DHHR to shift foster kids to managed care

January 27, 2019
Jeremiah Samples, deputy secretary for the West Virginia Department of Health and Human Resources, discusses a bill to reform the child welfare system in the House of Delegates' Senior, Children and Family Issues Committee on Jan. 17 in Charleston.

CHARLESTON — While lawmakers continue to consider legislation that transitions the state’s foster children into managed care, an official with the West Virginia Department of Health and Human Resources said Friday the agency intends to move forward with a managed care model regardless of whether the legislation passes.

DHHR Deputy Secretary Jeremiah Samples testified Friday before the House Judiciary Committee that the department doesn’t need legislative approval to contract with a private managed care organization to oversee medical and other services provided to foster care children, as well as those receiving adoption assistance, those formerly in foster care and those at risk of entering foster care.

“DHHR has been working for a time to move this population of vulnerable children to a managed care portfolio,” Samples said to the committee. “We don’t need the Legislature’s approval to do that. We have the authority to do that. It’s a policy decision by your colleagues to codify that.”

The Judiciary passed an amended version of the bill, House Bill 2010, with a vote of 13-11, on for consideration by the full House of Delegates.

Among other amendments, the committee added a provision to the bill aimed to ensure that DHHR employees who are involved with developing or maintaining contracts may not go on to work with an agency that benefited from the contract for up to two years. It also added an amendment instructing the DHHR to conduct a study and make recommendations for improving services for kinship foster care families in the state.

During a public hearing earlier last week, child welfare advocates and others expressed mostly opposition to managed care and HB 2010.

Samples said Friday that a managed care bill has come up several times in the past few years. Last year, he said, the department started having meetings with “stakeholders” about care management approaches. The DHHR had earlier considered moving foster kids into an administrative service organization model of care, he said.

“The comments we received were overwhelmingly in favor of going in the direction of managed care because it was more tested nationally and found to be superior for a number of reasons,” Samples said. “So in the second and third rounds of this public comment process, that has been the feedback we received thus far.”

Samples said Friday contracting with a managed care organization would require redirecting an estimated $225 million from the Bureau for Children and Families and the Bureau for Medical Services.

The $225 million would cover the state’s foster care children and those receiving adoption assistance. Two other populations, those at risk of entering foster care and those who were formerly in foster care, would be transitioned in later, he said.

Samples said the department would continue the transition to managed care unless the Legislature passed a bill telling it not to.

“We have 400,000 individuals in managed care today,” Samples said. “We did that without legislative authority or approval. We have the authority vested in Medicaid as a single-state agency through our arrangement with the federal government. It’s an executive branch decision.”

Samples said, in introducing the bill, the lawmakers were legislating what the department has been working on for a year.

“We’d been working on a model of care management model and (with) the feedback we have determined that the managed care approach is the best approach for the state to help deal with this crisis,” Samples said. “Now the Legislature has take their policy prerogative and introduced a bill to codify what we have found through this research. And if they do not pass anything, then we will continue down that path to implement managed care strategy for this population. We don’t need the Legislature to pass this bill for us to do that.”

Samples said he thinks there’s a benefit to having the executive, legislative and judicial branches of the government working together on a policy question with one voice.

“And when we’re talking about an issue as serious as child welfare — and it is, at least in my opinion, the most serious question facing West Virginia, the most serious challenge that we face — then it helps.”

He added that there have been “mixed opinions” about what approach the DHHR should pursue.

“I will say we have to do something,” Samples said. “We cannot continue to kick the can down the road. There’s a crisis today, and we are underserving these kids, and we must do something as a state.”

Betty Rivard, a Charleston resident who retired from the DHHR and has been outspoken in her opposition to a managed care model for foster children, said Friday she’s confused by the department’s decision to move forward regardless of what happens with the bill.

She said in previous meetings DHHR Secretary Bill Crouch has said he takes his direction from the governor, the Legislature and the federal government. Samples in previous meetings has told lawmakers they make the policy, she said.

“So here we are all of a sudden and the department is forging ahead on a major, major revolutionary change in how it does business, and a business that affects the most vulnerable West Virginians all over the state,” Rivard said. “And they’re saying, ’We’re going to do this regardless of what the Legislature votes/

“It’s just not adding up. I don’t understand what’s changed.”

Rivard said part of her concern is that using a managed care model would take the state in the wrong direction and hurt people, and part of her concern is the message the DHHR is sending.

“It’s like we’re being told it doesn’t matter what we do, this is going to happen regardless,” Rivard said.

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