COGE report recommends New Hampshire split apart health department, embrace AI

This article was originally published by New Hampshire Bulletin.

It was one of Gov. Kelly Ayotte’s earliest priorities this year: A “Commission on Government Efficiency” that would review ways to reduce cost and waste in the New Hampshire government and whose acronym, COGE, bore a striking resemblance to DOGE, the controversial federal effort led by Elon Musk. 

Now, 10 months after the governor first introduced the concept, that commission has delivered to Ayotte its first report. 

The final 77-page document, created mostly out of the public eye by a team led by former Republican Gov. Craig Benson and former AutoFair Automotive Group CEO Andy Crews, includes suggestions for both basic and transformative changes. Here are some of the report’s major recommendations. 

A Splintering of Health and Human Services?

One idea in the COGE report would be a major change: the breaking up of the state Department of Health and Human Services. 

The report calls for “a careful, data-driven evaluation” to determine whether the department should be split into smaller agencies. Currently, the agency oversees a number of areas that include child protective services, mental health care, public health, and Medicaid and Medicare services. That wide-ranging mandate has caused Health and Human Services to grow into a “behemoth agency” that makes accountability difficult, the report argues. 

“The scale of its operations can obscure performance, complicate oversight, and slow decision-making,” the report states. “In some areas, divisions have grown large enough to function as stand-alone agencies in all but name, each with its own administrative structure, management layers, and reporting processes.” 

The report argues that to be effective, the split should result in a reduction of bureaucracy, not an increase. “Smaller agencies could set clearer goals, benchmark progress, and identify inefficiencies more quickly,” the report states.

COGE includes a number of other ideas for streamlining health care. The report argues Health and Human Services should increase its efforts to find fraud within the Supplemental Nutrition Assistance Program and stand up an automated verification system for Medicaid enrollment.

Embracing AI

The COGE report says artificial intelligence could be an asset to the state — if used correctly. 

The best use case, COGE argued, is to help automate routine tasks. That could include summarizing regulatory documents, sorting correspondence, and flagging duplications. It could also help to verify information by using databases and to detect anomalies that could indicate fraud.

“The goal is to use technology to handle time-consuming, repetitive, or highly administrative tasks so that state workers can focus their time and expertise on work that requires human judgment, compassion, and decision making,” the report states. 

That approach requires human input, the report notes: “These pilots should be designed with clear objectives, human oversight, and measurable outcomes such as time saved, backlogs reduced, or improved citizen response times.”

The report also recommends the use of AI chat assistants. “These tools can safely respond to basic inquiries, such as providing office hours, directing citizens to forms, or checking the status of simple requests,” the report states. 

Beyond AI, the report suggests creating a statewide system to manage constituent interactions, allowing departments to better share information about residents’ concern and problems. 

Workplace Overhauls

The report recommended the state end remote work options and move fully to in-person work in order to support teamwork.

Some recommendations call for new programs to improve the state’s workforce. The report recommends that state agencies increase externship opportunities for state university and community college students to allow more hands-on experiences. And it suggests building partnerships between community colleges and trade schools and the state’s Department of Corrections to provide more work training for inmates.

Other work-related suggestions are focused on reducing costs. The report asks state departments to conduct a “top-to-bottom review” of management-to-staff ratios. It also urges them to post job openings “at their original classification and pay level,” and not post the salaries of departing employees.

COGE called on the University System of New Hampshire to catalog administrative roles that are redundant and could be eliminated, and it said state agencies should conduct a similar review of public information officers.

It also said state agencies should look into ways to streamline legal services, perhaps by eliminating in-house attorneys in favor of support from the Department of Justice. 

Reducing State Oversight Boards

Two recommendations centered on state boards. The report said the state Office of Professional Licensure and Certification should consider keeping the “largest and most complex” boards as governing entities, but converting smaller boards to advisory panels.

And it said lawmakers should look into easing some of the professional requirements for serving on a state board, to favor experience over educational attainment or credential achievement.

Tighter Controls Over Indigent Defense, Right-to-Know Requests

In a suggestion that echoed efforts on the Executive Council, COGE suggested creating a centralized system for courts to evaluate applications for indigent defense counsel. 

In October, Republican Councilor John Stephen of Manchester led a move to hold up reimbursing the state’s Judicial Council for $5.5 million of funding, arguing that more controls are needed to confirm eligibility. Weeks later, the council approved $1.5 million of that reimbursement — about a quarter of the Judicial Council’s request — with Stephen saying the rest of the money would be contingent on the creation of a verification system.

The COGE report agreed with that suggestion, stating that the judicial branch should create a “centralized clearing system” using standardized criteria to determine income eligibility.

COGE also suggested the state should change its laws to only require indigent defense counsel be provided to defendants whose charges could result in jail time, and not just a misdemeanor or fine, in order to reduce costs. That would peg the state’s policy to the minimum required indigent defense level established by the 1972 U.S. Supreme Court opinion in Argersinger v. Hamlin. 

One recommendation by COGE would reduce Executive Council oversight, however. The report calls on the Legislature to consider raising the spending threshold for state contracts to require council approval; currently that threshold is $10,000, meaning the council has a number of opportunities to block funding or ask questions.

And the report urges a change to the way agencies process right-to-know requests: COGE suggests prioritizing records requests from New Hampshire residents and organizations over those based out of state.

Infrastructure Efficiencies

Large portions of the COGE report mention the need for state departments to reduce waste. In some cases, that means auditing state-owned properties to determine which ones are underused and could be sold off. 

In other cases, COGE has called on departments to adopt collective standards for vehicle fleets, and to possibly pool vehicles across multiple agencies. The report recommends reviewing “who genuinely requires access to a State vehicle.” 

The report says more reviews should be taken to reduce energy costs and HVAC optimization. 

And it calls for the Department of Transportation to take over management of the state’s ports and harbors from the State Port Authority in order to expand access to federal grants and pursue a better transportation strategy that could boost state revenue.

Uncertain Future

The report immediately drew praise from Ayotte. But it is not clear how many of the recommendations might be quickly implemented. Some could be achieved through executive order, but many would require comprehensive legislation. For lawmakers, the filing period for 2026 legislation has passed, but there are some mechanisms to introduce late legislation. 

Nonetheless, Ayotte said she would begin sifting through the suggestions and determine which she might push for. 

“This was done the New Hampshire way, with contributions from Commissioners, state employees, and members of the public who shared their input and ideas,” Ayotte said. “This report shows that when we focus on making operations better, we can deliver more value for taxpayers and build a more modern, efficient, and responsive government for all of New Hampshire.”