Abuse. Overdoses. Mental illness. Health officials say they need a nearly $300 million budget increase to respond to these problems.

Jan. 9—West Virginia health officials say they urgently need nearly $300 million in new funding to help residents who desperately need drug treatment and recovery, protect the state's children from abuse, and aid those mired in poverty.

The health officials laid out their case to Gov. Jim Justice for a 25 percent budget increase, in an internal government document obtained by Mountain State Spotlight. Without the extra funds, they say a statewide recovery program will end, thousands may lose health insurance and they won't have enough workers to respond quickly to child abuse allegations.

In the 50-page request, health officials outlined the stakes:

"Without this Improvement, West Virginia will remain the state with the highest youth and adult prevalence of tobacco use," they wrote of a $1.9 million increase for tobacco prevention programs.

"If the improvement is not funded, the hospital will not be able to provide inpatient psychiatric services for individuals committed to our care," they wrote of a line item to hire more psychiatric nurses.

And simply: "If ongoing funding is not provided those programs will end," they said of one of Justice's signature initiatives — the Jobs and Hope program, connecting people in recovery to work.

Now, it will be up to Justice to either provide the additional funds for these critical health programs, or deny them to maintain the flat budget he's touted each year of his administration. In an email last week, Justice spokesperson C.J. Harvey wouldn't say whether the governor will grant the health officials' request to increase their budget this year.

"The Governor's proposed FY 25 budget will be presented to the Legislature in conjunction with his State of the State Address ... Wednesday, January 10, and available on the Legislature's website shortly thereafter," he wrote.

In the past, Justice has said the state has no need to set aside extra funds "or to grow government," touting the flat budget he's said led to a "rocket ship ride" of success in West Virginia. Budgets that are "flat" allocate nearly or exactly the same amount of funds to state agencies each year.

Just last week, Justice said he plans to propose another flat budget this year, that West Virginia already has "goodness" and that he wants to "mind the store."

Spokespersons for the Department of Health, Department of Human Services and Department of Health Facilities did not respond to questions, including a question about whether any denied funding increases due to previous flat budgets had detrimental effects on residents' health.

Generally, state agencies' submitted budget increase requests aren't made public, according to Brent Boggs, a Democrat and former House Majority Leader. After talks with state agencies, the governor presents his recommended budget, with any increases he's agreed to, at the start of the 60-day legislative session. Before it's finalized, the House and Senate will both have a chance to make changes to the governor's proposed budget.

Senate President Craig Blair, R-Berkeley, said last week he's been in favor of a flat budget for a long time because by design it "squeezes" agencies so they can find places to cut.

Ann Ali, House of Delegates spokesperson, said House Finance Committee Chair Del. Vernon Criss, R-Wood, wanted to review the governor's recommended budget before answering questions.

Here are some of the vital programs that officials warn could end or be diminished without a budget increase:

Suicide, mental health and substance use disorder

Without $1.8 million in new funding for the state's suicide hotline, the 988 call line, the service will be canceled, according to the budget request.

The latest available data from the federal Centers for Disease Control and Prevention shows that West Virginia, which has lacked enough mental health care providers for decades, had the tenth highest suicide rate in the country in 2021.

"It is not possible to put a value on a life or the repercussions a tragedy could have on a family," state health officials wrote in their request.

Health officials also requested more money to prevent drug use and help people struggling with substance use disorder recover and rebuild their lives. As people who needed help turned from opioids to heroin to using a mix of drugs, including those laced with fentanyl, West Virginia has had the highest drug overdose death rate in the country since 2010.

The request includes a $6 million increase for substance use disorder prevention and more than $2 million to continue the governor's Jobs and Hope program, which provides job training to people in recovery.

When Justice announced Jobs and Hope at his State of the State address in 2019, he called it "Jim's Dream."

"I want it to be a dream that we can take our people off this terrible drug trail, and we can put them in a job, and we can give them real live hope," he said.

As of last March, state officials said the program helped more than 4,000 people find jobs and around 400 participants had graduated. Now that Justice's initial $10 million in funding has ended, health officials say the program will be discontinued without the additional funds.

Child health, abuse and neglect

Maureen Runyon has worked in child advocacy for about 30 years, and said the state's child protective service workers have never had enough time to handle all the cases assigned to them. She says she's heard them say the problem has grown worse lately.

