Bill Crouch Story Archives - West Virginia Public Broadcasting

Appeals Court: Medicaid Program Must Cover Gender-Affirming Care

The Fourth U.S. Circuit Court of Appeals in Richmond, Virginia, upheld a lower court ruling Monday on a vote of 8 to 6 that the state’s Medicaid exclusion violated federal law.

A federal appeals court has ruled that West Virginia’s Medicaid program must cover gender-affirming surgeries.

The Fourth U.S. Circuit Court of Appeals in Richmond, Virginia, upheld a lower court ruling Monday on a vote of 8 to 6 that the state’s Medicaid exclusion violated federal law.

The Fourth Circuit ruling also applies to North Carolina’s health insurance program for state employees.

The states had argued that cost, rather than bias against transgender beneficiaries, was behind excluding gender-affirming surgeries. West Virginia’s Medicaid program does cover hormone therapy, office visits, counseling and lab work.

The court’s majority found that the states’ exclusion did not apply to the same procedures, such as mastectomies or breast reductions, for patients with cancer or excess breast tissue who are not transgender.

Attorney General Patrick Morrisey, a candidate for governor in the state’s Republican primary, said he’d appeal the case to the U.S. Supreme Court.

“Our state should have the ability to determine how to spend our resources to care for the vital medical needs of our citizens,” Morrisey said in a statement.

The West Virginia lawsuit, filed in 2020 in the U.S. District Court for the Southern District of West Virginia, named the former Department of Health and Human Resources and its former secretary, Bill Crouch, as defendants.

The suit also covered PEIA, the state employees’ health insurance program.

District Judge Robert Chambers ruled against the exclusions in 2022. Morrisey appealed to the Fourth Circuit.

New DHHR Workforce Initiatives Come In Bunches

Several moves to bolster the West Virginia Department of Health and Human Resources workforce came from the governor’s office Wednesday morning.

In his Wednesday coronavirus briefing, Gov. Jim Justice re-introduced his new DHHR leadership team after the retirement announcement Monday from Sec. Bill Crouch.

“That is Dr. Jeff Coben, the associate vice president for Health Affairs and dean of the West Virginia University School of Public Health, as our interim secretary,” Justice said. “Along with Dr. Clay Marsh and Ret. Gen Jim Hoyer as DHHR advisors, we will absolutely get into this and have hit the ground running.”

Justice said over the past 48 hours, his leadership team, along with some newly appointed DHHR agency directors, had identified some ‘bottlenecks’ in hiring practices and put several new workforce recruitment initiatives into action.

Justice said four Child Protective Services positions were offered in the Eastern Panhandle. Coben said two of those positions have already been accepted. Justice explained that some Eastern Panhandle CPS hiring bonuses were increased from $2,500 to $5,000.

The governor admitted the moves were made, in part, in a response to a publicly shared letter he received from Sen. Charlie Trump, R-Morgan, identifying a dearth of crisis level child welfare shortcomings specific to the Eastern Panhandle.

“These are addressing the needs that Sen. Trump brought up,” Justice said. “Today we have authorized the $2,500 CPS hiring bonus for CPS workers in Morgan, Berkeley and Jefferson counties be moved to $5,000.”

Justice also issued an executive order to entice DHHR retirees to return to work on a limited basis without losing any of their retirement income.

In the briefing, new DHHR Interim Secretary Dr. Jeff Coben said the department hiring freeze has been lifted and employee recruiting and retention efforts will immediately increase.

“We’re working with the Division of Personnel to clear out some lists of potential applicants who may want to work at DHHR,” Coben said. “We will also immediately begin to further recruit for our workforce needs by reaching out to our high school programs, the Mountaineer Challenge Academy, our vo-tech programs, as well as health sciences students and others throughout the university along with the Jobs and Hope program.”

Coben said he was working on plans to acquire additional technology allowing DHHR people to work smarter and more efficiently to manage cases that are in the system, both now and in the future.

In the briefing, Marsh said department priorities will focus on the health and well being of all West Virginians, especially the most vulnerable.

