Should state’s largest cabinet department be split in two?

DOVER — About one in every five state employees who works in a cabinet agency (which is to say most state workers bar educators) is employed by the Department of Health and Social Services, and a whopping 27 percent of General Fund spending for the current fiscal year goes to the agency.

That, in summation, is why some believe the time has come to break up the state’s largest and most complex cabinet agency.

At the end of June, the General Assembly approved a resolution establishing a task force to review the department and whether Delawareans would be better served by splitting it into several autonomous units.

While it may have been overlooked by some due to the chaotic nature of late June, when the annual legislative session concludes for the year, any reorganization could have a tremendous impact on the entire population of Delaware, for better or for worse.

Founded in 1969, DHSS has always contained an amalgamation of services, and today it deals with issues as varied as drug addiction, animal welfare and disabilities.

Though all state agencies have undergone changes since their creation, DHSS has seen more than most in its 50-year history. In 1975, some parts of the agency were spun off into a separate Department of Correction. Eight years later, the Department of Services for Children, Youth and their Families was formed from part of DHSS and a few other state entities.

Today, the Department of Health and Social Services consists of 11 divisions: Visually Impaired, Substance Abuse and Mental Health, Social Services, Aging and Adults with Physical Disabilities, Management Services, Public Health, Medicaid and Medical Assistance, Health Care Quality, State Service Centers, Developmental Disabilities and Child Support. It employs about 3,900 people, with total spending of about $1.38 billion in the current fiscal year.

Given all that, the main sponsor of the resolution believes a deep dive is overdue.

“We have so many of these other things that have fallen into the pockets of it, and so I think it is so worthwhile of a conversation,” Senate Majority Leader Nicole Poore, a New Castle Democrat, said last week. “And as a legislator, sometimes you go to the extreme to get the conversation going.”

Nicole Poore

The task force examining the prospect of dividing DHSS into several smaller parts held its first meeting Tuesday, and while most of the discussion centered on what the group’s plan for the upcoming months should be, the audience of 50 or so did get a glimpse at what the process will look like.

Task force participants, including health experts, state officials and members of the public, raised several concerns in the initial gathering, such as what impact on federal funding a reorganization would have and whether DHSS is following its statutory limits and duties. The group plans to split into smaller subcommittees to examine a variety of specific issues, with a final report due to legislators March 31.

In short, members aim to look at not just the theory (the agency’s structure) but also the practice.

“It’s really about how people in Delaware are experiencing help from the government when they most need it, when they’re most vulnerable,” said task force member Anne Farley, who has a doctorate in public health policy.

But while the possibility of breaking up the agency has been welcomed by some advocates and officials, a few decision-makers don’t seem as keen on it.

The legislation creating the task force was introduced only after an initial bill from Sen. Poore met with pushback from the executive branch. Though the resolution simply directs the committee it establishes to study whether the agency could be made more efficient if it were broken up, the bill instructs the body to determine how DHSS should be split up.

“Given the advancements in both individualized care and the policy landscape, the inevitable conclusion is that DHSS’ dual roles must be separated into two separate” cabinet-level agencies, the bill states.

According to agency officials, Sen. Poore did not consult DHSS before filing the first proposal.

A spokesman for Gov. John Carney was vague when asked about a reorganization, writing in an email any possible changes to DHSS should not take place without first hearing substantial feedback from the many Delawareans who interact with its services on a daily basis.

In an interview, DHSS Secretary Kara Odom Walker, a member of the task force, defended her agency.

Department of Heath and Social Services Secretary Kara Odom Walker

“I don’t think government should reorganize on its own,” she said. “It really has to be focused on what clients need and what families need.”

While Dr. Walker emphasized she and her staff are open to feedback and possible changes, she also indicated she believes the current structure makes sense.

Though DHSS may be large, the field of health is extremely broad, encompassing environmental and life factors like employment, education and housing in addition to just medicine. Those “social determinants” play a large role in one’s physical and mental wellbeing, she said.

As a further argument in favor of keeping 11 different divisions under one umbrella, she noted many people require multiple services. Someone with a drug problem might need more than addiction treatment, for instance — they could also benefit from employment and mental health counselors.

“I do feel like the emphasis based on evidence and research is that we know coordination matters,” Dr. Walker said.

According to DHSS, 21 other states have consolidated health and social service agencies. Several appear to be even broader than Delaware’s department.

DHSS is currently in the middle of an unrelated agency review focused on reducing waste and redundancies.

Sen. Poore said her initial plan was to break off several parts of the agency dealing with the most vulnerable Delawareans: the elderly, people with disabilities and those on Medicaid.

“When you think about that, in everyone’s district across the state we all have that same population. How are we effectively making sure those folks are getting what they need?” she said after the task force meeting Tuesday.

Terry Olson, the executive director of the nonprofit Arc of Delaware, applauded the committee’s intentions. He’s hopeful a review could lead to greater attention being paid to some areas, such as more funding for direct support professionals, who care for individuals with developmental disabilities.

“We believe this DHSS Reorganization Task Force represents an important opportunity for the state of Delaware and all stakeholders to strategically analyze and improve the diverse, essential services to our most vulnerable citizens, for which DHSS is responsible,” he wrote in an email.

“The Arc believes that this Task Force should look at all aspects of DHSS. The organization, the structure and the size and scope of the services DHSS oversees is enormous. If it becomes apparent through the work of this Task Force that the efficiency and effectiveness of DHSS and the services they oversee could be improved by dividing DHSS into two Departments, The Arc would support this initiative.”

The Ability Network of Delaware, another group that works with Delawareans with disabilities, sounded a similar note. Thomas Cook, the executive director of the not-for-profit, said he currently has concerns about a lack of both communication and funding from DHSS, and although he is unsure the best way to address those issues, Mr. Cook is excited about the final recommendations.

Among the organizations with a seat on the task force is the Delaware Healthcare Association, which represents 16 hospitals and other health care providers in the state. Association President Wayne Smith said his members are waiting to see what the group concludes before taking a stand.

“We’ve found DHSS to be on the whole a fairly good partner,” he said.

Upcoming meeting dates have not been announced yet.

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