Alaska Legislature: House Health & Social Services, 4/2/26, 3:15

This meeting of the House Health and Social Services Committee will now come to order. It is 3.22 p.m., Thursday,

April 2nd, 2026,

in Davis 106. Members present are Representatives Schwanke, Mears, Prox, Gray,

myself,

Chair Miena, and we also have Representative Fields calling over via teleconference. Let the record reflect that we have a quorum to conduct business.

Please take this time to silence your cell phones for the duration of the meeting.

of the meeting.

Staffing the committee today,

we have Andrew Giannani,

our Health and Social Services Recording Secretary,

Kyla Tupo,

our LIO Moderator,

and Katie Georgiou, my committee aide.

If you need anything during the meeting,

please don't hesitate to get her attention.

We have four bills on today's agenda.

First,

we have House Bill 376 by the House Education Committee on expanding early intervention services for children.

I'd like to invite Representative Andy Story and her staff.

staff K Kali K Laib home to introduce the bill and uh to introduce the bill.

Good afternoon and thank you Chair Mina and members of the House and Social Services Committee. For the record I am Representative Andy Story,

representing District 3,

which includes North Juno here in the Mendenhall Valley,

Fritz Cove Road,

Auk Bay,

Out the Road,

Gustavus, Haines,

Klukwan and Skagway.

I also have the honour of serving as the legislative liaison to the governors council on disabilities and special education. The council supports uh this investment in early invention in the bill that we are hearing today in early intervention which works with infants and children who show developmental delays in their growth. Members of the council will be providing invited testimony at the end of my remarks.

And and I am joined by my staff member, Kaylee Holm.

Uh and toge together today um I have the pleasure of introducing House Bill three seventy six, expand early intervention services on behalf of the House Education Committee. This bill is companion legislation to Senate Bill one seventy eight, sponsored by the Senate Health and Social Services Committee.

Right now Alaska is on the wrong side of the pay now or pay more later for early intervention services. Approximately ninety percent of a child's brain development occurs before age three, making the earliest years of the life of life most critical period for development.

When developmental delays are identified and addressed during this time children often need fewer intervention services when they start kindergarten and later in school and show better future outcomes.

Importantly, families are supported earlier to help their children early in life,

empowering parents to support their children's developmental growth.

When those delays go unaddressed during this time, families and children experience greater stress, the child shows less progress, and the state frequently ends up paying far more later through special education services, health care and other support services.

Unfortunately,

many young Alaskan children with meaningful developmental delays are unable to access services until after this critical stage of development simply because the state of Alaska is one of the three states with the most restrictive eligibility standards for early intervention services in the nation,

requiring children to show a 50% delay before they are eligible for services.

this prevents many children from receiving sru support when it could have the greatest impact and yield the greatest cost savings. House Bill seventy six

House Bill 376 improves Alaska's early intervention system in three main ways.

First, the bill amends Alaska's Medicaid statute to add early intervention services to the list of optimal services the Department of Health may provide, which positions the state to receive federal Medicaid reimbursement for services that are otherwise funded largely with state dollars.

Second, the bill requires the Department of Health to review the

Review the conditions that qualify as a disability and make recommendations to the Alaska State Legislature on updating those conditions.

This periodic review ensures that the program reflects current medical knowledge and best practices.

Third,

and most importantly,

the bill updates Alaska's eligibility criteria for early intervention services.

House Bill 376 aligns Alaska's definition more closely with federal standards.

under the Individuals with Disabilities Education Act and lowers the eligibility threshold for services. Under this legislation,

children would qualify for services if they demonstrate a twenty five per cent delay in one area, or twenty per cent uh developmental delay in two or more developmental areas. Overall, House Bill three seventy six is about helping Alaska's children get the support they need

At the earliest possible stage, improving long-term outcomes for families while making better use of state and federal resources.

With that, Madame Chair and members of the committee,

my staff, Kaylie Hohm, um may walk you, if you please, uh through the cent section analysis and then we have um three people for invited testimony today um and we have a PowerPoint uh that uh uh Nim Dardas will go through. And um I think it might be best to hold questions till after the um

um presentations, um but if you please uh Kaylee is ready to go through the sexual analysis.

Thank you. Does the committee wish for this actual analysis?

All right, please go ahead.

Okay.

Good afternoon, for the record, Kaylee Holm, staff to Representative Andy Story.

Section one of House Bill 376 adds early intervention services to the covered medical assistance service. So this will allow services currently being paid for by the state to be reimbursed through Medicaid and increase access to federal dollars. Section two

amends to clarify the purpose section of the Alaska Early Intervention Statute to be more narrowly focused on eligible children with developmental delays,

ensuring resources are directed to those with the greatest need.

Section three removes outdated paraprofessional training requirements and requires a regular five-year review to qualifying

the Department of Health to have a regular five-year review of qualifying disability conditions to ensure the program stays aligned with current medical research best practices and eligibility stays up to date.

Section four clarifies the eligibility of early intervention services. It specifies that children under the age of three qualify if they are experiencing a developmental delay or disability. This helps simplify the eligibility language in the statute and ensures programs consistently identify and serve children who need and whose need and support during the early stages of development

is met. Section five removes language allowing services to be eliminated if funding is insufficient. This will help ensure that once a child qualifies for those services they can no longer be removed from receiving those services even if there are funding limitations, creating stability for families that rely on the programs. Section six is the meat of this bill. And it updates the definition of developmentally delayed.

And it aligns Alaska's definition with federal, the federal Individuals with Disabilities Education Act by lowering that threshold that the representative spoke of earlier to twenty-five percent.

Section seven repeals and reenacts the definition of early intervention services and provides a comprehensive list of services that may be provided.

Section 8 repeals several outdated sections of the law, including the definition of core and additional to early intervention services, because these long definitions no longer apply and are replaced with all the criteria and qualifying services in Section 7.

Section 9 requires the Department of Health to submit a report to the legislature, and this will help the legislature evaluate how well the program is working and determine whether there needs to be additional improvements. Section 10 directs the Department of Health to amend and substitute the state Medicaid plan to ensure the changes of this bill can be implemented within the federal Medicaid system. This is going to be necessary to allow

access to that federal reimbursement services. Section 11 provides the Medicaid-related changes to the bill to take effect only if the federal— only if and when the federal government approves the amendments to the state Medicaid plan. This protects the state for ensuring the program only moves forward if the federal requirements are satisfied. And then Section 12—

finally, Section 12 and 13 are effective dates. So, Section 12 speaks to Section 1, which says that it only takes effect after the U.S. Department of Health and Human Services approves the amend plan.

And this will give the department time to make the necessary administrative and federal changes to implement the program. And then Section 3 is for the rest of the bill, and that effective date is July 1st,

2026.

And all these changes are based on recommendations from the Alaska Department of Health Coordinating Council and were developed with input of providers, advocates, and families across Alaska, some of who the representative already mentioned today are here as expert witnesses to testify. So with that, I conclude the sectional analysis.

Thank you.

Thank you Ms. Holm for the sectional analysis. I'd like to now transition to our invited testimony. First we have Nev Dardis, director of reach infant learning programme. If you could please come to the presenters table, put yourself on the record and begin your testimony.

Good afternoon. My name is Niamh Dardis. I am the Director of the Reach Infant Learning Programme based here in Juneau, but we also serve ten communities throughout Southeast Alaska. I also currently serve as the Vice President of the Alaska Infant Learning Programme Association. And through the wonders of technology I am joined today by two colleagues. Um Amy Simpson is on the line in Anchorage as is Rich Saville and if the um committee allows, I will just ask Amy to introduce herself.

Um and then followed by Rich and then we'll proceed through our slide show.

That sounds good. Miss Simpson, please put yourself on the record.

Good afternoon. For the record,

my name is Amy Simpson.

I am the Executive Director of Programs for Infants and Children,

also a member of the Interagency Coordinating Council of the Governor's Council on Disabilities and Special Education.

It's a mouthful.

Also a member of IALPA and I am a speech therapist providing early intervention services in Alaska.

for the past 31 years.

I'll turn it to Rich.

Thank you, Amy.

Thank you, Amy. Good afternoon. My name is Rich Saville.

I am the Education and Early Intervention Coordinator for the Governor's Council on Disabilities and Special Education.

In that role, I staff the Interagency Coordinating Council and have been working on this project. Thank you.

