Wos Resignation May Open Door for Medicaid Reform
RALEIGH — The resignation of state Health and Human Services Secretary Aldona Wos, announced Wednesday, could bring Medicaid reform, a goal of Senate legislative leaders, one step closer.
“We will do Medicaid reform in this session. That’s a commitment I can make. I’m not ready to go home until we’re done,” said Sen. Ralph Hise, R-Mitchell, co-chairman of the Health Care and Health and Human Services Appropriations committees.
Senate Republican leaders announced Wednesday afternoon that they would remove Medicaid reform provisions from their budget proposal “in the coming days” to speed an agreement on the slow-moving spending plan.
Gov. Pat McCrory, who appointed Wos when he took office in January 2013, presented her with the Order of the Long Leaf Pine at the Executive Mansion on Wednesday with a teary embrace. Her last day will be Aug. 14.
“I have already stayed longer than I intended,” mostly due to “the importance of ensuring that the department itself is strong and sustainable,” Wos said as she addressed senior members of her staff, House and Senate members, and Cabinet officials.
“My work at the department has required me to stay two years and eight months away from my family, and it is simply time for home,” said Wos.
Her resignation was announced a day after the Department of Health and Human Services said it finished the fiscal year with $130.7 million cash on hand. That marks the second consecutive Medicaid surplus after a nearly $2 billion shortfall over the previous four years.
McCrory said he found “an incredible new leader to take this department to another level,” and in 54-year-old Rick Brajer of Raleigh, the state “got the talent it deserves.” Brajer will receive $140,000 as Wos’s successor. Wos served for $1 per year.
Brajer has no prior government service. He is a medical and health care industry executive, most recently as CEO with ProNerve of Denver.
Brajer, who said his Yugoslavian parents took “incredible pride” in becoming naturalized citizens after emigrating here in 1949 with the aid of the Lutheran Church, spoke of his faith and the blessings this country offered to his parents in building a middle-class family while working at a machine manufacturing company.
In accepting the position, Brajer said: “I’m motivated by a sense of duty. I’m motivated by the change of leadership challenge. I’m motivated to become part of your cabinet. … By faith I believe it will be demonstrating God’s love in action.”
He said he would tackle the job “with the same energy, and the same dedication as the generations of North Carolinians that came before me.”
Asked about the prospect of expanding Medicaid under the federal Affordable Care Act, Brajer said, “Our administration’s [first] priority is Medicaid reform.”
Sen. Louis Pate, R-Wayne, co-chairman of the Senate Appropriations Committee on Health and Human Services, said he doesn’t know Brajer, but “I do like what I heard.”
Asked if a new DHHS secretary would change the calculus in negotiating Medicaid reform, Pate responded, “No. I think we’re going to do what’s best for Medicaid in our state.”
Rep. Marilyn Avila, R-Wake, chairman of the House Health and Human Services Appropriations Committee, said “there will be adjustments,” with a new secretary, “and you always hope that as good as the past was, the future’s going to be better.”
Avila added that a new head of DHHS “may introduce a new perspective [to the Medicaid reform debate], and people are always, I hope, open to new perspectives, and can make a difference.”
Hise said problems remain with Medicaid spending forecasts, and, “we’ve still got a growth in spending that is absolutely unacceptable.”
On Tuesday, Sen. Tom Apodaca, R-Henderson, chairman of the Senate Rules Committee, moved House Bill 372, the 2015 Medicaid Modernization Act, to Hise’s Health Care Committee. It had been in the Ways and Means Committee, where Senate leaders typically bury legislation.
“I would most likely view [H.B. 372] as the vehicle for Medicaid reform if the vehicle is not the budget,” Hise said. He said he feels “very good” about the direction of conversations he has had with House leaders on Medicaid reform.
While not revealing which chamber is moving in what direction, Hise said, “I am committed on seeing that we have a mixed model in this state” in which both managed care organizations and provider-led entities administer Medicaid networks. McCrory and the House favor only doctors and hospitals administering the networks.
Hise also said any reform must involve conversion from a fee-for-service to a per-member, per-month payment system, and he still favors a Medicaid agency separate from DHHS, which the House opposes.
McCrory said Wos “made a tremendous impact on the state of North Carolina in the efficiency of government and the quality of health service.” He said she “did everything that we asked for, and exceeded my expectations” with her passion, energy, and enthusiasm.
He said Wos reversed the Medicaid spending overruns, tackled Medicaid reform for the first time in 40 years, and reorganized the bureaucracy using private sector principles that led to huge improvements in DHHS performance.
Wos launched the NCTracks computer billing system that “was hundreds of millions of dollars over budget, and years behind schedule” when his administration inherited the program, McCrory said. Acknowledging it had a rough start, he said Wos “took all the hits,” and now nearly 100 percent of transactions with NCTracks are successful.
McCrory credited Wos for developing a comprehensive mental health plan and reforming the Office of Chief Medical Examiner, which was “significantly understaffed and underperforming.”
Dan E. Way (@danway_carolina) is an associate editor of Carolina Journal.