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Medicaid Deficit Looms

West Virginia Medicaid is facing a budget deficit in 2024.

West Virginia Medicaid, which covers more than a third of all West Virginians, is facing a budget deficit in 2024.

Cindy Beane, the state’s commissioner for the Bureau of Medical Services, presented an update on the Medicaid program during a Joint Committee Meeting on Government and Finance on Tuesday. She told lawmakers the health coverage program for approximately 36 percent of West Virginia residents is facing a budget deficit of $114 million.

Gov. Jim Justice commented on the potential budget deficit during his regular weekly briefing.

“But the net of the whole thing in regard to Medicaid is we have, we have a backup and a way to cure this problem,” Justice said. “And really, and truly to cure it with with being able to go to the feds and have them send significantly more dollars than they’re doing today by just moving a fee situation around which we can absolutely do.”

To fix the deficit, Beane suggested raising the tax Medicaid charges managed care organizations to a maximum of 6 percent.

“But I would tell you, if it ain’t broke, don’t fix it,” Justice said. “You know, and right now, what we’re doing is working and we want to just keep it going, we’ll keep watching.”

Medicaid accounts for the largest portion of the Department of Health and Human Resources’s budget, according to Beane. State and federal government funds contribute to the program.

According to Beane’s presentation, in the current fiscal year (FY24), the state government paid more than $1 billion in expenditures for Medicaid and the federal government paid more than $4 billion.

Fiscal year 2025 begins in July of 2024 and the agency is projecting the Medicaid program to cost the state and federal government more than $5.2 billion.

During the COVID-19 Public Health Emergency, the federal government provided resources for expanded Medicaid and assistance programs.

This allowed Medicaid to not remove people from the program during the pandemic, causing enrollment numbers to grow from 504,760 people in March 2020, to 667,471 at its highest during COVID-19, Beane said.

“The federal government opened up the Medicaid rolls to many more people but in doing that they provided a supplement payment,” Brian Abraham, Justice’s chief of staff said. “Well, that supplement is starting to come due.”

Beginning in April, the state started the “unwinding” process of removing people from the program who no longer qualified and those who did not fill out paperwork to renew their coverage.

According to Beane, eight months into the process the state’s Medicaid program is down to an enrollment of 539,250.

Abraham said past administrations took money from rainy-day funds and other similar sources to fill any Medicaid fund deficit opting for federal reimbursement.

“We came up with a strategic plan,” Abraham said. “We have medical care organizations that provide services to DHHR. For these Medicaid services, there’s a fee that they get, and it’s on top of what they normally pay, we have the ability to raise that fee on their behalf, we pay them that money, and then we ask the federal government for reimbursement of which for every dollar we spend of that fee, we get back approximately 75 cents. So we think that has the opportunity to nearly or if not completely close that deficit.”

Abraham said the Justice administration’s managing of their affairs is what has allowed for a continuous flat budget with a surplus.

“We also have the ability to make other strategic decisions which will influence the budget, I will say this back to the budget generally, by what Gov. Justice has done throughout his time as governor, and that is being disciplined and keeping a relatively flat budget, we can manage these kinds of situations,” Abraham said.

Child Care Centers To Receive Final Pandemic-Era Payment

A final pandemic era payment will be issued to child care centers across the state, according to Gov. Jim Justice.

Starting Sept. 30, states will lose access to federal pandemic-related stabilization money aimed at bolstering child care services in the U.S. but Gov. Jim Justice said Friday that there is enough leftover pandemic-related stabilization money to distribute a final payment for October.

In 2021, $40 billion in funding went to child care centers across the nation from the American Rescue Plan Act.

With this funding set to expire, a bill in Congress to extend child care funding has gone nowhere.

According to the Administration for Children and Families, in West Virginia, 645 child care centers and 925 child care family homes received stabilization payments totaling more than $160 million.

The child care centers used the funds to pay for personnel costs and keep programs staffed. In some cases, child care centers used the funds to keep prices lower for parents struggling to pay for child care that now costs an average of $15,000 a year for one child, according to a Care.com study.

Child care family homes used the money to pay for personal protective equipment (PPE) to ensure safe environments for children and staff.

“It will be slightly lower than the normal monthly payment,” Justice said. “However, again, you got to realize this is just an extra payment that nobody really expected.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Officials Advise Caution Against Fall Respiratory Illness

A new vaccine to protect against the many strains of COVID-19 will be available at the end of September.

Dr. Clay Marsh, the state’s coronavirus czar, stressed that threats from the coronavirus haven’t gone away during Gov. Jim Justice’s regular briefing.

