Medicaid Story Archives - Page 3 of 16 - West Virginia Public Broadcasting

W.Va. Ranks Among Best At Connecting Residents With Substance Use Treatment

In 2023, West Virginia ranked fourth highest in the United States for initiating and treating substance use disorder in residents with the condition. The data was collected by the Centers for Medicare & Medicaid Services.

In 2023, West Virginia was one of the most effective states at connecting residents with substance or alcohol use disorders to treatment, according to federal health officials.

At 52.1 percent, West Virginia had the fourth highest percentage of individuals with substance or alcohol dependencies who began and received treatment last year out of 45 participating states and U.S. territories.

This data was compiled by the Centers for Medicare & Medicaid Services (CMS), the agency that oversees federal healthcare systems. Each year, the agency aggregates data on a variety of state-level health resources and outcomes.

Treatments for substance use disorders include medication, counseling, rehabilitation services and behavioral health resources, according to a Wednesday press release from the West Virginia Department of Human Services (DoHS).

“Our commitment to providing diverse and effective treatment options is reflected in the improved outcomes we have achieved,” said Cindy Beane, commissioner of the DoHS Bureau for Medical Services, in the press release.

“West Virginia’s commitment to providing evidence-based practices is being recognized nationally and modeled in other states,” she said.

The DoHS credits the state’s strong CMS score to an increase in substance use disorder treatments offered to West Virginia Medicaid members.

This followed the 2017 implementation of substance use disorder waivers for Medicaid users with substance dependencies, which allowed them to access free treatments.

“Overcoming a substance use disorder is not as simple as resisting the temptation to take drugs,” said Christina Mullins, DoHS deputy secretary of mental health and substance use disorders, said in the press release.

“Like many other chronic conditions, effective treatment options are available for SUD,” she said. “While no single treatment method is right for everyone, recovery is possible, and help is available.”

As of November 2023, 34 states and the District of Columbia offered similar waivers for residents with substance use disorders.

At a press briefing Wednesday, Gov. Jim Justice thanked DoHS staff for supporting substance use disorder treatments across the state. He also emphasized his ongoing investment in programs addressing substance use disorders in West Virginia.

“We’re making a dent. We’ve got a long way to go,” he said. “There are a lot of folks that are taking advantage and getting some real help, and getting their lives turned and going in the right direction.”

“We’re making a difference,” Justice continued.

Free Guidance For West Virginia’s Uninsured On Jan. 9

Uninsured West Virginians can sign up for health insurance for free with trained counselors on January 9.

On Jan. 9, organizations from around West Virginia will work together to create the first Cover WV Day to offer the uninsured a free and guided path to health insurance coverage.

More than 20 organizations are joining in this effort to offer free assistance to those who need coverage. The WV Primary Care Association, the WV Navigator Program, the WV Office of the Insurance Commissioner, and many other non-profit organizations and community health centers have joined to offer more than 30 locations across the state for this one-day event.

Each location will offer walk-in hours where anyone can get questions answered or receive free help enrolling in health insurance.

All locations will be staffed by certified assisters such as Health Insurance Navigators or Certified Application Counselors who provide free help with Medicaid, Children’s Health Insurance Program (CHIP), and Health Insurance Marketplace enrollments.

The Open Enrollment period for the Marketplace ends on Jan. 16.

According to Jeremy Smith, the program director for WV Navigator, about 6 percent of West Virginians lack health insurance.

“We’re actually a little bit better than the national average as far as our uninsured rate is concerned, but we still have a ways to go,” Smith said. “I mean, we definitely know that there are over 100,000 people in West Virginia that don’t have health coverage and we think that the majority of them would probably qualify for either the West Virginia Medicaid program, the CHIP program for kids, or the plans on what’s called the Health Insurance Marketplace.

Organizers aim to educate West Virginians about the different options available to those needing health coverage.

“I do see that mindset from people that especially if they’ve lost Medicaid or if they’ve lost the job that provided insurance, they think they just have to go without until they find a new job that offers it, but with the marketplace, that’s not the case,” Smith said. “The Health Insurance Marketplace is designed for people that can’t get Medicaid, they can’t get Medicare, or they can’t get insurance through a job.”

West Virginia Medicaid and the Health Insurance Marketplace provide options for most people without coverage. According to Smith, four in five people who get a plan on the Marketplace can qualify for plans starting at under $10 per month this year.

“Even if they’ve checked in past years, and maybe they thought it was unaffordable, they should come back and definitely check again this year, because with all the updates the plans are affordable, all doctors are in-network, medicines are covered,” Smith said. “It’s just a really good option for people.”

For more information or a list of site locations, please visit www.wvnavigator.com or www.wvpca.org or visit the Facebook page.

Smith said anyone who cannot make it to any of the locations for the event can call 304-356-5834 with any questions.

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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