West Virginia Watch

Stop kicking the Medicaid can down the road 

By: Ellen Allen

March 28, 2024

That’s a wrap on the 2024 legislative session. And despite disappointments, we did see some legislative wins. Let’s start with the good news for West Virginians and some things we can celebrate.

Expanding Medicaid dental coverage

Studies have shown that social determinants of health, such as income, housing, environmental exposure, education and race, all influence the health status of a population. West Virginians for Affordable Health Care (WVAHC) advocates for the promotion of the health status of West Virginians by using Medicaid funding and buying power to help fund social determinants of health.

House Bill 4933 strengthens the health of West Virginians by raising the Medicaid Dental Benefit from $1,000 to $2,000 over two years for adult recipients. This is meant to allow Medicaid recipients more flexibility, thus allowing them to get both sets of dentures at the same time at a cost of about $600 each.  

Dental health is inseparable from health in general and we’re pleased to see this step being taken to help the many West Virginians who desperately need dental services.

Pushing back on Big Pharma

Under the federal 340 B program, health care providers like hospitals and community health centers that fit certain criteria, like being a public or nonprofit organization with a high volume of low income or uninsured patients, can get medicines at a discounted rate, allowing them  to sell the medicines at a discounted rate to low income or uninsured patients. Such health care institutions are known in the program as safety net providers.

However, in 2020, manufacturers started implementing restrictions on contract pharmacies.

For example, if a safety net provider ordered insulin for its contracted pharmacies, drug manufacturers would refuse to send the insulin to the rural pharmacies. 

Senate Bill 325 challenges those restrictions by forcing them to ship to rural contract pharmacies or be imposed a $50,000 fine per order for failing to do so. 

This will help thousands of rural West Virginians who need affordable prescriptions. 

Keep in mind that Big Pharma never argued that these patients don’t qualify for a federal program that’s been around for 30 years, and we undoubtedly know that this federal program allows West Virginians to get their much-needed medicines without driving long distances or crossing state lines to procure discounted prescriptions that are no longer available to them in their communities. 

Now, let’s switch gears to the not so good news. 

Unfortunately for nearly a third of West Virginia’s population, lawmakers failed to address the current Medicaid shortfall, or the looming shortfall for Medicaid FY 2025.

Lawmakers cannot continue kicking this can down the road. Medicaid is working, and it’s a lifeline to over a third of West Virginia adults and half of our children. We urge lawmakers to address Medicaid sustainability in the May interims or special session.  

Medicaid has always played a vital role as an insurer for low-income families in the Mountain State — particularly kids. Medicaid and CHIP (Children’s Health Insurance Program) are integral to our health care system, and it insures nearly half of West Virginia’s kids. According to the Kaiser Family Foundation, 47.1 percent of West Virginia’s kids qualify for Medicaid and CHIP. The national average is 39 percent.

It’s important to remember that Medicaid is a federal-state financial partnership, under which the federal government picks up a fixed percentage of states’ Medicaid costs by “matching” state Medicaid funds with federal funding.  This means that for every $1 cut in its Medicaid spending a state makes to help close its budget deficit, it also loses federal funding as well. As a result, the actual total cut to a state’s Medicaid program is significantly larger and its harmful impact would be greater.  

According to Georgetown University’s School of Public Policy, the negative effect of Medicaid cuts on the state’s economy could also be considerably larger, which would both deepen and prolong the economic downturn, lead to bigger and continued state budget deficits, and necessitate further damaging Medicaid cuts.

Such cuts, for example, could include slashing Medicaid reimbursement rates to hospitals, physicians, nursing homes and other providers. In turn, that would significantly reduce access to needed care if providers are unable to continue to furnish the same level of services to Medicaid beneficiaries, no longer take Medicaid beneficiaries or cease operations entirely.

Translation: Fewer dollars mean fewer resources for low-income families, people with disabilities, pregnant women, and others who rely on Medicaid for health coverage. The state’s going to lose funding for all those people who have been dropped. Even though these poorer states spend less per resident on Medicaid, their federal reimbursement rate is relatively high, and so the impact of federal cuts is large. 

House Bill 5647 would have addressed the Medicaid funding shortfall by increasing and maintaining the bracketed tax rates on the privilege of establishing or operating a health maintenance organization. 

HB 5647 passed the House, but the unexpected news of a potential “claw back” of federal funds caused it to be put on hold until funding could be addressed during a special session in May.

West Virginians for Affordable Health Care remains laser focused on protecting and preserving Medicaid, which is a critical component of West Virginia’s health care infrastructure, because we recognize how inextricably linked Medicaid is to the health care infrastructure of our state.