Navigating Gubernatorial Transition in North Carolina: A Q&A with Debra Farrington of NC DHHS

Farrington, a former Milbank Fellow, emphasized identifying priorities, engaging with legislators, and documenting relationships with community partners, so that important initiatives are understood as shared commitments. She also underscored grounding the agency’s work, particularly efforts related to rural and minority health, in its mission and the data showing both progress and the ongoing needs of residents.

To start, can you describe the major transitions that North Carolina’s Department of Health and Human Services experienced over the last couple of years?

North Carolina experienced a number of transitions recently. At the end of 2024, the state elected a new governor, Josh Stein, after a long period under Governor Roy Cooper, who was a strong advocate for health and human services, especially for those who are marginalized and in need of better health. Because NC DHHS is a cabinet agency, that meant preparing for a change in executive leadership, priorities, and relationships. At the same time, there were leadership changes at the federal level, shifts in the state legislature, and changes across North Carolina’s 100 counties. Some of those changes were planned, such as retirements or career moves, while others reflected the uncertainty that comes with any political transition. It was a time of uncertainty for us, and a time to refocus and recommit.

What made this transition especially complex from a health policy perspective?

The transition came at a time when North Carolina had just achieved or launched several major health policy priorities. Medicaid expansion had passed after extensive bipartisan negotiation. It was a huge success for our General Assembly to agree that expansion was important for North Carolina from an economic and health standpoint. The state had also made an investment of more than $835 million in behavioral health, an area long recognized as underfunded and urgently in need of attention. In addition, the Healthy Opportunities Pilots, authorized through Medicaid’s 1115 waiver, were underway in multiple regions of the state, to address nonmedical drivers of health such as food. And early results were showing some of the outcomes we had hoped for.

We spent time thinking about how to sustain these successes. For example, the behavioral health investment planning was just beginning, and Medicaid expansion could change if federal funding ratios change. We needed to maintain our connections in the General Assembly, and with community partners, and make sure that our new executive branch leaders were equipped with the information that they needed to continue forward movement.

How did the department think about sustaining Medicaid expansion during the transition?

Medicaid expansion passed because of leadership from the governor, bipartisan support in the General Assembly, and tremendous community support. It was a North Carolina win. By anchoring Medicaid expansion to the future of the state, rather than to a single administration or political party, leaders have helped maintain support. That has meant continuing to educate policymakers, maintaining legislative relationships, and ensuring that community voices are heard. Medicaid expansion changed real people’s lives by providing access to health care on the day it went live, and nobody has been willing to lose the gains achieved.

What approach did the department use to prioritize work before the administration changed?

The department began planning more than a year in advance. Senior leaders, guided by then-Secretary Kody Kinsley, identified a list of priorities that needed to be accomplished before the transition. That list included major fiscal investments, initiatives that were already underway, and opportunities where timing mattered. We set milestones and metrics to track. At the same time, we continued the day-to-day work of an agency responsible for serving millions of people. The goal was to strike a balance and be good stewards of the day-to-day dollars while focusing on our priorities.

How did communication support the transition strategy?

Communication was built into the transition plan from the beginning. For external audiences, the department identified which accomplishments should be marked by press releases, community events, or public celebrations with partners. The intent was not only to announce progress but to reinforce shared ownership and visibility. Internally, leaders used staff newsletters, informal gatherings, and celebratory events to keep employees connected to the mission and to each other. The Office of Minority Health also developed a community and partner engagement initiative, asking each division to identify its key partners, advisory groups, councils, commissions, meeting schedules, and opportunities for public involvement. That information was organized into a guide that we publicized.

Why was the community and partner engagement guide important?

The guide helped preserve relationships during a period when leadership, priorities, and public expectations could have shifted. By documenting partners, public bodies, advisory structures, and engagement opportunities, the department made its network visible and durable. The guide also created transparency: community members could see where decisions were being discussed, which groups were connected to which issues, and how to participate. For incoming leaders, it served as a map of the department’s civic infrastructure. Publicizing the guide also created an expectation that the department would continue to listen, convene, and collaborate.

How did the department maintain relationships with the legislature across the transition?

North Carolina DHHS had already invested in legislator relationships at multiple levels of the organization, and that foundation proved essential. The governor’s office, the secretary, senior leaders, and dedicated legislative liaisons all played roles in maintaining open lines of communication with the General Assembly. Another important practice was hosting legislative open houses for newly elected members. These gatherings gave legislators a chance to meet senior leaders and staff, learn about programs, and connect on a human level in a setting that’s not politically charged.

How did leaders manage staff anxiety during the transition?

We tried to be open and honest and share as much information as we had. We encouraged managers and division directors to pass information through the organization and held town halls to answer questions. They also acknowledged that some employees, especially those in positions tied closely to appointed leadership, needed practical support. The department offered opportunities for staff to update résumés, practice interviews, and think through career options. That support was valuable even for employees who ultimately stayed, because it helped them reflect on what they had accomplished and regain a sense of agency. Leaders also invited staff who had lived through prior transitions to share their experiences. Hearing from colleagues who had navigated earlier changes and remained with the agency helped reduce uncertainty and normalize the transition process. We also developed a transition notebook that served as a guide for our incoming new governor’s office

What role did the transition notebook play?

The transition notebook converted anxiety into an action plan. Each division had the opportunity to describe its mission, the populations it served, its major responsibilities, and priority areas. The notebook gave incoming leaders a practical orientation to the department’s work, but it also empowered existing leaders and staff to tell their own story.

How did the department continue work focused on populations with the greatest health needs?

We have had staff focused on addressing the needs of populations who have the greatest health disparities for decades. We have an Office of Rural Health that’s existed for 50 years, and an Office of Minority Health that’s existed for 35 years. During the transition, staff had understandable questions about whether they would be able to continue the work. We responded by being transparent about uncertainty while also emphasizing that the underlying needs of our populations had not changed. Our health disparities reports and other data continued to show infant mortality, maternal mortality, were highest in communities of color, so we needed to be able to continue to lower the numbers of babies and mothers that were dying. That is difficult to argue with — and when we describe the work that way, we see widespread support for it.

Looking back, what would leaders have done differently?

One lesson was the importance of even more frequent, face-to-face communication with staff at multiple levels. While the department communicated through formal channels and middle management, some staff later shared that they wanted more facetime during that difficult transition period.

What were leaders especially glad they did?

We were able to maintain the levels of trust that we had built through all levels of government during the transition. I think those relationships and the communication that had been established prior to the transition helped us navigate a difficult time. And I’m glad to say that our teams are intact and growing. I’m also happy about the way that I was able to advocate for the work that we do in all of our offices, including rural health and minority health. One of the ways that I did that was by being clear about our goals and our vision, as well as what we’ve accomplished and what work remains.

This interview was condensed with the assistance of AI.