it was  drawn up  on paper;  it was  necessary to  keep                                                                    
following and analyzing  the data to make  changes along the                                                                    
way. He  stated that  looking at how  the state  could start                                                                    
managing care would be critical  to saving money. All of the                                                                    
items  listed on  slide 9  were already  under analysis.  He                                                                    
stated there  were many  more options.  He relayed  that the                                                                    
multitude  of moving  parts was  challenging. He  pointed to                                                                    
various forms of legislation and  at least two major reports                                                                    
currently before  the legislature  (slide 10).  He continued                                                                    
that somehow during the current  session the items needed to                                                                    
be  included in  a Medicaid  reform bill.  He stressed  that                                                                    
passing  a bill  was critical  and AMHTA  was willing  to do                                                                    
anything to  help facilitate the  process. He  believed that                                                                    
the Senate  Finance Committee  had appointed  a subcommittee                                                                    
to  look at  the different  bills and  reports to  determine                                                                    
putting legislation together.                                                                                                   
Mr.  Webb addressed  slide 12  titled "Why  is the  Trust so                                                                    
engaged with Justice Reinvestment?":                                                                                            
     · Trust beneficiaries account for more than 40%                                                                            
       bookings and 40% of DOC population, each year                                                                            
     · For felony offenses, Trust beneficiaries remain in                                                                       
        jail twice as long as non-beneficiaries                                                                                 
     · Recidivism rates are approximately twice as high for                                                                     
        Trust beneficiaries                                                                                                     
Mr. Webb elaborated that in  some institutions the number of                                                                    
trust beneficiaries was as high  as 75 percent. On any given                                                                    
day,  65 percent  of inmates  were  trust beneficiaries.  He                                                                    
believed that for  misdemeanor offenses, trust beneficiaries                                                                    
spent 2.5  times longer in  jail than  non-beneficiaries. He                                                                    
referred to the  governor's report on DOC  related to deaths                                                                    
that  had  occurred   in  DOC  (some  of   whom  were  trust                                                                    
beneficiaries).   He   explained   that   the   victim   and                                                                    
perpetrator  in most  recent death  in  Anchorage were  both                                                                    
trust beneficiaries.  He detailed  that the victim  had been                                                                    
under  an AS  Title  47  hold -  due  to  alcohol or  mental                                                                    
illness - and  should not have been confined.  The trust had                                                                    
been  working  on  getting  services  in  place  to  prevent                                                                    
individuals from  getting into the criminal  justice system;                                                                    
and if obtained  to be treated well and safe  and to get out                                                                    
as quickly  as possible. He  stressed the need  for services                                                                    
in the  community in order  to help individuals  succeed and                                                                    
stay out of prison.  He emphasized that justice reinvestment                                                                    
was critical to AMHTA.                                                                                                          
1:51:56 PM                                                                                                                    
Mr. Jessee  addressed how to  keep beneficiaries  from going                                                                    
back to jail  on slide 13. The slide  illustrated the three-                                                                    
legged stool  model that included: housing,  employment, and                                                                    
support for recovery.  He moved to slide  14 titled "Justice                                                                    
     There is a critical intersection between criminal                                                                          
     justice reform and Medicaid expansion and re-design in                                                                     
     re-establishing access to behavioral health services                                                                       
     for Trust beneficiaries at high risk of and with                                                                           
     involvement in the criminal justice system.                                                                                
Mr.  Jessee  addressed  some of  the  obvious  savings.  For                                                                    
example, the state saved money when  DOC sent an inmate to a                                                                    
hospital to  get them  signed up for  Medicaid in  order for                                                                    
the federal  government to pay  most of the bill  instead of                                                                    
using General  Funds as it  was currently doing.  Many other                                                                    
parts were  dependent upon looking  at Medicaid as a  way of                                                                    
funding many of  the components. He furthered  that DHSS was                                                                    
being proactive  in working with  the federal  government to                                                                    
get some  flexibility in the  state's Medicaid  program that                                                                    
could really help related to justice reinvestment.                                                                              
1:53:19 PM                                                                                                                    
Mr. Jessee addressed "What's Next?"  on slide 15. He pointed                                                                    
to  a visionary  moment a  couple  of years  earlier in  the                                                                    
House  Finance   Committee  where  the   co-chair  [Co-Chair                                                                    
Neuman]  had  placed  intent language  in  the  budget  that                                                                    
brought  together  the  Alaska Housing  Finance  Corporation                                                                    
(AHFC), the  Department of Labor and  Workforce Development,                                                                    
and AMHTA  to begin  to address how  to change  the criminal                                                                    
justice  system. He  stated  that  the recidivism  reduction                                                                    
plan  had  set  the  stage  and  started  the  momentum.  He                                                                    
highlighted that the  collapse in the price of  oil had made                                                                    
recidivism reduction  even more exigent. He  addressed other                                                                    
items on the slide:                                                                                                             
     · Recidivism Reduction Plan                                                                                                
     · DOC -Prisoner Reentry Initiative (AK-PRI)                                                                                
     · Pew Public Safety Initiative, Justice Reinvestment                                                                       
     · Criminal Justice Commission                                                                                              
     · SB 91                                                                                                                    
     · Alaska Justice Information Center                                                                                        
Mr.   Jessee  elaborated   that  he   hoped  a   plan  would                                                                    
incorporate as  many recommendations  from SB  91 (sponsored                                                                    
by  Senator  John Coghill)  as  possible.  He addressed  the                                                                    
final point on  slide 15 and relayed that  the joint funding                                                                    
of the Alaska  Justice Information Center had  come from the                                                                    
House  Finance  Committee.  He   detailed  that  the  center                                                                    
allowed for  the collection and  analysis of the  data about                                                                    
the  justice  reforms  in  order   to  be  data  driven  and                                                                    
thoughtful  as   the  system  evolved.  He   explained  that                                                                    
Medicaid  reform and  justice  reinvestment were  integrally                                                                    
Mr. Jessee  spoke to the trust's  long-term funding strategy                                                                    
on  slide 16.  He referred  to talk  he had  heard from  the                                                                    
legislature  about the  trust's propensity  to come  up with                                                                    
program ideas that  used GF as a fund  source, which created                                                                    
a challenge. He  agreed that the trust did do  some of that,                                                                    
which was one  of the values of the trust;  it was a venture                                                                    
capital  fund  that  allowed  AMHTA to  try  some  ideas  to                                                                    
determine  what  worked.  He  furthered  that  much  of  the                                                                    
trust's funding also went to  long-term ongoing projects. He                                                                    
detailed that 39 percent of  the trust's budget came through                                                                    
the  state  budget  in  the  form  of  Mental  Health  Trust                                                                    
Authority Authorized  Receipts (MHTAAR) and 25  percent came                                                                    
from authority  grants. Between the  two, 65 percent  of the                                                                    
trust's  budget  was  committed   to  long-term  support  of                                                                    
programs. He  explained that there  was not just a  focus on                                                                    
the "next  shiniest thing," but  about supporting  key parts                                                                    
of the mental health program.  The trust recognized that the                                                                    
current  year  was  a  huge challenge  for  the  budget.  He                                                                    
addressed  FY  17  operating increments  on  slide  17.  The                                                                    
primary  focus  for the  upcoming  year  was on  information                                                                    
technology and  telehealth service system  improvements. The                                                                    
improvements were part of the  effort to build a sustainable                                                                    
budget by  using IT  and telemedicine  to reduce  costs. The                                                                    
more the trust could do to  serve people remotely would be a                                                                    
big cost saver.                                                                                                                 
1:57:56 PM                                                                                                                    
Mr. Jessee  addressed the  FY 17  capital budget  request on                                                                    
slide 18. He  explained that the capital budget  was not the                                                                    
normal bricks  and mortar -  most of  the money was  not for                                                                    
constructing things. For example, many  of the funds for the                                                                    
Homeless Assistance  Project and  the Special  Needs Housing                                                                    
Grant  were  for  ongoing   operating,  which  were  granted                                                                    
annually  for three-year  periods. He  stressed that  it was                                                                    
absolutely critical  that the capital  budget remain  in the                                                                    
budget because  it accounted for  a critical safety  net for                                                                    
the  trust's most  vulnerable  beneficiaries.  He turned  to                                                                    
