Make WV Healthy Act waiting on governor’s signature; troubles with Rural Health Transformation Program spending authorization?
By Autumn Shelton, RealWV
CHARLESTON, W.Va. – The Make West Virginia Healthy Act of 2026, intended to help residents adopt a healthier lifestyle, has passed both the House and the Senate, and is now waiting for the governor’s signature.
House Bill 4982, the Make West Virginia Healthy Act of 2026, passed the House on Feb. 9 and the Senate on Feb. 19. The legislation is intended to promote physical activity, nutrition and general wellness all in an effort to reduce the serious health risks faced by many West Virginians.
The bill’s sponsor Del. Evan Worrell, R-Cabell, chair of the House Health and Human Services Committee, explained the Act before the House on Feb. 9.
According to Worrell, this bill is not a “federal takeover” or a “mandate on families’ personal choices,” instead it is “coordination, accountability and a return on investment” in a state that spends billions treating hypertension, diabetes, heart disease and more.
“West Virginia leads the nation in chronic disease, disability, preventable illness, and that’s not a talking point, we’re talking about our neighbors, more specifically our workforce, and definitely our Medicaid budget,” Worrell said. “And, whether you’re on this side of the aisle or that one, we’re all paying the bill for a system that waits until people are very sick before we act.”
The bill lays out plans for a “Food is Medicine” program conforming to the Rural Health Transformation Program, a part of the Trump administration’s “One Big Beautiful Bill,” which appropriated $199.5 million to the state of West Virginia for fiscal year 2026, with additional funding anticipated to reach at least $500 million over the next five years. However, Senate Bill 570, which authorizes the transfer of the federal monies to the Department of Health is awaiting advancement by the House Finance Committee, despite being passed by the Senate on Feb. 13.
“Food is Medicine” would permit the state’s Department of Human Services, Bureau for Medical Services, to “encourage Medicaid managed care organizations to offer nutritional services within the state Medicaid program,” according to the legislation. This includes nutrition related case management, nutrition counseling, medically tailored meals, produce prescriptions, and partnerships with farmers or food producers to prioritize the use of locally grown food.
The bill also allows for the continuation of a seemingly obscure state Office of Healthy Lifestyles, which would be responsible for the establishment of a Healthy Lifestyle Coalition by July 1, 2026. The Healthy Lifestyles Coalition would consist of 13 members, appointed to four-year terms by the Secretary of the Department of Health.
The legislation states that the Office of Healthy Lifestyles would work with the West Virginia Department of Education, the West Virginia Department of Agriculture and the Bureau of Medical Services to coordinate plans to develop physical fitness and nutrition initiatives for public school students, including guidelines for physical education courses, create a map of food deserts and provide a plan to increase the availability of fresh, local foods in those communities, implement a sustainable Farm-to-School program, and develop a county-grant program to help implement plans for a healthier lifestyle.
“We’re gonna focus on physical fitness, but not punishment,” Worrell said of the public education component of the bill. “Kids don’t lose recess for bad grades. Schools with limited resources get flexibility and students with IEPs are protected.”
Worrell said the data collected through the Act would remain anonymous, including body mass index data, but would be used to see what is working, and what isn’t.
Additionally, Worrell said that healthy kids grow up to become healthy adults who, when they enter the workforce, “miss fewer days, cost less to insure and stay employed longer.”
“If we want companies to invest here, if we want to grow our economy, if we want fewer people dependent on government programs, then we must confront the reality that chronic disease is one of the biggest barriers to prosperity in West Virginia,” Worrell said.
Del. Mike Pushkin, D-Kanawha, minority chair of the Health and Human Resources committee, said that while this Act will be funded, in part, using federal Rural Health Transformation dollars, he has concerns that this will not be enough to offset the loss of billions of dollars in Medicaid spending or for the “thousands and thousands” of West Virginians who will lose Medicaid, which were also part of federal spending cuts in the One Big Beautiful Bill.
“That money was put in the federal spending bill because of a concern about all these cuts to Medicaid, these rises in premiums that will cause people to no longer be covered and the hit this was going to have on our rural hospitals because of the concern of states like West Virginia,” Pushkin said.
Del. Kayla Young, D-Kanawha, also expressed concern about this legislation, saying that she did not like the mandated return of the Presidential Fitness Test that this bill provides.
