By Kathleen Stoll
Jan 18, 2022


I first met Samples when he worked for the West Virginia insurance commissioner. He is a sharp and dedicated who cares deeply about low-income West Virginians. I deeply respect how Samples has weathered political change in our state and kept his eyes on the big goals, like reducing the number of uninsured West Virginians. State administrators often go without accolades and, too often, become the public scapegoat for harmful policies they did not ask for or create.One of Samples’ skills is lifting his head out of the daily details of running a state bureaucracy and pinpointing big issues and problems that need addressed.

From Kabler’s article, quoting Samples:

“’[T]he benefits cliff is a national phenomenon that precludes individuals from accepting jobs or promotions because it would result in the immediate loss of safety net benefits including Supplemental Nutrition Assistance Program payments and, most notably, expanded Medicaid coverage. It is a logical reason someone would not take a job, would not take a promotion, not earn extra money,’ [Samples] told the Joint Committee.

“[Samples] used the example of a single person working a part-time minimum wage job, receiving SNAP benefits (commonly referred to as food stamps) and Medicaid. If that person earns more than $18,000 a year, the worker would lose those benefits. They would need to earn $33,500 to break even for the value of those lost benefits, he said.”

I want to put a face on that problem. One of my neighbors is a mom — divorced with a preschool age daughter and a steady boyfriend. From our chats, my impression is that she is smart and energetic, and is a devoted parent. Unfortunately, she did not have a chance to go to college.

My neighbor made a couple recent decisions in her life based on sound economic calculus. She is not thrilled with these decisions but based them on practical considerations of what is best for her family.

First, she is not looking for a new job. For her, working does not equal health insurance and food on the table. As Samples explained, unless she makes over $33,500, replacing her health insurance (with a private plan with deductibles and copays), as well as her food stamps, will wipe out her take-home pay. And she adds another cost factor in her equation — child care. The average annual cost of child care in West Virginia is $728 per month.

Second, she told me she is not getting married again because the new “household” income with her boyfriend’s wages in the mix could knock her off Medicaid. Medicaid eligibility for a household of three is only $30,305 a year. Again, she fears the “Medicaid cliff.”

For my neighbor, the net economic impact of a job or marriage is negative. And she risks losing her health coverage. This mom’s decisions are smart; it’s the policies that are crazy.

West Virginia can begin to fix these policies. Delegate Evan Worrell, R- Cabell, introduced House Bill 3001 last year and is reintroducing a similar bill this year. The legislation would create a Medicaid buy-in, so someone like my neighbor can pay a small, sliding-scale premium to keep Medicaid or similar coverage and not fall off the Medicaid cliff.

Most, if not all, of the cost of this program would be paid for with federal money. I will spare you all the details of federal Medicaid and Affordable Care Act waivers. There is every reason to believe that the current administration would green-light such a program.

The state already has the Medicaid Work Incentive for people with disabilities. According to the DHHR, this program “assists individuals with disabilities in becoming independent of public assistance by enabling them to enter the workforce without losing essential medical care.”

Worrell’s bill would expand the state’s workforce by helping more people like my neighbor recalculate their back-to-work equation and get on the path toward financial independence. And she might plan a wedding.

Kathleen Stoll is policy director for West Virginians for Affordable Health Care ( and operates a policy and economic consulting business, Kat Consulting.