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Department of Health and Human Resources

The West Virginia Department of Health and Human Resources (DHHR) was a cabinet-level department of state government, responsible for the state’s health and welfare programs and many social services. Upon its creation in 1989, the DHHR absorbed existing agencies with health and welfare functions, particularly the Department of Health and the Department of Human Services. These agencies date their origins through various predecessors to West Virginia’s early days as a state. Effective January 1, 2024, DHHR was eliminated and split into three separate agencies.

The foundation for the Bureau of Children and Families, which now administers public assistance programs for the DHHR, was laid in 1863. That year, the first West Virginia legislature enacted a law giving counties the responsibility for poor relief and the operation of alms houses or poor farms. The Mother’s Pension Law, authorizing counties to pay monthly pensions to mothers who had no property or resources and whose morals were above suspicion, was enacted in 1915. The Board of Children’s Guardians, established in 1919, was replaced in 1931 by the Department of Public Assistance.

In 1936, the legislature authorized creation of county departments of public assistance within the Department of Public Assistance to administer at the local level all existing public welfare programs including those eligible for federal funding. The Department of Public Assistance later became the Department of Welfare. West Virginia piloted the U.S. Department of Agriculture’s Food Stamp program in 1961 and was the first state to issue food stamps.

The health functions of the DHHR date back almost as far as its public assistance role. In 1881, the West Virginia Board of Health was established to regulate and license the practice of medicine and surgery; to conduct sanitary investigations; to maintain quarantine centers; and to establish county health boards with the consent of local governments. The Board of Health was abolished in 1915 and replaced by the Department of Health. In 1945, the Health Department assumed advisory medical supervision of state hospitals.

Major organizational restructuring took place in 1949, when the department shifted its emphasis from communicable diseases to chronic illnesses and other public health issues. The legislature created the Department of Mental Health in 1957. During the 1977 legislative session, a consolidated Department of Health was created, combining the old Department of Health, the Department of Mental Health, Commission on Mental Retardation, public institutions, and smaller boards and commissions.

The largest change came during the 1989–90 reorganization of state government, when the Department of Health and Department of Human Services merged to form the Department of Health and Human Resources. Also brought under the DHHR umbrella were the Human Rights Commission, the Women’s Commission, and the Commission on the Hearing Impaired.

The DHHR was among the very largest agencies of state government, with more than 6,000 employees in five bureaus:

• The Bureau for Public Health worked with local health departments. The bureau administered programs that ranged in scope from regulating hospitals and nursing homes to working to reduce tobacco use.

• The Bureau for Children and Families administered most of DHHR’s major public assistance programs such as SNAP (formerly known as food stamps) and Temporary Assistance for Needy Families (TANF), as well as Child Protective Services and Adult Protective Services. The ‘‘welfare agency’’ direction of the bureau changed in 1996 with the enactment of federal welfare reform during President Clinton’s administration. These watershed reforms reduced welfare assistance by limiting the years of eligibility and encouraging welfare recipients to return to work.

• The Bureau for Behavioral Health and Health Facilities ran state health facilities and regulated private providers of behavioral health services.

• The Bureau for Child Support Enforcement established paternity, child support, and medical support and enforces support orders, including spousal support.

• The Bureau for Medical Services was the state Medicaid office. Medicaid, a federal program of the Social Security Administration, pays for health care for women, children, and adults below a certain income level. At the beginning of the 21st century, Medicaid paid for more than half the births in West Virginia. The legislature integrated a sixth division, the Children’s Health Insurance Program (CHIP), into the Bureau for Medical Service in 2022.

In addition to the five bureaus, the Office of Inspector General policed legal and ethical issues at the DHHR, provided an impartial hearing process to clients who felt they had been unfairly treated, and monitored the receipt and use of federal funds. DHHR also managed the state Health Care Authority, Office of Health Facilities, and Office of Drug Control Policy.

