As the federal government continues to disperse emergency funds across the country, West Virginia lawmakers and advocates alike must focus on how the American Rescue Plan Act (ARPA) can further the state’s health, workforce, and economic recovery. ARPA was signed into law in March 2021. Amongst other provisions, the legislation includes expansions to food assistance, housing support, unemployment benefits, tax credits for working families, and health coverage to ensure a robust recovery as the COVID-19 pandemic persists. ARPA’s health investments in state agencies and health programs present significant opportunities to complement work already happening on the state level.
Through ARPA, West Virginia can build on recent state-led efforts, including expanding Medicaid to cover oral health for adults and postpartum services, with federal funding and support. APRA provides funding to several health programs, including subsidies for health insurance through the Affordable Care Act’s marketplace, public health infrastructure, community health workers, mental health and substance use services, home and community-based services, postpartum care, Medicaid expansion, and more. While West Virginia was one of the first states to expand Medicaid and implement the increased health insurance subsidies on the individual marketplace, there are still several outstanding opportunities for health-specific investments. If targeted effectively, these funds can solidify West Virginia’s path to a more robust, more equitable recovery. Here are four priorities for decision-makers and advocates to consider when planning for the use of ARPA funds.
Decisionmakers may find it tempting to spend ARPA funds on temporary fixes. But crisis-response investments without a broader strategy to address the need for more robust, permanent public health infrastructure do a disservice to all West Virginians in the long term. While strengthening infrastructure should include improvements to traditional physical infrastructure, it must also incorporate and prioritize human infrastructure and support those who provide vital services. Without this emphasis, West Virginia cannot meaningfully combat the effects of COVID-19 and structural racism to better weather future storms.
Through ARPA, West Virginia will receive a $14.6 million supplement to the Community Mental Health Services Block Grant (MHBG) and the Substance Abuse Prevention and Treatment Block Grant (SABG). With these monies, the state could augment the number of facilities and available beds that provide treatment for behavioral health issues and that prioritize person-centered care while also supporting a larger public health workforce dedicated to treatment at those facilities. Adequate support offers improved paths for training, credentials, and benefits to support workers’ physical and mental well-being.
Many West Virginians, especially residents of color and rural residents, do not have access to services that address rapidly changing lifestyles and approaches to care, let alone services that actively counteract the effects of structural racism and classism. By expanding the services available through Medicaid, West Virginia can better cover people who face health vulnerabilities, including those with disabilities. By addressing health care gaps, the state will better protect those who are at the highest risk of illness during a pandemic.
West Virginia has already begun to use ARPA funds to address shortages in the home- and community-based (HCBS) workforce. ARPA includes an increased federal match toward these Medicaid services, which could bring an estimated $558 million into West Virginia. These services allow people with significant physical or cognitive limitations to receive care in their homes or a home-like setting while remaining integrated with their respective communities.
The state has several areas of focus within these services that they are prioritizing, including increasing compensation and training for workers within HCBS, expanding eligibility and the range of services provided, and streamlining the system. These and other key features will benefit those who utilize such services, as well as the people who serve them, both in the short- and long-term.
The COVID-19 pandemic reinforced the importance of a diverse and sufficiently supported health workforce in protecting all residents of the Mountain State. Community health workers – who are both public health workers and intermediaries between health services and communities – and direct support professionals, who provide care directly to individuals with disabilities through programs like HCBS, serve vital roles in bridging the gaps between the health care system and the unique needs of individuals and communities.
Despite the ongoing need to better integrate and increase the pay for a range of health care workers, West Virginia remains behind other states in adequately supporting these essential workers. The state struggles to recruit and retain health care workers, in part due to low wages. Continuing to underfund diverse and necessary care severely limits resources for the people and communities with the most significant health challenges, as well as exacerbates structural racism and classism within the health care system. West Virginia can improve the care system throughout the state by guaranteeing that essential health workers receive the wages and support that reflect the value of their vital services, and ensuring that training is flexible and addresses current and anticipated health needs across the state. ARPA provides several grant opportunities that West Virginia leaders should leverage to invest in long-term solutions. Additionally, ARPA’s fiscal recovery funds to state and local governments can be utilized to support the public health workforce. Finally, restoring and supplementing funds to the state’s public health departments, which perform a broad range of services in their respective communities, is critical for health outcomes across the state.
Conversations with communities that COVID-19 has disproportionately harmed will continue to play an essential role in determining the most helpful ways to address the pandemic’s impacts. With changing social and economic circumstances throughout the state and country, these discussions on how best to target funds cannot be held during one-time meetings. Instead, West Virginia can make the most of ARPA’s opportunities by implementing comprehensive plans that allow flexibility to respond to feedback from individuals, families, and communities. Ensuring that decisionmakers address their respective communities’ needs will help overcome structural biases in aid and investment. Additionally, planning for regular evaluations of the funding’s impact – instead of treating APRA as a standalone, one-time action – can help to better target funds and improve health outcomes for all West Virginians.
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