West Virginia Department of Health and Human Resources Budget Presentation 1st Session of the 85th Legislature January 2020 DHHR Mission Statement The mission of the West Virginia Department of Health and Human Resources (DHHR) is to promote, protect, manage, and provide appropriate health and human services for our residents to improve their health, well-being and quality of life. 2 WEST VIRGINIA Department of Organizational Structure Of?ce of In spector Gen era Jolynn Mara [lnteri?n) oar . Cabinet Secretary Control Policy Director Bob Han sen I Of?ce of Health Facilities ChiefOperating Of?cer Deputy Secretary Shevana Lusk JerEmiah Samples Health Care Authority Exemtive Director Barbara Skeen {Interim} Bureau for Bureau forChildren and Bureaufer BureauforPublic Health Bureaufor Health Ch Id Support Enforcement Families Be haworall?ealth Commissioner MedicaIISerwces lnsurartce Proyam Commissioner Commissioner Catherine Slemp Director . Christina Mullns CIndyBeane Jean Kranz Garrett Jaoo b5 UndaWatts Secretary?s Priorities 1. Substance Use Disorder 2. Child Welfare Reforms 3. Facility Reforms Substance Use Disorder Efforts • • • • • • • • • • • Treatment Beds: started at 197, now at 740 with 950 expected Recovery Beds: over 1,200 Quick Response Teams: 22 counties/communities Law enforcement Assisted Diversion Programs: 15 counties SUD education provided by all three medical schools to over 1,000 clinicians and professionals Collegiate recovery programs: 10 campuses 17 harm reduction programs with 1,665 referrals to treatment Long-Acting Reversible Contraception is now offered in 2 regional jails; 2,217 women received reproductive education and 86 initiated a long-acting contraceptive method Residential treatment services for pregnant and postpartum women in 5 of 7 Regions (Regions 6 and 7 under development) Naloxone: Provided over 10,000 doses to local health departments and thousands more to first responders Provided 54 scholarships and loan repayment for 22 clinicians 5 SUD Efforts Continued • Family Treatment Courts in five counties • MAT in all 10 Regional Jails • Awarded five-year Centers for Medicare and Medicaid Services (CMS) Maternal Opioid Misuse grant to enhance the State’s Drug Free Moms and Babies Program. • Awarded a second CMS grant to increase access to evidence-based treatment and recovery services. This grant will focus on developing adolescent treatment and expanding use of technology solutions. • Working with WVU, Marshall and ten hospital systems to develop a comprehensive approach to screen, and link people with SUD to treatment. • Launched two pilot projects in Jefferson/Berkeley and Wyoming Counties to develop comprehensive systems of care. 6 Child Welfare Reforms 1. Strengthening child welfare workforce 2. Moving foster care into managed care 3. Implementation of Family First Prevention Services Act (FFPSA) 4. Development of a Medicaid waiver for children with Serious Emotional Disorder (SED) 5. Partnering with Legislature on child welfare reforms 7 Facility Reforms 1. Sharpe recertification completed 2. Implemented new billing strategy 3. Chapter 27 reforms to reduce forensic diversions in two years 8 fl - Reso rces DHHR Budget WEST VIRGINIA Department of Healt ?Hu 11 Resources DHHR Budget by Funding Source SFY2021 Non-Appropriated Special 584,501,378 1% Appropriated Special $494,048,680 8% Federal Block Grant $258,640,450 4% I General Revenue Federal Revenue Federal Block Grant I Appropriated Special Non?Appropriated Special Total Department Budget SFY2021 109,754,835 Special Revenue excludes duplication 10 DHHR Budget SFY2021 Other includes: MIS, HR, Admin, Inspector General, Secretary’s Office, Communications, General Counsel, Tiger Morton, Women’s Commission, Deaf and Hard of Hearing, Developmental Disabilities Council, ODCP 11 Full Time Employees by Bureau Bureau Bureau for Behavioral Health Bureau for Children and Families Bureau for Child Support Enforcement Bureau for Medical Services Bureau for Public Health Children's Health Insurance Program Office of Health Facilities Health Care Authority Human Rights Commission Other* Department of Health and Human Resources Vacant FTE 12.00 285.00 52.85 17.32 152.48 1.00 346.55 2.00 9.50 108.40 987.10 Filled FTE 56.00 2363.75 440.80 82.68 502.95 8.00 1278.55 7.00 17.50 529.86 5287.09 Total FTE 68.00 2648.75 493.65 100.00 655.43 9.00 1625.10 9.00 27.00 638.26 6274.19 ▪ Other includes: MIS, HR, Admin, Inspector General, Secretary’s Office, Communications, General Counsel, Tiger Morton, Women’s Commission, Deaf and Hard of Hearing, Developmental Disabilities Council, and the Office of Drug Control Policy. Information as of December 2019. ▪ Total FTEs may not sum correctly due to rounding. 