[8] On September 8, 2010, Disability Rights North Carolina wrote an open letter to the Department of Justice and Centers for Medicare & Medicaid Services, stating that despite thousands of individuals being referred to in-home PCS (Personal Care Services) since April 1, "relatively few" individuals had received care since, despite NCDHHS' code dictating that "assessments and patient notification should occur within 14 days."

Democratic critics of the bill said the change could provoke federal officials to withhold some or all of the state's Medicaid money, but Republicans countered that if it did, NCDHHS could suspend that part of the statute while seeking a waiver from the feds.

[10] To allow input on what to cut, Cansler made North Carolina Medical Care Advisory Committee meetings public.

[12] By October 2011, NCDHHS was facing a projected $139 million budget shortfall for Medicaid, partly because of "other agency liabilities that weren't paid for in the spending plan."

Also, a slow approval process for changes from the Centers for Medicare and Medicaid Services was projected to interfere in actually implementing the cuts before the state's deadline.

[13] In response, House Speaker Thom Tillis argued the shortfall was the fault of NCDHHS for not communicating, stating "a lot of those cuts were made in consultation with the secretary and the Department of Health and Human Services.

Among other budgetary missteps, the audit claimed that the computer system had been altered after final approval, leading to unexpected changes in the software.

[5] Despite the General Assembly's response to the Medicaid budget shortfall in October 2011, over the following months money was not indicated by lawmakers as available[14] except through the governor's office,[15] leaving NCDHHS the choice of either "large-scale rate cuts or the elimination of some optional services".

[7] Governor Perdue named Al Delia, her senior policy advisor, as acting secretary of the department in early February.

The North Carolina Association of Long Term Care Facilities asserted that if the conflicts were not resolved, "30,000 people could be 'put out on the street'."

On April 4, federal regulators gave "tentative approval" to NCDHHS' proposal, giving the state until the end of 2012 to implement fixes to personal care services.

[19] In October 2012, the state governor had $20 million shifted from other NCDHHS departments to fund adding 6,300 pre-kindergarten slots for at-risk toddlers.

[22] In October 2012, it was projected that "more than 11,000 disabled people in group or adult care homes will no longer qualify for the services through Medicaid as of Jan. 1 because the state considers them functional enough to live without them.

Wrote WRAL, "the crisis was triggered in July when the Republican-controlled legislature approved a one-word tweak to the state budget that excluded group homes from a nearly $40 million fund intended to cushion the effects of Medicaid eligibility changes for programs for the disabled.

Wos released her responses to the audit, agreeing on all points with the auditor, including the conclusion that NCDHHS had consistently exceeded budgeted amounts for administrative costs due to lack of oversight.

[30] Also that month,[31] after three years in development[32] NCDHHS oversaw the statewide rollout of NC Fast, a new system meant to manage the state's food stamps.

[26] In September 2013, Wos attracted criticism in the press for NCDHHS pay hikes, as well as a number of department hires that other employees perceived as underqualified.

[36] In early 2014, NCDHHS dealt with a backlog of duplicate food stamp applications in the NCFast system, with many people waiting over a month for benefits.

[37] On January 23, the USDA threatened to withhold $88 million in administrative funding for the state's food stamp program unless the backlog was promptly dealt with.

In July 2014, the press revealed that in March, "the staff of the Guilford County [NCDHHS had been] instructed not to enter information into NC FAST in order to hide a case backlog from the [USDA].

[26] By 2015, NCDHHS had announced that the glitches from both NCTTracks and NC Fast were resolved, and Wos had "[convinced] the legislature of the need to invest in the state’s medical examiner system.

[42][43][44] [45][46] She dealt with multiple health crises in North Carolina including the Opioid epidemic, GenX in drinking water, and the COVID-19 pandemic.

[47][49] The Department led North Carolina through a transition from free-for-service Medicaid to a model contracted by the state with private insurance companies that are paid pre-determined rates to provide health services.

[47] Healthy Opportunities was created, an initiative testing the impact of providing high-need Medicaid enrollees with housing, food, transportation, and interpersonal safety interventions with the goal of improving public health and reducing costs.

[47] The plan also updated the Controlled Substance Reporting System, helping doctors identify patients at risk of misusing opioids.

[47] In 2019 Cohen criticized the North Carolina House of Representatives' proposed budget for 2019–21, arguing that it harmed North Carolinians by making massive cuts to the Department of Health and Human Services, potentially impacting "everything from health inspections of restaurants to the safety of drinking water to child protective services.

[50] Cohen stressed the need for North Carolinians to wear face masks, practice social distancing, and wash their hands in order to prevent the spread of COVID-19.

[53][54] The Department announced the creation of up to 300 testing sites in North Carolina, active through July, and requested more supplies from the federal government.