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They’re Not Doctors. But They’re On The Front Lines Against W.Va.’s Health Struggles.

Lyle Marcum can’t drive to the doctor when he’s feeling ill. He couldn’t go to a downtown grocery store if there was one, which there isn’t. But when he has a hankering for fresh watermelon, he takes his wheelchair across the railroad tracks to where the Williamson Health and Wellness Center operates a farmers market.

Written by Laura Williamson, American Heart Association News

WILLIAMSON, West Virginia — Lyle Marcum can’t drive to the doctor when he’s feeling ill. He couldn’t go to a downtown grocery store if there was one, which there isn’t.

But when he has a hankering for fresh watermelon, he takes his wheelchair across the railroad tracks to where the Williamson Health and Wellness Center operates a farmers market.

As he shops for fresh fruits and vegetables, the 71-year-old stops to chat with the community health workers he credits with keeping him alive.

“If it wasn’t for them, I wouldn’t be here today,” he said.

Marcum lost his left leg to Type 2 diabetes and has been diagnosed with high blood pressure and heart disease. He’s one of thousands of residents who benefit from the center’s work tackling the devastatingly high burden of chronic illness in this small, rural Appalachian community in southwestern West Virginia.

At the center of it all are the community health workers, or CHWs, whose job includes helping clients learn to eat healthier and so much more.

The CHWs literally keep hearts beating in this coal-mining town along the Tug Fork River, overlooking the Kentucky border. Williamson is the seat of Mingo County, where the population has been steadily falling for years.

In a state ranked among the least healthy in the nation, where nearly 1 in 3 people describe their health as fair or poor, statistics suggest Mingo County’s roughly 22,000 residents face the biggest health challenges of all.

Their life expectancy is an estimated 67.2 years based on figures from 2019-2021, according to the latest County Health Rankings and Roadmaps data. That’s compared to 72.9 years for West Virginia and 77.6 for the nation during that same time period.

About 17% of adults in West Virginia have diabetes and 15% have cardiovascular disease – the highest rates in the nation, according to an America’s Health Rankings’ analysis of federal data that also showed 43% have high blood pressure. The county rankings show roughly 42% of Mingo County adults struggle with obesity, 37% are physically inactive and 28% smoke – all rates that exceed state and national averages. Poverty, lack of health insurance and scarcity of hospitals and health care professionals exacerbate these challenges.

Williamson residents also have high levels of food insecurity. So, community health workers distribute boxes of heart-healthy foods and show residents how to cook them.

Because the area lacks recreational facilities, CHWs organize walking groups and free community yoga classes. They also go to the homes of people like Marcum to take blood pressure and blood glucose readings and to help them manage their medications.

One of the most important roles the health workers play is to listen to their clients’ problems and encourage them when they feel frustrated and discouraged.

“They’re like family,” said Marcum, who told his care team, “I don’t need a wife. I got you all.”

“Some of these people have no family,” said Stephanie Bowman, a certified nurse practitioner and project manager for the CHW program in the department of family and community health at Marshall University’s Joan C. Edwards School of Medicine in Huntington, which provides ongoing training and technical assistance to their sites. “Just to have that visit even once a week, it makes all the difference in that person’s life.”

Williamson was the first of 24 sites serving 800 people across West Virginia, Kentucky and Ohio to use the CHW model developed under a 2012 federal grant.

The CHW model quickly proved successful. Within six to 12 months after enrollment, 60% of participants had lowered their A1C – a test that measures average blood glucose control for the past two to three months – by 2.4%. Emergency room visits fell 22% and hospitalizations declined 30% within a year.

When the grant ended in 2015, the model’s developers obtained funding to replicate it on a larger scale, while working with health insurers and Medicaid managed care organizations to create a shared payment plan that would sustain it on a longer-term basis.

Initially focused on helping people with high-risk diabetes, the model expanded in 2017 to cover other chronic illnesses, including heart disease and chronic obstructive pulmonary disease, and continues to expand.

CHWs are at the center of care teams managed by a nurse, nurse practitioner or doctor, who stays in contact with the primary care provider to make sure a care plan is being followed. CHWs are full-time employees and work directly with the patients, reporting back to the nurse. They are intentionally not medical professionals.