12 SFY 2020 Supplementals Program Amount Office of Health Facilities $10,000,000 Office of Health Facilities: Facility Improvements Office of Medical Cannabis Total $714,368 $920,500 $11,634,868 13 SFY 2021 Improvements Program Amount Social Services Shortfall Child Protective Services Staffing Office of Health Facilities CHIP State Match Adult Protective Services Staffing Facility Improvements Foster Care Ombudsman Expanded School Mental Health Special Project Cases IDD Waitlist Total $14,962,767 $4,425,999 $10,000,000 $7,090,665 $268,592 $1,925,000 $288,402 $1,120,000 $150,000 $19,788,253 $60,019,678 14 Bureau for Medical Services Federal revenue represents spending authority appropriation – Amount authorized to spend if federal awards and expenditures occur as estimated. 15 SFY 2021 Improvements IDD Waitlist: $19,788,253 Expenditure Summary: • This funding will allow the Bureau for Medical Services (Medicaid) to clear those individuals currently on the waitlist for Intellectual/Developmental Disabilities (IDD) Waiver. Benefits of Funding/Effects of Not Funding: • Continued extensive waitlist and inability to access services available via waiver program. • Possible risk of litigation. • Inability to maximize federal revenue opportunities under the Medicaid program. 16 IDD Waiver Overview IDD Waiver Enrollment and Spend 4950 $400,000,000 4900 $350,000,000 4850 $300,000,000 Fiscal Year Total Expenditure Slots Avg Cost PMPY 2013 $335.9M 4,492 $75,000 2014 $355.3M 4,526 $79,000 2015 $361.3M 4,618 $78,000 2016 $333.7M 4,629 $72,000 2017 $307.9M 4,625 $67,000 2018 $305.3M 4,630 $66,000 2019 $300.0M 4,896 $61,000 4800 $250,000,000 4750 $200,000,000 4700 $150,000,000 4650 $100,000,000 4600 $50,000,000 4550 4500 $FY15 FY16 Slots • FY17 Spend FY18 FY19 Linear (Spend) DHHR added 262 IDD Waiver slots in FY2019. 17 Positive Trend in Medicaid Budget 1. Another positive year for Medicaid budget 2. In SFY 2020, Medicaid projected $309 million reserve 3. With savings, the Justice Administration has been able to: a) b) c) d) e) Increase rates for multitude of providers Expand services to vulnerable children Eliminate waitlist for Aged and Disabled Waiver Fund Medicaid Families First Reserve Fund Eliminate the Intellectual/Developmental Disabilities Waiver Waitlist f) Backfill other critical areas of state budget, including services for foster care, the disabled, and CHIP 18 Medicaid Families First Reserve Fund • The Medicaid Families First Reserve Fund is critical to the future of Medicaid’s budget • The Fund will help the state cover future Medicaid budget shortfalls • The Fund serves as risk-based capital for Medicaid in case unexpected increases in claims, i.e., flu outbreak • Private sector has 200-300% and PEIA 14% reserve • If monies are directed away from this Fund for other base building Medicaid expenditures, Medicaid would have less money to carry over to offset future projected budget shortfalls and those shortfalls would be higher due to increased expenditures in program 19 Risks if Reserve Fund Not Adopted • Scenario 1: If monies are directed away from this Fund for other base building Medicaid expenditures, Medicaid would have less money to carry over to offset future projected budget shortfalls and those shortfalls would be higher due to increased expenditures in program • Scenario 2: If monies are directed away from this Fund for non-Medicaid purposes, there will be less carryover money to address projected future shortfalls in the Medicaid budget 20 Reasons for Medicaid Savings ▪ Medicaid state spending reductions represent the culmination of multiple policy changes and factors over the past several years 1. Change in IDD Waiver services 2. Change in traditional Federal Medical Assistance Percentage (FMAP) 3. Decrease in enrollment/utilization 4. Mitigation of Rx costs increases and increase in Rx rebate 21 Match Rate Increase From 2014 Federal Fiscal Year Traditional FMAP % 2014 71.09% Expansion FMAP % 100% 2015 71.35% 100% 2016 71.42% 100% 2017 71.80% 95% 2018 73.24% 94% 2019 74.34% 93% 2020 74.94% 90% 2021 74.99% 90% 22 Match Rate State Increase Funding Impact Regular FMAP Expenditures FMAP Increase from 2014 Every 0.5% Shift Reduction in State Dollars $3 Billion 3.90% $15 Million $115.5 Million For illustration purposes, assume Medicaid expenditures of $3 billion. For every 0.5% increase in FMAP, there is a $15M reduction in State funding required for the program, assuming fixed total expenditures from year-toyear. 23 Medicaid Enrollment Trend Medicaid Enrollment by Year and Population 250,000 200,000 150,000 100,000 50,000 0 SFY15 SFY16 SFY17 Aged/Disabled Adults SFY18 SFY19 Children 24 Medicaid Pharmacy Spend Medicaid Pharmacy Expenditures $800,000,000 $700,000,000 $600,000,000 $500,000,000 $400,000,000 $300,000,000 $200,000,000 $100,000,000 $SFY15 SFY16 SFY17 SFY18 SFY19 25 Nursing Home Cost Trends by Service Category Nursing Home Patient Count to Spend 13,000 $800,000,000.00 12,800 $700,000,000.00 12,600 $600,000,000.00 12,400 $500,000,000.00 12,200 12,000 $400,000,000.00 11,800 $300,000,000.00 11,600 $200,000,000.00 11,400 $100,000,000.00 11,200 11,000 $0.00 FY 2015 FY 2016 FY 2017 Patients • • FY 2018 FY 2019 Total (FFS and MCO) Payments Long Term Care costs are a key driver of the Medicaid budget. While patient counts are stagnant, Medicaid averages $30 million in cost increases annually. The State is evaluating a Prospective Payment System (PPS) for reimbursement, which would align with other states and help to reduce annual cost increases. 