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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.

Raw Milk Sales Legal In W.Va. As Avian Flu Cases In Cattle Rise

Starting in early June, West Virginians will be able to purchase raw milk, as long as it is properly labeled.

House Bill 4911 removes the restrictions on the sale of raw milk and permits the sale of raw milk as long as the containers are clearly labeled as ungraded raw milk along with the seller’s name and date of production.

The practice of “herd sharing” has been legal in West Virginia since 2016. A herd share lets people enter agreements to share milk-producing animals and drink raw milk.

According to Commissioner of the West Virginia Department of Agriculture, Kent Leonhardt, his department enforces herd-sharing rules.

“And there was rules that the Department of Agriculture had to enforce,” Leonhardt said. “And so those that was going along swimmingly, but there’s still a faction of folks that want to consume raw milk. They don’t want a portion of a cow, they want just to buy it, you know, by the quart, by the gallon, and not have to own a piece of the cow.”

Leonhardt said in previous years, the West Virginia Legislature moved bills surrounding the sale of raw milk, but those bills required fiscal notes from the Department of Agriculture.

“This time, they put a bill through with no requirements at this point in time on the Department of Agriculture,” Leonhardt said. “And so the Department of Agriculture does not have a responsibility in this bill.”

Herd sharing will still be an option, but the bill allows farmers to sell raw milk directly to consumers.

“It has to have certain labeling requirements,” Leonhardt said. “So the consumer knows what they’re getting. And that’s been a position all people have a right to choose. But they need to be aware of what they’re consuming.”

House Bill 4911 faced pushback from Democratic lawmakers concerned about the health impacts of drinking unpasteurized or raw milk.

“But the bill passed kind of overwhelming in the legislature. There was only a couple of folks that voted against it,” Leonhardt said. “And generally, that was either on a legal side or a medical side of things.”

Milk bought in a grocery store in West Virginia has been pasteurized, whereas raw milk has not.

Marie Krause, a dairy scientist and associate professor at West Virginia University’s (WVU) Davis College of Agriculture, said pasteurization is a process that removes pathogens and viruses from milk.

“If you’re talking about big dairy processing plants, like the milk you can buy in the grocery store,” Krause said. “Basically, that has been raised to a temperature of 161 degrees Fahrenheit for 15 seconds. So it’s a high temperature but short time, but that time, and that temperature is enough to kill major pathogens, and also viruses such as the bird flu, or the H5N1 virus. And by doing that, you basically minimize the risk of getting a foodborne disease from consuming milk.”

Another process grocery store milk goes through is homogenization.

“Homogenized just means that you basically disperse the fat molecules in the milk,” Krause said. “So when you buy milk in the grocery store, the fat doesn’t rise to the top of the container.”

Krause said while some argue there are benefits to drinking raw milk, she has found none in her studies.

“There really are no health benefits to consuming raw milk versus pasteurized milk,” Krause said. “We do know that some of the vitamins that you find in milk, the content of those minor vitamins, is reduced by pasteurization, but not to a degree where it affects the nutritional value of milk.”

But another factor is worrying detractors of raw milk: Bird flu is showing up in cattle herds across the county.

In April, testing conducted by the Food and Drug Administration (FDA) on pasteurized, commercially purchased milk found genetic evidence of the H5N1 bird flu virus. But, that genetic evidence had been killed by the pasteurization process.

“However, the CDC has also collected milk samples in grocery stores across the U.S. and they have found fragments of the virus in that milk so that means that you know milk is going into milk processing plants from cows that shed the virus in their milk,” Krause said. “So they might not be sick but they’re still shedding the virus and pasteurization will kill that virus so there’s no risk associated with drinking milk that you buy in the grocery store.”

So far, the U.S. Department of Agriculture (USDA) has confirmed infections of 34 herds in nine states: Texas, Kansas, Michigan, New Mexico, Idaho, Ohio, South Dakota, North Carolina and Colorado.

On April 24, 2024, the USDA issued a federal order to limit the movement of lactating dairy cattle.

“We were getting ready to put a restriction on the lactating cows, dairy cows, moving into the state, but the USDA put a stop to that, prior to us implementing our rule,” Loenhardt said. “We are allowed to do certain things under statute to protect the health of the citizens and the herds and the livestock of the state of West Virginia.”

Leonhardt said pasteurization does kill the bird flu.

“I want to make sure that the citizens understand that work,” Leonhardt said. “The Department of Agriculture is watching it. We’re aware of it. And we’re doing everything within our authority and powers to make sure the citizens eat from a safe and healthy food supply.”