“That’s our children and our elders, looking at making sure that we have the right team, the right workforce, to be able to bring the care that these vulnerable West Virginians need,” Marsh said. “Then, starting to extend the focus to the mental health crisis that is currently not only our state, but our country. Then, the issues with substance use disorder. West Virginia leads the country in substance use related deaths and addiction related deaths.”

In the briefing, Hoyer said he would extend efforts to reach the best DHHR client outcomes.

“The governor tasked us to work with all the different constituency groups,“ Hoyer said. “We’ll leverage the partnerships we built with the Joint Interagency Task Force to get to those groups and work with everybody to understand the challenges as we work through this.”

Justice was asked how he might find legislative common ground after Senate President Craig Blair, R-Berkeley, and other lawmakers vowed to renew efforts to separate DHHR into two departments and not wait on seeing any fruits of the McChrystal study implementation. He said there were things that Crouch could have done a lot better, but said he also did a lot of good. He said the staff at DHHR, including Crouch, did not need to be “kicked around.”

“It was not support, it was just a constant undermining,” Justice said. ”I am absolutely for things being better but in a smart way and on a smart pathway and not just jumping on a soapbox.”

DHHR Sec. Crouch Retiring: Justice Announces New Leadership Team

Gov. Jim Justice announced that Department of Health and Human Resources Secretary Bill Crouch will retire effective Dec. 31, 2022.

This is a developing story and will be updated.

Updated on Monday, Dec. 12, 2022 at 1:30 p.m.

Gov. Jim Justice announced in a livestream Monday morning that Department of Health and Human Resources Secretary Bill Crouch will retire effective Dec. 31, 2022. Justice said Crouch has held the position for almost six years.

“It’s a position that came with COVID, and all the different ramifications of COVID,” Justice said. “We should absolutely all be very thankful and appreciative of the job that he’s done, because it’s one almost thankless job. Bill Crouch led us through all this and absolutely did an amazing job.”

Crouch’s retirement comes amid a number of legislative concerns regarding DHHR client outcomes and not meeting staffing and health care challenges. He was also dealing with a federal investigation on alleged disability discrimination.

In his resignation letter, the 72-year-old Crouch responded to what he calls a “year of constant scrutiny.”

“DHHR staff have become collateral damage and that is wrong. The staff of DHHR are the most dedicated and smartest group of people that I have ever worked with, and I thank them for their hard work and their loyalty,” Crouch said in his letter. “That is not to say that DHHR is perfect. We need to continue to make improvements, but the perception that everything is broken is wrong.”

Saying he’s an impatient man who wants results efficiently and quickly with the challenges DHHR faces, Justice named Dr. Jeff Coben, Dean of the West Virginia University School of Public Health, as Interim DHHR Secretary. Coben said he’s well versed in DHHR operations.

“I’ve spent about 12 years working closely with the dedicated staff of DHHR,” Coben said. “I look forward to working with all of those inside DHHR and those throughout our community and throughout the great state to address the many health issues we face as a state head on and as quickly as possible.”

Late last month, the governor released a report from management consultants McChrystal detailing steps the agency should take to improve services and a lapse in internal communication. The DHHR has a nearly $7.5 billion budget.

In his letter, Crouch said there are only a couple of study implementation decisions remaining, and those can be finalized by the end of the year as a part of the transition.

“Virtually all our problems are workforce problems. We have staff shortages in all bureaus and areas of DHHR, from attorneys and nurses to food service staff in our facilities,” Crouch said. “Salaries are inadequate, and applicants for health professionals and for non-healthcare positions are in short supply.”

Justice also said that Coronavirus Czar Dr. Clay Marsh and Ret. Gen. Jim Hoyer, the Joint Interagency Task Force director, will be advisors to DHHR and the governor’s office through the process of selecting a permanent DHHR secretary and implementing the McChrystal DHHR reorganization report. Both Marsh and Hoyer pledged full support.

“We’re dealing with an agency that deals with the most vulnerable of our population, whether it’s our seniors or young children,” Hoyer said. “Clay and I will do our best to provide the best support and advice we can to the governor to move things in the direction that we need to.”

Justice said Marsh and Hoyer will serve as advisors throughout the rest of his time in office. Justice’s term as governor ends in January 2025.

