West Virginia Medicaid History and Facts

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Initial Medicaid Implementation: West Virginia initially began their Medicaid program in July of 1966 one of the first states to take up the program. When the program first began, the state did not offer a program for the medically indigent. The state had previously participated in the Kerr-Mills program prior to enacting Medicaid. The program was enacted in 1960 and beneficiaries were eligible based on having an income less than $1,500 per a year. The benefit covered hospital care for less than 12 days per a year and certain chronic conditions for which regular prescription drug coverage is required. Relatives had the legal responsibility to contribute to the health expenses of the beneficiary and if they are unable to cover the costs, the state would provide services.

Key Medicaid Political Issues: West Virginia’s Medicaid program has largely been focused on the rural population that makes up a large portion of the state. In recent years, West Virginia has been hit by the opioid epidemic and has one the highest rates of opioid related mortality in the country. The state has worked to increase the number of providers that can prescribe opioid treatment. An estimated 22,000 West Virginians have received opioid use disorder treatment under the Medicaid expansion. The state, due to its heavy mining industry, has a program through Medicaid that pays for services for people suffering from black lung, a disease that is contracted through frequent exposure to air particulates involved in mining. West Virginia has the second highest match rate in the country at nearly 75 percent. This is determined because the state has a high rate of poverty and low level of state resources.

Medicaid Expansion Implementation: West Virginia expanded Medicaid on October 1, 2013 with coverage beginning January 1, 2014. The state took advantage of certain flexibilities to allow eligible Medicaid beneficiaries to more easily enroll. The state used the SNAP enrollment records to find people who would be eligible for Medicaid based on their income. The state then sent letters to these individuals and allowed them to opt-in to automatic enrollment into Medicaid. 72,158 people enrolled through this process.  The state saw one of the largest drops in uninsurance rates in the country. The state has debated adding a work requirement to the Medicaid expansion population but the proposal failed in the legislature in 2018 and 2019. The state has seen a 40 percent reduction in uncompensated care costs since the Medicaid expansion went into effect. The decision to expand Medicaid was relatively uncontroversial in the state. West Virginia gives considerable power to the governor to change Medicaid policy without the legislature and in 2013, then-Governor Tomblin, a Democrat decided to expand Medicaid. The state elected not to run a state-based exchange.

General facts about West Virginia Medicaid:

Medicaid program name: Medicaid

CHIP Program name: CHIP

Separate or combined CHIP:  Separate

Medicaid Enrollment: 532,000 (December 2018 estimated)

Total Medicaid Spending: $4.0 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 26%

Share of Children covered by Medicaid: 50% (estimated)

Share of Medicaid that is Children and Adults: 74%

Share of Spending on Elderly and people with disabilities: 61%

Share of Nursing Facility Residents covered by Medicaid: 75% (estimated)

FMAP: 74.94%

Expansion state: Yes

Number of people in expansion: 181,000 (2017 estimated)

Work Requirement: No


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