At the time of this reporting, no cases of avian flu have been found in West Virginia cattle.

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

Discussion: Parental Interventions For Children’s Mental Health

One in seven West Virginian children experience anxiety or depression. Appalachia Health News Reporter, Emily Rice spoke with Keith Schemper, adviser for Psychosocial Support at Save the Children about how parents can intervene.

This interview has been lightly edited for clarity.

Emily: So what does the mental health landscape look like in West Virginia?

Schemper: In West Virginia, more than one in seven children, so nearly 45,000 kids, are experiencing anxiety or depression, which is higher than the national average by more than 2 percent. In West Virginia, Save the Children partners with schools in six rural counties to provide early learning programs and resources to children, families and communities, fill in critical gaps and supports for kids and communities where child poverty is as high as 39 percent.

Emily: What steps can be taken to kind of ease the accessibility of mental health care for children in an area like West Virginia?

Schemper: Well, obviously, overall, we need to provide more accessible support, especially in rural communities, you know, but also, we need more touch points. When statistics look bleak, and the issue feels overwhelming, we need to do what we’re doing here today, which is to bring awareness to mental health issues, and then focus on what each of us can do to support ourselves, you know, in our families.

Emily: What are some steps that a parent could take to open up the conversation about mental health for their children?

Schemper: Some steps that you could take to open up the conversation would be things like connecting frequently with your child. So having those regular check-in times, maybe during the morning or evening routines, asking open-ended questions while doing activities together? So not asking “How was your day?” As a child, I would answer that question “fine” probably 99 percent of the time, but rather than asking, “What happened at school today?” or “Tell me about your day?”

Other things you can do is prepare your children for new situations by talking through any small or big changes that are coming up in their lives. It could be the first day of kindergarten, an older sibling going to college or getting a shot at the doctors, and this lets them know what they can anticipate and also can help ease their worry and anxiety. Another step could be to validate your child’s feelings. So telling them it’s okay to feel and express their emotions. And you could even model this as a parent and allow them to identify and name their feelings and work with them on coping skills. And then also just talking through the tough time. So being honest about the facts and using language and terms that your child understands and acknowledging how hard, sad, frustrating what they’re going through must be providing comfort and coming up with solutions together.

Emily: What are some signs of depression and anxiety for parents to look out for?

Schemper: Parents and caregivers know the children in their lives best. So, at the most basic level, they should be looking for changes in behavior from what they would consider typical. So for example, with depression, this might look like you know, feeling sad, hopeless, irritable, a lot of the time, when maybe that’s not typical. Not wanting to do or enjoy doing things they typically find fun and then showing changes, you know, eating patterns, sleeping patterns, or energy levels.

Emily: How would a parent establish that safe space?

Schemper: For one by meeting them at their eye level if they’re younger children, so you’re not hovering over them, by validating their feelings again, asking open ended questions and asking them what their feelings, to help them identify an appropriate emotional label for that feeling.

Emily: And so could you speak to why it is important for parents to take time to take care of their own mental health and what steps they can take to do that, for the benefit of their children as well as themselves?

Schemper: Yeah, when parents support their own needs, they’ll be better able to support the needs of the children in their lives. So this includes maintaining the routine for yourself. Sometimes it’s just simple things. It’s good eating, sleeping, physical activity patterns and regular pulse checking with your own feelings and emotions.

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

Mountain Valley Pipeline, Children’s Mental Health And Song Of The Week, This West Virginia Morning

On this West Virginia Morning, Curtis Tate tells us about problems with the Mountain Valley Pipeline as it nears completion, Emily Rice discusses children’s mental health with state expert and Mountain Stage brings us the Song of the Week with Watchhouse performing “The Wolves.”

On this West Virginia Morning, Curtis Tate tells us about problems with the Mountain Valley Pipeline as it nears completion, Emily Rice discusses children’s mental health with state expert and Mountain Stage brings us the Song of the Week with Watchhouse performing “The Wolves.”

West Virginia Morning is a production of West Virginia Public Broadcasting which is solely responsible for its content.

Support for our news bureaus comes from Shepherd University.

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

West Virginia Morning is produced with help from Bill Lynch, Briana Heaney, Chris Schulz, Curtis Tate, Emily Rice, Eric Douglas, Jack Walker, Liz McCormick, and Randy Yohe.

Eric Douglas is our news director. Teresa Wills is our host. Chris Schulz produced this episode.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning