Budget Story Archives - West Virginia Public Broadcasting

Advocates, Lawmakers Worry For Future Of Medicaid In W.Va.

Health care services for nearly 30 percent of West Virginia’s population may be difficult to access if lawmakers don’t fully fund the Medicaid program in an expected special session.

Medicaid provides free or low-cost health coverage to low-income people, families and children, pregnant women, the elderly and people with disabilities.

According to the Kaiser Family Foundation (KFF), West Virginia has the highest percentage of Medicaid enrollment in the U.S., with more than 564,000 people enrolled, or 29 percent of the state’s population in 2017.

According to the West Virginia Center on Budget and Policy, the Fiscal Year 2025 budget the legislature passed this year underfunded the state’s Medicaid program by about $150 million.

The budget Gov. Jim Justice originally proposed fully funded Medicaid, according to Kelly Allen, executive director of the West Virginia Center on Budget and Policy.

“By our analysis, it was underfunded by about $150 million relative to the governor’s proposed budget, which would have fully essentially funded Medicaid according to what Medicaid agency officials were saying that they needed to keep current levels of services,” Allen said.

Medicaid is a joint federal and state program, which means for every dollar the state allocates toward the program, the federal government matches those funds through the Federal Medicaid Assistance Percentage (FMAP).

Each state’s FMAP is based on a formula in the federal Medicaid statute that is based on state per capita income. The lower a state’s per capita income, the higher the state’s FMAP, or federal Medicaid matching rate will be. These rates vary from 50 percent to 74 percent.

West Virginia’s Fiscal Year (FY) 2025 FMAP percentage is 73.84 percent with a multiplier of 2.8 percent.

“Because Medicaid is a matching program,” Allen said. “For every dollar of state funding that we spend, we pull down almost $3 in federal funds, that can actually total over $600 million in potential cuts to Medicaid, which is about 12 percent of the entire program.”

The governor’s proposed budget allocated about $517 million to Medicaid, whereas the enacted budget allocated $438 million.

Justice said during a press briefing on April 17 that he is not to blame for the budget cuts and said he would check and see if there was any way that it could be funded, without bloating the budget.

“Why did we do this? Why in the world did we do this? Why did we strip $100 million out of something that we didn’t have to do and absolutely we knew it was going to really hurt people,” Justice said.

Lawmakers said the budget cuts were necessary due to possible federal government clawback of $465 million in COVID-19 relief funding for schools.

Justice announced Friday that West Virginia will not face that clawback.

“I don’t think that argument ever carried a lot of water because I don’t think that was a reason to underfund the budget itself, I think that was a reason to hold on to surplus dollars, those one time dollars that they didn’t allocate,” Allen said.

Allen said before the pandemic, the state was spending more on Medicaid than it is now. That is because during the pandemic, a public health emergency allowed additional federal funds to be distributed to programs like Medicaid.

“One factor that allowed the state to have a flat budget for all of these years was, we didn’t, we weren’t really able to reduce our state spending on Medicaid, because we were getting all this extra federal Medicaid money due to the pandemic,” Allen said.

In 2023, federal spending stopped with the end of the public health emergency and the passage of the Consolidated Appropriations Act.

“This isn’t really an issue of Medicaid spending being out of control or a big spike in Medicaid spending,” Allen said. “It’s really just that that federal, extra match expired, which we always knew it was going to. And the state’s responsibility now is essentially to go back to its pre-pandemic levels of Medicaid funding.”

If lawmakers don’t amend the budget in an expected May special session, there are a few ways that Medicaid costs could be reduced including a reduction in eligibility.

Currently, single adults who make about $20,000 a year, or a family of four earning around $40,000 annually qualify for Medicaid. The program also covers insurance for children and people with disabilities.

Cynthia Persily, secretary of the West Virginia Department of Human Services, testified in front of the Joint Health Committee on April 15 that services could be cut if the program is not fully funded.

