Sunday, February 28, 2010

Alaska Medicaid Trends - Report By Janet Clark to House Finance

How to present all this information?  Back to the Fire Hose analogy.  I've got my notes while I was there.  I could also try to go through and pick out key points, plus there was the Powerpoint presentation and the Report and Janet Clarke emailed me copies of those today.
So, the easiest way is to give you the Executive Summary.  And then I'll give you my written notes of the mostly questions and answers from the committee members.  The previous post gave a short summary of what people in this meeting said about ways to control costs of Medicaid.

You can also listen to the audio of the meeting from Gavel to Gavel.

EXECUTIVE SUMMARY (from the Report by Clarke)

In January 2010 the House Finance committee requested consulting assistance to review Medicaid expenditures and projections (which are expected to spike by 17% in FY2010) to better understand the cause of the increase and impacts on budgets. 


Three questions were asked
  1. What caused the large increase in Expenditures from FY2009 to FY2010 and why did it happen?
  2. What is an appropriate level to budget for Medicaid spending in FY2010?
  3. What is an appropriate level to budget for Medicaid spending in FY2011?


Several different sources of data including Medicaid spending, enrollment, recipients, Food Stamp caseloads, Alaska Population trends, and the Consumer Price indices were used in the analysis.  Interviews with State officials supplemented the data.


Medicaid spending is based on three main components:  
Each of these components has been analyzed for their impact on Medicaid spending. 
Expenditure trends were developed and spending over time was analyzed.  Reviews were completed of the current budget supplemental budget request and FY2010 and FY2011 forecasts by the Department of Health and Social Services were analyzed.

Over 11,000 more Children are now enrolled in the Medicaid program than they were one year ago, causing the substantial spike in the budget.
Recipients (those who use services) grew at a slower pace than enrollees.
The cause of the increase is primarily tied to Economic conditions (Unemployment rate at 8.8%) and Alaska’s population increase.
Other factors such as price and utilization also contributed to the increase.
The most recent monthly trends in Medicaid spending show a slowing of expenditures.
Recommended FY2010 Supplemental:     
  • $36.8 Million GF (General Fund)(Alaska Pays)
  • $37.7 Million Fed (US pays)
  • $74.1 Million TOTAL
[NOTE:  This is a recomendation for a SUPPLEMENTAL Increase.  The Total is below:]

FY2011 Medicaid Budget:   [FY 2011 = Fiscal Year 2011, which goes from June 2010-June 2011]
  • $    441.6 Million GF
  • $ 1,318.2 Million TOTAL

My notes convey the back and forth between the committee members and the people presenting.   And the questions you surely have from the above are discussed.   I've tried to clean up the typos.

KEY PLAYERS Janet Clarke  was hired by the Finance Committee to review the department budget proposals on Medicaid.  She used to work in the Department and if I got things right, she left about two years ago.  She clearly knew what she was doing.  And the Finance Committee clearly respected her knowledge.

Finance Committee Members: 

CO-CHAIR: Representative Hawker CO-CHAIR:Rep Stoltze  Absent
VICE-CHAIR: Representative Thomas
MEMBER:Representative Austerman
MEMBER:Representative Fairclough
MEMBER:Representative Joule  Absent
MEMBER:Representative Kelly Absent
MEMBER:Representative Doogan
MEMBER:Representative N.Foster
MEMBER:Representative Gara
MEMBER:Representative Salmon 
So, Janet Clarke came up to present her report.  The rest is my running notes, which I've gone through to highlight and clean up spelling a bit.  But recognize these are a ROUGH RECORD not a true record.  You get here Clarke's presentation (without the charts) and the questions and answers.

Clarke:  Page 1 of Report: Page 3 - Medicaid declined 2007 and 2008, without cut in service, in part due to good economy, but also cost cutting.

But itʻs back up now. Terms like FMAP  - Federal Medicaid Authorized Percentage - is the federal matching rate.  Alaskaʻs FMPA would have fallen to 50% but the Economic Stimulus Bill (ARRA) increased the rate to 61.12%.Asst When the stimulus FMAP goes away in 2011, the state will be faced with another $100 million.

Thomas:  You mentioned tribal.  Without them, how big would this be? Clarke:  Itʻs about $150 million. Salmon:  We had a report from non-profits out of Anchorage and mentioned the state was funding their program - about $1 million.  Do you know what area of the state that is coming from?

Clarke:  I do not.

Doogan:  So I can understand this, if this were a 50/50 match, it would be about $900 million each, but because itʻs 60/40 it would be lower, but the stateʻs share would still be higher than now.  Is that because some of the programs are 100% Fed?

Clarke:  Youʻre absolutiley right, some are 100%, some 90% and other formulas.

Doogan:  If we go back to 50/50 - how much is it going to jump up?

Clarke:  It will depend on the National formula.  Iʻve seen numbers from $100-120 million.

Clarke:  Factors that determine the spending.  Itʻs an entitlement program.  If people are eligible, they can get the services. Slide: 

Three components of growth:  Price, Population (Enrollment and Recipients) and Utilization.

Part I:  Price: 
1.  Change in CPI. [Consumer Price Index] Now 3% is general cost increase. 2.  Physician rate increases are within normal CPI, but this cost was beyond the CPI.  There were changes in the Medicaid formula that increased Dental rates by 5% and the second which increased medical rates by 15%.  The medical rate increase wasn't anticipated and was linked to a change in the formula the feds use to calculate rates.

Part II:  Population:
1.  Enrollment in Medicaid     
children  , adults, seniors
- main growth is children     Medicaid children monthly enrollment (6100 increase July 09-Dec 09)     
- red Denali Kid Care (2300)(150-175%)     
-grey Regular poverty level (about 9000) [I'm not sure what these numbers mean, perhaps I got them wrong - I think she was dividing the kids into those who got Denali Kid Care and those who qualified through poverty.  But the numbers don't add up.]

Hawker:  Timing on chart is that the low point was last January and so the increase began after we funded last year.

Clarke:  Part III - Recipients - those covered who actually use it. (Medicaid Recipients Chart) Children, Disabled Adults, Adults, Elderly, Disabled children Medicaid Children Monthly Recipients: Last January trend was declining, then it hit.

So, itʻs the children that are increasing.  How to measure?
1.  Look at numbers of enrollees and look at how many use services?  2009 97% used services.
2.  Look at costs/medicaid enrollee. 2006-2009  fairly stable.  About $8200 per enrollee. 2010 - Three models.
a)  high forecast - >$9000 for FY2000
b) low forecast (really moderate, I wouldnʻt call it low)
c) check write and thatʻs $8243(?)

Austerman - thru 2008 actual?  Yes.  2010 been what so far?

Clarke:  Between checkwrite and low projection.

Austerman - pretty much following the trend

Clarke:  Couple things. 
1)  in spring spending accelerates 
2) Also some programs that department pays lump sum payments - some tribal payments and others, special one to API, and thatʻs not taken into account.

