ALASKA
Faced with waiting lists for community-based services for people with disabilities, Alaska engaged in a number of planning efforts in 2002 to advance home and community-based care. The state also is using federal grant funds to develop consumer-directed models of care for some of its programs.
Planning and Reports
Alaska is carrying out long-term care planning through four planning and advocacy boards, funded by the Alaska Mental Health Trust Authority and state general revenue. The four boards worked together to produce a planning document, In-Step, Comprehensive Integrated Mental Health Plan, which was released in December 2001. The Alaska Mental Health Board addresses mental illness; the Governor's Council on Disabilities and Special Education handles developmental disabilities; the Advisory Board on Alcoholism and Drug Abuse is responsible for chronic alcoholism issues; and the Alaska Commission on Aging deals with Alzheimer's Disease and related disorders.
The state is crafting a mental health strategy through its Community Mental Health/API Replacement Project that is aimed at better serving individuals with mental health problems. Part of the strategy involves replacing the aging Alaska Psychiatric Institute with a new facility. Components of the project include a single point of entry to assistance and services, enhanced crisis respite, enhanced detoxification treatment, intensive community-based services targeting the highest users of API acute care services, and training.
Home and Community-Based Care
A "Developmental Disabilities Wait List Report" was published in November 2002. Prepared by the Division of Mental Health and Developmental Disabilities, the report noted that 3,552 people were receiving various developmental disabilities services as of June 30, 2002 with 1,233 people on a waiting list. Another report, "Waiting in Line for Treatment," released in February 2002 by the Division of Alcoholism and Drug Abuse, summarized the results of a survey conducted in late 2001. The survey showed that, on any given day, an average of 302 people living in eight Alaska communities signed up for treatment in a program that had no space available for them.
The state received a $1.4 million Systems Change grant from the federal government in 2002 to develop a consumer-driven care coordination system. The project will focus on delivering services using case management models, establishing a reimbursement methodology for individual budgets, and developing a system for purchasing services through fiscal intermediaries or service brokers.
Agency Reorganization
The new administration of Governor Frank Murkowski in March 2003 announced a major reorganization of the state Department of Health and Social Services (DHSS), an agency of 2,700 employees with a $1.6 billion budget. The move included the transfer of senior services from the Department of Administration to DHSS.
Department officials said the restructuring would make the department operate more efficiently. A new Senior and Disabilities Services Division will provide care for seniors and disabled Alaskans. This division includes the former Division of Senior Services and Adult Public Assistance (formerly in the Division of Public Assistance) and several other functions from the former Division of Medical Assistance, where Medicaid functions had been centralized. Divisions will have responsibility for their own Medicaid services. A new Behavioral Health Division will include functions formerly in the Division of Alcoholism and Drug Abuse and the Division of Mental Health and Developmental Disabilities.
As it left office at the end of 2002, the Knowles administration dropped plans to issue new regulations that would have sharply curtailed services under a Medicaid home care program for people with mental retardation, severe medical conditions, or developmental or physical disabilities. The Department of Health and Social Services cancelled hearings in November 2002 on proposed new regulations for the program after considerable opposition developed among parents, foster parents and advocates. The changes would have limited some types of home care assistance, added restrictions on foster families, prohibited the purchase of certain types of special equipment, and restricted funds for home modifications. The program cost more than $100 million in FY 2001 and served about 2,700 people.
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