“Whenever there’s a shortage in Medicaid dollars, there are several things that we can do, right,” Persily said. “We can decrease enrollment in Medicaid, we can decrease services, or we can decrease the reimbursement rate. And so there would have to be some sort of combination of those three pieces in order for us to make Medicaid whole.”

Allen said there are many services the federal government considers optional.

“But I don’t think you and I and most West Virginians would think they’re optional,” Allen said. “That’s things like prescription drugs, substance use treatment, physical and occupational therapy, things like waiver programs, intellectual and developmental disability programs. These are all programs that are optional for states to offer, but they’re really, really important to people.”

A representative from the Department of Human Services, Whitney Wetzel said in an email statement to West Virginia Public Broadcasting that the department is hopeful the budget will be restored in a special legislative session. However, if cuts are sustained, the DoHS’s Bureau for Medical Services (BMS) will review optional services and rates.

Wetzel further explained that Medicaid eligibility rules are mandated by the Centers for Medicare and Medicaid Services (CMS).

“There are currently no plans that would impact members’ eligibility,” Wetzel wrote.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

Advocates Seek Bigger Slice Of State Budget To Address Domestic Violence

Domestic violence prevention nonprofits have not received a state budget increase since 2009. Advocates hope a special session of the West Virginia Legislature could change that.

Tucked away on a side street of downtown Martinsburg, the Eastern Panhandle Empowerment Center (EPEC) is a domestic violence prevention nonprofit serving Morgan, Berkeley and Jefferson counties.

EPEC was founded in 1977 and expanded with time. Ten years ago, Executive Director Katie Spriggs said the EPEC served 250 people annually. Now, it serves more than 1,400 people each year.

Visits to EPEC may be on the rise, but Spriggs said funding has not increased sufficiently to meet them.

Looking at EPEC’s first-floor office it immediately becomes clear. Each day, staff members squeeze into corners of the room with laptops and cell phones in hand.

“We have probably on an average day 12 people that work out of this office, so it’s not large enough,” Spriggs said.

According to Spriggs, moving out of EPEC’s apartment-turned-office into a larger space would bring benefits. But a potential move and the expansion of current EPEC services are constrained by the same factor: the budget.

“We’re kind of stuck,” she said. “We haven’t seen an increase in so long that it’s really difficult to make the budget work every year.”

In West Virginia, domestic violence prevention nonprofits receive funding through a variety of sources, like private donations, federal grants and a line item included annually in the state budget.

But the state has not boosted that line item since May 2009, even as the cost of living has risen.

In recent years, Gov. Jim Justice has pursued a flat budget, which means freezing state spending so it stays the same each year. While surplus funds get redistributed, they do not supplement every budget item.

At the same time, Spriggs said that federal support for nonprofits through the Victims of Crime Act has become jeopardized by a recent reallocation of funds.

Continuing to provide resources to survivors of domestic violence requires reliable funding on the state level, she said.

Katie Spriggs, executive director of the Eastern Panhandle Empowerment Center, is in the process of digitizing decades of the center’s paper records.

*Photo Credit: Jack Walker/West Virginia Public Broadcasting*

Sara Belvins O’Toole, director of development at Huntington’s Branches Domestic Violence Shelter, said part of the need for additional funding stems from changing conversations around domestic violence prevention.

In the early days, Belvins O’Toole said advocates were focused primarily on removing individuals from crisis situations.

They now understand helping people stay away from abusive relationships requires more holistic assistance, she said.

“People who are just plopped out of a situation and put into another environment don’t have the resources and the skills and the support that they need to actually stay away from a person that was violent in their life,” Belvins O’Toole said. “Especially if that person was in control of the finances.”

Approaching domestic violence on a holistic level means considering other factors that put survivors at risk, like housing insecurity and child care needs.

