The OMCFH is the WV Title V agency and housed within the Bureau for Public Health (BPH) under the umbrella of the DHHR. This structure lends itself to easily interact and collaborate with the Bureau for Children and Families, the Bureau for Medical Services (Medicaid), the Office of Nutrition Services (WIC), and the Health Statistics Center (Vital Statistics) to name a few. The Office also houses Board of Pharmacy personnel to assist with data needs for the Opioid/drug overdose crisis. In addition, the Office provides administrative oversight for the Department of Education’s Part C/Early Intervention Program and Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program.  Every five years, the OMCFH conducts the required Title V Needs Assessment. The Needs Assessment is used to evaluate competing factors which impact health delivery services from the program level and drives activities to improve the health status of the maternal and child health population. 

WV, the second most rural state in the nation, is the only state located entirely within the area known as Appalachia.  Even so, WV is located within 500 miles of 60% of the nation's population. The state is traversed by two north/south and one east/west interstates that connect its major population centers. In addition, I-68, which ends at Morgantown, where West Virginia University (WVU) is located, provides access to Washington, D.C. and Baltimore, MD. Interstate 68 also connects with I-79S, providing access to Charleston, WV, the state capitol and I-79N providing access to Pittsburgh, PA. Winding secondary roads connect the majority of the state's population, with little to no public transportation available between many of the small, isolated towns. Therein lies the single most often cited issue with access to health care for many of the state's residents.  

WV is surrounded by Pennsylvania, Maryland, Virginia, Ohio, and Kentucky and is commonly referred to as a South Atlantic state. The Appalachian Mountains extend through the eastern portion of the state, giving WV the highest elevation of any state east of the Mississippi River. 

WV reached its population peak a half century ago with 2,005,552 residents counted in the 1950 US Census. The State's population has not exceeded the 2 million mark since then, but has fluctuated between 1.7 and 1.9 million depending on the State's economy. Charleston, the state capitol and largest city, and Huntington are the only cities with populations nearing 50,000 people. WV is the 41st largest and the 38th most populous state in the county.  Two-thirds of the State’s 1.8 million people live in communities with less than 2,500 residents; 44 of the 55 counties in WV are federally designated as non-metropolitan by the Federal Office of Management and Budget and 51 counties are designated fully or in part as Health Professional Shortage Areas (HPSA) and/or Medically Underserved Areas. 

Appalachia is distinguished by mountainous terrain, geographic isolation, and a history of economic underdevelopment. Although conditions in Appalachia have improved in recent years, these improvements have not benefited all communities equally. Isolated, rural areas continue to experience the most adverse social, economic, and educational deficits, resulting in significant health disparities in the incidence, prevalence, mortality, burden of chronic diseases, and their risk factors, as well as access to care. Not surprisingly, WV consistently ranks in the top three nationally in adults self-reporting their general health as either “fair” or “poor”. Data indicates that 18% of individuals could not afford needed health care services and approximately 21.4% of adult West Virginians do not have a specific primary care physician (PCP) or health care provider.

WV's population is mostly homogeneous with little racial or ethnic diversity.  The 2018 Census population estimates for WV reported that 93.5% of WV residents are White, 3.6% Black, 0.3% American Indian and Alaska Native, 0.8% Asian, and 1.8% were more than one race.  The Hispanic population was reported as 1.7%. 

WV has one of the oldest median ages (41.3 years) and percent of people age 60 and older in the nation according to 2015 US Census population estimates data. Between 2000 and 2010 people age 85 and older increased by 24.8%; the number of individuals age 90 and older grew by 41.3%. Although the population has fluctuated between 1.7 and 2.0 million over the last 50 years, the number of births have declined from 50,000 births in 1950 to 19,715 tentative births in 2016, dropping from a rate of 25.4 births per 1,000 to 11.2 births per 1,000, compared to the US rate of 12.6. Because of its older population, WV ranked first among the states in the percentage of its residents enrolled in Medicare (18.4%, compared to a national average of 13.9%). Older West Virginians value their independence, self-sufficiency, and preservation of the family homestead. This lifestyle is demonstrated by the fact that residents maintain one of the highest percent of home ownership in the nation at 73.4% compared to 66.9% nationally. Almost 85% of individuals age 65 and older own their home.

