Public Employee Insurance Agency Story Archives - West Virginia Public Broadcasting

Teachers, School Service Personnel Rally Ahead Of PEIA Hearing In Morgantown

Teachers and school service employees rallied Tuesday night ahead of a Public Employees Insurance Agency (PEIA) hearing in Morgantown.

PEIA is holding hearings across the state to receive input from state employees and retirees on proposed price increases to their health care plans that would take effect next summer. Changes include a 14 percent increase to premiums and a 40 percent increase to deductibles.

Members of the American Federation of Teachers – West Virginia (AFT) gathered outside of the Erickson Alumni Center at West Virginia University ahead of testifying in front of the PEIA Finance Board. They were joined by the West Virginia Education Association, as well as the United Mine Workers of America, who represent some school service workers.

Tena McElwain, a bus driver for Monongalia County Schools and the AFT service personnel president for the county, said the rally is a show of solidarity.

“The rally is just to show support, unity,” she said. Hopefully we can take care of PEIA this year, working through the legislatures and finding appropriate funding for it.”

McElwain said the proposed increases would cut even further into paychecks for service workers, and make vacancies even harder to fill.

“Right now there’s a shortage in Mon County for bus drivers, secretaries, aides, custodians, cooks, because of the PEIA increases,” she said. “We’re more or less working to pay insurance. We’re not taking anything home after PEIA comes out, we still have bills.”

Cullen Hencke, also a Monongalia County teacher and the vice president of the local AFT chapter, said teachers and school personnel aren’t the only ones that will be impacted by the rate increases.

“Sometimes we’re the loudest voices about these issues, but we know that they affect lots of other people who West Virginians care about and look to and in times of need,” he said.

Carol Roskos, a Monongalia County teacher and president of AFT Moningalia, echoed McElwain’s concerns of the rate increase’s economic impact.

“I would like to see the public hold their elected officials accountable for being responsible for helping West Virginia to run efficiently as a state,” she said. “If West Virginia is not taking care of their employees’ health insurance, there is a possible economic fallout that could happen if folks tend to leave the state or seek employment somewhere else.”

At least four officials elected to state office were present at Tuesday’s meeting, including Sen. Mike Oliverio, R-Monongalia, Del. Anitra Hamilton, D-Monongalia and Del. John Williams, D – Monongalia, but many attendants expressed dismay that more politicians were not present.

Del. Joey Garcia, D-Marion, was recently elected to the state senate for District 13. He spoke to the rally ahead of the hearing, and said PEIA’s problems were created by the legislature, and they can be fixed by the legislature.

“They’re fixes that an incoming governor can propose when we get into the legislative session this coming February,” Garcia said. “I’m hopeful, I think these people here are hopeful that their voices will be heard. And I just said a second ago, you can listen, or you can actually look at something, and see where people are. And I think that’s what we’re going to see a lot tonight about how this has affected people in their pocketbooks.”

Attendants at the Nov. 19, 2024 PEIA Finance Board hearing in Morgantown listen to a presentation on proposed increases.
*Chris Schulz/West Virginia Public Broadcasting*

Kristie Skidmore was elected president of AFT – West Virginia over the weekend. She echoed others and said she is concerned the rate increases will worsen the existing teacher shortage.

“A big picture that we need to look at is when members can’t afford health care, and they can’t afford to stay in the state, they’re going to go elsewhere, and they’re going to make more money, and they’re going to have better health care,” she said.

Dale Lee, president of the WVEA, said that healthcare is a national issue that cannot be fixed at the state level, but some of the burden needs to be redistributed away from employees.

“The burden of the increased cost shouldn’t be borne solely on the employee, and in this plan, more than 40 percent of the costs are going to directly to the employee,” Lee said. “Because not only do you have the premium increases of the 80/20 which, by law, you have to do, but you have $76.4 million in benefit reductions that is born solely on the employee.”

Lee pointed out that pay increases implemented by the legislature were intended to help address PEIA rate increases, but have had little effect.

“It’s really not a pay raise, because you’re not being able to have any more additional dollars for gas bills, electric bills, groceries, things like that,” he said. “You’re actually seeing your buying power decrease in this. So we really haven’t received a raise. It’s been an offset.”

The final public hearing in the series will be held in person Thursday, Nov. 21 at the Culture Center in Charleston.

PEIA Hearings Continue And A Look At The Legacy Of Marshall Memorials, This West Virginia Morning

On this West Virginia Morning, every Nov. 14, Marshall University and the Huntington community have remembered and honored the 1970 football team, and all of the 75 who perished that year in a plane crash. For more than half a century, these annual memorial events have honored revered memories, but they have also inspired a legacy of positive personal and physical growth.

Also, in this show, PEIA continues to hold hearings across the state over proposed price increases that would take effect next summer, the state Supreme Court rules on football playoffs and an Elkins residential facility for children in foster care is slated to close by the end of the year.

