Texas Health and Human Services Executive Commissioner Kyle Janek (2008 photo by AP's Harry Cabluck)
The agency that periodically looks at whether state agencies are efficient has urged that five existing social services agencies be merged into one.
The consolidation would reduce fragmentation in programs such as Medicaid and women’s health, help the five departments better manage their $24 billion of contracts and finish a streamlining effort the Legislature began in 2003, said a report released Friday by the Sunset Advisory Commission.
A 15-year-old pilot program for mental health services delivery in the Dallas area, NorthSTAR, is “outdated” and should be blended into a statewide model, the commission’s staff report also recommended.
“The state did not finish the job,” the report said of a 2003 law that reduced Texas’ health and human services system from 12 agencies to five.
One of them, the Health and Human Services Commission, oversees the rest and administers most of the state-federal Medicaid program for the poor.
Its leader, former state Sen. Kyle Janek, did not specifically comment on the sunset group’s recommendations.
In a written statement, Janek said he’s pushing the four department chiefs under him “to look for ways we can simplify things behind the scenes so it’s easier for people to get the help they need, no matter which of our agencies they turn to first.”
Rep. Garnet Coleman, center, at a 2013 mental health forum in Dallas (Brad Loper/Staff photographer)
Janek said the state’s sprawling health and welfare bureaucracy will “be ready to quickly put in place” whatever changes lawmakers approve next year “to improve our programs and ensure we operate as efficiently as possible.”
A veteran House social services policy writer, though, disputed the report’s recommendation of further consolidation.
Rep. Garnet Coleman, D-Houston, noted that smaller agencies, overseen by independent boards appointed by the governor, were used until the early 2000s.
The arrangement worked better than the current system, under which Janek and the four other department heads are named by and answer directly to Gov. Rick Perry, Coleman said.
“Moving the deck chairs around doesn’t solve the customer service problem and it also consolidates more power under one person, the governor,” he said. “So it lends itself to more political decisions.”
The report said the existing set up suffers from problems such as “blurred accountability,” duplicated administrative support staffs and unnecessary expenses.
“Fragmented programs result in divided policy direction and weakened administrative oversight,” it said.
Instead of unwinding the 2003 consolidation, though, the report urged lawmakers to create one big commission “with divisions established along functional lines.” Such a merger “clarifies lines of authority [and] helps to reduce the silo mentality that the five-agency system reinforces,” it said.
In mental health, the report recommended discontinuing NorthSTAR. Since 1999, the program has provided talk therapy, psychotropic drugs, psychiatric hospitalization and substance abuse treatment for Medicaid recipients and uninsured poor people in Dallas, Collin, Ellis, Hunt, Kaufman, Navarro and Rockwall counties.
The report criticized NorthSTAR as standing apart from society’s ongoing push to integrate mental and physical health services. It said the pilot “continues to exist as an island with the state,” and is unable to tap into federal funds provided under Texas’ Medicaid “transformation waiver.”
Coleman, though, said NorthSTAR has avoided mistakes state officials imposed on the rest of the state in the past decade, such as trying to limit state help to people diagnosed with schizophrenia, bipolar disease and major, treatment-resistant depression. NorthSTAR used a managed care model and helped all comers, he said.
“They’ve been able to serve more people and it works,” he said. “Consumers, mental health advocates, everybody I’ve talked to loves NorthSTAR.”
The sunset commission, a 12-member group comprised of five senators, five state representatives and two public members, will meet next month to take up the staff’s recommendations.