According to America’s Health Rankings, WV ranked poorly in 2018 across a number of health measures, including overall health, obesity, and physical inactivity. Perhaps most concerning is a decline in its rank in overall health from 41st in 2011 to 46th in 2017. In 2018 there was a rebound to 44th. A major contributor to WV’s poor overall health is obesity. Obesity is a major risk factor for many diseases and chronic conditions including heart disease, cancer, Type 2 diabetes and stroke. In 2018, the percent of obese adults reached 38.1%; WV ranked 50th in obesity. A key factor to reducing and preventing obesity and other related chronic conditions is regular exercise (physical activity). Unfortunately, WV ranks low in this important lifestyle behavior. Again, according to America’s Health Rankings in 2018, WV was ranked 43rd with 31.6% of the population reporting being physically inactive. Other health issues affecting the state include high rates of diabetes and smoking. The percentage of the adult population who has been told by a health professional that they have diabetes increased from 4.7% in 1996 to 15% in 2017. In 2018, WV ranked 50th in terms of smoking with 26% of the adult population indicating that they currently smoke daily. This percentage has remained fairly stable over the past 10 years, unaffected by the numerous public health interventions to reduce smoking although, according to the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) data, smoking during the last three months of pregnancy has decreased to 22.82% from 25.2% in 2015 and in 2017 further decreased to 18.57%.  The WV Vital Statistics reports smoking during pregnancy at 25.4% for 2016 and for at 24.7% in 2017.  

There are three tertiary care hospitals; WVU (Ruby Memorial) located in Morgantown, Charleston Area Medical Center (CAMC) located in Charleston, and Cabell/Huntington located in Huntington with each having a level III Neonatal Intensive Care Unit. There are currently 25 birthing hospitals in the State. There is one standalone children’s hospital located in Charleston, WV called Women and Children’s Hospital under the CAMC umbrella. An additional Children’s Hospital is currently under construction at WVU located in Morgantown, WV. There are limited pediatric specialists in WV with most located at one of the three tertiary care centers. The OMCFH contracts with WVU Pediatrics/Genetics to provide six (6) satellite clinics throughout the state to provide services for children with special health care needs. The Newborn Screening Program has an active Advisory Committee involving pediatric specialties; pulmonology, hematology, genetic specialists, immunology and Cystic Fibrosis.

There are 51 Rural Health Clinics in WV (Kaiser, 2015) and 28 Federally Qualified Health Centers (FQHCs) provide services at 270 sites in the State (Kaiser, 2015).  Six percent of WV residents lack health insurance (Kaiser, 2015) and according to the 2016 National Survey of Children’s Health only 5.3% of WV residents lack health insurance. According to the Economic Research Service, the average per capita income for WV residents in 2015 was $36,644 ranking WV 49th and rural per capita income lagged at $33,487. Estimates from 2017 indicate a poverty rate of 17.9% exists in WV.

Congress passed the Patient Protection and Affordable Care Act (ACA) which was signed into law on March 23, 2010. Healthcare reform dramatically impacted health programs and services in WV. One major impact of healthcare reform is the increase in the income eligibility limit for children served by the state Medicaid program. Effective January 1, 2014, the upper income limit for Medicaid children, aged zero to one, increased to 158% Federal Poverty Level (FPL) and children aged six through 18 increased to 133% FPL, while the WV Children's Health Insurance Program's (WVCHIP) eligibility is 300% FPL. This increase caused many children that were income eligible for WVCHIP to transfer enrollment to Medicaid. Approximately 5,482 children moved from WVCHIP coverage to Medicaid coverage through June 30, 2014. In addition, some Medicaid children became eligible for WVCHIP, and some WVCHIP and Medicaid children became eligible for Advanced Payment Tax Credits (APTC) through the marketplace. Medicaid eligibility for pregnant women also expanded to 158% FPL. WVCHIP has implemented a number of changes in order to comply with the ACA.  The most notable activities include:

• Transitioning income eligibility determination to one based on Modified Adjusted Gross Income – effective October 1, 2013;
• Dropping the waiting period required before a child becomes eligible for WVCHIP;
• Redesigning the premium program to comply with regulations regarding premium collections and program enrollment; and
• Transitioning WVCHIP kids in families with incomes up to 133% FPL to the Medicaid program.

Other eligibility standards for Medicaid in WV also changed significantly. With the dependent child requirement dropped and increased income limits, virtually any legal resident making less than 138% of the FPL qualifies for Medicaid coverage. This means that a single person can make up to $15,856, a two person household, $21,404, a three person household $26,951 and a four person household $32,499. The new guidelines eliminate the asset test previously required for non-disabled adults and the elderly. Individuals in these categories with assets that exceed around $4,000 in value, even including cars or retirement savings, were previously ineligible for traditional Medicaid coverage, regardless of their income. Under expansion, these assets are no longer considered and eligibility is based strictly on income.  At this point in time, over 147,000 West Virginians have been newly enrolled in Medicaid.  The US Department of Health and Human Services (DHHS) reported that WV had the second greatest increase in Medicaid enrollment in the country.  The DHHS found that WV Medicaid enrollment increased by 38.5% compared to an average of 12.3% of those states that expanded Medicaid. According to recent Urban Institute projections, 176,000 WV residents are eligible for the expanded Medicaid program.  This means that 80.4% of all those eligible in a ten-month period were enrolled.  The successful enrollment process in WV has had a positive impact on WV health care providers.  According to West Virginian's for Affordable Health Care, hospitals have seen the number of self-pay (uninsured) patients decrease dramatically. In July of 2019, WVCHIP will cover all pregnant women between 139% and 300% of the Federal Poverty Level (FPL). Title V provided coverage for prenatal visits and $1,000 towards delivery costs for those pregnant women up to 188% of the FPL. In response to the new WVCHIP coverage, Title V is will cover premium payments for pregnant women who are unable to pay to ensure coverage continues six months postpartum and will provide prenatal care, pharmacy, and an amount to be determined on labor and delivery charges for pregnant women up to $325% of the FPL or another percentage to be determined.     

