Idaho Department of Health and Welfare reorganizes leadership, shifts programs under Medicaid

The Joint Finance and Appropriations Committee on Jan. 13 heard an overview of an organizational restructuring at the Idaho Department of Health and Welfare aimed at improving line of sight and accountability across the state's largest agency.

Director Alex Adams told the committee he had accepted organizational recommendations from his predecessor and implemented changes intended to clarify reporting lines and align the department’s budget to where work is actually performed. "Budgets are laws, not suggestions," Adams said, describing the need for daily attention to appropriations.

Legislative Services analyst Alex Williamson walked the committee through the requested alignment in the governor's recommended program maintenance request. Key changes include promoting the Medicaid administrator to a deputy director role (while retaining Medicaid duties); splitting Family and Community Services (FACS) out; renaming Support Services and Licensing to the Division of Operations; grouping Public Health and Self Reliance as Health and Human Services; and creating an internal Child, Youth and Family Services division. Within that structure, Williamson said child welfare would be retitled Youth Safety and Permanency, service integration would become Family and Community Partnerships, and developmental disability services would be renamed Early Learning and Development.

The agency also proposes moving Extended Employment Services (EES) out from developmental disability services to a Medicaid budgeted program because Medicaid staff currently administer that program, not because EES is funded primarily by Medicaid. The Idaho Child Care Program (ICCP) was proposed to move under Early Learning and Development and receive its own appropriation unit so it can be budgeted separately. Williamson said staff who administer the Idaho Behavioral Health Plan and the Medicaid program integrity (fraud investigations) unit would also move under Medicaid.

Adams said he created a new chief of legislative and regulatory affairs to serve as a single point of contact for the Legislature, and a chief financial officer reporting directly to the director. The director distributed an organizational chart showing 22 executive leadership positions, 15 of which are either new or occupied by employees in newly created roles, and said the department includes roughly 3,000 employees operating from about 74 buildings at 37 locations.

Adams described the logic behind other operational moves as well: behavioral health is largely managed through Medicaid contracts, so it was moved under Medicaid to streamline reporting and decision-making; financial services were centralized under the new CFO to improve budget oversight; and a program manager for communications and customer experience was added to the executive team. He said the objective was to put the "right people in the right seats" and that many of the new leaders were experienced state managers pulled into DHW to accelerate changes.

Williamson said the budget request presented to the committee would align appropriation units in statute with the actual work happening in the department and that the committee will consider those alignment decisions as part of program maintenance this week. Director Adams said he expects to return to the committee multiple times for division-level hearings as the session continues.

The reorganization will be reflected in the department's program maintenance request and the committee's forthcoming decisions about the Health and Human Services appropriations.