26 Medicaid Hospital Expenditures Hospital Trend Over Five Year Period $450,000,000.00 $400,000,000.00 $350,000,000.00 $300,000,000.00 $250,000,000.00 $200,000,000.00 $150,000,000.00 $100,000,000.00 $50,000,000.00 $FY 2015 FY 2016 FY 2017 Inpatient FY 2018 FY 2019 Outpatient 27 Medicaid Hospital Enhanced Payments Directed Provider Payments $400,000,000 $350,000,000 $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $SFY15 SFY16 Directed Payments SFY17 SFY18 SFY19 Disproportionate Share Hospital (DSH) 28 FQHC Expenditures Federally Qualified Health Centers (FQHC) Patient Count to Spend 190,000 $90,000,000.00 180,000 $85,000,000.00 170,000 160,000 $80,000,000.00 150,000 $75,000,000.00 140,000 130,000 $70,000,000.00 120,000 $65,000,000.00 110,000 100,000 $60,000,000.00 FY 2015 FY 2016 FY 2017 Patients • FY 2018 FY 2019 Total (FFS and MCO) Payments While patient utilization of FQHCs has increased since SFY14, increases in prior years also result from Medicaid cost settlements that have occurred. 29 Medicaid Budgetary Drivers and Risks 1. Increase in medical claims due to unforeseen issues (flu outbreak, HIV, hepatitis, etc.) 2. Increased costs due to aging population 3. Drug epidemic 4. Children suffering from trauma (SED Waiver) 5. Risk of reduction or loss of Federal matching funds 6. Policy decisions to increase payments/expand benefits 7. Lawsuits/court orders to expand benefits/payments 8. Increased Rx costs due to new drugs entering market 9. Increased enrollment if there is an economic downturn 30 Children’s Health Insurance Program Federal revenue represents spending authority appropriation – Amount authorized to spend if federal awards and expenditures occur as estimated. 31 SFY 2021 Improvements CHIP State Match: $7,090,665 Expenditure Summary: • The Children's Health Insurance Program's enhanced federal matching percentage bump of 23% expired September 30, 2019. Effective October 1, 2019, the state is required to fund 6.3% of program costs. The program has adequate funding to cover these additional costs through SFY20. Benefits of Funding/Effects of Not Funding: • If funding is not received, the program would need to review enrollment caps, provider reimbursement rates, or modifications to benefit structure. 32 CHIP Funding Projections 100% $2,900,000 $8,568,133 $10,821,466 $11,426,069 $12,064,190 $49,857,595 $50,874,466 $53,716,858 $56,716,824 90% 80% 70% 60% 50% $50,602,791 40% 30% 20% 10% 0% SFY 2020 SFY 2021 SFY 2022 Federal SFY 2023 SFY 2024 State ▪ WV CHIP covers children enrolled under both the CHIP program and Medicaid program. ▪ CHIP was fully federally funded through 9/30/2019. By 10/1/2020, CHIP will return to its enhanced FMAP of 82.46%. ▪ CHIP began covering pregnant women during SFY20. 33 CHIP Budgetary Drivers and Risks 1. 2. 3. 4. 5. 6. Increase in medical claims due to unforeseen issues Risk of reduction or loss of Federal matching funds Policy decisions to increase payments/expand benefits Lawsuits/court orders to expand benefits/payments Increased Rx costs due to new drugs entering market Increased enrollment if there is an economic downturn 34 Bureau for Public Health Federal revenue represents spending authority appropriation – Amount authorized to spend if federal awards and expenditures occur as estimated. 35 SFY 2020 Supplementals Office of Medical Cannabis: $920,500 Expenditure Summary: • One-time funding will be used to cover contract costs that will be needed during calendar year 2020 for Medical Cannabis Laboratory. Benefits of Funding/Effects of Not Funding: • The Office of Medical Cannabis is charged with regulating growers, processors, laboratories, and dispensaries under WV Code, and staff is needed to administer and operate the program as required. Medical Cannabis is required to have licensing and "seed to sale" tracking systems in place, and the Medical Cannabis Laboratory is responsible for meeting lab testing requirements outlined under the Code. • Medical Cannabis will be unable to meet mandates during SFY2020 without Supplemental funding. 36 Expected WV Medical Cannabis Implementation Timeframes Tasks Year 1 Year 2 Banking solution in place for all areas of state government BPH releases cannabis industry applications BPH closes application window Successful applicants selected Cannabis industry build out complete, deemed operational by BPH Initial grow/ process period complete First cannabis products available for patient use 37 BPH Budgetary Drivers and Risks 1. 2. 3. 4. 5. 6. 7. 8. 9. State Labs and Medical Examiner facility failures Technical equipment updates/failures Large scale disease outbreaks (hepatitis A) Continued high death rates Birth to Three enrollment increases Medical Cannabis program Local Health Department funding issues Emerging infectious diseases (Ebola, Zika, etc.) Loss of federal funding 38 Bureau for Children and Families Federal revenue represents spending authority appropriation – Amount authorized to spend if federal awards and expenditures occur as estimated. 