Emily Rice Published

Lawmakers Consider Affordable Medicaid Buy-in Program

After federal and state level changes to Medicaid, many Americans will be left without health insurance coverage by the end of the year.

To remedy the financial strain on West Virginia families, lawmakers are considering a bill to create a high-quality, low-cost health insurance plan for low income residents to pay a low monthly premium based on a sliding scale.

House Bill 3274 would create the Affordable Medicaid Buy-in Program to help alleviate financial strain on recipients of Medicaid who start a job that disqualifies them from receiving their benefits.

The House Health and Human Resources Committee recommended passage of a strike and insert amendment to the bill on Feb. 16, 2023.

Medicaid buy-in programs soften the “cliff effect” for recipients who lose their coverage when starting a new job that pays too much for Medicaid eligibility, until they can earn enough to afford other health insurance plans.

According to the U.S. Department of Health and Human Services, a one person household that earns $14,580 or less annually is considered to be in poverty. A three person household is considered in poverty if they earn $24,860 or less annually.

Families who have been bumped off of their Medicaid coverage and earn less than 200 percent of the federal poverty level would be eligible for the buy-in program.

Cindy Beane is the commissioner of the Bureau for Medical Services, part of the West Virginia Department of Health and Human Resources (DHHR). She said individuals lose their Medicaid coverage when they earn 138 percent of the federal poverty level. 

According to 2023 data from the U.S. Department of Health and Human Services, an individual would lose their Medicaid benefits in West Virginia when they earn more than $20,120 annually. The Affordable Medicaid Buy-in Program would allow that threshold to rise to 200 percent, or $29,160 annually.

“What we find is, there’s individuals that will, because health premiums and everything else is higher on the marketplace, they’ll try to keep their income below to keep their insurance,” Beane said. “And that’s not what we want, we want people to have good jobs, be proud of their jobs and have a career and you don’t want health care being the barrier to that.”

According to the West Virginia Center on Budget and Policy, transitions in and out of Medicaid eligibility based on small income changes can be disruptive to affected workers and families, creating challenges to accessing providers, obtaining needed medications, and seeking care.

“It would kind of get us on the road to basically what I would like to call it, it’s like the Medicaid Cliff Bill,” Beane said. “There’s individuals that are working, and they’re working hard. And they really want to better their situation.”

Often, the cliff effect leaves the worker with no choice but to turn down promotions, raises, or even resign from their job in order to keep their benefits. Some will leave the workforce because losing their state benefits will impact their finances far more than what they’re being paid for their labor.

West Virginia is one of 44 states that already operates a program similar to a Medicaid buy-in, but for adults with disabilities. The Medicaid Work Incentive Network (MWIN) allows enrollees who work to pay a small monthly premium to keep Medicaid coverage when they no longer qualify for Medicaid. 

These programs eliminate barriers to employment by allowing the worker to buy-in to their current health benefits when starting a new job. The Medicaid buy-in program would be structured differently than the MWIN, but it shows the success of these work incentive programs.

House Bill 3274, creating the Affordable Medicaid Buy-in Program, is being reviewed by the House Health and Human Resources Committee.