It's a Hard Day's Work for Wisconsin's Human Services Chief
First there was the threat of budget cuts to Wisconsin's publicly funded health insurance program, BadgerCare, which insures 110,000 low-income children and their working parents. Then there was a clash with state Republicans over the amount of federal funding available for medical assistance. Then there was the food stamp problem--inherited by Nelson from a previous administration--which escalated in June when Wisconsin was pegged with having the third-worst error rate in the nation for its food stamp program in 2002. Add to that a more recent controversy that erupted when a sexual predator was released from prison into a suburban community that housed a new shelter for abused and neglected children.
Yet, throughout it all, Nelson has persevered. Appointed as head of the Department of Health and Family Services last January by Wisconsin Governor Jim Doyle, she gained responsibility for 6,700 employees and a $5.5 billion budget, the bulk of which covers medical assistance. A seasoned public figure, she has worked in policymaking and executive management positions for both the state and Dane County for more than 25 years, and was cited as the first Public Administrator of the Year by the Capitol Chapter of the American Society of Public Administration.
In her newest post, Nelson leads the nation in proposing progressive health care solutions to over-extended state budgets--admittedly her biggest challenge. But, as she acknowledges, fiscal challenges can also offer opportunities for improvement and streamlining. In her case, that means lowering health care costs while preserving services for poor families, the elderly, and people with disabilities.
Nelson's agenda also includes allowing patients the greatest amount of control over their health care. She is co-founder of the Center for Patient Partnerships at the University of Wisconsin-Madison, which promotes this patient-centered approach. "One of our priorities is long-term care reform to provide older people and people with disabilities more choices to receive help at home," she says.
In the meantime, Nelson is pleased that despite the state's fiscal crisis, it was able to preserve the BadgerCare program, which helps Wisconsin maintain its low rate of uninsured residents. The service has come at a cost, however. With pandemic lack of funding, the Department of Health and Family Services had to reroute resources meant for the food stamp program. Nelson plans on remedying, or at least addressing, the disorganization and error rates which have long plagued that program in her state.
Other perpetual concerns include improving the health, safety, and well-being of all children, especially those who are at risk; fostering access to health care; and organizing her department to ensure efficiency and accountability.
"It's a big agenda," admits Nelson, "and a challenging time to pursue it. Yet we're committed to moving it forward and believe that in the next few years we can make significant progress."