Raleigh, N.C. — Department of Health and Human Services Secretary Aldona Wos and her top leaders endured a day-long grilling from lawmakers Tuesday, as members of the General Assembly probed everything from the state of two troubled computer systems to the higher-than-normal salaries given politically connected advisers.
On Monday, @NCCapitol asked five big questions that Tuesday's hearing could have answered. Here are the answers we heard:
1) What exactly is wrong with NCTracks and NC FAST, and when will they be fixed?
NCTracks is the system the state is using to pay doctors, hospitals and others who provide treatment to Medicaid patients. As we reported in an earlier post, lawmakers continue to have serious concerns.
NC FAST, which is the system responsible for getting food stamp recipients their benefits, got a better reception. While not problem-free, lawmakers told DHHS staff that it seemed many of the problems associated with it seemed to be getting resolved.
2) What exactly does the McCrory administration plan to propose with regards to Medicaid?
We still don't know, although lawmakers think they see some writing on the wall.
Earlier this year, McCrory and Wos rolled out a proposal that seemed to call for private companies to take over the state's Medicaid program. Such a "managed care" system would allow the companies to take the risk of caring for patients, giving private providers the incentive to find ways to save money on care.
Wos insisted Tuesday that no decisions had been made, although she acknowledged the path earlier efforts were walking down. Carol Steckel, who until Tuesday was the state's Medicaid director, had been part of those earlier efforts, Wos said.
"She had drafted a sketch of some kind of reform with the data we had," Wos said. But that sketch was incomplete, and the department plans to "go back on the road" to gather more input from providers in November.
"Dispel the rumor then," asked Sen. Tommy Tucker, R-Union. "Are we or are we not looking at privatizing Medicaid in the state?"
Wos didn't exactly knock down that rumor, saying only that it was too early to say what the state might do.
"You're asking me without having all the data available to answer a question," she said.
But Sen. Martin Nesbitt, D-Buncombe, pointed to a pattern. Steckel, he said, was leaving to work for a managed care company. Bob Atlas, the person Wos hired to be an outside consultant on Medicaid reform, is an expert in managed care. Early efforts pushed the idea of a managed care system.
"This duck's quacking," Nesbitt said, adding that something that walked and talked like a duck, or managed care, likely was.
3) Will the governor and his secretary openly defy the legislature on drug screening for benefits?
Not exactly. This was a bill that Gov. Pat McCrory said he would not put in place right away because he said it could lead to lawsuits and that the legislature did not provide enough funding.
Wayne Black, director of social services for the state, said that state law doesn't require drug testing to go into place until next year.
"We are currently researching drug testing policies, procedures (and) rules in other states. Particularly, we are looking at Arizona and Utah," Black said. The state is also meeting with county agencies to figure out what the impact of the law might be and how the state might best go about putting it in place.
Asked directly whether the McCrory administration was avoiding putting it in place, Black said no.
"In the law, it says it will be effective Aug. 1, 2014. We are in research mode at this time," he said, going on to talk about the problems of finding the right drug screening system.
4) What is the state of the Medicaid budget?
A presentation from the state Office of Budget and Management seemed to indicate that spending was ahead of where it should be for the first quarter, but because of problems with NCTracks, there wasn't good enough data to say for sure what the "run rate" at the agency is or will be.
5) How much longer will Aldona Wos keep her job?
Another way to ask this question might have been: How will Wos handle criticism over stories that politically connected individuals got high-paying jobs despite being very young or high-paying contracts that amount to salaries higher than the governor's?
This may have been the most brutal part of Wos' day, with lawmakers on the left and right taking pot-shots at the agency.
Regarding Les Merritt, a former state auditor who is serving as the chief financial officer of the Division of Mental Health on a $300,000-plus contract, Rep. Beverly Earle, D-Mecklenburg, was incredulous. Why was he a contractor rather than just an employee, she asked.
"He has chosen not to be here for the long-term," Wos said, adding that such contracts were typical for workers who didn't plan to work for more than a year or two.
"It's hard for me to believe he'd be that valuable," Earle replied.
Others focused on young staffers making more than $80,000 despite having no health policy experience.
"What am I to tell a teacher whose making $30,000 a year? If you were in my shoes, how the state can hire somebody for $85,000 or $65,000 or $314,000 or somebody who can work for one month and make more than a teacher does in a year? I need to know how to respond to that," Tucker said.
In general, Wos replied to criticism saying she needed good people to tackle tough problems.
"My obligation as secretary is to find the best possible team in order to get the job done," she said.
But lawmakers told the secretary that the hires were not received well by the general public.
"People forget all that," Tucker said. "All they know is what they see in the press, and they blame us."
McCrory has heaped praise on Wos and said he would not interfere with her decisions. But it was clear Wednesday that lawmakers were not happy with some of the feedback they were getting on her department.