We also have stories on a continued fall in West Virginia’s drug overdose death rate, a pollution lawsuit ends in a hung jury and a land grant university gets an agricultural laboratory.

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 Shepherd University and Marshall University School of Journalism and Mass Communications.

Maria Young produced this episode.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning

Public Employees Ask PEIA Not To Raise Rates

State employees had the opportunity Monday evening to make their voices heard about proposed rate increases to their health insurance.

About 160 people attended a virtual public hearing held by the West Virginia Public Employees Insurance Agency (PEIA), to hear proposed changes to their health insurance for Plan Year 2026, beginning July 1, 2025.

On Oct. 24, PEIA and the Retiree Health Benefit Trust (RHBT) Finance Board met to discuss proposed changes to rates.

Brian Cunningham, the director of PEIA, presented the Finance Board’s proposed rate increases, then took questions and comments from the audience.

The board’s proposal includes a projected five-year plan to raise member payments and restore PEIA reserves. Those proposals include more than doubling some copays along with premium increases through 2029.

Cunningham said the rate increases can be attributed to the passage of Senate Bill 268.

The 2023 bill mandated a spousal surcharge and formalized the 80/20 rule, which requires insurance companies to spend at least 80 percent of the money they take in from premiums on health care costs and quality improvement activities.

“As it relates to spousal surcharge, the board is proposing a $350 spousal surcharge,” Cunningham said. “Currently, that spousal surcharge is $147.”

The bill also required PEIA to increase reimbursement to healthcare providers.

“The other things that are driving cost increases, (you) may have heard of Senate Bill 268, which resulted in increased reimbursement to healthcare providers,” Cunningham said. “In plan year 2024 PEIA paid out more than $70 million more in healthcare providers and reimbursement to healthcare providers, particularly inpatient hospitals.”

Finally, Cunningham said, rising prescription drug costs are spurring rate increases for employees.

“A significant driver of the cost of prescription drugs are what are known as GLP-1’s,” Cunningham said. “GLP-1’s are prescription drugs like Ozempic and Mounjaro. GLP-1’s were responsible for almost $53 million in cost in plan year 2024 which is approximately 20 percent of the overall net cost, or the overall net drug spend at PEIA.”

In March, PEIA canceled a 1,000-person pilot program that covered weight-loss drugs due in part to the program’s cost to the state. However, advocates of the program say the state will end up paying more for the health complications that will be caused by obesity.

West Virginia state employees from all walks of life voiced their concerns about increasing healthcare costs.

Retirees on the call say they worked their lives for their retirement, and these rate increases will not be feasible on a fixed income.

Teachers on the call say their salaries do not cover their expenses, but they have continued to work their state jobs for the benefits because it outweighed the cost and they care about their work.

Jamie Tallman was one of 165 West Virginians on the virtual call who spoke during Monday’s hearing. He has been teaching in Grant County for almost 40 years.

He says he and his wife will have to consider selling their home and downsizing if the rate increases are implemented. That echoes sentiments from his fellow state educators that affordable health benefits were leveling out the low salaries provided by the state.

“This would be the most severe pay cut, basically, that I would receive as an educator in all my career. And I know somebody said last night, it is a perk,” Tallman said. “The insurance has kind of been a perk, you know. We work right up there, 49th, 50th, you know, in teacher salary.”

Most speakers said if the rates are raised they will have to consider leaving the state entirely or stopping work for the state.

Cunningham encouraged PEIA members to reach out to their lawmakers to let them know their concerns.

PEIA is continuing to hold public hearings throughout the week.

State Employee Health Insurance Ends Pilot Program To Treat Obesity, Related Illness

Advocates of a pilot program that covered expensive weight loss medications for West Virginia state employees say the state will end up paying more for obesity-related health problems. In March, the state’s Public Employees Insurance Agency (PEIA) canceled a 1,000-person pilot program that covered the medications due in part to the cost of the medicines.

Now lawmakers and health officials are working behind the scenes to find a solution.

West Virginia is not alone in its struggles with obesity. Before 2013, no state in the U.S. had an adult obesity rate at or above 35 percent. Ten years later, in 2023, data from the Centers for Disease Control (CDC) found that almost half the nation – 23 states including West Virginia – had reached that level, with more than one in three adults, or 35 percent, listed as clinically obese.

However, West Virginia’s obesity problem is more pervasive than in other states. According to 2024 CDC data, 41.6 percent of West Virginian adults are obese. The same report shows 24.8 percent of youth ages 10 to 17 are obese, giving West Virginia a ranking of 51 among the 50 states and D.C.

Searching For Solutions

In recent years, weight loss drugs like Ozempic have become household names. This type of drug is called a GLP-1, which stands for glucagon-like peptide receptor agents. These drugs treat Type 2 diabetes and obesity. Zepbound, Mounjaro and Wegovy are also well-known GLP-1s.

