West Virginia officials aim to keep more kids with mental health and emotional problems in state by asking the federal government for permission to bill Medicaid for new types of services, including support for overwhelmed parents, in-home therapy, and mentors to help youth with life and social skills. 

In 2015, the Department of Justice wrote a letter to then- Gov. Earl Ray Tomblin, warning West Virginia officials that the state was out of compliance with the Americans with Disabilities Act (ADA) because the state had "needlessly segregated thousands of children far from family and other people important in their lives." 

Vanita Gupta, principal deputy assistant attorney general, wrote that "West Virginia has built its entire children’s mental health system, including child welfare and juvenile justice, around placement in segregated residential treatment facilities." 

Tuesday, the West Virginia Department of Health and Human Resources (DHHR) began accepting public comments on an application for a waiver that Allison Adler, DHHR spokeswoman, said is "part of DHHR’s child welfare reform effort and will provide an array of services that enables children who would otherwise require institutionalization to remain in their homes and communities."

About 350 West Virginia children are at psychiatric residential treatment facilities out of state, according to the application.

The Kaiser Family Foundation reported more than 50 percent of West Virginia children were covered by Medicaid in 2017. Medicaid, known by many West Virginians as their "medical card," is a federal and state program that pays for health insurance for low-income people. All foster children are eligible for Medicaid. 

State officials want the federal government to approve the Children with Serious Emotional Disorder Waiver and agree to let them use Medicaid to pay for services other than medical care — for things like case workers who link children and families to appropriate health care services, and who help youth find jobs and turn on utilities when they age out of the Medicaid program.

State officials also want Medicaid to pay for respite care, meaning caregiving for children with special needs to give families relief, and non-medical transportation to job development sites, where youth would learn about conflict resolution in the workplace and about professional clothing and conduct. 

If the Children with Serious Emotional Disorder Waiver is approved, Medicaid would also fund family support workers to offer parenting education and mental illness education in the home, as well as help families practice skills they've learned in therapy. Parent support workers, meaning those who've dealt with similar problems in their own families, would also be paid to offer guidance.

They're also asking Medicaid to pay for in-home family therapy; assistive equipment, like a therapeutic blanket; and specialized therapy, which could include services like art, music, or equine therapy. 

Jen Eva, who gave a presentation on the waiver at a meeting of the Medical Services Advisory Council last week, said state officials would prioritize the roughly 550 children currently in psychiatric rehabilitation treatment facilities or other residential treatment providers, in state or out. The next highest priority would be those at risk of residential placement. 

In their application, state officials say that without those services, those children would be more likely to require hospitalization or institutionalization. 

Youth ages 3 to 22 with mental health problems who substantially interfere with their ability to function at school and with their families would be eligible.

State officials would have to show the services are cost-effective in three years. Eva said they would hope to serve 1,000 children in year two and 2,000 children in year three.

Eva said the majority would be foster children. State officials have said West Virginia leads the nation in the number of children removed from the home.

Kelli Caseman, director of child health at the advocacy group West Virginians for Affordable Health Care, called the waiver application a "good first step."

She noted that West Virginia has historically not had enough mental health care providers. She said the waiver may encourage more providers to work in the state if they know they can bill for their services, and added that ensuring families know about the services would require a robust public education effort. 

The waiver is available for public comment until May 23.

To find the application, go to dhhr.wv.gov/bms and click on "Public Notices."

Comments may be mailed to the Home and Community-Based Services (HCBS) Unit at: The Bureau for Medical Services, 350 Capitol Street, Room 251, Charleston, WV 25301. They may also be emailed to BMSSEDWaiver@wv.gov

If you do not have access to the internet or need an accessible format or a paper copy, you may call 304-356-4897.

After the public comment period has closed, the application will be submitted to the federal government. 

Email: ebeck@register-herald.com and follow on Twitter @3littleredbones

React to this story: