DPHHS nominee faces questions over Kentucky disease outbreak, Medicaid work requirements

Formey Kentucky official Adam Meier is Gianforte’s pick to lead the state’s health agency

Adam Meier

Lawmakers pressed Wednesday Gov. Greg Gianforte’s nominee to head the Department of Public Health and Human Services on his stances from everything ranging from Medicaid to tribal healthcare to his home state’s handling of a Hepatitis outbreak.

More than 30 individuals applied to head up DPPHS, the state’s largest agency, Lt. Gov. Kristen Juras told the Senate Public Health, Welfare and Safety committee. She said the governor deemed Adam Meier, a Kentucky-based consultant who previously served as that state’s cabinet secretary for Health and Family Services, to be the most qualified.

Meier served in that position for around a year and a half, following a term as deputy chief of staff for policy under former Kentucky Gov. Matt Bevin, a Republican. During his tenure as cabinet secretary, Meier said he ran many of the same programs contained in DPHHS, including Child and Family Services, addiction prevention and rehabilitation services — Kentucky was the epicenter of the country’s opioid epidemic, he noted — and federal programs like Medicaid.

“As I looked at what Gov. Gianforte stood for, and as I looked at his vision, I knew that that was somebody that I could help, and that I could help effectuate that vision,” Meier told the committee.

Meier’s nomination was supported by several officials from both states.

“He’s someone who found folks to solve problems and did it in a nonpartisan way,” said John Tilley, a former Kentucky lawmaker who served as the secretary of the Kentucky Justice and Public Safety Cabinet.

For the most part, Meier’s hearing was casual and friendly, with lawmakers joking with him about the weather and offering warm welcomes to the Treasure State. The committee had even offered the opportunity to send Meier their questions in advance, something a spokesman for the Senate GOP said is ultimately at the chair’s discretion.

The committee’s Democrats did not send their questions in advance, a caucus spokesperson said. Sen. Jill Cohenour, D-East Helena, told reporters earlier in the week to expect “tough questions” of Meier, whose appointment the state Democratic Party opposes.

Though their inquisition was relatively brief, Democrats on the committee did touch on the two main reasons for the party’s opposition.

For one, in 2018, a deadly Hepatitis A outbreak spread across the state of Kentucky into rural, impoverished areas of Appalachia, fueled in part by intravenous drug use. Infectious disease experts urged the health department to quickly build out vaccination capacity to respond to the disease, but progress under acting public health Commissioner Dr. Jeffrey Howard was slow, the pot of money set aside to battle the disease was small, and Kentucky’s outbreak became the deadliest in the nation, as reported by the Louisville Courier-Journal.

Howard worked under Meier, and Meier defended the acting commissioner’s work to the Courier-Journal, saying the state faced logistical problems in administering the vaccine.

“In Louisville, we had what was called the gold-standard response,” Meier told the Senate panel Wednesday. “But in the rest of the state, we lacked the critical infrastructure to reach these folks who had these outbreaks.”

He said he learned from the outbreak some lessons that could be useful in administering the COVID-19 vaccine to Montanans — for example, as the Kentucky health officials struggled to reach people out on “5-acre parcels in the mountains,” they found it was more effective to come to convenience stores to get out the vaccine.

“You have to be creative about how you reach folks,” he said.

Lawmakers from both parties also pushed Meier on his approach to Medicaid and other forms of welfare, with Sen. Brad Molnar, R-Laurel, asking how Meier could reduce Medicaid and TANF caseloads by returning people “to being solid citizens.”

Meier said it’s important to take a multigenerational approach, focusing on building a “ladder for employment” that lifts families out of poverty.

Democrats, meanwhile, pressed him on Kentucky Gov. Bevin’s plan to create enhanced work requirements for able-bodied adults on Medicaid in the form of a waiver that was blocked by a federal judge despite approval from the Trump Administration.

Medicaid expansion in Kentucky was done via executive action, whereas in Montana, the Legislature sets the policy related to the program.

Meier compared the changes to Medicaid in Kentucky as a kind of “health savings account” — able-bodied adults in the program received basic coverage, but had to work or participate in “community engagement” programming to earn dental and vision coverage.

In 2016, officials in the state estimated that the change, a campaign promise of Bevin’s, could result in 95,000 Kentuckians being kicked off the program.

Meier’s advocates also included Montana citizens who said case workers with Child and Family Services were abusing their power, echoing a concern shared by some in the Legislature that the agency was mishandling cases to the detriment of children, though some of the allegations border on conspiratorial.

“There is no department in state government more feared than DPHHS,” said Robert Leach, a perennial candidate who most recently launched a challenge to Cohenour with greater transparency for the agency as his rallying cry.

“It’s about creating a culture of safety,” Meier said in response to a question from Molnar about addressing “bad actors” in Child and Family Services. “Child welfare workers don’t wake up in the morning intending to cause a bad outcome. That’s not to say that does not occur.”

Other sticking points were on the budget. Lawmakers in the Senate have proposed a “starting point” for DPHHS’s budget $1 billion less than current spending; meanwhile, the governor’s budget keeps funding for the $3 billion agency closer to current levels.

“Section B (the budget subcommittee that set the starting point) is taking a different approach, but we’re all building to the same place,” Meier said, adding that he’d like to see a budget as close as possible to Gianforte’s proposal.

“In the end, we’re looking for a budget that allows us to effectively serve the people we need to serve,” he said.

Meier also acknowledged one area where he had relatively little experience compared to the expectations for the job: dealing with the sovereign tribal nations in Montana.

“This is something that’s new to me, something I’m eager to learn more about,” said Meier, whose home state has no federally recognized indigenous tribes. “My reputation is someone who works with stakeholders.”

The committee did not take action on Meier’s confirmation, which also requires approval by the full Senate.