“Many people are asking, why would I need to consider this updated shot and the reason why is because this shot is directed against the newest and latest most common forms of COVID-19 that are circulating,” Marsh said.

The West Virginia Department of Health and Human Resources reported three additional deaths attributed to COVID-19 since last week’s update for a total of 8,183.

Marsh said the new vaccine is highly effective at protecting against the most common forms of the virus, belonging to the Omicron family.

While COVID-19 is still a threat, Marsh also cautioned against other forms of respiratory illness that become prolific in the fall. A new preventative medication against Respiratory Syncytial Virus Infection (RSV) will be available and Marsh recommends those 8 months and younger receive the preventative medication.

For adults more than 60 years old, Marsh recommends the new RSV vaccine to avoid the illness.

“That RSV shot is truly a vaccine and we recommend that anyone over 60 or any child eight months and under be given those respective shots with the winter upcoming,” Marsh said.

According to Marsh, the benefit of the vaccines that have been given is limited to about four to six months and recommended those in high-risk groups check the state’s vaccine calculator to check if they are up to date on their shots.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Arriving At The New Normal

As the world steps into the actuality of the “new normal,” how do the end of these designations affect West Virginians?

The End Of The COVID-19 Public Health Emergency Brings Changes To Benefits

Thursday, May 11, the U.S. officially canceled the designation of COVID-19 as a public health emergency in the country.

Also this week, the World Health Organization (WHO) removed its designation for COVID-19 as a “global health emergency.”

For the first time in more than three years, the general public and health providers will live in a post-COVID-19 world, at least on paper.

As the world steps into the actuality of the “new normal,” how do the end of these designations affect West Virginians?

The Virus

While COVID-19 is no longer a health emergency, it is still an infectious illness that is a significant cause of acute illness and can cause long-term health complications all over the body known as long COVID. In special populations, COVID-19 is still life-threatening.

According to Clay Marsh, West Virginia’s COVID-19 czar, current research shows that staying current with recommended vaccination reduces the risk of long COVID, as does taking the oral anti-viral paxlovid or the drug metformin, if one tests positive for COVID-19.

“We have learned a lot about COVID-19, and to further ensure our health, we need to continue to practice what we learn,” Marsh said. “COVID-19 will remain an infectious disease that will cause illness, hospitalization and death, but by staying smart and following the guidance of our healthcare providers, we can keep each other safe and stop more preventive deaths from COVID-19.”

The Food and Drug Administration and the Centers for Disease Control (CDC) have recommended another booster for those over 65 years old and are four months or more from the last Omicron COVID-19 shot. Those who are immunocompromised will benefit from another shot as soon as two months after the last, according to the CDC.

The West Virginia Department of Health and Human Resources (DHHR) recommends West Virginians check the state’s vaccine calculator to see if they are due for a booster shot.

In West Virginia, 8,125 deaths have been attributed to COVID-19, as of May 10, 2023.

Pandemic-Era Healthcare Benefits

During the Public Health Emergency, Medicaid and the Children’s Health Insurance Program (WVCHIP) suspended eligibility redetermination processes, allowing coverage to continue regardless of changes in circumstances.

However, Medicaid and WVCHIP continuous eligibility provision was separated from the Public Health declaration in December 2022. This signaled the beginning of the unrolling of beneficiaries from these programs.

“For the past three years, the Medicaid program has been growing,” said Rhonda Rogombe, health and safety net policy analyist for the West Virginia Center on Budget and Policy. “One because people were not losing coverage. And two, the pandemic triggered an economic downturn that like made a lot more people eligible for the program.”

When the upcoming unrolling of benefits was announced, advocates worried beneficiaries would lose their coverage because they may have moved over the pandemic.

“Most of the denials that we’re seeing on the national level, are for procedural reasons, which means that somebody didn’t determine their paperwork or fill it out correctly,” Rogombe said. “We don’t have specific state numbers yet. We still see them by the end of the month. But West Virginia follows natural trends when most people who are losing coverage are losing it because they didn’t complete and return that paperwork on time.”

Jaqueline Hale is the Virginia State Network Director at Unite Us. Unite Us West Virginia is a network of health and social service providers. The network is supported by an West Virginia-based Unite Us team focused on community engagement, network health and optimization and customer success. Hale also covers portions of southern West Virginia.

“The fact that people haven’t had to do this for three years, so one, that could be out of practice,” Hale said. “I know, I’m always struggling to find, you know, where’s the shot record? Where’s that last pay stub? Right? How do I download it from wherever if you even have that capacity to have access to an online payroll. So it’s just a heavy administrative burden and recognizing that a lot of our families, a lot of our individuals are dealing with multiple complex issues.”