Economic hardship, especially in early childhood, has been shown to put children at risk for developing special health care needs later in life. This supports the need to ensure all children have adequate health insurance to allow for preventive measures and early intervention to attempt to mitigate potential issues before they develop. According to the National Survey of Children’s Health (NSCH), the rate of uninsured children under the age of 18 continues to decline. According to the 2003 survey, 6.6% of WV children were uninsured. The most recent survey (survey year 2016) found that 4.5% of WV children are uninsured, lower than over half of the other states, but according to the 2018 WVCHIP Report there are only 2.8% children currently uninsured. As the ACA is fully implemented, the prevalence of uninsured children should continue to decrease. To illustrate this point, the CSHCN Program provided Title V coverage to as many as 23 uninsured children in 2009 and in 2017, all CSHCN-enrolled children were covered by insurance.

The ACES Coalition of West Virginia includes over 70 different organizations and individuals working together to improve the health and well-being of all West Virginians by reducing the impact of Adverse Childhood Experiences (ACEs) and preventing their occurrence. The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being. The Coalition is working to apply that study and additional ACEs research findings in WV.

The OMCFH is participating in integration of services with emergency medical personnel, Child Protective Services, community health centers, school counselors, and others to develop a culture supportive of interventions using a trauma-informed approach.  A trauma informed approach comprises six basic elements that are applied to all activities and interactions with agency clients and with agency workers (Fallot & Harris, 2009). These core elements are: safety, trustworthiness, choice, collaboration, empowerment, and cultural relevance (Proffitt, 2010). These philosophical principles help to shape the culture of assault service programs and the services provided to survivors of ACEs or trauma.

To address health access challenges, the OMCFH and its partners encourage the use of community health centers by low-income and/or uninsured individuals where free services or sliding fee payment is available. WV is largely dependent on the community health center network, with their core of family physicians to serve not only medically underserved geographical areas, but also the uninsured and those that have recently been insured. However, because of Medicaid expansion, the number of physicians needed to serve previously uninsured individuals has increased and rates of medical school students choosing family practice to serve in underserved areas is decreasing (Chen et al, 2014). So far, little progress has been made to address this national shortage. 

The OMCFH has been acknowledged for its positive partnerships across the State including the medical community, the University System, the State Department of Education, the Perinatal Partnership, and the March of Dimes.  The OMCFH is known for its willingness to engage and participate alongside stakeholders in designing systems of care to serve the maternal and child health population. The Office knows that resources are scarce and WV cannot afford to duplicate existing systems that are working well. The OMCFH also understands that it must join other stakeholders to achieve goals.

The OMCFH has established partnerships with FQHCs, free clinics, private practicing physicians, local health departments, and hospital-based clinics to ensure access to high quality medical services for all WV residents.  The OMCFH also supports a network of parents who are employed by the Center for Excellence in Disabilities (CED) at West Virginia University.  These Parent Network Specialists offer parent-to-parent support for families with children who have disabilities. 

The Office continues to hold contracts and formalized agreements, both internal and external, to the DHHR for direct services offered throughout the State. The Office also has in place many systems with partnerships that contribute to the early identification of persons potentially eligible for services. These population-based systems include the Birth Score Program, birth defect surveillance system, newborn metabolic screening, newborn critical congenital heart defects screening, childhood lead poisoning screening and newborn hearing screening. These systems rely upon partnerships to conduct the screenings, and report findings to the OMCFH to ensure appropriate follow-up and surveillance activities.