The current list price – which is set by the drug manufacturer before applying insurance or discounts – for Ozempic is $968.52 per month. When prescribed, patients take four doses per month, one dose per week.

According to a New York Times article that spotlighted West Virginia in the nation’s struggle to afford weight loss medication, most Medicaid programs cover these medications to manage diabetes. Medicare covers Wegovy and Zepound when they are prescribed for heart problems.

PEIA director Brian Cunningham told the New York Times in June that West Virginia’s pilot program cost around $1.3 million a month, despite rebates from manufacturers for a little more than 1,000 patients.

The Pilot Program At Work

Laura Davisson is West Virginia University’s (WVU) director of Medical Weight Management, a professor, and associate program director for internal medicine. She said West Virginia’s obesity problem can no longer be ignored.

“Not every single patient is a candidate for surgical treatment, and now we have these medicines that are out there that are fantastic,” Davisson said. “They’re giving really great results. They’re very well tolerated and these are tools that we need to have in our toolbox so that we can give each individual patient the full spectrum of treatment options.”

PEIA started the pilot program in 2019 to assist members with the cost of GLP-1s. PEIA provides health coverage for more than 230,000 public employees and retirees.

“We can have a lot more success if we do this systematically and medically, rather than just continuing, which we’ve done for decades now, of telling people just eat less and exercise more, because we’ve been doing that and it’s not working,” Davisson said.

However, on March 15, 2024, PEIA paused the pilot program due, in part, to the rising cost of GLP-1s. The state honored existing pre-authorizations through June 30th or the term of authorization, whichever was longer.

State officials told MetroNews in August that reasons for pausing the program were “multifaceted,” but included cost, supply shortages, potential side effects and inconclusive results.

“Since they announced canceling the pilot, I have met with them again and given them all the data I could come up with, but from their patients, I’ve shown them data showing that return patients of theirs in the pilot that have come to see us have shown a 15.4 percent decrease in their body mass index,” Davisson said.

Cassie Maxwell is a wife and mom from Morgantown. She has been living with obesity since her late teenage years and says she has experienced a significant amount of stigma around her weight.

“Lots of medical problems that I had were very dismissed,” Maxwell said. “There were lots of false assumptions that my weight was related to willpower, and was just told over and over by numerous doctors, eat less and move more, eat less and move more, and it wasn’t working.”

Maxwell was diagnosed with polycystic ovarian syndrome and insulin resistance. Two and a half years ago, her primary care physician referred her to the medical weight management clinic at WVU.

“I was able to actually get comprehensive evidence-based care for my obesity, which is a chronic health condition, and then I was able to get this comprehensive treatment that included behavioral therapy, it included access to exercise physiologists, access to registered dieticians, and for me, it also included medication,” Maxwell said.

Maxwell said her GLP-1 prescription radically changed her and her family’s lives by allowing her to lose almost 150 pounds.

“The main reason I qualified for the program is because I had reached pre-diabetic numbers, I no longer am in that range,” Maxwell said. “I no longer have high blood pressure. My cholesterol is better than my husband’s, so I’m doing really great cholesterol-wise. My sleep apnea has gone away. All of these things that were that I needed treatment for medically have all improved.”

Maxwell found out she was part of the GLP-1 pilot program when she learned it was ending.

“All of these were things that I needed treatment for medically have all improved, and my insurance is pretty much telling me all of those things need to come back,” Maxwell said. “You even need to get sicker before we’re willing to cover your chronic medical condition, which isn’t fair, because they cover every other chronic medical condition.”

Legislative Efforts To Save The Program

During the 2024 regular legislative session, Del. Kayla Young, D-Kanawha, introduced House Bill 4979 to provide insurance coverage for GLP-1 class medications with a valid prescription after hearing from “dozens” of constituents.

“West Virginia has really high rates of heart disease, and various chronic diseases, many of which are caused by weight, or where weight is at least a factor,” Young said. “I know that we’re spending so much money on taking care of West Virginians and their health concerns, and if this is a medication that can help to get them to a healthy place where they can live longer lives and feel happier and be healthier, I don’t know why we wouldn’t be providing that medication that seems to be working for a very large population of people.”

The bill never moved past the House Committee on Banking and Insurance.

During a special session of the legislature in May of 2024, Del. John Williams, D-Monongalia, introduced another bill in the House in an attempt to save the program, House Bill 116, to require PEIA to reimburse covered persons for GLP-1 agonist medications prescribed by a physician for weight loss.

“This issue is really coming to a head with these individuals losing their coverage,” Williams said. “So I thought that it would have been a failure on my part, on the people I’ve talked to, to not at least try.”

William’s bill never made it past the House Finance Committee.

The Cost Of Care

Davisson and Maxwell agree West Virginia will end up paying for its obesity problem, one way or another.

