West Virginia Code of State Rules Agency 78 - Human Services
West Virginia Code of State Rules – Agency 78: Human Services
1. Overview
Agency 78 of the West Virginia Code of State Rules (CSR) governs the Department of Health and Human Resources (DHHR) and its various programs that provide services to residents in need.
Purpose:
To regulate human services programs, including public assistance, Medicaid, child protective services, foster care, and other welfare programs.
To establish consistent procedures for eligibility, benefits, administration, and enforcement of human services laws.
Legal Basis:
The rules are authorized under the West Virginia Code, primarily under Title 9 (Public Welfare) and Title 49 (Human Services).
Agency 78 rules are legally binding and have the force of law. Agencies must follow the rules, and citizens can challenge agency decisions if rules or statutory requirements are violated.
2. Structure of Agency 78
Agency 78 is divided into series that address different programs or administrative functions. Major series include:
CSR §78-1 – Administration
Defines organizational structure of DHHR.
Establishes responsibilities of the Secretary of DHHR, local offices, and program staff.
Covers policy issuance, records management, and reporting requirements.
CSR §78-2 – Eligibility and Public Assistance Programs
Rules for Temporary Assistance for Needy Families (TANF), food assistance, and other welfare programs.
Specifies eligibility criteria, application procedures, and documentation required.
CSR §78-3 – Medicaid Programs
Details eligibility, covered services, provider requirements, and reimbursement procedures.
Includes procedures for appeals when benefits are denied or terminated.
CSR §78-4 – Child Protective Services and Foster Care
Sets procedures for investigating child abuse and neglect.
Explains requirements for foster care placement, licensing, and monitoring.
CSR §78-5 – Adult Protective Services
Addresses protection of vulnerable adults from abuse, neglect, or exploitation.
CSR §78-6 – Administrative Hearings and Appeals
Provides procedural rules for contested cases.
Ensures due process under the West Virginia Administrative Procedure Act (W. Va. Code §29A-1-1 et seq.).
Explains notice, hearings, representation, and appeal rights.
3. Key Provisions Explained
A. Eligibility and Benefits
Applicants must meet specific income, residency, and need-based requirements.
Documentation (e.g., proof of income, medical necessity) is required.
Benefits can be denied, reduced, or terminated for noncompliance or ineligibility.
Recipients have the right to request a fair hearing if they disagree with the agency decision.
B. Child and Adult Protective Services
Mandates investigations of abuse, neglect, or exploitation.
Requires caseworkers to follow detailed procedures for reporting, assessment, and intervention.
Licensing of foster homes and care facilities ensures safety and compliance with regulations.
C. Administrative Hearings
Agency 78 establishes procedures consistent with the West Virginia Administrative Procedure Act (APA).
Individuals may contest agency actions through:
Written request for a hearing
Opportunity to present evidence and witnesses
Right to appeal an adverse decision to the West Virginia Office of Administrative Hearings
Decisions must be based on substantial evidence and follow W. Va. Code rules.
4. Case Law Context
Several cases illustrate how West Virginia courts handle disputes involving Agency 78 rules:
A. Procedural Fairness in Administrative Hearings
State ex rel. E.S. v. West Virginia Department of Health and Human Resources:
Court emphasized that DHHR must follow its own rules and the APA. If a hearing is held without proper notice or opportunity to present evidence, the decision may be invalidated.
Key principle: Due process must be upheld, even in administrative agencies.
B. Eligibility and Benefit Denials
In Re: T.M., 2018 W. Va. LEXIS 420:
Court upheld DHHR denial of benefits because the agency properly applied its eligibility rules.
Principle: Courts give deference to agency interpretations of regulations if they are reasonable and within statutory authority.
C. Child Protective Services
A.B. v. W. Va. DHHR, 2019 W. Va. LEXIS 95:
Court ruled that proper procedures in investigating alleged abuse are critical. Failure to follow rules, such as notifying parents or documenting evidence, can invalidate agency actions.
Principle: Agency 78 rules governing protective services must be strictly followed to protect rights and safety.
D. Standard for Judicial Review
Courts review Agency 78 actions under the “substantial evidence” standard.
Decisions are overturned only if:
The agency acted outside its authority
There was a violation of procedural rules
The decision was arbitrary or unsupported by evidence
5. Practical Implications
For Recipients of Human Services
Always maintain documentation (income, medical records, reports).
If denied benefits, you have the right to request a hearing under CSR §78-6.
Understand the timelines for appeals; missing deadlines may forfeit your rights.
For Agency Staff
Must follow CSR 78 procedures strictly to ensure decisions are legally defensible.
Must document all actions, notices, and communications.
Adherence to CSR rules reduces the risk of successful judicial challenges.
For Courts
CSR 78 is considered binding but is reviewed in light of statutory authority and procedural fairness.
Courts generally defer to agency expertise but enforce adherence to APA procedures.
6. Summary Table of Key Series (Plain-English)
| CSR Series | Purpose | Key Rights/Requirements |
|---|---|---|
| 78-1 | Administration | Organizational rules, staff duties, recordkeeping |
| 78-2 | Public Assistance | Eligibility, application, benefits for TANF, food programs |
| 78-3 | Medicaid | Eligibility, covered services, provider rules |
| 78-4 | Child Protective Services | Abuse investigations, foster care, licensing |
| 78-5 | Adult Protective Services | Protection of vulnerable adults |
| 78-6 | Administrative Hearings | Contested case procedures, due process, appeals |
7. Key Takeaways
Agency 78 provides binding rules for human services in West Virginia.
Procedural fairness is critical; courts enforce due process under APA.
Beneficiaries have rights to hearings and appeals if benefits are denied or services are improperly terminated.
Courts defer to agency expertise if rules are reasonable and properly followed, but violations of rules or statutory authority can lead to reversal.
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