Austerman:  so that number will continue to go up?

Clarke:  Yes

What are the factors that led to increase?
Price:  about 3% Population:  11,000 more kids enrolled, about 5% Utilization:  a little bit

Whatʻs causing this?  Alaska Public Assistance Caseload Trends.
Economy is having an impact. Food stamps and medicaid growth almost exactly the same.  FS is a leading indicator, shows where medicaid enrollment will go

Gara:  Food stamps qualifier?  150%

Salmon:  Simple, yellow line on the bottom is what?

Clarke:  ATAP & Tribal TANF  - itʻs very stable and has been great success, Welfare reform set 5 year limit. Alaska Temporary Assistance Program - Remarkable decline in that program.

Clarke:  Dept. of Labor website - Alaska population grew at highest rate in years, birthrate highest since 1992.  Previous studies.  Medicaid pays for 40-50% of births in Alaska.  So population has contributed to cost increase. Delayed impact from SB 27, 2007, Denali Kid Care Program, had been at a 200% Poverty level and was change in 2003 to 175%.  But changed to fixed rate, whatever the number in 2003 = 175%  but in 2007 it actually was 150% of poverty level.  So in 2007, they put it into the law that it was 175%.  They thought kids would return by 2008.  There was a delayed impact.

Last thing:  Two issues that have garnered a lot of media attenion
1. H1N1
2.  Health Care reform These seem to increase utilization

Salmon:  Why is the Adult Public Assistance a straight line?

Clarke:  Itʻs for elderly

Foster:  Would be interesting to see correlation between cost of energy and utilization.  Also, looking at this geographically - urban or rural?

Clarke:  One good thing about Medicaid program:  They have data.  You can get any info you like, just depends how deep you want to drill. 

Hawker:  Medicaid democraphics follow Alaska Demographics.  In urban areas, youʻll see - itʻs not that the services are different between rural and urban - if they are in rural Alaska and they have access to native health care, theyʻll get 100% from the feds.  This allows the state to afford more for the rest of the state.  And transportation costs are high.  And feds keep asking about transportation costs because they are so high.

Chart:  Medicaid Projections Three different monthly forecasts.  Which is most accurate? April 2008 high forecast 1.13Billion for FY 2008, low $984.   Come together in June when we get the actual spending Jan 2010:  suggests 1.26 billion 1.2 and 1.16 Billion. Chart:  Monthly Medicaid Spending Goes back to October 2008.  Weekly trends, but shown as monthly.

Fairclough:  p. 17 after birthrate in Alaska, State lost three cases that were restricted by 2006 intent v. court ruling on controlling costs.

Clarke:  Dept of Law Iʻm sure will talk to you.  When the intent went into place, it dropped and has slowly come back up.  Urge Leg. to consider.
1.  Because of special stimulus FMAP.  If we accept the money, we canʻt cut eligible for services.
2.  I think in the future if Legislature needs to contain costs, will have to put it in legislation.  Legislative intent is just legislative intent.  Having lived through cost containments, there will be challenges by people being cut.

Fairclough:  Want to know what was reinstated and how that related to intent?

Clarke:  Austermanʻs earlier question.  $682 million since Jan. 2010.  Thatʻs $1.2 billion for the year if it continues. 

Gara:  People w/o health insurance going to emergency room.  Those people arenʻt even covered by medicaid.

Clarke:  If they do go in and then qualify for medicaid theyʻre signed up, but ask the department.

Austerman:  Please repeat numbers Clarke:  getting close to $1.2 billion figure. Next charts boring.  Just numbers.  Medicaid Supplemental Alternatives $88.4 million.  that would be $1.264 billion.  I think it is trending to $1.2 billion, about $64 million less, but Iʻm sensitive to the unexpected.  I recommend give them this extra cushion.  That would save $7 million in general funds.

Hawker:  Making judgment calls around the margins.

Gara:  This isnʻt going to impact their costs, just whether there is a supplemental.

Clarke:  This is the supplemental.

Gara:  Through June.  Youʻre hoping theyʻll need $70 million less.  But whether you are right or they are right, it wonʻt affect the actual costs.

Clarke:  I was asked to give my best guess.  But youʻre right Medicaid spending is what it is.

Gara:  If we overestimate, they wouldnʻt overspend it, right?

Clarke:  Typically, there are controls.  This isnʻt to say there arenʻt transfers.  But this department has been historically upfront and returning any extra.

Foster:  Dept. basically is guessing $88 million and youʻre recommending we come in at $74 million.  This is the low forecast plus 2%. Austerman:  Does this increase their starting base next yearʻs budget.

Clarke:  No, it does not affect the base.

Hawker:  it doesnʻt affect the base.

Foster:  You said in response to Gara that Medicaid is what it is.  But one area we do have control.  If there were more facilities around the state IHS, then the state would be paying less of that 50% correct?

Clarke:  I think youʻre correct on an individual basis. FY 2011:  Last Page:  FY 2011 Medicaid Budget: DHSS & Consultant Comparison Both come to the same place.  We get there through different paths.  I think weʻll spend less this year.  I think Medicaid will grow 12% this year and about 7% next year.  (not 100% sure of the numbers.)  Yes, these are large numbers and they are reasonable.

1.  I want to go back and look at containment issues and how they were handled back to 07 and 08.
2.  Behoove us to look at FMAP and changes needed at end of that, possibility of legislation...?

Gara:  Follow up on Rep. Fosterʻs question.  Lack of education.  The IHS funding, if you qualify it is 100% payment.  If it happens in IHS facility that helps us a lot.  Iʻm not clear if someone who qualifies goes to Providence, can you qualify automatically if you go to a non IHS facility?

Clarke:  No.  Has to be in qualified IHS facility.

Gara:  Is there a saving if there are more IHS facilities.

Clarke:  Looking at long term care and nursing homes, there are few in rural Alaska, thatʻs the one area you have.

Hawker:  Let Ms. Clarke off the stand.

Doogan:  I still donʻt get the big spike in medicaid costs that begins in 2009.  3% CPI increase, but not for long.  Some charge changes but not tht big.  Population graph - medicaid recipients total - those trend lines are flat or going down.  Then utilization, I donʻt actually see a particular chart here, but if the other two arenʻt doing it, it has to be more people using the service.

Clarke:  If you go to page 10.  I didnʻt put all charts in powerpoint presentation.  In the Report

Switch to the Commissioner and two Deputy Commissioners:
Bill Hogan Commissioner 
Alison Elgee Assistant Commissioner Finance Management Services
Bill Streur Deputy Commissioner for Medicaid & Health Care Policy

Commissioner Hogan:  If anyone knows this, itʻs Janet and I think itʻs an excellent report. Respond to Rep. Doogan.  Page 13. This is serious stuff.  We take this very seriously.  Iʻve spoken with the Gov.  who committed to the Leg. Leadership to look at this for FY 12. Economic Stimulus.  We have the enhanced FMAP rate through Jan. 2011.  Various things that extend that through June 2011. 

