Medicaid Story Archives - Page 3 of 15 - West Virginia Public Broadcasting

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.

Department Of Health And Human Resources To Change Family Assistance Eligibility Systems

Residents in Clay, Hardy, Kanawha, Mercer, Mingo, and Randolph counties that participate in family assistance programs will become part of a pilot program beginning Monday, according to the Department of Health and Human Resources.

Residents who receive benefits from assistance programs will begin the transition to a new system. They will be moving from the RAPIDS system to WV PATH. DHHR programs supported by the new WV PATH include: Medicaid, West Virginia Children’s Health Insurance Program (CHIP), the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and other state-operated assistance programs. A statewide transition is slated for spring of 2024.

The transition will not impact the way residents apply for assistance programs. This switch will allow DHHR to receive a better funding match of 90 percent of federal dollars to 10 percent of state dollars.

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.

Morrisey Argues Against Gender Affirming Care Through Medicaid

West Virginia Attorney General Patrick Morrisey does not think the state’s Medicaid plan should cover gender-affirming surgery.

On Thursday, West Virginia Attorney General Patrick Morrisey said his office argued a case before the Fourth U.S. Circuit Court of Appeals involving the state’s decision not to cover gender-affirming surgeries under its Medicaid plan.

That case is an appeal from an order last year from a federal district court. It said the state’s choice not to cover gender-affirming care under Medicaid violates the U.S. Constitution’s Equal Protection Clause.

The original class-action lawsuit was filed in the U.S. District Court for the Southern District of West Virginia on behalf of three Medicaid recipients. Christopher Fain, a Medicaid participant; and Zachary Martell and Brian McNemar, a dependent and state employee, respectively.

Usually, three-judge panels decide cases on appeal, but the Fourth Circuit set the argument before the entire court in this case and a related case out of North Carolina.

For now, gender-affirming care is covered under the state’s Medicaid program.

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WVU Researchers Seek Participants For Telehealth Study

A study will measure the effectiveness of telehealth as a means for patients to remain at home while managing their care.

Researchers at West Virginia University (WVU) are enrolling participants in an extended telehealth pilot program.

The project is a collaboration of the WVU Health Affairs Institute and West Virginia Department of Health and Human Resources, Bureau for Medical Services.

The program is an expansion of previous telehealth pilot work and will provide telehealth care to beneficiaries of Home and Community-Based Services.

Participants will have the opportunity to receive six months of telehealth services in their homes for free.

“With our telehealth program, one component of it is remote patient monitoring, monitoring of vital signs,” Associate Professor in WVU’s School of Public Health, Steven Davis, said. “They’re transmitted remotely.”

Participants will also receive a call from a nurse a couple of times a month to discuss their well-being.

Davis said telehealth can be a positive addition to existing health care.

“We would rather coordinate with their primary care providers to catch things early on so that they’re going to a lower level of care versus more costly care,” he said.

People living in West Virginia often need to go back to the hospital or are not able to live at home due to a variety of physical and mental health issues, according to Davis.

Telehealth can assist in monitoring these conditions closely to prevent unnecessary hospital visits or delays needing 24-hour care outside of the home.

To be eligible to participate, individuals must be a Medicaid Aged and Disabled Waiver, Intellectual/Developmental Disabilities Waiver, or Traumatic Brain Injury Waiver member.

Individuals interested in participating in the Extended Telehealth Pilot should complete a short interest form available on the Health Affairs Institute website at healthaffairsinstitute.org.

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

Medicaid Fraud Unit Experiences Gains Under Attorney General

In October of 2019, the West Virginia Legislature moved the Medicaid Fraud Control Unit from the Department of Health and Human Resources to the Office of the Attorney General.

During a Post Audits Subcommittee meeting Sunday, Audit Manager Mike Jones presented findings comparing three years before the change to three years after. He said the results of the transition were positive.

Jones noted among other changes that the Attorney General’s office pursued the recovery of three times the actual damages, plus costs, as allowed by code. He explained that resulted in a significant increase in the civil recovery orders.

Jones described that as a significant hammer in their negotiations with providers.

“Another change was to conduct both criminal and civil investigations concurrently until a charging decision was made,” he said. “This has allowed the fraud unit to more efficiently transition cases that do not meet the burden of proof required of a criminal case to a civil investigation. This change contributed to an increase in the number of cases closed by the fraud unit.”

Using a chart, Jones explained that the three-year totals for case referrals and cases opened from referrals more than doubled since reorganizing under the Attorney General.

Case referrals increased from 794 under DHHR, to 2046 under the Attorney General. The total cases opened increased from 138 under DHHR to 339, a 145 percent increase.

The second core function of the Fraud Unit is to refer cases of fraud and abuse or neglect for prosecution. The fraud unit increased the total cases referred for prosecution from 38 under the DHHR to 54. The total number of convictions jumped from 14 to 34, a 143 percent increase.

The third core function of the fraud unit is to seek recovery of funds through recovery orders. The fraud unit saw a modest increase of $23,000 in criminal recovery orders. It did experience significant increases in both global and non-global civil recovery orders of approximately $12.5 and $35.5 million respectively.

The Fraud Unit ultimately increased its total recovery orders from approximately $27 million under the DHHR to $75 million under the Attorney General at an increase of 176 percent.

The Medicaid Fraud Recovery Unit only pursues providers like nursing homes or doctors that have defrauded the system. A different unit, still within the DHHR, pursues Medicaid fraud against people who use the system.