Gov.-elect Janet Mills speaks to reporters Wednesday, Nov. 7, 2018, in Portland, Maine. Credit: Robert F. Bukaty | AP

Gov.-elect Janet Mills on Friday announced her choice to fill one of the most significant roles in her administration, introducing Jeanne Lambrew as her nominee to be Maine’s next commissioner of the Department of Health and Human Services.

Lambrew served under President Barack Obama as director of the Office of Health Reform at the U.S. Department of Health and Human Services, and later as his deputy assistant for health policy during the implementation of the Affordable Care Act. She also served in the federal department coordinating health policy during former President Bill Clinton’s administration. Lambrew is a former senior fellow at the Center for American Progress and a senior fellow at the Century Foundation, a progressive think tank in Washington, D.C.

“In Jeanne Lambrew, I’ve found a health expert of the highest regard. Someone who will execute the transformation that Maine people have demanded,” Mills said Friday.

Part of Mills’ goal in filling the important Cabinet-level position, she said, was to find someone “who exhibits understanding and compassion who will reinvigorate morale within DHHS and who will reorient the direction of the department toward its fundamental mission of serving the most vulnerable people here in Maine,” Mills said.

During her time as deputy assistant for health policy to Obama, “Lambrew played an integral role in implementing the Affordable Care Act — a job she wants to finish now for her home state of Maine,” the governor-elect said.

Lambrew said she will help Mills “deliver on expanding Medicaid,” and “restore trust in state government, starting with the Department of Health and Human Services.”

“In Maine, a high priority is revamping the department to be sure it delivers on its core mission,” Lambrew said. “Should the Legislature confirm my nomination, I will give my all to these tasks. Doing so here would be especially meaningful to me.”

Lambrew grew up in the Portland area, where her mother, Pat Lambrew, worked as a nurse and her father, Dr. Costas Lambrew, worked as a doctor at Maine Medical Center for nearly 40 years. The couple live in Scarborough.

She is the first prospective Cabinet member to be named by Mills and more are likely to come next week. Lambrew and Mills’ other Cabinet nominees will be interviewed by legislative committees before going to a confirmation vote in the Maine Senate.

DHHS has the largest budget of any state agency, with an annual operating budget of $3.4 billion and more than 3,400 employees. During Republican Gov. Paul LePage’s almost eight years in office, it has been a flashpoint for controversy, with the administration’s push to reduce public assistance rolls and emphasize work requirements clashing with Democrats’ policy priorities. If confirmed by the Maine Senate, Lambrew will wade into those ongoing conflicts.

An ongoing dispute over whether to expand Medicaid under the Affordable Care Act, as approved by Maine voters in 2017, continues to play out in state courts. Mills has vowed to implement expansion as one of her first acts as governor, but it remains a huge fiscal and bureaucratic challenge to put in place a system to implement expansion.

After two young girls died, allegedly at the hands of their caregivers, the way DHHS handles child protective services has come under scrutiny. And the status of federal certification for the state-run Riverview Psychiatric Center remains uncertain.

During the administration of John Baldacci, the last Democrat to serve as governor, DHHS experienced major computer network problems and incurred multimillion dollar debts to Maine hospitals after falling behind on Medicaid payments.

LePage made paying back those debts a hallmark of his governorship. In early 2011, he hired former Democrat and Maine Hospital Association lobbyist Mary Mayhew as his first DHHS commissioner. She held the position until May 2017, becoming one of the more controversial members of LePage’s Cabinet. After an unsuccessful campaign in the Republican gubernatorial primary earlier this year, she started work in October as director of Medicaid and the Children’s Health Insurance Program for the federal government.

In addition to managing the day-to-day operation of the sprawling department, Lambrew will face the challenge of steering Mills’ policy initiatives through the institutional changes that Mayhew made at DHHS.