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SALT LAKE CITY — Utah lawmakers are considering a merger between the Department of Health and the Department of Human Services, drawing concern from some groups that say a pandemic isn't the time to make a major change.
But supporters say it will streamline services for those most in need.
HB365 would start the process to join the two agencies into a Department of Health and Human Services in July 2022. The agencies would form a merger plan to present to the Legislature by December.
Bill sponsor Rep. Paul Ray, R-Clearfield, said the move is needed because "there's a lot of redundancy in the way we do things here."
"We feel that the best way to be more efficient and effective as we deliver services to the public is to combine these two agencies together and try to break down the silos and get the communication going so people aren't going to two, three, four different places to get services," Ray told members of the House Health and Human Services Committee on Thursday.
Rich Saunders, Utah Department of Health executive director, said he spent the past several years working with programs in the state health department, where he got to know the people and services offered as well as the "deficits and deficiencies in the services."
"I think with this HB365, bringing some of those experiences will be pretty valuable as we evaluate this and begin to move forward with it," Saunders said.
The bill passed the House 64-5 on Friday. It will move to the Senate for consideration.
Changing 'in the midst of a pandemic'?
The Utah Department of Health has been on the front lines of the state's pandemic response, which has elevated officials like state epidemiologist Dr. Angela Dunn to celebrity status in the state.
Carrie Butler, with the Utah Public Health Association, said the group is excited to examine "efficiencies between the two departments."
The best way to be more efficient and effective as we deliver services to the public is to combine these two agencies together and try to break down the silos and get the communication going so people aren't going to two, three, four different places to get services..
–Rep. Paul Ray, R-Clearfield
But she said the group has "a little bit of concern about moving public health out of the spotlight."
Courtney Bullard, education and collaborations director at Utah Health Policy Project, expressed concern about how the merger could impact patients.
"Because of the direct service work we do in communities throughout Utah, we also do agree there are silos and communication barriers that could and should be mitigated, and we appreciate the conversation about fixing this from the Legislature and the governor," Bullard said during the Thursday meeting.
But the group worries "about how this merger will actually improve efficiency, and the potential for unintended consequences," she said.
"First is the timing. While in the midst of a pandemic still, we just do not think that now is the time to implement a big change that this bill will make," Bullard said.
While in the midst of a pandemic still, we just do not think that now is the time to implement a big change that this bill will make.
–Courtney Bullard, education and collaborations director, Utah Health Policy Project
The group also has concerns about whether moving eligibility to the Department of Workforce Services will actually increase efficiency.
"We really want to make sure that this is a transparent process that includes broad, stakeholder input. And to this point, we don't feel like that has happened," Bullard said, adding that the group wants to work with the Legislature on the goals of the bill in interim study.
Todd Losser, executive director of Utah Public Employees Association, said the organization doesn't believe the merger will lead to a reduction in jobs. The association plans to work with Cox's office and state agencies on the issue moving forward, Losser said.
Audrey Wood, representing the Home Health and Hospice Association of Utah, said the group appreciates the 2022 implementation date for the merger.
"Our major concerns are the stability and continuation of programs and services provided by the agencies during the transition, and we believe with the delayed implementation date that accomplishes that," Wood said.
The Utah Medical Medical Care Advisory Committee, which is a coalition of advocate groups, in a statement in January contended the change needs "greater stakeholder input and evaluation" before it becomes law, among other issues.
"Otherwise, it could have unintended consequences on the health and security of Utah Medicaid beneficiaries. We instead support recommendations in the governor's agency transition reports to 'address Medicaid structural issues by convening a Public Health and Health System Task Force,'" the group said.
'This is not an intent to cut jobs'
The merger seeks to "improve delivery of these critical services mostly to our underserved and marginalized communities," according to Saunders.
In the current system, the Department of Workforce Services handles most Medicaid eligibility work. The bill would move all Medicaid eligibility oversight to that department so it's "all under one roof," Saunders said, with the new Utah Department of Health and Human Services handling service delivery and interactions between providers and members for Medicaid.
The departments have already started holding town hall meetings with public health workers to discuss the changes and "reassure our employees that they're needed. This is not an intent to cut jobs," Saunders said.
"We're very key on not letting services be lapsed or gaps be created in the services," Saunders said.
We're very key on not letting services be lapsed or gaps be created in the services.
–Rich Saunders, executive director, Utah Department of Health
He promised that public health won't "lose its voice" in the process. The merger will promote an integration between physical and behavioral health resources, according to Saunders, as well as more accountability in the public departments.
Tracy Gruber, executive director of the Department of Human Services, said that due to the departments being separate, clients need to work with different caseworkers and have their data in separate systems.
"We've been meeting with our staff, and at least from the Department of Human Services staff side, they understand the complexities of the individuals they're serving and the challenges it takes for coordination," Gruber said.
Rep. Marsha Judkins, R-Provo, questioned whether the process might need the help of those with expertise in mergers, as unexpected issues can arise when two parties join together.
"Sometimes we don't see things as clearly in our own house as someone coming from the outside," she said.
Ray said that if such expertise becomes necessary, "those safety nets are there" with funding requested in the bill. But the state already has a "good template" for merging the departments, he said.
The bill carries a fiscal note of $1.63 million in one-time funds and $135,000 in ongoing funds.
He said he started looking at the issue a few years ago, but the pandemic put it on the "backburner" last year. Gov. Spencer Cox's administration asked Ray if he's still interested in working on the merger "and if it still makes sense."
"I've never had a better partner on something like this because his biggest concern is end user, delivery of services and efficiency, which is where I am, too, so it worked out really well," Ray said.