slide 19 titled "Cash Assets at  End of FY15." The pie chart                                                                    
broke  out  the  trusts  cash  assets,  which  totaled  $550                                                                    
million. He  detailed that the total  included a combination                                                                    
of the  original settlement, inflation proofing,  Trust Land                                                                    
Office contributions ($100 million),  Trust Land Office real                                                                    
estate  acquisitions,  unrealized appreciation,  and  budget                                                                    
reserves (the most critical part  of the trust's budget). He                                                                    
explained  that  the budget  reserves  were  needed for  the                                                                    
trust to continue to make a payout in times of recession.                                                                       
Mr.  Jessee relayed  that  the trust  used  a percentage  of                                                                    
market value (POMV) strategy rather  than relying on income,                                                                    
profit, or loss from  year-to-year (slide 20). Currently the                                                                    
POMV  for the  trust's payout  was 4.25  percent. The  FY 17                                                                    
anticipated income  was presented  on slide 21.  He detailed                                                                    
that  the  payout  equaled  approximately  $20  million.  He                                                                    
explained   that  the   prior  year's   average  lapse   was                                                                    
approximately $3  million. He  noted that  if an  agency did                                                                    
not use all of the money  the trust had allocated, the funds                                                                    
were deposited  back into  the fund  and were  available for                                                                    
reallocation  by  the trustees  in  future  years. The  land                                                                    
office  average spendable  income was  over $4  million. The                                                                    
average interest  was $187,000 and total  anticipated income                                                                    
was almost $29 million per year.                                                                                                
Mr. Jessee turned  to slide 22 titled  "Payout History." The                                                                    
chart illustrated  that the payout  had started at  a fairly                                                                    
low level,  primarily because the  budget reserve  was built                                                                    
up  over  time.  As  the  reserve had  grown  and  had  been                                                                    
inflation proofed,  trustees had  been able to  increase the                                                                    
payout. He pointed  out that income had  also increased over                                                                    
2:00:59 PM                                                                                                                    
Mr. Webb turned to slide 23 titled "Trust Land Office":                                                                         
     GOAL: Match or exceed spendable income generated by                                                                        
     cash investments                                                                                                           
     KEY STRATEGIES:                                                                                                            
        · Acquiring income-generating real estate                                                                               
        · Exploring and marketing mineral resources                                                                             
        · Land trade with Forest Service to increase                                                                            
          marketable timber                                                                                                     
Mr. Webb  stated that AMHTA  understood that "we are  all in                                                                    
this together."  The trustees recognized  that it  was their                                                                    
responsibility to  do everything  possible to  help generate                                                                    
income  that  the  trust  could  use  to  provide  services,                                                                    
supports, and  venture capital  for trust  beneficiaries. He                                                                    
highlighted that the trust had  1 million acres of land, but                                                                    
half of  the total only  included subsurface rights.  All of                                                                    
the impediments  that hindered  development of  the resource                                                                    
base in Alaska applied to the  trust just as they applied to                                                                    
the  private sector.  He  added that  the  trust faced  some                                                                    
additional  challenges  that  the  private  sector  did  not                                                                    
necessarily face.  He discussed  that the  trust had  a good                                                                    
bit  of principal  and income  generated by  the Trust  Land                                                                    
Office. The  trustees recognized  that the  trust had  to do                                                                    
more and  had set an ambitious  goal for the land  office to                                                                    
match  or   exceed  spendable   income  generated   by  cash                                                                    
investments  (from  non-cash  investments).  The  trust  had                                                                    
asked John  Morrison (executive director  of the  Trust Land                                                                    
Office) to develop a plan to  achieve the goal as quickly as                                                                    
possible over time,  with the recognition that  it would not                                                                    
occur  over night.  He  noted that  there  would be  interim                                                                    
goals along the way to ensure progress was made.                                                                                
JOHN  MORRISON,  EXECUTIVE   DIRECTOR,  TRUST  LAND  OFFICE,                                                                    
highlighted  slide  24  titled  "Trust  Land  Office  Annual                                                                    
Revenue  -  FY1995-FY2015."  The   slide  included  a  graph                                                                    
representing the income the Trust  Land Office had generated                                                                    
since  inception in  1995. He  pointed  out that  in the  20                                                                    
years  the  land  office  had   generated  $180  million  in                                                                    
principal and  income revenue. The  land office  mission was                                                                    
to  maximize revenue  for  the  trust; it  made  all of  its                                                                    
resources decisions  in the best  interest of the  trust and                                                                    
its beneficiaries.  He shared that  the office had  taken on                                                                    
the  mantra  to diversify,  develop,  and  defend the  trust                                                                    
assets. He  pointed to the left  side of the graph  (1995 to                                                                    
2010)  and  noted that  2011  had  been  a pivotal  year  of                                                                    
change.  He  noted  that  the various  colors  on  the  bars                                                                    
represented income  streams from different trust  assets. He                                                                    
detailed  that pink  and green  represented land  and timber                                                                    
transactions,  which were  both  non-repeatable events.  The                                                                    
transactions  had been  large cash  contributions of  mostly                                                                    
principal that  were available to  be invested.  However, he                                                                    
noted that  once the land  had been  sold or the  timber had                                                                    
been harvested it  was gone. Beginning in 2010  and 2011 the                                                                    
land office had  taken on an active  engagement to diversify                                                                    
its income streams, specifically  focusing on areas where it                                                                    
could  generate predictable  and repeatable  income revenue,                                                                    
which  was much  more  difficult to  come  by than  one-time                                                                    
infusions  of principal  from  the sale  of  an asset.  Over                                                                    
time,  the land  office had  developed from  a typical  land                                                                    
office towards a sophisticated, fixed asset model manager.                                                                      
2:05:35 PM                                                                                                                    
Mr.  Morrison  addressed a  chart  on  slide 25  related  to                                                                    
changing  timber revenue  from FY  95 to  FY 15.  The darker                                                                    
green portion of the chart  represented timber revenue since                                                                    
inception  compared  to all  other  revenue  shown in  light                                                                    
green.  The  land office  and  been  working with  the  U.S.                                                                    
Forest  Service  for  many  years  in  Southeast  Alaska  to                                                                    
exchange  roughly 20,000  acres  of trust  land with  20,000                                                                    
acres  of forest  service land  across several  communities.                                                                    
Much  of the  land the  land office  wanted to  exchange was                                                                    
located in areas  that were not as marketable  as they would                                                                    
like;  the land  office hoped  to  trade it  for other  land                                                                    
including trees  that would  be marketable  and harvestable.                                                                    
In  the future,  the  trust expected  to  come forward  with                                                                    
legislation to move the  exchange forward. Additionally, the                                                                    
land office  could not  focus on any  one resource  base. He                                                                    
elaborated that  at one  point in  time timber  had provided                                                                    
plenty of revenue, but those days were gone.                                                                                    
Mr. Morrison  turned to  a chart on  slide 26  and addressed                                                                    
revenues   versus   expenditures.  The   chart   illustrated                                                                    
principal revenue  in blue and  income revenue in  green. He                                                                    
pointed  out  that  the  income  revenue  was  always  above                                                                    
operating  expenses  (shown  in  purple).  The  land  office                                                                    
strived  to specifically  provide more  income revenue  than                                                                    
costs.  He  believed the  land  office  was providing  great                                                                    
value  to the  trust in  its responsible  management of  the                                                                    
assets.  He   noted  that  the   income  revenue   line  was                                                                    
directionally correct with a continuous increase over time.                                                                     
2:08:11 PM                                                                                                                    
Mr. Webb thanked the committee for its time.                                                                                    
Co-Chair  Neuman  noted that  in  the  past there  had  been                                                                    
discussion  on  how  treatment  after  arrest  would  impact                                                                    
recidivism.  He  asked  for Mr.  Jessee's  thoughts  on  the                                                                    
Mr. Jessee  replied that  a huge  percentage of  the state's                                                                    
jail  population  were  pretrial individuals.  He  explained                                                                    
that  most  of the  crimes  were  associated with  substance                                                                    
abuse. He  stated that  if treatment  could be  delivered to                                                                    
the individuals  at the  point of entry  into prison  - when                                                                    
many of the individuals were  highly motivated to get out of                                                                    
trouble by getting  sober - it would be a  huge piece of the                                                                    
