Agency Streamlining Still Needed; More Options in Play in 2025
In the 125th General Assembly (2023-24), South Carolina legislators passed a bill separating the behemoth Department of Health & Environmental Control (DHEC) into separate agencies (Act 60, 2023). Following that much-needed reform, legislators’ efforts turned toward finding comprehensive measures that would streamline health functions across state government. The state had 6 separate agencies that all dealt with the health of South Carolinians.
Last year the Senate passed S.915 and the House passed H.4927, each combining health functions across numerous freestanding state agencies into a new Executive Office of Health and Policy. The concept was on a glide path to the Governor’s desk, and the result was to be the most significant realignment of state government agencies since 2014, and perhaps even since 1993.
The changes proposed represented a significant opportunity—not only to save taxpayer dollars by eliminating duplication, but to serve citizens more effectively, particularly those with complex health needs that transcend existing agency organizational charts. Unfortunately, even though S.915 passed the Senate 44-1 and the House 98-15, a last-minute procedural move kept the bill from being signed into law.
For the 126th General Assembly (2025-26), Senator Harvey Peeler (R-Cherokee) has taken another crack at streamlining with S.2, a more limited bill which establishes the Department of Behavior Health and Developmental Disabilities. The Peeler plan merges three existing agencies: the Department of Mental Health, the Department of Disabilities and Special Needs, and the Department of Alcohol and Other Drug Abuse Services. This more nuanced reorganization has been proposed as an alternative to the establishment of the Executive Office of Health and Policy, which would have incorporated five state agencies.
On the House side, Representatives Lee Hewitt (R-Horry) and Sylleste Davis (R-Berkeley) have filed H. 3613, which is similar to last year’s Executive Office of Health and Policy bill.
What now?
Although the splitting of DHEC created an ideal opportunity to further restructure South Carolina’s health agencies the very next year, late is better than never. Each of this year’s bills, in their own way, improve on previous attempts at healthcare restructuring because they incorporate lessons learned from past debates and address concerns raised by stakeholders. The new 2025 bills include more accountability measures and clearer delineation of responsibilities. Additionally, they keep the more comprehensive approach to healthcare management, considering the interconnected nature of various health services.
Thankfully, it is clear from the text of each bill that any new health agency will not be granted increased powers. The supreme authority of the governor over his or her cabinet agencies, oversight and confirmation procedures already in place, and additional safeguards built into the legislation are designed to protect the rights of citizens from arbitrary government police powers. There are additional political, legal, and administrative remedies outside of these as well.
Why now?
Health agency restructuring represents a crucial step towards modernizing South Carolina healthcare in order to better serve “the least of these” among us. By consolidating as many as five or as few as three health agencies under a single umbrella accountable to the governor instead of a board, South Carolina can achieve greater efficiency, reduce bureaucratic hurdles, and provide more coordinated care to its most vulnerable citizens.
As an example, let’s take a family with a child with developmental needs. With those developmental issues, there are often mental health needs and substance abuse concerns in play in the family as well. An agency with all three portfolios would be in a better position to provide a “one stop shop” than three separate agencies with three separate siloed bureaucracies. With the restructuring that each of these bills enshrine, access to these services would be streamlined. Restructuring allows for a single point of contact for certain health needs, which inevitably reduces waiting times and improves service delivery. Restructuring also ensures that lessons learned from past inefficiencies are taken into account.
Regardless of which bill South Carolina’s legislators ultimately advance, S.2 or H.3613, it is clear that change is needed to improve coordination between different health departments with many of the same clients. This will ultimately lead to better health outcomes for all South Carolinians.