Department of Human Services

The new director of the state Department of Human Services wants to expand the conversation.

Rachael Wong has been at the helm of the state Department of Human Services for just 2 1/2 months and already has made it clear how she intends to run the department — which has more than 2,300 employees, an annual budget of more than $2.7 billion and four main divisions that provide programs and services to more than 330,000 of Hawaii’s low-income and “vulnerable” population, including medical assistance, child welfare services, vocational rehabilitation, food stamps and housing.

“In alignment with the (Gov. David Ige) administration, but also just personally with who I am, this is about pulling back the curtain on government,” Wong said earlier this month at her first meeting with the Star-Advertiser editorial board.

“And it’s not just to say these are how our policies and decisions are made, but it’s about engaging with stakeholders, whether that’s legislators or the media or the people we serve. It’s engaging those folks so that it’s an ongoing conversation, so by the time the decisions get made, it’s not a surprise.”

The idea of good communication seems to have always been prominent in Wong’s outlook. She said she learned about it from her paternal grandfather, who often had prayed for “health, safety and good communication.”

Wong said she came to realize the importance of health when her own health was endangered by the auto-immune disease lupus, as well as a kidney transplant, which more or less sidelined her for years, and helps explain the career path she has followed.

Prior to joining DHS, she was vice president and chief operating officer, since mid-2012, of the Healthcare Association of Hawaii, which represents acute-care hospitals, long-term care facilities, home health agencies and hospices. She also was executive director of Kokua Mau, the nonprofit hospice and palliative care organization, and the Hawaii Consortium for Integrative Healthcare, a nonprofit dedicated to “improving the quality of health care by finding common ground with Western medicine and traditional, natural healing practices.”

She has served on numerous local and national boards and committees, most having to do with health-related issues.

A graduate of Punahou School, Wong also earned a bachelor’s degree in East Asian studies and a certificate in women’s studies from Princeton University, a master’s degree in public health from University of Hawaii at Manoa, and a doctorate in public health from University of North Carolina at Chapel Hill.

Wong, 43, is married to Brad Chun, a doctor at Kokua Kalihi Valley, and lives in Manoa.

Question: What do you perceive are the biggest challenges to delivering the services that you’re supposed to deliver, and reaching the people that you’re supposed to help? Is fraud a major problem? Is it funding? Is it poverty in Hawaii? What broadly do you want to focus on?

Answer: One is resources. I walked into the director’s office the first day and looked around. Everybody came in, gathered, and I said, there’s eight people here. There’s eight people in the director’s office running this department. There are staff offices, but still, it’s very, very lean. … So resources on a general level.

The second is, having come from the outside and having my own impressions, and then coming inside, I realized that DHS is not often perceived positively, and that’s a huge uphill battle to be able to climb, and that’s part of the reason (I’m) here. …

There’s a lot of hot-button issues, you know? So we hear about MedQuest. We’re talking about the amount of money that comes through, because of our Medicaid programs, for one. We have our public assistance programs, having to do with the Benefits, Employment and Support Services Division. And then also the Child Welfare Services branch. There’s a lot of things that come out in the news that people hear about, but what folks don’t get to hear about is, one, the staff who works here,

When I came in on Jan. 1, one — I say this all the time — I’m continually awed by the people who work at the Department of Human Services. I feel like I’ve hit the biggest nonprofit in the state, because people come here because they care. The folks don’t come here to make a lot of money. They come here because they believe in the mission, and the individuals and families that the programs are touching. …

So meeting with all of you is something we’ve been talking about pretty much since I came on, so we can encourage the dialogue so there’s more understanding about what the department does.

Q: What was it about this particular department that you think you can make a difference with?

A: … If I had been asked to run any other agency — and I don’t think I would have been asked to — I don’t think I would have accepted.

I mean, I would have said, “How can I best serve?” but I don’t think I would have been the best fit. And the reason why DHS is something that fits is because (I thought), yeah, this is an opportunity. My background is in public health. I’ve been working grassroots, I worked in end-of-life care, I’ve been working health care, most recently worked with the Health Care Association of Hawaii, bringing the public health care perspective to the health-delivery system.

But looking at social determinants of health, it’s how we live, it’s the communities in which we’re born, live, age, work and die.

You know, the Federal Reserve Bank coined the phrase, “Your zip code is more important to determining your health status than your genetic code” — where you live versus your genetic code.

So when you look at the programs we have — public assistance, TANF (Temporary Assistance to Needy Families), SNAP (Supplemental Nutrition Assistance Program), general assistance; when you look at child welfare services, keeping kids safe; keeping seniors safe with Adult Protective Services, with Med-Quest, providing health care coverage and access to people who are poor and vulnerable, vocational rehab, to people who are disabled — I mean, this is the fabric of our community. …

And if we can provide the programs and services to help people become self-sustaining and independent, or if they can’t, to provide them with the programs where they can continue being part of our community, that’s public health at its core.