“The community health worker is a peer, a neighbor,” Bowman said. “They know the community and they understand the culture. They have the ability to see the person in their home, with the patient at ease, to be in a space where they can learn their self-management skills.”

When a patient enters the program, “we ask that they do a home visit right away,” Bowman said. Sometimes, a patient is reluctant to have someone in their home, so they meet at a neutral location, such as a library or a park. “But eventually that home visit happens, and that’s when the transformation begins.”

Once a CHW enters a home, they can identify the challenges the patient faces, Bowman said. They may not have enough resources to feed themselves, or they may be eating foods contributing to their illness. They may not be getting enough physical activity or know how to properly manage their medications.

“Sometimes it’s just a matter of needing better organization or understanding what resources are available when they have food insecurity,” she said.

Sometimes, the problem is keeping medical appointments.

“A lot of times, people don’t go to the doctor unless there’s something wrong with them,” said Samantha Runyon, one of Williamson’s community health workers. “And then they have transportation issues, insurance issues.”

Checking blood glucose and blood pressure levels regularly allows the team to better track people’s health so they don’t get sick, Runyon said. “If they have high blood sugar, we can speak to their doctor and get changes made to their medications sooner, rather than them waiting until their follow-up appointment to see the doctor.”

More often than not, a personal bond forms. And that’s when real progress begins, Bowman said. Community health workers “have the ability to connect and build rapport with the patients. When they do, magic just happens.”

Tony Delong can attest to that. His blood pressure and blood glucose levels were so high that when he first went to the wellness center for a checkup, he was immediately enrolled in the CHW program.

“They got me started that day,” he said, remembering how his A1C had climbed to more than 14% – double the goal for most people living with diabetes. After prescribing medication, CHWs “came to my home and called me every couple of days to do my readings – my weight, my blood pressure and check my blood sugar.”

The 64-year-old said the CHWs didn’t just manage his health. They also provided moral support and encouragement, getting him involved in support groups for people with diabetes and heart disease. They encouraged him to walk several miles a day and provided him with a blood pressure monitor so he could take readings on his own. Within a few months, his A1C was within goal and his blood pressure had returned to normal.

“They kept me motivated, and that includes helping me with things to eat,” Delong said. “I used to be a meat-and-potatoes guy. Now I’m practically a vegetarian.”

A big part of the job is helping people manage their risk factors to prevent progression of heart and kidney disease, said Melissa Justice, a nurse on one of the care teams.

Craig Warren has both. The 57-year-old entered the program a decade ago after he had a stroke, then had a toe amputated from nerve damage caused by Type 2 diabetes. The medication he took for his toe contributed to kidney damage, Justice said, and three years ago Warren received a kidney transplant.

Justice works with him to keep his blood glucose and blood pressure levels under control so that he doesn’t need to see his kidney doctor, 30 miles away in Logan, or his transplant team, 81 miles away in Charleston. His cardiologist is also 80 miles away, in Huntington.

“We have to keep up the preventive work so they don’t have to see a specialist,” said Justice, who coordinates the wellness center’s community health worker program. “We have no specialists here.”

Justice said the people they see have made steady progress, particularly in blood pressure control. In 2019, 65% of patients had blood pressure under control. In 2020 – the first year of the COVID-19 pandemic – that percentage rose to 72%, increasing to 75% in 2021. Currently, about 77% of patients maintain blood pressure within the normal range.

While enrollment in Williamson’s program was initially slow, it quickly picked up and at times, they’ve had more people seeking services than they could help.

“I’m one of the lucky ones,” Warren said. “I’m lucky to be alive.”

American Heart Association News sent reporters to five states to cover rural health challenges, and how people in rural America are working to overcome them.

Lawmakers Search For Answers In Elderly Patient’s Boiling Death

The commission that oversees West Virginia’s state-run hospitals questioned state officials but received few answers following the January death of a man held at a state-run psychiatric facility.

The Legislative Oversight Commission on Health and Human Resources Accountability (LOCHHRA) attempted to get more information Tuesday about the circumstances surrounding the death of an elderly, nonverbal man who was left unattended in scalding water at Hopemont Hospital, a long-term care facility in Preston County.

