By Victoria Wallack

Statehouse News Service

While the recent focus in Augusta has been on the resignation of the Health and Human Services commissioner, the real problem in the beleaguered department, observers say, is the state has been without a full-time Medicaid director since the King administration.

The job is advertised at an annual salary of $89,000, but that’s low by national standards, officials say. Making matters worse, the state’s Medicaid office has been in chaos for a year after a new computer system was installed last January that literally couldn’t pay bills from healthcare providers.

That meltdown led to a restructuring of the Medicaid office, which is just now being implemented, and will include a reshuffling of upper-management; higher quality standards inside the department; and, a focus on staff training and “customer” service.

“They didn’t want to bring somebody into a complete disaster area,” said Rep. Hannah Pingree, D-North Haven, the co-chairman of the Health and Human Services Committee.

“It’s a hard job to recruit for. It’s OK pay for Maine, but it’s not like it’s a really high-paying job. There’s a lot of pressure, a lot of responsibility,” Pingree said, adding, “it’s up there,” with the commissioner’s job at the Department of Health and Human Services.

Maine’s Medicaid department spends more than $2 billion a year in state and federal funds taking care of 260,000 Medicaid recipients in the state. It handles bills from close to 7,000 Medicaid healthcare providers.

Nobody in charge

Rep. Darlene Curley, R-Scarborough, a member of the Appropriations Committee, was author of legislation that set up a blue ribbon commission to look at the issues facing Medicaid. She thinks the governor’s office has spent too much time promoting the Dirigo Health subsidized insurance program and state health plan and not enough on the problems at DHHS.

“Time and talent has been spent on Dirigo, which is important, but there’s been no time left and no priority given to make sure the Medicaid program is being run adequately,” Curley said.

“It’s important this program has leadership. It just can’t go leaderless for three years,” said Nancy Kelleher of AARP, who worked for several Democratic House speakers and now is a lobbyist.

At Kelleher’s urging the bipartisan commission, of which she was a member, last week called for “immediate professional leadership with vision, skills and experience to provide stability, long-term planning and evaluation and adequate staffing of the Medicaid program.”

The last official head of the state’s Medicaid program, now known as MaineCare, was Eugene Gessow, who worked for former DHHS Director Kevin Concannon under Gov. Angus King. Concannon is now the director of human services in Iowa and Gessow works for him there.

There have been several acting directors and currently DHHS Deputy Commissioner Mike Hall is in charge. He has restructured the department in hopes of making it more responsive to healthcare providers and Medicaid clients and to avoid the kind of management snafus that led to the computer meltdown.

The most recent acting director, Christine Gianopoulos, quit and went to work at the Maine State Retirement System in June. Christine Zukas-Lessard, who was acting director before Gianopoulos and most recently deputy director, has moved into another part of the department since her deputy job was eliminated under Hall’s restructuring plan.

What’s ahead

That plan includes eliminating six upper-management jobs in the Medicaid department and replacing them with positions deemed more relevant to the tasks at hand.

The existing managers have been invited to apply for the new jobs, said outgoing DHHS Commissioner Jack Nicholas. “We’re removing layers of management,” he said, and making the Medicaid office more responsive to healthcare providers and Medicaid recipients. There also will be a focus on staff training.

Pingree, whose committee’s briefing on the plan was postponed because of last Friday’s snowstorm, said she didn’t know all the details of the restructuring, but had a sense of its direction.

“My general understanding is that it’s been a fairly dysfunctional office. Staff have not enjoyed working there; they felt they haven’t had the right training. Supervision hasn’t always been great,” she said.

Sen. Richard Rosen, R-Penobscot and Hancock, who sits on the Health and Human Services Committee, said someone with an intimate knowledge of federal Medicaid law is needed to run the department because the state “really pushes the envelope to the absolute limit” in terms of drawing down matching federal funds. The federal government, on average, gives the state $2 for every $1 it spends on Medicaid programs.

“The Legislature and the governor’s office together have laid on the department requirements to implement policies that are really demanding,” Rosen said. “Policy makers are directing the department to expand (Medicaid) eligibility and to implement all kinds of new funding schemes.”

“If you’re going to run your program in that matter and you’re going to push the limit on funds…it’s critical you have someone in that office that is top notch,” Rosen said.

“There’s just not that many people that fit these requirements,” said Nicholas, who earlier this month announced he was leaving the department in mid-January because his “all-consuming job” was taking too much time away from his family. “You just don’t find one walking on the streets.”

A national search is underway with the help of a recruiter, and Nicholas said interviews should start in late January or early February.

Nicholas said his own resignation should not affect the recruitment effort, but others aren’t so sure.

“Turnover sets you back,” said Kelleher.