There are a number of State laws and policies that guide WV's Title V Program. These laws include but are not limited to:

a.  Children with Special Health Care Needs:  Provides specialty medical care, diagnosis, treatment and health care coordination for children with special health care needs and those who may be at risk of disabling conditions.  Staff provide care coordination, develop and monitors treatment plans and assist families with scheduling and transportation for medical care.  Title V funds are used as payor of last resort.  (WV Code § 49-4-3)

b.   West Virginia Birth to Three:  Provides therapeutic and educational services for children age zero-three years and their families who have established, diagnosed handicaps, developmental delay or are at risk due to biological factors.  The goal is to prevent disabilities, lessen effects of existing impairments, and improve developmental outcomes.  These services are provided by community-based practitioners.  (WV Code §16-5k, P.L. 99-457/Part H)

c.  HealthCheck (EPSDT): Educates Medicaid-eligible families about preventive health care for children and encourages their participation in the program while ensuring the following:  1) children are screened and re-screened according to periodicity tables established by the American Academy of Pediatrics; 2) medical problems identified by examination are treated or referred; 3) children/families receive transportation assistance; and 4) help with appointment scheduling. (Medicaid 42 FR §§441.50 – 441.62)

d.  Oral Health Program:  Provides statewide coordination for oral health activities including planning, school-based sealants, fluoride efforts, workforce shortages, and community involvement.  (WV §16-41)

e. Right From The Start (RFTS):  Arranges care for government sponsored obstetrical populations and children up to age one (Title V, Title XIX, Title XXI) that meet pre-established medical criteria.  State staff have responsibility for care protocol development and dissemination; provider recruitment; and system development that assures patient access to quality, comprehensive, timely care.  RFTS services are provided through a community-based network of nurses, social workers, and physicians. (WV §9-5-12)

f.   Birth Score:  Population-based surveillance project that is administered by WVU in partnership with OMCFH to identify infants at risk of post-neonatal death in the first year of life and to provide appropriate interventions for those determined at risk.  (WV Code §16-22B)

g.   Newborn Hearing Screening:  All children born in WV are screened at birth for the detection of hearing loss.  Children who fail the screen are followed and assisted in obtaining further diagnostic care to assure that children with a loss receive appropriate medical intervention.  (WV Code §16-22A)

h.   Women’s Right to Know:  The Women’s Right to Know (WRTK) requires informed consent for an abortion to be performed, requires certain information to be supplied to women considering abortion, and establishes a minimum waiting period after women have been given the information.  The law specifies exception for medical emergencies and requires physicians to report abortion statistics.  Further, the WRTK law requires DHHR to publish printed information and develop a website on alternatives to abortion.  (WV Code § 16-21-1)

i.   Maternal Risk Screening:  Maternal Risk Screening is a comprehensive and uniform approach to screening conducted by maternity care providers to discover at-risk and high-risk pregnancies. The law provides for better and more measurable data regarding at-risk and high-risk pregnancies.  The law requires DHHR, BPH, OMCFH to convene the Maternal Risk Screening Advisory Committee annually and provide administrative and technical assistance to the Committee as needed.  A Prenatal Risk Screening Instrument (PRSI) was created to be used by all maternity care providers and is to be submitted to OMCFH at the first prenatal visit.  The uniform maternal screening tool is confidential and shall not be released or disclosed to anyone including any state or federal agency for any reason other than data analysis of high-risk and at-risk pregnancies for planning purposes by public health officials. Data is housed within OMCFH.  (WV Code § 16-4E)

j.   Family Planning Program:  Arranges for comprehensive physical examination, lab testing, counseling, and education, as well as contraceptive services to persons of childbearing age.  Provides technical assistance and establishes operational standards for medical providers.  (WV Code §16-2B)

k.  Breast and Cervical Cancer Screening Program:  Promotes early detection of breast and cervical cancer through screening, follow-up services, and education to low-income women.  Available in all 55 WV counties through county health departments and primary care centers – a total of 132 sites. (WV Code §16-33)

l.    Newborn Screening Program:  All infants born in WV are tested for 30 disorders that include SCID, CCHD, newborn hearing, and NAS and includes follow-up services.  The Program also provides for some special nutritional needs as a payor of last resort.  Children who are positive are referred to the Division of Infant, Child, and Adolescent Health, Children with Special Health Care Needs Program, for support services.  (WV Code §16-22)

m.   Lead Screening:  This Project is a collaborative effort between two Offices in the Bureau for Public Health, the OMCFH and the Office of Environmental Health Services (OEHS).  The mission is to determine the extent of childhood lead poisoning and identify potential areas that may have more lead poisoning episodes.  All laboratories that collect blood lead samples are required by statute to send results to OMCFH.  The OEHS provides assessment of home and environment for residences of children with elevated blood lead levels. The CSHCN Program provides care coordination to children with elevated levels, and who qualify for the CSHCN Program.  Additionally, a referral to the OEHS will be made for home assessments.  (WV Code §16-35-4a)

n.   Infant and Maternal Mortality Review Panel:  The Infant and Maternal Mortality Review Panel evaluates maternal and infant deaths to understand the diverse factors and issues that contribute to deaths that are preventable.  The panel identifies and implements interventions to address these problems.  (WV Code §48-2SA)