History Repeats: DHHR Recommendations Similar to Previous Efforts | News, Sports, Jobs

picture by: Photo courtesy of WV Legislative Photography

Lawmakers are considering a McChrystal Group report recommending organizational changes to DHHR.

CHARLESTON — Gov. Jim Justice and West Virginia Department of Health and Human Resources Cabinet Secretary Bill Crouch said they will quickly implement recommended changes to the agency, but if we think you’ve heard that before, they’d be right.

Speaking earlier this week at a virtual press briefing from Capitol Hill, Justice and Crouch said they will implement recommendations from an organizational assessment and strategic plan for DHHR led by the group. Virginia-based McChrystal.

“Let’s go,” Justice said. “Some things are going to have to be approved by lawmakers, but some things we can do now. We have to move on this…we are moving forward.

“We’re moving very quickly,” Crouch said. “I understand the need to act quickly and I had planned to act quickly… most of these cases where we don’t need legislation. We think we will be operational here with new people and new positions. I’m glad to have help.

Among the McChrystal Group’s recommendations, the report’s authors recommend the addition of three new assistant secretary positions: an assistant secretary for child protection who will oversee the child support enforcement and social services offices , an Associate Secretary for Access and Eligibility who will oversee the Offices for Family Support and Medical Services and an Associate Secretary for Substance Use Disorders who will oversee the Office of Drug Control Policy and the Office of Behavioral Health.

The report recommends the creation of integration teams to help coordinate between new assistant secretaries and existing offices. The report recommends retaining the state health officer with the Office of Public Health who continues to report to the state health office. The director of the Threat Preparedness Center and chief operating officer roles would remain largely unchanged.

The McChrystal report, which took 17 weeks to complete and cost the state more than $1 million, did not satisfy lawmakers, many of whom spoke out last weekend at interim legislative meetings at the Cacapon Resort State Park in Berkeley Springs. The legislature passed a bill earlier this year that would have split the DHHR in two, but the judiciary vetoed that bill in favor of a top-down review of the DHHR.

“We’ve tried all of these things in the past,” House Majority Leader Amy Summers, R-Taylor, said after hearing a presentation of the report last Sunday by the McChrystal Group. “We had three assistant secretaries. We had integrated teams. This is where I worry about the bulk of the report…we are disappointed with the meat of the report.

It turns out that the McChrystal report’s recommendations for new DHHR deputy secretaries are similar to a proposal by a former DHHR cabinet secretary in response to a nearly decade-old study that also recommended splitting the DHHR into of them.


Former Governor Earl Ray Tomblin commissioned a study of DHHR in 2012, which was completed by Pennsylvania government strategy group Public Works in 2013. The report, which cost taxpayers more than $330,000, or a third of the cost of the McCrystal Group report, had two purposes: to make recommendations to reduce Medicaid costs and to examine the effectiveness and capacity of DHHR.

The Public Works report included 78 recommendations that would have resulted in $56.7 million in savings or new revenue in the first year and $283.8 million in savings or revenue after five years. One of the conclusions of the Public Works report was the need for a realignment of services within DHHR, such as the division of services between two assistant secretaries – one who focuses on health services and the other on social services.

“Our findings indicate that the West Virginia health system faces systemic challenges involving rising health care costs, poor health outcomes, and lack of access to appropriate care,” the authors wrote. authors of the report. “However, the West Virginia Department of Health and Human Resources and other health care agencies, rather than working together to alleviate these issues, are plagued by fragmentation, a workforce insufficient and the absence of an overall strategic vision and a sustainable accountability mechanism.

“Agency reorganizations alone do not necessarily save money,” the report continues. “However, over the long term, it is critical that West Virginia health care agencies be structured so that they can continuously focus on strategic opportunities to contain health care costs and improve quality.”

The DHHR under former Cabinet Secretary Karen Bowling implemented many of Public Works’ recommendations, but she disagreed with the splitting of the DHHR into separate divisions. Instead, Bowling created three new assistant secretary positions for health services, human services, public insurance and strategic planning. According to a 2014 article in the Charleston Gazette-Mail, Bowling said the positions would streamline decision-making.

“If you were to look at the previous organizational chart, you would see a very large organization, everyone reporting to the cabinet secretary,” Bowling said. “The idea behind the vision is to ensure that, from an accountability point of view, there is a good outcome for all of our offices. We really need to be able to make quick decisions and good decisions, and if the Cabinet Secretary is the only reporting entity, that can really delay those decisions.

It’s unclear when the new assistant secretary positions disappeared, but at the time of the McChrystal Group’s report, only two assistant secretary positions were on the organizational chart. According to the DHHR website, the agency has had only one deputy secretary since Saturday, Russell Crane.


Kelli Caseman, executive director and founder of Think Kids, has seen it all before. A child health advocate for over 18 years, Caseman founded Think Kids in 2020.

In an interview on the Mountain State Views podcast recorded Wednesday, Caseman wondered if the McChrystal report’s recommendations would make a dent in the state’s poor health care rankings.

“This is not our first report,” Caseman said. “I feel like we’ve been here before, so I don’t believe much in major implementation of what we got from this report.”

West Virginia’s health issues are having a major effect on the state’s children. According to West Virginia Kids Count, in a hypothetical classroom of 30 children, five are born exposed to drugs, seven live below the poverty line, and of the 18 covered by Medicaid, three would be in the foster care system.

DHHR’s budget for the current fiscal year includes $7.5 billion in federal and state funds. Federal funding, which makes up the majority of DHHR’s budget, comes with specific requirements depending on where the money comes from.

“If we’re still around 68% federal, that’s money that comes with very concrete goals and objectives of what you need to do. If you have a strategic plan with goals and objectives, and 68% of your money already has goals and objectives, are you creating more efficiency or creating more work on top of a system that, we know, has many vacancies and high turnover? »

The judge said Wednesday he trusted Crouch to implement the McChrystal panel’s recommendations. Justice compared the situation to what he inherited with the Department of Transportation. After the Roads to Prosperity highway bond program, additional funding for the maintenance of secondary roads, and the purchase of new highway repair vehicles, the DOT was able to advance maintenance and new construction projects.

“I expect a very good performance,” Justice said. “We’ve got a lot of problems, but DHHR has always had tons of problems… We’ve got a lot of holes in the levee that we absolutely need to plug, and we’re there… If we take the time to breathe just a little bit and let our people put your feet under them and be absolutely able to meet the recommendations of this report, you will see the exact same level of progress continue.

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