With significant support from the West Virginia National Guard, DHHR led West Virginia’s governmental efforts in fighting the COVID-19 pandemic from 2020 to 2023. For much of that time, DHHR issued health policies as they were revised and posted daily updates regarding active number of cases by county, deaths, hospital occupancy rates, and vaccination rates, among other information. In June 2020, less than three months into the crisis, state Health Officer Dr. Cathy Slemp resigned following public criticism from Governor Jim Justice for inconsistencies in data reporting. He replaced her with Dr. Ayne Amjad, who served in that role before stepping down in October 2022. She was succeeded by Dr. Matt Christiansen.

For decades, DHHR had been frequently criticized by legislators, public health advocates, and other sources for mismanaging and understaffing some of its key programs, particularly with regard to child welfare. By November 2021, the vacancy rate statewide for social workers was 27 percent, although that number was much higher in some counties and regions, such as the Eastern Panhandle. This resulted in slow response times following reports of potential child abuse or neglect. The DHHR consistently cited lack of proper funding and staffing as causes, at the same time the number of children in state custody rose dramatically due, in part, to the state opioid epidemic. During its 2022 session, the legislature attempted to eliminate the DHHR, but Governor Justice vetoed the bill and commissioned a $1 million audit of the department. The resulting McChrystal Group report recommended keeping the DHHR intact while improving leadership and communication, especially in terms of child welfare, substance use disorders, and workforce. Legislative leaders publicly criticized the McChrystal Report for ignoring what it considered core systemic problems within the department, beginning with agency leadership.

On October 14, 2022, state senate president Craig Blair and other legislative leaders formally contacted the governor over credible allegations of abuse and neglect of vulnerable residents at state-operated facilities. In 2023, the legislature voted to eliminate the DHHR, replacing it with three separate agencies. The governor signed the bill into law despite vetoing similar legislation the previous year. In May 2023, Justice appointed cabinet-level secretaries to lead the following new departments:

• The Department of Health includes the Bureau for Public Health, Office of Emergency Medical Services, Office of the Chief Medical Examiner, Center for Threat Preparedness, Health Care Authority, Office of Inspector General, and Human Rights Commission.

• The Department of Health Facilities includes the Bureau for Behavioral Health, Bureau for Child Support Enforcement, Bureau for Family Assistance, Bureau for Medical Services, Bureau for Social Services, and Office of Drug Control Policy.

• The Department of Human Services includes Hopemont Hospital, Jackie Withrow Hospital, John Manchin Sr. Health Care Center, Lakin Hospital, Mildred Mitchell-Bateman Hospital, Welch Community Hospital, and William R. Sharpe, Jr. Hospital.

The new law, and the agencies, went into effect January 1, 2024.

In 2019, attorneys filed a major class-action lawsuit against the state for allowing the supposed mistreatment of more than 6,000 foster children. In 2024, a federal judge sanctioned the state for destroying emails related to the case. In early 2024, the former DHHR also made news for several high-profile tragic cases involving abuse and neglect in foster homes and state-run facilities.

Written by John D. Law

Sources

1. Gov. Justice Appoints Three Secretaries to New Departments of Health, Human Services, and Health Facilities. Press release, May 24, 2023.

2. Morris, Jeff. Gov. Justice Signs Bill to Split West Virginia DHHR into Three Departments. WCHS-TV, March 6, 2023.

3. Yohe, Randy. Despite Criticism, DHHR Moving to Immediately Implement Reorganization Study Recommendations. West Virginia Public Broadcasting, November 14, 2022.

4. Knisely, Amelia Ferrell. WV’s Lack of CPS Workers Means Kids Don’t Get Help: The Problem Isn’t New, and Is Getting Worse. Mountain State Spotlight, January 13, 2022.

5. Knisely, Amelia. Reports Show People with Disabilities Are Abused in State Care Project. West Virginia Public Broadcasting, November 3, 2022.