39 SFY 2021 Improvements Social Services Shortfall: $14,962,767 Expenditure Summary: • To cover additional costs from continuing growth in child welfare services, foster care subsidies, adoption subsidies, implementation of the Family First Act and elimination of IV-E Waiver program funding. Benefits of Funding/Effects of Not Funding: • Inability to provide socially necessary services to those families deemed eligible to receive. • Risk of losing federal funding due to inability to meet match requirements. 40 BCF Child Welfare Expenditure Trend State Fiscal Year Total BCF Child Welfare Expenditures/Projections 2017 $246 million 2018 $296 million 2019 $327 million 2020 $336 million* 2021 $350 million* 2022 $362 million* 2023 $375 million* 2024 $390 million* 41 *Projections SFY 2021 Improvements Child Protective Services Staffing: $4,425,999 Expenditure Summary: • The increased caseloads in child welfare combined with significant recruitment and retention issues necessitate increased staffing and other personnel strategies to improve caseloads. Benefits of Funding/Effects of Not Funding: • Improvement to staff morale due to decreased overtime and caseload by retaining staffing levels sufficient to meet caseload ratios that align with federal guidelines. • This funding would help to increase salaries in the Eastern Panhandle, develop on-call payment, improve training programs, and hire mid and upper level management positions to provide more oversight. 42 CPS Referrals Received and Accepted for Investigation CPS Referrals 45,000 40,000 39,488 38,614 42,425 42,370 40,633 Number of CPS Referrals 35,000 30,000 25,000 28,098 27,070 27,091 24,169 21,814 20,000 15,000 10,000 5,000 0 2015 2016 2017 2018 2019 State Fiscal Year Received Accepted Source: BCF Data provided to Legislative Auditor, 2019 43 SFY 2021 Improvements Adult Protective Services: $268,592 Expenditure Summary: • Adult Protective Services (APS) has experienced an increase in the number of investigations and open adult protective service cases in the last five years. APS referrals have increased by over 7,000 with the number of accepted referrals doubling from 2015 to 2018. To help address this increase, the Department is requesting additional APS positions. Benefits of Funding/Effects of Not Funding: • Staff morale due to decreased overtime and caseloads by retaining staff and providing for more constant staff/caseload ratios. 44 Adult Protective Services Referrals and Investigations 18000 15903 16000 14000 15092 14885 13889 12000 9521 10000 9188 8000 6545 6539 6000 4000 2000 0 2016 2017 APS Referrals Received 2018 2019 APS Referrals Accepted for Investigation APS referrals assigned to workers for investigation increased 40.38% from SFY2016 to SFY2019. Allocated APS Worker positions have not increased during that same time frame. Source: Bureau for Children and Families FACTS tracking system 45 BCF Budgetary Drivers and Risks 1. 2. 3. 4. Child welfare crisis Decrease/change in TANF funding Loss of Safe at Home Waiver Facility costs at West Virginia Children’s Home (state operated facility) 5. Lawsuits/court orders 6. Changes in Federal match 46 Bureau for Behavioral Health Federal revenue represents spending authority appropriation – Amount authorized to spend if federal awards and expenditures occur as estimated. 47 BBH Percent Allocations by Focus Area 9% 2% 7% 38% Intellectual and Developmental Disabilities Adult Mental Health Substance Use Disorder Children's Mental Health 44% Administrative 48 SFY 2021 Improvements Expanded School Mental Health: $1,120,000 Expenditure Summary: • To establish ongoing funding through the Bureau for Behavioral Health to implement and sustain Expanded School Mental Health pilot sites throughout the State. Senate Bill 483 was passed during 2018 but provided only one-time funding for pilot programs. Benefits of Funding/Effects of Not Funding: • If additional funding is not made available, the bureau will not be able to provide ongoing funding for those programs beyond FY2020 and expand the services to new sites. 49 SFY 2021 Improvements Special Project Cases: $150,000 Expenditure Summary: • These funds will support the unique needs and complex services required to transition and maintain individuals in an appropriate level of care. These funds shall only be utilized to cover necessary services that have no other funding source or will serve as a bridge to another funding source. Benefits of Funding/Effects of Not Funding: • Specific funding will allow the bureau to better account for the costs associated with the care of individuals who are released from state facilities that cannot be funded via other programs. 50 BBH Budgetary Drivers and Risks 1. 2. 3. 