Alaska Department of Health and Social Services

OVERVIEW Governor Dunleavy’s Executive Order 121 (EO 121) to restructure the Department of Health and Social Services (DHSS) into two departments became law March 19, 2022. The two departments are legally operating entities as of July 1, 2022. Restructuring DHSS into two departments allows for better alignment of mission sets and the time and space to work with providers, beneficiaries and federal partners to improve the system of care. The state is committed to ensuring continuity of services to beneficiaries and timely payments to providers. Avoiding such disruptions will be each department’s highest priority. No other department in the state comes close to the number of personnel, budget, or services that DHSS is responsible for. For example, the DHSS budget is equivalent to that of 12 other state departments, the court system, the legislature, and the Governor’s office. The number of personnel in DHSS equals that of 7 other state departments combined. In our research, it became clear that it is not standard practice to have this type of “mega-agency” providing health and community services. Wyoming, for example, breaks these services into two departments. South Dakota spreads them across four departments. The work that is done at DHSS touches nearly all Alaskans. The breadth and span of this work is tremendous. And all agree that there is an undeniable need in this state to improve outcomes. With OCS, there is a 52% turnover rate for case carrying workers. Conservative estimates show that this costs $13 million a year to the state and the high turnover results in children staying in foster care too long while families are delayed in working plans, decreasing family resiliency. In Medicaid, we have 4-5% annual growth for the most expensive budget item in the state. Alaska is one of last remaining fee for service states, and we must collaborate on solutions for value-based care. SB 74 (2016 law) provided authorities to implement many innovations – but these goals have not been achieved because of the lack of bandwidth to work effectively with stakeholders and federal partners. By restructuring DHSS into two departments you allow for alignment, and the time and space to work with providers, beneficiaries and federal partners to design a better system of care. The two departments will have different missions and tasks. The Department of Health (DOH) will have focus and oversight on health care services, payment, and public health, as well as more time to work with all stakeholders to improve and implement innovation for the single largest budget item in the state, Medicaid. The Divisions of Behavioral Health, Health Care Services, and Senior and Disability Services, provide regulatory oversight, claims processing, facility licensing and the enforcing of Medicaid and state regulations. The Department of Family and Community Services (DFCS) will have an aligned focus of supporting and improving our child welfare system and our facilities that serve Alaskans around the clock. DFCS divisions provide 24/7 care for specific populations and are in the role of a direct care provider. For example, Alaska Psychiatric Institute (API) and the Alaska Pioneer Homes (AKPH) provide care for patients and elders, and when eligible can bill Medicaid for the services provided – in much the same way that hospitals and clinics work. The involvement of Health Care Services (HCS) is to process those claims to Medicaid, the same as they would for any other provider in the state. The Alaskans that we serve deserve this attention. By narrowing the span of control, by aligning the divisions and focusing on long term system improvements and stakeholder engagement, this will allow us the opportunity to work better for Alaskans. The leadership of each department will be able to focus on work processes, maximizing efficiencies, incorporating innovative ideas, with the mission of improving outcomes for the Alaskans that we serve.