By Rose Hoban
After two-and-a-half sometimes tumultuous years, state Department of Health and Human Services Sec. Aldona Wos has given her resignation to Gov. Pat McCrory, saying that “it’s time for me to go home and be with my family.”
The announcement came a day after DHHS officials revealed that for the second year in a row Medicaid finished the fiscal year in the black.
“Today I’m proud to report that North Carolina’s Medicaid budget is in far better shape,” McCrory said. “In fact, yesterday the $130.7 million cash in hand [announcement] is great news for all of us.”
Both Wos and McCrory became tearful during a press conference held at the governor’s mansion in Raleigh Wednesday morning, as McCrory praised Wos’ “incredible passion, ethics and knowledge.
“I have never been around an individual who is so intelligent,” said McCrory, who also praised her work ethic, noting that she often worked 14-hour days, seven days a week. “She taught me so much.”
As McCrory finished his introduction, choking up, a glum-looking Wos gave him one of the two tissues in her hand. She grew tearful as she gave acknowledgements to people in the room.
Wos even took a moment to call out Sen. Tommy Tucker (R-Waxhaw) from the audience to give him a hug. Tucker has frequently criticized Wos in legislative committee meetings, using blistering language to take her to task for the department’s failings.
“I have already stayed longer than I expected and certainly longer than I originally planned, and I apologize for that to my family,” Wos said. “But I stayed because of the importance of ensuring that the department itself is strong and sustainable as we face the future in our state.”
Wos also told reporters that her mother is sick and that she wanted to spend time with her at the end of her life. Wos’ father died while she was in office, in May 2013.
Challenges
“When you first appointed me to this position, the operational, the budgetary, the staffing challenges that we were confronting at the department were truly numerous, longstanding and very well documented,” Wos said to McCrory.
Wos, a Polish-born physician, came into office at the beginning of McCrory’s term, in January 2013, stepping into her role at a time when the state Medicaid program had not met its budget goals for several years.
Wos’ first big public outing was declaring the Medicaid program “broken” in the wake of a damning report by State Auditor Beth Wood. Later reports found the departmental response had been heavily edited to downplay the department’s efforts to manage the program.
She also oversaw the rollout of the NCTracks Medicaid management and billing computer system, which was riddled with glitches and left hundreds of health care providers frustrated and often without payment for their services.
Another computer program caused Wos headaches, as the rollout of the NC FAST system, which is slated to collect data and help with registration for social services and entitlements, left thousands of people waiting months for approval for food stamps.
Although McCrory said Wednesday that Wos “took all the hits, took all the bullets,” she angered county managers when she cast blame on county officials for not keeping up with record keeping and registration of people applying for entitlement programs.
She also took criticism for hiring high-priced consultants to help reorganize the Medicaid program, and increasingly took criticism from members of the Senate Health Care Committee, who opposed her vision for Medicaid reform.
But Wos eventually grew into her role, surrounding herself with seasoned bureaucrats to build a management team that has gotten the state’s mental health system stabilized, improved Medicaid forecasting, advocated for improvements to the state Medical Examiner’s office and championed a Medicaid reform plan that’s garnered support from the health care community.
“The improvement process has at times been truly painful, and it has been much slower than I would have desired,” Wos said. “However, governor, with your encouragement, with your support, we have stabilized and we have redirected the department and made significant progress in improving the operations.”
Moving forward
Wos will be replaced by Rick Brajer, 54, who has lived in Raleigh for the past decade.
Brajer, a management consultant who has run several health care and diagnostic services companies, will take over Wos’ position on Aug. 17. Wos’ last day will be Aug. 14.
Brajer has not served in government before. But in a press release, McCrory said “his background in healthcare and in business is the perfect fit for the department and the work that lies ahead.”
Brajer said he was planning to start meeting with legislators in the coming days.
“There’s going to be significant emphasis on Medicaid reform, mental health, substance abuse and continuing to derive synergies through modernizing and … our IT systems,” he told reporters.
Brajer also said he wanted to continue emphasizing the Medicaid reform philosophy that has set Wos at odds with members of the Senate.
“We continue to believe that a provider-led approach really should receive the first opportunity,” he told reporters.
Brajer said that cost containment in the Medicaid program was a core priority for the governor and the administration, “and personally, for me.”
At the same time, he said his and his family’s volunteer efforts over the past decade have “focused on families that need a hand up.”
“Our vulnerable citizens are a high priority for me and this administration,” he said in response to a question about his emphasis on cost. “I was communicating how much respect our state has for those people through how large of a portion of the budget they’ve already dedicated.”
“We have a responsibility as good stewards to make sure we do the best possible with those existing funds, so that we can serve more people today,” he said, “but also allow us to continue to invest in other things that the state has also prioritized.”
Brajer said he believed his private-sector experience would be a strength as he steps into this governmental role.
One of Wos’ parting comments, however, might be good advice for her successor.
“Government takes time,” Wos told reporters after the announcement. “Programs take time and we sometimes are too impatient; we think in terms of a year, or two years or four years. And yet, when it comes to health care and billion-dollar industries in our mental health care and substance abuse programs and our physical care, it takes time to develop the policies, implement those policies.”
“You have to be extremely patient to see the benefit of those policies,” Wos said.
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