Legislature should be cautious on DHHR split

By: Kathleen Stoll
March 5, 2022

Shooting fast from the hip works in old Westerns, but in the real world it is just a plain dangerous way to resolve problems, especially for bystanders.

I have commented before that the state Legislature reminds me of the Wild West: You never know what magic show patent medicine will be hawked. Or what bills will stampede through the committee corrals. House Bill 4020 is another illustration.

When the West Virginia House Health and Human Resources Committee passed a bill to mandate that the Department of Health and Human Resources (DHHR) dramatically and rapidly restructure, I felt like warning all West Virginians to grab the kids and run for cover. Nothing on the Health Committee agenda for Feb. 17 alerted the public that this major decision would be discussed. And now HB 4020 has passed the full House. It mandates two DHHR secretaries (one yet to be recruited or hired) to work together to figure out how to split the agency and 140-plus different streams of federal money, by July 1, 2023.

Tight timeline. Especially since there isn’t any current detailed public plan already in place to guide this mandated DHHR split. There was a plan kicking around in 2013, but there have been a lot of changes since then. I am unaware of any recent process to secure public input or allow local health and social services providers to weigh in on this proposed split. There are no current studies comparing West Virginia to models in other states.

HB 4020 divvies up DHHR agencies and boards. How was this one-for-you-and-one-for-me process done? The DHHR bifurcation would put health services in one department and other
social services in another department.

It might not be so simple.

For example, consider the services needed by children in foster care and for families at risk of having a child placed in foster care. Those kids and families need an integrated, coordinated system that brings health services and social services together easily and seamlessly.

And think beyond foster care kids and at-risk families. If we think about any family that we want to help survive tough times and get back on their feet, we need an array of services. It isn’t just one bucket of services or the other. A family can simultaneously need affordable health care, food stamps and other food assistance to keep meals on the table, assistance keeping a roof over their heads, and opportunities to gain new skills or education to secure a good job. And more. Think about the DHHR WV Path online integrated application portal. Which side of the bifurcation does it land on? Families need a one-stop application and enrollment process for all these support programs.

I get that DHHR is a large bureaucracy, and sometimes it is hard for consumers, clients, service providers, legislators and others to grasp and navigate. But splitting a beast in half does not necessarily make it run better or make it simpler to manage. It can make it harder for the front legs to know what the back legs are up to – inherently inefficient.

If this split is a backdoor approach to cutting the DHHR budget, that is just plain wrong. Most of the complaints that I hear from families interacting with DHHR are related to completing eligibility applications and renewals for Medicaid and other services. I believe many of these problems are directly linked to underfunding and, in turn, understaffing at DHHR – at the local level and up the management ladder.
To be clear, I don’t oppose a careful consideration of a DHHR restructuring with full opportunity for public input from consumers as well as health and social service providers. Too often restructuring is seen as an easy cure-all or magic bullet.

Major restructuring is not planned and implemented quickly. Let’s talk about a realistic timeline for an organized effort to gather appropriate inputs and information to clearly articulate the problems and goals, and then to consider responsive options for any restructure. A thoughtful plan must address any potential negative impacts on DHHR clients and employees.

I hope the Senate will slow down and reconsider a public process that more carefully takes aim to hit the bull’s-eye — an improved DHHR for West Virginians.

Kathleen Stoll serves as the Policy Director for West Virginians for Affordable Health Care (wvahc.org) and operates a policy and economic consulting business, Kat Consulting.


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