Health Commissioner Endorses "Mega-Agency"

Texas’ top health official told lawmakers Wednesday that they should combine the state's five health departments into one “mega-agency.”

A single, consolidated health commission would better serve the state’s most vulnerable populations, Health and Human Services Executive Commissioner Kyle Janek told the Sunset Advisory Commission, which evaluates the efficiency of state agencies.

The state’s fragmented health system has “gotten sloppy,” forcing the agencies “to do some things that to the public look rather strange,” Janek said.

The massive Health and Human Services Commission administers Medicaid, a joint state-federal health care program for the poor. It also oversees four smaller agencies that assist groups like foster children and the elderly. Sometimes, Janek said, the various agencies have had to draw up special contracts just to work with one another on issues related to Medicaid. 

Consolidation, proposed by Sunset Commission staff, would be a huge undertaking. The five agencies employ more than 54,000 staff, and in 2013 spent a combined $34.5 billion, 89 percent on Medicaid.

Advocacy groups for children and people with disabilities have pushed back against consolidation, saying the state’s neediest populations would be neglected under the new structure.

“We all agree on the importance of efficiency in our programs,” said Eileen Garcia, chief executive of the advocacy group Texans Care for Children, in a statement. “However, burying existing agencies within another layer of bureaucracy at this point would divert attention away from fixing the real problems identified by Sunset, disrupt services for children and families, and create new inefficiencies.”

The Sunset Commission will hear public comments about the recommendations on Thursday.

At Wednesday's hearing, lawmakers asked Sunset staff whether the consolidation was necessary, because they predicted only modest savings as a result.

“I’m still not sure exactly what we’re trying to fix here,” said state Sen. Brian Birdwell, R-Granbury.

A large-scale consolidation would not be unprecedented. In 2003, lawmakers combined 12 health and human service agencies into five.

Janek said one drawback of consolidation would be its effect on recruitment. It is more attractive to potential hires if they can have the title of agency head, he said.

State Sen. Jane Nelson, R-Flower Mound, who chairs the commission, said the recommendations were intended to improve continuity within the state health system. “Overall, I think Sunset has made a very good case for consolidation,” she said.

Janek said he would like to keep his job as the state's top health official, if Gov.-elect Greg Abbott reappoints him in February. As for how the consolidation would take place, he said, “We’ll work with you however y’all want to do it.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.