long-term  strategy  to  bring budgetary  stability  to  the                                                                    
criminal  justice system.  He emphasized  that the  more the                                                                    
state  could  do  to  provide  access  to  treatment  before                                                                    
individuals  even  went  to  trial, would  be  a  huge  step                                                                    
forward.  Currently  there  was   not  capacity  to  deliver                                                                    
treatment even to individuals who wanted the services.                                                                          
Co-Chair Neuman  remarked on Mr. Jessee's  earlier testimony                                                                    
that  the first  thing they  were  trying to  develop was  a                                                                    
recidivism  reduction plan,  which  had  been followed  with                                                                    
work by Pew and  beneficiaries' recommendations. He surmised                                                                    
that  the  next  step  would be  to  work  towards  allowing                                                                    
treatment  after arrest.  He stated  that in  many cases  it                                                                    
took two  years before a  person was sentenced.  He remarked                                                                    
that the  goal was to  provide people with  opportunities to                                                                    
access treatment.                                                                                                               
Mr. Jessee agreed.                                                                                                              
Vice-Chair  Saddler  wondered  how many  beneficiaries  knew                                                                    
they were beneficiaries. Mr.  Webb answered that individuals                                                                    
receiving services knew they were  beneficiaries. He did not                                                                    
have specific numbers for each  of the various programs, but                                                                    
could  work  with  DHSS  to   get  the  information  to  the                                                                    
committee. He believed there were  many individuals who were                                                                    
either undiagnosed and did not  know or who may be diagnosed                                                                    
but may not  be aware they were a trust  beneficiary. He did                                                                    
not know how to count that.                                                                                                     
2:11:12 PM                                                                                                                    
Representative Gattis referred  to a person who  had been in                                                                    
Goose Creek  Correctional Center who had  been released from                                                                    
prison  in the  past month.  She  elaborated that  he was  a                                                                    
military  veteran with  post-traumatic stress  disorder. The                                                                    
individual had  been fearful about  leaving jail  because he                                                                    
knew that without treatment he  would probably reoffend. The                                                                    
individual had begged to receive  treatment. She stated that                                                                    
it had been very difficult to  figure out how to gain access                                                                    
to services. She emphasized the  importance of improving the                                                                    
Representative Gara  referred to  a discrepancy  between the                                                                    
number  of  people  needing   treatment  and  the  available                                                                    
treatment. He  believed there was  a growing  recognition in                                                                    
the legislature  that the situation  did not provide  a cost                                                                    
savings. He wondered if there  was a measurement on what the                                                                    
state  and private  sector would  need  to do  to raise  the                                                                    
level of  available treatment  to match  the level  of those                                                                    
needing it.  He spoke  specifically to heroin  addiction and                                                                    
noted  that  many communities  did  not  have the  treatment                                                                    
available. He  furthered that when individuals  did not have                                                                    
access to  treatment they committed  felonies and  made drug                                                                    
dealers  more   powerful.  He   asked  about   the  specific                                                                    
treatment lag related to heroin abuse.                                                                                          
Mr. Jessee answered  that there was not  an effective system                                                                    
to determine the  overall unmet need. Many  agencies did not                                                                    
keep a  waitlist; therefore,  it was  not possible  to track                                                                    
the number  of people  who had asked  for services.  He knew                                                                    
the  lag   was  substantial,  because  they   knew  of  many                                                                    
individuals who  had sought treatment  but had  not received                                                                    
access.  The key  was  to  find the  most  efficient way  to                                                                    
provide access to treatment, which  was the reason they were                                                                    
looking  at  primary care,  a  funding  mechanism, and  some                                                                    
cost-effective systems  that were not just  stand alone silo                                                                    
programs.  He  stated that  Medicaid  expansion  was a  huge                                                                    
piece of  the picture.  He remarked that  Medicaid expansion                                                                    
would apply  to single  individuals between  the ages  of 18                                                                    
and 65  who did not  have much  money. He remarked  that the                                                                    
cohort sounded  like many of  the individuals coming  out of                                                                    
prison. He  relayed that thousands of  the individuals would                                                                    
be eligible  for Medicaid under expansion.  He addressed the                                                                    
heroin  issue and  stated that  it was  getting worse  every                                                                    
day. He believed there was work  to be done along the entire                                                                    
continuum, beginning with physicians  and how they prescribe                                                                    
opioids. More  importantly, was  how physicians  worked with                                                                    
their  patients to  get them  successfully  off opioids.  He                                                                    
stated  that even  the treatment  community was  chasing the                                                                    
capacity issue.                                                                                                                 
2:15:54 PM                                                                                                                    
Representative  Gara addressed  the lands  issue. He  stated                                                                    
that he  was not a big  fan of giving the  Trust Land Office                                                                    
the most controversial lands to  make money off of. He spoke                                                                    
specifically  to the  Chuitna  Mine, which  was  now in  the                                                                    
hands of  the land office.  He stated that many  people knew                                                                    
the pros and  cons of the specific project. He  spoke to the                                                                    
litigation and  permitting costs in defending  opposition to                                                                    
the mine from  fishermen and village residents.  He asked if                                                                    
the  land office  paying for  the  litigation or  if it  was                                                                    
funded by the Department of Natural Resources.                                                                                  
Mr. Morrison  answered that  as the  land holder,  the trust                                                                    
had a  lessee pursuing the  mine. If  the land office  was a                                                                    
party to  the lawsuit it  would bear the cost,  otherwise it                                                                    
was not the land office's  responsibility. He added that the                                                                    
land office  was only  the land owner  and not  a permitting                                                                    
Representative Gara asked  if the Chuitna Mine  had cost the                                                                    
land office money. Mr. Morrison  replied in the affirmative.                                                                    
He detailed  that there had  been some significant  costs to                                                                    
the land office  pertaining to staff time  and resources, in                                                                    
addition to interaction with the attorney general's office.                                                                     
Representative Kawasaki  thanked Mr.  Jessee for  serving on                                                                    
the  Criminal   Justice  Commission  and  remarked   on  the                                                                    
importance of  seeing the value  in the continuum.  He noted                                                                    
there were numerous criminal  justice reforms coming through                                                                    
in  tandem  partly  due  to   a  rising  corrections  budget                                                                    
including options  such as supervised  release. He  asked if                                                                    
the trust  would be prepared  for individuals coming  out of                                                                    
the  prison system.  He wondered  how to  prevent recidivism                                                                    
once the individuals were out.                                                                                                  
Mr. Jessee answered  that the trust and  the departments had                                                                    
been working  hard on the  issue in a collaborative  way. He                                                                    
spoke  to  the  positive working  relationship  between  the                                                                    
current [DHSS] department and other  agencies. He noted that                                                                    
recently  the commission  had been  lamenting that  DHSS did                                                                    
not  have  a  seat  on  the  commission.  He  spoke  to  the                                                                    
importance  of the  relationship  and collaboration  between                                                                    
the different involved agencies.  He stressed the importance                                                                    
of getting something done.                                                                                                      
Representative  Kawasaki asked  whether Mr.  Jessee believed                                                                    
that   if  the   bills  including   sentencing  reform   and                                                                    
supervised release  pass that DHSS  and AMHTA would  be able                                                                    
to take up "that part, that sort of slack..."                                                                                   
Mr. Jessee answered that a  Medicaid reform bill also needed                                                                    
to be passed.                                                                                                                   
2:20:10 PM                                                                                                                    
Representative Kawasaki  asked for an explanation  of income                                                                    
generating real estate (slide 23)  related to the Trust Land                                                                    
Office. He asked if it  was in-state housing or out-of-state                                                                    
Mr.  Morrison   answered  that  the  land   office's  income                                                                    
generating real  estate was  solely focused  on out-of-state                                                                    
acquisitions of a variety of different real estate.                                                                             
Co-Chair Neuman asked Mr. Morrison  for a report on the land                                                                    
office's total  land, leases,  land for  sale, and  other in                                                                    
order  to learn  how the  office  operated. He  asked for  a                                                                    
