The West Virginia Legislature is being asked to pass House Bill 2010, which mandates that the state invest hundreds of millions of federal and state dollars in a contract with a single insurance corporation whose business is built on handling transactions by phone.
Our Department of Health and Human Resources is rushing to transfer its resources and oversight for child welfare and foster care over to this kind of business to serve as a Managed Care Organization.
We need to keep the “human” in Health and Human Resources. In-person casework has always been at the core of its work with child abuse and neglect, youth services and foster care.
A number of legislators from both parties have been expressing their discomfort with what is occurring. They know from their constituents that we are dealing with a crisis, most of it related to drug addiction, that is creating unbearable pressure on these child welfare and foster care systems.
The DHHR has told lawmakers that it is incapable of getting the job done, and the only answer is to transfer funds and delegate its accountability to an MCO that promises to fix it all.
Based on what I have read so far of more than 700 pages of contract materials that the DHHR has put out for comment, I am convinced more than ever that this transfer is a giant step in the wrong direction.
Do we really want to pay call centers to remind foster parents to get kids to appointments when the foster parents are already being paid to do this? Will Child Protective Services workers feel pressured to set aside abuse and neglect reports in order to get kids to their periodic screenings to save the MCO from hefty fines under their contract? Important though these appointments may be, protecting the safety of kids at risk has to come first.
I also question how anyone can really grasp family dynamics to make a decision affecting their services just by talking with one or more of the family members over the phone. Or if the MCO staff can even get a glimpse into the home environment of these families without visiting their homes in person as child welfare workers do.
It is like a perfect storm of misplaced priorities. We have real problems to solve here. Collectively, we know what these problems are and what to do about them. We cannot afford to indulge in paying for an MCO solution that is in search of a problem.
What the state must do is take the estimated $25 million per year — this is likely to be a lot more as needs and costs increase — that is now being projected for the MCO’s annual administration and profits and invest it in our own caseworkers, communities and services.
We can use these funds to build staffing capacity for licensed professionals via career ladders and adequate compensation, deploy community planners to assist on the ground with the coordination of services and expand badly needed prevention and early intervention options to cover our whole state. We can establish an organized, fair and inclusive system for kinship care. We can build on work already being done to provide universal health records with confidentiality protection.
Simply put, we do not need to pay millions per year for an added layer of bureaucracy to “manage” care for vulnerable children and families. We must invest these funds into ensuring that high-quality professional services are available in every part of our state. There also might be roles for trained paraprofessionals, like the homemakers and case aides the DHHR used to employ, to work alongside the caseworkers as part of a team in support of a family.
This is not a quick fix. However, there are already people making these kinds of investments in their own education, in teaching new generations of social workers, counselors, psychologists and other helping professionals, and in building community coalitions to coordinate and make the most of available resources.
We need to learn more about what our institutions and communities are doing and invest in their work.
Bringing in a call center of care or case managers, as this proposed DHHR MCO contract would do, is not the answer. Talking with strangers by phone might be helpful in some situations, but overcoming deep-rooted trauma and making critical changes in someone’s life requires a hands-on approach.
We need a public planning process that is not limited by focusing on this MCO contract as the predetermined solution. We must identify our real problems and mine our ideas and experiences for the best way to solve them.
We need to take a little more time to start over and do this right. The immediate deadline for the federal Families First Act planning and implementation is flexible, and some states have already been granted extensions. The crisis we are in does not justify going full force in the wrong direction.
We need to listen carefully to everyone’s voice, including foster, adoptive and kinship parents, parents in recovery and youth who are old enough to tell their stories. Look at what is working and spread the word. Build on our considerable strengths as individuals, families and communities.
Tell the MCO corporations that are itching to control and profit from our hundreds of millions of dollars in funds that they need to look elsewhere.
I know that we can do this and take care of our own, as we have always found ways to do in our state.
In fact, we are the only ones who can.