“It was removed from national guidelines in 2013,” Young said of the Presidential Fitness Test. “It was removed in 2013 because it has a 70 year track record of failure. It has never, ever worked. It started in 1953 – the Presidential Fitness Test, you might think it measures fitness because it’s in the name. It doesn’t. It’s a standardized test that kids take once a year, maybe. And, it really measures strength.”
Young said she wished the state would invest in “social determinants of health” rather than programs that “shame” kids who cannot meet certain goals. However, she said she would support the bill.
Lastly, the bill establishes the Feed to Achieve Act, which would give the Department of Education and county boards of education the ability to establish a fund or non-profit foundation for the purpose of providing “supplemental or matching funds to increase participation in the nutrition programs in the Feed to Achieve initiative.”
The bill states that, “expenditures from the state or county funds or by the foundations shall be used for provision of food to students through any of the programs or initiatives approved by the Office of Child Nutrition, including the following programs: School Breakfast Program, National School Lunch Program, the Summer Food Service Program, the Fresh Fruit and Vegetable Program, the Child and Adult Care Food Program, the farm-to-school initiative and community gardens. Expenditures may also be made for initiatives developed with the Department of Human Services and public-private partnerships to provide outreach and nutritional meals when students are not in school.”
Troubles with federal spending authorization?
Although this bill to establish the Make West Virginia Healthy Act of 2026 has made its way through the legislative process, the West Virginia Department of Health, on Monday, expressed “serious concern” that the delay in legislative spending authorization for the $199.5 million in federal funding “puts critical rural health improvements, and future federal funding, at risk.”
In a press release issued on Monday via social media, West Virginia Department of Health Secretary Dr. Arvin Singh was quoted as saying:
“West Virginia worked extremely hard to secure this nearly $200 million federal award. Timely execution is now essential to protect it. The federal government approved a specific plan with defined milestones, timelines, and guardrails. We are obligated to execute that plan as approved. Delays may jeopardize meeting federal performance requirements, and unnecessary procedural hurdles increase the risk of lost time, lost momentum, and, potentially, lost opportunity for our rural communities.”
The release from the Department of Health also states the following:
“West Virginia has already been awarded nearly $200 million in federal funding for FY2026 to expand telehealth, strengthen rural workforce recruitment, modernize health technology, and improve chronic disease and behavioral health coordination. If West Virginia cannot fully authorize and deploy these funds in a timely manner, program implementation remains on pause and future federal funding may be jeopardized.
The award from the Centers for Medicare & Medicaid Services (CMS) was granted following federal approval of West Virginia’s detailed multi-pillar transformation application. Federal regulations require that federal grant funds must:
-Be spent within the approved application and scope of work
-Align with approved budget categories and cost principles
-Meet defined performance benchmarks and reporting requirements
Material changes to scope, budget categories, or program structure require prior approval from CMS under federal award modification standards. West Virginia cannot unilaterally redesign or materially alter the program outside the federally approved guardrails.
Implementation requires operational flexibility; exact expenditures may not always match projections line-for-line due to:
-Competitive Request for Proposal (RFP) and Assistance (RFA) pricing
-Workforce market conditions
-Vendor availability, and
-Timing adjustments within the federal performance year
Federal guidance anticipates such potential discrepancies, but unnecessary delays such as, layering additional state-level rigidity, or requiring parallel application amendment approvals and/or reporting beyond CMS requirements creates a dual-approval structure that compounds delay while federal performance-based timelines continue.
The CMS Rural Health Transformation Program framework is performance-based and time-bound.
Under federal requirements, delay, under-expenditure, or missed performance milestones may impact future funding that will impact the ability to increase rural health access and care.
Neighboring states are advancing similar rural modernization efforts in telehealth, workforce recruitment, and health technology infrastructure amidst a competitive vendor and workforce marketplace. In addition to potentially reducing the state’s ability to secure partners for rural West Virginians, delay means telehealth expansion launches later, workforce recruitment incentives are delayed, and rural providers wait longer for support.
DH remains committed to transparency, compliance with West Virginia law, and strict adherence to CMS grant requirements. DH respectfully urges timely legislative authorization consistent with the federally approved RHTP plan so that West Virginia can protect the nearly $200 million already awarded and begin implementation of the initiatives that will help transform the delivery of healthcare in West Virginia.”
