DHHR preparing for a year of changes in foster care

CHARLESTON - The next year for foster care in West Virginia will be full of changes as the state prepares to select a managed care organization to oversee the health care of children in state custody.

Jeremiah Samples, a deputy secretary for the Department of Health and Human Resources, said selecting an MCO will help the state comply with a settlement between West Virginia and the federal Department of Justice.

"The agreement with the DOJ basically calls for the state to continue its efforts to deinstitutionalize the care provided to children that are in state custody," Samples. "West Virginia has had historically high percentages of children that are in state care in congregate care settings, or institutional settings."

Samples said the state was beginning to make some efforts to reduce the number of children in congregate care, but the opioid epidemic ramped up and more and more children were removed from their homes.

Since 2014, the state saw a 67 percent increase in the number of children in state custody. Over that same period of time, though, Samples said the number of children in congregate care decreased.

Congregate care differs from institution to institution, but it often involves children living in a facility away from their families and sometimes far away from the community they're from. As a part of the program, they usually attend structured therapy programs. Experts say children should be put into congregate care only as a last resort, and even then, it shouldn't be a permanent solution.

The DOJ, after a lengthy investigation, found that West Virginia failed to meet its obligation to disabled children eligible for state care.

U.S. Assistant Attorney General Eric Dreiband, with the DOJ's Civil Rights Division, said there was "reasonable cause" to believe the state violated the Americans with Disabilities Act by not giving these children the mental health care "in the most integrated setting appropriate for their needs."

"The agreement commits the state to make available mental health services to children in their homes and communities in the intensity and for the duration of time that they need them," Dreiband said. "The agreement requires the state to expand mental health services across the state."

The services will include wraparound facilitation, behavioral support services, family support and training services, in-home therapy, children's mobile crisis response and therapeutic foster care, among others.

Samples said that having a managed care organization for children in foster care will help the state meet the requirements of the DOJ settlement. He said DHHR has data to show that MCOs reduce the use of congregate care.

"There are children who are placed in institutional care by their parents as well, and a percentage of those families have Medicaid. When we implemented those changes in Medicaid a few years ago, we saw a decrease in the number of parental placements in institutional care. Why was that? It's because these managed care companies were able to coordinate services for the children in their own community," Samples said.

While providing care in a child's community is the best practice, Samples said managed care companies prefer that for a simple reason: It's cheaper.

Earlier this year, state lawmakers passed House Bill 2010. The 44-page bill requires the DHHR to transfer children in foster care to the rolls of a managed care organization by January 2020.

Managed care organizations are private companies that try to increase the quality of healthcare their members receive while also trying to lower costs by setting guidelines on which care is medically necessary. An MCO cannot deny court-ordered health care to a child.

Before the state selects a company to be West Virginia's MCO, it will have to put out a request for bids. Whatever contract the state ultimately signs will be worth millions of dollars.

In anticipation of putting that out for bid, DHHR previously accepted public comments on the idea before lawmakers started discussing an MCO. DHHR officials have said they planned to use an MCO, even if HB 2010 didn't pass.

"We have gone through and had another public comment period," Samples said. "We put out on the website our responses to those comments. It's quite voluminous. We got a lot of great questions. I think there is a lot of improvement to the original draft thanks to those comments."

Compared to the first public comment period, Samples said there was a "significant increase" in the number of comments the agency received. He attributes that to the media attention the bill got during the legislative session.

"One of the changes stemming from the most recent public comment period involves the socially necessary service process," Samples said. "Essentially, these services are paid for by the Bureau for Children and Families. They are services designed to help families and parents take better care of a child, which could include a broad range of support services like help with re-unification or transportation to various types of therapies.

"Basically it's manning those services but not in a full capitated model. That's pretty wonky in terms of the insurance lingo, but basically we're still paying fee-for-service for those supports. Then the managed car company for that part of the service array, will be tracking it, doing utilization management, making sure the services are provided properly But they won't be including that in their capitated payment."

Another change, Samples said, seeks to clarify the relationship between Child Protective Services and whatever managed care organization is selected. Samples said that relationship will be further clarified when an actual contract is drafted.