After nearly an hour of discussion Thursday, the House of Delegates voted 67-32 to pass a bill making changes to the state’s foster care system.
House Bill 2010 includes a provision that moves West Virginia’s foster care children, those receiving adoption assistance, onto the rolls of a private managed care organization. Also included in the managed care plan, but phased in later, would be people up to age 26 who formerly were in foster care and those families at risk of entering foster care.
The Department of Health and Human Resources is currently accepting public comments on a draft contract with an MCO company. An agency official said last week that DHHR has the authority to move the children into managed care and intended to do so with or without the Legislature’s approval.
Proponents of House Bill 2010 and the managed care model argued Thursday that the bill isn’t perfect, but it’s a first step to handling a child welfare “crisis” in the state brought on in part by the opioid epidemic.
“I would agree with almost every single person who stood up and said that this is not a perfect bill,” Delegate Kayla Kessinger, R-Fayette, said. “I’m the lead sponsor of the bill and I agree. This is not an end-all, be-all to the foster care crisis.
“But every single one of us need to recognize that we’re in a state of emergency in West Virginia right now,” she said. “We are number one nationally in child removals. Our system has tripled in just the last few years because of our overwhelming drug crisis. The system is the problem.”
The state has failed its foster children, she said.
“The conversation shouldn’t be about corporations and about bottom lines, it needs to be about these kids,” she said. “They’re the ones that are falling through the cracks and they’re the ones that we’re trying to rescue.”
Those who support a managed care model have argued that it would offer foster care children more continuity of care, prevent the duplication of health care services and ensure that a child’s full medical records go with him or her when they are placed in a home or residential facility.
They also say managed care has the potential to help West Virginia children get access to mental health services within the state. The Department of Justice has been investigating the state over the past few years after writing then-Gov. Earl Ray Tomblin in 2015 to say that the state didn’t comply with the Americans with Disability Act’s requirement that children with mental illness get services in their communities.
As of the 2018 fiscal year, West Virginia currently had 501 children in state custody who were being treated in facilities outside the state.
Opponents of moving the foster care children to managed care expressed discomfort at a private managed care company making a profit from caring for vulnerable children.
DHHR has estimated that the managed care contract would require redirecting $225 million from the Bureau for Medical Services and the Bureau for Children and Families. About 10 percent of the contract would be used for the company’s administration costs, including 1 percent for profit.
Delegate Barbara Fleishschauer, D-Monongalia, said she’d gotten one email in favor and several opposing the bill. Those who opposed it, she said, didn’t understand how the state could give the care of its foster children to a profit-making company, she said.
“They don’t understand why we would be giving away something that the state has been doing since the ’30s to a profit-making company,” she said. “I think their bottom line is we shouldn’t be making profits off of our most vulnerable children.”
Marissa Sanders, director of the West Virginia Foster, Adoptive and Kinship Parents Network and other foster care parents came to the House Chamber prior to the vote Thursday. Sanders said her main concern with HB 2010 is the move to managed care.
She said she worries that foster families will be denied the care they need, will have to change doctors and will have another layer of bureaucracy to deal with.
“The medical card works very well right now,” she said. “So [managed care is] not really a solution to anything, and it’s going to make things more difficult for foster parents.”
Cheryl Ord, of Poca, is a former longtime foster care parent with three adoptive teenagers and a granddaughter in her home.
As a kinship placement, Ord’s granddaughter is already on managed care through Medicaid, and she said she’s had trouble getting her a diagnostic test for autism, which she suspects her granddaughter has. The company has declined to pay for the test, she said.
“It just makes it so hard for everyone to not be able to get [care],” Ord said. “These kids already come with lots of baggage, and having to go from place to place to try to get the care they need is ridiculous. It’s bad enough on straight Medicaid.”
Besides the managed care provision, HB 2010, as amended, also:
- Changes foster care family certification from one year to three years, with a requirement of an annual safety inspection
- Says the court may not terminate the right of a parent on the sole basis that the parent is participating in a medication-assisted treatment program for substance use disorder
- Requires DHHR to do a study and make recommendations for improving services for kinship foster care families in the state
- Says that courts may not order a child to be placed in an out-of-state facility unless the child is diagnosed with a health issue that no in-state facility serves, or the placement out of state is in closer proximity to the child’s family for the necessary care, or the services are able to be provided more timely
- Requires DHHR employ a private “foster care ombudsman” to advocate for the rights of foster care families to resolve complaints about managed care
- Requires a residential child care center that has entered into a contract with the state to accept a certain number of foster children to accept any foster child who meets the program’s criteria if the child care center has not met the maximum capacity in the contract