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In her first full month on the job, Maine’s new Health and Human Services Commissioner Jeanne Lambrew is striving for a bottom-up approach — in policy, in acquainting herself with department employees and in public transparency.
Lambrew was Gov. Janet Mills’ first and most high-profile Cabinet pick, having previously worked under President Barack Obama during the rollout of the Affordable Care Act.
DHHS is the state’s most embattled — and, after education, second most expensive — department. The agency’s child welfare arm, the Office of Child and Family Services, is in the midst of an audit, commissioned last year after a government watchdog report found evidence that DHHS mismanaged the handling of abuse complaints related to the deaths of two young girls.
In a sit-down interview with the Bangor Daily News, Lambrew said she wants to restore trust and morale among department employees, broaden the state’s social service programs, and increase general department transparency.
“We are for identifying challenges and surfacing them, because the first step to solving a problem is to air it and to get feedback on it,” she said in her office Thursday.
The interview has been edited for clarity and length.
BDN: Let’s start with your work on the Affordable Care Act. What do you see are some of the risks involved on building Medicaid expansion on a program that’s under attack by a lot of Republicans?
Lambrew: When you look at the states that have expanded Medicaid … many of them have Republican governors, many of them have bipartisan support in their Legislature, so I do think that while there might have been early concern about the Medicaid expansion, I think that has significantly changed over time.
That’s partly because of the evidence. States who have expanded Medicaid have more people insured, lower health insurance premiums … stronger hospitals, stronger economies. So, that evidence has been part of of the reason why, I think, the controversy is not what it used to be.
Do you plan to withdraw the state’s waiver request to impose work requirements on some Medicaid recipients?
Lambrew: Back in December, [President Donald Trump’s administration] approved the previous administration’s request, and the state had 30 days to accept that waiver. On Jan. 22, the governor announced she would direct me and [Department of Labor Commissioner] Laura Fortman, to work together on how we give people in MaineCare access to job training, job training support, education. But she said she’s not convinced that making requirements, rather than these connections to job programs, would be effective in helping Mainers go back to work, so we turned down the waiver, but I was directed along with Commissioner Fortman, to find ways to aggressively to promote work for our workers.
In the context of reviewing our TANF program, we’re also looking at what additional work support we can do for people in MaineCare.
Do you plan to lift the five-year lifetime cap on TANF (Temporary Assistance for Needy Families)?
Lambrew: As I just said, we’re doing a review of all the policies, the funding and opportunities. We’re still going through that, in part because there was some funding left from the previous administration.
For example, we’re going to see if, through executive action, we can begin to increase some of the benefits for working families, try to figure out how we tackle the hunger problem in the state and see what other opportunities we have within the existing program to make advances. We’ll be doing it piece by piece. When we see opportunities, we’re going to take them. I think you’ll see us announce one of those opportunities in the next couple weeks.
Do you plan to apply for waivers from the Supplemental Nutrition Assistance Program work requirements for able-bodied adults without dependents in high-unemployment areas?
Lambrew: We’re definitely looking at it. But it’s still a work in progress. We are trying to, though, look at TANF, look at SNAP, look at MaineCare but do so in an integrated way. These same people are involved in some of our work training and educational programs, so we’re trying to make sure we’re doing this in a systematic way.
With the recent Public Consulting Group’s report that came out and with the knowledge of the Office of Child and Family Services struggles, please talk a little bit about how you plan to improve the department in a day-to-day way.
Lambrew: We really are taking in this administration and this department, the term transparency seriously. We did, when we got the final report, post the evaluation, even though there’s a lot of things in there that are immediately problematic and things we want to act on. We also posted one on the child behavioral health system, at the Centers for Disease Control and Prevention, we reinstated the practice of posting health alerts that had been discontinued by the previous administration.
We are for identifying challenges and surfacing them, because the first step to solving a problem is to air it and to get feedback on it.
Our goal is going to be to take all those recommendations [annual Child Welfare Ombudsman report, OPEGA’s final report] try to synthesize them, get our frontline workers’ perspectives, get our stakeholders’ perspectives, get the public involved so when we plan or start taking steps to make improvements, we’re not doing it in a top-down way but really trying to engage the people to rebuild trust.
One of the things I’ve heard in my short period of time is we need to restore trust — trust in the team of people that are going in trying to balance the safety concerns with reunification, trust with the system to make sure that things are appropriately reported, and trust by the families.
We want to make sure we are building the changes around the families, the people who work with those families and the systems.
