Health and Welfare director outlines reorganization, aligns budget to new structure; committee probes fleet, MMIS and ombudsman

Alex Williamson of the Legislative Services Office and Alex Adams, director of the Idaho Department of Health and Welfare, briefed the Joint Finance and Appropriations Committee on the department's proposed internal reorganization and the budget implications.

"The Department of Health and Welfare can be found beginning on page 2-4 in your budget book," Alex Williamson said as she opened an agency overview that described the department's responsibilities and staffing. Williamson said the department is authorized 3,015.94 full-time positions (FTP) and reported 315.57 vacancies as of the end of August; she cautioned that the vacancy figure is likely out of date because of ongoing turnover.

Director Alex Adams said the reorganization is intended to improve lines of accountability and operational results. "Budgets are laws, not suggestions," Adams told the committee, saying he created a new chief financial officer role reporting directly to the director and split previous deputy director duties so Medicaid and child welfare have separate deputies.

Major reorganization points presented by Williamson and Adams included: - Splitting Family and Community Services (FACS) from Medicaid and behavioral health and elevating the Medicaid administrator to deputy director while retaining Medicaid duties. - Renaming Support Services and Licensing to the Division of Operations and grouping Public Health and Self-Reliance as Health and Human Services. - Rebranding certain programs (child welfare to Youth Safety and Permanency; service integration to Family and Community Partnerships; developmental disability services to Early Learning and Development). - Moving Extended Employment Services (EES) and community developmental disabilities program staff into Medicaid to align budget appropriations with who is administratively running the programs. - Creating a legislative and regulatory affairs chief to centralize points of contact with the Legislature.

Committee members pressed the director and analysts on several budget items tied to the reorganization. Representative Tanner and others asked about a request to replace 60 state vehicles; Director Adams said the department operates a statewide fleet of 435 vehicles, two-thirds used by child welfare staff, and that vehicle ages and mileage justified the replacements. "Goal as a department is to replace the entire fleet every 7 years," Adams said. The department requested $1.8 million to replace 60 vehicles in this budget cycle; Williamson said the mileage on the vehicles proposed for replacement ranges from about 105,000 to 159,000 miles.

Adams also discussed MMIS, the state's Medicaid Management Information System. He said the MMIS modernization is a major IT project—previously estimated at about $180 million—and that the department has posted IT positions tied to MMIS work, with hires anticipated in the coming weeks to support the program.

The committee asked about the newly created ombudsman office and its role in oversight. Adams said the new ombudsman, Trevor Sparrow, has met with department leadership and he described the relationship as "symbiotic," emphasizing the department would provide records the ombudsman needs to carry out oversight.

On one budget question committee members raised about aligning staff and budget lines, Williamson said the agency is requesting the legislature's approval to realign budgeted program appropriation units to match the department's administrative structure; the governor's recommendation generally followed the agency's request.

The department will return for division-level budget hearings later in the session; many of the implementation questions raised by members, including the detailed vehicle list and MMIS hiring timeline, were deferred to those subsequent hearings.