Well, as introduced by Representative Storey, we're here today to speak about the expansion of eligibility for Alaska's Infant Learning Program and Part C services. Every week we hear from parents across the state who are not calling because things are going well. They're calling because something feels wrong. My baby isn't sitting yet, my toddler stopped talking, I don't know what's happening but I know something is wrong and my child needs help.

Great.

My baby isn't sitting yet.

My toddler stopped talking. I don't know what's happening, but I know something is wrong and my child needs help. Those parents are doing exactly what we asked them to do in being responsive to the children, noticing early and asking for support.

Those parents are doing exactly what we asked them to do in being responsive to the children, noticing early and asking for support. But under Alaska's current system far too often we have to tell them we see the delay, we agree there's a concern, but your child isn't delayed enough and that is devastating.

But under Alaska's current system, far too often we have to tell them We see the delay.

We agree there's a concern, but your child isn't delayed enough, and that is devastating.

HB 376, the bill before you today, asks a simple but profound question:

will Alaska meet these families and intervene when it matters most, or after the most powerful window for change has closed, when delays are harder and more expensive to address? We know the first three years of life present the strongest and most cost-effective opportunity to influence long-term health, learning and developmental outcomes.

This bill is not about creating a new program. It is about using our existing early intervention infrastructure and system at the right time and for the right children so we are not waiting for problems to escalate before responding.

So what is IDEA Part C?

IDEA Part C is a federally mandated program grounded in a simple promise that if an infant or toddler has a diagnosed condition or shows signs of a developmental delay, support is available and their family will not face it alone. In Alaska, this is delivered through the Infant Learning Program administered by the Department of Health.

ILP services are jointly funded by state and federal dollars. They are voluntary and free to families.

They are voluntary and free to families.

They are delivered in natural environments such as homes, child care settings, playgrounds and tribal settings across the state. We do not maintain wait lists. Each child referred must be evaluated and a decision on enrollment made within forty five days.

And most importantly, they are family centred, meaning children are not treated in isolation.

Parents are respected as their child's first and most important teacher and are coached to support their child's development through daily routines such as mealtimes,

bath times and play.

From a health care perspective, Part C is often preventative care. It supports motor development, communication,

feeding,

social emotional development, and early brain wiring before challenges deepen requiring more intensive and costly intervention.

But despite having a strong system in place, Alaska currently maintains one of the most restrictive eligibility criteria in the nation to access these high quality services.

A child must demonstrate a fifty percent developmental delay or half of the lifetime of a delay in order to qualify. H.B. three seventy six modernizes that threshold so we can support children before delays become deeply entrenched.

Here we can see Alaska's IEP network.

Our infant learning programmes serve families in every corner of this great state, from Utqiagvik to Metlickatla,

Bethel to the Copper River Basin, from Nome to Juneau.

IOP providers travel by snowplane,

skiff, four wheeler, ferry and floatplane.

They sleep on school gym floors and community centre cots, because when a parent reaches out, IOPs don't wait for convenience,

good weather or geography.

Our teams are comprised of Occupational Therapists, Physical Therapists, Speech Language Pathologists,

with pathologists, infometal health specialists, social workers, making up some of the most highly specialised paediatric providers in the state. And annually, ILP serves about nineteen hundred children statewide. However, every year we also evaluate hundreds more who demonstrate real concerning delays, and we were required to turn them away because they do not meet that fifty percent delay threshold. Those children don't disappear.

Those children don't disappear.

They simply wait, often until kindergarten or later, when services are more intensive, more expensive, and less effective. HB 376 closes that gap.

HB 376 closes that gap.

And now I'm going to turn it over to my esteemed colleague Amy to speak a little bit more on what we know about the science of brain development and the importance of those early years window.

Ms. Simpson,

I think you might be on mute.

I'm sorry. Thank you. Thank you. For the record, this is Amy Simpson.

This slide is amazing because when I started my career 35 plus years ago,

there was not science on why early intervention is so important.

But since then, there has been multiple studies that

that prove what a remarkable thing a baby is,

right?

So when we think about what a baby learns in the first years of life,

it's truly remarkable.

Children go from crawling to walking to running. They learn an entire language,

sometimes two or three.

And they develop the ability to communicate, solve problems,

and regulate their emotions.

This rapid development is possible because the child's brain forms nearly 1 million

connections a second, which is crazy, right? And they make these connections through the

experiences that they have,

right?

So by age 5,

90% of their brain connections have already been formed.

Sensory systems such as hearing and vision peak out at 1 year of age. Remarkable.

By 5, or between the ages of 2 and 5,

they develop memory,

language,

communication, and reasoning.

It's truly—

typical development is amazing.

But when there is a delay in intervention, because when children are showing delayed development,

we risk that critical window of brain development when we can, when they can be, when they're ready to learn and grow most optimally.

Next slide,

Niamh.

And we'll just take a quick at ease for me to transition the gavel to Representative Mears. At ease.

We are back on the record with House Health and Social Services.

Please continue with your presentation.

Sure.

I'm Amy Simpson.

Knowing what we know now about brain development, it appears counterintuitive that the majority of public spending occurs after the age of five.

This graph highlights the disconnect,

right?

We are not making those early investments in helping children succeed during the most optimal time of their development.

We wait until later when costs are significantly more and returns are less impactful.

Next slide, me.

Now we are working to follow that science.

By expanding eligibility,

we will be able to serve more children earlier when intervention can have its greatest impact.

Currently, Alaska has the most restrictive eligibility in the nation.

A child must be 50% delayed before they're eligible for services.

through the infant learning program.

However, when that same child turns three,

they may qualify for special education services in the school district at 25% delay.

So that disconnect is one of the things that we're trying to fix with this bill.

Research supports the value of early intervention.

So James Heckman is a Nobel Prize winning economist.

And he found that investing in high quality early childhood programs reduced further public spending on special education,

health care,

welfare programs, and criminal justice system.

These early investments also improve education,

employment,

health outcomes,

producing long-term savings for governments and society.

Which is huge,

right?

The National Early Intervention Longitudinal Study or the NEAL study found that 46% of children who received early intervention services did not require special education services when they entered kindergarten.

Based on this data, we estimated that that would result in a...

$34.9 million annual savings to the special education budget going down the road. So that small investment today in early intervention creates huge impact financial savings later on.

And I think it's Rich's turn.

Yes, thank you. Uh please introduce yourself for the record and begin your testimony.

Thank you for the record.

This is Rich Saville with the Governor's Council on Disabilities and Special Education.

And I'm just going to talk briefly about the work that got us here.

So as staff person for the ICC and the Interagency Coordinating Council,

one of my roles and one of the Council's, the ICC's roles is to advise the Department of the Implement Program on financial aspects of the program and try to help them figure out.

you know just financially how to how to use the money the most wisely and so we started having conversations back in 2022 about the funding for the program and how it had been flat for so long and also having parallel conversations about eligibility and how restrictive it was and so the ICC decided to form a subcommittee to start looking into these things and so

That's kind of where this most recent movement was born,

and with the help of the Alaska Mental Health Trust,

we were able to commission a group, a company from Portland,

or from Eugene,

excuse me, Oregon,

who...

have been have long long time ties to Alaska and the infant learning program specifically so they're very familiar with this and through working with them they were able to develop a report that's available on the governor's council's website

And in that report, there are many, many recommendations.

The ones I'll touch on today are pertinent to this bill, and it's been mentioned before.

The biggest one is to align the Part C criteria with the Part B or special education criteria so that kids are treated equally.

Currently,

under three,

you're not eligible for services until you have a 50% delay,

but as soon as you turn three,

you're eligible with only a 25% delay. So we want to clean that up.

that up. We want to be sure kids are having equal opportunity to these services.

Excuse me.

The other recommendations from the report in this bill are to

update the qualifying automatically qualifying conditions list so beyond the percent delay there also there's also a list of diagnoses that if your child is diagnosed with one of them you automatically qualify for services under the infant learning program so there is work being done to update that list and also this bill would as mentioned previously allow for the department and the infant learning program and their providers to build

build Medicaid for these services to help share that cost with the federal government and also would allow the

The Individual Family Service Plan,

which is required for each family to have one of those within the ILP services and programs,

to allow that to be a qualifying authorizing document for Medicaid,

which would just make things much simpler for families, especially in rural areas where providers are few and far between and if they can get that plan developed with their local providers,

it would streamline.

things greatly and get kids receiving services more quickly.

Next slide.

Okay.