report  on  the  Chuitna  Mine project  and  the  associated                                                                    
Representative   Edgmon   commended   the   presenters   for                                                                    
providing a  presentation focused on  sustainable budgeting.                                                                    
He remarked that three-quarters  of the state's inmates were                                                                    
in the non-violent  category. He asked about  the 60 percent                                                                    
portion  of the  prison population  with mental  illness. He                                                                    
queried what portion of  the non-violent offenders struggled                                                                    
with mental illness.                                                                                                            
Mr.  Webb answered  that the  commission had  a report  done                                                                    
related to inmate  information and they would  provide it to                                                                    
the committee.  He did not  recall the percentage or  if the                                                                    
data   was  broken   out  by   violent  versus   non-violent                                                                    
offenders.  He recalled  that it  was  primarily broken  out                                                                    
into misdemeanor versus felony cases.  He shared that he had                                                                    
been  a probation  officer  in  the past  and  his wife  was                                                                    
currently a district  court judge who ran  the mental health                                                                    
court in Anchorage. He assured  the committee that virtually                                                                    
all  individuals  in  the mental  health  court  were  trust                                                                    
beneficiaries   and  many   individuals  in   regular  court                                                                    
hearings  were trust  beneficiaries as  well. He  noted that                                                                    
the vast  majority of those  offenders were  non-violent. He                                                                    
stated that  there were non-violent offenders  who were held                                                                    
in corrections for lengthy  time periods, sometimes awaiting                                                                    
a  competency evaluation.  He  elaborated  that sometimes  a                                                                    
person   was  held   longer  in   corrections  awaiting   an                                                                    
evaluation than they would if  they were actually sentenced.                                                                    
He stated that it was  a significant problem. He stated that                                                                    
trust beneficiary  felons spent twice  as long in  prison as                                                                    
non-beneficiary    felons,     while    trust    beneficiary                                                                    
misdemeanants  spent  2.5  times  as  long  in  prison  when                                                                    
compared  to  non-beneficiary  misdemeanants.  He  concluded                                                                    
that   it  was   a  significant   portion  of   the  overall                                                                    
corrections population and cost.                                                                                                
2:25:15 PM                                                                                                                    
Mr.  Jessee added  that a  large number  of the  non-violent                                                                    
offenders were  in prison for  drug or alcohol  offences. He                                                                    
stated that  the country  had learned the  hard way  that it                                                                    
was  not  possible  to  imprison  its  way  to  solving  the                                                                    
addition problem and the war  on drugs. Additionally, it was                                                                    
very  expensive. He  stated that  there  were a  significant                                                                    
number  of people  in prison  for  non-violent offences  who                                                                    
were addicts and that prison was not helping them.                                                                              
Representative  Edgmon  noted  that Mr.  Jessee  had  placed                                                                    
emphasis on  Medicaid expansion and  its value to  AMHTA. He                                                                    
asked  about  the trust's  reach  to  beneficiaries and  how                                                                    
expansion would allow services to stretch.                                                                                      
Mr. Jessee  answered that individuals who  were now eligible                                                                    
had  been  unresourced  [prior to  Medicaid  expansion].  He                                                                    
detailed that  individuals going  to a mental  health center                                                                    
or  substance abuse  treatment provider  were often  told by                                                                    
providers that they only received  a certain amount of grant                                                                    
money, lost money on every  Medicaid person they served, and                                                                    
had to  use some of their  grant money to subsidize  the low                                                                    
Medicaid reimbursement rate. He  questioned how many totally                                                                    
unresourced individuals could be  brought into service - the                                                                    
answer was  not very many.  He furthered that  by increasing                                                                    
eligibility for  what amounted  to health  insurance allowed                                                                    
providers to  have a  payment source to  begin to  build the                                                                    
capacity  needed  to  serve people.  He  spoke  to  criminal                                                                    
justice reform  and discussed that many  individuals were in                                                                    
jail due  to substance abuse  issues. He discussed  that DOC                                                                    
had begun to rebuild  its treatment programs for individuals                                                                    
in prison,  but if  there was no  support for  recovery upon                                                                    
release  from  prison,  the individuals  would  go  back  to                                                                    
prison.  He stated  that overlaying  the Medicaid  expansion                                                                    
population  with  the  individuals   coming  out  of  prison                                                                    
indicated that it  was the same group. He added  that it was                                                                    
the group  the state had  to resource  in order to  have the                                                                    
capacity to do justice reinvestment.                                                                                            
2:28:13 PM                                                                                                                    
Representative   Wilson   spoke    about   the   timing   of                                                                    
assessments. She  wondered how  much the state  was spending                                                                    
on assessments  (down the line versus  pretrial) and whether                                                                    
there  was  follow up  to  determine  whether treatment  was                                                                    
received.  She   was  interested  to  know   how  many  more                                                                    
assessments would be needed in  pretrial. She wondered about                                                                    
current treatment in  jails. She knew there  was very little                                                                    
treatment  offered  in  Fairbanks  jails.  She  wondered  if                                                                    
individuals going  through treatment received  a certificate                                                                    
or other.  She wondered how  many of the trust  clients were                                                                    
"mixed  up"  in  the  Office of  Children's  Services  (OCS)                                                                    
process. She  guessed that the  figure exceeded  80 percent.                                                                    
She believed an  area that was not  discussed frequently was                                                                    
whether a  person received  appropriate treatment  or merely                                                                    
treatment  that  enabled  the  state to  check  a  box  that                                                                    
treatment  had occurred.  She wondered  if there  was anyone                                                                    
following up  with the  clientele, she  did not  believe so.                                                                    
She  discussed  the state  tearing  families  apart and  the                                                                    
difficulty of  putting them back  together. She  needed help                                                                    
to understand  how AMHTA worked with  that population, which                                                                    
was also  competing for  a limited  amount of  mental health                                                                    
treatment  services. She  reasoned that  unless someone  was                                                                    
keeping  track,  it would  be  very  difficult to  determine                                                                    
where  the funds  needed to  go. She  continued that  it had                                                                    
nothing to  do with Medicaid expansion;  the group currently                                                                    
qualified for Medicaid. She wondered  if AMHTA had looked at                                                                    
the specific population.                                                                                                        
Mr. Webb replied that he  had been a child protection social                                                                    
worker in the  past. He affirmed that when  AMHTA had looked                                                                    
at its  cases, approximately  80 percent  involved substance                                                                    
abuse  on the  part of  the parent  or caretaker.  He stated                                                                    
that  children's mental  health was  covered with  Medicaid;                                                                    
many,  but  not  all  parents   had  Medicaid  coverage.  He                                                                    
stressed that  the capacity  issue was  the big  problem. He                                                                    
questioned   whether   there   was   capacity   to   provide                                                                    
appropriate  treatment for  parents when  it was  needed and                                                                    
whether  the  individuals  would accept  the  treatment.  He                                                                    
relayed that  he had learned  from his past  experience that                                                                    
the state  did not have  the capacity.  He did not  know the                                                                    
current figure  related to kids placed  in out-of-home care.                                                                    
He stated  that it  used to  be much too  long; it  was also                                                                    
expensive. He agreed with  statements made by Representative                                                                    
Wilson.  Many  of the  children  ended  up in  the  juvenile                                                                    
justice system and later the  adult criminal justice system.                                                                    
He  had personally  witnessed the  situation from  a child's                                                                    
early formative years, through  the juvenile justice system,                                                                    
and on  to the criminal  justice system. He  emphasized that                                                                    
it was a common occurrence.                                                                                                     
2:33:20 PM                                                                                                                    
Representative Wilson  remarked that  the state spent  a lot                                                                    
of  money  on  parents  in  court  when  nothing  was  truly                                                                    
happening. She  did not  believe the money  was spent  in an                                                                    
intelligent way.  She stated that  the parents did  not have                                                                    
an  advocate.  She  stressed  that  it  was  the  Office  of                                                                    
Children's Services, not parents'  services. She believed it                                                                    
was  time  to place  more  focus  on  the parents,  who  she                                                                    
believed  were doing  their  best. She  stated  that if  the                                                                    
money currently being spent could  be channeled to the right                                                                    
