The Idaho Department of Health and Welfare (DHW) is perhaps the most high-profile state agency in our government. It is ultimately responsible for around $6.5 billion in federal and state funds and manages programs ranging from Medicaid and foster care to state psychiatric hospitals.
Following a 2023 audit that found serious deficiencies in DHW’s administration of federal grants, prompting a referral to the attorney general’s office, then-Director Dave Jeppesen retired at the end of the year. Gov. Brad Little appointed Department of Insurance Director Dean Cameron to lead the agency on an interim basis before selecting his budget director, Alex Adams, as its permanent head in 2024. When Adams left for a position in the Trump administration in 2025, Little elevated DHW Deputy Director Juliet Charron, who has continued efforts to stabilize the embattled agency.
However, just over a year after her own appointment, Charron announced that she would be leaving the agency at the end of this year for family reasons. Boise State Public Radio reported the news last week:
Emily Callihan, Gov. Brad Little’s communications director, confirmed Charron’s departure Wednesday afternoon, saying she would leave her post before the end of this year to “focus more fully on supporting her family as her father faces significant health challenges.”
In a letter to IDHW employees, Charron wrote that serving as the agency’s director “has been one of the greatest honors of my professional career.”
“This has not been an easy decision. The past year has brought significant challenges for my family, and I realize that they need more of my time, attention, and support.”
Callihan didn’t offer an exact date for when Charron would step down, nor who might replace her on an interim basis.
In addition to managing the state’s largest budget, DHW has taken on the responsibility of overseeing nearly $1 billion over the next five years in Rural Health Transformation funding. Whoever takes on the role in January will immediately step into the spotlight as the Joint Finance-Appropriations Committee (JFAC) begins parsing budget requests for DHW and its various divisions. Agency directors often testify before JFAC to justify budget requests or provide context for various line items. Whoever takes on the role, whether as permanent or acting director, must be prepared for this task.
Gov. Little has been in this situation before. When Dave Jeppesen retired at the end of 2023, the governor appointed Department of Insurance (DOI) Director Dean Cameron as interim director of DHW. Cameron led the agency throughout the 2024 legislative session while the governor searched for a permanent replacement. Little appointed Alex Adams in May, and Adams took office on June 5, 2024, but did not receive Senate confirmation until January 20, 2025.
A similar sequence could play out following Charron’s departure, with an interim director overseeing DHW during the 2027 legislative session and a permanent successor appointed afterward. Under Idaho law, department directors can begin serving before Senate confirmation, meaning a permanent director appointed in summer 2027 would face confirmation in 2028.
Who Gov. Little will choose to lead DHW remains a mystery, but there are several interesting possibilities:
Monty Prow currently serves as the deputy director for Child, Youth, and Family Services within DHW. He previously served as director of the Department of Juvenile Corrections, giving him the valuable experience of having led a cabinet-level agency. If the governor is planning to promote from within DHW, as he did with Juliet Charron, Prow would be an obvious choice.
Miren Unsworth would also come from within DHW, having spent 21 years at the agency, including as a deputy director and division administrator. She currently serves as deputy director of Health and Human Services and has experience with multi-system integration.
Jared Larsen spent more than five years as counsel and policy advisor to the governor and now serves as chief of staff at DHW. Since the director of DHW must work closely not only with the department itself but also with the governor’s office and the Legislature, Larsen’s résumé could make him uniquely qualified to handle all three facets of the role.
Lori Wolff succeeded Alex Adams as administrator of the Division of Financial Management (DFM) when he moved to DHW in 2024. Prior to that, she served in the governor’s office and as administrator of the Division of Human Resources. However, Wolff also spent 18 years at DHW itself, in roles including deputy director and division administrator. Will Gov. Little return to the DFM well one more time?
Lauren Smyser took over as the governor’s director of operations this past summer, after previously serving as deputy general counsel for the governor and working in DFM. Smyser is an attorney who specializes in healthcare law and could bring a unique perspective to DHW. She is younger than most cabinet-level directors and has spent less time in government, so this would be a much more out-of-the-box pick.
Other top officials at DHW—Sasha O’Connell, who leads the Division of Medicaid; Michael Pearson, who leads operations; and Misty Lawrence, the chief financial officer—could also be under consideration.
Whoever is picked, whether as an interim director for the 2027 legislative session or as permanent director going forward, will have their hands full with a massive budget and numerous programs, many of which are inextricably connected to the federal government.
The cost of Medicaid—especially Medicaid Expansion, which covers working-age, able-bodied adults—continues to climb. Idaho needs a director who, like Alex Adams, understands the necessity of reining in spending, reforming processes, and maintaining focus on the responsibilities the Legislature has assigned to the department. Whoever the governor chooses will have a significant influence on the fiscal health—and actual health—of our state for many years to come.
Newsletter
The Dept. of Insurance brings you up-to-date regarding the Idaho School Benefit Trust, new health insurance rates, and a couple of convictions for fraud.
Video of the day
My family has been buying Johnsonville jalapeño and cheddar sausages from Winco lately, and my children have really enjoyed them, especially my five-year-old son. He wanted to see how such things were made, so I found this video on YouTube that turned out to be exceptionally well done:
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