Setting The Stage: The Consolidated Appropriations Act

Changes at the Federal level to Medicaid benefits have led to programs such as the proposed Medicaid Buy-In Program included in House Bill 3274, being implemented throughout the United States.

During the COVID-19 pandemic, benefits were expanded, and restrictions loosened to help immediate needs across the country. Now, federal lawmakers are reining in this spending through actions such as the Consolidated Appropriations Act.

The act passed in December 2022, ending the Medicaid continuous enrollment provision, effective March 31, 2023 with a “phase-down” in COVID-enhanced federal matching funds, through the end of the year.

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 before the COVID-19 pandemic, 515,000 individuals were enrolled in West Virginia Medicaid.

“Since the start of the pandemic, March of 2020, and not being able to disenroll anybody, our rolls just keep on increasing, so we’re now up to 690,000 individuals on West Virginia Medicaid, and we know a lot of these individuals no longer qualify for Medicaid for a variety of reasons, so, we will start that unwind,” Beane said. “As we unwind and people drop off our roles, we won’t need that money per se. So as far as us losing the money, we are losing the money that we’re also losing what the money was intended to pay for those individuals who will be starting to come off the rolls.”

In a budget presentation to the state Senate Finance Committee on Jan. 31, the DHHR reported that approximately 36 percent of West Virginians are enrolled in Medicaid.

The federal government provides each state with a Federal Medical Assistance Percentage (FMAP). The amount of which varies by state, based on the state’s per capita income. States with lower per capita income typically have a higher FMAP. However, each state’s FMAP cannot be less than 50 percent.

According to Beane, West Virginia’s FMAP is usually 75/25, or matching funds of three to one.

“What happened when the public health emergency came, every state was given an additional six percentage points in their FMAP. So, if you think about it, that took us up to 81 percent (in federal funding). What that equates to for West Virginia Medicaid is about $50 million extra dollars a quarter,” Beane said. “Why we were given that additional funding is because during the public health emergency, we were not allowed to disenroll anyone, meaning Medicaid, typically people come on and off Medicaid.”

Under the Consolidated Appropriations Act, the expiration of the continuous enrollment condition and receipt of the temporary Federal Medical Assistance Percentages (FMAP) increase is no longer linked to the end of the Public Health Emergency (PHE).

Public Health Emergency Federal Medical Assistance Percentages increase will be gradually reduced and phased down beginning April 1, and ending on December 31.