places,  it could  stop  the current  trend,  and the  state                                                                    
would win  in many  areas. She understood  that AMHTA  had a                                                                    
full plate, but she hoped the issue was on its radar.                                                                           
Mr. Webb answered that the issue was on AMHTA's radar.                                                                          
Representative Munoz referred to  Mr. Webb's testimony about                                                                    
a  case in  Anchorage where  a person  had been  murdered in                                                                    
prison.  She  shared   that  she  had  grown   up  with  the                                                                    
individual  in  Juneau.  She  detailed   that  a  number  of                                                                    
failures  had occurred  consecutively with  the man's  case.                                                                    
She  made   corrections  related   to  the   situation.  She                                                                    
explained that  he should  have never  been held  in prison.                                                                    
She furthered that  he had been picked up  for loitering and                                                                    
had  been held  in prison  for  two weeks  before his  legal                                                                    
guardian was  contacted; he  had been  murdered in  jail the                                                                    
following day.  Prior to the  arrest, he had been  living in                                                                    
stable housing until  the State of Alaska had  shut down the                                                                    
group  home where  he had  lived.  The state  had failed  to                                                                    
follow him  into a new  housing placement. She spoke  to the                                                                    
importance of follow through.                                                                                                   
Mr. Webb  replied that both  the victim and  perpetrator had                                                                    
been through  his wife's mental  health court. His  wife had                                                                    
been the judge who had  ordered the competency evaluation of                                                                    
the  perpetrator.   He  stated   that  the  case   had  been                                                                    
heartbreaking. He spoke to system  failures and relayed that                                                                    
both the  victim and  perpetrator had  been in  jail because                                                                    
they had both lost housing.                                                                                                     
2:37:14 PM                                                                                                                    
Representative  Guttenberg  believed  the trust's  work  was                                                                    
going down a positive path  and was providing the state with                                                                    
tools for  improvement. He wondered about  the optimum place                                                                    
to  provide  treatment in  one  place  in order  to  prevent                                                                    
something  negative from  happening.  He  wondered how  many                                                                    
people the state could keep out  of jail by giving a certain                                                                    
number of treatments  in order to prevent  fewer people from                                                                    
going  to jail  and  to decrease  violence.  He wondered  if                                                                    
there was an  optimal number related to  treatment. He asked                                                                    
if there was a program  indicating that the state was moving                                                                    
in the right direction. He  reasoned that at some point when                                                                    
funds to  corrections were cut, negative  things happened in                                                                    
other areas.                                                                                                                    
Mr.  Webb answered  that he  did not  believe such  a report                                                                    
existed.  He spoke  to the  importance of  the question.  He                                                                    
stated that everything  is a balance. He  furthered that the                                                                    
state was balancing public safety  with the cost of creating                                                                    
public safety. Over  the years the state had put  all of its                                                                    
"eggs  in  the  basket"  of confinement  and  punishment  to                                                                    
achieve  public safety.  He  discussed  that government  was                                                                    
risk adverse; it  was hard to take a chance  and it was much                                                                    
easier  for district  attorneys  to  recommend the  harshest                                                                    
penalty, be  tough on crime,  and recommend no  bail because                                                                    
it  protected the  attorney for  acting in  the interest  of                                                                    
public safety. He  relayed that the goal was  to get smarter                                                                    
in how the state did  business by assessing actual risk that                                                                    
people  present. There  were tools  available to  assess and                                                                    
mitigate risk. He did not know  if an absolute cost could be                                                                    
placed on  achieving the balance,  but he was happy  for the                                                                    
trust to look  into the issue. He relayed  that other states                                                                    
(e.g. Texas) had undertaken similar system reforms.                                                                             
Mr. Jessee replied that there  was no easy button. He stated                                                                    
that  the  goal  was  to  find  the  sweet  spot  where  the                                                                    
investment was bringing a desired  return without throwing a                                                                    
lot of money  at the last piece. He used  the Bring the Kids                                                                    
Home  program as  an example.  He detailed  that there  were                                                                    
still 100 kids out-of-state  because the cost for developing                                                                    
services  in  Alaska  for  the  specialized  population  was                                                                    
prohibitive.  He  communicated  that   the  state  would  be                                                                    
looking  for  the same  sweet  spot  in the  justice  system                                                                    
reforms  as well.  He  referred to  Medicaid  fraud and  the                                                                    
associated costs.  He stated that  it was possible  to spend                                                                    
$100 million and  still not catch every  fraudulent case. He                                                                    
relayed  that   the  state  could  not   afford  to  provide                                                                    
treatment  to everyone,  all of  the time,  at any  time. He                                                                    
addressed determining  how much  treatment to  provide based                                                                    
on a  positive return on  investment. He stated that  it was                                                                    
not a relevant question at  the current stage because it was                                                                    
too  far off.  He believed  the  time would  come where  the                                                                    
state  did get  close  enough to  address  the question.  He                                                                    
reasoned  that  if the  state  kept  watching the  data  and                                                                    
analyzing  the results,  he believed  the  state would  know                                                                    
when it reached the point of diminishing returns.                                                                               
2:43:10 PM                                                                                                                    
Representative  Guttenberg  noted  that many  times  it  was                                                                    
possible to  see how treatment versus  no treatment impacted                                                                    
individuals by  tracking two or three  individuals. He spoke                                                                    
to  the difference  in court  time, jail  time, and  the re-                                                                    
criminalization  process. He  was aware  there was  no sweet                                                                    
spot  or easy  answer. However,  the more  examples provided                                                                    
would  help the  legislature to  focus on  making the  right                                                                    
Co-Chair  Neuman stated  that the  legislature and  Congress                                                                    
funded  behavioral  health   programs  for  substance  abuse                                                                    
treatment. He opined that the  problem was getting the money                                                                    
to  the  street.  He stated  there  were  behavioral  health                                                                    
programs  that  did   not  apply  for  grants   due  to  the                                                                    
cumbersome  amount   of  associated  paperwork   needed  for                                                                    
compliance. He wondered if the  flow of funds to clients was                                                                    
impeded due to too much regulation.                                                                                             
Mr.  Jessee  replied  in the  affirmative.  He  agreed  that                                                                    
accountability was needed,  but people needed to  be able to                                                                    
do  their  jobs  to  achieve  desired  outcomes  instead  of                                                                    
spending  too much  time on  paperwork.  The department  had                                                                    
asked Tom  Chard with the Behavioral  Health Association and                                                                    
Kate Burkhart with  the mental health and  alcohol boards to                                                                    
look at the issue  and they had come up with  a good list of                                                                    
recommendations for  some changes. He was  not certain about                                                                    
the current  status of the department's  process. He relayed                                                                    
that it would  be a piece of the  behavioral health redesign                                                                    
within the  larger Medicaid redesign.  He questioned  how to                                                                    
find the sweet spot  for accountability without impeding the                                                                    
outcome  that was  trying  to be  achieved.  He stated  that                                                                    
having a willing partner at  the department was a huge piece                                                                    
of the puzzle that had not always been available.                                                                               
Co-Chair  Neuman  thanked  the presenters  and  stated  that                                                                    
AMHTA provided significant and respected work.                                                                                  
AT EASE                                                                                                                         
2:47:19 PM                                                                                                                    
2:53:03 PM                                                                                                                    
^FY  17 BUDGET  OVERVIEW:  DEPARTMENT OF  HEALTH AND  SOCIAL                                                                  
2:53:15 PM                                                                                                                    
VALERIE  DAVIDSON, COMMISSIONER,  DEPARTMENT  OF HEALTH  AND                                                                    
SOCIAL SERVICES  (DHSS), provided a  PowerPoint presentation                                                                    
titled  "Department of  Health  and  Social Services,  House                                                                    
Finance, FY2017 Department Overview"  dated January 27, 2016                                                                    
(copy  on   file).  She   expressed  appreciation   for  the                                                                    
opportunity   to  present   the  department's   overview  in                                                                    
furtherance of  their   mission to  promote and  protect the                                                                    
health  and  wellbeing  of   Alaskans.  She  indicated  that                                                                    
additional  detail would  be  provided  by the  department's                                                                    
divisions  during  the   budget  subcommittee  process.  She                                                                    