What Happened?

In January, an elderly, nonverbal man with dementia was left in scalding hot water by nurses at a state-run, long-term care facility. The man, referred to as Resident #19 in the Office of Health Facility Licensure and Certification’s (OHFLAC) report, had burns covering 35 percent of his body from being left in the 134 degree whirlpool bathtub for 47 minutes.

In a press release from Jan. 5, the West Virginia Department of Health Facilities (DHF) released a statement calling the incident an “equipment malfunction.”

“A thermostat on a water tank servicing one residential unit failed resulting in unsafe water temperatures,” the release reads. “Subsequently, one resident of the facility was treated for burns.”

According to the OHFLAC report, the nurses on staff did not tend to Resident #19’s burns immediately or call 911. They conferred with one another about whether or not the man had a skin condition that could cause his skin to peel before realizing he was burnt from the bath.

Two hours after the incident began, the man was transferred to a local hospital, then to a burn unit in another state where he later died from his injuries.

State Lawmakers Want Answers

Lawmakers were met with little response from general counsel for the Office of the Inspector General, Jessica Whitmore, who told lawmakers she could not provide details about the case, only the procedure of the investigation.

“I cannot discuss specifics of this report,” Whitmore said. “This report was conducted pursuant to federal regulation, and federal regulation by the CMS (Centers for Medicare and Medicaid Services) does not allow us to testify about specifics of reports.”

Sen. Vince Deeds, R-Greenbrier, asked Whitmore what federal regulation prevented her from discussing the report.

“There should be a mechanism for transparency and clarity within a facility,” Deeds said. “I just don’t feel quite comfortable with it right now. It feels like you’re trying to give me partial answers to things, because there may be some reasons that you just don’t want to discuss this.”

Whitmore cited federal regulation under 45CFR part two, which provides procedures when voluntary testimony is requested or when an employee is subpoenaed.

“It says we cannot discuss the specifics of any investigation we do pursuant to our agreement with CMS as the state survey agency,” Whitemore said.

Legal Director of Disability Rights of West Virginia Mike Folio told WVPB Wednesday the Office of the Inspector General (OIG) should have been able to answer LOCHHRA’s questions.

“For OIG to send an attorney up there and not to answer subsequent questions is just outrageous to me,” Folio said. “And I’m not necessarily faulting the attorney. I’m faulting the inspector general, who was the governor’s deputy chief of staff.”

In response to a question from Del. Amy Summers, R-Taylor, Secretary of the Department of Health Facilities Michael Caruso said he is not allowed to elaborate on the investigation.

“What I would like to expand to tell you is that when an isolated incident occurs, in any facility, we immediately jump on that situation, we’re the ones that reported to OHFLAC, we’re the ones that call all the other entities that then get involved in that process, we’re the ones that solve the problem, and we solve that problem pretty quickly, with an unfortunate situation that it did occur,” Caruso said.

A Timeline Of The Incident

*Editor’s note: The following may be difficult for some readers.

On Jan. 4, 2024, according to the OFLAC report, a nurse aide put the man, who was nonverbal, into a whirlpool tub and filled the tub to knee level, then realized the water was too warm and asked another aide to try to adjust the water.

“I walked in and put my hand in the water and said, ‘that’s hot.’ The [sic] looked at the temp gauge and it was 134 (degrees),” a nurse’s aid said in a statement in the report. “The water was past his knees but not running. I immediately turned the temp down and ran cold water in the bath. It cooled down and I went out of the bath back to my task I was doing. Then when I walked back up the hall, I overheard he had blisters and recalled what happened. I knew the bathtub would go to 140 (degrees) but I didn’t report it because the other staff told me it was normal and how to fix it.”

According to the report, readings of water temperatures taken from January to December 2023 show the water temperature at Hopemont Hospital was consistently above the regulation 110-degree maximum.

“This gentleman had no reason to die, none at all,” Folio said. “It’s quite appalling, quite frankly. I have evidence that for months before this gentleman was placed in a whirlpool to be boiled alive, that their maintenance team knew and their nursing staff knew that the water temperature at this location was around 134 degrees.”

