Charleston – The West Virginia Department of Health and Human Resources has selected a managed care organization, Aetna Better Health of West Virginia, to oversee the care of children in state custody.

West Virginia lawmakers passed a bill, sponsored by Del. Kayla Kessinger, R-Fayette,  during the 2019 legislative session to let a managed care organization coordinate care for the nearly 7,000 children in state custody, including those in foster care and kinship care. States pay set fees to managed care organizations to reduce costs for Medicaid populations while aiming to improving quality and health outcomes.

DHHR officials have also said they needed to transition foster children to managed care because they were overwhelmed by the increase in children in state custody, a symptom of the drug crisis.  West Virginia has the highest per capita rate of children in state custody in the United States.

Meanwhile, some child welfare advocates have warned a managed care organization would be too focused on profit.

State officials said, in a press release, that Aetna would "aim to streamline the administration of health services; tailor services to meet the needs of enrolled populations; coordinate care for members; and work to transition members from out-of-state care to community-based treatment in West Virginia." 

"In addition, the state will integrate the oversight of its Socially Necessary Services (SNS) program under this contract to promote a holistic approach to care management for both medical and social services."

“West Virginia is in the midst of a child welfare crisis, and DHHR believes the utilization of an MCO to help provide coordinated care to this vulnerable population will assist us in addressing this issue,” Jeremiah Samples, Deputy Secretary for DHHR, said in a statement. 

Kelli Caseman, director of child health for West Virginians for Affordable Health Care, said that the kids involved in the "child welfare crisis" are experiencing their own "health care crisis."

"Children of all ages who are affected by the drug crisis – whether exposed to drugs in-utero, neglected or abused, or living in toxic environments –  usually have elevated health care needs, as healthy human development requires our needs for physical and emotional care to be met," she said. "Fragmented transitions between the child welfare system, foster care placements, living with grandparents and other family members – these threaten a child’s needed sense of safety and stability and can perpetuate traumatic experiences.

"These kids need access to comprehensive health care, with a health history that stays intact as they transition between living environments and systems. They also need a system that works to first keep them in their homes – with their families, schoolmates, and communities – before removing them. I believe that an MCO program for this specific demographic of kids and families can provide this, so I'm cautiously optimistic and eager for first steps to be taken."

She also noted that Aetna has already served as a managed care organization for West Virginia Medicaid recipients for years. 

"They've placed an emphasis on trauma-informed care recently, and most importantly to me, they expressed an interest in forming a stakeholders group to use data from the program to articulate the needs of these kids as we move forward," she said. "That means that not only the health care system but those in the foster care, child welfare, health care, public education, and juvenile justice systems can better understand the health care needs of these kids and how to prioritize challenges to improving them."

The release also said that Aetna would oversee the care of children who qualify for the federal Serious Emotional Disturbance waiver. DHHR has applied for that waiver in order to use Medicaid for more services for children with mental health problems. 

They've said Medicaid would pay for a mobile crisis response team 24 hours a day, as well as increased wrap-around services.

That might mean that case workers would ask questions and determine that one family needs more frequent home visits from mental healthcare providers, or that another family simply needs help finding a baby-sitter. 

Medicaid would also pay for expansion of in-home services, including the number of home visits by mental health care providers, as well as respite and support for overwhelmed parents,

Meanwhile, healthcare providers have bemoaned low Medicaid reimbursement rates, as well as a lack of mental health care providers in the state. 

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