Seeking efficiency, Alaska breaks its health agency into two new departments
The Department of Health and Social Services has been split into separate organizations
The offices of the Alaska Department of Health and Social Services are seen in Juneau on Friday, July 1, 2022. The department is being split into two separate agencies. (Photo by Lisa Phu/Alaska Beacon)
The state agency that led Alaska’s response to the COVID-19 pandemic has been dissolved. As of Friday, the Alaska Department of Health and Social Services is now two separate agencies: the Department of Health and the Department of Family and Community Services.
The split, first proposed by Gov. Mike Dunleavy in late 2020, is intended to improve services to Alaskans, according to Dunleavy’s administration.
While the state has done years of preparation with the public, stakeholders, and partner agencies, the restructure still presents some unknowns, and officials familiar with health care and public aid are watching with interest.
Adam Crum, commissioner of the former Department of Health and Social Services, is commissioner for the new Department of Health. He said the split doesn’t change how the public interacts with the services.
“None of the services they receive or the people they interact with change. There are no changes to the public-facing side,” Crum said.
All the divisions previously housed under Health and Social Services have been split between the two new departments. According to the state, this allows for the missions of the different parts of the department to be better aligned. And it allows for more time and space to work with providers, beneficiaries and federal partners to improve services.
Medicaid’s size encouraged a split
Before the split, DHSS was by far the state’s largest agency, with 3,259 employees and a budget of $3.5 billion. More than two-thirds of that consists of Medicaid, which provides health care to one in three lower-to-middle-income Alaskans.
The new Department of Health will take over responsibility for Medicaid. It includes the divisions of Public Health, Public Assistance, Behavioral Health, Health Care Services, and Senior and Disabilities Services.
Medicaid is a very big important item, and it's going to require a lot of time and attention in partnership to make sure that we're setting up the best system in Alaska. – Adam Crum, commissioner of the Alaska Department of Health
Medicaid is a very big important item, and it's going to require a lot of time and attention in partnership to make sure that we're setting up the best system in Alaska.
– Adam Crum, commissioner of the Alaska Department of Health
“How do we pay for prevention more? A lot of this work is on the waiver side, and other items like that. Medicaid is a very big important item, and it’s going to require a lot of time and attention in partnership to make sure that we’re setting up the best system in Alaska,” he said.
The Department of Family and Community Services will take over the state’s child welfare system and 24/7 facilities providing direct services to Alaskans. It houses the Division of Juvenile Justice, Alaska Psychiatric Institute, Alaska Pioneer Homes and the Office of Children’s Services.
Keeping them separate from Medicaid will allow the department’s commissioner to focus on their administration.
“When you take away the single biggest budget item as a form of responsibility, that then allows them to give specific cabinet-level focus on items of concern, like the Alaska Psychiatric Institute and Office of Children’s Services,” Crum said.
Crum said that despite the name changes, those who use state services will find most things the same – “same emails, same addresses, same physical locations.”
One of the people most closely watching the new Department of Health is Jared Kosin, president and CEO of the Alaska Hospital and Healthcare Association.
The association, formerly known as the Alaska State Hospital and Nursing Home Association, supported the split, saying in testimony that it hopes the reorganization “will support ease of access and continuity of care” across departments.
“Leading up to today, we haven’t had any concerns. I haven’t heard of any disruptions from the field,” Kosin said.
Gov. Mike Dunleavy first announced plans to split the department in December 2020. He proposed an executive order but withdrew it in 2021 after state legislators identified problems.
His administration redrafted the order, and it became final in March after the Alaska Legislature failed to object. Lawmakers set budgets for the new departments, and on Friday, the start of the state’s fiscal year, those budgets became active.
Improving child welfare is a focus
One of the focuses of the Department of Family and Community Services is to oversee and improve the state’s child welfare system. Shortly after Dunleavy first announced plans to split Health and Social Services in December 2020, Central Council of the Tlingit and Haida Indian Tribes of Alaska had some concerns about how it would affect the tribal organization’s working relationship with the Office of Children’s Services. It still does.
“We don’t know how it’s going to impact our work, so it’ll be interesting to see how it plays out,” said Mary Johnson, tribal family and youth services director at Tlingit and Haida.
Through a compact, tribal organizations and the state work together on child welfare issues. The state pays the tribes to do a lot of the work needed to meet federal requirements.
Johnson wants to see the work the tribes have been doing move forward and she hopes the new commissioner continues to keep the compact a priority. Dunleavy appointed Kim Kovol as acting commissioner for the Department of Family and Community Services on Wednesday. Prior to the appointment, Kovol was a special assistant to the governor focused on social services.
“Change is always scary because you don’t know what is going to happen exactly. And a lot of what we do is built so much on relationships, especially between the tribes and the state. Having to go back and establish new relationships with a new set of administration, that’ll be a difficult challenge. But, hopefully, things will remain the same, if not get better,” Johnson said.
Members of the Alaska Public Employees Association, the union representing supervisor-level employees, had concerns when the split idea was proposed in 2021.
Jeff Kasper, the association’s business manager, said some employees felt that the middle of the COVID-19 pandemic wasn’t the right time to shake up the state’s public health administration.
There also was general suspicion about Dunleavy.
“I think initially, we were kind of suspicious of things that Gov. Dunleavy does, because some of his actions seem to be directed toward unions, negatively,” Kasper said.
The administration withdrew the split in 2021 and reintroduced it again this year.
“We haven’t received a whole lot of complaints so far from our members,” Kasper said.
He said the union doesn’t yet have an opinion about the split. “We’re hanging back. And as they move forward with the reorganization, we’re going to be looking at it and seeing if there’s going to be any issues that arise, and we’ll deal with those as they come. I guess we’re not terribly concerned right now,” Kasper said.
Trevor Storrs of the Alaska Children’s Trust has been watching the split for its effect on the Office of Children’s Services, which handles child abuse complaints and monitors foster-care programs.
“All of us just want to see them be successful, because no matter how they are — whether they’re a single entity or split into two or three — we want to ensure that those who are accessing services, which is children and families, that the services are maintained — or more importantly — actually improve,” Storrs said.
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