“We have to do a little bit of that other work like housing advocacy, like legal advocacy — all of those things that are providing support,” Belvins O’Toole said. “It’s not about just getting somebody out of crisis anymore. It’s about supporting them into a life free from violence.”

But this is easier said than done. Joyce Yedlsoky, team coordinator at the West Virginia Coalition Against Domestic Violence (WVCADV), said that the state’s flat budget has also affected separate nonprofits that address these needs directly.

In turn, she said domestic violence prevention advocates must wear multiple hats, spreading their time and funding thinner.

The budget “being able to account for other aspects that survivors need” is important as well, she said.

Through the WVCADV, Yedlosky works with the 14 licensed domestic violence prevention nonprofits located across West Virginia. In February, she helped arrange a visit to the State Capitol featuring representatives from each of these organizations.

The advocates lined the Capitol’s lower rotunda with tables, passing out stickers and informational flyers to visitors and lawmakers alike.

Yedlosky also took the time to speak with lawmakers about the nonprofits’ current financial needs, and said they were generally supportive of securing new funds.

But, since then, Yedlosky said lines of communication between lawmakers and the nonprofits have all but closed.

“Since the session ended, we haven’t heard from lawmakers specifically around our funding,” she said.

Staff members Katie Brougham, Serena Hemple and Foxfire Formoso (from left) stand in the entryway of the Eastern Panhandle Empowerment Center.

*Photo Credit: Jack Walker/West Virginia Public Broadcasting*

By the time this year’s regular session of the West Virginia Legislature ended, no budget line increases for domestic violence nonprofits had been passed. New funding for services like child care were also left out entirely.

Still, this year’s budget is not completely settled. Gov. Jim Justice has expressed disapproval of some funding omissions from this year’s budget, and in March announced plans to call a special legislative session to reconsider the budget.

Justice said he plans to hold the session by May 14, the state’s primary election. Members of the Legislature’s leadership have indicated they would prefer for the session to coincide with interim meetings beginning May 19.

In a dream scenario, Yedlosky said she would like to see a $500,000 cost-of-living increase to the state’s funding for domestic violence nonprofits, which currently sits at $2.5 million split annually between all 14 licensed organizations.

But Yedlosky said she’s not holding her breath for what the special session will bring.

“To be honest, I don’t think that that’s on the table for the special session,” she said. “It would be really nice if it was.”

Instead, Yedlosky said she hopes that lawmakers will reverse course and provide new funding to other services like child care.

“I do believe if they reinstate back some of the huge cuts that they made, that’s also going to help survivors,” she said. “That’s my hope.”

Back in the Eastern Panhandle, Spriggs echoed Yedlosky’s calls for a cost-of-living budget increase. She described an increase like this as a critical way to reduce the risks that survivors of domestic violence face across the state.

“A line item increase on the state budget would not only keep the lights on and give us a foundation to grow on,” she said. “It would also prevent violence. A lot of violence.”

For more information on domestic violence prevention resources in West Virginia, visit the West Virginia Coalition Against Domestic Violence’s website.

No $465M COVID-19 Education Funds Clawback Justice Says

Gov. Jim Justice announced Friday that West Virginia will not face a clawback of $465 million in COVID-19 money from the U.S. Department of Education, alleviating concerns raised by state lawmakers during the final days of the legislative session in March.

The Republican governor said in a statement that federal officials approved the state’s application for a waiver for the money, which was a portion of the more than a billion dollars in federal aid the state received to help support students during the COVID-19 pandemic.

In order to receive the money, the state needed to keep funding education at the same or a higher level than before the pandemic. In other words, the federal money could supplement existing state investment in education but not replace it.

For federal spending packages passed in 2020 and 2021, that meant a dollar-for-dollar match. For 2022 and 2023, the federal government examined the percentage of each state’s total budget being spent on education.

Those regulations were waived for West Virginia in 2022. As lawmakers worked to finish the state budget in March at the close of the session, the state had not been approved for a waiver for 2023.