In a statement, Senate President Craig Blair, R-Berkeley, said he is cautiously optimistic that a change in leadership at the Department of Health and Human Resources would be a good first step toward returning the agency to better footing.

“There’s no question about it: DHHR is not in a good place, and it’s going to take a lot of work to make things right. We believe that it’s going to take statutory changes to make some of these major overhauls, but we hope this change in leadership brings a change to its management culture,” Blair said. “We look forward to working with Interim DHHR Secretary Dr. Jeffrey Coben as we move forward with advancing significant changes to one of our state’s most critical departments. We wish Secretary Crouch well in his retirement.”

Editor’s note: This article was updated to include additional details and statements from involved and concerned parties.

It was also updated to reflect when Sec. Crouch took over DHHR.

DHHR Secretary Discusses Progress In Reorganization Plan

The Department of Health and Human Resources is now working to implement recommendations from the independent McChrystal group in an effort to improve internal communications and client outcomes.

The West Virginia Department of Health and Human Resources is a multi-billion dollar agency with myriad departments under its umbrella. There are many who want to see it reorganized.

DHHR is now working to implement recommendations from the independent McChrystal group in an effort to improve internal communications and client outcomes.

Government Reporter Randy Yohe talked with DHHR Cabinet Secretary Bill Crouch on the progress so far.

Randy: I see where you’ve named Jessica Hudson as the DHHR Chief Operating Officer. She will oversee about everything from what I read, and looks like a second in command. You say her position will establish a direct line of oversight and communication in helping eliminate some of the silos that have developed over the years. Mr. Secretary, in layman’s terms, explain what the study meant by the silos and silo challenges and how Ms. Hudson’s position may help improve outcomes.

Crouch: I have meetings with the commissioners every week, I have a meeting with each of the bureaus every other week with the deputies and attorneys and others. At that level, everything works well. But what they’re referring to is down below that. Everything below that level of communication with the secretary’s office, meaning our HR people, our finance people, and that’s not great. That’s what we’re trying to fix.

Several secretaries ago, I’m not going to mention the secretary’s name who I was told did this, but that person allowed all of the bureaus to have their own HR person, their own finance person and their own support services inside the bureaus that led to these towers of folks who didn’t communicate among the towers. So what we’re doing is breaking those silos down that were built. We’re going to have those folks reporting directly to the people that are really ultimately responsible in the DHHR secretary’s office for getting bills paid for getting people hired, etc.

Randy: You’ve said improving child welfare outcomes as a DHHR top priority. How do you believe study implementations, including a designated child welfare leader, will help reach those desired outcomes?

Crouch: By coordinating those services underneath the deputy secretary and through the coordination with the other deputy secretaries. Deputy Secretary Christina Mullins is absolutely phenomenal when it comes to mental health services. In focusing on where the need is, we’ve never really had that focus of mental health services with children until Christina went into that role. Now she can work with Kammie Chapman, who is the Deputy Secretary for Children and Adult Services. They’re really focused on dealing with this child welfare problem directly.

Randy: Explain a little more on how the integration teams focused on communications will actually help legislators understand DHHR progress and enhance the legislative ability to make better informed decisions on DHHR policy and funding.

Crouch: It’s the issue of the liaisons and how we do that. We’re still working through the best way to do that and would like to have some conversations with folks in the legislature that I’m not sure we’re going to have. If it’s going to work I want their input. I certainly respect that body. They’re one of the branches of government that’s critical to improving health care for their citizens and health care for our children, so I’m very open to that. It’s more confrontational right now, more like “gotcha” on DHHR. With everything we do, there’s criticism instead of looking at the positives and what we’re doing.

Randy: House Speaker Roger Hanshaw says he may make leadership changes that focus on DHHR. And he says there have been talks with you and DHHR regarding legislation, helping implement the McChrystal study recommendation and other DHHR needs. So there’s already activity in motion?

Crouch: I am very impressed with the Speaker. He’s very deliberate in terms of how he looks at issues. And I’m very open to talking about changes that improve health care and estate. And so I’m very hopeful we can do that.