introduced various colleagues within DHSS.                                                                                      
2:55:26 PM                                                                                                                    
Commissioner  Davidson addressed  slides  3  through 6  that                                                                    
included  detail on  the  department's  eight divisions  and                                                                    
their directors. The Alaska Pioneer  Homes was run by Vickie                                                                    
Wilson and  its mission was  to provide the  highest quality                                                                    
of life  in a safe  home environment for older  Alaskans and                                                                    
veterans. The Division of  Behavioral Health acting director                                                                    
was Randall Burns  and the division's mission  was to manage                                                                    
an  integrated and  comprehensive  behavioral health  system                                                                    
based   on   sound    policy,   effective   practices,   and                                                                    
partnerships.   The  Office   of  Children's   Services  was                                                                    
directed by  Christy Lawton and  the mission was  to prevent                                                                    
and respond  to child maltreatment  in order to  ensure safe                                                                    
children and  strong families. The  Division of  Health Care                                                                    
Services was  directed by Margaret Brodie  and their mission                                                                    
was to manage healthcare coverage  for Alaskans in need. The                                                                    
Division of  Juvenile Justice  was run by  Rob Wood  and the                                                                    
division's   mission   was   to  hold   juvenile   offenders                                                                    
accountable  for  their  behavior, promote  the  safety  and                                                                    
restoration   of  victims   and   communities,  and   assist                                                                    
offenders  and  their  families   in  developing  skills  to                                                                    
prevent  crime.  The  Division   of  Public  Assistance  was                                                                    
directed  by  Sean  O'Brien  and   aimed  to  provide  self-                                                                    
sufficiency and  basic living expenses to  Alaskans in need.                                                                    
The  Division  of Public  Health  was  directed by  Dr.  Jay                                                                    
Butler  and worked  to  protect and  promote  the health  of                                                                    
Alaskans. The  Division of Senior and  Disabilities Services                                                                    
was run  by Duane Mayes and  its mission was to  promote the                                                                    
independence of  Alaskan seniors  and persons  with physical                                                                    
and developmental disabilities.                                                                                                 
2:57:27 PM                                                                                                                    
Co-Chair  Neuman asked  Commissioner Davidson  to return  to                                                                    
slide 3 and review numbers on the slides.                                                                                       
Commissioner Davidson returned to  slide 3 and detailed that                                                                    
the Alaska Pioneer Homes represented  about 2.3 percent ($62                                                                    
million total including $32  million in undesignated general                                                                    
funds (UGF)) of the department's FY 16 operating budget.                                                                        
Co-Chair   Neuman  spoke   to  the   state's  aging   senior                                                                    
population, the waiting list to  get into the Pioneer Homes,                                                                    
and the increase  in the cost in medical  services. He asked                                                                    
if there  was an  expectation that the  cost to  operate the                                                                    
Pioneer Homes would increase.                                                                                                   
Commissioner  Davidson  answered  that  there  had  been  an                                                                    
increasing level of acuity in  Pioneer Homes' residents. She                                                                    
detailed that  in the  past some of  the residents  had only                                                                    
required  Level  1  services (a  low  number  of  services).                                                                    
Presently the  facilities were seeing an  increased need for                                                                    
services (Levels  2 and 3).  She furthered that  because the                                                                    
state   did  not   have   many   other  providers   offering                                                                    
Alzheimer's related  services, the Pioneer Homes  had become                                                                    
the default treatment centers in the state.                                                                                     
Co-Chair   Neuman   remarked   that  individuals   had   the                                                                    
opportunity  to stay  in the  Pioneer Home  as their  health                                                                    
deteriorated  (based on  income). He  believed the  cost for                                                                    
Level  3 services  was  $7,000 to  $8,000  per resident  per                                                                    
month, which was almost completely covered by the state.                                                                        
Commissioner  Davidson  replied  that the  department  could                                                                    
provide the committee with a  more detailed breakdown of the                                                                    
costs for each  level of care at a later  time. She affirmed                                                                    
that  the higher  levels of  care were  more expensive.  She                                                                    
explained that  typically Level  1 residents  may be  in the                                                                    
home because they had a  spouse in the facility who required                                                                    
Level 2 or 3 services.                                                                                                          
Representative  Wilson stated  that numbers  were needed  to                                                                    
understand how  many people the  Pioneer Homes  were serving                                                                    
in each of the three service levels.                                                                                            
Commissioner Davidson replied  that the department typically                                                                    
provided  the  information  when  the  divisions  did  their                                                                    
detailed presentations, but she would add it to the list.                                                                       
Commissioner  Davidson  addressed  Health Care  Services  on                                                                    
slide 4.  The division administrative portion  accounted for                                                                    
$22  million of  the total  DHSS operating  budget including                                                                    
$8.6  million in  UGF. She  noted that  the figures  did not                                                                    
include Medicaid payments. The  Division of Juvenile Justice                                                                    
accounted  for  $60.3 million  ($56.2  million  UGF) or  2.2                                                                    
percent of the department's total operating budget.                                                                             
Representative  Gara  asked about  slide  4  related to  the                                                                    
Office  of  Children's  Services   (OCS).  He  believed  the                                                                    
division's   mission  should   be  [to   ensure]  safe   and                                                                    
successful  children.   He  felt  that  sometimes   after  a                                                                    
response  to a  crisis there  was not  the necessary  follow                                                                    
through to help a child succeed.  He noted that OCS did work                                                                    
on many things,  but he observed that a  goal for successful                                                                    
children was left out of the mission.                                                                                           
3:03:23 PM                                                                                                                    
Commissioner  Davidson thanked  Representative Gara  for his                                                                    
comments. She addressed slide 4  and relayed that the Office                                                                    
of Children's  Services accounted for $151.4  million ($87.4                                                                    
million  UGF)  or  5.5 percent  of  the  department's  total                                                                    
operating budget.  She moved  to slide  5 and  addressed the                                                                    
Division  of  Public  Assistance budget  of  $313.7  million                                                                    
($147 million  UGF) or  11.4 percent  of the  DHSS operating                                                                    
budget. She  noted that  many of  the programs  were federal                                                                    
pass through programs.  She moved to the  Division of Public                                                                    
Health,  which  represented  $134.7 million  ($49.6  million                                                                    
UGF)  or  5 percent  of  the  department's operating  budget                                                                    
(slide  6).  Senior  and Disabilities  Services  represented                                                                    
about  2.7 percent  of the  budget or  $73.5 million  ($48.6                                                                    
million UGF).                                                                                                                   
Commissioner Davidson  turned to  slide 7 and  addressed the                                                                    
department's  service  population.   The  chart  listed  the                                                                    
department's three  primary priorities including  health and                                                                    
wellness across  the lifespan;  health care  access delivery                                                                    
and  value; and  safe and  responsible individuals,  family,                                                                    
and  communities. She  pointed to  the bottom  of the  chart                                                                    
indicating   that  the   department  served   Alaskans  from                                                                    
prenatal to death (including burial assistance).                                                                                
3:06:11 PM                                                                                                                    
SANA EFIRD,  ASSISTANT COMMISSIONER, FINANCE  and MANAGEMENT                                                                    
SERVICES,   DEPARTMENT  OF   HEALTH  AND   SOCIAL  SERVICES,                                                                    
addressed  slide   8  that   illustrated  the   process  the                                                                    
department  had undergone  to examine  the activities  under                                                                    
the divisions to  determine how the programs  fit within the                                                                    
department's  identified   mission.  The  chart   broke  the                                                                    
department  into  priority,  core  services,  divisions  and                                                                    
funding sources for each. She  explained that each tear drop                                                                    
illustrated on  the chart represented the  divisions and how                                                                    
their budget aligned  to each of the core  services. Slide 9                                                                    
included a  comparison between total  budgets for FY  15 and                                                                    
FY 16; in total the  department's budget had decreased $75.3                                                                    
million. She noted  that the slide also  illustrated how the                                                                    
total funds  were allocated  between the  department's three                                                                    
Ms. Efird turned to slide  10, which illustrated the journey                                                                    
the department had  been on in the past  year. She discussed                                                                    
that DHSS  originally focused  on ensuring  that all  of the                                                                    
pieces of the division's  programs and activities aligned to                                                                    
help achieve the department's  mission, priorities, and core                                                                    