So beginning FY 2012, weʻll need about $125 million more.  (was that billion?) You can see there were circumstances occurring - change in unemployment rate.  26% increase inf food stamps and 9% unemployment. Best way to address this is economic development and more jobs.  As jobs are developed, but we also provide many safety net programs.  Medicaid is one of them.

Hawker:  to your last comments.  Would like to give your clairvoyant, Mr. Streuer, I would like to eat some crow.  Last year you did warn us there was a change on the horizon.  We were looking at the trends to the data points up to the point when we sat here.  Mr. Streuer, I donʻt know how you did it, but you predicted the state economy better than anyone else.
Disclosure:  Heʻs also one of my constituents.

Fairclough:  If we cross tab unemployment and  industries that they are coming from - construction academy, health industry, retail outlet?

Hogan:  Itʻs possible, we have data on people leaving public assistance rolls and where they might go.

Austerman:  What kind of analysis can we get if we have 9% unemployment and itʻs higher Outside, are people moving here to get work? 

My fingers are getting tired.

Salmon: Today I got call from DOT and two days ago from DOL, theyʻre coming back with answers.

Hogan: Cost containment measures several years ago. ONly those eligible were actually getting the program and were only getting the right amount of service. We scrutinized that carefully.

Hawker: We were getting documentation of serious abuses.

Hogan: Absolutely correct. We began to reduce hours people eligible for. Some legal entities felt we didnʻt have legal criteria, objective criteria for determining that. One of the lawsuits. The technical term is ʻmaterial improvementʻ. Since then weʻve adopted a more defendable tool. If you have further qustions, Stacy Crayley? at Department of Law can help.

Hawker: Weʻre trying to encapsualte 8 years of budget reviews into a two hour abstract.

Hogan: REspond to Gara about emergency rooms. Our providers, get the person to sign up if they are eligible, and that eligibility is retroactive. But there are many individuals who do not qualify for medicaid and who do not have insurance. Hospitals are not compensated.

Gara: Iʻm not going to pretend there is some easy solution there. Is that a significant expense and if it is, is there a way to redirect them to less costly service.

Mr. Streuer: Frequent flyers - people who use emergency in lieu of personal physician which could be dealt with much lower costs. We can identify these people and try to put them in touch with primary care provider. To avoid this. Constant problem. New system will give greater lattitude to identify. A couple areas weʻre looking at: Medical home. Assigning someone to work with a particular provider and get all their care through that provider. IHS facility and ocmmunity health centers willing to step forward.

Gara: Anything in the works in cost savings relating to Rep. Fosters comment about getting more federal funding through use of IHS programs.

Streuer: Ongoing program. Itʻs money in the bank.

Gara: Using Neighborhood Health Center. Hard to make an appointment, first come first served, so people go to emergency room.

Doogan: Look at anual medical spending, looks like in 2000 Medicaid was an inoffensive $600 million and in ten years has gone up 100% and in next two years it will have tripled in those 12 years. At some point Iʻll need that answer before the budget leaves the committee.

Hawker: 2003 legislature, remember chart we saw where it was marching upward. I asked. Then they said Iʻm not sure why, it just keeps growing. We intuitively knew it was those three components. We attempted to fund, but took a while, an appropriation for agency to engage consultant to analyze system to look at causal factors. To see how we might contain costs. I think a year or two before - you were working as a staffer - people were looking at 20 years having a $3billion medicaid program. I take pride that we have leveled and stabilized the program. I donʻt think itʻs that mysterious. Med costs are going up like crazy, population going up like crazy.

Allison Elgee, Asst for HHS: Department did develop a model. Annually you get a report with a ten year look assuming no changes. Weʻre looking at a program in 20 years it will be $3.5 billion. We arenʻt talking about reducing meicaid, were talking about bending the curve.

Another point to clarify, need to replace $120 costs in funds that disappear, thatʻs before projection for growth. so it will be higher.

1.  how many IHS qualified patients are seen under medicaid program?
2. In trying to save money. Hospital near native population incurring costs fo $10 million and all qualify and FMAP is 50%, can state pay for IHS facilities? And shift the costs to the feds.

1. Yes, very specific info about IHS beneficiaries who are eligible for medicaid etc. and we can give you that.
2. Longterm facilities in Anchorage, Bethel and ?? With help of legislature weʻve given these facilities capital monies.

Austerman: Iʻm not out to take anything away from anyone at this time. But if I understand Janetʻs presentation. Partly set on how we set the eligibility. At one time we fixed it at 175% of poverty level and then it drove back down, but then it generated more kids coming into the system. It behooves us in the long term to look at price of oil and dribble coming out of oil pipeline, somewhere weʻre going to have to figure how these two points cross. Not going to do it in this budget cycle.

Hawker: this conversation is a recurring theme. Iʻm musing philosophically on the record, always dangerous, within the stte budget, we the leg were having the biggest difficulty with University for a number of reason. Way to address that was to restructure the subcommittee and have those sessions directly without being filtered. Iʻd be telling this committe to comtemplate doing the same and looking at this as a committee as a whole since it has great economic challenges.

Hogan. With you, it helps that you understand our budget. We have confidence we can do something about this, not helpless. We can bend the curve. We arenʻt helpless. We can insure people get quality services, but bring this under control. There will be painful decisions and we need to work together. The Gov. is absolutely committed.

Hawker: No bearing at all on Rep. Jouleʻs handling of that subcommittee.

Fairclough: Bending the curve. Invest truly in what is harming Alaskans in many ways. Some are duplicated. They access as many services as possible to find help, and not in a very cost effective way. Trying to find relieve. Housing and everything else. Suggest to Austermann. Instead of bending the curve, maybe we throw everything out of the box onto the floor to produce a totally different curve. Bending the curve doesnʻt work for me. Waiting on prevention only costs us more dollars exponentially.

Hogan: Echo Rep. Faircloughʻs comments on prevention. A challenge. Medicaid doesnʻt pay for prevention. Have to think of other ways to affect number of people eligible for medicaid.


Controlling Medicaid Costs (Short Summary from House Finance Report)

I'm going to do two or three posts on Friday's Finance Committee Hearing on Medicaid Costs.  This is "single greatest line item of state spending."  So,
  • it is very complicated (but not impossible)
  • it is important for Alaskans to understand
  • the information provided at the hearing made things fairly easy to understand
This post is introductory, brief, and an looks at ways to control costs.   This is stuff most people hide from because it seems too difficult to grasp.  I challenge you to read this post carefully.  It's short.  It should give you some handles for starting to understand this issue.  The next post will offer my rough notes of the actual presentation so you can see the kinds of questions that legislators asked and the answers they got.  This post is extracted from that. 

