CHARLESTON, W.Va. (AP) — When Belinda Crookshanks' son and daughter-in-law died of drug overdoses on the same day in April 2015 at age 35, her grief was compounded by a stark financial fact: Despite the family's limited resources, the state's indigent burial fund wasn't going to help pay to bury them.
In another part of West Virginia that month, Carol Nay said goodbye to her 36-year-old son, another overdose victim. Nay couldn't afford the funeral, either, and she said the funeral home never mentioned the state indigent burial program. Its budget had been depleted a month before.
Dying comes at a huge cost for some West Virginia families, particularly in late winter and spring. In a trend some funeral directors blame on the opioid epidemic, for at least the fifth straight year, West Virginia's indigent burial program has run out of money months ahead of the end of the fiscal year, according to the state Department of Health and Human Resources, the fund's administrator.
The drug blight has ravaged the entire Appalachian region. West Virginia has the nation's highest drug overdose death rate by far, with 41.5 deaths per 100,000 people, compared with a national average of 16.3.
West Virginia's DHHR has paid for more than 10,000 indigent burials since 2011. The state allocated about $2 million for indigent burials this year.
"It used to be it would run out in May," said Charlie Mathena, of the Memorial Funeral Directory of Princeton. "Then it would run out in April. Then it would run out in March. And now at the end of February, we've exhausted all the funds. This is not an overnight issue."
The last time the fund covered an entire fiscal year was in 2004, when the Legislature provided supplemental funding, according to DHHR spokeswoman Allison Adler.
At least 17 states and the District of Columbia offer financial help for indigent burials, according to the Wisconsin-based National Funeral Directors Association. In other states, burial assistance is available at the county level.
Paying for indigent burials has challenged other states, too.
Illinois Gov. Bruce Rauner, a Republican, suspended his state's fund two years ago to help with a budget shortfall. Payments resumed this fiscal year through the end of December, but the future is in limbo.
In Indiana, a $1.6 million state appropriation for indigent burials "does not meet the current demands on the program," and an increase is sought for next fiscal year, said Jim Gavin, spokesman for the Indiana Family and Social Services Administration.
While it's unknown whether the need is based on a surge in drug overdoses, such deaths in Indiana have risen every year this century, hitting 1,245 in 2015, according to federal figures.
Besides West Virginia, Massachusetts, Pennsylvania, and Rhode Island offer burial funds and also rank in the top 10 nationally in overdose deaths.
Crookshanks said she holds no hard feelings toward West Virginia for running out of money that could have lessened the cost of funerals for Austin and Amanda Pulliam.
"The state right now is probably overwhelmed with what's being brought to them," Crookshanks said.
The Pulliams' teenage son found their bodies in their South Charleston home. Sweethearts since high school, they died of a mix of heroin and other drugs, Crookshanks said.
Their funeral bills came to more than $20,000, including more than $4,000 for the grave marker alone. To pay for it, Crookshanks said the families scrambled for donations from her hospital co-workers along with her daughter-in-law's side of the family.
"For people that didn't have the means that we had, I can't imagine what they go through," Crookshanks said. "Because the funeral homes make it very clear to you. They look right at you and they go, 'Well, this has to be paid for before you have the service.' They don't do anything until you pay for it."
It cost Nay $10,000 for Jeremy Nay's funeral. She agreed to a payment plan with the funeral home. She hasn't been making regular payments lately because of a career change but plans to resume payments as soon as she can.
Nay never considered having her son cremated.
"I knew that I was already dealing with so much pain that that would cause more," she said.
Mathena said funeral directors want to be compassionate and show respect. But "at the same time, we've got to keep the lights on and gas in the car," he said. "There's only so much flexibility you can do."
Mathena and Curtis McKinney, a director at the Fanning Funeral Home in Welch, estimate that indigent burials account for up to 20 percent of the funerals they handle.
West Virginia's indigent burial fund pays up to $1,250 for funerals, leaving families responsible for the rest of the bill, which can be as low as $1,200 if it involves a cremation.
Last year, failed legislation would have reduced the state's indigent burial burden from $1,250 to $1,000 and limited the DHHR's obligation to pay for 2,000 indigent funeral services in any fiscal year.
More than 1,500 such requests have been made this fiscal year, Adler said. Requests peaked at 2,475 in 2012-13.
"The whole situation is at epidemic proportions," Mathena said. "I don't know what the answer is. I know if we don't get a handle on it, it sure is going to take a lot of people away from us."