Finance committee hears health department changes

BOISE — The new head of the state’s largest agency is well-accustomed to speaking before the state budget-writing committee, but on Monday he did so for the first time as the director of the Idaho Department of Health and Welfare.

Director Alex Adams, previously the governor’s budget director, gave a brief overview of his agency Monday in the Joint Finance and Appropriation Committee and went over organizational changes he’s implementing that will need legislative approval.

The committee will take up the proposed changes Friday when it begins to pass maintenance budgets — a process started last year of passing budgets with ongoing expenditures first and later taking up requests for new spending. The reorganization proposal uses existing funding in the department’s budget and is not a request for new spending.

“Your organizational chart defines your lines of visibility, lines of accountability,” Adams told members.

The indirect support services budget request would result in about a 2.4% reduction in spending from last year.

Adams will return to the committee for specific requests for different divisions within the department, such as Medicaid and child welfare.

Adams became the new agency head in June and has since made a number of leadership and organization changes, the Idaho Press previously reported. He has repeatedly said his main focus is to improve the state’s foster care system.

Among his changes is increasing the number of deputy directors in the office from three to four.

One of the changes is to separate divisions of Medicaid and child welfare, which had previously had one director overseeing both.

“From a budget perspective, 87% of my budget is Medicaid, and 87% of my headaches are child welfare,” Adams said.

Juliet Charron, who previously served as the administrator of the Medicaid Division, became the new deputy director of Medicaid and behavioral health. Monty Prow was hired as the new deputy director of child, youth and family services. Prow previously served as director of the Department of Juvenile Corrections.

The Division of Public Health, Self Reliance was renamed to Health and Human Services, and is led by Deputy Director Miren Unsworth.

And Jared Larsen was named chief of legislative and regulatory affairs.

Adams is also moving some programs into different divisions, which he said was to align the budgeting of those programs more with how they are being administered.

Adams also moved the agency’s chief financial officer position so it reports directly to him, instead of being placed under several division heads.

Adams also presented the budget for the licensing and certification division of the agency, which totals about $2.4 million in state general fund spending.

This budget included a request for authority to use existing money budgeted for personnel to pay contract nurses when staffing shortages occur in order to keep up with compliance for federally mandated certification surveys in skilled nursing facilities.

The Department of Health and Welfare is the only state agency that needs legislative approval to move money in this way, which Adams underscored.

Sen. Kevin Cook, R-Idaho Falls, said this difference is because lawmakers wanted visibility into how that money was being spent.

Senate Minority Leader Melissa Wintrow, D-Boise, asked how much was being spent on contract nurses versus state employees for this work. Adams responded that an employee was paid about $35 an hour while a contract nurse could go up to $95 an hour, but there was an effort to reduce turnover of employees to avoid contracting out.

In total, the health department oversees more than $5 billion in state and federal funds — much of that is federal spending through programs like Medicaid.

Budget hearings for mental health, psychiatric hospitalization, and substance abuse programs are scheduled for Monday. Divisions of welfare and public health will be Feb. 3, and child welfare on Feb. 20.

Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.