What Happened Friday and Why?
The House Finance Committee commissioned, Janet Cooke, a former Health and Social Services employee, to evaluate the HHS' supplementary budget request for $88 million for Medicaid. (Supplementary budget means coming back mid year after seeing actual costs and adding to the original budget.)  They wanted to know:

  1. What caused the increase from FY 2009 to FY 2010?  (Fiscal Year 2009.  Alaska State fiscal years begin July 1 the year before - for FY 2009 that would be July 1, 2008)
  2. How much should the legislature add to the existing FY 2010 budget? (This year has already been budgeted so how much will the Department need to cover the costs? *
  3. How much should the legislature spend for the next FY (2011)?
Two Terms

*Medicaid is an entitlement program.  This means if people meet the criteria for the program, they are eligible for services.  Thus the cost is not predictable.  If more people qualify (lose their jobs) or if those qualified get sick more, or if prices rise, the State is still obligated to pay and the costs will rise.

Also, the state shares these costs with the federal government.  FMAP stands for Federal Medicaid Authorized Percentage - the federal matching rate.  Alaskaʻs FMAP would have fallen to 50% (this year, I think) but the Economic Stimulus Bill (ARRA) [American Recovery and Reinvestment Act of 2009] increased the rate to 61.12%, meaning the federal government will pay 61.12% and the state 38.88%.  (Actually there are different formulas for different populations and programs.  So, for instance, Alaska Natives treated in an IHS facility get 100% federal reimbursement.)

Control of Costs:

Medicaid is an entitlement program.  If people are eligible, they are entitled.  So if the pool of eligible people increases, the costs go up.  That leaves limited options.  Here are some of the options I heard discussed at the hearing:

1.  Alaska Natives treated at IHS (Indian Health Service) facilities are covered 100% by Medicaid.  Therefore, the more Alaska Natives get care at IHS facilities, the less the state has to pay.  Thus there are several places where the state has some leverage:
  • Helping set up IHS facilities in places where large numbers of Alaska Natives live but can't get to IHS care.  The issue of longterm care came up as one with the most potential, because now there are few or no such facilities in rural Alaska.
  • Encourage Alaska Natives to use IHS facilities
As one legislator said, because of the IHS Alaska Natives get 100% paid by the federal government, and that leaves more money for non-Native Alaskan care.

2.  Prevent small problems from escalating into large problems
  • Make more preventive care available.  (I believe it was Clarke who pointed out that Medicaid won't pay for this)
  • Make primary care facilities (including quick access) available in communities so that people go to primary care doctors instead of emergency rooms. 
  • Develop the economy, create jobs so that people move out of poverty and get health insurance
These ways that the State can affect Medicaid costs are just one issue that arose in the Friday hearing on Medicaid costs of the House Finance Committee.  I'll put up at least one other posts on this.  It is complicated, but Janet Clarke's report helps a great deal.

Getting a sense of Medicaid costs - a huge part of the Alaska State budget ($1.2 Billion) - is not that hard.  There will be repetition in the next posts, but I'm finding that the repetition is critical in my own understanding of this.

Saturday, February 27, 2010

If Thoreau Had a Blog - "will not any endeavor to cure the brain-rot"

A Juneau friend has lent me a book of poetry edited by Robert Bly.  I've never been particularly attracted to Bly, but there are a lot of poems by different poets in this book.  The Rag and Bone Shop of the Heart is subtitled "Poems for Men."  Except this piece by Thoreau is prose.

And I can't find, in the book, where this piece is from.  There's a copyright section at the end, but I guess this is old enough that the rights were public.  Fortunately, today, unlike 1992 when the book was published, I can easily find the source through Google.  It's little, but cumulative, issues like this, that I think have soured me on Bly.   In any case, Google tells me this is from the conclusion of Walden Pond.  So you can read what I left out, plus the rest of Waldon Pond at the link if you choose.

I fear chiefly lest my expression may not be extravagant enough, may not wander far enough beyond the narrow limits of my daily experience, so as to be adequate to the truth of which I have been convinced. Extra vagance! it depends on how you are yarded. . .
I desire to speak somewhere without bounds; like a man in a waking moment, to men in their waking moments; for I am convinced that I cannot exaggerate enough even to lay the foundation of a true expression. Who that has heard a strain of music feared then lest he should speak extravagantly any more forever?
Why level downward to our dullest perception always, and praise that as common sense? The commonest sense is the sense of men asleep, which they express by snoring. Sometimes we are inclined to class those who are once-and-a-half-witted with the half-witted, because we appreciate only a third part of their wit. Some would find fault with the morning red, if they ever got up early enough. "They pretend," as I hear, "that the verses of Kabir have four different senses; illusion, spirit, intellect, and the exoteric doctrine of the Vedas"; but in this part of the world it is considered a ground for complaint if a man's writings admit of more than one interpretation. While England endeavors to cure the potato-rot, will not any endeavor to cure the brain-rot, which prevails so much more widely and fatally?

Would this Thoreau's blog have any readers today?  How would he have written this today?  Would he think, perhaps that today we have taken his call for extravagance a bit too far?  Or not far enough?   I'm sure he would still be railing against the limits of common sense and brain-rot. 

From Boloji:  

Six hundred years ago Kabir was born in India in 1398 AD. He lived for 120 years and is said to have relinquished his body in 1518. This period is also said to be the beginning of Bhakti Movement in India.

A weaver by profession, Kabir ranks among the world's greatest poets. Back home in India, he is perhaps the most quoted author. The Holy Guru Granth Sahib contains over 500 verses by Kabir. The Sikh community in particular and others who follow the Holy Granth, hold Kabir in the same reverence as the other ten Gurus.

Kabir openly criticized all sects and gave a new direction to the Indian philosophy. This is due to his straight forward approach that has a universal appeal. It is for this reason that Kabir is held in high esteem all over the world. To call Kabir a universal Guru is not an over exaggeration. To me personally, the very name Kabir means Guru's Grace. 

And from Sacred-Texts:

The Vedas

There are four Vedas, the Rig Veda, Sama Veda, Yajur Veda and Atharva Veda. The Vedas are the primary texts of Hinduism. They also had a vast influence on Buddhism, Jainism, and Sikhism. Traditionally the text of the Vedas was coeval with the universe. Scholars have determined that the Rig Veda, the oldest of the four Vedas, was composed about 1500 B.C., and codified about 600 B.C. It is unknown when it was finally committed to writing, but this probably was at some point after 300 B.C.
The Vedas contain hymns, incantations, and rituals from ancient India. Along with the Book of the Dead, the Enuma Elish, the I Ching, and the Avesta, they are among the most ancient religious texts still in existence. Besides their spiritual value, they also give a unique view of everyday life in India four thousand years ago. The Vedas are also the most ancient extensive texts in an Indo-European language, and as such are invaluable in the study of comparative linguistics.