Recent History Of Too Hot Water

In December 2023, the month leading up to the incident, temperature readings were 126 degrees at its lowest on Dec. 21, 2023. The highest temperature recorded in December was 140 degrees and the water was that temperature on Dec. 6, 13, 14 and 22.

“The temperature, by regulation generally speaking, is supposed to be maintained by the facility,” Whitmore said. “If they are not in compliance with it, the facility would have the responsibility of coming into compliance. So that doesn’t always mean that they report it to us as a deficiency. It’s if you are running a facility and you see a problem, you are expected to fix it prior to us. There’s no mandated reporting.”

There were three Facility Reportable Incidents reported on Jan. 4 at Hopemont Hospital. The first was the report of the resident’s burns.

“Imagine being in water at that temperature for 47 minutes,” Folio said. “You’re elderly, you have dementia and you’re nonverbal. He couldn’t even scream for help, because he was nonverbal. They abandoned him while the staff members are out there in the hallway, surfing the internet on their phones.”

Needs Not Addressed Quickly

The second incident report stated that the registered nurse did not assess or treat the resident with severe burns timely. According to the report, the registered nurse (RN) was suspended in addition to the nurse aide.

According to the statement of one of the health service workers, the patient was left in the empty tub for a while after the incident before staff moved the patient to his room.

“I decided he needed to be moved to his room via wheelchair because he was ripping his skin off his legs by rubbing them together and ripping the skin off his feet by rubbing them on the drain,” the statement reads. “We put him to bed and placed wet rags on his burns and stayed with him trying to keep him comfortable waiting to see what was going to happen.”

Emergency Medical Service records referenced in the report show no one called 911 until 8:54 p.m. The resident was taken to the tub room at 7:12 p.m.

According to the Nursing Home Administrator’s statement, he went to the nurse’s station after watching the resident writhing in pain and advised the RN that the resident needed pain management immediately.

Regulatory Guidelines Not Met

A third facility-reported incident dated Jan. 4, 2024 stated the maintenance supervisor had been monitoring water temperatures for over six months, which did not meet regulatory guidelines. The Maintenance Supervisor failed to report the temperatures or attempt to make any changes to meet regulatory compliance. The report said he was aware of the guidelines for water temperature and chose to keep it warmer per staff request.

Hopemont Hospital was surveyed by a team from the Office of the Inspector General from Jan. 9, 2024 to Jan. 12, 2024 and had 44 residents.

On Jan. 11, 2024, Hopemont Hospital adopted a bathing policy which includes taking water temperatures prior to individual resident bathing to ensure a temperature of no higher than 110 degrees Fahrenheit, and supervision of residents during bathing to prevent harm.

A Painful Death

A report from the local hospital where the resident was transferred revealed the resident had third-degree burns to bilateral lower extremities and feet, left hand, bilateral buttocks and scrotum. The estimated surface area of the burns was 35 percent of his body.

The report concludes with the man being transferred to Preston Memorial Hospital for emergency care, then transported to a neighboring state burn center, but he succumbed to his injuries according to Disability Rights of West Virginia.

A spokesperson for the state health department told West Virginia Watch the department fired four nurses, including three contract employees, who were involved in the patient’s death.

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

Department Of Human Services Continues To Deny Culpability In Passing Of Boone County Girl

Cynthia Persily sat down with a WSAZ reporter to discuss the case. Persily told WSAZ that the Department of Human Services had no records at all of Kyneddi Miller.

The West Virginia Department of Human Services (DoHS) released a statement Tuesday refuting recent reports from southern West Virginia television station WSAZ about the 14-year-old girl who was found in a near skeletal state by Boone County deputies.

The station recently reported that the Department of Human Services did in fact have contact with the family of the now deceased Kyneddi Miller. This was based on documents from an anonymous whistleblower who claimed to be a social worker with the department. It included cases in 2009 and 2017.

Additionally, the station had information from the state police indicating that Child Protective Services had been notified about the alleged abuse and neglect.

