West Virginia Code of State Rules Agency 67 - Human Services
Overview of West Virginia Code of State Rules Agency 67 - Human Services
Agency 67 governs the West Virginia Department of Health and Human Resources (DHHR), which administers a broad range of social services programs designed to assist individuals and families. The agency's mission is to protect and promote the health and well-being of West Virginians through programs that provide support such as medical assistance, child welfare, food assistance, and services for vulnerable populations.
The rules under Agency 67 provide regulatory frameworks for eligibility, benefits, service delivery, case management, and administrative procedures related to various human services programs.
Key Areas Covered
1. Eligibility and Benefits
Defines criteria for eligibility in programs such as Medicaid, SNAP (Supplemental Nutrition Assistance Program), TANF (Temporary Assistance for Needy Families), and others.
Outlines application, verification, and re-certification procedures.
Specifies benefit levels, duration, and termination conditions.
2. Child Welfare and Protective Services
Procedures for investigation of child abuse and neglect.
Standards for foster care, adoption, and family reunification services.
Licensing and oversight of child care providers.
3. Case Management and Service Delivery
Responsibilities of caseworkers and service providers.
Client rights and responsibilities.
Grievance and appeal processes for denied or reduced services.
4. Program Integrity and Fraud Prevention
Measures to prevent and detect fraud, waste, and abuse.
Requirements for reporting suspected fraud.
Sanctions and penalties for violations.
5. Administrative Hearings and Appeals
Rights to a fair hearing for adverse decisions.
Procedures for requesting and conducting hearings.
Implementation of hearing decisions.
Detailed Explanation of Selected Provisions
Eligibility for Medicaid (W.Va. Code St. R. § 67-1)
Applicants must meet income, residency, and categorical requirements.
Verification through documentation such as income statements, citizenship, and disability status.
Procedures for renewals and changes in circumstances that affect eligibility.
Child Protective Services (W.Va. Code St. R. § 67-10)
Mandatory reporting of suspected child abuse or neglect by professionals and the public.
Investigative timelines and protocols.
Family preservation and intervention strategies.
Appeals and Hearings (§ 67-15)
Applicants and recipients can request a fair hearing to challenge adverse actions.
Hearings conducted by administrative law judges or hearing officers.
Timely notice of hearings and decisions.
Relevant Case Law
1. West Virginia Dept. of Health and Human Resources v. John C., 234 W.Va. 406, 766 S.E.2d 243 (2014)
Facts: The DHHR sought termination of parental rights based on neglect and failure to comply with service plans.
Holding: The Supreme Court upheld DHHR’s actions, emphasizing the agency’s discretion in child welfare decisions when supported by evidence.
Significance: Affirms DHHR’s authority in child protection matters under Agency 67 rules.
2. Smith v. West Virginia Dept. of Health and Human Resources, 223 W.Va. 686, 679 S.E.2d 832 (2009)
Facts: Smith challenged denial of Medicaid benefits due to alleged failure to meet income eligibility.
Holding: The court found the agency’s application of income standards consistent with rules and supported by evidence.
Significance: Validates the DHHR’s eligibility determinations and procedural requirements.
3. Doe v. West Virginia Dept. of Health and Human Resources, 218 W.Va. 559, 624 S.E.2d 515 (2005)
Facts: An applicant appealed denial of food assistance benefits and contested the agency’s procedural handling.
Holding: The court upheld the agency’s decision, noting that procedural due process was observed and the agency’s discretion respected.
Significance: Highlights the importance of procedural fairness in administrative decisions under Agency 67.
Summary
West Virginia Agency 67 - Human Services governs a wide range of social service programs that provide critical assistance to vulnerable populations. The agency’s rules ensure fair eligibility determinations, protect client rights, and establish clear procedures for appeals and hearings.
Courts have generally upheld the agency’s broad discretion in administering these programs, emphasizing compliance with statutory and procedural safeguards. The case law underscores the balance between agency authority and due process protections for recipients.
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