The question threw the state’s budget process into disarray and caused uncertainty in the days before the 60-day legislative session, with lawmakers saying they would pass a “skinny budget” and reconvene to address unfinished business in May, when the financial situation is clearer.

Justice said then that his office was negotiating with the federal government and that he expected a positive resolution, citing funds dedicated to school service and teacher pay raises each year since 2018 — when school employees went on strike over conditions in schools.

On Friday, he praised the federal government’s decision, and he said he was never concerned the waiver wouldn’t be approved.
“This announcement came as no surprise and was never a real issue,” Justice said.

He also said the state has dedicated money to building projects and putting teaching aides in classrooms to improve math and reading skills. The state said it spent $8,464 per K-12 pupil in 2024, compared with $7,510 during Justice’s first year as governor in 2017, according to documents submitted to the federal government.

But because state spending increased overall — from $4.9 billion in 2017 to $6.2 billion in 2023 — the percentage marked for education decreased. The key metric eliciting pause from the federal government was an 8% decrease in the education piece of the budget pie — from 51% in 2017 to 43% last year.

Justice said the state’s investment in education speaks for itself: State leaders also approved $150 million for the state’s School Building Authority in the state budget for the fiscal year starting in July.

State Budget Revenue Healthy, Officials Unsure About Tax Cut Trigger

State revenue is solid for the year, and over estimates, but down from last year because of personal income tax reductions and severance taxes.

West Virginia tax collections are higher than estimated, but it is unclear if another personal income tax cut will happen in 2025.

Legislators heard Monday from Mark Muchow, the deputy secretary of the state Department of Revenue, about 2024 budget revenue numbers.

“After nine months, the state has collected more than $4.07 billion. That’s $522.9 million above estimate,” Muchow said. “It’s down from last year by 11.6 percent, which is pretty good considering that we cut the income tax by 21.25 percent and some reductions occurred in the severance tax as well.”

Muchow said personal income tax collections are $184.1 million above estimate for the year. He explained that it is down 9.4 percent year to date over last year.

“Again, 9.4 percent is pretty good considering that we cut the tax rates by 21.25 and the income tax as a whole was over 40 percent of general revenue fund collections,” Muchow said.

Severance taxes on coal, gas and oil were budgeted for just $22.1 million for this fiscal year to date. So far, the state has collected $48.129 million. That sounds promising, except the previous fiscal year brought in nearly $85 million at this point in 2023 and is off more than 43 percent.

Since taking office, Gov. Jim Justice has maintained relatively flat budgets and kept budget estimates low as well. That has guaranteed annual budget surpluses. Over the last few years, they have topped $1 billion each fiscal year.

Last year, when the West Virginia Legislature passed the personal income tax cut, the bill included triggers that would further reduce those taxes. The triggers are tied to budget surpluses.

Del. Larry Rowe, D-Kanawha, asked about the trigger mechanism during Monday’s meeting.

“Are you able to project whether the August trigger is going to come into play or not?” he said.

“It’s too early for us to do that type of projection. There’s a lot of revenues outstanding. I do believe that the income tax is going to trend lower over the final, at least over the April, May period, [it] may bounce back in June,” Muchow said. “But there’s too many variables out there to make a good, firm analysis on the trigger.”

“When do you think you’ll comfortably be able to make that calculation?” Rowe asked.

“We will not have a complete idea till the end of June,” Muchow said. “But we’ll have a better idea for the end of April. And even better at the end of May. So by the end of May, things will be a little bit better in focus than they are today.”

“So if we were to have a special session in May, and that has been discussed, then you may have the numbers you need to calculate whether the August trigger will come into play?” Rowe asked.

“We’ll have a better idea, but not a perfect idea,” Muchow said. “Again, there’s a number of variables outstanding that we’d have to consider in that equation.”

The Legislature is expected to return to Charleston for a special session on the budget in mid-May following the election but before the end of the month.