Friday, February 26, 2010

Did I Mention How Beautiful Juneau Is?

I got to sleep in and didnʻt get up til 9am. Then I worked on some posts and since the sun was shining again, went for a run.

It turned out that in the Channel it was foggy again.

Since I met that geologist while I was taking a picture 
like this, there will be no stopping me.

On the way back the creek was generating its own fog.

And when I got home, the crocus had opened.  I guess this is included in the rent.  The stigmaʻs bright orange reminded me that crocus stigmas are the source of saffron.  But it turns out not just any crocus.  From Local Harvest:
The expensive saffron spice that you buy in the store is the dried female portion (stigma) of the Saffron Crocus. Why not grow your own? Saffron is the world's most expensive spice. Fortunately the home gardener only needs a couple dozen Saffron Crocus to produce enough saffron for some occasional dishes throughout the year. The corms will multiply each year, and to prevent overcrowding, corms are divided every 4 to 5 years. Saffron is grown mostly as a culinary and medicinal herb, having been cultivated for at least 4,000 years. Historically saffron has also been used as a natural dye for hair and natural fabrics, and for use in perfumes. Medicinal: Traditional use for its spasmolytic and sedative effects. Ornamental: Saffron blooms in mid-fall, producing exquisite brightly colored, lilac-purple blooms, each with three vibrant red stigmas. Even if you never harvest Saffron Crocus for food use, it deserves its own special place in the flower garden.
 Unfortunately,  the site also says it grows in zones 6-9.  That would work in Juneau I suspect, but not in Anchorage.  

So then I went down to the capitol and sat in on the full Finance Committee hearing on the medicaid budget which was interesting, but they didnʻt talk about the mental health budget or Bring the Kids Home.  But Iʻd gotten a call from Rep. Jouleʻs staff to pick up the spread she they were working off of at the subcommittee meeting so Iʻll try to make the corrections this weekend. 

And when I was back home, K and P knocked on the window and invited me to walk back up Perseverance Trail.  P picked up a friend's dog - Apollo - and off we went.  Except an almost full moon was coming up as the sun was setting and I kept pulling out my camera.
From the street outside our gate.

Looking back as we walk up Basin Road past the houses.

Looking up ahead.  

Walking back.

Dan Sullivan House Judiciary Confirmation Hearing

Itʻs hard to be purely a reporter (in the literal sense) and not to add shading on the confirmation hearing for Dan Sullivan. In fact, simply presenting the cold facts would hardly convey the very warm reception Sullivan received. Committee Chair Jay Ramras did everything but blow kisses at the nominee and his in-laws (former Fairbanks Rep. Hugh ʻBudʻ Fate and former UA Regent Mary Jane Fate) who were in attendance.  He constantly called him "General" instead of "Attorney General."*  He looked at him like a kid staring at his new puppy. [If you question my interpretation, you can listen to the hearing yourself on Gavel to Gavel. NOTE: old hearings tend to disappear and this link is no longer good.]

And Sullivanʻs resume is very impressive - Harvard undergrad, George Washington law school, Marines, White House Fellow, Assistant Secretary of State ...

He presents his strong qualifications on this first video clip.

In his opening remarks Sullivan outlined four key areas of focus:

  1. Protecting Alaskans first, in the criminal side, and he cited Gov. Parnellʻs sexual assault initiative and second in "the many other areas in the work that we do."
  2. Support Economic Opportunity - which he acknowledged was not something you associate usually with an attorney-generalʻs office.  He specifically mentioned intervening in Endangered Species cases and Outer Continental Shelf cases, "anywhere the stateʻs economic interests are focused."
  3. Protecting the Stateʻs fiscal integrity - collecting monies owed the state or fighting law suits against the state.  
  4. Promoting good government and making sure our state operates within the parameters of the Constitution of the state.

Then he added "the challenges of improving the life in rural Alaska." (His mother-in-law is a Koyukon Athabascan who was born in Rampart.)

While most of the committee members continued the effusive tone the Chair set, Rep. Herron, from Bethel, did question him closely about the stateʻs apparent challenging of federally recognized tribal sovereignty for Alaskaʻs Native peoples in the Kaltag case.  He seemed to sidestep the question whether the state is trying to take over tribal jurisdiction in custody cases by talking about areas of cooperation with Native organizations and by emphasizing concern about sovereignty over non-Natives. Hereʻs part of the Herron-Sullivan exchange:

Again, you can listen to the hearing on Gavel to Gavel.

One might get a little concerned when a Judiciary chair suggests to an Attorney General nominee that he try a little civil disobedience and become the Rosa Parks of Attorneys General and defy the feds in their interference in stateʻs rights through the Endangered Species Act and through Environmental Protection Act.  To the attorney-general nomineeʻs credit, he deflected that role and spoke of other strategies, such as getting other attorneys-general to see that Alaska was just one of the first and that it was in their own interest to support Alaska now, because this was ʻcoming soon to a theater near you.ʻ

Clearly, the Judiciary Chairʻs rapture over this nominee was not simply related to his resume.  Ideology, which included a strong anti-federal government stance on environmental issues (and to a lesser extent tribal sovereignty,) was clearly an important part of this based on the chairʻs explicit support of this stance.  One would hope there would be at least a symbolic acknowledgment that there are many Alaskans who do not share this perspective.   The sense portrayed was of black and white with no suggestion that while there may well be serious problems with the implementation of federal policies in Alaska, that there is some merit to the intent of the laws and regulations.  Only Herron raised a contrary idea on a central issue.

Again, though, the attorney-generalʻs experience in Washington DC - as White House Fellow, as an aide to Condeleezza Rice, and as an Assistant Secretary of State - showed when he said that we shouldnʻt view Washington as a monolith, that there are a number of different factions, and heʻs lobbying many beyond the first line agencies such as Interior.

The fact that Dan Sullivan has been in the job as Attorney-General for eight months now also reraises the question raised when Wayne Anthony Ross was rejected for Attorney-General.  While Ross is, as far as I know, the only Attorney-General not to be approved, it does raise questions about the Legislatureʻs Constitutional powers to approve cabinet appointments, if they start serving when appointed and - in this case - for eight months and counting, before they are approved. On the other hand, this is probably preferable to the long delays at the Federal level when the Senate delays confirmation hearings and nominees wait months, even years, to be confirmed.

And I wouldnʻt be surprised to see Mr. Sullivan running for Governor or Senator sometime.  How about a Republican primary with Mayor Dan Sullivan running against AG Dan Sullivan?

*See Virginia protocol , US State Dept. Protocol for the Modern Diplomat.

Legislator and Staffers Play the Alaskan Bar

I think that public folks deserve a little privacy and I have no intention of posting pictures of legislators drinking in bars.  But I think this is not in that category. I learned Wednesday that there would be a legislator and two staffers on stage. 

I do have to warn you the sound does not reflect how well all three of these singers performed.  In the bar, the sound was good and they all were more than respectable.   