“We are aware of information suggesting that West Virginia State Police intended to make a referral on this child in March 2023,” Department Secretary Cynthia Persily said. “However, a comprehensive search of DoHS records suggests no referral was ever made.”

Nearly two weeks after WSAZ’s report, Persily reiterated the department had no records of abuse.

“DoHS never received an abuse or neglect referral relating to the death of Kyneddi Miller, and was therefore not involved in the life of this child prior to her passing,” Persily said.

In the same statement, Persily said that the whistleblower broke state and federal law by sharing the information with WSAZ.

“We are extremely disappointed by the disclosure of information relating to those prior matters by an anonymous informant and by members of the local media,” Persily said.

DoHS Promises Transparency In Spending New Reserve Fund

Following a special session focused largely on funding her department, the Secretary of the West Virginia Department of Human Services, Cynthia Persily, released a statement promising transparency Tuesday.

Lawmakers from both sides of the aisle and both chambers made one thing clear this special West Virginia Legislative session: they do not trust the Department of Health and the Department of Human Services to spend money.

Following a special session focused largely on funding her department, West Virginia Department of Human Services (DoHS) Cabinet Secretary Cynthia Persily released a statement promising transparency Tuesday.

“Today’s restoration of more than $183 million in funds will allow DoHS to continue to provide essential services through its Bureau for Child Support Enforcement, Bureau for Behavioral Health, Bureau for Family Assistance, Bureau for Medical Services, Bureau for Social Services, and the Office of Drug Control Policy,” Persily said.

Instead of restoring the budget line items cut from the state budget passed on the last night of session, Senate Bill 1001 appropriates money to a new reserve fund of $183 million. The bill also makes $5 million available to the Department of Health. Lawmakers hope the cabinet secretaries of the departments will spend on underfunded line items.

The secretaries have the ability to move only 5 percent of any money from one existing account to another. The reserve fund is new and it will expire March 31, 2025. It is not encumbered, so the cabinet secretaries are not required to spend the money on specific items.

The House and Senate could not agree on how the money should be allocated and how much transparency and accountability should be attached to the funds.

Del. Amy Summers, R-Taylor, amended the bill in the House Finance Committee to require increasing reimbursement rates for companies and their employees providing services for people with disabilities.

The House sent that version over to the Senate, where Summers’ amendment was stripped and the Senate reverted to their plans – Sen. Eric Tarr’s, R-Putnam, original amendment.

“That reserve fund is there so that the quarterly disbursements, if they aren’t enough for any given line that has been cut, they can make a transfer, but the secretary has to sign off on it,” Tarr told West Virginia Public Broadcasting. “She has to report on the transfers monthly to the joint committee.”

Tarr’s amendment also includes language that requires the unexpended reserve funds be returned to the Treasury by March 31, 2025.

House language to prohibit any funds from being transferred out of the home and community-based waiver programs was retained in this version.

When the bill arrived back in the House, delegates from both sides of the aisle expressed outrage at the Senate’s actions. They refused to concur and sent the bill back to the Senate.

The Senate then adjourned sine die. By taking no action, the Senate left the House to jump through hoops to get Senate Bill 1001 back on the floor and up for consideration.

Procedurally, the House had to move backward in order to take the bill back up. They had to vote to undo their Monday night actions, then vote to concur with the Senate, lest the bill die and the funding be left incomplete.

The House did just that and passed the bill, as amended by the Senate, with a nearly unanimous vote. The bill now awaits Gov. Jim Justice’s signature.

In her statement, Persily said she plans to use more than $89 million to remedy the anticipated Medicaid shortfall for Fiscal Year 2025.

Persily also said she heard the legislator’s concerns about the need for transparency and that the DoHS is committed to providing it while continuing to analyze reimbursement rates for all providers of services.

“As appropriate and feasible, DoHS will continue to make adjustments to rates as necessary for providers as early as July,” she said. “The department appreciates the work of the legislature and thanks each member for their time and attention to the crucial needs of West Virginia’s most vulnerable residents.”

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

House Funds Waiver Programs In Final Hours Of Special Session

An extraordinary legislative session ended with tensions high among lawmakers who wanted more transparency in spending from the Department of Health and Department of Human Services.

