Medicaid Expansion Story Archives - West Virginia Public Broadcasting

Free Two-Day Clinic Coming To Charleston

A non-profit provider of pop-up clinics will deliver free dental, vision and medical care to those in need in Charleston.

Remote Area Medical (RAM) collaborated with West Virginia Health Right to set up a free, two-day clinic Oct. 21 and 22.

RAM works on a Community Host Group model, meaning, a local group reaches out to their organization for a visit, but must provide support to the non-profit during the duration of their stay.

Angela Settle is the CEO of West Virginia Health Right, based in Charleston, West Virginia.

“West Virginia Health Right serves the underserved, and it is a free and charitable clinic every day, 365 days a year,” Settle said. “But this is basically doing that on steroids over two days. And we have to get all the volunteers, raise all the money to support it, you know, to pay for the rooms for their staff to feed all the volunteers, you know, things like security and porta potties and all that kind of stuff we are responsible for doing as a community host partner.”

This is not the first time West Virginia Health Right has teamed up with RAM to provide health care to those in need. The first clinic was set up in Elkins after the 2016 flood.

“The next year, it moved to the Bible Center School, just because it’s a nice, you know, bigger location and kind of more central to southern West Virginia. And we stayed there and had one every year, I can’t tell you how many we had,” Settle said. “I’d say probably seven or eight.”

According to RAM clinic coordinator Brad Hutchins, their model works well in West Virginia because it meets patients where they are, literally and figuratively. All services are free and no ID is required.

“Because honestly, it doesn’t matter, at least not to, not to us,” Hutchins said. “If a patient comes in and they have a need, if we have the capacity to serve them, that’s what we’re there to do. That’s what the volunteers sign up for. So ultimately we just come and dedicate that amount of time to see as many patients as that time allows.”

Due to time constraints, patients of the RAM clinic should be prepared to choose between dental and vision services.

“You know, so, RAM we see that, you know, we’re not the solution, of course, but we are a resource that’s able to bridge the gaps and bring needed vision, medical or dental services, to these, to these areas that are underserved,” Hutchins said.

Services available at the free RAM clinic include dental cleanings, fillings, extractions and X-rays. Services also include eye exams, eyeglass prescriptions, eyeglasses made on-site, women’s health exams and general medical exams.

Starting January 1, 2014, West Virginia expanded Medicaid under the Affordable Care Act. Under the expanded eligibility guidelines, adults aged 19 to 64 are eligible for Medicaid with a household income up to 138 percent of the poverty level.

For a single adult in 2023, that amounts to $20,120 in total annual income.

Settle praised West Virginia’s expansion of Medicaid but said there are still a lot of people out there in need who cannot qualify.

“We know that expanding Medicaid was wonderful, that helped, but there’s still a lot of people out there in need,” Settle said. “Because, you know, there’s a lot of working poor, and I mean that lovingly – people that work every day, but maybe make too much for Medicaid, but they don’t qualify, or the benefits that they qualify for are too pricey.”

Medicaid enrollment in West Virginia is up 80 percent since 2013 but is expected to continue to decline as disenrollments continue after a three-year pause for the COVID-19 pandemic.

During the COVID-19 pandemic, benefits were expanded, and restrictions loosened to help immediate needs across the country. Now, those benefits have run out.

“People are deciding between health care, and the basic necessities like food, utilities, et cetera,” Settle said. “So we want to be instrumental in removing that. We want to make sure that people have access to health care.”

An integral part of continuing health care is follow-up appointments. Hutchins says West Virginia Health Right will help with care plans.

“And she provides her organization a lot of support, not only throughout the planning, and execution, but also they have a big hand in the follow up care process as well,” Hutchins said. “So we don’t actually provide any services that we can’t first align the follow-up care plan for because it benefits no one for us to come in and identify an issue with the patient without offering some type of solution.”

Settle said Health Right aims to be a source of resources and information to the public it serves.

“Well, we don’t want to be a dead end, you know, if somebody found out that they have an issue that day, we want to certainly, you know, be a follow-up source for them, where they can come to and get that rectified,” Settle said. “It’s not enough to just see them that one day, we want to make sure people have follow-up care.”

