West Virginia Still Weighing Health Exchange, Medicaid Options

Article

West Virginia Gov. Earl Ray Tomblin has yet to decide whether to open the Medicaid program to more lower-income residents, or how individuals and small businesses will seek coverage through the federal health care overhaul, administration officials told legislators this week.

Several lawmakers questioned whether the Legislature should instead take the lead after seeking updates from Nancy Atkins, head of the agency that oversees Medicaid, and Jeremiah Samples, who’s become in the in-house expert on the federal law for the state Insurance Commission.

Sen. Evan Jenkins, a Cabell County Democrat, noted that the 60-day legislative session begins Wednesday. Jenkins, executive director of the West Virginia State Medical Association, which represents physicians, asked whether the session might end in April without answers.

“I’m trying to figure out to what extent the Legislature can or should be proactive and engaged in the decision process, or should we just sit back and wait to hear from the administration,” Jenkins said.

Atkins said Tomblin, a Democrat, awaits results from an analysis of the possible costs and benefits from expanding Medicaid.

“I might remind you that actuarial study was requested by the Legislature,” said Aktins, commissioner of the Bureau of Medical Services.

The federal law calls for states to offer Medicaid to adults with unadjusted annual household incomes of up to 138 percent of the federal poverty level. That’s a far higher income level than West Virginia currently allows, and amounts to about $31,800 for a family of four. An estimated 130,000 West Virginians would gain coverage.

But while upholding the overhaul last year, the U.S. Supreme Court struck down its threat to withhold a state’s existing federal Medicaid dollars if a state refuses to expand its rolls. Around 415,000 West Virginians received health care services through Medicaid during the past budget year. West Virginia has the 12th-largest Medicaid program when measured as a percentage of a state’s population.

Samples, meanwhile, said he expects officials will work right up until the Friday deadline for a blueprint for its health care exchange. The overhaul requires each state to set up a marketplace within which individuals and small businesses can pool their buying power and seek coverage from private insurers. Samples’ office has estimated that 37,000 to 60,000 West Virginians would seek insurance through the exchange once it opens.

West Virginia has decided to partner with the federal government for its exchange, instead of running one on its own or leaving it entirely to the U.S. government to operate. While exchange details remain elusive, Samples told lawmakers that he could help resolve some confusion about the exchange concept. Samples said the exchange will not offer its own health coverage plan, process claims, set premiums or tell insurers how much they can pay providers. Insurance agents will continue to sell coverage plans, and negotiate with insurance companies for their commissions, Samples said.