The shake-up of the agency’s leadership on Tuesday has rekindled discussion of whether the agency is too big for its own good. But advocates warn against creating even more “silos” between department services that are already hard for Vermonters to access.
Harry Chen, interim secretary of the agency, said the concern about AHS’ size is real but the right leadership team can handle management of the complex array of programs. Chen took over Tuesday after Gov. Peter Shumlin fired Doug Racine on Monday evening.
“If you do have appropriate leadership and an appropriate leadership structure, it’s hard to say what is too big,” Chen said.
A larger agency is easier to coordinate and integrate, he said, and he worries that splitting the agency would create separate silos.
The Agency of Human Services makes up half of state government. It has 4,000 employees and runs prisons and provides substance abuse treatment, health insurance plans, child protection, food stamps, fuel assistance as well as mental health services and a host of others.
It oversees six departments: Disabilities, Aging and Independent Living; Corrections; Health; Children and Families; Mental Health; and Vermont Health Access.
Some lawmakers say the agency is simply too big to be managed effectively.
Sen. Jane Kitchel, a former AHS secretary from Caledonia County, said the state should consider separating health care from the rest of the agency.
“Now is the time to look at what is the realistic scope and breadth of responsibility and whether that’s expecting too much,” Kitchel said.
Kitchel said the Department of Vermont Health Access started out as a small office in the 1970s but has become the state’s biggest project as it builds Vermont Health Connect and moves toward a universal health care system known as “single payer.”
Sen. Dick Sears, D-Bennington, and Senate President Pro Tempore John Campbell also say now is the time to think about restructuring AHS.
“It may be important to begin to think about the role of health care and how enormous that role is,” Sears said.
Julie Tessler, executive director of the Vermont Council of Developmental and Mental Health Services, said she welcomes a conversation on more effective structures for AHS. But as the state develops its new health care model, mental health and disabilities services should not be left out of the reform agenda, she said.
Ideally, it’s good to have all social services departments and prisons within the same agency, because they often serve the same set of clients, Kitchel said. Policies and services in one department should complement those in the other departments, she said. But in some areas that is not happening.
Silos are a big concern for organizations that help Vermonters access AHS services. They say the services that come from the same agency don’t “talk to each other” and waste time for clients and the state.
Linda Ryan, co-chairwoman of the governor’s Pathways from Poverty council, said the group has been mulling ideas for how to restructure human services.
“We wouldn’t like to see different services be silo-ed out,” Ryan said.
The group hasn’t made a formal recommendation or taken a vote, and has been focused mostly on services provided by DCF, which include support for victims of alleged child abuse as well as economic services such as food stamps.
The council wants a more fluid model where people can access all services through any one “door.”