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

Online Storybook Tells Success Stories Of Those On Medicaid

Almost a third of West Virginians rely on the Medicaid program for their health coverage. That includes single moms, caretakers, students and every kind of West Virginian under the sun. A collective of healthcare advocacy groups want to highlight those folks. Their stories include accessing essential health services like delivering a baby or seeing a therapist. As different as their needs were, Appalachians For Medicaid says these patients had the peace of mind that they wouldn’t be strapped with outrageous hospital bills. The group created an online storybook giving voice to those in West Virginia, Kentucky, Tennessee, and Ohio.

West Virginia Public Broadcasting’s June Leffler spoke with Jessica Ice. She is executive director for West Virginians for Affordable Healthcare and collaborated on the project. Those text and video stories are available at
appalachiansformedicaid.org.

This interview has been lightly edited for clarity.

Leffler: So tell me why you wanted to produce this series of stories?

Ice: We think that using stories to put a face to the numbers and the data around Medicaid can really bring home how important this program is, for a variety of populations. We’re really focused on the pregnancy ones, because we’re working on an initiative here in West Virginia to extend Medicaid coverage for postpartum people for up to a year. So we’ve got stories about why that’s so important. But there’s others, folks who lost their jobs because of the pandemic, we’ve seen a huge increase in Medicaid enrollment that way. We just got a nice story that’s not in the storybook that we’ll put out soon, that I think is is a pretty important one. It shows how Medicaid really helps people who work and live healthy lives. There’s this misconception that Medicaid is for people who don’t work or who don’t contribute to society, whatever that means. But the truth is, people on Medicaid, 50 to 60 percent of them, do work. Others are children or folks with disabilities. You know, if you name a Medicaid subject, that impacts the people, we probably have a story for it. And we’re constantly gathering those.

Leffler: So sometimes people that are on Medicaid, do carry this stigma, that even though they qualify for this assistance, that for some reason they aren’t entitled to it or shouldn’t be entitled to it. Have you seen any of that in your stories?

Ice: You touched on something that’s been around since probably the inception of the Medicaid program back in the 1960s, before I was even born. What you’re touching on is this idea that help from the government automatically makes a person unworthy of living a full and healthy life, and we know that’s just not true. Government support is there for people who need it, and that’s how we take care of our neighbors. At any given time, about a third of West Virginians rely on Medicaid for their health insurance, and having health insurance isn’t something to be ashamed of.

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

Study Finds Medicaid Expansion Improved Colon Cancer Rates in Appalachian Kentucky

A new study has found that Medicaid expansion through the Affordable Care Act led to a profound impact on diagnosis and survival rates of colorectal cancer in parts of Appalachia.

Researchers from the University of Kentucky looked at the impact of Medicaid expansion and colon cancer in Kentuckians. They found that after Medicaid expansion, there was a substantial increase in the number of Medicaid patients who received colon cancer screening. The most prominent increase, though, was in the Appalachian part of the state, where 43 percent more patients were screened after expansion than before.

The increase in screening also meant an increase in early-stage diagnosis of the disease, when colon cancer is more easily treated, and a 27 percent decrease in risk of death.

Kentucky and West Virginia both first expanded Medicaid in January of 2014, according to the Kaiser Family Foundation. Kentucky has the highest rate of colorectal cancer in the country – and West Virginia has the third highest rate, according to the Centers for Disease Control and Prevention.

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

Study Shows Medicaid Expansion Improves Early-Stage Cancer Diagnosis

A new study from Indiana University has found that the Affordable Care Act led to an increase in early-stage cancer diagnosis in Medicaid expansion states like West Virginia.

The research suggests that public health insurance may increase cancer detection. Early cancer detection is linked to better outcomes for patients and fewer deaths. West Virginia has one of the highest rates of cancer in the nation.

The research found that Medicaid expansion increased early cancer detection rates by 6.4 percent from pre-ACA levels. There was no detectable impact on late stage cancer diagnosis rates.

Researchers concluded that expanding access to health insurance and health care has a measurable impact on diagnosis and treatment.

The study was published this month in the American Journal of Public Health.

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

Healthy Debate: What The Republican Health Bill Taught Us About Medicaid

It’s hard to find a spot on the map where the proposed repeal of the Affordable Care Act would have a bigger effect than in the Ohio Valley. By one measure, for example, the proposal could mean West Virginia’s rate of people who lack health insurance would climb by nearly 300 percent — the biggest such change in the country. The projected declines in Kentucky and Ohio are also more than twice the national average. This is largely due to proposed changes in Medicaid.