Randy: The studies seem to show a need for a marked improvement in upper level managers listening to frontline DHHR workers needs opinions and concerns for proper policy implementation. Why was this a problem? And what are your expectations for improvement?

Crouch: We have a lot of folks out in the field, we have people throughout the state that may even feel a little disconnected from DHHR. I’ve asked our folks, this was probably six months ago, that everyone that supervises people are now required to go through a management training course. We have to have better managers and folks who really care about the people that work under them, and make sure the message, in terms of our approach, gets down to them.

You have to have a team of people who work together and need to feel like they’re part of that team, and they need to know they’re appreciated and what they do is important. We are requiring training for those folks who are facing the public or have responsibilities to deal with the public or deal with others. If they man the front desk at our local offices, then they have to take customer training service. So it’s kind of the same thing, we want people who interface with the DHHR to feel comfortable and to get the service that they need.

Randy: Your three priorities are child welfare, substance use disorder and workforce. Can you give me some specific examples of how you see study implementation directly benefiting the clients that DHHR serves, and the frontline workers who have served those clients?

Crouch: We haven’t talked about SUD [substance use disorder] much. We’re having some success with SUD, but this is still a huge problem in West Virginia. The dates are already set to meet with Homeland Security so we can work with them in terms of coordinating issues and communities where there are increases in drug use, to try to focus on reducing those drugs coming in. Those individuals who were found and arrested, we need to get the appropriate ones’ treatment, and those who are selling and dealing, they’re going to jail. But those individual users out there, we need to get them into treatment and try to get them back into society.

We’re going to fix these problems. We’re going to have a real impact in the next year or two years in terms of the child welfare issue. The SUD problem is really the toughest one. We’re making progress on child welfare. No one likes to talk about that. They’d like to point out the problems but we’ve got to do better and we’re going to do better.

Advocate Brings Transparency Concerns About Treatment Of People With Disabilities To Lawmakers

The state health department is attempting to conceal information about the treatment of people with disabilities who are in state care, according to an attorney with Disability Rights West Virginia.

The state health department is attempting to conceal information about the treatment of people with disabilities who are in state care, according to an attorney with Disability Rights West Virginia (DRWV).

Mike Folio, attorney for DRWV, told state lawmakers Tuesday that this year his organization made 80 visits to William R. Sharpe Hospital, a state-run psychiatric facility in Weston. Under federal law, DRWV monitors the treatment of West Virginians with disabilities in facilities run by the West Virginia Department of Health and Human Resources (DHHR).

“Last Tuesday, two of my advocates and I … met with Sharpe Hospital employees, who I would call our informants. They shared with us disconcerting information that they were told by (DHHR) leadership not to talk to DRWV,” Folio told lawmakers in the Joint Health Committee.

“As we dig into this, we see a pattern, a practice, a habit, a custom of concealing information,” he continued. “That violates federal law.”

Folio said what’s going on at Sharpe Hospital is “an abysmal failure.” In contrast, he noted that DHHR is doing well with patients at the state-run Mildred Mitchell Bateman psychiatric hospital in Huntington.

DHHR Cabinet Secretary Bill Crouch was given the opportunity to rebut Folio’s comments in front of lawmakers. He called for an investigation of his agency and into DRWV’s practices and said DHHR does its own investigations of its state-run hospitals. The state Office of Health Facility Licensure and Certification, which is under DHHR, also conducts facility investigations.

“The implication that we’re covering things up … it is wrong. We take good care of folks,” Crouch said. “We don’t sweep things under the rug. We tell the truth.”

The presentation to lawmakers added to the growing list of issues that have come to light about DHHR’s treatment of people with disabilities who are in their care.

In October, Senate President Craig Blair, R-Berkeley, sent the governor a list of what the lawmaker called abuse under DHHR’s care and issues at Sharpe, and his letter included concerns about DHHR’s transparency about issues. And last month, the U.S. Department of Health and Human Services launched an investigation into DHHR’s alleged discrimination against patients with disabilities by allowing them to be unnecessarily institutionalized. Lawmakers have heard concerns about treatment of patients with disabilities in previous legislative sessions.

