Former York state representative Bev Mackereth has been acting secretary of the Pennsylvania Department of Public Welfare since February. She is in the process of being confirmed as leader of the department, which administers a wide range of social services, including Medicaid (aka Medical Assistance), foster care and developmental programs for those with cognitive disabilities.
Mackereth recently took time to answer a few questions for the Business Journal.
Q: You've had contact with the DPW in a variety of ways throughout your career. How has actually being in the department changed your perspective?
A: My perspective was not real positive when I wasn't working here. You know how you tend to point fingers and it's somebody else's fault? Between having worked in York County in human services and child welfare, and then having worked as a state legislator for eight years, everything that went wrong was DPW's fault. Now that I'm here, you do see the other side and that perspective. I would say that's the biggest difference.
It's so easy to point fingers when you don't want to take the responsibility sometimes, and generally what I find in most of the issues, if you want to look at blame there's plenty to go around. Sometimes it's not DPW and sometimes it is, and sometimes there's just a lack of communication or coordination of effort. Being inside now, I also get to see when I was a state rep and some of the votes I made and some of the laws I passed, the impact and unintended consequences. I think that's what happens as you have the ability to move from one work environment to another.
What are your goals for the department?
The first thing is we really want to make sure we are serving the people that we were created to serve, the most vulnerable people in Pennsylvania. A lot of what we were doing in the last couple of tough years were reforms made, a lot of cost containment, and where that was necessary, it is important for us to get back to basics and look at what are we doing.
A couple of examples: Moving from people being in institutional settings to community and home-based ones — whether it's children, intellectually disabled adults or seniors — is a common theme throughout our work. We're looking at what's working in one system that could work in another, bringing everyone together to really be focused on what we're here to do. Getting people off the lists, that's a priority for the governor and for us.
Making sure that people have the right services. We're all working on what the investments we need to make for the needs of individuals, and whether the dollars we're spending are being used in the right way. Many of our deputy secretaries would tell you that there are some individuals we spend millions on, yet we do nothing to improve their quality of life. That's not what we're here to do.
It's a big job. We work with people and provide services to people from birth through death. To move forward, I think we have to begin with finding commonalities among the populations. There are so many common things in the work that when you do it for one population but don't even try it for another, how does that make sense?
According to the National Association of State Budget Officers, 33.3 percent of Pennsylvania's total expenditures in 2012 were on Medicaid. Only Missouri was above us, at 35 percent. Why is our percentage so much higher than so many other states?
One thing that we have to keep in mind is that our general fund budget is not that big. We do a very good job in Pennsylvania. Our state budget is $28 billion, and our Medicaid funding is about 29 percent, I believe, of the state budget. And 75 percent of the DPW budget is Medical Assistance.
Our benefit packages are pretty robust. We have moved to managed care for physical health and behavioral health, but our two populations that cost the most are seniors and people with disabilities, and with those two populations we do not have managed care. We will certainly in the next few years begin the conversation to see whether it is the right thing to do for Pennsylvania.
We are the fourth-highest population of seniors, and we have a very high, very high — I don't know what the numbers are — very high population of people with disabilities living in Pennsylvania. I was with the governor when we went to meet (U.S. Department of Health and Human Services) Secretary (Kathleen) Sebelius and her group, they felt that that percentage of our Commonwealth budget was pretty high, too. That's why we're working with them to look at what could our benefit packages look like.
I know there's a lot of criticism about whether or not we should have jumped in (with expanding Medicaid) or whether we shouldn't have, and the reality is, with it being 29, 30 percent of the entire commonwealth budget, we'd better do it right. If we expand on what we have and include more people without doing something to reform our packages, I'm not sure it's sustainable financially for Pennsylvania or for the federal government. And it's all tax dollars.
Other than the possibility of expanding Medicaid, what changes is the department facing?
Around the issue of the Affordable Care Act, much of the discussion has centered on the Medicaid expansion, and yet what we're doing right now has gotten very little attention. I think it's because we opted to go with the federal exchange (the public health insurance marketplace), but that doesn't mean we do nothing. I get why people don't understand it, but we have to entirely change our systems.
Once you go into the exchange they look at — I think it's line 26, on your income tax form, minus your deductions, and if you meet certain criteria you'll be able to pick from various insurance plans that work for you. If you qualify for other things — they'll have all of our eligibility for everything — then they'll send it down to us.
We only have until Oct. 1 to have our systems up and running and working together. This is a daily ordeal for us to get to the point where we're going to be ready to connect to the federal exchange and be able to handle the phone calls, which we've never had to handle before. Just gearing up for the Oct. 1 date has been very challenging. We have to update Compass, the state's online system where a person can go, fill out the form and see what benefits they are eligible for, such as MA, LIHEAP, SNAP. We'll have to update that to include the ACA application. There's a lot of interfacing networks that needs to occur.
There are a lot of people in Pennsylvania who — I hate the term "woodwork," but that's the term that is being used nationally. It describes people who are eligible today for MA but who, for whatever reason, are not on it. We believe that once the push is in for everyone to have insurance, once the day comes that there won't be uncompensated care to hospitals, that everybody will be pushing to get people on MA. So the people who don't have it today will sign up for it. That means our system has to be able to deal with them. We're thinking it will be a huge influx of people who are eligible and who should get MA.