Amid Foster Care Reforms, How Will W.Va.'s New Managed Care Affect Foster Kids?

The West Virginia Legislature recently passed a major foster care bill, which provides more resources for foster care parents among other provisions.

This bill is part of ongoing reforms to the state’s overwhelmed child welfare system, as officials work to manage the futures of nearly 7,000 children in state custody. Last year the West Virginia Department of Health and Human Resources announced it had selected Aetna Better Health to help manage health services for foster children. 

A managed care model is essentially privatized government services. In most states, including West Virginia, Medicaid is managed through similar private care models. 

This shift to a managed care model is a result of House Bill 2010, which was sponsored by Republicans and passed into law last year.

Roxy Todd sat down with two of the managers of Aetna’s new managed care system, Todd White and Kathy Szafran.

***Editor’s Note: The following has been edited for clarity and length.

Todd: There are some concerns that a for-profit companies, such as Aetna, have profits in mind over the welfare of people and children. Here in West Virginia, you know, there’s no denying we have a broken foster care system. How will this shift help address that?

White: Sure. So we’ve been here for over 23 years. What we’re looking to do is not take money from the system and ship it to a for-profit company. In a managed care model, the goal is to shift the care from like an emergency room setting, from an inpatient setting, to more of the preventive services. So you see those utilization numbers go up, with the hope that the emergency room utilization will drop. And so our job is to make the state’s program as efficient as possible, while driving all the healthcare outcomes.

Szafran: And when you look at it from the perspective of where do we start intervening our current foster care system, we’re intervening in a very reactive way. We’re the ones who aren’t getting involved when, you know, children have experienced a lot of adversity. Families are totally falling apart. And the services that many of these kids end up needing tend to be very high-end, expensive services, because of the amount of complications they’ve experienced.

Todd: As you know, there’s current litigation here against the state of West Virginia on behalf of foster care children who allege the DHHR has rampant issues with institutionalization for children, inadequate mental health services, and overextended caseworkers. And meanwhile, we see that in Texas, there’s also been a similar lawsuit. And that state has been embroiled in this litigation for years. And Texas moved to a managed care model in the 1990s, I believe. So how is the shift going to improve the underlying issues that are really affecting our foster care crisis here in the state?

White: So I’ve thought about this a good bit. And so a lot of the issues that we see on the general Medicaid side over the last several years, it’s not an issue with the services that are available, you know, through the benefit structure, it’s really the resources from the provider side and where do we expect to come in and be able to help the program is to take some of the load off of the CPS workers. We’ll have a care coordinator working with the family as well. We’re really hoping to kind of go in and take some of the load off these folks that’s been doing this by themselves for quite some time.

Szafran: Yeah. And I can’t emphasize enough the importance of care managers in the communities, knowing the communities and knowing the families. That’s another very positive part of how I approach this. It will allow the continued development of community resources as the care managers work with the CPS staff, to best serve children, where they’re at, and assisting families. Also, looking at this with a trauma-informed lens, and really understanding the ramifications of trauma and how it affects children and families, short term and long term. I think that is very significant for a managed care organization to adopt this cutting-edge science approach to well-being. I think it’s very critical, and I think that the outcome will be positive for West Virginia.

Todd: You mentioned trauma-informed care. Here in West Virginia we have a shortage of mental health providers that specialize in taking care of children who have a background in trauma. So how do we address this shortage?

Szafran: Oh, that’s the fun part of the job. Part of the training collaborative is going to be connecting and training throughout the state. And one of the beauties of being trauma-informed is more and more people are coming to the table and wanting to learn. There’s a variety of trainings that we can utilize. school systems now are coming and saying we want to become trauma-informed schools, and different health providers. It’s something I’m very, very proud to say that I’ve been part of. It is critical to all of our children and to our families that this is how we see the world, and it’s much more than a training. It’s much more a paradigm shift into how we evaluate, how we work with, and how we deal with each other. So when you said, mental health professionals, trauma-informed care is the bus driver, right? Good trauma-informed care is the lady who works in the cafeteria. Everyone can be trained on how to be sensitive to trauma in the lives of others, so that you don’t have to be a licensed mental health professional. You can be an incredible teacher, you can be an awesome foster parent, and still be very cognizant of what that means to be trauma-informed. So whoever the caregiver is for the child can impact that child and help them heal. If they understand that the behavior that they see is more of a way a child is trying to explain what’s happening, not just a behavioral disruption. So I think that’s really critical that we continue educating and training throughout the state.