As Congress debated Republican health measures that would roll back the ACA’s expansion of Medicaid, the full extent of Medicaid’s role in Kentucky, Ohio, and West Virginia gained more public attention. Rural hospitals, people living with disabilities, displaced coal miners, addiction treatment services, care for the elderly — all could be affected by cuts to Medicaid.

That rising awareness has focused public attention, sparked protest, and put some regional lawmakers on the spot.

Medicaid’s Reach

Until the recent debate, Medicaid was most commonly known for providing primary medical care to the poor. According to the Kaiser Family Foundation there are 4.6 million people served by Medicaid in Kentucky, Ohio, and West Virginia.

As the ramifications of proposed changes to the ACA became clear, more health care providers began to speak up about the widespread but less obvious ways that Medicaid supports their work.

Hospital officials say Medicaid has been crucial in keeping rural hospitals open. The Kentucky Hospital Association estimates that rural hospitals and health centers in the state receive about 70 percent of their revenue from Medicare and Medicaid.

Teresa Fleming is the financial officer for one of those rural health centers, Mountain Comprehensive Care, which serves five eastern Kentucky counties. Fleming said the expansion of Medicaid came just as many coal miners in the region were losing jobs and health coverage.

“The Affordable Care Act came at the right time and basically correlated with the mine layoffs,” she said. “So that gave our patients safety or at least some security that they would have some kind of coverage so they could go see their providers.”

Services supported by Medicaid also allow people with disabilities to live in their communities and outside of institutions. According to the Kaiser Family Foundation nearly 760,000 people with disabilities in Kentucky, Ohio, and West Virginia depend on Medicaid.

Jeff Edwards, executive director of Kentucky Prevention and Advocacy, said those services allow people with disabilities to lead fuller lives and contribute to their communities.

“When we hear they are going to dismantle Medicaid we are thinking about adults, people who need some help in the morning to get dressed and get in a wheelchair but then go on to work a 40-hour-a-week job,” he said.

If those services are cut, he said, “We will start filling institutions back up.”

The Addiction Factor

The ACA allowed more people suffering with addiction to get more resources, according to treatment specialists throughout the region.

Looking just at numbers from the Medicaid expansion through the ACA, researchers at Harvard and New York University estimate nearly 215,000 additional people were able to seek addiction and mental health treatment.

In Portsmouth, Ohio, a city hit hard by the addiction crisis, the health department was able to connect more people to treatment thanks to the coverage gains.

Portsmouth, Ohio, public health nurse Lisa Roberts saw what happens when addiction treatment abruptly ends. “It could just be catastrophic.”

The progress they’ve made could be lost under the proposed repeal plans because Scioto County, where Portsmouth is located, also struggles with unemployment.

“So many of our people depend on types of insurances that would go away,” Lisa Roberts, a public health nurse with the department said. “We just have a lot of people here who don’t have access to good, regular, employee-covered health insurance.”

This resonates with Ohio Valley politicians considered to be key votes in the repeal effort.

Republican Senators Rob Portman of Ohio and Shelley Moore Capito of West Virginia both cited the potential loss of coverage and funding for addiction treatment as reasons they would oppose the current Senate plan.

Senate leaders attempted to win back their support with the promise of $45 billion in addiction treatment funding spread out over about a decade, up from $2 billion in an earlier version of the bill.

But treatment specialists and state leaders say that’s far from enough to make a difference.

Ohio’s Republican Gov. John Kasich said on ABC’s “This Week” that the funding was “like spitting in the ocean. It’s just not enough.”

The left-leaning Center for American Progress estimates that Kentucky, Ohio, and West Virginia would get a $443 million share of the funds per year over that time period. But the CAP analysis estimated the full cost of treatment in Ohio alone would be over $2 billion by 2026.

It’s difficult to predict these numbers with complete accuracy due to the changing nature of the opioid epidemic and state investments in more treatment efforts. But numbers like these are enough to give Senators Portman and Capito pause when considering a repeal effort.

Public Protests

Sen. Capito and other regional lawmakers have also been the focus of newly energized activists who have organized numerous sit-ins, marches, and other events that saw people taking to the streets, even in some places that are deep-red in their politics.

The demonstrations frequently included people with disabilities or health problems advocating for themselves — people in wheelchairs or those with chronic conditions who couldn’t stand for long but who turned out anyway. Many independent, grassroots groups coordinated via social media to create “pop up“ protests at every turn of the legislative process.

Demonstrators were also fueled by fresh reminders from emerging science showing just how important health care access is in the area.