Those who may have lost their benefits or health insurance coverage during the unrolling process can submit the required renewal forms for coverage redetermination through West Virginia People’s Access To Help (WVPATH).

For those who no longer qualify, West Virginia Navigator is a free, non-profit program that offers enrollment assistance for the Health Insurance Marketplace and is available to any West Virginia resident.

SNAP and Food Banks

According to advocates for food security, charitable programs are unable to support those facing hunger fully. A combination of charity and government assistance programs are necessary to help bridge the meal gap, especially in a post-COVID economy with record-breaking inflation rates.

Cyndi Kirkhart is the CEO of Facing Hunger Food Bank, based in Huntington. It is one of only two food banks in West Virginia. The other is Mountaineer Food Bank, based in Gassaway.

Food insecurity will only increase along with inflation costs. Kirkhart said she budgeted $2.5 million to purchase food for the Facing Hunger Food Bank in 2022. The bank actually expended $4 million to feed its community.

Along with other changes to beneficiary requirements, on July 1, the work requirements for the Supplemental Nutrition Assistance Program (SNAP) for “able bodied adults without dependents” resumes, statewide.

Since April 2020, the West Virginia Department of Health and Human Resources has issued SNAP emergency allotments, increasing each household’s monthly benefit.

Now, those monthly SNAP benefits have returned to the pre-COVID-19 Public Health Emergency level based on the household’s income, assets, household size, and other non-financial factors. About 170,000 households have been affected.

SNAP is a program of the U.S. Department of Agriculture administered by DHHR’s Bureau for Family Assistance.

The “able-bodied adults without dependents” work requirement reinstatement will impact SNAP recipients ages 18 to 49 without children or other qualifying dependents, and who lack an identified condition that would prevent them from participating in a qualifying work, volunteer, or education activity.

“The stigma associated with the word ‘able bodied’ insinuates that they are unable to ascertain work and that’s not entirely the case,” Devon Lopez, associate director of customer and community success at Unite Us West Virginia, said. “However, our platform really is designed to empower organizations to help connect individuals in need for services. And so really taking the stigma associated with what asking for help might look like for individuals in the community, and really empowering organizations to help be the advocate for them and connect them to those resources.”

According to the DHHR, all potentially affected individuals will receive a letter in mid-May with more information.

“We know that someone’s overall health is adversely affected by their ability to be able to access food and proper nutrition,” Lopez said. “So in the past three years, they’ve been able to access, you know, these benefits that have been providing them with food boxes and meals. However, as they no longer qualify on this public health emergency ends, and they’re, they’ll have to re enroll for these or just not qualify for them at all anymore, we’re going to see a severe increase in those with those food needs.”

Kirkhart said work requirements are more complicated for those living in rural areas.

“You know, obviously folks focus on some of the expectations that there’s work associated with getting benefits and those type of things,” Kirkhart said. “The narrative never changes about that, because we serve very rural and remote communities where there is no public transportation. There are few if any jobs are volunteer opportunities to complete hours.”

Kirkhart also said her food bank and its mobile units are already seeing an increase in need in the community from the beginning of this year’s unrolling of beneficiaries. She expects to see more families in need after their stores of food run out.

“We’re kind of seeing the increases that I kind of expected would occur,” Kirkhart said. “So right now we’re about 25 percent (of spent funding), over the previous like 23 percent. Our mobile pantries in this last month have really started to grow. So I expect statistically, after review of this month, we’ll probably see more than 35 percent because sometimes people had food resources, and you know, they had kind of stocked up in anticipation.”

PEIA Legislation And COVID-19 Emergency Food Support Ending, This West Virginia Morning

On this West Virginia Morning, some struggling families may now have less government support for food, as COVID-19 pandemic-era emergency allotments come to a close. Appalachia Health News Reporter Emily Rice has more.

On this West Virginia Morning, some struggling families may now have less government support for food, as COVID-19 pandemic-era emergency allotments come to a close. Appalachia Health News Reporter Emily Rice has more.

Also, in this show, the state Senate over the weekend passed a bill making changes to the Public Employees Insurance Agency (PEIA). Health costs everywhere keep increasing, but the state program hasn’t kept up, causing some hospitals to declare that they would no longer accept the program.

In our latest episode of The Legislature Today, Chris Schulz spoke with Fred Albert, president of AFT-WV, and Del. Matthew Rohrbach, R-Cabell, the deputy speaker of the House, to understand the bill.

West Virginia Morning is a production of West Virginia Public Broadcasting which is solely responsible for its content.

Support for our news bureaus comes from West Virginia University, Concord University, and Shepherd University.

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