June Leffler Published

Report: A Third Of West Virginians Use Medicaid

Illustration of hands giving money to the world.

West Virginia has a much higher rate of Medicaid enrollment than most states. That’s due to high numbers of low-income households, Medicaid expansion, and now the COVID-19 pandemic.

The West Virginia Center on Budget and Policy released a report on just how many people use Medicaid in the state, and what budget issues the program may face down the road.

June Leffler spoke with health policy analyst Rhonda Rogombe in the studio.

Leffler: So Rhonda, tell me how pervasive is Medicaid in the state.

Rogombe: Medicaid provides health insurance to 584,000 West Virginians, which is about a third of our state. So Medicaid is a really, really important program across the state in terms of just providing health care and giving people access to essential services,

Leffler: How many federal dollars does this program bring into the state, and how is that funding impacting our economy?

Rogombe: So the federal government provides about 70% of Medicaid dollars, which is about a five to one ratio. So for every $1 West Virginia invests in Medicaid, the federal government will provide five. As a result of the COVID-19 pandemic, that amount has increased to about 5.7 dollars per one state dollar. So overall, the state in fiscal year 2022 will receive about 4.2 billion federal dollars.

Medicaid dollars don’t just stay within Medicaid, they support the healthcare workers, and other industries that ultimately help support the healthcare system. So in West Virginia, Medicaid supports about 25,000 jobs. That equates to about $5.7 billion in economic activity, which is about 3% of GDP across the state.

Leffler: And you mentioned the pandemic, could you just give me a sense of how that has impacted this program and people seeking out Medicaid coverage.

Rogombe: So the pandemic has been really pervasive for health outcomes across the United States and across the world, of course. And so one way that the federal government has responded is by increasing dollars to Medicaid and other social services, to help mitigate the hardships associated with not only this health crisis, but the economic crisis that has come alongside that. Medicaid is an incredibly responsive program in the sense that as the economy worsens more people become eligible for the program. And so that has increased the number of people since January 2020 who are enrolled in Medicaid. And at the same time, as the federal government has provided states with more money for Medicaid, they have also tied certain requirements to those dollars, one of which requires that states don’t kick people off of Medicaid throughout the public health emergency. And so the combination of that mandate and increased economic hardship has led to the program growing over the course of the pandemic.

Leffler: Rhonda, can you just talk a little bit more about the future of this program? The state has a surplus of money, but your report says that Medicaid might have some financial shortfalls in the near future.

Rogombe: I think that the state isn’t fully accounting for the needs that the Medicaid program is facing. The dollars within the Medicaid program often find themselves supporting other services, which limits the ability of the program to fully serve its constituents. And so if you look at the budget outlook that is in the report, you’ll see that over time, the state must provide more and more funds to overcome this shortfall that is in the program. According to that, Medicaid insolvency would be around fiscal year 2025. But because of the additional COVID funds that the federal government has provided, that’s been pushed to fiscal year 2026. And that basically is a result of flat budget projections (despite increased poverty over the past several years), tax cuts, and other policy changes that are not responsive to the needs of Medicaid constituents across the state.

And so those factors really drive some of the problem with Medicaid in the state. But we also provided some solutions, not all of them are necessarily fiscal, but will ultimately help improve outcomes.

Leffler: Is this shortfall your own projection or a projection from the Department of Health and Human Resources?

Rogombe: These figures came from a DHHR presentation. So they are also well aware of the challenges that are facing the program and work really hard to make the program as accessible as possible. But there are some ways that we found through our own research in talking to Medicaid constituents that could help further address some of those problems.

Leffler: What do those solutions look like?

Rogombe: So the first thing that we talked about was data transparency, just being able to fully assess the problems in Medicaid and knowing how different demographics are impacted by different pressures within the program can help offer more tailored and more nuanced solutions that could better serve West Virginians, in particular West Virginians of color and other demographics that we don’t really get to see just from top line figures. Another thing that we talked about, and one that DHHR also supports, is increased staffing and increasing the wages of staffers to reduce turnover. And so with that solution would help increase user experience and also reducing the turnover would reduce training costs, and just help make the program more efficient in that way. We also talked about some administrative streamlining things like just a few solutions that will automate some processes and make the work of the caseworkers a little bit less. So ex parte renewals, just using existing database numbers to renew someone automatically without them or a caseworker having to go in and doing those things manually.

And then the last one was just related to increasing the available funds for Medicaid, increasing the budget to be responsive to the actual needs of constituents and the actual needs of the program, rather than just having a flat budget projection.

Leffler: Are you saying that this flat funding will not be sustainable because more and more people are going to enter Medicaid or more people are not going to be able to get off of Medicaid. I guess people are thinking that the past year has been really hard. Are you seeing that, while the past year has been hard, it’s really not gonna get easier?

Rogombe: Well, I think that the pandemic has shown us a lot about Medicaid and about our health care system. And while the public health emergency will eventually end and we will see some decreases in the Medicaid program in response to that, just given the lagging economic recovery, it may not go back to the figures that we saw before the pandemic.

I think that moving forward, we can be more proactive about our health outcomes. And be more proactive about our budget in ways that are actually responsive to the needs of the people here and not just projections that were created years ago and then just remain that way because of budgetary pressures, rather than what is actually going on in the state.