Medicaid

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In 2013, Governor Tomblin chose to expand the state’s Medicaid program, providing healthcare coverage for 150,000 more West Virginians. Up until this point, Medicaid expansion has had no impact on the state’s budget.

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If you are a healthcare provider in West Virginia today – a dentist, doctor, counselor, therapist – and a Medicaid patient comes into your office for treatment, you might not get paid for seeing them. Or the payment will be delayed for…well you don’t actually know how long the payment will be delayed.

This is all due to the state budget crisis.

On West Virginia Morning, statehouse reporter Ashton Marra brings us the latest from the special session of the legislature and health reporter Kara Lofton talks with two medical providers who have been warned by the state that Medicaid reimbursements could be delayed by the on going budget talks at the Capital. 

These stories on West Virginia Morning from West Virginia Public Broadcasting – telling West Virginia’s story.

West Virginia Department of Health and Human Resources

More than 24,000 doctors across West Virginia who accept Medicaid were put on alert Monday that the state may not be able to "continue to process claims at the same consistent level."  

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A report released today from Families USA found that West Virginia has one of the most successful Medicaid expansion programs in the country.

The report used U.S. Census data to compare the rate of uninsured workers in all 50 states during 2014, the first year Medicaid expansion was offered. It found that West Virginia had reduced uninsured worker rates by 30 percent – 5 points higher than the expanded Medicaid state average. Non-expansion states reduced their uninsured worker rates by 13 percent on average.

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A state official says a court order regarding Medicaid managed care contracts will cost West Virginia millions of dollars.

Bureau for Medical Services acting commissioner Cindy Beane says the order also could affect delivery of services to some Medicaid recipients.

Ashton Marra / West Virginia Public Broadcasting

West Virginia has been plagued for the past few years with budget deficits. To deal with the shortfalls, the governor has cut state agency budgets across the board, implemented hiring freezes and dipped into the state’s Rainy Day Fund.

This year, Gov. Earl Ray Tomblin cut the House and Senate approved budget by an additional $11 million, leaving some service programs to wonder how they’ll keep their doors open. The Charleston Health Right is just one of those service programs.

The West Virginia Health Right clinic located in Charleston's East End is a free and charitable clinic that provides medical, dental and vision services to more than 15,000 uninsured and underinsured West Virginians each year. 

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A public-private partnership to identify and provide help for at-risk Medicaid patients was announced Wednesday.

The state has teamed up with the nonprofit company Partners in Health Network. Cabinet Secretary Karen Bowling, with the Department of Health and Human Resources, explained the program. She said the first step is to identify Medicaid patients who visit emergency rooms often.

For instance, community organizers in Mingo County and other parts of southern West Virginia fought to clean up their local governments. In the process, they drew the wrath of powerful politicians.
e-wv, The West Virginia Encyclopedia online. / WV Humanities Council

West Virginia University

West Virginia University is getting a nearly $2 million grant to help improve health care statewide.

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The pill is called Sovaldi and it’s profoundly changing outcomes for Hepatitis C patients.

Just 5 years ago the cure rate for most patients in the US was about 50%. Now with Sovaldi, made by Gilead Sciences Inc. of California and approved by the FDA last December, the latest Hep C regimen is making therapy shorter, more tolerable, and the cure rate is reaching 95-100 %.

That’s significant for West Virginia, which has the second highest prevalence of Hepatitis C in the country.

  West Virginia officials are launching an initiative to help Medicaid members with behavioral health diagnoses live healthier and happier lives.

The West Virginia Department of Health and Human Resources Bureau for Medical Services said it launched the Health Homes initiative for behavioral health on July 1.

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West Virginia has increased the amount it spends to allow the disabled to live outside institutions in the years since a landmark Supreme Court ruling.

The 1999 decision said unnecessarily segregating people in mental hospitals, nursing homes and other institutions amounts to discrimination.

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  West Virginia has increased the amount it spends to allow the disabled to live outside institutions in the years since a landmark Supreme Court ruling.

The 1999 decision said unnecessarily segregating people in mental hospitals, nursing homes and other institutions amounts to discrimination. Advocates for the mentally ill, older people and the disabled cite the ruling in arguing for home- or community-based care. The ruling has limitations. It says individuals should be "reasonably accommodated" and offers no guidance on allotting funds.

Capitol
Kristi George / West Virginia Public Broadcasting

  Legislative auditors say West Virginia is at risk of losing millions of dollars in federal Medicaid funding because state hasn't complied with a 2011 directive. The directive requires states to suspend Medicaid payments to health care providers if fraud allegations are determined to be credible. A legislative audit says Medicaid has paid at least $17.9 million to providers whose cases were referred to the state's Medicaid Fraud Unit. The payments could be as a high as $211 million.

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  The number of West Virginians getting health insurance through two programs has increased more than in almost any other state since Medicaid was expanded under the Affordable Care Act.

That's according to federal data released this week on those enrolled in Medicaid and the Children's Health Insurance Program as of April 30.

The Charleston Gazette reports that nearly 154,000 West Virginians had enrolled in one of the programs since open enrollment began.

U.S. Attorney Booth Goodwin
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  A Massachusetts clinical testing lab will pay the federal government more than $4 million to settle a health care fraud case in West Virginia.

U.S. Attorney Booth Goodwin announced the $4.67 million settlement with Calloway Laboratories, Inc. on Wednesday.

Goodwin says in a news release that an investigation found that Calloway Laboratories performed a medical review with urine drug screens that isn't covered by Medicare or West Virginia's Medicaid program. The company submitted claims for the review using a code for pathology services, which are covered.

West Virginia Morning
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We take you through the process of signing up for health care coverage through the Affordable Care Act and Medicaid before Monday's deadline. We conclude our series on the Story of the Jews in West Virginia about the Ahavath Shalom congregation in Bluefield. Holly Williams performs "Drinkin'" on this Mountain Stage song of the week.

Ashton Marra / West Virginia Public Broadcasting

The House and Senate have come to an agreement on the state's budget for the next fiscal year. The process was stalled earlier in the week.

Negotiations between legislative leadership and the governor centered on two issues: how much money to pull from the state Attorney General's Consumer Protection Fund and how much money they could use to expand the Aged and Disabled Waiver Program for seniors.

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Senate Bill 534 was introduced in the Senate Tuesday to increase the excise tax on cigarettes and other tobacco products.

The proposal would mean a $1 increase in taxes on a pack of cigarettes to $1.55 total. On all other tobacco products, the tax increases from 7 percent of the wholesale price to 50 percent.

“From a polling standpoint, people say they don’t have a problem with increasing cigarette taxes,” said Senator Bob Plymale, the bill’s lead sponsor.

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