4. SUD Epidemic Decrease in Federal funding Lawsuits/court orders Provider shortages in community mental health for adults and children 51 Bureau for Child Support Enforcement I General Revenue Federal Revenue Total Budget SFY2021 $35,049,098 52 Office of Drug Control Policy Total Budget SFY2021 $545,153 53 2020-2022 State Response Plan ▪ Three-year Plan ▪ Developed by Governor’s Council on Substance Abuse Prevention and Treatment ▪ Framework for State and Communities ▪ Public Comment Incorporated ▪ Seven Areas of Focus o Prevention o Community Engagement and Supports o Health Systems o Treatment, Recovery, and Research o Court Systems and Justice-Involved Populations o Law Enforcement o Stigma 54 Office of Inspector General Federal revenue represents spending authority appropriation – Amount authorized to spend if federal awards and expenditures occur as estimated. 55 SFY 2021 Improvements Foster Care Ombudsman: $288,402 Expenditure Summary: • Funding will be used to hire additional staff to help fulfill the duties of the Foster Care Ombudsman per House Bill 2010. Benefits of Funding/Effects of Not Funding: • The Foster Care Ombudsman and additional staff will advocate for the rights of foster children and foster parents, participate in any procedure to investigate and resolve complaints filed on behalf of a foster child or foster parent, monitor the development and implementation of federal, state and local legislation, regulations and policies with respect to foster care services, establish and maintain a statewide uniform reporting system to collect and analyze data relating to complaints, and participate in ongoing training programs related to his or her duties or responsibilities. 56 Office of Health Facilities WEST VIRGINIA De artm Hu Resources Non?Appropriated Office of Health Special 261,836 0.12% I General Revenue Appropriated Special Non-Appropriated Special Total Budget SFY2021 $213,556,025 57 Hospital Name State Hospital Metrics Location BuiltHeType Bed Capacity Bed Census Hopemont Terra Alta, Preston County 1913 Nursing Home 98 Licensed 50 Jackie Withrow Beckley, Raleigh County 1927 Nursing Home 199 Licensed 144 Available 80 John Manchin Jr. Fairmont, Marion County 1899 Nursing Home, Outpatient Clinic 41 Nursing Home 35 Lakin West Columbia, Mason County 1926 Nursing Home 114 Licensed Welch Welch, 1902 McDowell County Nursing Home, Acute Care Hospital 59 Nursing Home 31 NH 55 Acute Care 3 Acute Bateman Huntington, Cabell County 1950 Psychiatric Hospital 110 Licensed 101 Sharpe Weston, Lewis County 1990 Psychiatric Hospital 200 Licensed 117 72 58 SFY 2020 Supplementals Office of Health Facilities: $10,000,000 Expenditure Summary: • Funding is used to cover continued increase in utilization of contract staff and personnel costs. Contractual costs exceed the amounts available from vacant staffing positions. • The volume of forensic and civil commitments continues to increase each year, resulting in diversions to other treatment facilities, which are state-funded costs. Benefits of Funding/Effects of Not Funding: • Inability to meet regulatory requirements for staffing resulting in substandard care and fines to the facility. • Inability to provide inpatient psychiatric services to individuals. 59 SFY 2020 Supplementals Office of Health Facilities, Facility Improvements: $714,368 Expenditure Summary: • Capital improvement needs related to safety and regulatory compliance at multiple state-owned facilities. Benefits of Funding/Effects of Not Funding: • Required to meet resident safety and regulatory compliance. 60 SFY 2021 Improvements Office of Health Facilities: $10,000,000 Expenditure Summary: • Funding is used to cover continued increase in utilization of contract staff. Contractual costs exceed the amounts available from vacant staffing positions. • The volume of forensic and civil commitments continues to increase each year, resulting in diversions to other treatment facilities, which are state-funded costs. Benefits of Funding/Effects of Not Funding: • Inability to meet regulatory requirements for staffing resulting in substandard care and fines to the facility. • Inability to provide inpatient psychiatric services to individuals. 61 SFY 2021 Improvements Facility Improvements: $1,925,000 Expenditure Summary: • The state hospitals have various capital improvement needs related to resident safety and regulatory compliance that include the following: radiology equipment, floor replacement, camera security systems, phone system, generator, dietary equipment, window projects, etc. Benefits of Funding/Effects of Not Funding: • To meet resident safety and regulatory compliance, and to be able to provide diagnostic testing for patients and aid physicians in providing accurate diagnoses. 62 Facilities Budgetary Drivers and Risks 1. 2. 3. 4. 5. Continued annual operational losses Capital outlays and maintenance Increases in diversions Certification and licensure issues Increases in contractual staff expenditures 63 Other DHHR Budgetary Risks and Issues 1. 2. 3. 4. 