“It made absolutely no sense to me. If we look at sheer numbers, right, if we just look at the cost of obesity-related health care conditions and know that it is treatable, and to say, ‘No, I’m going to stop covering this, and I’d like to take on all of those additional health care costs.’ Sounds completely ludicrous, but yet here we are,” Maxwell said.

Sen. Tom Takubo, R-Kanawha is the Chair of the Joint Standing Committee on Insurance and PEIA.

“Every year, one of the most difficult things for any business, whether it’s small or large or government, is healthcare cost, and these medications for PEIA had quickly climbed to about $90 million so that completely breaks the bank,” Takubo said.

Takubo acknowledged the effectiveness of the medication and the implications of treating obesity in a state with rates as high as West Virginia’s but says his job as a legislator is to pass a balanced budget.

“We certainly want to keep insurance viable for state employees, and that one class of medication has just gone crazy in terms of cost, and so lot of balls in the air on that one,” Takubo said. “So we’re just trying to work a way through it.”

Takubo says he and his colleagues in the legislature are working “creatively behind the scenes,” speaking with the manufacturers of GLP-1’s.

“There needs to be parameters around qualifying criteria and things like that that have to also be developed,” Takubo said. “But we’re working on all the above.”

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.

Rail Safety Issues And First Public Hearing For PEIA Changes On This West Virginia Morning

On this West Virginia Morning, the first of four public hearings held by the Public Employees Insurance Agency (PEIA) Monday drew criticism about changes to the plan. Caroline MacGregor reports.

On this West Virginia Morning, the first of four public hearings held by the Public Employees Insurance Agency (PEIA) Monday drew criticism about changes to the plan. Caroline MacGregor reports.

Also, in this show, last month’s toxic train derailment in East Palestine, Ohio, put rail safety in the spotlight. Charleston native Sarah Feinberg was involved in crafting rail safety regulations. She served as chief of the Federal Railroad Administration in the Obama White House. Feinberg spoke with Curtis Tate about some of the issues raised by recent derailments.

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.

Assistant News Director Caroline MacGregor produced this show.

Listen to West Virginia Morning weekdays at 7:43 a.m. on WVPB Radio or subscribe to the podcast and never miss an episode. #WVMorning

Transgender Medicaid, PEIA Recipients Sue W.Va. DHHR For Discrimination

National advocates for LGBTQ rights are suing West Virginia health leaders, saying state-run plans for insurance are discriminatory toward the transgender West Virginians who rely on them.

A class action lawsuit filed Thursday by Lambda Legal targets West Virginia’s Medicaid program, which serves low-income residents of the state, and the Public Employees Insurance Agency, which offers coverage to state employees and their families.

According to the complaint, all plans offered via Medicaid and PEIA list gender-confirming care as an “exclusion,” or a specific medical service that the plan will not pay for.

Gender-confirming care can include hormonal replacement therapy, surgery and counseling. Access to this kind of care, attorneys write, can reduce the stress and discomfort that transgender people face when the gender they were assigned at birth doesn’t align with their gender identity.

Christopher Fain, one of three West Virginia men listed as plaintiffs in Thursday’s lawsuit, said that for him, gender-confirming care has been life-saving. Fain, a transgender man who uses Medicaid, said he had to pay out of pocket for gender-affirming surgery.

“This care is not optional. This care is essential and medically necessary,” Fain said at a virtual press conference Thursday. “To be denied coverage for care simply because I’m transgender is not only discriminatory, but demoralizing”

Fain spoke Thursday alongside attorneys from Lambda Legal, the Employment Center and Andrew Schneider, executive director of Fairness West Virginia.

“The state of West Virginia shouldn’t single out certain communities to deny health care coverage. But these blanket exclusions do just that,” Schneider said. A survey from Fairness West Virginia released in November found that around 25 percent of transgender West Virginians rely on Medicaid for health care, and roughly 14 percent rely on PEIA.

The same survey reports that 45 percent of transgender West Virginians, not specifying health care coverage, have experienced some discrimination in health care, while 17 percent have been refused care.

Schneider described Fairness West Virginia’s Transgender Health Initiative, which was designed to train doctors and medical providers on transgender health needs.

“We work with doctors whose hands are tied and can’t help their patients access gender affirming care they need because of the exclusions,” Schneider said.

The state Department of Health and Human Resources, which oversees the Bureau for Medical Services and West Virginia Medicaid, said they needed more time Thursday afternoon to look over the lawsuit.

Members from PEIA also said they needed more time to review the lawsuit.

Lambda Legal has filed similar class action lawsuits in other states like Georgia, Arizona and North Carolina. Several cases related to Medicaid are still pending, although the legal team has seen a handful of victories regarding public employee plans in Alaska and Wisconsin.

Emily Allen is a Report for America corps member.