Justice Calls On FEMA, Lawmakers To Supplement Storm Aid

After intense storms last week, Gov. Jim Justice is seeking federal aid from FEMA and the creation of an on-retainer state emergency fund by West Virginia lawmakers.

Updated on Wednesday, April 10 at 3:35 p.m.

Gov. Jim Justice is developing a disaster declaration request for the Federal Emergency Management Agency (FEMA) over severe weather events that occurred across West Virginia last week.

If approved, the request would grant federal relief funding to West Virginia residents affected by last week’s incidents, which included flooding, tornadoes, and destructive winds. The storms claimed the life of one Wood County resident and wrought structural and property damage statewide.

To qualify as a FEMA disaster, weather emergencies must reach a threshold of local damage that warrants federal intervention.

To strengthen the state’s case for a disaster declaration, Justice said during a virtual press briefing Wednesday that he would combine each of last week’s incidents into a single request.

“The problem with FEMA is they want a great number of people that are affected, or a great amount of property damage,” he said.

Justice has already declared ongoing states of emergency for 12 different counties in response to the incidents. These declarations facilitate state-level emergency response efforts, but do not secure the funding a FEMA disaster declaration provides on the federal level.

During the call, Justice also voiced disapproval of state lawmaker’s inaction on aspects of his budget proposal for the 2024 regular legislative session, which he said would have aided the state’s response to the emergencies so far.

Storms in West Virginia’s Northern Panhandle elevated the Ohio River’s water levels, causing severe flooding in nearby Wheeling last week.

*Photo Credit: Wheeling Fire Department*

Justice specifically pointed to a $50 million emergency fund that he requested to have on retainer for unexpected crises.

“The $50 million in regard to emergency funds, because of catastrophic events within our state, is something that is so important,” he said. “It’s unbelievable.”

But, in a statement following Wednesday’s briefing, Speaker of the West Virginia House of Delegates Roger Hanshaw, R-Clay, pushed back against Justice’s characterization of budget proceedings.

Hanshaw said that any funding set aside in this year’s budget would not yet have been accessible in response to last week’s storms.

Additionally, Hanshaw said that the state’s $85 million Civil Contingent Fund can be applied toward immediate disaster relief with the governor’s approval.

“If the governor wishes to respond to this tragedy in any way, he has the full capacity to do so, unfettered by the Legislature,” he said.

Justice has already declared that he will call lawmakers back to the Capitol before May 14 for a special session of the West Virginia Legislature, with expansions to the state’s budget at the top of his mind.

In pushing for these expansions, Justice said he will renew calls for the state to set aside an emergency relief fund.

“I will surely put that back on the call,” he said.

**Editor’s note: This story was updated to include a comment from Speaker of the West Virginia House of Delegates Roger Hanshaw, R-Clay.

W.Va. Grapples With IDD Waiver Program

In the final hours of the 2024 regular legislative session, lawmakers passed a budget that cut funding for IDD waivers.

The IDD Waiver Program

By connecting people with disabilities with resources like home health care workers and financial support, the Intellectual and Developmental Disabilities (IDD) Waiver program allows people with disabilities to live outside hospitals and institutions.

Department of Human Services (DHS) Secretary Christina Mullins testified before the Joint Standing Committee on Health and Human Resources on Dec. 12, 2023 about the status of the IDD program.

Alongside her, Robert Hansen, special assistant for IDD at DHS, also testified about the program, stating West Virginia has approximately 33,000 individuals in the state who have a mental, intellectual or developmental disability.

“Six thousand of these individuals are currently being served by the IDD waiver program,” Hansen said. “And then we also have 530 individuals who are on the waitlist to enter that program. And today we have approximately 73 individuals who are IDD who are in our two state hospitals.”

Hansen also told the joint committee that workforce shortages place a burden on the IDD system.

