West Virginians for Affordable Health Care submitted comments in strong opposition to the proposed Medicaid Fiscal Accountability Regulation package in its entirety and urges CMS to not move forward with finalizing any aspect of these regulations. There is no question that these proposed regulations will put West Virginia at risk of losing what has been long-accepted ways to raise state funds for our Medicaid program and reimbursing participating providers. The proposed regulations will create vague, unnecessary and misguided restrictions on how West Virginia can raise state raise revenues to cover the state share of the cost of our Medicaid program. This uncertainly will lead to cuts in eligibility, benefits and/or provider rates, which will lead to more uninsured and under-insured West Virginians, and in turn, an increase in uncompensated care costs for our rural health providers and lead to health facility closures. Thus, these proposed regulations will harm the low-income population of West Virginia families who rely on Medicaid for health care, West Virginia rural health providers, and all West Virginians who utilize those providers.