So it doesn’t matter what I read. It’s what this department is, and I’ve been continually affirmed. … It’s a lot of information, but the people I’ve found here are amazing.

Q: It’s just been two months, right?

A: (Laughs)

Q: You still have that glow. … But one big thing is the KOLEA (the Kauhale Online Eligibility Assistance system, which was reported recently to be having technical problems). How are things going with that?

A: If you want to go this way, do you want to talk about dispelling what’s out there, the chatter? Like the 11,000 people on backlog type of thing?

Q: The 11,000 (the number of people having trouble registering for eligibility assistance) was … testified before the oversight committee to the feds. So that is documented. … So when you say KOLEA works, what exactly do you mean by that?

A: Broadly in more lay terms, because I think it’s more technical than I am, … there is a vision that is going to be implemented. So at DHS, we have this Enterprise platform, which is … our IT system that we’re building, and the goal really is to link all our eligibility system, plus case-management, all together. It’s almost like, here’s the platform and you’re putting on all these different hubs, and KOLEA is the first one, for Medicaid eligibility. So eventually we’ll be able to have people come in through different portals so they can apply, and you can only find them in that one data base, and we want to be able to share this with the rest of the state. … And what I have found is, the system works.

Q: Now that the legislative session is underway, are there specific bills you are supporting or opposing at this time?

A: The ones that come out of our administration are the continuation of the two sustainability bills. That’s an opportunity to draw down more funds for both hospitals and nursing facilities that take care of Medicaid patients.

Q: Because you know the budget is tight, … have you had a chance yet to figure out where are the duplications here? Are there some other efficiencies that you need to get a handle on? Do you have a sense yet of where those might be?

A: We’re starting to, and going back to the DHS Enterprise platform that we’re building, it’s to decrease duplication and redundancy and actually use IT so that we’re being more efficient and the people, the bodies that we have can do the people work. … I mean, this really is about being more efficient and strengthening families and communities.

Q: You mentioned that one of your goals is to help your clients build sustainable lives for themselves. And we tend to write editorials supportive of SNAP and support for families, and then we immediately get a backlash from readers or whoever saying, “Why is government making it easier for people to get government benefits. Why aren’t they making it harder?”

What is required of the clients to eventually support themselves? What incentives are in place to encourage or force, depending on who is making the comment, these people who are getting government help to eventually wean themselves off?

A: I’ve been answering these questions since I’ve been meeting with legislators and with stakeholders out in the community. They say, “We hear about so-and-so who got a one-way ticket here and he went straight to the window and applied. Can we make it a 30-day waiting period? Can we make it so the folks have to live here?”

And so I go back and I find out …that we’re following federal guidelines. We’re meeting the federal requirements. So if someone is using their EBT (Electronic Benefit Transfer) card, we can’t restrict beyond what the federal guidelines are for what they can purchase and what they can’t. It’s unconstitutional to set up parameters that people have to wait. So, one, we’re following federal guidelines.

Two, I believe in casting the net so that we’re catching those who most need the help. And then, we have our fraud unit. We have people working to prevent fraud, looking at the misuse of benefits. But if we’re truly the Department of Human Services, we need to be making sure that who need the help are going to access to those services.

Q: At the beginning of the recession, there were cuts and budget crises, and there were cuts made, and now there’s some kind of, depending on how you view it, a recovery, and yet poverty seems to be on the increase. How do you see that? Do you see that as the long-term after-effects of the recession and job losses?

A: You know, coming from the outside when I was working with providers, and we were looking at behavioral health and readmissions at ERs (hospital emergency rooms), and repeated admissions, over and over — what folks could analyze, the people who had been in behavioral health at the ERs for a long time, they could say, “Oh, you can take actually take this back to when there were cuts in community-based case-management services.” They could correlate that this is the catch up.

So there’s that aspect. You’re talking about the reductions in forces, the cuts throughout programs. We’re always going to play catch up from that because of the impact it had on the people living in the community and the resources of staff, the resources that state and county and other programs could offer. And the nonprofits out there and everything.

The second thing is, talking about the economy doing well, you know, I came on and, yeah, the Council on Revenues said we’ll be up by 1 percent, $800 million we’re rolling over, and was rudely awakened, getting the first introduction into state government and understanding, wait, all that money, that $800 million has already been allocated. Right?

So Gov. Ige comes in, he inherits a budget, like we all inherit a budget, and there’s no new programs that are being added. We were very strongly told, you pare down your list of additional requests. You have enough to continue what you’re already doing, and keep paring, keep paring. We kept going forth with priority lists and it kept getting pared down and pared down. … We submitted another list and so I came in and there was a list of 154 line items above the base budget. When we took it in for the budget, we got it down to maybe a hundred, or maybe less than that … And then it keeps getting winnowed down.

And so every time folks say “can you do this, can you do this,” you know, it is lean times. … When we talk about the economy doing better, I think it’s doing better than we were in ’09. Are people living in poverty? Yes. And when we talk about these issues — it’s poverty, it’s education, it’s the very issues that this department is facing.

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