services.  The next  piece was  related to  establishing the                                                                    
department  measurements   that  would  roll  up   into  its                                                                    
objectives,  core  services,  and  priorities  in  order  to                                                                    
provide  a snapshot  of  the  department's performance.  The                                                                    
chart   was  the   first   step   towards  identifying   the                                                                    
information. She  explained that the illustrations  had been                                                                    
created  by   utilizing  inexpensive  software   to  collect                                                                    
information to  visually show where the  department stood on                                                                    
its  performance measures  toward  its  priorities and  core                                                                    
services. The  left hand  side of  the chart  included three                                                                    
dashboards  representing the  department's three  priorities                                                                    
(health  and  wellness  across  the  lifespan;  health  care                                                                    
access  delivery   and  value;  and  safe   and  responsible                                                                    
individuals,  family,   and  communities).   Each  dashboard                                                                    
included  red,  yellow,  and  green   with  a  level  marker                                                                    
indicating  the department's  performance in  each priority.                                                                    
The core service fed into  the dashboards, which also showed                                                                    
objectives.  Other   charts  on   the  slide   showed  which                                                                    
measurements fed  into each of  the dashboards  to determine                                                                    
what was shown on the priority dashboard.                                                                                       
3:10:55 PM                                                                                                                    
Co-Chair Neuman  asked for verification that  the department                                                                    
was  judging  itself  based on  the  priorities.  Ms.  Efird                                                                    
replied  in   the  affirmative.   She  clarified   that  the                                                                    
information shown  on slide 10  pertained to  the department                                                                    
as a whole.  She explained that each of  the divisions would                                                                    
extract some  of their key  measurements and  performance to                                                                    
show  the  committee.  She  furthered  that  the  dashboards                                                                    
represented  another   tool  to  measure   the  department's                                                                    
success in working towards aligning  its budget and spending                                                                    
funds  on items  to achieve  its priorities.  The department                                                                    
was  still   working  to  determine  where   it  could  pull                                                                    
information  from  that  showed  outcomes  instead  of  only                                                                    
focusing on the number of people coming through the door.                                                                       
Vice-Chair Saddler  asked where the  results-based budgeting                                                                    
had helped  the department better manage  its priorities and                                                                    
budget. He  referred to the dashboard  illustrations (slides                                                                    
10 and 11)  and asked for verification that  green was good,                                                                    
yellow indicated  that improvement  was needed, and  red was                                                                    
Ms. Efird  replied in the  affirmative. She  elaborated that                                                                    
it  was  the  department's first  attempt  without  spending                                                                    
significant  money on  a software  program  that would  help                                                                    
DHSS  have a  point of  collection for  department measures.                                                                    
She furthered that the information  was not as sophisticated                                                                    
as they  would like because  it did not  necessarily measure                                                                    
the balance  of efficiencies  and funds;  however, it  was a                                                                    
starting  place. She  addressed  what the  performance-based                                                                    
model  had done  for  the department.  She  stated that  the                                                                    
model had given DHSS a platform  to speak from in one voice.                                                                    
She discussed that  they were working to  illustrate to each                                                                    
of  the divisions  how their  work contributed  to achieving                                                                    
the department's  priorities. She  furthered that  the model                                                                    
had  created a  cross-divisional  conversation to  determine                                                                    
any  duplications  and  to  look  at  ways  to  support  and                                                                    
leverage  programs.  The  department was  also  starting  to                                                                    
collect information  on how  all of  the various  pieces fit                                                                    
together to achieve the department goals.                                                                                       
3:14:15 PM                                                                                                                    
Commissioner Davidson  addressed FY 16 highlights  of budget                                                                    
changes on slide  13. She began with  updated information on                                                                    
the  status  of  Medicaid  expansion.  Through  the  end  of                                                                    
December [2015],  7,957 Alaskans  had been  enrolled through                                                                    
expansion. As  predicted, more men  than women  had enrolled                                                                    
(approximately  4,267 men  and  3,690  women). Total  claims                                                                    
paid through December were about  $21.6 million (100 percent                                                                    
federal  receipts).  She  relayed that  the  department  did                                                                    
expect  the number  to increase.  She  explained that  under                                                                    
federal Medicaid  rules there was  a one year  timely filing                                                                    
limit.  She expounded  that providers  offering services  to                                                                    
Medicaid beneficiaries had up one  year to bill for services                                                                    
provided. She  shared that the  information would  be posted                                                                    
on the  DHSS website  in order  to provide  transparency and                                                                    
better   information   to    the   public   about   Medicaid                                                                    
beneficiaries   including   where   they   lived,   services                                                                    
accessed, and other.                                                                                                            
Commissioner  Davidson  discussed   that  the  way  Medicaid                                                                    
beneficiaries  were counted  could be  difficult to  manage.                                                                    
She  explained  that people  went  on  and off  of  Medicaid                                                                    
constantly throughout  the year.  For example, a  person may                                                                    
get  a job  and  may no  longer qualify  for  Medicaid or  a                                                                    
person may  lose a  job and  suddenly qualify  for Medicaid.                                                                    
She furthered  that at  the end of  the year  the department                                                                    
could  look  at  how  many unduplicated  Alaskans  had  been                                                                    
covered by Medicaid;  it would typically be  a higher number                                                                    
(e.g. around 148,000 Alaskans). Whereas,  at a point in time                                                                    
the number may be lower.  For example, in December there had                                                                    
been  129,366 Alaskans  enrolled in  Medicaid including  the                                                                    
expansion  population. The  largest Medicaid  population was                                                                    
in  Anchorage   and  Mat-Su,   followed  by   the  Interior,                                                                    
Southwest, Gulf  Coast, Southeast, and Northern  Alaska. She                                                                    
reiterated that the information would  be posted on the DHSS                                                                    
website.  Children   accounted  for  the  majority   of  the                                                                    
Medicaid  beneficiary  population  at 54  percent,  with  an                                                                    
additional  2  percent  experiencing  disabling  conditions.                                                                    
Currently (under expansion) seniors  accounted for 6 percent                                                                    
of  the   Medicaid  population,   21  percent   were  parent                                                                    
caretakers,  and  11  percent  were  adults  with  disabling                                                                    
conditions. She added that the  information would be updated                                                                    
monthly on the department's website.                                                                                            
3:17:45 PM                                                                                                                    
Commissioner Davidson  continued to address points  on slide                                                                    
13. She addressed the Alaska  Pioneer Homes rate increase to                                                                    
8.5 percent scheduled  to take effect February  1, 2016. She                                                                    
detailed  that it  was  the  first time  the  rate had  been                                                                    
increased in  many years. Additionally, there  was a request                                                                    
for letters of interest to  the public inquiring whether any                                                                    
organizations or  companies were  interested in  taking over                                                                    
the  management   and  operations  of  Pioneer   Homes.  The                                                                    
department would  report back to the  legislature about what                                                                    
kind  of  interest  it received.  She  addressed  the  third                                                                    
bullet point  on slide  13 related  to the  reprogramming of                                                                    
the  Ketchikan  Youth  Facility. The  department  recognized                                                                    
that   the  state   did   not   have  sufficient   treatment                                                                    
facilities, especially  for adolescents. She  expounded that                                                                    
DHSS was currently pursuing an  opportunity with the Centers                                                                    
for  Medicare and  Medicaid Services  (CMS) to  redesign and                                                                    
reprogram the  Ketchikan facility  in order to  provide more                                                                    
intensive  services  to  youth  throughout  the  state.  She                                                                    
explained  that  the  youths requiring  detention  would  be                                                                    
transferred to the facility in Juneau.                                                                                          
Co-Chair Neuman thanked the department  for looking into the                                                                    
privatization  of Pioneer  Homes.  He remarked  that he  and                                                                    
Commissioner   Davidson  had   discussed  juvenile   justice                                                                    
centers in the  past and where there had been  a movement to                                                                    
try to  move more  civil cases over  to tribal  entities. He                                                                    
asked for an update.                                                                                                            
Commissioner  Davidson replied  that the  conversations with                                                                    
tribal   organizations   continued,   but   were   in   very                                                                    
