OBAMA JOB WATCH: Department of Health and Human Services (Updated July 17)

July 17

David Hansell, who was the commissioner of the State Office of Temporary and Disability Assistance for New York, will be the principal deputy assistant for Carmen Nazario, who has been nominated to be Assistant Secretary for Children and Families (if and when Nazario is confirmed).

Announcing the loss of his commissioner, Gov. David Patterson (D) said Hansell “helped to broaden the scope of the agency’s mission from moving individuals from welfare to work to a focus on enhancing…economic security.”

July 14

This week President Obama nominated Regina Benjamin to be the next Surgeon General. The selection has some advocates hopeful that the office will return to prominence and shine a light on some critical youth health issues.

“We’re encouraged by Regina Benjamin’s background of working with low-income communities in Alabama and hope she is as aggressive about the health needs of children as she has been for the health needs of her patients in Alabama,” said William Bentley, CEO of Voices for America’s Children.

Benjamin took her medical and business degrees back to Bayou La Batre, Ala., just 30 miles from her hometown of Mobile, and started the Rural Health Clinic, a nonprofit that provides everything from primary care services to lab work and minor surgery in an area where some patients need to make payment in oysters and shrimp.

The clinic was knocked over by Hurricane Georges in 1998; Benjamin rebuilt it. The storm surge from Katrina destroyed it again; she rebuilt again. In 2006, one day before the clinic was supposed to reopen, a fire gutted it. It continues to operate in a rented house nearby as a new clinic is built on the grounds of the old one.

Last year, Benjamin’s work in Bayou La Batre garnered her a coveted spot in the MacArthur Fellows Program – popularly known as a “genius award” – from the MacArthur Foundation, a distinction that comes with $500,000 over five years to be spent at the recipient’s discretion.

“We need a strong advocate, which I think we now have, that understands the barriers that face so many children and youth in getting access to quality health care,” said Dr. Irwin Redlener, co-founder and president of the New York-based Children’s Health Fund.

Obama’s selection of Benjamin is fairly reminiscent of George W. Bush’s selection for Surgeon General, Richard Carmona. He was a 17-year member of the Arizona special weapons and tactics (SWAT) team before becoming a trauma surgeon and a professor of surgery at the University of Arizona. That’s a very different career path than Benjamin’s, but both are candidates whose legitimacy comes from on-the-ground experience.

Now the question is: Will the Obama leadership at Health and Human Services -which houses the Surgeon General’s office – utilize Benjamin? Carmona is by all accounts a dynamic, engaging guy, but there was some speculation that HHS leaders did not want him to outshine bigger fish or say something too controversial.

It’s hard to look at the scorecard from the Bush White House and not think that the Surgeon General’s office was sidelined. Clinton appointee David Satcher released 14 official reports from 1998 to 2002. Several of them focused largely on youth, including timely looks at children’s mental health and youth violence.

Over the same amount of time, from 2002 to 2006, Carmona produced two studies: one on secondhand smoke and another on osteoporosis. Satcher put out more reports in his two years under President Bush than did the president’s own appointee.

Marsha Raulerson, a friend of Benjamin and the past president of Voices for Alabama’s Children, would like to see Benjamin focus on a slate of prevention issues: healthy lifestyle, immunization and nutrition. “I’d like to see her put a lot of emphasis on the health care of children as a means to prevent adult disease, and I think she’ll do that,” Raulerson said.

Redlener also voiced a desire for prevention advocacy, and said he’d also like to see the office address specific barriers that keep youth from seeing doctors, such as communities without enough medical professionals, inadequate public transportation and cultural language barriers. 

June 30

Bryan H. Samuels, a veteran youth services leader in Illinois, has been tapped to head the Administration on Children, Youth and Families (ACYF) a key youth-serving agency for Health and Human Services Secretary Kathleen Sebelius.

Samuels, who grew up in a residential school from age 7 on, ran the Illinois Department of Children and Family Services (DCFS) from 2003 to 2006. During that time, those familiar with his work say, he helped continue to reduce caseloads and the number of children in state care — a trend initiated by his predecessor, Jess McDonald.

After resigning the DCFS post, he became chief of staff to U.S. Education Secretary Arne Duncan when Duncan led the Chicago Public Schools.

ACYF is part of the Administration for Children and Families, a division of the Department of Health and Human Services (HHS). It houses the Family and Youth Services Bureau, which funds services that range from homeless youth shelters to abstinence education, and the Children’s Bureau, which manages the matching funds that go to states for child welfare services and conducts Child and Family Services Reviews (CFSR) of the 50 states child welfare systems.