Thank you, Neve. So this slide is just a visual illustration of kind of what Amy was talking about with the cost savings.

So by making this investment today,

after four years,

This project would be budget neutral.

So the money you put in that year's budget would be recouped on the back end in cost avoidance or savings in special education.

At about year six and a half,

not only are you budget neutral for that year's money,

but you've also made up for that initial four years of investment that was there as kind of seed money for this project. So once you get to about six and a half.

And after seven years,

this is completely broken even,

and everything beyond that, you're just saving money.

So the back end cost,

you can see that line that just kind of shoots up. That's just the net savings over time.

Every year, once we get this rolling,

every year there'll be almost,

as Amy said,

$35 million a year in cost avoidance and special education costs. And not only...

Would we be saving money?

And Amy touched on a few of these, but I think this is important.

You know, we will be reducing the future need for adult home and community-based waiver services,

which can save the state money.

We'll see reduced crime and victimization.

Fewer kids will be in the juvenile justice system, which will take some pressure off of the Office of Children's Services and the foster care system.

It will reduce the needs for special needs daycare.

We're all aware that daycare is a struggle in our state right now.

By reducing the need for that specialized care,

we can see more parents get back to work so we'll improve the workforce.

And down the road as these kids who got these services,

these infants and toddlers start graduating,

we'll be graduating far more people every year who are ready to

go on to post-secondary education schools or vocational programs or just to enter the workforce in general.

I know I see it and I think everybody does how much help we need in the workforce in all areas, right?

So this is something that's long-term planning for that kind of thing as well.

And I think that is it for me.

Thank you.

We'll go back to Amy.

Are we back for more on the slideshow? Oh,

Yes. Yes.

Yes.

Oh yes, thank you.

I'm glad.

I just want to note thank you, Mr. Seville, for bringing up

special education or special needs child care, it's not something that we really talk about, but you know,

thank you for bringing that up.

So yes,

Thank you. Again,

Amy Simpson,

Programs for Infants and Children.

This chart shows the reality of ILP funding over the last several years.

As a director and the person responsible for creating budgets and managing grants, this chart highlights the challenge that I face.

Costs have increased for everything. We all know.

But for businesses like mine,

where 87% of our budget is personnel costs.

In health insurance and other benefits,

this gap has resulted in being able to hire fewer professional staff to provide services to kids and families.

Caseloads are very high and ultimately kids are getting less services.

The federal IDEA Part C,

as Niamh stated before, states that we are not allowed to put children on wait lists, so if they're eligible,

they need services and we will provide those services.

But what that means is that children today are receiving services at about half the frequency that they were receiving services in 2011 and we just can't continue to do.

more with less.

Next slide please.

So this graph,

I'm sorry,

I'm kind of a visual person.

I kind of like graphs,

so sorry about this.

This graph, I think, really shows the downstream impact of our restrictive eligibility.

These bars represent the number of children being served in special education in schools across the state.

At the peak of identification occurs between seven and nine years, or second to fourth grade.

Great.

There are relatively few children receiving preschool special education at three because they're not enrolled in ILP services and they weren't therefore provided services to help them enter those preschool services,

right? Research tells us that if kids are identified and received services in ILP that the number of kids needing special ed services

This later would be much less because nearly half of them would not need services when they reach kindergarten.

Imagine the impact of more children being successful in school,

ready to learn at kindergarten.

Teachers would be more effective,

kids would learn to read,

excel in math,

make friends,

and this is our future workforce.

And that is it.

Um so we included this slide just because based on some questions that we've had earlier and just in our own internal discussions about how maybe this project could relate to the rural health transformation programme and the funds available through that um the majority of the infant learning programmes across Alaska and those represented by EALPA have had ongoing intense conversations both looking at how collectively and individually we could access these funds.

And while there are seven there are many LOIs have gone in and initiatives that we're seeking to spearhead such as expanding rural access,

improving efficiencies across regions through information systems sharing,

leveraging technology more in our work and then of course stabilizing and retaining our current highly skilled workforce.

What we keep coming back to and running into is that party services are highly

regulated federally directed program with strict equity requirements and so without a statewide framework guidance and regulation it's difficult for individual programs to move forward equitably and ensure that the system remains intact and equitable and accessible throughout the state and so HB 376 provides that statewide alignment creating a foundation for innovation without

Without compromising the federal compliance or regional equity,

that is essential.

And so with that, I will be closing up.

HB 376 is not about expanding a program.

It's about fixing a broken timing problem.

Right now, Alaska tells families they must wait until their child struggles before help is allowed to begin.

This bill says something different.

It says, we believe parents,

we trust early warning signs,

we understand brain science, and we are willing to act when it matters most.

We cannot change where a child is born or the circumstances that they come into,

but with HB 376,

we can change when help becomes available to them.

Early intervention changes trajectories. It strengthens families in our state, and it saves the state money.

money in the long run. And so behalf uh on behalf of Alaska's Infant Learning Programs and the infants and toddlers that count on us, I urge your support of this bill. And thank you so much for your time today, and we're happy to field any questions.

Oh, thank you very much, Ms Dardis. And uh to Mr Saville and Ms Simpson, thank you for joining us as well. Representative Gray.

Thank you. Through the chair, I have three questions. I want to state before I ask my questions that I support the bill.

But I'm going to ask these questions anyway. So we're one of three states that's at fifty percent. In slide six, Miss Simpson mentioned that other states are at thirty three percent or twenty five percent. I'm curious about how many states are at thirty three percent, how many states are at twenty five percent?

Through the chair, Representative Gray, I'll ask if Amy can answer that.

Through the chair,

Yeah. Through the chair, Representative Gray,

I don't have those specific numbers because states are altering them all the time,

but I can get that information for you. The majority of states have moved to a 25% delay,

and many of them have staggered things. So there might be a 25% delay

for kids that are over the age of two,

but under the age of two,

there might be a 33% delay,

but I can get that data for you.

Thank

Follow

Thank you, Representative Gray.

Thank you.

So, um...

My follow-up questions will explain kind of where I was going with that question.

So right now we're serving 1,900 in our program,

and I'm curious about how high we can go,

how many more infants can we serve at current staffing levels.

Niamh, do you want me to

hit

Oh,

that one?

Sure,

Sure, you can start.

Okay.

Through the chair,

Representative Gray,

this is Amy Simpson.

I believe that we are at

capacity where we are now like I if if we were to change the bill without any funding increases it would be it would be very very very challenging to serve more children with the financial resources that we currently have however with the bill and the ability to to access Medicaid to

Diversify our funding and to utilize more federal,

some federal match dollars for Medicaid reimbursements, it would be helpful.

Final follow-up.

Representative Gray.

Thank you. So my final follow-up is something that we see in so many parts of Department of Health and departments of

family and social services,

which is that we have

allotted for a lot of positions and they're vacant.

And so my fear is, you know, we go to 25%, we know that we're maxed out at 1900,

we're potentially doubling the number of infants that we need to serve.

How fast can we hire the people needed to do that?

And having the money there and having the positions there doesn't necessarily mean that people are applying and filling the positions fast enough.

enough.

And so to bounce back to my first question,

I didn't know if not because I don't think we want to serve as many infants as possible, but maybe we do need perhaps a staggered approach of going to 33% for a period of time so that we have enough,

so that we're not overwhelming the system, since we're not allowed to have a wait list,

we must serve every infant that qualifies.

But how do we?

How do we fulfill that obligation if we don't have the people and the system is maxed out?

Um.

For the record, this is Amy Simpson,

and so Richville talked about a report that was done by the Governor's Council on Disabilities and Special Education.

That report had a subsequent we worked on. I'm on the subcommittee,

the ICC Finance Subcommittee. We also worked on an implementation plan for expanded eligibility.

And what that does is it incrementally increases eligibility over a number of years.

And so we would start out by expanding the diagnosed conditions such as premature infants and children with unilateral hearing losses and kids exposed to substances in utero.

that those kids would be automatically eligible for Part C,

the next phase would be to drop that number down to 40 or 35% delay and then the following year drop it down further so that we can gradually build up our workforce over time because the professionals that we hire within IOP,

there are national shortages in those.

those positions.

In addition to that is really working with the university and others to enhance our training,

our pre-service training so that we can grow our own providers in these areas.

I

Oh.

hope that answers your question.

