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Health and Welfare reorganizes leadership, aligns budget to operations
Summary
The Idaho Department of Health and Welfare described a reorganization that creates a fourth deputy director, moves behavioral health under Medicaid, establishes a chief financial officer and a legislative/regulatory affairs office, and requests budget alignment so the legislature’s appropriations reflect current administrative lines.
Alex Williamson, budget and policy analyst with the Legislative Services Office, and Alex Adams, director of the Idaho Department of Health and Welfare, explained the department’s internal reorganization during the committee’s Jan. 13 budget hearing.
Williamson told the committee the department requested changes to align the budget structure with how work is currently performed. The reorganization includes renaming and refocusing divisions: Family and Community Services (FACS) will be split out; Medicaid and behavioral health divisions will be overseen by a deputy director promoted from the Medicaid administrator position; support services and licensing will be renamed the Division of Operations; public health and self-reliance will be grouped as Health and Human Services; and a new internal division titled Child, Youth, and Family Services will be created with child welfare, family and community partnerships, and early learning and development as subcomponents.
Director Alex Adams described the reasoning for the changes as improving lines of accountability and operational clarity in a large agency serving multiple functions. “Budgets are laws, not suggestions,” Adams told the committee, saying he needs a CFO who reports directly to the director and a structure that gives line-of-sight to both Medicaid (which makes up the bulk of the department’s appropriation) and child-welfare work.
Adams said the department has 3,000 employees and programs ranging from Medicaid and SNAP to vital statistics and license regulation. As part of the reorganization, the agency has created a chief financial officer position that reports to the director, expanded from three to four deputy directors to separate Medicaid and child welfare oversight, and established a chief of legislative and regulatory affairs to centralize communications to the legislature.
The department asked the committee to align the legislatively budgeted programs with the internal structure so questions and oversight could map to the actual staff and reporting lines that perform the work. Williamson said the alignment request is included in the agency’s program maintenance submission and would be considered in the committee’s program maintenance work later in the week.
Other specifics mentioned by the department include moving Extended Employment Services (EES) and some community developmental disabilities programs to Medicaid budget lines because the staff who administer those programs now sit within Medicaid; creating a program-appropriation unit for the Idaho Child Care Program (ICCP) so it can be tracked separately; and appointing a program manager for communications and customer experience.
Why it matters: The proposal aims to align appropriations and decision units with how the department is organized operationally. The changes could affect how the legislature tracks and questions programs during budget deliberations and could change where particular programs are funded within the department appropriation structure.
Follow-up: Director Adams and LSO staff said they will return for further division-level budget hearings and that these organizational changes are part of the agency’s program maintenance package for committee consideration.