For more on Samuels, click here.


Prominent youth researcher and Clinton-era leader Joan Lombardi will serve in two roles for Kathleen Sebelius, the secretary of health and human services (HHS). Lombardi is deputy assistant secretary for the Administration for Children and Families (ACF), will also be ACF’s interdepartmental liaison for early childhood development.

Lombardi was deputy assistant secretary for children and families under Clinton, and before that served as his associate commissioner of the Child Care Bureau. Since then Lombardi has served as director of The Children’s Project, which helped foundations develop youth-related policy initiatives and projects, and as a professor at Georgetown University’s Public Policy Institute. 

Lombardi will likely answer to Carmen Nazario, who has been nominated by Obama to head up ACF. Nazario’s confirmation hearing has not been scheduled yet.


June 8

Cindy Mann, who has been influential in the development and expansion of state child health insurance programs (SCHIP), will lead the Center for Medicaid and State Operations (CMSO) for Health and Human Services

Mann was the executive director of the Center for Children and Families at Georgetown University’s Health Policy Institute. She was a notable voice for expansion of SCHIP, a movement that was thwarted by two vetoes by President Bush and then signed off on by President Barack Obama in February.

Mann was perhaps most effective in highlighting the problems with a directive issued by the Bush administration that could have stunted states’ efforts to reach more youths with SCHIP. That directive has since been rescinded.

This is not Mann’s first time at CMSO, which is a part of the larger Center for Medicare and Medicaid Services. Before going to Georgetown, Mann was director of the Family and Children’s Health Programs at CMSO from 1999 to 2001, when SCHIP was in its infancy. 


June 4

Eskinder Negash has been appointed to be director of the Office of Refugee Resettlement, a division of the Administration for Children and Families that handles federal work on unaccompanied alien children and human trafficking.

Negash is currently the chief operating officer at the U.S. Committee for Refugees and Immigrants (USCRI), a position he has held since 2002. He has three decades of experience working with refugee populations, both in the United States and in Sudan. Negash has first-person experience as well; he came to the U.S. as a refugee from Eritrea.

ORR’s budget has grown about $100 million since 2005, when it was $485 million.

May 6


Carmen Nazario, a former Clinton administration official at HHS’s Administration for Children and Families, is the nominee to lead the agency for the new administration.

We mentioned a few candidates for this job before (see below), including former assistant secretary for children and families Olivia Golden. Nazario served first as Golden’s associate commissioner for child care, and then became her principal deputy in 1999.

Nazario’s name may ring out less on the mainland than that of Golden or even Joan Lombardi, who also ran the child care bureau for a time under Clinton. But Nazario’s experience with family-serving agencies is remarkably diverse. She cut her executive teeth running social services in Norfolk, Va., and Loudoun County, Va., then served as Delaware’s secretary of health and social services.

“She’s very talented and thoughtful, and very committed to kids,” said Golden, who recruited Nazario for the federal post from the Delaware job.

“She was competent and hard-working,” recalls Tom Eichler, who preceded Nazario at Delaware’s health and social services post before leading the Delaware Department of Services for Children, Youth and Their Families.

“She did a lot around welfare reform – things that impacted greatly around children – and developed a fine national reputation,” Eichler said.

After her stint with Clinton, Nazario took a job with the Jordan Poverty Alleviation Program, a USAID-funded project to help Jordan develop a social service system. And from 2003 to 2008, she ran Puerto Rico’s Administration for Children and Families, which has a staff of 4,000.

The last permanent assistant secretary for children and families was Wade Horn, who left the Bush administration in April  2007. The agency, which oversees programs ranging from foster care and homeless youth services to unaccompanied minors and child support enforcement, is usually provided a budget just south of $50 billion.

March 4

Health and Human Services Designee Kathleen Sebelius is expected to face some tough questions about her views on abortion from Republicans, then be confirmed, assuming she and the IRS are square. On youth issues, her reputation is built mostly around her strong push to expand health coverage to more children in Kansas and her support for early learning.

“The governor’s support for investments in early learning was a key factor in increases over the past several years for programs such as Smart Start, Early Head Start, Pre-K and the Early Childhood Block Grant,” said Gary Brunk, CEO of Kansas Action for Children, in an e-mail.

But Sebelius has something in common with Anne Holton, one of the candidates who might serve as Sebelius’ assistant secretary for children and families (see below). They both drew the ire of child welfare watchdog Richard Wexler, whose pen is mightier than many a sword.

