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Under Charles Smith, the longtime ally of Gov. Greg Abbott picked to lead the state’s Health and Human Services Commission, Texas’ government health care infrastructure is hemorrhaging veteran employees and facing criticism for its response to the humanitarian crisis caused by Hurricane Harvey.
Dozens of experienced senior staff members have left the agency since Smith took over last year. Current and former employees attribute the exodus to widespread dissatisfaction with the executive commissioner, whom they say lacks technical knowledge of the agency and pushes a political agenda backed by the governor.
Interviews with 11 current and former long-serving health commission staff, ranging from senior executives to mid-level managers, paint a picture of a state agency in disarray, with veteran staff clashing regularly with Smith and his supporters in the governor’s office. The internal conflict has spurred a wave of resignations, leaving the agency with a void of talent that critics say is hampering the state’s ability to aid victims of Hurricane Harvey.
“It’s hard to watch,” said one former high-ranking health commission official, who spoke on the condition of anonymity because of an ongoing professional relationship with the health commission. “Anybody with any knowledge or experience is not going to stay.”
When Jami Snyder, chief deputy director of the state’s Medicaid program, announced her resignation late last month, she joined a long list of senior employees who have left under Smith, including Gary Jessee, the former medical and social services czar; Lisa Carruth, the former chief financial officer; Lisa Kirsch, who helped oversee Medicaid and the Children’s Health Insurance Program; and Pam McDonald, the former director of rate analysis.
Health commission insiders told The Texas Tribune that this “brain drain” is the result of low morale at the sprawling agency, whose primary responsibility is providing public benefits to millions of low-income and disabled Texans. Disability advocates, state lawmakers, doctors and health insurers have all echoed disgruntled staff members’ concerns, saying the ongoing employee exodus has noticeably detracted from the agency’s work.
“It is so scary to me,” said one recently departed senior employee, who also requested anonymity because of an ongoing relationship with the agency. “I’ve never seen anything like this. Who’s going to look after the people who need help, the poor people and the elderly in this state, the disabled?”
Virtually no current or former employees interviewed by the Tribune agreed to be identified by name. State employees are typically barred from speaking with reporters, especially when they have critical things to say about their workplace or bosses. Many former senior staffers who now work in private-sector jobs — as lobbyists, consultants or advocates for disadvantaged Texans — requested anonymity because they still have professional contact with the agency.
Among his supporters, including Abbott, Smith is seen as a strong leader who has overseen numerous reforms and brought fresh blood to an agency in need of new direction. The commission is currently undergoing a massive restructuring, merging with two other state agencies and reorganizing its leadership structure, after state lawmakers ordered the consolidation in 2015.
“Have there been some retirements there? Absolutely,” said John Scott, who spent nine months in 2015 as the agency’s chief operating officer after being brought on by the governor. “I think there’s always a nervousness about that, but I think that at the end of the day, it has the chance to be great.”
A spokesman for Abbott agreed.
“Whenever there is a change in the status quo, there are bound to be individuals that are displeased,” John Wittman, the spokesman, said in an email. “When the Governor came into office, the Health and Human Services agency was riddled with scandals and he charged the Executive Commissioners – now Charles Smith – to take action to restore accountability and trust.”
A rocky start
Smith, who declined to be interviewed for this story, took the helm of Texas’ health commission after a long career at the attorney general’s office. As Abbott’s deputy for the child support division, he developed a close bond with the man who would later be elected governor.
When Abbott appointed Smith as executive commissioner of the sprawling Texas Health and Human Services Commission in June 2016, it came at a tumultuous time for the agency. Smith was considered a more permanent replacement for the previous commissioner, Chris Traylor, a longtime public servant who had briefly reversed his retirement plans to lead the agency through a crisis period.
Traylor, and later Smith, was charged with cleaning up a mess after the previous commissioner — Kyle Janek, a former state lawmaker — resigned amid a scandal over how the agency awarded a large government contract.
Smith, who had spent less than a year as a deputy to Traylor, was suddenly tapped by Abbott to take charge of administering massive government assistance programs that the governor had spent years criticizing. Under Abbott, the state’s official policy was that former President Barack Obama’s signature health care law should be dismantled and that states should have more power to cut costs and restrict eligibility for Medicaid, the public health insurance program that serves roughly 4 million Texans at any given time.
At the attorney general’s office, Smith had overseen a division with 2,700 employees. His new role placed him over a network of government agencies with roughly 60,000 employees and an $80 billion two-year budget. It is a huge operation, one that has amassed more than 200 terabytes of information about its clients and public health trends — double the amount of information the Hubble Telescope has sent to Earth, one government report found.
Before the Texas Senate confirmed Smith’s re-appointment to the head of the commission this year — they had previously confirmed him just to finish out Traylor's term — he told lawmakers that his job held personal significance. One of eight children raised by a disabled veteran in the Texas Panhandle, Smith said he grew up in public housing — “the projects” — eating “government cheese.”
“I really feel a strong calling to this work, because it’s an opportunity to make a difference for people who can’t help themselves, and it’s an opportunity to provide temporary assistance to those who might need short-term aid,” he said.
But health commission employees said Smith’s lack of experience in health care policy, in addition to his closeness with Abbott’s office, has impeded the agency’s work.
“He doesn’t actually understand health and human services, and it’s making people’s lives miserable,” said one program administrator at the agency, who spoke on the condition of anonymity out of fear of retaliation.
Among the recurring complaints from agency insiders about Smith’s leadership is that he has allowed Abbott’s office to pressure the agency into many high-profile, controversial policy decisions that they said would have been rejected by previous commissioners.
One veteran former employee said the political pressure on state workers had noticeably intensified under Abbott, the result of “a closer link between the governor’s office and the agency.”
