State’s plan for reducing foster kids in group homes met with pushback 

West Virginia foster care leaders are trying to reduce the number of foster children who are institutionalized, and they’ve rolled out a plan that could eliminate certain types of care in hopes of pushing kids to community-based services.

The problem, child residential providers say, is there’s a critical shortage of pediatric behavioral health providers around the rural state.

Providers are pushing back on the proposed plan, saying the state should, instead, focus on reducing the number of children coming into foster care — not swiftly eliminating treatment options that could force more vulnerable kids out of state or leave them without help.

“Funding, growth and expansion for our community based prevention services and treatment foster care must be more robust before we dismantle and eliminate the levels of care currently serving youth who need these services,” said Katrina Harmon, executive director for the West Virginia Child Care Association, which represents residential programs that offer housing, mental health services and more to foster kids.

“Once those front end services are healthy and readily available statewide, a natural reduction of the state’s reliance on residential care will occur,” Harmon continued. 

The Department of Human Services is under a federal mandate to reduce the number of children who are in group homes. State data showed more than 500 kids in foster care living in in-state group homes and hospitals; more than 300 kids live out of state in facilities.

Following an increase in the number of children who need in-state services, West Virginia foster care leaders explained to lawmakers that they’ll ask 46 in-state facilities to restructure how they provide care — including treatment for trauma — to foster kids. 

The changes would affect residential homes, specialized intensive treatment facilities and emergency shelters that serve foster kids. 

The Department of Human Services wants to eliminate lower levels of care in an effort to push kids to community-based services instead of institutionalizing them. Additionally, they’ll financially incentivize providers who can provide intense care for children so they don’t have to go out of state for services.

Stephanie Williams is the executive director of Davis Stuart, a therapeutic residential facility in Lewisburg. 

“With these proposed changes, the only way for a child to receive any type of residential treatment services is to enter the system as an intensive case,” she said. “The children that we serve do not fit that mold … This systemic change will require children to ‘fail up’ to get into the system.”

She continued, “Please do not let these children fall through the cracks.”

Foster children may be in need of specialized care due to behavioral or emotional challenges; additionally, the state does not have enough traditional foster homes for the more than 6,100 kids in care. 

The plan, expected to go into effect in October, would also increase the health department’s Medicaid program costs in 2025 by $7.4 million. West Virginia Medicaid faces a multi-million dollar budget deficit for next year, which was not addressed by  lawmakers during the recent session despite legislation aimed at fixing it. 

​A DoHS spokesperson did not respond to specific questions in an email for this story, including how the changes would benefit children who are in the troubled child welfare system.

“The West Virginia Department of Health and Human Resources (now DoHS) is meeting with the residential treatment providers serving children regularly during this time of transition,” DoHS Communicators Director Whitney Wetzel said in December in response to questions. 

She added that in August 2023 the department provided an overview of the model resident during a meeting of Kids Thrive Collective, which brings together state foster care leaders and relevant stakeholders to discuss foster care challenges.

Providers outlined concerns to lawmakers

Davis Stuart offers child counseling and crisis intervention, and the facility also offers equine and agricultural programs to children. 

“For most of the children we serve, we are their first out of home placement,” she said. “Most of our children come to us woefully behind in school and they are able to get caught up and succeed for possibly the first time in a school setting. They learn important life skills … which they often do not have the opportunity to learn at home.” 

Under the proposed changes, the state will also change how it reimburses the youth residential programs, moving to a “fee for service” structure — thus eliminating certain kinds of less-intense treatment currently provided.  

Providers will have to agree to the new structure in order for the state to reimburse them through Medicaid dollars. 

Williams said it could push smaller providers out of business. 

“We will no longer be able to offer treatment services or have educational services on grounds,” she explained. “Our kids will be required to attend public school and will only have access to very limited or currently non-existent community services for their treatment needs.”

The West Virginia Child Care Association, which represents Davis Stuart and other providers, sent multiple letters to lawmakers that outlined residential providers’ concerns as lawmakers discussed ongoing foster care issues during the recently-adjourned legislative session. 

“The proposed new structure will eliminate the ability to deliver crucial treatment services within current Level I and II residential treatment facilities and creates a gap for youth who do not need highly intensive treatment interventions,” a letter sent in December said. “Level One and Two residential treatment facilities currently make up the largest number of treatment beds for West Virginia youth and effectively [provide services] to youth while receiving support, resources and stability that cannot currently be found within their home settings and rural communities … Where will these youth be served?”

In an email, House Health Committee Chair Amy Summers, R-Taylor, deferred questions about the process to the state health department. Senate Health Committee Chair Mike Maroney, R-Marshall, did not respond to an email for this story. 

Harmon also raised transparency concerns about the plan, saying, “Model input and rate negotiation is little to non-existent, and providers do not feel they have been active participants in that development process.”

In response to those concerns, Wetzel said in a February email that the DoHS leadership had actively engaged with “a wide range of stakeholders and service providers over the past year,” which included “regular meetings and weekly office hours specifically aimed at soliciting input.”

She continued, “DoHS recognizes the importance of inclusive participation in the planning process and remains committed to fostering open dialogue and collaboration with all stakeholders … DoHS is dedicated to continuously improving our efforts to ensure transparency and accountability in all aspects of our work.”

Changes will require some kids to attend traditional public schools

Jacob Green, superintendent for the West Virginia Schools of Diversion and Transition, said the proposed changes will affect how public schools operate on the grounds of residential facilities. 

The state education department currently operates schools for children in kindergarten through 12th grade at the residential facilities.

“Many have been through significant trauma — partially the foster care youth. We try to keep that teacher student ratio low so we can get that student on track,” he said. “We will continue to do the best we can … even if that means digging deeper into public schools.”

Green explained that some schools will remain on-site, while other students “will be engaged in a transitional school program” to help transition them into specific public schools.

“The WVSDT will be providing support within the county school district for transitions students,” he said, adding that his department is working with the DoHS during the changes. He’ll begin reaching out to county school districts about the pending transitional programs. 

The state health department recently posted a summary of its proposed foster care changes for public comment, which will run through April 15. 

Editor’s note: This story was updated to correct the number of West Virginia foster children residing in in- and out-of-state facilities.