Thank you. And I should also mention we do have some folks from the Department of Health online to help with our discussion today. We've got Pam Burton, the Health Program Manager for the Division of Senior and Disability Services, Nicole Wehry, Administrative Operations Manager for the Division of Senior and Disability Services, as well as Susan Kessler, a Research Analyst IV from the Division of Senior and Disability Services.

Thank you. I would—

I forgot to

you

process

re

that.

yeah.

Yeah.

Processes.

I would— thank you so much, Chair Gray. I just wanted to put your name on the record, please. My name is Eve Dardis

Thank you.

and just to add to what Amy spoke to, I think it's important to recognize that while this is absolutely a state-required, state-sponsored program, it is carried out through a network of independent providers. And when you look at the flat funding that we've had for over the last

Mm-hmm.

decade, and you look at the outcomes that we are seeing in children that we are currently able to serve and how we are

meeting our deadlines, we are getting out to rural communities. I can see that we have a very effective network at attracting and maintaining highly qualified staff.

Is it easy?

Absolutely not.

But I believe that with funding, with our,

you know, support of our current workforce and just the existing structure,

I have a lot of confidence that when everything aligns, that with just desire,

passion and our current know-how,

that we would be well positioned to increase capacity.

Thank you very much. All set for the moment? Representative Prox.

Yes, thank you. Through the chair, I support the idea for sure. This this makes sense.

From our perspective of the state budgeting and from certainly the perspective of people, children, etcetera, um and it looks like this problem has been well, I think you said two thousand and twenty two that you've been working on studying all this. So that you have would seem like a lot of data.

Um and

I guess I'm wondering if there would be enough to have kind of a business plan

developed if we were to go to the bank if you will and borrow some money to show that

um at some point in the future I think you said four years to break even.

Um

if uh

if oil companies could break even in four years, they'd be really happy with whatever they're trying to do.

So something on on that order of a business plan with um

measurable goals and objectives and what we think it will take to get there and report on that back every

six months or something like I think six months is what's required in the executive budget act. It sounds like you have enough background and data that we could establish a baseline and do something like that. Are you working on that now?

I think I will ask Mr. Saville, Rich, do you want to take?

Yes,

thank you. For the record, this is Rich Saville.

I'll do my best,

but I will reserve my right to phone a friend if needed. Through the

chair, Representative Crocks.

We,

I'm going to back up just a little bit. We,

in recognizing

the necessity of needing answers to the questions that Representative Gray just asked, we did commission a second report that really looked at how to implement this process,

what we need to do

as far as easing into things yearly,

how to build the workforce out over time so that the system's not overwhelmed.

And so there is— that report is also available on our website.

And I'm not sure if it answers the question of a business plan per se,

but I think it does answer,

it does give some insight into

how the department could go forward with kind of working on a plan like that and kind of the idea, the hopes that how it would roll out.

I'm not sure that anyone,

any of us would be the proper people to develop that business plan for the state system necessarily.

And so I might ask Pam or Susan from the department to answer that,

but I also would let Amy or Eve, if they'd like to jump in, try to help answer that question as well.

Representative Storey has joined us at the testifier table, so we'll

see if she wants to jump on this before going to Ms. Kessler.

I thank you Madam Chair. I just wanted to point out um that we did as part of your packets today have the report about recommendations to expand eligibility and funding for the Alaskan Infant Learning Program, so you do have that in your packet. And I just wanted to draw that to your attention, but I would like to go forward with who um Mr Savelle thinks we should talk to next. So thank you.

Ms. Kessler, how are you feeling about answering that question?

Yes.

It was a little hard, it was a little rambled. So hi, this is Susan Kessler,

I'm a Research Analyst IV with the State of Alaska. I'm the Unit Manager for the Infant Learning Program.

Through the chair,

I just want to make sure I understand the question you want me to answer. Is it related in general to Representative Prox's question about where will we go from here as far as data?

Representative Prox, you want to

Yes.

refine

your question?

Yes, through through the chair um it appears that you've collected quite a bit of data and information and and somebody has done some planning on this. And

Mm-hmm.

can we, or do we have enough information and I suppose expertise to develop a what would be considered a business plan that we have

Um this is the baseline need, we think we think this is the market. If we invest X number of dollars, we should be able to hire one number of agencies and people and in really quite short order we're going to be able to avoid spending somewhere else in education primarily, if nothing else.

I'll jump in a little bit.

Also,

Representative Prox, I think we also need to be careful that we're not studying this study that we need to study a little bit with that so that we're not spending more time thinking about what needs to be done rather than actually getting the work done. But I'll let Ms. Kessler reply.

Sure. Well, thank you for a chance to kind of speak today.

You're speaking my language.

I'm the data gal for the infant learning program,

and I think we absolutely have the data and planning skills available to tackle this.

We have a very robot data system because we have a lot of federal reporting that we have to do. So we have data on the number of referrals,

children.

The number of children referred,

the amount of service per child,

the type of service per child,

the number of children involved. We also have a lot of personnel data such as the number of providers,

their average type,

whether it's physical therapy,

occupational therapy,

special education,

how they're spread across the programs.

All of that we have as well as...

There's a lot of fiscal data and that's where we're looking at really pulling together a more clear funding formula.

We have an RFI kind of on the table for that right now to look at you know things like how do we ensure funding is sufficient for each region.

So I would just say I would probably be getting a lot of that data and our

Our team would be doing the planning and feel confidently we'd have everything we need to be able to do that.

All right.

Another big piece of it would be, of course, the Medicaid numbers.

So that could be something that, you know, grows as we develop those Medicaid billing rates and all of that.

Thank you.

Thank you very much. So are there any wrap-up thoughts on this? Because I— this is our first hearing here, and I do want to note that we do have other bills to work through today. We're almost an hour in. Representative Schwanke.

Uh thank you Madam Chair. I have a couple different questions, things that uh I would hope we could kind of dive into a little bit deeper, maybe in another hearing, but um my understanding is one of the reasons that

Initially, the fifty percent was set for zero through threes because a lot of these delays, especially when it's a single developmental delay or a mild developmental delay that they do resolve on their own without any sort of um intervention. And so when I was looking at other states it seemed like there were um uh more complex

regulations surrounding different types of delays,

and so I really appreciated if it was Ms.

Simpson that noted that, you know, or someone else that was online,

very clearly, when there are diagnosed conditions,

premature birth,

you have a hearing loss,

you have substance abuse, obviously there are going to be some types of delays that are

You can identify them right away.

You know exactly what's happening and in that particular infant's case then you know 25% delay is you know you know you want to get on it right now.

Other things are there's a lot of reasons why children are delayed in some of these individual factors.

I guess I would like to see a little bit more deep dive into some of those individual delays. I think there's five different domains and which ones specifically really are the most serious? Can we isolate a couple? Can we address this maybe in a step-wise manner?

Rep Gray kind of noted,

you know, it's...

A bill can pass but appropriations are annual, and i if a bill like this passed, it would f open the floodgates for who would qualify, and if uh a future Legislature decided not to appropriate funds or a Governor were to line-item veto those funds, it would just crush existing I_L_P_ providers.

I don't think we want that.

So I guess I would ask that we, you know, have a little bit more opportunity to dive into some of the specific delays that are just the most significant and severe within the state of Alaska specifically,

perhaps substance abuse issues, you know, full-on hearing loss, something like that when you understand that, you know, early on.

I think that that would help us maybe hone in on the things that are really most critical that we could address first and just maybe try to find a stepwise way to get into this because I would I'm just afraid that the language that's in the bill currently is it could potentially backfire if appropriation doesn't come because of that.

An extra five and a half million dollar ask is a big lift um in the current fiscal environment. So just more of a request for additional information later. Thanks.

Take

Thank you. Did you want to address that, Representative Story?

Ah yes, uh thank you uh Chair Maris and thank you Rep. Schwanke for those questions and Rep. Prox. So I think I'd be very happy to work with all my invited testifiers and I get some more of that information for you. And I think Rep. Prox was asking for how would we st how would the programme step up with funding and I mean with the staffing and make sure there's would be staff in place. How d how would that look. So are dollars would be sure to

to be impacting those families and children that need help. So we will work on that together and look forward to be coming before the committee at another time.

Uh thank you.

Thank you. One quick one.

Representative

Prox?

Have you applied for any funding or whatever through the Rural Health Transformation Plan? Or do we need a bill in order to make that possible?

Through the chair,

I think Mr.

Savelle can answer that question.

Mr. Saville?

Thank you for the record. This is Rich Saville.

