North Carolina's new health leader wants to build on recent successes

Yahoo

13-02-2025

Devdutta Sangvai, Department of Health and Human Services (Courtesy photo)
North Carolina's top health officials start their jobs at the beginning of each new administration looking to master the details of the vast agency they lead and with budget recommendations to prepare.
Dr. Devdutta 'Dev' Sangvai, the new secretary at the state Department of Health and Human Services is facing that and much more.
The department will be looking for support in the legislature to expand a Medicaid program that addresses non-medical factors that influence health such as nutrition and housing, improve the child welfare system, and build on the work of the last few years improving behavioral health care.
And it will have to do all this while navigating turbulence from Washington that could keep patients, medical providers and policy makers off balance.
Congressional Republicans are contemplating Medicaid cuts that will affect state budgets and people who rely upon the insurance. Robert F. Kennedy Jr., founder of an anti-vaccine organization, is preparing to hold the nation's loudest health policy megaphone. Diversity programs and funding are being axed at the same time that North Carolina's public health goals focus on equity.
Sangvai was president of Duke Regional Hospital in Durham before joining Gov. Josh Stein's administration to lead DHHS. He spent more than 20 years at Duke and earned an MBA from its business school.
He took over from Kody Kinsley, who was at DHHS for nearly seven years, three of them as secretary.
Sangvai said in an interview that while at Duke he witnessed the benefits of Medicaid expansion and the state's sharpened focus and increased spending on behavioral health care.
Since North Carolina expanded Medicaid on Dec. 1, 2023, more than 625,000 low-income adults have enrolled in the government health insurance.
Sangvai wants to build on the foundation established under the previous administration with a focus on expanding access to care and to the department's services.
'Some of my priorities are really thinking about how do we strengthen access in all North Carolina communities? And there are a few areas I think we need to look at – some of our state run facilities. How do we increase access there? And access is just not bricks and mortar. It's also the services we provide,' he said.
'At the end of the day, we want to make sure that individuals are able to access health care when they need it in a setting that makes sense for them.'
The agency has struggled with high job vacancy rates for years that could be a bar to expanding access.
Last May, the state Human Resources office reported DHHS had some of the highest vacancy rates among state agencies, at about 26%.
Sangvai put the existing job vacancy rate at 20% to 23%.
Health care technicians are the frontline workers at the three psychiatric hospitals and the three developmental centers the state operates. Entry-level health care technician positions had a vacancy rate of 42% in December 2023, according to the Human Resources report.
Some people with developmental or intellectual disabilities have been unable to obtain help living in their communities because of shortages of direct care workers. These workers are not employed directly by the state, but work for companies that bill Medicaid.
State officials have taken some steps to address workforce shortages.
Last year, DHHS and the state Commerce Department published a workforce development plan that included direct care workers.
In its 2023-24 budget, legislators committed $20 million per year over two years to sign-on or retention bonuses for state healthcare facility workers. The legislature has also allowed DHHS to offer targeted salary increases to recruit and retain some staff.
Creating and strengthening a sustainable workforce is one of Sangvai's goals.
Sangvai said he wants to add an element to retention efforts by creating 'joy and belonging' at work, and making sure employees know they can move out of entry level jobs. Filling vacancies addresses immediate needs, he said, but people may not stay in those jobs for long.
'Let's create that growth opportunity, and not just create a situation where that individual then vacates the position and we're back to where we started before,' he said.
Giving people the chance to fill jobs that fit their professional goals and personal strengths may help keep people from leaving, he said.
'We're going to have to create career development opportunities. We're going to have to educate individuals on what the possibility might be, and then think creatively.'
North Carolina's Medicaid expansion law includes a requirement for DHHS to pursue permission to add work requirements to the benefit if it appears possible that the federal government will endorse it.
In his first term, President Donald Trump's administration approved state requests to require adults who were able to work to hold jobs in order to receive Medicaid.
Courts stuck down some state's plans for Medicaid work requirements, and the Biden administration rescinded other permissions.
Georgia survived a court challenge to work requirements. It instituted a 'Pathways to Coverage' program that offers most Medicaid services to low-income adults who work, go to school, or perform community service for at least 80 hours a month. A review of the program found 4,231 people were enrolled at the end of its first year, far short of the 25,000 to 100,000 expected to enroll.
The report found that an unwieldy enrollment process and restrictive eligibility requirements hindered enrollment.
Work requirements are back on the list of possibilities for all states, along with other changes that could affect the state's Medicaid program.
Sangvai wouldn't speculate on what could happen with North Carolina Medicaid, but said he hopes the same bipartisan cooperation that fueled improvements of the last few years continues.
'It's in that spirit of consensus and collaboration that I hope prevails as we think through any of the changes that may come before us,' he said.
DHHS 'is focused on the work that's ahead of us, recognizing that we may need to respond to something when it becomes more granular.'
Last year, DHHS published a detailed report on health disparities that looked at differences in access to health care, incidences of cancer and heart disease, and other measures of wellbeing by race, ethnicity, and geography.
The state's 10-year plan for improving health, 'Healthy North Carolina 2030,' focused on equity and factors that influence good health.
Trump has diversity, equity, and inclusion in his crosshairs. He has abolished federal DEI programs and put workers who were running them on paid leave.
Sangvai stressed that health differences are not based solely on race. Whether people live in rural or metro areas, whether or not they have disabilities, or are military veterans, are also play a role in health and access to health care. There's significant overlap between rural/urban health disparities and disparities based on race, he added.
'Our focus is going to be on ensuring that our programs meet the needs of most North Carolinians,' he said.
Kennedy, who some doctors fear will spread misinformation about vaccines, won confirmation Thursday to become the U.S. Health and Human Services secretary. In his Senate confirmation hearings, Kennedy refused to agree that the COVID-19 vaccine saved lives or to accept the validity of scientific studies that said there's no link between autism and vaccines. The American Public Health Association and more than 75 Nobel laureates opposed his nomination.
DHHS and the state's medical providers will continue to encourage vaccinations, Sangvai said.
Sangvai said when he saw patients, he routinely spent time answering their questions about vaccines. Health care providers should be prepared to have conversations with patients, sometimes more than once.
'People are going to trust their healthcare provider probably more than anyone else,' he said.