The other thing we’re doing is trying to staff up. We’ve already posted nine jobs in the last month for caseworkers. We’re trying to take the pressure off the call center because there have been waits and it’s been a real problem. We’re looking at both human solutions and technological solutions.
And we’re looking for leadership. On Tuesday, we’ll have an acting director who previously worked at OCFS — Elissa Wynne — as we’re doing a national search. Trying to find somebody who can come at this with a fresh perspective but a perspective of the state where there have been some successes, I think, will be a way to reinvigorate this very important office.
Are there any practices of the Office of Child and Family Services arm of DHHS left over from the previous administration that you want to uphold?
Lambrew: I want to, in fairness to this process, do what I described — get all the recommendations lined up, get feedback from our team, stakeholders, the public, before saying yes or no, because I don’t want to create the top-down mentality of we know what’s right, we’re not going to take a pick and just go with things without that involvement.
Part of my overall goal for the department is engaging our workers, the people in the private sector who are close partners in crafting solutions, so it feels premature to say what parts of the child welfare system we’ll keep and what we’ll change.
My hope is that in the same way we’re trying to be communicative about the MaineCare expansion, sooner rather than later, we can do the exact same thing in child welfare. You’ll hear shortly from us on our first, immediate steps.
Do you think family reunification should be prioritized?
Lambrew: I don’t think there’s an either/or; there’s always a balance. So, we are in this process of working through ways to ensure safety while focusing on reunification and permanency wherever possible. We are going to figure out a balance that is an operational balance that our case workers can have as they deal on a case by case basis.
Have you started communicating with on-the-ground caseworkers yet?
Lambrew: Started, yeah. We’re trying to figure out ways to do this in a way that’s respectful, so we get to hear all voices.
Do you think if a parent is found to be an active drug user, it should necessarily warrant their child being taken out of their custody?
Lambrew: Child safety is our priority and my understanding is that substance use may be a factor in the decision, but I will say that this is something that we would need to have an expert give you an answer on. I don’t think there’s a black-and-white decision on this. Within that, we also have to be sensitive to the fact that there are also federal laws and requirements around this.
Will you talk a little bit about how the department will work with Gordon Smith, the leader of the administration’s efforts to address Maine’s opioid addiction epidemic?
Lambrew: It is day to day, and it’s wonderful because I think he brings to the job passion and energy and ideas. So, we talk regularly, different parts of the department work with him.
It really is trying to take the executive order that the governor signed last week, put behind that all the type of activities that we hear the department can act on, and then execute. Because a fair amount of his work will involve departmental work, we’ll be aggressive at doing what we did last week, which is looking at existing funding, where it will define this state opioid response grant that had basically $600,000 available for recovery coach training. We were able to buy naloxone to be distributed to sites all over the state. That’s an example of what we’ll be doing a lot of in the coming months.
I think our next focus is going to be MaineCare because clearly expanding MaineCare helps many of the people with substance use disorder. I think it’s one of the best things a state can do, to begin to tackle this crisis, because it will support treatment, it will support recovery, but it will also support prevention.
How many positions does the department want to fill?
Lambrew: We’re still looking at that. Last week, I had signed off on 95 vacancies to be posted, and we’re triaging them to areas like child care caseworkers, public health nurses. These are vacancies where funding has already been appropriated. So this is getting us back to the departmental headcount where we should be.
Inadequate mental health supports have been a problem in Maine for awhile. As far as community mental health programs go, do you have particular ideas on how to improve some of those services?
Lambrew: Mental health is probably an area where, nationwide, we’re all trying to think through: how do you design a system that runs the spectrum, from prevention, to early intervention, to appropriate treatment in the appropriate setting?
And I say that’s a process because we’re trying to map this out to make sure that when we do our incremental policy, we know where we’re going to be, three to five years from now. It’s so important to have a comprehensive mental health system so people are not inappropriately sent to the hospital or emergency rooms and are getting the type of treatment that’s effective.
We’re doing a mapping project on this and again looking for ways to use the opioid crisis — which is the tip of the spear — to create those kind of systems. So, while we’re addressing the opioid crisis, the next one down the highway can be addressed in this system.
So, it is part of the larger effort that the governor has directed Gordon to do and us to do to develop this more comprehensive and humane and prevention-oriented system.
We are going to take a holistic approach to working on touching all those people both who support the frontline workers but who are on the front lines to make sure that they feel their work is valued and their input is valued.