preliminary stages.  She referred to legislation  offered by                                                                    
Senator  Pete Kelly  (SB 74)  that included  a directive  to                                                                    
DHSS to  explore privatizations of the  Division of Juvenile                                                                    
Justice  facilities.  She  relayed  that  the  Norton  Sound                                                                    
Health Corporation  had expressed interest in  the operation                                                                    
of the facility in Nome.  The department had the opportunity                                                                    
to realize  the savings for  100 percent federal  match. She                                                                    
explained that  when an  Indian Health  Services beneficiary                                                                    
who  was  also eligible  for  Medicaid  received their  care                                                                    
through an  IHS facility,  the services were  considered 100                                                                    
percent  federal match.  She shared  that the  previous year                                                                    
stated  that the  preceding year  Governor  Bill Walker  had                                                                    
sent a letter to Secretary  Sylvia Burwell [Secretary to the                                                                    
U.S.  Department of  Health  and  Human Services]  inquiring                                                                    
about 1115 waiver opportunities  in order to position Alaska                                                                    
to better  partner with tribal health  organizations to take                                                                    
advantage of  100 percent federal match.  The real challenge                                                                    
had been  to determine  what was  considered through  an IHS                                                                    
facility. Historically,  CMS had  specified that  travel and                                                                    
accommodation services  were only covered at  50 percent and                                                                    
services   referred  beyond   the  tribal   health  system's                                                                    
capacity to  provide the care  were also not through  an IHS                                                                    
facility  and  were therefore  only  covered  at 50  percent                                                                    
federal   match   (slightly   higher  for   children).   The                                                                    
administration had communicated that it  would like to do an                                                                    
1115 waiver  that would allow 100  percent reimbursement for                                                                    
travel and  accommodation services because they  felt it was                                                                    
a critical access  to care issue (the  beneficiaries did not                                                                    
have  the  access  without   the  travel  and  accommodation                                                                    
service). The  administration had also  said that if  it was                                                                    
beyond  the tribal  health system's  capacity  to provide  a                                                                    
service,  which would  require a  patient  to go  to a  non-                                                                    
tribal  hospital   or  facility,   the  patient   should  be                                                                    
considered 100  percent federal  match because  they started                                                                    
in a  tribal health  facility. She furthered  that Secretary                                                                    
Burwell had sent a letter  to Governor Walker answering that                                                                    
an  1115  waiver  would  not  be  the  solution  because  it                                                                    
required  budget  neutrality  for  the  federal  government.                                                                    
Alternatively, Secretary  Burwell had communicated  that the                                                                    
federal government  would change national policy  to be able                                                                    
to accommodate  the request, which  would impact  Alaska and                                                                    
34  other states  with a  significant  tribal presence.  She                                                                    
stressed that  it was probably Alaska's  biggest opportunity                                                                    
for saving.  Consequently, DHSS was continuing  to negotiate                                                                    
with CMS  about the specifics.  She relayed that  DHSS would                                                                    
do its  best to  determine if there  was any  opportunity to                                                                    
retroactively apply  the policy. She emphasized  that it was                                                                    
a tremendous  opportunity for Alaska.  She noted  that South                                                                    
Dakota was  also aggressively pursuing the  opportunity. The                                                                    
state   was  fortunate   that  it   had   a  great   working                                                                    
relationship with  CMS. She shared  that she  had previously                                                                    
worked for tribal health for 15  years and they had tried to                                                                    
get the federal match the entire time she had been there.                                                                       
3:25:02 PM                                                                                                                    
Ms.  Efird addressed  the reduction  to the  Senior Benefits                                                                    
Program in FY  16 of approximately $2.6  million (slide 13).                                                                    
She  detailed  that the  program  had  three payment  levels                                                                    
(based  on  income  levels):  $125,   $175,  and  $250.  The                                                                    
reduction  would  be  taken  to  the  highest  income  level                                                                    
(lowest  payment   level)  and  would  affect   about  5,348                                                                    
Co-Chair  Neuman asked  for  the cost  per  year. Ms.  Efird                                                                    
replied that  the current Senior Benefits  Program had about                                                                    
$20 million  for FY 17.  There had been  approximately $22.6                                                                    
million  prior  to  the  reductions.   She  noted  that  the                                                                    
governor had proposed the same number for FY 17.                                                                                
Representative Guttenberg asked about  the Pioneer Home rate                                                                    
increase. He hoped  it meant the Pioneer  Homes could charge                                                                    
more  and get  reimbursed more.  He asked  if there  was any                                                                    
impact on the residents.                                                                                                        
Commissioner Davidson answered that  DHSS would bill Pioneer                                                                    
Home residents for the rate  increase; it could be billed to                                                                    
insurance, Medicaid,  or self-pay.  The Pioneer Homes  had a                                                                    
sliding fee  scale for self-pay residents.  She communicated                                                                    
that residents would not be thrown out on the street.                                                                           
Representative  Gara  asked  for  verification  that  people                                                                    
using  self-pay   would  pay   the  8.5   percent  increase.                                                                    
Commissioner Davidson replied in the affirmative.                                                                               
Commissioner  Davidson thanked  the committee  for providing                                                                    
funds  for  the  additional  positions  for  the  Office  of                                                                    
Children's  Services to  address  its increased  utilization                                                                    
for  children needing  out of  home  services. She  detailed                                                                    
that 13 of  the positions had been filled  and an additional                                                                    
10 would be filled within the  next 30 days. The remaining 3                                                                    
positions would be filled within  60 days. Additionally, the                                                                    
department  had  been able  to  transfer  2 other  positions                                                                    
Co-Chair Neuman  asked for verification that  the department                                                                    
had  the funds  in hand  for the  needs (e.g.  office space,                                                                    
computers,   and   other).   Ms.  Efird   replied   in   the                                                                    
Representative  Wilson asked  the  department  to follow  up                                                                    
with  the  number  of positions  filled  with  case  workers                                                                    
versus social  workers. She asked  where the  positions were                                                                    
located.  She wondered  how many  families each  case worker                                                                    
was  assigned to;  she stated  that many  families had  more                                                                    
than one child that may be  assigned to one caseworker.  She                                                                    
spoke to  the reunification rate  of children going  back to                                                                    
their parents. She had observed  that most reunification had                                                                    
been to parents or a family  member, but she did not believe                                                                    
placing  a   child  with  a   family  member   qualified  as                                                                    
3:29:34 PM                                                                                                                    
Co-Chair  Thompson  noted that  the  26  positions had  been                                                                    
funded with federal  money. He remarked that  there had been                                                                    
an  indication  that  the  money may  not  continue  in  the                                                                    
future. He asked for an update.                                                                                                 
Ms. Efird replied that there  had been a number of different                                                                    
changes throughout the budget  process. She detailed that in                                                                    
conversations   with  OCS   and  the   Division  of   Public                                                                    
Assistance,  some  Temporary  Assistance  for  Needy  Family                                                                    
(TANF)  funds had  been identified,  that could  be used  to                                                                    
cover  the   child  advocacy   centers'  funding   from  the                                                                    
department.  She   furthered  that  General  Funds   to  the                                                                    
department  had been  cut, but  had subsequently  been added                                                                    
back.  There   was  a  small   amount  of   federal  funding                                                                    
associated  with the  positions  that  the department  could                                                                    
collect. The  federal dollars that had  been identified were                                                                    
TANF funds  that could  now be used  for the  child advocacy                                                                    
centers. The department did not  anticipate that the funding                                                                    
would be reduced in the next few years.                                                                                         
Representative  Gara  asked  about  the  current  number  of                                                                    
foster  children in  Alaska. He  noted that  the number  had                                                                    
risen to  2,500 from 1,700,  but he believed the  figure was                                                                    
presently  over 2,800.  Commissioner  Davidson replied  that                                                                    
there were currently over 2,800 foster children.                                                                                
Co-Chair  Thompson addressed  the agenda  for the  following                                                                    
3:33:02 PM                                                                                                                    
The meeting was adjourned at 3:32 p.m.                                                                                          

Document Name Date/Time Subjects
AMHTA Overview HFIN presentation .pdf HFIN 1/27/2016 1:30:00 PM
DHSS-HFIN Dept Overview FY2017- FINALa.pdf HFIN 1/27/2016 1:30:00 PM
DHSS LegLog 3589 DHSS HFIN Overview Responses.pdf HFIN 1/27/2016 1:30:00 PM
FY2016 Alignment Visual HSS_Funding Breakdown.pdf HFIN 1/27/2016 1:30:00 PM