“There’s also a lack of specialists that can work effectively with people with IDD, and that includes individuals that are trained in positive behavior support, and then people who are trained in applied behavior analysis,” Hansen said. “These are individuals that can work with patients, clients who are identifying and having serious issues and could be a support and for the direct service staff and helping to develop active treatment plans to address the behavioral issues that may be becoming more and more of a concern.”

Mullins testified that not only are workforce shortages the biggest challenge DHS faces but that those workers need development training.

“We’d like to increase the availability of training for all levels of staff,” Mullins said. “This training should include coaching and mentoring to ensure that select placement can be achieved. It’s not enough just to train, we have to also mentor.”

During the last 10 months, Mullins and Hansen have provided sworn testimony to various committees of the legislature that depict a crisis among the workforce of the IDD program largely due to low wages that cause operating losses at the state psychiatric hospitals.

Budget Cuts

In the final hours of the 2024 regular state legislative session, West Virginia lawmakers passed a budget that cut funding for IDD waivers.

In 2023, the IDD Waiver budget line item was $108,541,736. In this year’s budget, the IDD Waiver program was allotted $97,687,562 — a decrease of more than $10.8 million.

Senate Finance Chairman Eric Tarr amended the cuts into the budget on the last day of the session. He said the decrease in funds for individuals with disabilities was an effort to increase transparency on the state health department’s spending following last year’s split of the Department of Health and Human Resources into three departments.

In a statement published on March 12, Tarr explained that his committee broke down much, but not all of Human Services in subsections and restricted the ability to transfer funds outside of those subsections.

“Ultimately, we increased the aggregate level of appropriation to Health, Human Services, and Health Facilities (what would have been DHHR) by about $9 million this year,” Tarr wrote. “However, this included a $100,000,000 improvement to contract nursing. This necessary improvement (which was needed to keep the state-owned hospitals open) required reductions in other areas.”

Tarr said during this process of breaking the department up, the Legislature found out that appropriations they made to medical services in previous years had been redirected to contract nursing in facilities.

“In other words, it became clear where money was being redirected relative to the Department’s appropriation request,” Tarr wrote. “The previous secretary was using a soft target request to fund mismanagement of contracts, which now exposed, is being corrected.”

Tarr said a subsection was created in the budget this year for waiver programs. He said his committee fully funded Title XIX, the Aged and Disabled Waiver, but cut all other line items, including the IDD Waiver, by 10 percent.

“The department can now transfer between waivers, but can no longer transfer to or from other sections,” Tarr wrote. “So, in short, there was a $100 million improvement to health facilities that resulted in a collective reduction of about $91 million to Human Services and Health Services.”

Mike Folio, legal director for Disability Rights West Virginia, said the budget cut not only affects those on waivers but loses federal matching dollars.

“With a budget cut of $11 million when you factor in the match through Medicaid, it’s roughly $33 million. What that translates into is diminished services,” Folio said.

Folio said the IDD waiver program was created decades ago by Congress to provide a lifeline to those individuals who are disabled and keep them from being committed to a psychiatric hospital.

Not only are outcomes better when an individual is able to be treated in a community-based program, but according to Folio, it is a cost-saving measure.

He said the cost to place someone at Sharpe Hospital is roughly $990 per day, per person. To place someone in a community program costs approximately $390 per day.

“They failed to do the required financial analysis to determine the impact of cutting the IDD waiver budget,” Folio said. “Had they done this and had they actually looked at the cost differential between institutional costs compared to community integration, they would realize that they would save $600 a day, get better outcomes, and actually comply with the law,” Folio said. “Certain members of the Legislature ignored those three accepted realities, and instead slashed the equivalent of $33 million out of the budget for individuals with developmental disabilities.”

During a press briefing, Gov. Jim Justice said he will call a special session for lawmakers to make adjustments to the health and human services budget.

“We have hundreds of thousands of people in West Virginia that are going to be affected — can you imagine, can you imagine the good work that we did and now we could possibly hurt those folks?” Justice said.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.