CHARLESTON — West Virginia lawmakers on the House of Delegates Health and Human Resources Committee passed a bill Tuesday that alters the way foster children access health care in the state, among other changes to the foster care system.
Most of the roughly 20 people who spoke at a public hearing on the bill Tuesday morning opposed the plan. Many worried that lawmakers' plan to contract with a managed care organization would harm foster children because they would be limited to a certain network of health care providers and because the company would be for-profit.
Foster children in West Virginia are covered by Medicaid, a government health insurance program for low-income people. Many in West Virginia refer to it as their "medical card."
According to the state Department of Health and Human Resources (DHHR), about 400,000 adults and children covered by Medicaid in West Virginia are already assigned to a managed care organization. According to Medicaid.gov, states pay those organizations to reduce Medicaid costs while aiming to improve health care quality.
The DHHR reported there were nearly 7,000 West Virginia children in foster care, kinship care or other custody of the state at the end of December.
House Bill 2010 is sponsored by House Assistant Majority Leader Kayla Kessinger, R-Fayette. Kessinger said a managed care organization would help foster families because the organization would keep track of medical records and all health care providers within the system could access them.
"The health and medical records for these children are falling through the cracks," said Kessinger, who asked that questions and answers be submitted in writing. "During our committee meeting last week, DHHR testified that there are instances where children received duplicate vaccinations and medical records have been lost.
“The existing system is clearly broken and our foster children deserve better,” she said. “A managed care system is a step in the right direction."
She added, "Forty-one other states are using managed care organizations and as far as we know, they have not experienced many of the same problems our existing system has created."
She didn’t respond to an additional question about whether lawmakers reached out to those states to ask them if MCOs were effective.
Other criticisms voiced during the public hearing on the bill included lack of foster parent input in the process; better uses for the millions of dollars to go to the managed care organization; and a process that many said felt rushed.
Marissa Sanders, of the WV Foster, Adoptive & Kinship Parents Network, said foster parents worry about a limited network of providers.
“This is one of the few parts of the foster care system that seems to be working pretty well,” she said.
Steve Tuck, CEO of the Children’s Home Society, suggested the bill lacked additional reforms, including incentivizing adoption and providing a stipend for families providing kinship care.
Sam Hickman, CEO of the National Association of Social Workers West Virginia chapter, noted that, "When a child is removed from the home, we should acknowledge that we all failed that child.
"What if we had the family education, prevention, and family preservation services in place — not to mention a state earned income tax credit — to keep that original failure from occurring?" he asked.
Jeremiah Samples, deputy secretary for DHHR, said following the meeting that there had been several opportunities for public comments. He also said that profit is already involved in the process, as health care providers, foster care agencies and others involved in the health care system already aim to make a profit.
Samples said about 400,000 people, including 200,000 kids, of the 530,000 people in West Virginia covered by Medicaid are already covered by managed care.
He said DHHR is overwhelmed by the child welfare crisis and lacks workers with the skill set of those at a managed care organization.
"I believe DHHR will still be held accountable,” he said. “This contract for managed care would be our contract, the department’s contract with this entity, and so if this entity has a failure then that's the department's responsibility, and we should be held accountable to that.
"But what I would state to committee and what I would state to the public is that we need support."
Some children needlessly go through repeated psychological tests because medical records aren’t transferred, Samples said.
“You start to internalize, ‘There’s something wrong with me.' That’s why they keep asking me all these questions.”
He also noted that claims are sometimes denied, even under the current model.
Kelli Caseman, director of child health at the advocacy group West Virginians for Affordable Health Care, said "...the kids who are affected by the drug epidemic are in a health care crisis.”
“It’s not just a foster care crisis or a child welfare crisis," she said. "It's a health care crisis."
She said they need more monitoring of their health.
“To put it simply, these kids aren’t making it to the doctor,” she said.
Several companies that offer managed care spoke in favor of the legislation.
The House Health Committee approved the bill with two amendments Tuesday afternoon, but the details weren’t immediately available. One of those amendments involves a foster care ombudsman; one involves letting kids seek care in other states if closer in proximity than a provider in-state.
Del. Joe Ellington, R-Mercer, chair of the committee, and Del. Jordan Hill, R-Nicholas, vice-chair of the committee, did not return calls before publication.
The bill goes to the Judiciary Committee and still needs to pass the full House of Delegates and state Senate before it would become law.
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