5. Federal match changes for DHHR IT systems Telephone and internet failures Capital costs for owned/leased properties Inability to recruit and retain staff Unfunded federal and state mandates 64 Budget Detail 65 SFY2020 Supplementals State share of DHHR Supplementals included in Governor’s Budget: Program Fund/Appropriation Fund Name Office of Health Facilities Shortfall 0525-33500 Institutional Facilities Operations 10,000,000 Office of Health Facilities - Facility Improvements 0525-75500 Capital Outlay and Maintenance 714,368 Office of Medical Cannabis 0407-42001 Medical Cannabis 920,500 Total Amount 11,634,868 66 SFY2021 Improvements State share of DHHR improvements included in Governor’s Budget: Program Fund/Appropriation Fund Name Social Services Shorftall 0403-19500 Social Services Child Protective Services Staffing 0403-00100/13000/46800 Child Protective Services Office of Health Facilities Shortfall 0525-33500 Institutional Facilities Operations Amount 14,962,767 4,425,999 10,000,000 Children's Health Insurance Program State 0403-85601/85602 Match CHIP Bureau for Children and Families 0403-00100 Adult Protective Services Office of Health Facilities - Facility Improvements 0525-75500 Capital Outlay and Maintenance 1,925,000 Office of Inspector General - Foster Care Ombudsman 0403-00100/13000 Personal Services/Unclassified 288,402 Expanded School Mental Health 0525-21900 Behavioral Health Program 1,120,000 Special Project Cases 0525-21900 Behavioral Health Program 150,000 IDD Waitlist 0403-46600 IDD Waiver Total 7,090,665 268,592 19,788,253 60,019,678 67 DHHR Budget by Funding Source SFY2021 FY2021 GOVERNOR'S BUDGET Percentage of Amount Total Request GENERAL REVENUE $ 1,133,121,871 18.43% FEDERAL REVENUE 4,398,082,906 71.53% 532,583,680 8.66% 84,501,378 1.38% $ 6,148,289,835 100.00% APPROPRIATED SPECIAL REVENUE NON-APPROPRIATED SPECIAL REVENUE TOTAL 68 Department General Revenue SFY2021 FY2021 APPROPRIATED GENERAL REVENUE GOVERNOR'S RECOMMENDED Fund 0400 Office of the Secretary Fund 0403 Division of Human Services $ 667,244 822,040,347 (Children & Families, Medical Services, Child Support Enforcement, Administration and Secretary's Office) Fund 0407 Division of Health - Central Office 74,928,981 (Public Health, Administration and Secretary's Office) Fund 0416 Human Rights Commission Fund Fund 0525 Division of Health - Consolidated Medical Services 1,419,645 233,418,154 (Behavioral Health and Health Facilities) Fund 0561 Division of Health - WV Drinking Water Treatment TOTAL 647,500 $ 1,133,121,871 69 Office of the Secretary DEPARTMENT OF HEALTH AND HUMAN RESOURCES Office of the Secretary Fund 0400 FY2020 Budget Bill & Amendments 0400 0400 0400 0400 00100 09900 13000 70400 Personal Services Unclassified Current Expense Commission for the Deaf & Hard-of-Hearing Total $ 384,638 6,459 50,613 225,534 667,244 Adjustment Base One-Time Funding Budget - 384,638 6,459 50,613 225,534 667,244 FY2021 Governor's Adjustments - Improvements Budget - 384,638 6,459 50,613 225,534 667,244 70 Division of Human Services DIVISION OF HUMAN SERVICES Fund 0403 (Children & Families, Medical Services, Child Support Enforcement) FY2021 FY2020 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 0403 00100 09900 13000 14400 18900 19500 19600 27400 38400 45500 46600 46800 51500 53300 54700 60300 63300 68800 Personal Services Unclassified Current Expense Child Care Development Medical Services (MEDICAID) Social Services Family Preservation Program Family Resource Networks Domestic Violence Legal Service Fund James "Tiger" Morton Catastrophic Illness Fund I/DD Waiver Child Protective Services Case Workers OSCAR and RAPIDS Title XIX Waiver for Senior Citizens WV Teaching Hospitals Tertiary/Safety Net Child Welfare System Medical Services - Surplus In-Home Family Education Budget Bill Adjustment Base & Amendments One-Time Funding Budget 48,078,212 5,688,944 11,404,008 4,102,718 456,292,248 196,114,014 1,565,000 1,762,464 400,000 105,695 88,753,483 24,917,075 6,493,207 13,593,620 6,356,000 1,334,615 18,429,035 1,000,000 562,742 102,628 51,429,035 800,000 (6,493,207) (1,334,615) (18,429,035) 48,640,954 5,688,944 11,506,636 4,102,718 507,721,283 196,914,014 1,565,000 1,762,464 400,000 105,695 88,753,483 24,917,075 13,593,620 6,356,000 1,000,000 Governor's Adjustments Improvements (268,592) 1,661,758 (140,000) (1,000,000) (227,178,000) (2,300,000) 395,237 14,962,767 19,788,253 2,925,998 Budget 50,034,120 5,688,944 11,761,873 3,102,718 280,543,283 209,576,781 1,565,000 1,762,464 400,000 105,695 108,541,736 27,843,073 13,593,620 6,356,000 1,000,000 (0403 continued on next page) 71 Division of Human Services, cont. DIVISION OF HUMAN SERVICES Fund 0403 (Continued) (Children & Families, Medical Services, Child Support Enforcement) FY2021 FY2020 Budget Bill & Amendments 0403 0403 0403 0403 0403 69800 70500 70700 70800 75000 0403 0403 75500 75900 0403 0403 0403 0403 0403 0403 0403 0403 0403 78900 83500 85100 85601 85602 91300 94000 95100 95400 935,000 6,758,806 25,819,096 5,693,743 WV Works Separate State Program Child Support Enforcement Temporary Assistance for Needy Families/MOE Child Care--Maintenance of Effort and Match Grants For Domestic Violence Shelters Programs and Statewide Prevention Capital Outlay & Maintenance Community Based Services and Pilot Programs for Youth Medical