[T]ime is ticking on the legislative session, but lawmakers are still puzzling through how best to provide oversight and management for Vermont’s largest state agency.
Two bills could significantly reform the Agency of Human Services. One, H.522, would create an independent office to oversee the child protection system. The other, S.107, would carve out a new body from AHS called the Agency of Health Care Administration.
Members of both chambers are working to wrap up the legislation before crossover deadline Friday.
The Senate bill, proposed by Sen. Jane Kitchel, D-Caledonia, who is a former secretary of human services, would create a new agency focused on managing Vermont’s health care programs.
The bill won unanimous approval by the Senate Government Operations Committee.
Kitchel and other lawmakers say the activities encompassed within the agency have increased considerably since its founding in 1970, a change driven largely by the growth of health care.
When Kitchel worked at the AHS, staffers used to joke that the Medicaid director could manage the health care program “out of his bottom drawer,” she said Thursday. The scope of the state’s health care program has grown considerably since then, she said.
“We have now an agency that has grown beyond the capacity of one person to manage,” Kitchel said.
The proposal ran up against opposition from the administration. In testimony early last month, Human Services Secretary Hal Cohen urged the committee not to move forward with the idea.
Cohen raised concerns about the difficulty of dividing up the agency because the Medicaid program is interwoven into many different branches of the system. He also argued that the integration of health and social services is part of the state’s holistic approach to serving the public. Breaking that up, he said, “moves us steps backwards.”
Health care draws on environmental and social factors outside of the traditional medicine structure, he said, arguing that it makes sense to include those services under the same umbrella.
“To break that up would really break up the whole concept of integration,” Cohen said.
Kitchel countered that argument, saying that within government all agencies are interconnected.
Establishing a separate agency for health care would ensure a reasonable scope of responsibility for the work of each agency and would better ensure that the head of the agency could truly be held accountable, she said.
“And when you’re worrying about a prison escape or a child being murdered and dying in custody, you probably aren’t thinking about how do we relate and what are the issues associated with an all-payer (health care) system,” Kitchel said. “It’s as simple as that.”
The legislation would do away with the agency’s current six-department structure. AHS currently comprises the departments of Vermont Health Access; Health; Mental Health; Corrections; Children and Families; and Disabilities, Aging and Independent Living.
The new agency would include departments of health access, mental health and substance abuse, long-term care, and public health, as well as a health care board and the Vermont Health Benefit Exchange.
According to Senate Government Operations Committee Chair Jeanette White, D-Windham, the committee voted the bill out unanimously Thursday.
The issue is not that the agency is too big when it comes to its size or the number of employees, she said. The problem is that it is tasked with too many functions, she argued.
“We need something totally devoted to health care,” White said.
Meanwhile, in the House Government Operations Committee, lawmakers are weighing legislation that would create a new position charged with oversight of the child protection system.
The child protection ombudsman would be appointed by the governor and lodged within the Agency of Administration.
Those in favor of the bill say it would provide a necessary level of external oversight of the child protection system.
Megan Palchuk, a Vermont resident who used to work as an ombudsman in the state of Washington, urged the committee not only to pass the bill but to expand the proposal.
Palchuk said it is important to have more than one person working in the independent office to manage the caseload and provide extra layers of support.
“I think if you want a neutral independent agency, you can’t have one person do that job,” Palchuk said. “It’s not realistic.”
Pamela Marsh, a Vermont attorney who specializes in the child protection system, also supported the bill.
Marsh said the current levels of oversight aren’t sufficient. The new office could also be a place where social workers could go to raise concerns without fear of retaliation from within the system, she said.
The proposal is not new. It came up in discussions when lawmakers were crafting the child protection system reform bill last session but was left out in part due to budgetary concerns.
However, some say the structures of oversight already in place are sufficient.
Commissioner Ken Schatz of the Department for Children and Families testified in front of the House Government Operations Committee. DCF supports oversight of the child protection system, according to written testimony from the commissioner’s office, but several tiers of oversight structures already are in place.
In addition to an internal complaint system, there are more than half a dozen other means of oversight. That includes regular case plan reviews for children in custody by an independent consultant, the Vermont Citizens Advisory Board, an appeal system, and a joint legislative panel, a memo from Feb. 10 states.
“Vermont already has a number of different forms of oversight in place,” the department memo says. “We have concerns about the potential redundancy with existing oversight and resource load this proposal entails.”
The committee took testimony on the bill Thursday morning with an eye to finishing work by the end of the week in order to meet crossover deadline.