A study published in the Journal of the American Medical Association’s publication JAMA Internal Medicine made headlines during the health debate for its conclusions that in parts of the Ohio Valley people can now expect to live shorter lives than their parents did.

The study found that Kentucky, Ohio, and West Virginia include 27 of the 50 counties with the country’s worst trends in life spans. Of the 10 counties in the U.S. with the worst declines in life expectancy, eight are in Kentucky.

It’s difficult to say what effect the activism has had on decision makers, but the correlations provide some indication. After activists staged sit-ins in her offices, for example, Sen. Capito issued a statement voicing her concerns with the Senate’s repeal-and-replace bill. “I did not come to Washington to hurt people,” she wrote.

Conflicting Claims

The protesters and Republican supporters of the bill had starkly conflicting messages about Medicaid’s future. Protesters often cited the Congressional Budget Office estimate that 22 million people could become uninsured under the Republican plan, due in part to Medicaid changes.

Kentucky Republican Sen. Mitch McConnell, the Senate’s Majority Leader, had a very different message when responding to a protest at a recent event in Paducah, Kentucky.

“Nothing that we’ve advocated so far would cause anybody currently on Medicaid to be taken off of Medicaid,” he said.

Sen. Mitch McConnell faces protesters at events around Kentucky.

Simon Haeder is an assistant professor at the John D. Rockefeller IV School of Policy and Politics at West Virginia University, where he focuses on health care policy. Haeder said McConnell parsed his words carefully to make that argument, emphasizing people who “choose” to leave. That would include people who signed up for health insurance only because the original ACA mandated that coverage.

But Haeder points out that many who qualified for Medicaid under the ACA’s expansion would likely make that “choice” to leave Medicaid only because they would find they could not re-enroll after revisions to guidelines for Medicaid qualification. Many families are eligible for Medicaid under expanded ACA income guidelines gave that option to more working class people. If those expanded income guidelines are rolled back, Haeder explained, people wouldn’t technically get “kicked off” of Medicaid but they would no longer be eligible to continue their Medicaid enrollment because their income was too high.

“The semantics are there to work with, I guess,” Haeder said of McConnell’s claim, “but the reality is very, very different.”

Others, he said, could be pushed off Medicaid and not be able to afford private insurance premiums. It’s also hard to predict an ever-shifting population of those who are eligible for Medicaid.

Not Over

Haeder said the ongoing debate helped educate people about the scope of Medicaid. A wide variety of groups from the American Medical Association and AARP to grassroots activists voiced their concerns. Haeder said that despite the apparent demise of the latest Senate bill, that conversation will continue, as will the legislative efforts to change the health care system.

“A lot of the stuff that is being discussed like the cuts to Medicaid can come back really, really quickly,” he said. “For example, in the budget negotiations coming up. It is not over by any stretch of the imagination.”

Proposed GOP Cuts to Medicaid Could Cause Job Loss, Hospital Closure in Rural America

A vote on the Republican plan to repeal and replace the Affordable Care Act has been put on hold after several Republican Senators, including West Virginia’s Shelley Moore Capito, have publicly said they cannot support it. Nationally, opposition for the bill continues to mount as more and more groups release reports about the negative impacts the current bill could have on access to treatment in rural areas, like much of West Virginia.

The most recent analysis of both the House and Senate versions of the bill was released earlier today by the Chartis Center for Rural Health. Chartis is a national firm that provides strategic and economic planning services to some of the largest healthcare providers in the country.

According to the group’s findings, if Congress follows through with the proposed cuts to Medicaid, rural health care providers could lose nearly a billion and a half dollars of revenue per year.

This comes at a time when 41 percent of rural hospitals are already operating with budget deficits and many others have closed due to financial strain. The continued loss of revenue, according to the Chartis report, could result in additional closures, leaving rural Americans with fewer options when it comes to health care.

But the impact to rural health systems is larger than access to treatment, the report says. It’s also economic.

If the Senate’s version of the bill to repeal and replace the Affordable Care Act would pass, the Chartis Center estimates 34,000 community and health jobs would be lost. States that expanded Medicaid, like West Virginia, are estimated to experience nearly twice the number of job cuts when compared to their non-expansion counterparts.

West Virginia’s Senators, Shelley Moore Capito and Joe Manchin, have both said they have concerns over the bill’s impacts in West Virginia. The actions by the Republican majority this week likely means the bill will see changes before being put to a final vote in the Senate.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.