I first found out about Paul Labolleʻs musical side when I stopped by Rep. Fosterʻs office and saw Paulʻs guitars.  

Thursday, February 25, 2010

Like Taking a Drink From a Fire Hose

Iʻm sitting in the public lounge sort of overwhelmed with left over photos, videos, and notes from meetings and other things since Monday (and beyond.)  Someone yesterday mentioned the old quote about drinking from a fire hose to describe being in the legislature.  It may be worse, because with the fire hose, you know youʻre being hit.  Here, much of what is hitting you, may be invisible and you donʻt even know itʻs happening.  The previous post on the prayer was something I thought I could throw out there quickly while I catch my breath.

Things I havenʻt posted yet:
1.  Progress of HB 289 amending the ethics laws to incorporate the changes the AG wrote into regulations but with changes to clarify and limit somewhat. This was discussed Tuesday at State Affairs and today passed out of committee. There are two parts:
    1. Paying the legal fees of executive branch employees charged but later exonerated on ethics charges.
    2. Clarifying when spouses and other Governor and Lt. Gov. family members travel can be reimbursed by the state. (I use the word ʻclarifyʻ broadly.)

      The audio for the Tuesday session is here.  It includes at the beginning discussion of authorizing bonds for housing loans for veterans.  They are state bonds, but using a federal program that only five states took advantage of.

[Rep. Gruenberg and staffer presenting amendments 
to HB 289 to State Affairs Committee]

2.  Discussion of the Fish and Game Budget at the House Finance Fish and Game Subcommittee meeting, Monday I think.  I hadnʻt been to one of their meetings before and the decorum was a little looser than most meetings Iʻve been to.  Commissioner Denby Lloyd and two of his staff took pointed questions from the panel. My sense was that some of the Representatives were frustrated about how the department allocates resources around the state.  I really have no context to say a whole lot more other than people I asked afterwards said, "There are less fish to allocate and everyone is frustrated."  Thatʻs pretty simplistic, but I donʻt have time to gain expertise on every issue and all the personalities.  You can listen to this one here. 

3.  The Supreme Court Chief Justice met with legislators yesterday at lunch to bridge communication issues.  Justice Carpeneti spoke about the meaning of ʻlegislative intentʻ and how judges determine it.  He also asked the committee whether his belief that sometimes legislators, on the losing side of a debate, make speeches on the floor about the intent in hopes of influencing future court decisions even though their position was not the prevailing intent.  The legislators there agreed.  This audio is worth listening to.  This was the first meeting as I understand it where the Supreme Court and the Legislature are trying to work on cross-branch communications.  This was sponsored by the House Education Committee.

Hō mai ka ʻike

From the House Journal, we learn that yesterday's session was opened with a Hawaiian prayer.  

The invocation was offered by the Chaplain, Pastor Judy Shook of Aldersgate United Methodist Church. Representative P. Wilson moved and asked unanimous consent that the invocation be spread on the journal. There being no objection, it was so ordered. I was in ministry for 6 years in Hawaii prior to moving to Juneau. This prayer is a Hawaiian chant written by Kumu Keala Ching:

[For the fanatically curious, the printed journal had the whole prayer in Hawaiian, but the online version only had the first and last lines of Hawaiian. I tried to find the way to write the letters with the ¯ (I learned this is called a macron) over them. I found the ¯ but couldn't figure out how to put the letter under it and after ten minutes of searching online, decided to just take a picture of the printed text. But then I wanted to type the title in Hawaiian so I looked again. By going into Apple system preferences, then to language and text, then go down the list and choose Hawaiian. If you have the language symbol - the flag - on your top bar - the one with the File, Edit, View, etc. - click on it and change to the Hawaiian flag. Then, if you want the macron above the letter, hit option+letter. I decided to just leave the photo of the poem instead of retyping.]

Wednesday, February 24, 2010

Rep. Joule Explains Budget Cuts to Bring the Kids Home Program

Yesterday I discussed concerns that the Bring the Kids Home program as proposed by the Governor would see major cuts. This morning I sat in on that hearing and blogged it live, or at least as much as I could keep up with. After that I got Mental Health Trust Director Jeff Jesse's response to the cuts, because his agency had committed funds on the assumption that the State would have a significant match. He said they'd have to cut back their funding. And here is Finance Subcommittee on Health and Social Services Chair Rep. Regie Joule's explanation of how they chose to make the cuts.

Mental Health Trust Head Jessee on Cuts to Gov's Budget

I spoke to Mental Health Trust Authority Chief Executive Officer* Jeff Jessee after the House Finance Sub Committee on Health and Social Services approved "99.6% of the Governor's budget" but not a key program of interest to the Trust - The Bring the Kids Home program that is funding community mental health programs so that kids that are now institutionalized outside of Alaska can be brought home and get treatment here.  Jessee said that not only does this have obvious benefits to the families and kids, it also will save the state considerable money.

*I've got Jessee's position mislabeled and his name mispelled in the video and I'll get that fixed when I get more time.

I'll put up a video comment from Finance Subcommittee Chair Joule as soon as I can.

Finance Subcommittee on Health Social Services Live

NOTE:  THESE ARE MY VERY ROUGH AS THE MEETING WAS GOING NOTES.  I'll try to clean them up a bit.  Basically, Chair Joule said that 99.6% of the Gov's proposed budget was approved.  I'll try to highlight the parts that were not.  I'm also working to put up an interview I did with Mental Health Trust Executive Director  Jeff Jesse which I'll get up as soon as I can.

I went to the wrong room this morning.  But fortunately the Education committee started on time and now I'm up at the House Finance Committee room and this meeting hasn't begun yet at 8:15am.

Feb 24 Wednesday 8:00 AMHOUSE FINANCE 519

Opening at 8:15 by Rep. Joule.
Joule: Anyone do Facebook? Invited to Mike's Place - Island Pub - met with First Alaska Fellows. Then see pony tail waving at me. Here was Willie Hensley sporting a pony tail as long as mine. Where Facebook comes in, be careful, we both had our pictures taken with hair out to sides and within seconds, it hit Facebook.

Ask Virginia to go through the packets. Then we'll entertain the Gov's amendments, then we'll discuss, and move it out. I think we can do this in short order.

Virginia: Technical changes but numbers didn't.

1. Fully funded medicaid - health, line 4, line 56, line 89, Gov. Amendments ??
Alcohol and Sub Abuse program - line 2 of spreadsheet. Therapeutic Case management, Clitheroe, Palmer Therapeutic Court, Substance abuse for pregnant women. one more I missed

[Numbers refer to lines on the budget spreadsheet]

Stimulus Funding
OCS line 51
Health Care Service 63 69
Public Assistance 77 81
Public Health 86

Gov Amend 1, 5, 7

Formula Programs
76 Enrollment growth
78 Burial costs
79 Sr. Ben enrollment

All 39 Emtar [MHTAAR] requests Fully funded
Beh Health Office of Child Service
Public Health
Div of S???