"We work with counties all over the region," Runyon, coordinator of the Children's Advocacy Center at Women and Children's Hospital in Charleston said. "And there is not one county that touches Kanawha that has enough CPS workers. And we frequently have workers come in our center here at Women and Children's and share how very overwhelmed they are, and how impossible it is for them to do their job well."

Last year, the Legislature passed a law instructing state officials to reduce child protective service worker caseloads and employ workers in regions based on population to result in fewer delays in investigations. But now, officials are telling Justice they'll need $9 million in new funding to accomplish this by hiring 100 new CPS workers.

Justice signed the 2023 bill into law, and has previously said the state must "assure every child in West Virginia has a healthy, happy childhood free from abuse and neglect."

Officials also asked for about $4.4 million in new funding for about 75 new youth service workers, who work to help prevent children from entering the juvenile justice system.

And they also warned that without increases to funding the state's Childrens' Health Insurance Program, thousands of children and lower-income pregnant women will lose health coverage. About 20,000 pregnant women and children are insured through the program, which has seen recent increases in enrollment.

The agencies also requested $2.3 million more for Birth to Three, a program that serves children with developmental delays.

Help for the low-income

Nearly one in five people who live in West Virginia, a historically poor state, are living below the poverty line; that's $30,000 in income a year for a family of four.

To meet the need, health officials want to add about 280 new economic service worker positions at a cost of about $15 million more this year. Those workers help low-income people receive benefits like food stamps, Medicaid and water and heating bill assistance and ensure those decisions are accurate.

Adding more workers will also help reduce worker caseload — currently about 950 cases per worker, when the preferred caseload is no more than 500. These high caseloads lead to low morale, high turnover and frequent errors. And when federal officials do find errors, the state has to send money back to the federal government.

Health officials also want about $130 million more for Medicaid; the program that provides health coverage to people with little or no income is facing a shortfall this year.

State-owned psychiatric hospitals

The two state-owned psychiatric hospitals — Sharpe Hospital in Weston and Mildred Mitchell-Bateman Hospital in Huntington — "will not be able to provide inpatient psychiatric services for individuals committed to our care" without about $60 million in new funding for nurses and a possible increase in beds, according to the budget request.

Mountain State Spotlight has reported that in recent years, health officials have increasingly confined people with certain disabilities, including low IQ, at the full or overcrowded psychiatric hospitals for long stays or indefinitely. Patient monitoring groups have also reported multiple cases of abuse as the hospitals have come under fire in recent years.

Disability rights advocates accuse health officials of "warehousing" patients for long stays and want to see pay raises to address a shortage of workers who help people with intellectual and developmental disabilities live independently.

Meanwhile, health officials, in their budget request, say they even lack the staffing to properly care for patients while they're at the hospitals.

Facing a severe workforce shortage there as well, state officials said they've faced higher costs because they've had to use contract nurses, and in lieu of enough nurses, they've had to employ more health service workers who don't have that medical training.

Additional requests

The budget improvement requests also include an increase for the employer share of PEIA premium increases and for across-the-board 6 percent state worker raises. Justice has said pay increases would make up for the planned PEIA premium increase, but the burden of paying for both the employer share of premium increases and the pay raises would fall on the agency.

Among other programs and services, the department asked for more funding to pay for disaster preparedness; tobacco cessation initiatives; school-based health centers and the aged and disabled waiver program, which provides workers to help seniors live at home instead of in nursing homes.

Justice will announce his budget on Wednesday, then lawmakers can make their own revisions. But if he budgets as he has in previous years, he won't grant health officials these increases, and instead possibly send them one-time funding allocations if there is extra money available.

Runyon says she's seen this before. After decades of watching lawmakers sporadically "throw money" at the CPS worker vacancy and child abuse crises in West Virginia, she hopes to see state officials fully staff the child protective services program this year by guaranteeing money in the budget.

Rhonda Rogombé, health and safety net policy analyst at the West Virginia Center on Budget and Policy, said state health departments' funds are stretched thin. She hopes to see state officials increase funding for even more pressing health needs in the state this year, since the state has lost COVID relief dollars, health care costs are rising and the pandemic has exacerbated problems like mental illness and financial stress.

"When people fall through the cracks, that's where we see a lot of the hardships that West Virginia has historically faced," she said.

Years of flat budgets, she said, have "essentially cut those programs off at the knees."

This story was originally published by Mountain State Spotlight. Get stories like this delivered to your email inbox once a week; sign up for the free newsletter at mountainstatespotlight.org/newsletter