During a sometimes-tense exchange, state lawmakers Thursday grilled Health and Human Services Secretary Dr. Aldona Wos about problems in her department, and one powerful state senator questioned whether the agency was fit to take on massive and complex reforms to the Medicaid program.
The back-and-forth between legislators, mainly Republicans, and Gov. Pat McCrory’s health chief came as she is trying to sell a Medicaid reform plan to the General Assembly ahead of the 2014 session in May. Medicaid reform is one of McCrory’s priorities, but some lawmakers have expressed reservations with the plan.
State Sen. Harry Brown, a Jacksonville Republican and Senate majority leader, ticked off concerns about Wos’ department, including the lack of “reliable data” coming from the agency, making it difficult for lawmakers to draft a budget. He also mentioned problems with the Medicaid claims system NC Tracks, the mailing of thousands of Medicaid cards to the wrong addresses, delays in getting people food stamps and the loss of key personnel.
“How can we as a General Assembly feel safe or comfortable that you can implement a reform package when we still have all these problems?” Brown asked. “That’s a real concern for us.”
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Wos responded that DHHS officials have been working in “crisis mode” since the new administration took over. And she acknowledged that the department is short-staffed and doesn’t have the “talent” it needs.
Addressing the Joint Legislative Commission on Governmental Operations before the questions began, Wos painted an optimistic picture of her department’s efforts to get a handle on its problems. She said the agency was at a disadvantage from the start of the new administration, given vacancies in leadership positions, the looming launches of huge IT projects, including NC Tracks, and the implementation of the Affodable Care Act.
“One of these would be a significant undertaking and challenge all by itself, but we faced all of these from the first day,” she said.
She then said Medicaid operations are stronger today than when she took over, NC Tracks is improving and that the department is working to provide better Medicaid forecasts.
But later, as lawmakers peppered Wos with questions, she became defensive, raising her voice on several occasions.
Sen. Floyd McKissick, a Durham Democrat, questioned whether a lack of adequate staffing was making it more difficult for the department to provide reliable data to lawmakers about Medicaid spending. Wos responded that Medicaid staffing has decreased since 2009 and that the program now has a 20 percent vacancy rate. She said the department is having trouble finding applicants with necessary skills.
“Where are those world-class actuaries? Where are the world-class project IT managers? Where are the world-class analysts ...?” she asked. “Please, I beg everyone, step up to public service and apply for these jobs. Otherwise, we’re going to need outside consultants and you’re aware of the finances behind that.”
Rep. Justin Burr, a Stanly County Republican, asked about efforts to recruit a Medicaid director, a position vacant for months. “Clearly, they need a leader over there,” he said.
Wos said the department hasn’t found anyone willing to take the job, despite a nationwide search. She said the agency is “micromanaged” by the legislature, and that has discouraged potential candidates.
“We have been struggling to try to find people who are willing to even look at this position,” Wos said.
Asked to explain what she meant by micromanaged, Wos said, “From my view, please set your goals, set your expectations and allow us to get there.”
Rep. Nelson Dollar, a Wake County Republican, said that despite the issues, Medicaid patients are getting the health care they need.
“People are receiving their services, whether it’s medical or behavioral health,” he said.
Dollar said the state over the past three years has done a good job fixing what had been a “horrendous problem,” referring to large Medicaid shortfalls of the past. Although uncertainty remains, officials said this week that this year’s Medicaid shortfall is expected to be between $69 million and $140 million, a smaller hole to fill than in recent years.
“This General Assembly has been extremely responsible and has fixed probably 90 percent of the problems that we inherited,” Dollar said. “We still have things that we have to resolve.”
Patrick Gannon writes for the NCInsider.com, a government news service owned by The News & Observer. www.ncinsider.com