For the chair,

actually, I would ask Amy or Niamh to answer that. I know that the individual programs have been looking at applying for funding for different types of things, and I think that they would have more direct information on that.

Miss Dardis.

Ms. Dardis. I think I'll refer back to just some of the information that I'd shared just on that brief slide concerning the Rural Health Transformation Fund. While, yes, individual programs are looking at pilot projects or different things that could be done specifically in our regions, to align with the current Part C requirements, it is very heavily regulated, and so in order to really leverage those funds, like, it does require, like,

a statewide, state-directed infrastructure. And so I think I would probably just ask Ms. Kessler if she wanted to add to that in terms of just from the state's perspective.

Ms. Kessler?

Thank you.

Thank you.

Hi, this is Susan Keppler for the record and actually I'd like to defer this question to Pam Burton.

She's been our lead person on the Rural Health Transformation Project dollars. Thank you.

Ms. Burton, welcome to the conversation.

Thanks for listening in.

Sure. For the record,

Sure.

this is Pam Barton. I'm a partner coordinator with the Department of Health,

Division of Senior and Disability Services.

As far as expansion of ILP services and using our HTP dollars for those expansion of services,

there are limitations on using the funds to sustain services. So although we have at the state level also submitted proposals.

I believe that programs have as well.

Ours right now are focused on workforce development to increase the provider base.

I hope that answers your question.

Thank you very much. Representative Story?

Hi, yes, thank you. Uh through the chair to Rep Rox and the committee, um my understanding is with the Rural Health Transformation Funds we're supposed to not um use it for operations, uh but something transformative. And one of my understandings is being able through this bill to qualify for Medicaid reimbursement, that would be how if that as as this bill built up and we re

And met those requirements. That would be the operational dollars, how it would continue because we would be switching from state funding to Medicare funding. And there are some opportunities for transformational things within the programme but we cannot use it for operations. But the goal of this is to get us set up for Medicaid reimbursement and that's how the programme is going to continue.

Thank you Representative Story. Do you have anything you wanna conclude with before we set the bill aside?

I thank you uh to the committee for your interest today, and I can see we know how important this is and so I look forward to our next hearing. Thank you.

Thank you. And then do you have a final.

Yep, just a quick comment. I personally it is ambiguous what

Exactly can be done with money, but I personally think that this would be transformational and that Medicaid and everybody else would save money down the road and just make an upfront investment. So give it a go.

Thank you for that.

And...

And as we said in our joint meeting with the Senate, with the RHDP,

I'm all f If the only thing we ever do with those dollars is work upstream, I think we're in a good spot, but of course we do have many more needs than that. And I'm not in charge of that, which is probably a good thing. So thank you uh with that we will set uh House Bill 376 aside for a future hearing. Uh we'll take a brief at ease to transition to House Bill 157.

We are back on the record with health, health, health and social services.

And we are on House Bill 157 by Representative Gray on adoption decree of siblings and we are doing public testimony here today.

We have no one signed up online.

Anyone else in the room that hasn't signed up?

Oh,

I need to, I need to open public testimony. I now open public testimony.

No one signed up, no one in the room, but we do have two folks online.

We have Amanda Metivier, Executive Director for Facing Foster Care in Alaska.

We are having two-minute public testimony today,

so please put yourself on the record and provide your testimony.

Good afternoon. For the record,

my name is Amanda Mateo. I'm the Executive Director of Facing Foster Care in Alaska,

and I'm testifying this afternoon in support of House Bill 157.

This bill was brought forward at the request of current and former foster youth across Alaska.

Our organization intentionally gathered input from youth who are currently in foster care and those who have recently transitioned out of the system.

And messaging from young people has been consistent in recent years and really for the last two decades that sibling relationships are essential and the physical and legal separation of siblings in foster care causes deep and lasting harm.

House Bill 157 directly addresses that harm by ensuring that siblings remain legal siblings when adopted into different families.

Adoption should be a moment of stability and celebration,

but for many youth it also brings grief in choosing one family over another.

Alaska has already taken steps to keep siblings together.

FFCA helped pass earlier legislation requiring the state to make every effort to place siblings in the same foster home or relative home,

and when that's not possible to try to maintain meaningful contact.

These aren't suggestions,

they're statutory obligations,

and when the state removes children,

keeping siblings together is a core duty,

not an optional best practice.

But too often siblings are separated simply because there are not enough foster homes or relative home placements, and that shortage has only worsened in recent years.

When siblings are separated without cause beyond there was no placement,

that's a systemic failure.

HB 157 ensures that adoption doesn't erase the legal recognition of siblings and it requires courts to consider whether post-adoption contact is in the child's best interest.

This aligns with what foster youth want.

This bill also complements the Indian Child Welfare Act.

It affirms that tribes determine who relatives are,

including siblings.

House Bill 157 aligns state law with principles in ICWA.

Budget and workload concerns are very real and I know that the state has brought that up about this bill,

but they don't relieve the state of its responsibility to preserve family relationships.

I think an important question would be how often is OCS failing to keep siblings together under current law and if the answer is it's often then the burden is not on youth to accept fewer rights to the adoption process it's on the state to meet the existing obligation.

House Bill 157 is driven by foster youth it's really a necessary correction to a systemic

Failure that often fractures families.

So I hope you'll support this bill and thank you for allowing time for testimony this afternoon.

Thank you very much for providing it. Next we will go to Barbara Melchik from Facing Foster Care in Alaska.

Please put yourself on the record and provide your testimony.

Thank you.

My name is Barbara Malchik calling in from Anchorage.

I spent my entire adult career as a guardian ad litem representing foster youth representing the best interests of foster youth and I've been involved as an active board member for FFCA ever since FFCA started which was over 20 years ago so I'm here testifying on behalf of FFCA in support of HB 157 I would note that I am a retired attorney

and I'm no longer practicing I'm in active status so even though I have a lot of opinions about the legal stuff I am testifying on behalf of SFCA and this behavior did a great job of summarizing most of what I was going to say but

I'll add a few things and that is that I listened to the hearing on Tuesday and was very pleased that it seemed that everybody agreed with the spirit of HB 157 which is expressed in the legislative intent language of section one and some questions were focusing on the existing rights of siblings in state custody and concerns about OCS workload and potential litigation around placement process.

Let's see.

So as Ms.

McKeever said,

while in state custody over the past few years, the statutes have been amended largely from input from SSCA to really promote their relationship.

As she said,

siblings have the right to be placed together if at all possible. If they're not placed together,

then they have the right to get contact information of each other.

efforts to provide frequent contact between siblings and the situation that's supposed to be reviewed regularly by the supervisor of the SPS caseworker to make sure efforts are being made to ongoing efforts to place the children together and also very importantly the court recognizes and it's in law a presumption that maintaining that sibling relationship is in the child's

set the interest.

So this the whole time that the children are in custody together they're promoting the contact it doesn't always happen but hopefully there's a lot of ongoing contact and then poof or maybe I should say boom as soon as the ink is dry on the adoption decree for one child then that vital connection is no longer legally recognized.

I know that representative Gray,

who's been a great advocate for foster youth, referred to this bill as largely symbolic and certainly it will go a long way to assure both the siblings who are getting adopted and the siblings who are still in custody that their brothers and sisters are still considered under the law to be their siblings.

But I like to think that this law goes a little further than that.

As noted in the testimony on Tuesday,

If after adoption the sibling is considered still a sibling,

then it would place them in the first placement preference,

which I think is a great thing.

So Alaska law has in the preferred placement preferences when a child comes into state custody.

The first preference is to try to place that child with an adult family member.

which is defined as including grandparents,

aunts and uncles, and siblings.

Also, it includes, would include...

adoptive homes where they've already adopted one of their siblings.

So that's the first placement preference.

The second one is with a family friend and only after those are ruled out should they be placed in licensed foster care with a stranger.

And these placement preferences were enacted in an attempt to make sure that children who can't be placed in their home are at least placed somewhere where they're comfortable,

where they know the people they're staying with, they can remain connected with their family, their culture,

etc.

So

if, well currently,

the adult family member definition would not include a sibling who had been adopted.

And so if a sibling,

if HB 157 passes,

then

sibling the adult family member definition of sibling would include an adopted sibling.

This was a very good thing because it would

keep the children together if they can be placed in the home of the home that adopted one of the siblings.