The West Virginia House of Delegates refused to concur with the state Senate’s amendment to Senate Bill 1001 in a late-night session Monday.

Instead of restoring the budget line items cut from the state budget passed on the last night of session, Senate Bill 1001 appropriates money to a new reserve fund of $183 million. Lawmakers hope the cabinet secretaries of the departments will spend on underfunded line items. The secretary has the ability to move only 5 percent of any money from one existing account to another. This fund is new and it will expire March 31, 2025. It is not encumbered so the cabinet secretaries are not required to spend the money on specific items.

On Tuesday, the Senate took no action on Senate Bill 1001 and sent the bill back to the House.

Emotions were high in the House after the Senate adjourned Sine Die without addressing the House’s version of the bill.

The House’s version would have required rate pay increases for those who work with individuals with intellectual and developmental disabilities, otherwise known as those served by the IDD waiver program.

In 2023, the previous West Virginia Department of Health and Human Resources (DHHR), Bureau for Medical Services contracted with Myers and Staffer, an actuary firm, to conduct a “rates” study of the Aged and Disabled Waiver, and Personal Care Services programs.

The study recommended a $6.5 million rate increase for the IDD waiver program to hire and retain direct care professionals.

“We the House feel it is very important to include these rate increases for providers because we are very short on providers,” Del. Amy Summers, R-Taylor, said. “And it is our job as the legislature to make sure this infrastructure is there.”

Del. Mike Pushkin, D-Kanawha, said he believes there will be no rate increases since the House’s amendment was not passed.

“I trust when they said under oath that they had absolutely no intention of increasing the rates,” Pushkin said. “That’s what they told us when they were under oath, there was not their intention to increase these reimbursement rates.”

One House amendment that was included in the final version of the bill is a line protecting the IDD Waiver line from any moving of monies within the department.

These concerns stem from a line of questioning during an interim meeting in April where Human Services Secretary Cynthia Persily testified that the department used funds from the IDD waiver program to pay for contract nurses and COVID-19 testing.

“I think the one issue that we did come to fix was the IDD issue in the stealing of money that was occurring out of that line item,” Del. Adam Burkhammer, R-Lewis, said. “I believe that this legislation stops that. It ensures that $97 million is going to IDD.”

By taking no action, the Senate left the House to jump through hoops to get Senate Bill 1001 back on the floor and up for consideration.

“The position that the House is in right now, is they need to recede from what they did yesterday, or the bill is dead,” Sen. Eric Tarr, R-Putnam told reporters after the Senate adjourned Tuesday.

Tarr said the bill was the product of months of negotiation among the House, Senate and governor’s office to go through and set up a mechanism for transparency.

“We don’t believe there’s a cash flow shortfall anywhere, and that’s coming up on us anytime soon,” Tarr said. “However, if there would be then there’s a reserve fund that has incredible transparency to it, that the secretary has to sign off individually on transferring those funds and the report to the joint committee on which line it went into, and why.”

Many lawmakers in the House expressed a desire for the cabinet secretaries to have to ask permission to spend, instead of reporting the expenditure after the fact.

“We can’t control where the money goes, specifically, but we can at least be told where it’s going to be spent,” Del. J.B. Akers, R-Kanawha said. “And pardon my language, I would hope that if it’s not spent the way that we intended, there’s hell to pay next year.”

In the Senate, only one Senator voted against this version of Senate Bill 1001 — Sen. Mike Woelfel D-Cabell. The House passed the bill nearly unanimously. It now heads to the governor’s desk for his signature.

Lawmakers Volley Over Best Means Of Medicaid Funding Transparency

Lawmakers said they did not think they could trust the secretaries of the Department of Health and the Department of Human Services to spend the money accordingly, without the line items.

The West Virginia House of Delegates refused to concur with the state Senate’s amendment to Senate Bill 1001 in a late-night session Monday.

Senate Bill 1001 and its counterpart, House Bill 101, aim to restore funding to the Department of Health and the Department of Human Services, focused on the state’s Medicaid and Title IX waiver programs.

Clawback Cuts

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

This included a more than $10 million decrease in the line item in the state’s budget for the intellectual and developmental disabilities waivers, commonly called IDD waivers program.

