The head of North Carolina’s troubled health and human services department told lawmakers Tuesday that moving the Medicaid program out from under her purview to a stand-alone agency would “be against common sense.”
“Absolutely not,” said N.C. Health and Human Services Secretary Aldona Wos in a response to a question about whether moving the $13 billion Medicaid outside of her domain would make things easier on the agency.
“To separate parts of [DHHS functions] out to the department will actually go backwards,” she said.
Wos made her comments Tuesday at a legislative oversight committee hearing. It also comes as lawmakers consider whether to embark next year on an ambitious plan by Senate Republicans to move the state’s Medicaid program to a standalone agency reporting jointly to the governor and state lawmakers.
A special program evaluation committee recently formed to consider different scenarios for Medicaid, an entitlement program that provides health care for the poor seniors, children and disabled residents, is funded through a mix of federal and state dollars.
Lawmakers have for years voiced frustration with faulty budget forecasts and unexpected cost overruns within the Medicaid program. Several Republican politicians — including legislative leaders and Gov. Pat McCrory — have held up the forecasting roblems as reason why North Carolina should not expand its Medicaid program, a move that would tap federal money to provide healthcare for an estimated 400,000 North Carolinians unable to afford their own insurance.
Wos, a Greensboro physician and wealthy Republican fundraiser appointed by McCrory to lead the state’s largest agency in January 2013, had plenty of other tough topics to cover with Tuesday’s legislative oversight committee. The tense reception has become a routine scenario for Wos as she’s grappled with negative coverage over high-dollar personal contracts and raises for close associates, as well as major disruptions in the state’s Medicaid billing and food stamp dispersal systems.
On Tuesday, Wos and her staff faced questions about a $6.8 million no-bid contract given to a consulting firm Alvarez & Marshal to advise and manage the Medicaid program.
Wos told lawmakers that she needed to hire the firm because she didn’t have any staff able to manage the program properly as she and other agency staff were developing a comprehensive Medicaid reform plan.
“We had an emergency,” Wos said. “We had to figure out how to get our daily work done.”
State law requires most contracts to go through a bidding process, in order to keep costs down and to allow for competition in lucrative contracts. Wos credited the consulting firm’s work with allowing the Medicaid program to meet its budget this year, and return $63 million to the state’s general fund.
Mark Gogal, the human resources director for DHHS, told lawmakers that the agency continues to suffer from a high number of vacancies in key positions as well a “double-digit turnover” of 11 percent in the agency.
One out of every five Medicaid positions is currently vacant, and the state agency has an overall vacancy rate of 14 percent, according to information provided by DHHS.
Gogal said the legislature gave the agency some flexibility with salaries, but that he still struggles to attract quality candidates at the rates offered to state workers.
Many of those leaving the agency are also moving on to better paying jobs, he said.
“If we can’t keep up, we are going to lose people,” Gogal said.
The committee hearing is continuing this afternoon, and can be watched via a WRAL livestream here.