It dawned on me that it's really ironic under the current definition because if the

adult sibling was either never in state custody or if they aged out of the system or if they're in a legal guardianship they would still be considered an adult family member of the child who's still in custody it's only when youth has been adopted that they're excluded so this would correct something that has been wrong

I think that I think it is a great thing that that and I know there was some reticence on behalf of the state to say well geez now we've got to figure out new adult family members but I think it makes it a lot easier for them because they know already know the families they know the child that they're not adopted and they know the children who are still in custody.

And as Ms. Matid here said,

it's consistent with ICWA, but also I would note that what I would say decides to do with this definition of sibling that does not impact our ICWA cases, which are 62% of all of our child native aid cases, because it is the child's tribes that determine who falls within their first placement preference,

which is extended family.

Thank you very much for your testimony this afternoon. If you have anything else you'd like to add,

I was just given the short version of the email for the committee,

which is house.hss at akleg.gov.

And if there's anyone else wishing to provide testimony,

that will work as well.

So that is all we have on the line for public testimony. So I'm now closing public.

public testimony.

So any discussion on this? And also to note we've got online for questions. Kim Swisher, the Deputy Director for OCS and Carla Erickson, the Chief Assistant AG.

Representative Prox.

Yes, thank you.

Like most of this stuff that we deal with, I'm learning.

The idea certainly seems reasonable to me,

but always in the detail. So I'm wondering if there's someone from the department probably that is wishing we had asked them any questions or have some other input on this bill before we move forward with it. Because I think the next step is the Judiciary Committee, is that correct?

They are going to be reviewing the legal challenges and what have you. But if there is anything

So

that you have been thinking about for the application, the execution of this from the department's perspective.

Okay, so that would be Ms. Swisher, do you have anything to add on the bill for the committee today?

For the record,

Kim Swisher, Deputy Director of Office of Children's Services to Representative Prax for the chair.

I don't know that I have anything to add that isn't already been presented and I do think cleaning up any of the legal concerns regarding definitions of siblings would get to most of our concerns at this time.

Thank you very much, Representative Gray.

Okay.

Thank you. Through the chair,

I actually have a question for Carla Erickson.

I think, Ms. Erickson, I'm curious,

having thought a lot about this for the last two days, that I think a big thing for me that I've learned from this first hearing is about this unintended consequence of when a child is adopted becoming a

stranger legally to their biological family, is this case of um when an adult child who was in the system was adopted out is not a relative to their younger siblings who are in the system, and therefore are not a priority placement.

And I'm just curious if you also see that as sort of an unusual and unexpected loophole that was just pointed out by the public testimony by Barb Malczek that if the child had aged out of the system or was not otherwise engaged with the system,

will they remain a legal sibling of any younger siblings that are in the system? But if they're adopted...

then they are no longer related to those younger siblings and therefore could not be foster placements for those young siblings in the future.

Ms. Erickson.

Miss Ericksen?

Thank you for the record,

Carla Erickson,

Chief Assistant Attorney General,

Department of Law Child Protection,

through the chair, Representative Gregg.

I think if what you're asking is

I've been well aware that that has been the problem for some years.

Um,

actually when people talk about whether or not a sibling who's been adopted into another family,

if that family enjoys a priority placement,

and they don't by virtue of the adoption,

but it is, as I agree with Ms. Malchik, if it was a guardianship potentially or an adult sibling that just simply aged out, then they would be a priority placement.

And so I certainly,

and this has been a topic of discussion,

as I said, for years.

So I understand the issue.

I understand the proposed fix.

I'm not sure if I'm answering your question. I think all the issues or potential issues or things that could be cleared up moving forward, I don't have anything to add to that from Tuesday.

But I'm not sure if I answered your question,

actually.

Representative Gregg?

Thank you. Through the acting chair.

You definitely addressed the question,

but I do have a follow-up question based on some of the discussion on

Tuesday and to the other public testimony that we heard today from Amanda Metivier, that so much already exists in statute that prioritizes siblings being placed together by OCS and thus being adopted together with their siblings,

and that due to lack of foster parents, lack of placement, sometimes it's not practical and that we have lots of examples of siblings being separated.

I'm almost curious if we don't need a new law so much as we need more foster placements so that we can follow the law as it currently is.

Can you respond to that?

For the record, Carla Erickson, Department of Law, to the acting chair, Rep.

Gray.

I think those are a lot of policy issues and things potentially directed to Ms.

Swisher to thus be answered.

I guess what I would clear up is what I was articulating on Tuesday as part of the concerns.

I think there are other statutes that do,

as Ms. Malczyk already indicated.

I strongly encourage placement with siblings together.

In particular, I think it's 47-14-100-R that talks about placing siblings together as well as maintaining relationships if they had a relationship before they came into care.

One question I have is how this reconciles with that to be read as a companion statute. I think the biggest potential area of concern from a litigation standpoint is

When the children,

and there could be years, keeping this in mind, there could be years between siblings coming into care in a family,

but when a child is adopted potentially to a non-relative or in the case of an in equicase,

a non-relative, non-Native Alaskan American Indian family,

and then years later another child is born.

This bill would have those siblings maintain their legal status as siblings,

and because then that they fall into the adult family member definition,

then that family,

adult,

non-relative,

non-Alaskan Native,

non-American Indian,

would have the same rights of placement by virtue of the fact that they are the parent or guardian of the child sibling as a biological.

grandmother or grand on either side of the family and if that's the intent of this legislation and the intent of the legislature then then that's absolutely fine of course that's what this does and there does exist some amount of litigation risk with that as I indicated litigation placement is our most litigated topic in child native aid proceedings already

and to include sibling issues,

visitation and placement where it all if at all possible.

So I think some of my concerns I think were speaking directly or issues speaking directly to that type of scenario because if the kids are adopted by relatives then the relatives are still the relatives and this problem doesn't really present itself.

Final follow-up.

Thank you.

Final follow-up.

Thank you. Through the acting chair to Ms. Erickson. So what I heard, and it didn't sound right to me, so I want to clarify what I heard and then you can correct me. A minor child adopted by a non-relative,

I don't see how that child could ever be a preferred placement. The child is a minor.

And if the child becomes an adult,

then the child is no longer a child and is a preferred adult placement.

So I'm not tracking that the non-relative family of the adopted child gets precedence over a grandparent.

Can you explain how suddenly that adopted family is trumping the grandparent?

Representative Gray,

I think maybe we need like charts and figures and to sit down to map some of these things out.

I'm having trouble following along with a verbal conversation, but I don't know where everyone else is with that.

And if you might like to defer that for a...

Thank you, Acting Chair Mears. I'd like to hear from Ms. Erickson, if that's okay.

Okay.

Okay.

Certainly,

I agree through the acting chair.

The sibling is not the actual placement, as I read this legislation.

It is what this legislation does is maintain that legal designation of a sibling.

And so then when you look at the definition of adult family member,

it includes the parent or guardian of the child's sibling.

So whomever adopted that sibling in the earlier case is the adult family member that shares the same space.

as a grandmother or an aunt or uncle or another adult sibling that had not been adopted.

Thank you. That is very helpful.

Thank you. Um at this time the committee is at that will conclude our discussion for the moment at this time uh the committee is setting an amendment deadline for House Bill 157 for Monday April sixth at twelve p.m. And we are setting aside House Bill 157 for future consideration. That I will take a brief at ease to hand the gavel back to Representative Mina and get ready for our next bill.

Back on the record. Thank you, Representative Mears, for taking the gavel as acting chair.

Next up, we have House Bill 244 by Representative Jubilee Underwood on CNA training. We will start by opening public testimony on House Bill 244. First off, is there anyone in the room who wishes to testify? Seeing none, is there anyone online who wishes to testify? First, we have Lorraine Thomas, board member with the Alaska Alzheimer's Association Alaska chapter. If you could please put yourself on the record— oh,

she just dropped off, it looks like. So we'll see if she might come back on. We'll go to our next testifier, Sophie Kunti, HR generalist at Hope Community Resources, calling in from Anchorage. Please put yourself on the record and begin your testimony. And we will also be limiting testimony to 2 minutes. So please start your testimony.

I thank you, Tamina, and members of the committee for the opportunity to testify today.

For the record,

my name is Jose P.

and I am affiliated with the community resources.

I'm calling from Anchorage,

and I'm here today in support of House Bill 244. In my work in human resources within the nonprofit sector,

I support teams that include CNAs providing care to vulnerable Alaskans.

Through that work, I see how essential these roles are in delivering.

or state keeps us from inhibitor care.