[MHTAAR = Mental Health Trust Authority Authorized Receipts]

Also Tobacco Prevention fully funded

Accepted all interagency transactions

Bring the Kids Home - fully funded 13 of MHTAAR requests and 2 of the

Reductions of Tribal, ok on transfer , but not postion
Did not accept money for new grants, but there is 2.3 million in base
Reduced increment by 50% ???

Foster Parent Training - reduced by 50%

Fully funded
Probation line 73 ???
Public health nursing grantees 82
Med examiner office line 87
Traumatic Brain injury and Senior Dis 91?
Rev. Collection cleanup

Did not make final decision on school based admin claims
Nor increments to tech services components - need to be made at full Finance commitee level - complicated and have leg technicalities. pass these on up to Full finance commitee

Did not fund new programs
12 Phd Internship program
20 Forensic ?? Team

Look at spreadsheet row 332 Funding multiplier determines if funded it has a 1, if it has a 0= not funded .5= 50%

[I'm going to post this and then keep going.]

Rep. Cissna: Are we cutting Bring the Kids Home in the Community area?
Virginia: Only cutting increments.
Joule: We continue funding, just not accepting the full amount. 99.6% of the increments  in this budget have been approved.
Cissna: I know this was a hard budget to take on and deal with. But we continue to not look at outcomes right next to our goals are. I have no idea what my complaint is. So that next year we have a much better understanding of what is at risk.

Joule: We aren't going to have much of a choice not to do that. House Subcommittee is just the first step before going to Finance committee. I truly appreciate your comments. If we are going to do this in a meaningful way, we'll have to look at more than just increments.

Five Amendments: By myself- behavioral health -

Amendment #1.  Peer Navigators $200K - this is one of those programs, not intimate with all these, but did see this one. I've had people who have been touched by this program after insurance has run out. People took the time, because of their own life experience, they were the people who had some of these issues. On the road to recovery and education, got into this line of work and they offer hope in a way others can't. Just reminded me how fragile we might all be. How close to the edge maybe some of us are. And after today's budget I may be that's a joke. I believe this has MHTAAR of $175K, not something new.

  Foster Care Special needs - request for $50K, on reassignment of homes try to keep in normalcy with schools, so this is bussing to old school. One time funding to see how it works. Will revisit.

 $300K General Fund Mental Health - Beh Health for detox. $518K ask. They have 9 emergency beds and 8 were being used for detox. Not a sexy act, it's reality. Will help community address those issues. Will take the pressure of the hospital and takes them to facility where they can get the treatment they need.

Keller: I want to commend you on the second one. Good use. Thank you.

Amendment is adopted.

Amendment #2: Rep. Dahlstrom and Joule - One time request Dept HSS primary eye care and vision in rural AK communities that don't have access. Lions Int. AK Optometrists, and ?? they are offering matching funds. They came up with pared down numbers, nothing extra they are asking. Children will be able to see so they can learn.

Joule: Comments? Adopted.

Amendment 3A:
Keller: Decrement in calendar abortions performed in AK 6.2% increase 1000+ received abortions or services $600K none qualifie under Hyde Amendment, confirms not money psent based on Federal rqts. Should I read it?

Joule: No. I will maintain objections
Dahl. yes. Keller yes Miller yes Heron no Cissnoa no Holmes no Joule no.
4=3 fails

Amendment 3B: Keller: Increment to Com Health centers to cover differential on per person bases on grant for senior services. Increase 23% so $51K reps ....
Cissna: I would like to support this incremental increase, because we have had huge problem with this population.

Amendment #4: Cissna. I would like to recommend we have addition here for Sateria ??? House operating in AK now - wonderful outcomes since July 2009. nationally has record of non-institutional - get people out of institutions into community and succeeding in their lives. one of the steps we need to make. They are also geting mental???
Dahlstrom: One time request?
Cissna: Yes. Just started last year and doing a number of different community and working with Alaska Public Housing Finance.
Dahlstrom: p. 2 says supported by AK Mental Health Turst. Will this cover the extra? Have they applied for other grants?
Cissna: Yes. This is for this year. Annually they need $250K for increased capacity and um. I don't know enough to say that faithfully.
Joule: I will maintain object
Keller no Millet no heron no Cissna yes Holmes yes Joule no Dahlstrom no
5-2 no

Amendment #5.
Rep. Holmes: We've heard on childhood obesity. 27% of High Svhool students. Half showing signs onf increased risk of blood pressure and cholesterol. This will do continuation funding for ongoing programs in six diff communities, so Statewide, with goals even more so.
Heron: We visited this last year at same kind of meeting. Failed in subcommittee and put back in Full Committee. Did something change?
Joule: Yes, Fed funding went away. Last year found $475K of fed money, That money is going away but the probelm isn't.
Cissna: Probably in terms of all the issues, one of the most severe is what is happening to our children. Obesity rate increasing, but to get programs that are in place used, we have to give them some funding. The obesity rise puts the kids in harms way for things like diabetes. It's right there ahead of them. Future increases in costs for the state with our youth having future diabetes. We need to think of future costs. Remove objection.
Amendment adopted.

I move to move the budget out of the committee.


Keller: I think it's a mistake to pass out a budget... without the amendment to exclude funding for abortion.

Joule: yes Dahlstrom yes Keller no Millet yes Cissna yes Herron yes Holmes yes
6-1 adopted

Joule: As you know Gov. has initiative on sexual assault, will be addressed at full Finance committee meeting.

Lunch with the Chief Justice Today

This looks like one of the most promising options today.  For people in Juneau, it's at noon.  For people out side, it's being teleconferenced.

Feb 24 Wednesday 12:00 PMCAPITOL 106

-- Please Note Time Change --
+ Lunch and Educational Interaction with TELECONFERENCED

Alaska Supreme Court Justice Carpeneti

Presentation: "Legislative Intent: What

Does it Mean to the Courts, and How Do

We Make it Clear?"

A light lunch will be served

The Gavel to Gavel Schedules still baffle me. I think partly it's because they can't have a link until it's time to watch or listen. You can click to the schedule here. This is what it says now:

12:00 pm
House Education Committee
Capitol 106
Audio stream will be available when the meeting starts.
-- Please Note Time Change -- Lunch and Educational Interaction with Alaska Supreme Court Justice Carpeneti Presentation: "Legislative Intent: What Does it Mean to the Courts, and How Do We Make it Clear?"
(TV coverage is planned)

Cloudy, Icy, Sunny - Juneau has weather for everyone

Our gate goes out to a very steep sidewalk.  Once I hit the sidewalk this morning I started sliding down.  Fortunately, there's a picket fence all the way down to the corner.  (We're on the top corner.)  So I skateboarded (without a skateboard) down the street.  I met our neighbor who was coming out and said, "I'll let you slide by" as I passed her keeping my balance with the picket fence.  It was grey and slightly drizzly.

