Idaho Health and Welfare outlines reorganization, IT and vehicle replacement requests in budget hearing

The Idaho Department of Health and Welfare presented an agencywide reorganization and several budget requests to the Joint Finance and Appropriation Committee on Monday, Jan. 13, including a proposal to realign programs under Medicaid, create a chief financial officer position, fund IT and SQL Server upgrades, and replace 60 state vehicles.

The presentation by Alex Williamson, budget and policy analyst with the Legislative Services Office, described the requested reorganization as an alignment of how the department is budgeted with how staff actually do the work. Director Alex Adams told the committee he accepted organizational recommendations from his predecessor and implemented changes intended to improve “line of sight” and accountability across the roughly 3,000‑employee agency.

The department asked legislators to move several budgeted programs so the budget structure mirrors day‑to‑day operations: Extended Employment Services (EES) and children’s developmental disability work would be moved under Medicaid; the Idaho Child Care Program (ICCP) would be given a separate appropriation unit under early learning and development; behavioral health staff administering the Idaho Behavioral Health Plan and the Medicaid program integrity unit would also move under Medicaid. Williamson said those changes are part of the governor’s program maintenance request and are being presented now so they can be considered with the rest of the health and welfare budget.

Adams said the reorganization reflects a management choice to separate some responsibilities previously grouped together: “budgets are laws, not suggestions,” he told the committee, adding that he created a new chief financial officer who reports directly to the director so the department can better monitor and live within appropriations. He also described moving from three to four deputy directors to give Medicaid and child‑welfare programs clearer lines of oversight.

On specifics, Williamson said the department is authorized 3,015.94 full‑time positions and reported 315.57 vacancies as of the budget submission; she cautioned that turnover means that snapshot changes over the year. The committee was shown a five‑year spending picture that included a large increase in 2023—about $670 million—driven largely by Medicaid population‑forecast adjustments, provider rate changes and a hospital assessment that raised reimbursements.

Budget requests in the indirect support services division include about $2.8 million in replacement items (visitation rooms, office remodels/furniture, and replacement of 60 vehicles), $1.8 million for Office of Information Technology hardware replacement (laptops on a four‑year cycle), and roughly $711,000 for a one‑time SQL Server upgrade with a separate ongoing $140,000 request for software assurance. The governor recommended most items but excluded funding for planned cloud server capacity after the agency found alternate solutions.

Committee members pressed the department on the vehicle request. Adams said Idaho Health and Welfare has about 435 state vehicles statewide and seeks to replace 60 this year; most use is in child welfare, where staff transport children to visits, court and health appointments. He said the agency aims to replace the fleet on a seven‑year cycle and that the vehicles proposed for replacement have odometer readings between roughly 105,000 and 159,000 miles. A representative of the department said prior requests had proposed fewer vehicles, and cost increases in the auto market have raised replacement costs compared with earlier estimates.

Members also questioned licensing and certification operations, which inspect health‑care facilities and long‑term‑care providers. Licensing and certification is authorized 71.9 FTP with 13.9 vacancies at budget submission, and the division has historically used contract nurses to perform surveys. Director Adams told the committee that permanent staff cost about $35 per hour whereas contract staff cost about $90–$95 per hour, and that the division’s vacancy and turnover rates have improved from pandemic peaks but still required contract support to meet federally required inspection cycles.

Committee members asked about the Department’s Medicaid Managed Information System (MMIS) upgrade and related positions. Adams said the MMIS modernization is a large project (the department has previously estimated roughly $180 million for the upgrade) and that several IT positions funded last year have been posted and likely will be hired in February to support the work.

The department also discussed the recently created Office of the Ombudsman; Director Adams said he has met with the ombudsman, Trevor Sparrow, and described the office as an oversight mechanism he supports.

The committee did not take final votes on the reorganization during this hearing. Williamson told members that the department’s reorganization and program maintenance items are scheduled to be considered as part of the broader health and human services program maintenance bill later in the week; enhancement appropriations for indirect support services, licensing and certification, and independent councils are scheduled for a later bill-setting vote.

Details the committee requested for follow‑up include an itemized list of fleet vehicles recommended for replacement, mileage and replacement criteria, and updates from the agency on hiring status for MMIS and IT positions. The Legislative Services Office and department staff said they will supply those materials to the committee and discuss division‑level questions in subsequent hearings.