In late 2007, Wexler, who heads the Alexandria-Va.,-National Coalition on Child Protection Reform, started digging into what exactly the Kansas Department of Social and Rehabilitation Services was counting as a child’s removal from his or her home.

He found that caseworkers frequently were removing children from their homes before a decision was made about the child’s short-term plan (back to family or into care), and calling it protective custody. Those put into this protective custody were not being counted as removals when the state reported data to the feds.

 In 2006, he estimated, Kansas undercounted its out of home removals by at least 2,000 by not including those placed into protective custody. Wexler took the information to ACF, but no action was taken.

That 80 percent of the youth in this “protective custody” were returned home without further placement is of no consolation to Wexler. Six days, which is the maximum the state agency has before holding a hearing in a case, is enough to do plenty of  damage to a young child, he explained to us in 2007.

“Children experience time very differently from adults – for children it moves far more slowly,” he said. “And the hurt is all compounded if the child is institutionalized, cared for by rotating shift staff.”

Others in child welfare are just fine with Sebelius. The Child Welfare League of America presented her with its Bright Futures Award in 2006 for Kansas’ progress as it moved toward privatization of its child welfare system.

“When it comes to the specifics of child welfare policy, a Sebelius-Holton team would be a dream team for special interests like the Child Welfare League of America, but not for children at risk of being torn from everyone they know and love,” Wexler wrote on his blog on March 1.

Feb. 5

Administration for Children and Families

There is no doubt that Tom Daschle’s withdrawal has slowed down significantly the hiring of assistant secretaries at HHS, including whoever will run ACF. There was talk early on that the top spot would go to Kevin Ryan, who helped turn around New Jersey’s child welfare system andlater was involved in reform work in Michigan and Washington, D.C. But Ryan is a family man, and although undoubtedly tempted by the idea of working with Obama, he is opting to stay where his wife and children are – in New Jersey – and run international youth services giant Covenant House (based in New York).

That leaves three people who sources say are interested in the job: Joan Lombardi, Olivia Golden, and Anne Holton. But as one source put it, with Daschle out “all bets are off.” It’s possible none of these candidates would be on the wish list of a new HHS designee; it’s possible one of them could actually be the designee for HHS.

Lombardi and Golden are well-versed in the ways of ACF. Lombardi held two positions within the agency under President Bill Clinton: deputy assistant HHS secretary for external affairs and associate commissioner of the Child Care Bureau. Golden ran ACF for Clinton from 1996 to 2001, and before that was the commissioner of children, youth and families, which is the position that oversees the Children’s Bureau and the Family and Youth Services Bureau.

The two took different paths after their time in the executive branch. Lombardi, who is now a consultant, became director of The Children’s Project at Georgetown University Public Policy Institute, an initiative to promote larger philanthropic and civic investments in working with youth and families.

Golden ran D.C.’s child welfare system for three years, beginning in 2001, and served as former New York Gov. Eliot Spitzer’s director of operations for one year, with intermittent stops at the Urban Institute (where she is currently employed).

Both Lombardi and Golden served with Voices for America’s Children Deputy CEO George Askew on Obama’s transition team for ACF. 

Holton is, sort of, an outsider to the federal fray. She was a juvenile and family court judge in Richmond, Va. But she is the wife of Virginia Governor, DNC Chairman and crucial Obama backer Tim Kaine (D), so it isn’t as if she lacks traction as a candidate.

Holton has made it her mission since becoming First Lady to promote in Virginia the permanent placement of older foster children, either in their foster homes or through adoption. She launched a nonprofit called For Keeps that serves as the central entity for that movement. Holton delivered a keynote speech on the initiative at this year’s National Council of Juvenile and Family Court Judges Conference in Norfolk, Va.

“We have incredible respect for Anne Holton,” said John Morgan, executive director for Voices for Virginia’s Children. “She is a great combination of having real heart and sensitivity and very much understanding the complicated policy involved” in children’s issues.

Richard Wexler, heads of National Coalition for Child Protection Reform, which advocates for increased attention to family preservation in the child welfare system, said Holton has not paid enough attention to birth parents during the For Keeps Initiative.

“She seems to view permanence for children only in terms of adoption,” Wexler said. “And at a time when impoverished families desperately need more help to stay together, she took the money they could have used and spent it instead on a giant, needless pay raise for middle-class foster parents.”

But Wexler praised her for changing “financial incentives to Virginia counties in a way that discourages institutionalization of children” in the child welfare system.


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