Much of Folio’s presentation focused on what he referred to as “patient dumping” or “warehousing patients” by allowing them to remain unnecessarily institutionalized. He said the agency has spent $20.3 million to institutionalize 29 patients this year, which is more than $700,000 a patient.

Crouch has maintained the state does not have enough community placements for people with disabilities.

“We certainly want these people in the right level of care. There’s no intent to keep people in psychiatric care,” he told lawmakers.

Folio is a former attorney for DHHR, and Crouch, in response to the presentation, said that Folio has made DRWV’s investigation a “personal attack” on the agency.

“Mr. Folio says that (DRWV) is not adversarial with DHHR … then he goes on to criticize every aspect of DHHR. Then, he gets personal with our CEO and myself,” Crouch said.

Folio told lawmakers, “We are not here as an adversary of DHHR. We are here as an ally of the disabled persons who have no voice.”

DHHR has currently instated a hiring freeze as it is undergoing an internal restructuring in an effort to improve agency outcomes. The changes following the $1 million review from the McChrystal Group, which said the agency was in need of “bold changes.” Lawmakers have criticized the report for its lack of substance amid the state’s poor health outcomes.

New Federal Investigation Targets DHHR’s Treatment Of People With Disabilities

The federal government has launched a civil rights investigation into the West Virginia Department of Human Resources’ treatment of persons with disabilities who are in the state agency’s care.

In a Nov. 14 letter, the U.S. Department of Health and Human Resources Office for Civil Rights said the investigation was based on a complaint filed by Disability Rights West Virginia (DRWV). Under federal law, the organization monitors the treatment of people with disabilities in the state’s facilities.

The investigation centers on DRWV’s complaint that DHHR allegedly unlawfully discriminated against people with intellectual and developmental disabilities by not providing appropriate services that could have prevented institutionalization.

“In the complaint, (DRWV) alleges that DHHR fails to administer services, programs and activities in the most integrated setting appropriate to meet the needs of qualified individuals with disabilities,” the letter stated.

The Office for Civil Rights said patients are “now needlessly segregated in state- operated hospitals.”

Under state law, DHHR is responsible for persons with disabilities who are in state-run facilities.

DHHR Cabinet Secretary Bill Crouch said Monday during the governor’s virtual briefing that the agency is cooperating with the investigation. He said the state struggles to have “adequate placements” for people with disabilities in community settings.

“I’ve talked for several years now about trying to make sure we have adequate placements for individuals in our psychiatric hospitals,” Crouch said. “I’ve said numerous times on this call and before the legislature that no one should live in a psychiatric hospital that shouldn’t have to. We’re looking at making sure we can move folks to an appropriate level of care.”

In response to the federal probe, DHHR spokeswoman Allison Adler said in an email, “The DHHR does not tolerate discrimination of any kind, and works diligently to prevent discrimination from occurring in any service, program or activity which is administered by the agency.”

West Virginia Public Broadcasting reported last month that Senate President Craig Blair, R-Berkeley, had asked Gov. Jim Justice to launch an independent investigation into DHHR’s treatment of people with disabilities.

Blair’s letter cited multiple examples of what he called abuse under DHHR’s watch, including people with disabilities being strangled, being forced to use the bathroom outside and dying from inappropriate nutrition. Blair included concerns about DHHR’s transparency about its oversight of persons with disabilities, as well.

Blair’s letter also cited concerns about DHHR’s oversight of Sharpe Hospital, a psychiatric facility in Weston, and DRWV is currently investigating DHHR’s oversight of Sharpe Hospital. After the WVPB story published, Crouch defended his agency, saying, “We don’t have any tolerance with regard to patient abuse.”

Crouch told lawmakers in November that the investigation and emails by DRWV attorney Mike Folio, a former DHHR attorney, into DHHR’s practices was “bordering on harassment.”

DHHR, which operates with a $7.5 billion budget, is currently undergoing an internal restructuring in an effort to improve its communication and overall outcomes. The agency also instituted a hiring freeze.

The changes follow a $1 million outside review of the agency, which said it needed to improve its communication as the state is performing poorly in many health outcomes. Lawmakers criticized the review, performed by the McChrystal Group, for its lack of substance.