Do the individuals being supported often have higher complexities,

many are living with Alzheimer's or dementia,

often alongside other chronic conditions.

As these conditions progress,

people may lose the ability to complete daily tasks independently,

and in many cases they begin to communicate primarily through behavior rather than words.

That means that caregivers,

especially CNAs, are not just providing physical support,

they're interpreting needs,

they're responding to behaviors,

and preserving dignity in really vulnerable moments.

HB 244 matters because it ensures that CNAs receive consistent,

meaningful training in these critical areas.

dementia care behavioral response activities of daily living and supporting emotional and mental health.

Importantly this bill does not have any licensing requirements,

it reduces strengths and clarifies the competencies we expect from those already doing incredibly important work. This is a practical and thoughtful next step and it supports both the workforce and the people that they care for.

Thank you Chairman and members of the committee for your time and consideration and I urge your support for this bill.

Thank you for your testimony.

Next we have Stephanie Sandlin, Outreach Director with Alzheimer's Research of Alaska.

Please put yourself on the record and begin your testimony.

Thank you, Chair and members of the committee.

For the record, my name is Stephanie Sandelin.

I'm the Outreach Director with Alzheimer's Resource Alaska and I'm calling from Anchorage.

Um in my previous role as provider outreach manager here I worked directly with providers, and there are a couple of things that I noticed in working with them. Um and that leads me to speak in support of Senate Bill 103 and House Bill 244, and specifically to highlight the need for and demand for dementia related training across Alaska. Um what I saw in the field was a clear demand for training.

When we announced our Dementia in Alaska Echo Series,

we had 120 people sign up within 90 minutes and we've consistently had over 200 participants per session.

That level of response reflects to our agency a clear and immediate need. Providers are actively seeking practical,

accessible training to better recognize and respond to dementia,

especially since they are often the first point of contact for individuals and families.

This is really important here in Alaska because so many communities have limited access to specialists.

Training would help ensure that frontline staff from community health aids to CNAs to clinic teams are better equipped to support people with dementia with dignity and appropriate care.

Um continued investment will strengthen care across the state and our numbers in the state are booming. Alaska is one of the states where dementia is growing at fastest rates in the nation, so this need is not going away and it will only grow. Thank you.

Thank you, Ms. Sandelin, for your testimony. Next we have Deborah Adams, board member of the Alzheimer's Association of Alaska,

calling in from Cordova. Please put yourself on the record and begin your testimony.

Ms. Adams, are you online?

Adams, are you online?

I was sorry I was muted. Excuse me.

Oh, no worries. We can hear you now.

Okay. Thank you, Chair Mina,

for the opportunity to testify today. For the record, my name is Deborah Adams.

I am a member of the Alaska chapter of the Alzheimer's Association,

and I'm calling today from Cordova.

I'm speaking today in support of Bill 244 with regard to CNA training.

HB 244 is of value to me for two reasons.

One, as a current board member of the Alzheimer's Association advocating on behalf of Alaskans with Alzheimer's and other dementias and I have participated in advocacy all the way.

to Washington DC for the past four or five years now and we are making great strides.

My second reason though more importantly is that as a caregiver for my late husband who passed away from Alzheimer's in 2017 I know firsthand what it takes to care for someone who's forgotten how to use a fork and who no longer understands how to dress themselves.

for simply needs someone to patiently walk into the toilet and hope you get there in time.

Eventually my husband lost the ability to speak and was completely dependent on me to meet all of his care needs and I did so for five years.

These are the kinds of situations that a certified nursing assistant would face in caring for dementia patients, and they do not currently have specific training to get them ready for these kinds of issues.

HB 244 puts specific CNA competencies into statute,

and it informs the caregiver and affords comfort and dignity to the most vulnerable Alaskans.

HP 244 assures those suffering from Alzheimer's and other dementias that they will indeed be cared for by trained professionals.

Please consider passing HP 244. 8,500 Alaskans currently diagnosed with Alzheimer's and other dementias.

So who clearly cannot speak for themselves will thank you, and I thank you.

Thank you, Ms. Adams,

for your testimony.

Next,

we have Michelle Cornwall,

Assistant Professor with the University of Alaska Southeast Ketchikan. Calling in from Ketchikan,

please put yourself on the record and begin your testimony.

Thank you very much, Chair,

and the opportunity to speak in Cessna 5 today.

My name is Michelle Cornwall. I am a...

Okay,

I'm the assistant professor with University of Alaska Southeast,

and I've had the opportunity to teach a CNA class for the last seven years.

We train about 40 CNAs a year, and I support...

Bill 244 today because I see how important our frontline staff is.

Our CNAs are providing support that get in the hospital,

assisted living,

long-term care, and home health.

They work with our most vulnerable residents and this gives them the opportunity to receive standardized care across.

state which will provide better care for our people living with dementia and Alzheimer's will they would get standardized education and understanding exactly what dementia was or is individual care how that's specific as they progress through on the disease process how care has to change and learning how to learn from your resident

and providing them with the individual care they need for where they are in the process.

Communication, communication is different when you're dealing with someone or you're helping someone that has dementia and you really have to learn different techniques that are specialized that aren't that can be unique to someone living with dementia.

Risk management, so understanding exactly what

what behaviors are and communications to figure out how to be the most supportive person that you can be with someone with dementia,

providing compassionate care for the residents and their families, realizing that dementia is not just a single person, it is a family that

situation that we deal with and it teaches us professionalism in which we learn the ethics and the specialty of the disease process and how to provide the most empathetic care that's based in respect and dignity thank you very much and I support HB 244

Thank you, Ms. Cornwall, for your testimony.

Uh last uh looks like we have March Stoneking with the AARP calling in from Anchorage. Please put yourself on the record and begin your testimony.

Thank you, Chair Mina and members of the committee.

For the record,

my name is Marge Stoneking,

Advocacy Director with AARP Alaska.

I'm testifying in support of HB 244.

Thank you for hearing this legislation this late in the day to address provider training requirements for CNAs that inform the quality of care for Alaskans living with Alzheimer's disease and other related dementias.

AARP Alaska is a champion for family caregivers.

a member of the Alaska Dementia Action Collaborative and a strong supporter of building a dementia capable workforce.

NHB 244 advances all three of those priorities.

As Alaska's population ages,

more families are affected by Alzheimer's disease and other dementia every year and direct care workers are increasingly called upon to respond to complex cognitive and behavioral needs.

HB 244 is a thoughtful practical bill that modernizes CNA training to reflect those realities.

It ensures that CNAs receive those core competency trainings in dementia care communication and behavioral health skills that are essential for providing safe, respectable,

and person-centered care and better training.

benefits everyone and helps CNAs feel prepared and confident in their work, improves quality and safety for residents and patients,

and gives families and family caregivers greater peace of mind and support.

It can also help reduce avoidable crises,

staff burnout,

and turnover,

challenges that are especially acute in Alaska.

So from our perspective at AARP, HB244 supports both quality of care and improvement and a stronger caregiving workforce,

and we urge your support.

Thank you.

Thank you, Ms.

Stoneking,

for your testimony.

Seeing no more individuals wishing to testify,

I'm going to go ahead and close public testimony.

Do we have any additional questions or discussion on House Bill 244?

And I also want to note that we have Director Sylvan Robb in person here with CPPL.

Representative Pox.

Thank you. Through the chair,

I would.

Give Director Rob a chance to come up if she thinks she needs to weigh in on this.

But the other question I had, it's a little bit not quite related but not essential.

The training that we're proposing, would that be available to laypersons,

lay caregivers?

I'm thinking of several friends that...

Um, went through trying to care for their spouse who had Alzheimer's and it was very difficult and this might have helped.

Director Rob,

could you come to the presenters table?

Good afternoon, for the record, Sylvan Raab, Director of the Division of Corporations, Business and Professional Licensing. Uh

Through the Charter Representative Prox, um the division is neutral on this legislation. It's really a policy call um for the Legislature to make uh and in terms of your question about the availability of um this training to lay people, so the legislation specifically addresses the um what topics need to be covered in a CNA program.

Um if the organizations uh that are putting that together

are interested in offering it to other people, that's something that would be for them to consider.

And I also forgot to note that we do have Lisa Sauter,

CEO of the Alzheimer's Resource Center Alaska, also online available for questions.

So I'll ask that question to Ms.

