CHARLESTON — The West Virginia Department of Health and Human Resources announced Tuesday that Aetna Better Health of West Virginia has been selected to serve as the managed care organization for children and youth in adoption and foster care placement and the state’s Children with Serious Emotional Disturbance (SED) waiver.
Searching for a way to better coordinate the health care needs of the booming foster and adoptive system, DHHR began work on transitioning to managed care a few years ago and got the final stamp of approval from the Legislature this past session.
DHHR leaders hope the implementation of managed care services for the state’s child welfare population will streamline the administration of health services; tailor services to meet the needs of enrolled populations; coordinate care for members; and work to transition members from out-of-state care to community-based treatment in West Virginia. In addition, the state will integrate the oversight of its Socially Necessary Services (SNS) program under this contract to promote a holistic approach to care management for both medical and social services.
“West Virginia is in the midst of a child welfare crisis, and DHHR believes the utilization of an MCO to help provide coordinated care to this vulnerable population will assist us in addressing this issue,” said Jeremiah Samples, deputy secretary for DHHR, in a release.
Aetna Better Health of West Virginia (formerly Coventry Health Care) has been serving members of the West Virginia Medicaid program since 1996. Currently, Aetna provides services to more than 137,000 Medicaid members, according to DHHR. The new program will transition approximately 20,000 new members to Aetna for care coordination services.
The decision to switch to a managed care organization was a controversial one, with many child welfare advocates expressing concerns it would actually make it more difficult to receive services for an already underserved population.
Marissa Sanders, organizer of the West Virginia Foster, Adoptive & Kinship Parents Network, said the biggest question the parents in the network have right now is how information will be distributed to them and how they can get their questions answered.
“A lot are asking, ‘Will I have to change my children’s providers? Will they be in network?,’ particularly if they have an adopted child and they have been with a provider for a long time. ‘When will I be able to check if they are in network? How will they figure out how to change providers? What happens if I have child with complex needs and need a provider out of network?’”
Sanders said she will reach out to DHHR to set up a meeting to get those questions answered.
The parent network is working to get a survey to foster, adoptive and kinship caregivers that was developed in partnership with Marshall University and DHHR. The goal is to gain a better understanding of the needs of these groups, the effectiveness of training and services currently provided, and how the child welfare system can better support families who care for children who are or were in the state’s custody.
Sanders said the survey has already been taken by more than 700 people, and her goal is to reach 1,000.
Along with adding the MCO, the same piece of legislation attempted to rectify other issues foster families have with the system by making state code more in line with prudent parenting standards, which gives parents more flexibility to make decisions for the children in their care.
It also created an ombudsman position to assist foster families with issues with the system and to recommend solutions to lawmakers. Last week, DHHR announced Pamela M. Woodman-Kaehler had been appointed to the position.
There is still more work to be done, Sanders and state legislators agree.
“We want to enhance any aspects of the system we can to make this endeavor less stressful for all involved,” said House Majority Leader Del. Amy Summers, R-Taylor, in a release this week. “This may be through new legislation or just alerting the relevant governmental agencies and foster care providers what needs to be done better to make the journey easier for all involved.”
Sanders said the network’s goals include doing more to clarify what authority parents have to make decisions for the children in their care and creating a Foster Care Bill of Rights. They would also like to see a centralized database of all foster parents, which could help to streamline placements and do targeted recruitment of new foster families, and more oversight of guardian ad litems and others involved in the system to ensure the needs of the children are being met.
Those goals may change as a result of the survey, Sanders said.
The survey is available at wvfosterparents.org/survey. It will be available until Nov. 18 to allow time for processing submissions ahead of December legislative interim committee meetings.
Follow reporter Taylor Stuck on Twitter and Facebook @TaylorStuckHD.