I went to the State Affairs committee meeting at 8am - I'll try to get something up on that - first new bonding for Veteran Housing Loans and second a bill to put into law what the AG had written in regulation about ethics complaint reimbursements and travel for the Governor's family members - though with changes to plug loopholes and make it clearer (at least that was the intent.)
 Someone lent me a car - the first time I've driven since we got here Jan. 13 - and I took J out to the airport where the sun was shining.  She'll be in Anchorage for a week.  This post is just an excuse to put up more pictures of Juneau.  It's also first time since our first weekend here, that I've been out of the downtown area in the daylight when I could see things.  And I realize we need to go exploring a bit.  As nice as downtown is, there's a whole spectacular bunch of worlds down the road too. 

This one I took almost without looking as I slowed down before getting on the highway from the airport road. I think the dark in front is mudflats. 

Tuesday, February 23, 2010

Bring Our Kids Home - Maybe Not

Here's a part of a story I found sticking out somewhere. That's to say, parts of the story were visible and parts still aren't.  I'm going to write about it, but take this as a 'present fiction.' Sort of like historical fiction, present fiction is based on bits and pieces of 'truth' but the rest of the 'truth' isn't known. What I'm going to do here is take some the fragments of 'truth' I found and try to make sense out of them. I'll try to let you know what is 'real' and what I'm sketching on my own.

I know a little about budget processes in government. Agencies in the executive branch have programs they want funded by the legislative branch. So each agency makes a list of their programs and how much each is going to cost. If they do it really well, they can link the money they are requesting with the outputs that money will 'buy.' 

"This $400,000 will buy one public transit buse that will carry 500 passengers a day, taking 40 cars off the road and emptying 40 parking spaces, and carrying 300 people who can't afford a car to work, who otherwise would be unemployed."  Of course, we can't know the outcomes so precisely, but it gives you the idea.     

[double click to enlarge photos]

First these budgets are (or should be) scrutinized inside of the executive branch. Then those programs that survive that process are sent to the legislature for approval. The legislators' job is to review these and find inefficient, ineffective, or unnecessary programs and cut them out. Legislators look good when they axe wasteful programs. Assuming, of course, that anyone notices and knows enough to understand what they have done.

Earlier, when I first got here, I started reading the budget documents for Health and Social Services. Some are written reasonably well with clear descriptions of outcomes. But it's pretty hard for outsiders to understand a program from pieces of paper. The programs that tend to get funded are the ones that have the best advocates - their descriptions get written well and/or people speaking for them are convincing to the funders. Selling programs isn't the same as operating them. The sales people could be much better than the programs they sell. And good programs may not have great salespersons.

The Bring the Kids Home program, it seems does not have good salespeople. This is a program, as I understand it - and I'm getting on shaky ground here - that is intended to set up networks around the state to provide community services for kids who have been institutionalized Outside (of Alaska, for non-Alaskan readers). The agencies that got money to implement this last year have been busy putting together programs and requests for proposals (RFP's) for agencies and businesses outside of government to run these programs. Apparently they are just about at the implementation stage and the money has been committed to the organizations that won various contracts to provide services.

The FY11 DHSS Budget (That's Fiscal Year 2011 Department of Health and Social Services) page 103 [I have a hard copy, couldn't find a matching link on line] has a section that mentions Bring the Kids Home:
Funding will assist in establishing serious emotional disturbance (SED) children's services in rural areas.  Almost 40% of youth experiencing SED in Residential Psychiatric Treatment Centers (RPTCs) out of state are Alaska Native.  This funding will develop services and strategies specific to tribal systems and improve funding mechanisms, such as Medicaid at 100% FMAP.  The funding will support tribes to expand health service delivery, as reommended by Senate Bill 61 (Ch 10, SLA 2007) (Medicaid Reform report).  Funding may support technical assistance and training from state staff or from contractors and/or adding additional staff functions to DHSS tribabl programs. . .
Another project in the budget (p. 105) includes:
...funding expands multiple grants to community behavioral health centers, to enhance outpatient services with innovative programs/training so as to reduce the need for residental level services for youth experiencing serious emotional disturbance (SED).  It will also emphasize special populations, such as Fetal Alchohol Syndrome, birth to six years, etc.  This increase in outpatient care assists in treating youth at the home and community-based level, and aoids utilizing costly residenatal care...

So, this is where the legislators and the sales pitches collide. Apparently, members of the House Finance Health and Social Services subcommittee, the committee that looks at the HSS budget, have found money that was allocated last year (or the year before) that hasn't been spent yet. This probably deserves them some kudos for looking closely enough to find these funds. Or perhaps there were people in the agency that tipped them off. I have no idea. I'm just listing possible ways this kind of thing could happen. And so, fulfilling their role as vigilant legislators cutting the fat out of the budget, so I'm told, consideration is being given to cutting that unspent money out of the budget. Not an insignificant amount I've been told. I've heard different numbers but one figure was about $750,000.

But, finding such unspent money is one thing. Understanding why it is there is another.  From what was explained to me, the money is unspent at the moment because of the planning and grant requesting and awarding process which has now taken place.  So the kinds of things outlined in those two quotes from the budget above, which were approved of last year and budgeted, have been worked on and the money has been promised to various contractors to provide services to keep kids with mental health issues in their communities where their family can visit them.  It just hasn't been spent yet.

So, because it hasn't actually been spent, it looks to people combing the budget for extra funds like an unnecessary expenditure.

At least that is the scenario that I understood.  The people who explained to to me might not recognize this version, so don't get too worked up.  The reason I'm not waiting until tomorrow to pass it by them is because at 8:00 am, there is a committee meeting where all this will be hashed out. 

We have reality television that is REAL and the stories directly affect our lives.  It's called Gavel to Gavel and you can see it live an unedited.  This post is the backstory for tomorrow's show.

Gavel to Gavel comes to you in different ways.  Try this link.
.  But these pages keep changing.  The live audio link won't be there until tomorrow and then this page will change.  But try it and see what you can find.

Here's the main Gavel to Gavel page.   Right now it says the House Finance - Health and Social Services Subcommittee will be live audio streamed tomorrow. But this page changes all the time as time passes. 

Here's the page that tells you where you can watch on television in your area.

Here's where you can get live feeds of the broadcasts on your computer.

I've given you one version of what may be happening with the Bring Home the Kids budget. 

I'm told there could be real drama at this meeting tomorrow as the Department of Health and Social Services works to get the committee members to understand that this is not unused money.  That this money is still there because it takes a certain amount of time to spend it well.  (And I'm not saying they are or are not going to spend it well because I can't judge that.  I can only convey what others have told me.) 

You can watch or listen to it live at 8am or you can listen to the archived audio after the meeting.  I've found they are usually pretty quick about getting that up.