Advocates wary of 'massive overhaul' planned for state services
- A proposal would consolidate four departments into one state Health and Human Services Department.
- The move is estimated to save taxpayers $95 million or more annually.
- One local lawmaker says the plan should be delayed a year while the "massive overhaul" is studied.
At the Yorktown Senior Center on Pacific Avenue, where Jennifer Stitzel assists up to 40 seniors daily, the director worries that she will lose funding under a proposed unification of four Cabinet-level departments into one state Health and Human Services Department.
Earlier this year, Pennsylvania Gov. Tom Wolf proposed the merger, which would consolidate the departments of Aging, Drug and Alcohol Programs, Health and Human Services. The move is estimated to save taxpayers about $95 million annually, as well as provide more efficient services.
Combining the departments would create an agency that handles about $40 billion in federal and state money, or nearly half the annual total for state government. The plan could eliminate each of the departments’ secretaries.
The combined agency would have a wide range of responsibilities, including administering Medicaid, responding to public health emergencies, inspecting health care facilities and distributing billions in aid to county social services programs.
A state government change of this magnitude will upend business as usual. Communicating changes and implementing them will take time, said Stitzel, whose work is backed by the York County Area of Aging and the state Department of Aging.
Stitzel, 55, said she’s unclear about how the funding pipeline works under the new model. She’s especially leery about how the state plans to protect lottery funds, which were originally designated for senior citizens programs.
“If I lose my center, they lose their resource,” Stitzel said of the seniors who visit the center. “They come here for lunch and leave. They eat, they leave. If you take away my programs, you’re taking away my food, you’re taking away the people. I can’t just say, 'I’m sorry, you go hungry.'”
The senior citizens who visit the center for needs ranging from from a hot meal to pet food to learning how to use the internet to secure health care insurance are low-income residents, Yorktown Senior Center board member Nancee Wert said. The 68-year-old added that she’s angry politicians would consider cutting the Department of Aging.
“This generation of seniors at the senior center right now, who have always worked and earned everything they have, could have it taken away from them,” Wert said. “There was no welfare system when they grew up. They really earned everything.”
Protecting seniors: There are 98,000 residents in York County over the age of 60, said Mark Shea, director of the York County Area Agency on Aging. Not having a designated, Cabinet-level secretary, he said, could be dire for his cause.
"Two years down the road and three years down the road, who knows if (lawmakers) will dip into the lottery fund,” Shea said. “I don’t want it to be diverted to other programs. The lottery helps seniors to stay in their homes. It’s the money that pays for an aide to come in to help them bathe, to allow an aging person to stay in their home safely.
"The lottery fund pays for the protection of older adults, the protection of older adults in York County.”
State Rep. Seth Grove, R-Dover Township, suggested lawmakers approve a constitutional amendment to restrict the use of lottery funds because he “would always be worried about manipulation” of them.
“This is a big undertaking,” he said. “I don’t think people realize this is a massive overhaul.”
Despite the unification plan's call to create collaboration, enhance program effectiveness and reduce unnecessary bureaucracy, there’s not enough evidence to justify the unification plan for the upcoming budget year, Grove said.
He said the Legislative Budget and Finance Committee and the Joint State Government Commission should complete studies before the proposed merger is considered. Lawmakers should then take up the issue in one year, he said.
Rethink services: According to the newly launched Health and Human Services Unification Information website, Wolf has worked with leaders of the four agencies to “rethink how state services are delivered.” Information on the site includes draft legislation, proposed organizational charts and a section for public feedback.
Wolf’s press secretary, J.J. Abbott, said the plan places emphasis on “human interactions.” The process would create “one point of contact,” instead of a person being “bounced around from department to department” where services might overlap.
He speculated the unification plan would get rid of department communication "silos," which can cause confusion and delays in service.
Administration officials said regulated providers, such as hospitals, nursing homes and child care centers, could see a reduction in their burden of requiring multiple licenses, audits and inspections while creating “one-stop shopping” for beneficiaries, including the elderly and the physically disabled.
First director: Wolf said he’s moving forward until he gets the green light from lawmakers. He announced that he would nominate Teresa Miller, state insurance commissioner, as the Department of Health and Human Services' first director.
Miller has worked capably with all four agencies and has extensive experience with issues involving mental-health treatment and long-term care for the elderly, the governor said.
Before she became Wolf’s insurance commissioner in 2015, Miller was a lawyer specializing in the implementation and enforcement of the 2010 federal health care law, the Affordable Care Act or "Obamacare."
She has worked for the U.S. Centers for Medicare and Medicaid Services and served in various posts in Oregon state government, including as its top insurance administrator.
Massive project: Gov. Wolf pitched the consolidation in January as a way to improve services and save money for a deficit-laden budget.
Advocates for the elderly and addiction treatment services have questioned whether they would receive as much attention from a bigger agency.
“The reasons why we became a department still stands,” York/Adams Drug and Alcohol Commission administrator Audrey Gladfelter said. “Having a Cabinet secretary really gives us a voice, and it gets us the right people to the table.”
Gladfelter acknowledged that it’s nearly impossible to have a “perfect system,” adding she supports the idea in spite of its potential faults.
“Will we be squashed down?” she said. “We had heard there will be a Cabinet-level position for the opioid crisis. Once people think the crisis is resolved, will that position go away?”
The drug and alcohol commission is responsible for planning, administering, funding and evaluating drug prevention, intervention and treatment-related services in York and Adams counties.
“It’s not like a switch is going to flip July 1,” Gladfelter said. “Any time you have a discussion of a massive project like this, there’s going to be an impact on different levels. We know it takes years for something like this to happen.”
What remains to be seen — if the merge is approved — is its efficiency rate, she said.
“I think pooling resources through consolidation is a good thing," Gladfelter said. "Any streamlining of potential resources, I’m a proponent of.”
When talking about the thousands of people her organization assists, she said, “they know the services they currently get, but they don’t know how they get them, because it’s so complicated. If the unification does not work out, that they don’t see anything beneficial from this, then they need to have voices and vote if something’s not right.”
Wolf’s goals under a new, unified Department of Health and Human Services include:
- Providing $26.2 million to move individuals with intellectual disabilities and autism from the waiting list and into services;
- Expanding efforts to address the heroin and opioid epidemic, including $10 million to expand access to naloxone for first responders and $3.4 million to expand specialty drug courts;
- Providing $2 million to establish an All Payer Claims Database to collect medical, pharmacy and dental claims and eligibility and provider files from private and public payers;
- Implementing an online lottery system known as iLottery to ensure system competitiveness and revenue growth to support programs for older Pennsylvanians
— The Associated Press contributed to this story.