CHARLESTON, W.Va. — After a passionate public hearing and then another two hours of committee debate, a bill that would revamp West Virginia’s foster care system cleared yet another hurdle.
The foster care bill was passed out of the House Health and Human Resources Committee, one of three committees assigned to consider it. It next moves to the House Judiciary Committee.
Delegates continued to ask questions about an aspect of the bill that would give managed care organization oversight of foster children’s healthcare.
“I have some serious concerns with this bill,” said Delegate Cody Thompson, D-Randolph. “This bill is managing the neediest of our most valuable resource, the children in our foster care system.”
West Virginia’s ongoing opioid addiction epidemic has put more and more strain on the foster care system. The state Department of Health and Human Resources has reported there are about 7,000 children in foster care.
DHHR has said it needs help managing the system. The agency says managed care would provide a benefit of tracking foster children as they move through the system, including practical matters such as records of doctor’s visits.
That was the message of Jeremiah Samples, deputy director of the agency, as he answered delegates’ questions.
“Is this going to save the state money? I’m trying to understand why we’re having this,” Thompson asked during Tuesday afternoon’s committee meeting.
Samples responded, “We do not have the staff to manage the number of children that are in care today. A lot of these children also have significant medical issues These are very vulnerable children. We need another set of eyes to assist the department in managing this system.”
The managed care organization would be allowed to have overhead — administrative costs and profit — of about 10 percent.
That amounts to about $33 million a year — money that critics of the bill said could be used for direct help of children.
“You could have chosen to take this money and invest it back in the department, but you chose not to right?” asked Delegate Barbara Fleischauer, D-Monongalia.
Samples responded that much of the money to pay for the managed care overhead could be achieved through greater efficiency.
He elaborated to describe duplicate medical costs that could be reduced with an organization to better track what care children have already received. He also described a goal of getting children out of long-term care, which could save money.
“We’re not taking money from anywhere in the department to pay for this,” Samples said. “It’s to help manage it through its own efficiencies by eliminating duplicative assessments.”
Fleischauer followed up by asking, “Your agency has decided it would be better to privatize this portion of it. You could have hired more nurses. You decided not to right?”
“Perhaps there are other ways,” Samples said. “We feel like this is the best way.”
Over the course of an hour Tuesday morning, West Virginia citizens debated whether the foster care bill will help or hurt the situation. The public hearing took place in the House of Delegates chamber.
Some social workers and family advocacy groups expressed caution.
“This bill rushes headlong into uncharted waters,” said Sam Hickman, director of the National Association of Social Workers in West Virginia.
He advocated for other changes instead, including an independent ombudsman to provide oversight of the system. That suggestion was adopted as an amendment by the House Health Committee.
Most speakers at the hearing opposed the bill — or at least said it should be slowed down for more vigorous discussion. Several speakers asked for a fiscal note to outline financial considerations.
“I ask you to slow down, I ask you to be very deliberate in this,” said Kristen O’Sullivan of Our Children, Our Future.
The intent of the bill is good, said Jim McKay, state coordinator of Prevent Child Abuse West Virginia.
But he, too, asked for more time to examine the proposal.
“We owe it to ourselves not to take the shortcut and make things worse. We need to go with a deliberative approach that listens to the voices of parents, parents who are opening their homes. There is probably a role for managed care, but we don’t have those answers yet.”
Other speakers said the influence of a managed care organization would provide continuity for children who otherwise may be shuffled from home to home without anyone being fully aware of their medical history.
“They will come with no health records, no histories. They may not even know who the last doctor was that the child has seen,” said Chantal Fields, executive director of West Virginians for Affordable Healthcare.
“We believe an mco program could really help with this type of situation.”
Patricia Fast, vice president of government programs for the Health Plan, a nonprofit providing managed care services, said medical care and social care have been fragmented.
“We believe we can bring more coordination of that care,” Fast said. ”
“We don’t think an mco approach alone is a silver bullet. We think an mco approach that looks at collaborating with all of you. We need to develop the best collaborative holistic approach that meets the needs of the child and the family.”