COLUMBIA, S.C. (WCSC) – This summer, one of South Carolina’s largest state agencies, the Department of Health and Environmental Control, will split into two new agencies over public health and environmental services.

On Tuesday, senators approved an even more seismic shift into who oversees the state’s health services, and it could have a major impact for millions of South Carolinians.

Right now, seven separate state agencies are responsible for the delivery of health services and human services in South Carolina.

Not only is that uncommon compared to the rest of the nation — it makes South Carolina an outlier.

“South Carolina is the most fragmented structure for health and human services delivery in the country,” Colleen Desmond with Boston Consulting Group (BCG) told a Senate subcommittee in January, saying a plurality of states, 19, have integrated all health and human services under a single umbrella organization.

The state’s Department of Administration contracted with BCG last year to study whether more changes to the agency structure would benefit South Carolinians, following the legislature’s 2023 decision to split DHEC in 2024.

The bill senators advanced Tuesday in a 42-1 vote builds off BCG’s recommendations.

S.915 would combine six separate state agencies into one, a new “Executive Office of Health and Policy.”

This office would merge the existing Departments of Alcohol and Other Drug Abuse Services, Disabilities and Special Needs, Health and Human Services, Mental Health, and Aging, plus the new Department of Public Health that will be created this summer when DHEC splits.

Under the bill, a new Secretary of Health and Policy would lead the new agency. That person would be a member of the governor’s cabinet and appointed by the governor, with senators’ approval.

“One of the primary purposes of this bill is to end the fractured nature of the way that we deliver public health services in South Carolina,” Sen. Tom Davis (R-Beaufort) said during Tuesday’s debate, which lasted just over an hour.

Davis, who shepherded the DHEC bill through the Senate last year and has been working on this legislation, said there is a correlation between the current fragmentation of health-related agencies and poor health outcomes for South Carolinians.

The interim BCG report found South Carolina is spending more money than some other states to boost people’s health, but it’s not paying off: South Carolinians rank among the unhealthiest Americans.

“We don’t get the healthcare outcomes we deserve based on the money we’re putting in,” Davis said.

Advocates for the merger said the current fragmentation of health- and human-service delivery across several agencies creates challenges for South Carolinians who don’t know where to go for care, especially when multiple agencies handle the same issue — for example, both the Department of Mental Health and Department of Alcohol and Other Drug Abuse Services treat substance-use disorders.

Then people fall through the gaps because these agencies don’t coordinate and communicate as well as they could.

“If we’re serious about improving healthcare outcomes — and again, this isn’t a bill in search of a purpose. The purpose here is, we aren’t getting the healthcare outcomes we deserve based on the money we’re putting in,” Davis said.

Some senators expressed concerns during Tuesday’s debate over funding and how this shift could affect dollars flowing to smaller and more rural parts of the state.

Under the current model, money from a state tax on alcohol sales goes directly to counties to fund local alcohol and drug abuse services.

It totals to about $5 million, and under this bill, the state would control where that money goes.

“One of the counties I represent, the needs are critical there, and they may have no outlet for behavioral health services, and so that’s what concerns me because I don’t know even what that $5 million hit might do to them locally,” Democratic Sen. Thomas McElveen of Sumter County, who ultimately voted for the bill, said.

But Davis said putting this money in the state’s control, distributed at the discretion of the secretary of the new agency, also allows South Carolina to better leverage Medicaid dollars that can become unlocked.

“One of the things that this does is it allows those dollars to be directed down to where the need is,” Davis said.

After a final vote in the Senate on Wednesday, this bill will head to the House of Representatives, where a similar companion bill awaits a debate.

Gov. Henry McMaster has expressed his support for this bill, saying he believes this consolidation is necessary and calling it one of the most important bills lawmakers can take up this year.

Copyright 2024 WCSC. All rights reserved.