State senators unconvinced on health and human services merger

[TexasTowelie]

Gov. Tom Wolf’s proposal to unify four Cabinet agencies into one Department of Health and Human Services by July was met with skeptical questions from unconvinced legislators at a Harrisburg hearing Wednesday.

Mr. Wolf’s administration has said the proposed merger of the Departments of Aging, Health, Drug and Alcohol Programs, and Human Services would result in better delivery of services and a savings of more than $90 million for taxpayers.

At a state Senate hearing, however, some legislators questioned whether such a large agency would deliver better services, or if certain issues — particularly the concerns of senior citizens and those facing addiction — would become lost in a mega-bureaucracy. The move would require legislative approval.

Sen. Lisa Baker, R-Luzerne, chair of the Senate’s Health and Human Services Committee, said she had concerns regarding the possible “downgrading” of drug and alcohol and aging concerns if those agencies were subsumed into the larger human services department.

Read more: http://www.post-gazette.com/news/state/2017/03/30/Pa-health-human-services-merger-tom-wolf-proposal/stories/201703300065

[PRETZEL]

1. I watched that hearing,

Sen. Baker as well as Sen. Brooks seemed pretty irate. Both I believe sit on the Senate Aging committee and raised some very serious concerns.

The big hype is to do this by July 1. From what I saw, no way.

Gov. Wolf is not going to look good on this one.

[DeminPennswoods]

2. Wolf did what Rs say they want

Gov Wolf did exactly what state Republicans are always clamoring for, streamlining state govt and cutting operating costs. Now they don't like it.

[PRETZEL]

3. I think it's different than what they would consider streamlining

The proposed system would ultimately reduce the Secretary of Aging and the Department of Drug and Alcohol Programs down to Deputy levels, with a layer of bureacracy between the Program Offices and the Secretary for HHS. Basically what the reorganization is doing is basically giving the current Department of Human Services the keys to the house.

Right now, the Wolf Administration is pushing something hard that they don't even know what it's going to really look like and how it will function within the communities, especially with 2 of the fastest growing populations in the state, the aging and those who need MA services.

If you're familiar with PCN network they show hearings and such. Over the last week or so there were 2 intergovernmental hearings, the latest was just this morning held by the House and the other was held by the Senate last week.

If you get a chance, they are very imformative.

[DeminPennswoods]

4. There's a state human services bldg

in my home town. All the human service agencies are located there in one place, so why not under a single state department? I've been through a fed gov't organization consolidation. It's difficult, but there's really no need for duplicate administrators all working toward the same end. The new agency also gets the same policy direction distributed to everyone. The right hand is more likely to know what the left hand is doing. If my experience with the state dept of revenue is any indication, the state agencies don't seem to coordinate much with each other.

[PRETZEL]

5. From my perspective

(and as a disclaimer I work in county human services department that is also doing exactly what is being proposed at the state level) it's no so much that it can't be done, but it's more of how it's being presented.

Believe me I know how it is in Harrisburg where 1 department doesn't talk to another. That is especially true for consumers in need of Medical Assistance services. Right now the hardest population being hit are seniors who are eligible for services but are having to wait sometimes a couple of months before they get approved.

Another issue is funding and who gets what. There has been over the last few years of the state going to what is termed a "Human Services Block Grant" system. Our county is one of them. There is a big push for the "no wrong door" entry. In theory that sounds great, but that doesn't alleviate the siloing that this proposal is saying it would eliminate. Consumers would still be referred based on needs and eligibility to those specific offices. No matter what the organizational chart looks like, at the base are the particular program offices. That's still siloing.

My area of expertise is in seniors. This is the population, despite being the fastest growing demographic, is the one that will be most affected. This proposed reorganization hasn't from everything I've read taken into account other initiatives that the state is currently undertaking. Within the next year, seniors who are both Medicare and Medicaid eligible will be migrated into managed care. There has been virtually no open discussion as to how this is going to operate and how it will be funded. Right now, these consumers are covered under Title XIX which is Medical Assistance. There has not been discussion that I'm aware of on how seniors who are not MA eligible but are in need of services will be treated. These are the people who have their services funded through a combination of state lottery dollars and federal Title III dollars. These consumers under this proposal would now be no different than any other MA eligible consumer.

Overall, there are just too many questions yet unanswered by the Administration that I've seen here in my county over the last year or so since the day our Commissioners announced that they are reorganizing human services in a similar fashion to the one proposed at the state leve.

[DeminPennswoods]

6. I understand your point

I'm sure you know also how frustrating it is for families of seniors, and sometimes seniors themselves, to have to navigate the system, to keep telling the same story to several or more organizations, to keep filling out same/similar questionaires and so on. That makes the ideas for "one stop shopping" or "consierge service" attractive.

I know there are a lot of questions about the "managed care" service that's in the works. I think having a single POC is doable, it's something I did during my time as a federal civil servant. Think about it as going through the line with a cashier, who is skilled/knowledgeable about their job, as opposed to going through the "self service" line where you have to figure out what to do.

FWIW, you should send your thoughts to Gov Wolf. He's a thoughtful guy and I'm sure would read your perspective as someone who works where the rubber meets the road.

[PRETZEL]

7. I don't disagree with the premises

a single POC is much easier for initial I & R and Intake services. That's one of the goals that is high on the list of priorities as my county is going through the reorganization. I don't think it works for all consumer groups however.

I still think the managed care when it rollls out is going to be a problem. I haven't heard of much talk from the western side of the state as to how the implementation is going to look like. I'm not even sure they even know for sure yet.

[bronxiteforever]

8. IMHO Drug and alcohol was a newly created cabinet position and a waste

It should go back to health( where it belongs) and the programs funded. Creating another state agency to raise d & a awareness is a waste. Aging has been around longer and the states population is highly concentrated with seniors so I don't have the same opinion.