The program allows people with disabilities to live outside hospitals and institutions by connecting them with resources like home health care workers and financial support.

In response to the cuts, advocates and providers alike have been sounding the alarm after the budget was passed in March.

Gov. Jim Justice said during a press briefing 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.

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

Justice announced in April that West Virginia will not face that clawback.

Pressing Costs

Lawmakers said they did not think they could trust the secretaries of the Department of Health and the Department of Human Services to spend the money accordingly, without the line items.

Before and during the pandemic, Persily testified that the previous Department of Health and Human Resources (DHHR) administration would use leftover funds to fund what she called “pressing costs.” According to Persily, this was common practice in the department before it was split into three separate departments by an act of the legislature last year.

Lawmakers and Justice now agree, the funding must be restored. Senate Bill 1001 allocates more than $5 million to the Department of Health and $183,437,463 to the Department of Human Services.

These monies would be placed in reserve funds that can be accessed by the agency secretaries when or if the money is needed. However, each chamber wants its own form of oversight over how these additional funds are spent.

An Extraordinary Session

“We all know that if we don’t have the workers to take care of individuals in these settings then we will take care of these individuals in state psych hospitals,” Summers said in committee Monday.

The House sent that version over to the Senate where Summers’ amendment was stripped and the Senate reverted it to their plans – Sen. Eric Tarr’s, R-Putnam, original amendment.

“That reserve fund is there so that the quarterly disbursements, if they aren’t enough for any given line that has been cut, they can make a transfer, but the Secretary has to sign off on it,” Tarr told West Virginia Public Broadcasting. “She has to report on the transfers monthly to the joint committee.”

Tarr’s amendment also includes language that requires the unexpended reserve funds be returned to the Treasury by March 31, 2025.

House language to prohibit any funds from being transferred out of the home and community based waiver programs was retained in this version.

When the bill arrived back in the House, delegates from both sides of the aisle expressed outrage at the Senate’s actions.

“So let me get this straight,” Summers said. “Our bill went over, where we had the rates in there, the rate increases for IDD, for TBI, for aged and disabled waiver, for personal care services that went over there. They didn’t like that. But then they made sure they stuck in the amendment that they wanted about, ‘We want all this money to expire to general revenue on March 31.’ And now we’re supposed to take that?”

Del. Michael Hite, R-Berkeley, said the House’s amendments were meant to restore money and direct it to specific funds and services.

“Not just to leave it up to the Department of Human Services, again, to do the right thing,” Hite said. “That was the purpose of our amendments. That’s what we voted on in here. To make sure that they did the right thing, because they have proven over and over again that they don’t do the right thing.”

Del. Joey Garcia, D-Marion, said this was the time to fight, and encouraged his fellow lawmakers to reject the Senate’s amendments.

“The lady from the 73rd, offered a great amendment,” Garcia said. “And I talked to somebody from the Senate here a second ago and asked, and they said, ‘Well, that should be up to the discretion of the secretary, whether or not they have the ability to do these provider rate increases, right?’ Well, they haven’t done it. We as a body have the ability to set that policy and say, ‘Yes, you will take that money, and you will fund those, because otherwise, what are we doing here, but trying to find an illusory solution?”

Del. Mark Zatezalo, R-Hancock, said it is the lawmaker’s responsibility to keep promises to their constituents, and by rejecting the Senate’s amendments, they’d be keeping their promises.

“I agree with my colleagues here, we need to stick with our position on this and make sure it gets to where it goes so that we basically are telling people the truth,” Zatezalo said.

Del. Eric Householder, R-Berkeley, disagreed with his colleagues. He said Senate Bill 1001 fulfilled their promise to the people of West Virginia, and lawmakers were putting that at risk.

“I can’t give you any guarantees, whether or not they’re going to recede or not,” Householder said. “You’re gonna put that at risk by having a conference committee, that it’s an unknown. I’m saying that if this bill restores the cuts, we’re better off to concur with the Senate amendment and move on.”

The House voted nearly unanimously to reject the Senate’s amendment and refused to concur, requesting the Senate to recede.