The agency recently encouraged employees to get clearance from higher-ups before doing any outside volunteer work, in case it posed a “conflict of interest” — which has drawn the ire of staff. And current health commission employees interviewed by the Tribune described new rules at work requiring them to get clearance for even minor policy decisions from the governor’s office. The effect on their work, they said, has been chilling.
“The micromanagement is insane,” said one recently departed staff member, who requested anonymity because of continued ties to the agency.
Other recent policies that have rankled longtime staffers include:
- A rule that would require medical providers to cremate or bury fetal remains from abortions and miscarriages that occur at a health care facility.
- The elimination of the agency’s refugee assistance program.
- An effort, now paused, to remove Planned Parenthood from the state’s Medicaid program.
- The awarding of a women’s health contract to the Heidi Group, an anti-abortion organization whose funding was recently scaled back after it failed to serve the high volume of patients it claimed it could.
Also ruffling the feathers of health commission employees is a hiring freeze ordered by Abbott earlier this year. Though the freeze was lifted Sept. 1, the agency still faces a shortage of employees across nearly all departments.
In addition, a new policy means many state workers no longer qualify for compensatory time off when they work more than 40 hours per week. Employees at all levels interviewed by the Tribune complained of feeling overworked and undervalued.
Other employees highlighted the recent departure of Rick Allgeyer, the agency’s former director of research who was forced to resign after helping academic researchers with a study that found fewer women accessed a Texas family planning program after Planned Parenthood was kicked out.
Carrie Williams, a spokeswoman for the agency, said that because the Health and Human Services Commission is part of the executive branch, it is proper to “keep the governor’s office in the loop on major decisions.”
“Close oversight and attention to detail is exactly what this agency needs right now,” she said.
Wittman, the governor’s spokesman, declined to comment on the allegations that Abbott’s office had pushed certain policies, but he said the governor is “pleased with the results he’s seen so far.”
Critics point to the agency’s actions in the month after Hurricane Harvey as evidence of its dysfunction.
Specifically, sources inside and outside the commission told the Tribune that the agency was slow to act in providing guidance and assistance to Texans affected by Harvey who qualify for public programs such as food stamps and Medicaid.
Doctors have complained that basic information, such as whether displaced Medicaid patients could seek care outside of their insurance network or get prescription medications refilled, was slow to emerge from the agency, and advocates for low-income Texans were frustrated to see a flurry of revisions to information posted on the agency’s website as victims sought government assistance.
Others pointed to the delay in rolling out disaster food stamps benefits. Hurricane Harvey made landfall in Texas on Aug. 25, and the health commission began rolling out disaster food stamps on Sept. 13, nearly three weeks later, but only in some counties. Houston, Corpus Christi and other areas that suffered some of the most extensive damage from the storm were not included in the initial rollout.
By comparison, when Hurricane Ike struck Galveston in 2008, then-Executive Commissioner Albert Hawkins announced the agency would provide emergency food stamps five days after the storm made landfall.
“When I see the response to Harvey, I am quite concerned about the level of expertise in the agency,” said one former commission official who has closely followed the hurricane response. “This stuff is not rocket science. We’ve had disasters before. There are templates for this.”
The Texas State Employees Union said this week that falling employee morale and a shortage of workers has hampered the state’s ability to provide recovery after Hurricane Harvey. Union officials say the health commission has lost nearly 11 percent of its eligibility operations staff — the workers who help connect Texans with public benefits.
In a statement for the union, Rashel Richardson, a caseworker in Houston, asked, “How are we supposed to work this much forced overtime week after week while our homes have been destroyed? How are we supposed to concentrate and get people services when we need services ourselves? It’s as if the state has no sympathy for workers who lost everything.”
Williams disputed claims that the state had been slow to react to the crisis.
“We've had everyone out in full force helping families recover from the hurricane by pushing out services, especially food benefits,” she said in an emailed statement. Comparisons to Ike, she said, were inappropriate, because Harvey was a “prolonged natural disaster” that caused more widespread damage.
It’s not just career bureaucrats who’ve taken issue with the agency’s inability to retain staff. State lawmakers, lobbyists and medical professionals who treat patients under the state’s care say the effects are evident.
“Certainly when there’s that level of turnover, it can become very concerning and difficult sometimes to navigate the system and move issues forward,” said Rachel Hammon, executive director of the Texas Association for Home Care and Hospice.
Disability advocates have also been outspoken about the commission’s loss of staff, with one group calling on the Legislature to do something about the issue they said threatened a “preventable and costly loss of services and supports.”
“The need that HHSC serves in Texas is tremendous,” Dennis Borel, the executive director of the Coalition of Texans With Disabilities, said in an email. “But recent trends are undercutting the agency's ability to meet this need: the drain of crucial program staff and leadership, the effects of the Governor's hiring freeze, chronic underfunding by the Texas Legislature, and the shutting out of stakeholders.”
Williams, the agency spokeswoman, said that turnover will happen as the agency experiences a top-to-bottom restructuring.
“Some people choose to leave an agency in the midst of major change, and that's expected,” she said. “We have a strong roster of talent that will continue to serve the people of Texas well.”
State Rep. Donna Howard, D-Austin, told the Tribune she frequently hears from health commission employees who are unhappy with the agency’s leadership.
“I know people complain about bureaucrats making decisions, but in this case we have the governor’s politicos making decisions rather than health professionals who actually know what best practices there are, and what the impacts are going to be to Texas citizens,” she said.
“It’s really appalling that we have gotten so far away from good public policy to where it’s politics that are governing what happens with health care services in our state," Howard said.
Disclosure: Planned Parenthood and Dennis Borel have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.
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