The road forward in human service

A May 18 hearing on legislation to continue work to create a new Department of Health and Human Services drew several positive endorsements and no opposition.

It was heartening to see. In our first year, the new department consolidated core operations in areas such as finance, human resources, licensing, contracts and regional operations. We saved $5.8 in annual cost to the state general fund, beginning with fiscal year 2005, through the elimination of 31 positions and through reorganization that could not have been possible without a single department.

None of these changes happen in a vacuum. Recent weeks are surely a reminder of that. Changes in a match rate that the federal Medicaid program pays to Maine and other states have required us to look again at budget savings initiatives. Difficult as the choices are, Maine would be in a more challenging position had we not undertaken reorganization in health and human services. In addition to the initial efficiencies, Maine is building stronger management of its service delivery, integrating its services and, most importantly, placing the needs of its customers – the users

of its services – in primary focus.

Even as these improvements occur and new challenges emerge, the new department also must repair past issues. News three weeks ago about a federal Office of Inspector General Audit finding for July 2000 through June 2003 in Maine’s adoption assistance program is one example. At least one reader of this newspaper misinterpreted that news as an indicator of continuing financial problems at the Department of Health and Human Services. As noted, however, the audit covered the period July 2000 through June 2003 – fully a year before the merger and related efforts to improve financial operations.

It is important for Maine citizens to know that the gaps in internal control that resulted in the prior questioned costs under adoption assistance have been fixed in the current fiscal years. The second page of the Office of Inspector General report affirms that the amounts claimed in 2004 and 2005 were determined to be reasonable. Even in the initial finding, there was never an issue of mishandled funds or payments not being made to providers or families. Instead, the central issue was fully documenting the proportion of funding, federal vs. state, supporting adoption assistance.

A different federal review of another and much larger department program – Food Stamps – concluded with an exit interview recently. Its major finding was that financial management of the program was greatly improved. That was important news for the department because we are working hard to improve our financial operations and accountability.

Looking forward, there will be other events to challenge us and tell us how we are doing. The general outlook is that major federal program, such as Medicaid, are likely to continue to have less to provide to states trying to meet real needs.

However, within the flux of different challenges and opportunities, the commitment we have made under Gov. Baldacci’s leadership is fixed. We are about the business of taking on long-standing challenges and building a first-rate health and human services delivery system. Too often in the past, we have built silos that focused inwardly instead of teams focused on the needs of Maine people. And yet we know that when our professionals team with Maine communities we get results other states envy:

. Smoking among high-schoolers in Maine has declined 50 percent since 1997.

. Our policies related to parity in mental health coverage are stronger than many other states and a platform for continued social progress.

. Low-income families in Maine who qualify for federal assistance are more likely to get that help because we connect people with those supports better than most states.

. And, Maine’s teenage pregnancy rate is consistently among the lowest in the nation.

Those are just some of the strengths we build from as a new organization, and we gain in those strengths as we put better management systems in place. Better systems of financial accountability are just one example – not an end in themselves but a means to deliver on the larger mission.

Maine will have a system of health and human services delivery that is tenaciously focused on enhancing the health, safety and independence of all Maine people. As we gain in that direction, the setbacks will be fewer and the possibilities endless.

Jack Nicholas is the commissioner of the Department of Health and Human Services. Appointed in 2004, he is a former state budget officer and former chief financial officer-chief operating officer for Catholic Charities Maine.