DHW director nominee outlines child‑welfare overhaul, integrity steps at Senate confirmation hearing

Alex Adams, the governor’s nominee to lead the Idaho Department of Health and Welfare, told the Senate Health and Welfare Committee he has spent his seven months in the job narrowing the agency’s focus to child welfare, reorganizing senior management and strengthening financial and program oversight.

Adams, who said he previously served as state budget director and director of the Board of Pharmacy, told senators he is pursuing “quality over quantity” at an agency he described as large and sprawling. He said he has eliminated internal regulations, is proposing statutory pruning, and is refocusing leadership energy on foster care outcomes.

Adams said the department now measures success by increasing the ratio of foster families to children and by keeping more children safely with biological parents through targeted supports. “Child welfare, child welfare, child welfare,” he told the committee. “The budget is a law, not a suggestion.”

Why it matters: The Department of Health and Welfare runs Medicaid, child welfare, food assistance and dozens of smaller programs that together represent the state’s largest agency by budget and affect vulnerable families across Idaho. Changes to staffing, rulemaking and budget priorities could alter how quickly children move to permanency, how funds are monitored, and how programs are run statewide.

Adams’ priorities and reforms

Adams described the department as having roughly 3,000 employees, 74 buildings in 37 locations and a broad set of duties ranging from hospitals and an intermediate care facility to vital statistics and licensing. He said his senior leadership team now has 22 members, 15 of whom are new or in new roles.

He described several specific steps his office has taken or will take: - Requiring senior-level sign‑off on federal grant applications, sponsorships, procurements, legislative actions and regulations under a system Adams called “One Department.” He said division administrators, deputy directors and the director must sign off. - Moving the chief financial officer to report directly to the director to improve early warning on budget overruns. - Creating an internal Office of Program Integrity (OPI) to provide internal review and earlier detection of problems; Adams said hiring for OPI had recently closed. - Cutting internal regulations and proposing statutory reductions: Adams said the department disposed of roughly 2,300 pages of internal regulations and plans legislative changes he described as “barbecuing” roughly 150 pages of statute and trimming about 200 pages of regulations this year. - Narrowing operational focus and adopting an execution framework (the “4 disciplines of execution”) to chase a limited number of measurable goals.

Adams said he has prioritized adoption as an immediate, actionable area and has waived adoption fees; he told the committee the department had completed “over 160 adoptions” since he started.

Child‑welfare metrics

Adams said the department is tracking a key ratio he described as foster-family capacity per 100 children entering the system. When he arrived the ratio was about 0.74 (74 families per 100 children); he said it is now approximately 0.94 (94 families per 100 children). Adams framed the goal as either increasing foster-family capacity or safely reducing entries by supporting biological families. He said the leadership team’s objective is to “double the rate of foster families relative to the number of children.”

Questions from senators and accountability measures

Senators questioned Adams about several high‑profile management and fiscal problems raised in earlier oversight and audits. Senator Lenny detailed prior findings including issues with the Community Partners grant (which he described as having more than $3 million in ineligible expenses and roughly $427,000 in over‑appropriated spending), a November 2023 episode of roughly $32 million in duplicate welfare payments, a separate audit finding about a $2.5 million misallocation to salaries in August 2023, and an internal review that flagged reimbursements for harm‑reduction materials.

Adams said corrective work was under way and described the specific controls he has instituted: updated HR conflict‑of‑interest disclosure requirements, federal‑grants training, a transparency team for public records, and the internal Office of Program Integrity. He said his predecessor submitted a corrective action plan for the Community Partners issues and that the department was executing that plan.

Other senators praised Adams’ focus on foster care. Senator Wintrow and others asked how Adams balanced rapid change with stakeholder input; Adams said he and his deputy for Child, Youth and Family Services, Monty Pro, met with an estimated 100–120 foster parents to gather feedback and identified communication and caseloads as recurring concerns. He said the department has implemented a 24/7 call center for foster parents and has a budget request to reduce caseloads.

Limits and next steps

Committee members did not vote on Adams’ confirmation at the hearing. The committee chair said confirmation would be considered at a later date, likely the following day.

Ending: The committee scheduled a vote for the follow‑up session; no formal confirmation action was taken at this meeting.