Teresa Miller, nominated Tuesday by Gov. Wolf to be the inaugural secretary of the proposed Pennsylvania Department of Health and Human Services, said she is a big believer in her boss' "government that works" mantra.

"That means we make sure we have nursing homes that are regulated appropriately and are protecting people. That means that our child-welfare system works and that kids are not falling through the cracks. That means all sorts of things that will fall under this new agency," Miller, 41, said in an interview Wednesday.

Advocates worry that initiatives, such as heightened oversight of nursing homes by the Department of Health, could fizzle because of the proposed consolidation of the Departments of Health, Human Services, Aging, and Drug and Alcohol Programs.

"I'm going to do everything I can to make sure we have continuity in operations. We want to look for areas to improve, but I certainly don't want to stop the momentum on any issues that are currently in progress," said Miller who has been Wolf's insurance commissioner.

For advocates, who sometimes fought for decades to get a department dedicated to their constituents, the consolidation is a tough pill to swallow.

"We're cautious about the whole thing," said Diane Menio, executive director of the Center for Advocacy for the Rights & Interests of the Elderly. "If this does happen, we want to make sure there's a good leader. I hope she's it. Whoever takes over, it's going to be a challenging job."

At a Pennsylvania Senate hearing last week on the consolidation proposal, experts who work in public health, addiction treatment, and mental health spoke of the difficulty dealing with fragmented systems in multiple, often competitive, departments.

A representative from Public Health Management Corp. said services often suffer because providers don't get the full picture of a client, who might be suffering from physical and mental ailments. Plus, the person might have a problem with housing, an issue that would remain outside the new department.

Miller said a priority for her would be: "What does the interface for a particular individual look like in terms of their interaction with the government and how do we make that more seamless for them?"

At the same time, she has to figure out the really critical deadlines, such as those involved in the implementation of managed care for nursing homes and other forms of long-term care, which is supposed to begin Jan. 1 in the Pittsburgh area.

"I'm also trying to be respectful of the fact that we don't have legislation passed yet to create this agency," Miller said. "A lot of what I'm doing now is spending time with the legislature on that. It's kind of a delicate balance. I'm trying to get steeped in all of the issues, but also recognize that there is still a legislative process to play out."