Frustration grows as DHHS stumbles

Editorial by Ned Barnett, News and Observer, September 8, 2013.

As Gov. Pat McCrory’s newly appointed secretary of the state Department of Health and Human Services, Aldona Wos gave a speech to employees in January in which she outlined her three priorities. The first and third seemed sensible enough, improve communication and seek a building to combine scattered offices. But No. 2 struck an odd note: “That we have proper cleanliness in our offices and our buildings.”

Now, eight months into her tenure, that priority has taken on a symbolic twist. Wos might have cleaned the clutter in some offices and buildings, but her department is becoming a mess.

There was, of course, the controversy of her hiring two 24-year-old former McCrory campaign aides at salaries of $85,000 and $87,500 each. And there is the problem with new computer systems that have slowed payments for food assistance and Medicaid providers. The News & Observer’s Lynn Bonner reported late last week that Wos hired an employee on leave from Wos’ husband’s company to serve as a senior adviser on a contract basis. He has been paid $228,000 for eight months of work.

Meanwhile, two top staffers have quit or been fired. Dr. Laura Gerald, State Health Director and director of the Division of Public Health, resigned abruptly in July after 18 months in her post. Gerald, a pediatrician trained at Johns Hopkins School of Medicine and Harvard, said in her resignation letter, “I have significant differences and disagreements with many of the policy and administrative directions that I see unfolding in North Carolina and the Department of Health and Human Services.”

Last week Wos fired Rebecca King, chief of the department’s Oral Health section, apparently because she told Wos that the department should have fought funding cuts that reduced her section’s staff by 30 percent. King, a dentist and past president of the American Board of Dental Public Health, wrote in an email to state Sen. Martin Nesbitt (D-Buncombe), the Senate’s minority leader, that, “What Sec. Wos is doing is wrong and she needs to be stopped.”

King, a longtime veteran of state government, said in a letter to friends and associates that her firing stemmed from a contentious meeting with the secretary.

“DHHS Secretary Wos repeatedly interrupted me during the short time that I was speaking and treated me with total disrespect. I have never been treated with such disrespect in any work setting.” Amid the controversies, Wos – a medical doctor and former ambassador to Estonia during the administration of President George W. Bush – is having trouble with her No. 1 priority, communication.

At an event during which she was expected to talk about the Affordable Care Act’s effect on North Carolina, Wos said she wouldn’t discuss it and instead spoke about freedom and her father’s experiences in World War II Poland. Reporters who approached her for comment after that and other public appearances have said they were blocked by her security personnel. Efforts to obtain comment from Wos or her department spokespeople last week were unsuccessful.

Nesbitt plans to take a closer look at the department after getting a “ton of email” saying that the computer systems for sending food stamp money (NC FAST) and payments to Medicaid providers (NCTracks) are not functioning properly. Instead of paying high salaries to new senior staffers, Wos should focus on getting the department’s basic functions carried out, Nesbitt said.

“Apparently they paid the wrong people because NC FAST isn’t fast and NCTracks isn’t on track,” he said.

DHHS officials say the computer systems were initiated by earlier administrations and they’ve been left to work out the flaws, but Nesbitt said the agency shouldn’t have switched if the new systems were not ready.

“If it isn’t working, kill it and go back to the other one,” he said. “You can’t just sit there and blame it on (former Gov.) Mike Easley. It’s their job to run state government. If they can’t do it, they’re going to fail.”

At DHHS failure would come at a high price. Many of the state’s most vulnerable residents rely on its programs, and its spending is a major force in the state economy. The department’s 17,000 employees serve a wide range of health needs. Its largest responsibility is administering Medicaid, the state-federal health care insurance for low-income people. Last year it paid $13 billion in claims.

McCrory appears unfazed by Wos’ missteps. Indeed, he told the Cary Chamber of Commerce last Thursday that he’s planning to make “controversial” proposals to change Medicaid. The complex task of executing such changes would fall to a department that is struggling to execute its basic functions.

Don Taylor, a Duke associate professor of public policy who writes widely on Medicaid, said the recent DHHS difficulties raise concerns about whether Wos could manage a Medicaid overhaul as proposed by McCrory. The plan calls for converting the current system of the state’s paying Medicaid providers into one run by health maintenance organizations.

“I don’t believe that Secretary Wos has the trust of the health policy and medical community necessary to oversee an ambitious reform such as the one outlined by the governor,” Taylor said.

At this rate, Wos may go from advocating departmental cleanliness to worrying about a call for a different kind of housecleaning at DHHS.