West Virginia is the latest state deciding to expand Medicaid eligibility under the Affordable Care Act, opening the state-federal insurance program to an additional 91,500 low-income residents, while also expanding managed care.
"At the end of the day we have weighed the options and believe expanding Medicaid is the best choice for West Virginia," Governor Earl Ray Tomblin, a Democrat, said at a press conference at Saint Francis Hospital in Charleston.
"In a state where heart disease, diabetes and other chronic health conditions occur at levels far too high, this expansion has the potential to provide meaningful improvements to the health of our citizens, to help maintain existing federal support for assistance programs, open the door to more economic development rooted in healthcare and lessen the cost of healthcare as a whole."
Tomblin did caution in a press release that "If the program becomes unsustainable, particularly after three years, or the federal government changes its promised funding allocations, we must be prepared to take action to protect our State."
Tomblin said the cost to West Virginia for the first three years would be about $15 million, with the federal government covering most of the cost of expansion. After federal support drops to 90 percent for the expanded population, the Tomblin administration estimates it would cost the state an additional $65 million a year, while drawing about $5.2 billion in additional federal funding over the next decade.
With close to one in four West Virginians on Medicaid and the program already accounting for more than 20 percent of the state's budget, long-term cost concerns are certainly heavy on Tomblin's mind. In his fiscal year 2014 budget proposal he called Medicaid the "state's largest budget driver," with the state is set to spend $880 million (and the federal government $3.1 billion).
At the same time, Tomblin said, there are costs associated with not expanding and leaving working class residents uninsured. More employers could be fined for not offering insurance to West Virginians who will now be covered through Medicaid, and hospitals will also likely see a decrease in uncompensated care.
As part of eligibility expansion, Tomblin wants to expand managed care for both current and new Medicaid members, particularly in the state's current fee-for-service behavioral and mental health programs.
Tomblin also wants to create a sliding-scale cost-sharing system for Medicaid members, to "curb inappropriate utilization," "encourage personal responsibility" and create a "larger degree of parity with private market," as he said in a presentation.
West Virginia is the 20th state, along with Washington D.C., to expand Medicaid under the ACA. The Appalachian state is also pursuing a partnership insurance exchange with the federal government.