Del. Evan Worrell, R-Cabell, questions West Virginia Department of Human Services leaders during a meeting of the Legislative Oversight Commission on Health and Human Resources Accountability in Charleston, West Virginia, on Tuesday, Dec. 9, 2025. (Photo by Will Price/West Virginia Legislative Photography)
State lawmakers are questioning how the Department of Human Services is trying to get a handle on the care crisis, raising concerns about tardy payments and a more than $300 million care technology platform that isn’t fully functioning.
The legislature’s job is to provide oversight of state agencies, and that’s what they do try to push for change in the state’s troubled foster care system with nearly 6,000 children.
On Tuesday, some members of the Legislative Oversight Commission on Health and Human Resources Accountability were particularly concerned to learn that DoHS is still struggling to pay caregivers on time, including agencies that place foster children with their family members and run group homes.
“Are you trying to put them out of business? Where would the department be if they couldn’t do business?” Del asked. Evan Worrell, R-Cabell, who chairs the committee. “It cuts across all service lines…I hear this all the time, I get calls all the time. What is the department going to do to change this? I’m trying to see a change for the better and I feel like I’m seeing a change for the worse.”
The state does not have enough foster homes for children – or some children require acute care in hospital-like facilities – so residential treatment facilities are critical to the well-being of West Virginia’s children.
Mia Johnson is CEO of Burlington United Methodist Family Services, which operates 82 residential children’s beds, group nursing homes and more.
“Unfortunately, our ability to continue this work is at risk,” Johnson told lawmakers. “The greatest threat to our agency is the continued failure of the payment and reconciliation systems in our partnership with DoHS.”
Earlier this year, Johnson told lawmakers that some DoHS grants were seven months tardy. She said there are currently ongoing delays in grants that are jeopardizing programs for families and staff retention. The payment delays endanger the company’s liquidity reserves.
Johnson said the delay in payments was one reason Burlington couldn’t commit to taking in certain more vulnerable groups of children, “such as sex offenders and sexually reactive children.”
“We can’t afford the insurance,” she said.
There are 543 foster children In Out-of-state group homestypically older children who require a high level of care due to behavioral or mental health issues.
DoHS Secretary Alex Mayer told lawmakers that DoHS is now looking for out-of-state providers to come to West Virginia to open beds for in-need foster children so they can bring children back into the state.
“I want to make it clear that since arriving in West Virginia, I have met with providers in groups and individually to discuss the possibility of specializing in levels of care that require us to send children out of state, and we have not received interest from any providers,” Mayer said.
In response, Sen. Eric Tarr, R-Putnam, didn’t understand why the state would look outside the state when it hadn’t properly paid its in-state providers.
“They are testifying that their business is on the verge of going out of business in West Virginia, so why on earth wouldn’t we support existing providers before we ask other providers to come in?”
Employees at Children First and Home Base, two social indispensable service providers in West Virginia, described several problems to lawmakers, including delayed state payments. Socially necessary service providers transport foster children to their biological family members; Vendors asked Gov. Patrick Morrisey to stop a fresh mileage documentation policy They said it was excessive, unnecessary and “forces some providers to withdraw their services.”
“Our concerns reflect real challenges that affect real families and the real frontline workers who care for them every day… We demand solutions that allow us to spend time caring for children, not compensating for flawed administrative processes,” said Caroline McMillen, Home Base’s chief human resources officer.
Bureau of Human Services Commissioner Lori Bragg said the department has conducted audits of housing providers and providers of socially necessary services in an effort to improve its finances.
Bragg said an audit revealed a $5.4 million overpayment to residential real estate providers. Another audit found that providers of socially necessary services were overcharging for mileage, she said.
The DoHS now requires providers to undertake additional verification to prevent future overpayments, and some of these fresh steps have resulted in payment delays. Payments are still being disbursed, she said, but noted there are sometimes delays of a week.
“We had to make sure we were spending the money where we were supposed to be spending it,” Bragg said. “I don’t think we’re being unreasonable.”
Worrell was not content with the situation and said, “I have to ask this question: Are you trying to bankrupt them?”
He continued, “Policies are being changed and enacted that will essentially result in providers going bankrupt and we will no longer have any in the state.”
Care provider issues related to the failure of the PATH system
Many foster parents’ problems with tardy payments were tied to the state’s PATH database system, a technology implementation under Gov. Jim Justice that was intended to more seamlessly manage child welfare cases, emergency food assistance applications and more.
The State contractually agreed with Optum in 2017 for the more than $300 million development of a fresh integrated entitlement system to manage its programs, but the rollout faced a number of delays – some due to the COVID-19 pandemic – and issues.
Johnson said that in one case, a foster child could not be found in the PATH database and therefore no payment was made.
The state hires a separate company, Acentra, to pre-approve some care services, such as mileage allowances from socially necessary service providers.
“Since October 2022, providers of socially necessary services have experienced significant and ongoing operational disruptions in the PATH and Acentra systems. The problems begin with significant reimbursement delays that threaten agency stability and the ability to pay staff,” McMillen said.
Tarr said the PATH system was a disaster and told DoHS officials he wanted to know how it would be fixed.
“It’s a hundreds of millions of dollars debacle, and we’re putting it on the shoulders of providers. We’re losing child care providers, we’re delisting foster care, we’re losing behavioral health providers. Why do we keep paying out hundreds of millions of dollars for this?” he asked.
Mayer, who inherited the PATH contract, said he is working on stern change to the system.
“It’s a failure,” Mayer told lawmakers. “Because of the changes that were made to the contract structure before I got here, we are navigating the constraints that we work within. And that has made it even more difficult for me to take action to hold on to the fire and really make change happen.”
He continued: “I’m not happy with the way things are… I think we’re on the way to making things better.”
The DoHS secretary says care reform is underway
Mayer explained to lawmakers his plan to improve child welfare after a fresh federal audit found that the state’s CPS workers failed to properly investigate The majority of referrals for child abuse and neglect occurred in 2023-2024.
The state did not comply with the federal Child Abuse Prevention and Treatment Act, which provides funding to states to improve child protective services and prevent child abuse.
Mayer, who was named head of DoHS after the audit was conducted, said he was not surprised by the findings and has already started working on the solution long-standing problems with CPS and following up on child abuse tips.
“I want to start with this: We take the (inspector general’s) findings seriously,” Mayer told lawmakers. “This is about the lives of children, the future of families and the credibility of state government. The audit confirmed the steps we have already taken, the problems we have identified and the approaches to addressing the issues raised in the report. In short, deep, sustained reform at the system level was needed and we have already begun that work.”
He laid it out Eight pillars of nursing reform This included implementing a statewide practice model to ensure CPS decisions are consistent and trauma-informed. The department wants CPS employees to spend more time with the families they serve.
Other initiatives include the redesign of the state’s electronic referral center for children. The DoHS aims to support foster families and kinship caregivers with specialized training when caring for children with high mental or behavioral health needs.
A group of Republicans in the House and Senate are pushing for foster care reform to be a priority in the upcoming legislative session, which begins next month. This week, she presented 16 draft laws for nursing care reformincluding a measure that would require CPS employees to wear body cameras when conducting child abuse investigations.
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