Sauter,

if the training that you have related to Alzheimer's and caregivers,

if that's publicly available? Yes, definitely.

Yes, definitely. Thank you, Chair and Committee.

We plan to have it available to any Alaskan that is in need of these services or anybody that is affected by an Alaskan who has Alzheimer's or dementia.

So it's certainly targeted at professionals,

but many and almost all of the skills are transferable to home caregivers who many times function in a capacity in the place of a paid caregiver.

Thank you.

Good to know.

Thank you.

Wonderful. Any other further discussion or questions from the committee?

Seeing none, I would now entertain a motion to move the bill from the committee.

Chair Mena, I move House Bill 244, Work Order 34-LS1207/A, as in alpha, from committee with individual recommendations and attached zero fiscal note. Is there any objection?

Seeing none, House Bill 244 passes from committee. We'll take a brief at ease to sign the committee report.

Back on the record. Last item on the agenda today is House Bill 236 by Representative Elise Galvin on the sale of diet and muscle growth supplements. This is the initial hearing of House Bill 236. I would like to invite Representative Galvin and her staff,

Monica Schwingendorf,

to introduce the bill before the committee.

Thank you, Chair Mena. I appreciate the opportunity to be here. Thank you to all of you in the House Health and Social Services Committee for hearing HB

236 today. For the record, my name is Representative Elise Galvin, and I'll be presenting this bill with my staff member Monica Schwingendorf.

Boy, what an exciting time to present a new bill to all of you on Passover, and really wishing you all well as we— this will only be a few minutes, and I want you to know that we're happy to come back to answer questions or answer questions offline. We do have— we did have We hope to have a researcher from Harvard available, but due to the time differences, they're not here, but we

also have Executive Director of AKEEDA, or Alaska Eating Disorders Alliance, here. And first I want to highlight both the purpose of this legislation and the importance. This bill before you matters because it directly addresses a growing public health concern affecting Alaska's youth.

This bill aims to ensure that individuals under the age of 18 will not have access to known-to-be harmful supplements. In 2023, 29% of Alaska's youth reported engaging in restrictive eating behavior.

And that's an alarming indicator of rising eating disorders and unhealthy relationships with food. Eating disorders are among the deadliest mental health illnesses,

second only to opioid use disorders. In the United States, one person dies from an eating disorder every 52 minutes. An estimated 10,200 individuals die each year

as a direct result. And in Alaska, if you're— if we're looking at this Census Bureau population statistics of 2018, that equates to approximately 23 lives lost annually. Nationally, there are more than 23,000 emergency room visits each year associated with adverse events related to dietary supplements.

So clearly, we have a lot of costs associated with this, let alone a lot of suffering. Each of these disorders cost our state

countless amounts of funds annually. In fact, $66,000 are spent each year on emergency room visits alone.

And these adverse events also cost employers countless work hours. Unfortunately, many dietary supplements marketed for weight loss and muscle building lack scientific evidence and are not subject to premarket approval by the U.S. Food and Drug Administration.

And so, products can be sold without being reviewed for safety and effectiveness. And we also know that they are marketed to consumers who are under 18.

The dietary supplements and muscle-building products are intended to supplement the diet and are distinct from conventional foods. They come in many forms and my staff will

get into more of the details, but just to give you a sense of it, it includes things like tablets, capsules, soft gels, gel caps, powders, bars, gummies, and liquids. And I think to get into more of that definition, I'm going to ask my staffer, Representative— pardon me, Monica Schwingendorf, to help us

get into some of the details, if I may, Representative Chair Mena.

Please go ahead.

For the record, Monica Schwingendorf, staff to Representative Galvin. Uh this definition is indeed broad, which is why I would like to focus more specifically on these products by categorising them into areas of concern, uh weight loss, muscle building, appetite suppressant and detox colon products. Uh I would like to focus on uh all four of these. Weight loss or fat burning supplements often are marketed as

This fat burners or metabolism boosters, which frequently contain stimulants or appetite suppressants. Uh muscle building supplements are commonly labelled as pre-workout, uh shredding, cutting or lean mass products which can include high doses of stimulants and other unregulated compounds. Appetite suppressants come in many forms, including pills, gummies and powders and are marketed as a way to

control hunger, or reduce food cravings. These products are especially concerning because they are strongly linked to restrictive eating patterns.

Detox and cleanse products such as teas, juices and laxative based supplements are often disguised as promoting wellness or gut health. Many of these products contain harmful ingredients and can worsen underlying health conditions. These supplements are widely used by teens attempting to lose weight and are often heavily marketed to boys and young men. They promote messages around controlling hunger and reducing cravings.

And in some cases are directly associated associated with purging behaviours. Additionally, many of these ingredients are not designed for developing bodies, raising serious health concerns.

For the record, Elise Galvin, representative for Midtown. And the Food and Drug Administration has stated that while dietary supplements can be beneficial to health, they can also pose risks, significant risks. With no age restrictions and limited oversight, youth are particularly vulnerable.

They often are targeted through social media and may unknowingly consume harmful substances, especially those already struggling with body image or eating disorders. Influencers frequently promote these products as healthy or safe, and young people may take these claims at face value without understanding the risks. Notably, about two-thirds of American adolescents ages 13 to 17 use

TikTok, and they increasingly are getting exposure to this sort of content. Research has shown that some of these supplements may contain dangerous or undisclosed ingredients, including, and these are the ones we're especially wanting to be looking out for. Some are undeclared pharmaceutical drugs such as Sibutramine, pronounced, sorry, Sibutramine.

And it's an appetite suppressant withdrawn in 2010 due to increased risk of heart attack and stroke.

And then another one is fluoxetine, Prozac, sometimes illegally added to weight loss products.

Another one, phenylethylamine, was banned by the FDA, or Food and Drug Administration, due to cancer risk and DNA damage. Stimulants such as BMPEA, and believe me, you don't want me to pronounce that one, but I will give you, I will spell it out if any of you need that, and DMBA and DMAA, these are all compounds related to

amphetamines. Hormone-like substances, including selective androgen receptor modulators, which mimic the effects of anabolic steroids. And then there's toxic contaminants, such as heavy metals, BPA, and pesticides. These substances have been linked to serious health effects, including cardiovascular complications, liver damage, hormone disruption, kidney injury, neurological effects, and increased risk of

cancer, and in some cases, death.

Even more concerning, these ingredients including SARMs or sibutramine, phenylethylamine, and others mentioned have been found in supplements even after

are being banned or flagged, and in some cases are not listed on product labels at all.

It can also dangerously interfere with medications, effectiveness reduced of uh medications, um increases drug potent potency, compounding effects, side effects, and accidental overdose from the same active ingredients. These products are widely accessible both online and in stores and are often marketed directly to young people as quick fixes that promote unrealistic body standards.

For individuals already struggling with eating disorders, these products can worsen their condition and increase the seriousness of the harm. For research, uh research further shows that the use of weight-loss supplements is linked to sign in significantly increased risk of eating disorder diagnosis uh within one to five years among adolescent girls.

Similarly, the use of muscle building supplements among adolescent boys has been associated with a higher likelihood of anabolic steroid use in adulthood.

Investigative reporting has also found that steroid-like drugs,

including illegal anabolic androgenic steroids,

are heavily promoted to young users on social media platforms.

Other states are u recognizing this is a growing issue. In 2024 New York became the first state to restrict the state of the sale of certain weight loss and muscle building supplements to minors.

States including Massachusetts, New Jersey,

California,

Illinois,

Maryland,

Washington,

Texas,

Virginia,

New Hampshire and Michigan have all introduced legislation which would prohibit the sale of dietary supplements for weight for weight loss or for muscle building to people under the age of eighteen.

And so that's why we're here today and I'm gonna have my staff read the following sectional analysis just give you a sense of of this bill specifics.

For the record.

Um.

Does the committee willing to hear the sectional?

No.

Okay.

Go ahead.

For the record, Monica Schwenkendorf, staff to Representative Galvin. I'm just going to give a brief of the section analysis. House Bill 236 does the following. It would regulate the sale of over-the-counter dietary weight loss and muscle enhancing supplements to minors. It would add definition for the following terms of dietary supplements:

over-the-counter weight loss drug and sell, the definition of seller. It would also restrict the seller from selling weight loss drug dietary supplements for weight loss or muscle building to a person under the age of 18 years of age through ID verification or proof of prescription. It would also establish fines for sellers who intentionally sell dietary supplements or muscle building products to minors.