DPHHS director spells out sweeping reorganization for lawmakers

HELENA — Department of Public Health and Human Services Director Adam Meier on Wednesday sought to explain his plan for overhauling the state’s largest agency and filling several prominent positions that are currently vacant, including the state’s next Medicaid director.

Montana Free Press reported in August that Meier notified staff of agency-wide changes that would soon go into effect, including an expanded pool of high-ranking employees who report directly to him. Meier’s proposed organizational chart was updated again at the end of that month, indicating that nearly all divisions within the department will be impacted by leadership shuffling.

In testimony before lawmakers on the bicameral interim budget committee that oversees DPHHS, Meier said the changes are meant to increase efficiency and improve communications with external stakeholders.

Since his appointment in January, Meier said, he has solicited input from staff members to understand “where they saw efficiencies, where they saw weaknesses, where they saw points where there [were] workflows kind of getting log-jammed,” he said. “What I wanted to do was really try to address some of those issues.”

Lawmakers on the budget committee asked Meier to explain his timeline for filling the roughly 15 positions listed as “vacant” or “TBD” on the staffing chart and replacing employees who have announced future departures, as well as how much the new positions would cost taxpayers. Citing estimates made in early August, Meier said the reorganization would mostly be covered by repurposing existing funds, but could boost the agency’s total costs by about $130,000, with $52,000 of that coming from the state’s General Fund. 

“I’m going to hold you to that number,” said Rep. Mary Caferro, D-Helena, admonishing Meier for not forecasting the expense during budget negotiations in the legislative session. Another Democrat on the committee, Rep. Mary McNally of Billings, also voiced concern that the reorganization would funnel state dollars toward larger executive salaries rather than direct services to Montanans.

Meier responded by suggesting that better management and team structures at the top of the organization might save the state money in the long run by minimizing turnover and improving workflow. 

“Honestly, when you look at the $3 billion that we’re spending a year in DPHHS, I don’t want to be a penny wise and a pound foolish,” Meier said. “I want to make sure that we’re addressing the gaps, that we’re not just in triage, but we’re able to really drive efficiencies in our operations, improve outcomes. And those things will then have, I think, savings for the state.”

Among the new staffing changes, Meier will be combining the Addictive and Mental Disorders Division with the Developmental Services Division, creating a new unit responsible for behavioral health and developmental disabilities. 

He will also be hiring a new employee to oversee state-run health facilities including the Montana State Hospital in Warm Springs and the Montana Chemical Dependency Center in Butte. Stabilizing and supporting workers in those locations, he said, is a pressing concern shared by many private behavioral health providers in the state. 

“We’re dealing with COVID. We have unprecedented workforce shortages and we can’t compete,” Meier said. “We’re just like a lot of the providers out there, with maybe the only difference [being that] we’re sometimes getting the most challenging of challenging, where there isn’t provider capacity to take some of these individuals on. And so we are struggling with workforce, with recruitment, with retention, with morale.”

Another hurdle Meier identified is hiring a new director of Medicaid and Health Services, a role that oversees a range of programs and direct services. Meier said he is conducting a nationwide search to fill that position, and noted that national Medicaid officials have informed him that several other states are looking to fill similar jobs.

“It’s a very specific skill set that, you know, isn’t readily available all the time within a state,” Meier said. “And so that one, I felt like it was important to cast a wide net just to see who the most-qualified person out there is.”

Other upper-level positions Meier said are close to being filled include a chief financial officer and a chief information officer, both of whom will report to him. Other new direct reports include a new state medical officer, a director of external relations and the existing Office of Inspector General headed by Carter Anderson. 

While layoffs don’t account for any portion of the reorganization, Meier acknowledged a problem of turnover throughout the department, including among employees at the state-run facilities. Rep. Terry Moore, R-Billings, pressed the director to deliver more specific data on vacancy trends within the department, a request Meier said he would fulfill.

“You always have some vacancy and obviously you would expect turnover,” Moore said. “But to what extent has that accelerated?”

Moore later asked Meier if he is optimistic about filling major leadership positions soon, acknowledging the importance of the roles that are currently vacant. Meier said he expects to find candidates for some of the roles in the coming weeks, while other jobs may take longer to fill.

The possibility of clunky transitions is part of what worries Caferro about the reorganization, she said in a Wednesday phone interview. Her fear is that upheaval at the top of the agency could contribute to interruptions of service for people who depend on the department to function well. 

“This is my third administration,” Caferro said, referencing her nine terms of legislative service. While there were smaller DPHHS reorganizations under former Govs. Schweitzer and Bullock, she said, “this is gigantic.”

Caferro also said she was put off by the decision to spend money on leadership changes and additions rather than increasing pay for direct service providers, referencing a hot-button issue that health service providers have been championing for years, which she said has “absolutely not” been prioritized by the Gianforte administration. 

“When you think about a person who cares for a senior citizen, an 80-year-old woman with Alzheimer’s,” Caferro said, “that worker does not make enough money to pay their bills. And that woman needs that worker.”

“What does this re-org mean for the people who need the services?” she continued. “How will this re-org improve the lives of Montanans? And I just don’t see it.”

Caferro said she does not expect to see the full effects of the reshuffling until lawmakers are back in session to evaluate the budget in 2023. The interim budget committee is expected to meet quarterly until then and can continuously solicit information from the department. The committee’s next meeting is scheduled for Dec. 15.