The West Virginia Department of Health and Human Resources is a cabinet-level department of state government, responsible for the state's health and welfare programs and many social services. Upon its creation in 1989, the DHHR absorbed existing agencies with health and welfare functions, particularly the Department of Health and the Department of Human Services. These agencies date their origins through various predecessors to West Virginia's early days as a state.

The foundation for the Bureau of Children and Families, which now administers public assistance programs for the DHHR, was laid in 1863. That year, the first West Virginia legislature enacted a law giving counties the responsibility for poor relief and the operation of alms houses or poor farms. The Mother's Pension Law, authorizing counties to pay monthly pensions to mothers who had no property or resources and whose morals were above suspicion, was enacted in 1915. The Board of Children's Guardians, established in 1919, was replaced in 1931 by the Department of Public Assistance.

In 1936, the legislature authorized creation of county departments of public assistance within the Department of Public Assistance to administer at the local level all existing public welfare programs including those eligible for federal funding. The Department of Public Assistance later became the Department of Welfare. West Virginia piloted the U.S. Department of Agriculture's Food Stamp program in 1961 and was the first state to issue food stamps.

The health functions of the DHHR date back almost as far as its public assistance role. In 1881, the West Virginia Board of Health was established to regulate and license the practice of medicine and surgery; to conduct sanitary investigations; to maintain quarantine centers; and to establish county health boards with the consent of local governments. The Board of Health was abolished in 1915 and replaced by the Department of Health. In 1945, the Health Department assumed advisory medical supervision of state hospitals.

Major organizational restructuring took place in 1949, when the department shifted its emphasis from communicable diseases to chronic illnesses and other public health issues. The legislature created the Department of Mental Health in 1957. During the 1977 legislative session, a consolidated Department of Health was created, combining the old Department of Health, the Department of Mental Health, Commission on Mental Retardation, public institutions, and smaller boards and commissions.

The largest and most recent change came during the 1989—90 reorganization of state government, when the Department of Health and Department of Human Services merged to form the Department of Health and Human Resources. Also brought under the DHHR umbrella were the Human Rights Commission, the Women's Commission, and the Commission on the Hearing Impaired.

The DHHR is among the very largest agencies of state government. It has approximately 5,800 employees in five bureaus:

The Bureau for Public Health works with local health departments. The bureau administers programs that range in scope from regulating hospitals and nursing homes to working to reduce tobacco use.

The Bureau for Children and Families administers most of DHHR's major public assistance programs such as food stamps and Temporary Assistance for Needy Families, as well as Child Protective Services and Adult Protective Services. The "welfare agency" direction of the bureau changed in 1996 with the enactment of federal welfare reform during President Clinton's administration. These watershed reforms reduced welfare assistance by limiting the years of eligibility and encouraging welfare recipients to return to work.

The Bureau for Behavioral Health and Health Facilities runs state health facilities and regulates private providers of behavioral health services.

The Bureau for Child Support Enforcement establishes paternity, child support, and medical support and enforces support orders, including spousal support.

The Bureau for Medical Services is the state Medicaid office. Medicaid, a federal program of the Social Security Administration, pays for health care for women, children, and adults below a certain income level. At the beginning of the 21st century, Medicaid paid for more than half the births in West Virginia.

In addition to the five bureaus, the Office of Inspector General polices legal and ethical issues at the DHHR, provides an impartial hearing process to clients who feel they have been unfairly treated, and monitors the receipt and use of federal funds.