Services Administrative Costs (MEDICAID) Traumatic Brain Injury Indigent Burials Children's Health Insurance Program Children's Health Insurance Program BRIM Premium Rural Hospitals Under 150 Beds Children's Trust Fund - Transfer PATH Adjustment One-Time Funding (800,000) Governor's Base Budget 135,000 6,758,806 25,819,096 5,693,743 Adjustments Improvements Budget 135,000 6,458,806 25,819,096 5,693,743 (300,000) 2,500,000 11,875 2,500,000 11,875 2,500,000 11,875 1,000,000 38,234,761 800,000 2,050,000 0 0 892,642 2,596,000 220,000 0 1,000,000 38,234,761 800,000 2,050,000 700,000 6,390,665 7,162,452 892,642 2,596,000 220,000 7,162,452 1,000,000 38,234,761 800,000 1,550,000 700,000 6,390,665 892,642 2,596,000 220,000 7,162,452 Total $ 973,902,261 33,000,000 1,006,902,261 46,824,678 822,040,347 Total 0403 $ 973,902,261 (500,000) (231,686,592) Proposed Supplementals: 72 Division of Health DIVISION OF HEALTH Central Office Fund 0407 (Public Health) FY2020 Budget Bill & Amendments 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 00100 04500 09900 13000 18400 18700 21000 22300 22500 35401 38300 42001 46700 55100 55300 57500 Personal Services Chief Medical Examiner Unclassified Current Expense State Aid to Local & Basic Public Health Services Safe Drinking Water Program Women, Infants and Children Early Intervention Cancer Registry Office of Drug Control Policy Statewide EMS Program Support Medical Cannabis Black Lung Clinics Vaccine for Children Tuberculosis Control Maternal and Child Health Clinics, Clinicians and Medical Contracts and Fees 12,694,773 9,666,347 671,795 4,838,459 14,160,490 2,211,323 38,621 8,134,060 206,306 567,953 1,845,271 2,380,489 170,885 338,235 379,256 6,342,707 FY2021 Adjustment One-Time Funding (351,700) (22,800) (920,500) Base Budget Governor's Adjustments Improvements Budget 12,694,773 9,314,647 671,795 4,838,459 14,160,490 2,211,323 38,621 8,134,060 206,306 545,153 1,845,271 1,459,989 170,885 338,235 379,256 (150,000) (600,000) (50,000) 12,544,773 8,714,647 671,795 4,588,459 14,160,490 1,891,323 38,621 8,134,060 206,306 545,153 1,695,271 1,459,989 170,885 338,235 329,256 6,342,707 (450,000) 5,892,707 (250,000) (320,000) (150,000) (0407 continued on next page) 73 Division of Health, cont. DIVISION OF HEALTH (Public Health) Central Office (Continued) Fund 0407 FY2020 Adjustment Budget Bill One- Time & Amendments 0407 62600 Epidemiology Support 0407 0407 0407 0407 0407 0407 0407 0407 0407 0407 62800 72300 72700 75500 77800 83400 87300 91300 91800 94400 Primary Care Support Sexual Assault Intervention and Prevention Health Right Free Clinics Capital Outlay & Maintenance Healthy Lifestyles Maternal Mortality Review Diabetes Education & Prevention BRIM Premium State Trauma & Emergency Care System WVU Charleston Poison Control Hotline Total $ Proposed Supplementals: Medical Cannabis Appr 42001 Total 0407 $ 1,547,192 4,263,706 125,000 3,750,000 100,000 1,000,000 49,933 97,125 169,791 2,021,322 712,942 78,483,981 FY2021 Base Funding Budget (1,295,000) 1,547,192 4,263,706 125,000 3,750,000 100,000 1,000,000 49,933 97,125 169,791 2,021,322 712,942 77,188,981 Governor's Adjustments Improvements (50,000) (30,000) (110,000) (100,000) (2,260,000) - Budget 1,497,192 4,263,706 125,000 3,750,000 70,000 890,000 49,933 97,125 169,791 1,921,322 712,942 74,928,981 920,500 79,404,481 74 Division of Health, cont. DIVISION OF HEALTH (Behavioral Health and Health Facilities) Consolidated Medical Services Fund Fund 0525 FY2020 Budget Bill & Amendments 0525 0525 0525 0525 0525 0525 0525 0525 0525 0525 0525 00100 13000 14901 14902 21900 22100 33500 35400 75500 80400 91300 Personal Services Current Expense Jim's Dream Jobs & Hope Behavioral Health Program - Unclassified Family Support Act Institutional Facilities Operations Substance Abuse Continuum Care Capital Outlay & Maintenance Renaissance Program BRIM Premium FY2021 Adjustment One-Time Funding Base Budget 1,632,588 14,113 9,000,000 71,843,953 251,226 137,929,180 5,000,000 950,000 165,996 1,296,098 Total $ 228,083,154 Proposed Supplementals: Institutional Facilities Operations Appr 33500 Capital Outlay & Maintenance Appr 75500 Total 0525 $ 10,000,000 714,368 238,797,522 1,632,588 14,113 9,000,000 71,843,953 251,226 137,929,180 5,000,000 950,000 165,996 1,296,098 - 228,083,154 Governor's Adjustments (9,000,000) 9,000,000 (4,500,000) (200,000) (3,160,000) Improvements 1,270,000 10,000,000 1,925,000 (7,860,000) 13,195,000 Budget 1,632,588 14,113 0 9,000,000 68,613,953 251,226 147,729,180 1,840,000 2,875,000 165,996 1,296,098 233,418,154 75 Division of Health, cont. DIVISION OF HEALTH (Public Health) WV Drinking Water Treatment Fund Fund 0561 FY2020 Budget Bill & Amendments 0561 68900 WV Drinking Water Treatment Revolving Fund --Transfer $ 647,500 FY2021 Adjustment One-Time Funding Base Budget 647,500 Governor's Adjustments Improvements Budget 647,500 76 Human Rights Commission HUMAN RIGHTS COMMISSION Fund 0416 FY2020 Budget Bill & Amendments 0416 0416 0416 0416 00100 09900 13000 91300 Personal Services Unclassified Current Expense BRIM