The Sunset Advisory Commission, charged with upholding accountability and efficiency at every Texas state agency, has found serious organizational and operational flaws at the Health and Human Services Commission.
The findings have significant implications for the legislative session that convenes in January. Health and Human Services Executive Commissioner Kyle Janek, a physician and former state senator appointed to his current job two years ago, has promised to fix the agency.
The sunset report, released last week, provides detailed recommendations for reform.
Health and Human Services, including Medicaid and various forms of public assistance, is the second-largest function in state government, behind education. The Health and Human Services Commission itself is allocated $48.5 billion in the two-year state budget, and it oversees agencies budgeted for another $25 billion.
The Sunset Advisory Commission’s task has been massive, nothing less than evaluating the effectiveness of landmark 2003 legislation that combined 12 state health agencies into five in the name of efficiency. The report calls the effort “far from complete.”
“The problem is not with the concept of consolidation” or the people who have worked on it, the report says. “The problem is with the nature of the system itself,” and “for whatever reason, the state did not finish the job.”
The problems include “blurred accountability, ongoing fragmentation of similar programs and services, and organizational misalignments.”
Parts of the report zero in on the Health and Human Services Commission’s Office of Inspector General, charged with rooting out fraud in Medicaid programs. Since 2011, the office has investigated a widespread scandal involving reports of fraud by dentists and orthodontists.
Of more than a half-billion dollars alleged to have been misspent, the office has recovered comparatively little. The sunset report says it has been poorly organized, which “fuels a perception that OIG makes up the rules as it goes.”
The legislative session is still three months away, and key posts are still to be decided in the Nov. 4 election. But Health and Human Services Commission changes will be a key part of the agenda.