Premium FY2021 Adjustment One-Time Funding Base Budget 1,073,553 4,024 331,304 10,764 Total $ 1,419,645 Governor's Adjustments Improvements 1,073,553 4,024 331,304 10,764 - 1,419,645 Budget 1,073,553 4,024 331,304 10,764 - - 1,419,645 77 Department Federal Revenue SFY2021 FY2021 APPROPRIATED FEDERAL REVENUE GOVERNOR'S RECOMMENDED Fund 8723 8802 8824 8750 8753 8793 8794 Division of Health Consolidated Medical Service Fund (Behavioral Health) Central Office (Public Health) WV Safe Drinking Water Treatment (Public Health) Maternal and Child Health Block Grant (Public Health) Preventive Health Block Grant (Public Health) Substance Abuse Prevention and Treatment Block Grant (Behavioral Health) Community Mental Health Services Block Grant (Behavioral Health) Total Division of Health $ 38,188,828 85,661,418 16,000,000 8,143,915 2,351,802 11,626,989 5,468,208 167,441,160 $ 519,874 519,874 Human Rights Commission Fund 8725 Consolidated Federal Funds - Human Rights Comm Gen Adm Fund Division of Human Services 8722 8755 8757 8816 8817 Consolidated Federal Funds-DHS General Administration (C&F, Medicaid, CSE, CHIP) Energy Assistance Block Grant (Children & Families) Social Services Block Grant (Children & Families) Temporary Assistance for Needy Families Block Grant (Children & Families) Child Care and Development Block Grant (Children & Families) Total Division of Human Services Total $ 3,999,072,336 35,392,725 17,848,495 127,660,783 50,147,533 4,230,121,872 $ 4,398,082,906 78 Department Special Revenue SFY2021 FY2021 APPROPRIATED SPECIAL REVENUE GOVERNOR'S RECOMMENDED Fund 5111 5144 5156 5163 5172 5183 5204 5214 5218 5420 Division of Health Ryan Brown Addiction Prevention and Recovery Fund (Behavioral Health) Vital Statistics (Public Health) Hospital Services Revenue Account (Health Facilities) Laboratory Services (Public Health) Health Facility Licensing (Secretary's Office) Hepatitis B Vaccine (Public Health) Lead Abatement Fund (Public Health) West Virginia Birth-to-Three (Public Health) Tobacco Control Special Fund (Public Health) Medical Cannabis Program Fund (Public Health) Total Division of Health $ 5,667,392 3,711,772 63,355,221 2,758,153 750,806 9,740 37,348 28,969,526 7,579 2,555,698 107,823,235 Health Care Authority 5375 5377 Health Care Cost Review Authority Fund WV Health Care Authority - Certificate of Need Fund Total Health Care Authority $ 2,150,925 1,304,765 3,455,690 $ 213,836,602 38,000,000 82,830,193 83,302,960 400,000 900,000 500,000 1,500,000 35,000 421,304,755 $ 532,583,680 Division of Human Services 5090 5094 5185 5365 5454 5455 5467 5468 5490 Health Care Provider Tax (Medicaid) Child Support Enforcement Medical Services Trust Fund (Medicaid) Division of Human Services Lottery Fund (Medicaid) James "Tiger" Morton Catastrophic Illness Fund Domestic Violence Legal Services Fund (Children & Families) WV Works Separate State College Program (Children & Families) WV Works Separate State Two-Parent Families Program (Children & Families) Marriage Education Fund Total Division of Human Services Total 79 Department “Other” Funding SFY2021 FY2021 NON-APPROPRIATED SPECIAL REVENUE Fund 5101 5107 5112 5113 5115 5117 5118 5119 5139 5146 5178 5197 5201 5205 5207 5208 5224 5225 8740 Division of Health Vital Statistics Service Fund Indirect Cost of Federal Programs Fund DHHR Special Revenue Trust Account Wellhead Protection Asbestos Abatement Licensure Infectious Medical Waste Nursing Home Licensing Board Certification of ICF/SNF Health Services Fee Insurance Property Loss Claims Fund Public Health Law Fund Breast & Cervical Cancer Diagnostic Treatment Drinking Water Treatment Revolving-Adm. Exp. EMS Licensure Gifts, Grants and Donations Radon Licensure Fund Healthy Lifestyles Fund Vital Statistics Improvement Fund Maternal and Child Health - EPSDT Total Division of Health $ 51,000 4,092,351 5,457,130 64,616 419,563 117,223 113,578 2,571,256 1,418,767 73,935 100,000 47,024 3,972,319 454,076 5,226,369 20,000 44,000 263,762 1,210,597 $ 25,717,566 80 “Other” Funding SFY2021, cont. FY2021 NON-APPROPRIATED SPECIAL REVENUE Fund 5050 5052 5057 5110 5450 5465 5469 Division of Human Services National School Lunch Hearing Impaired Domestic Violence DHHR Criminal Background Check Women's Commission Gifts, Grants, and Donations Children's Trust Fund Other Special Revenue Total Division of Human Services Fund 5353 $ 55,916 17,819 533,557 920,319 12,447 1 184,200 57,057,803 $ 58,782,062 Human Rights Commission Gifts, Grants, and Donations Total Human Rights Commission 1,750 $ 1,750 81 Contact Information Bill J. Crouch Cabinet Secretary West Virginia Department of Health and Human Resources One Davis Square, Suite 100 East Charleston, WV 25301 Phone: (304) 558-0684 Email: DHHRSecretary@wv.gov Website: dhhr.wv.gov Jeremiah Samples Deputy Cabinet Secretary West Virginia Department of Health and Human Resources Phone: (304) 356-5405 Email: Jeremiah.Samples@wv.gov Starlah Wilcox Chief Budget Officer West Virginia Department of Health and Human Resources Phone: (304) 558-2814 Email: Starlah.A.Wilcox@wv.gov 82