West Virginia Medicaid Eligibility And Enrollment
- Are you thinking of applying for Medicaid in West Virginia? Learn everything you need to know about the eligibility criteria, whats covered and how to apply.
As of September 2020, Medicaid in West Virginia provided health care to more than 541,000 people through Medicaid and CHIP programs. The state aims to provide Medicaid to 550,000 residents and has broad eligibility categories to help accomplish this goal. All low-income residents of West Virginia who are struggling to pay for health care may be able to access assistance through West Virginia Medicaid.
Medicaid Expansion Helping To Combat Opioid Crisis
The opioid crisis has hit West Virginia particularly hard, and the state has the nations highest drug overdose death rate. About 22,000 people covered under expanded Medicaid had received treatment for mental health and substance abuse disorders by early 2017. Without Medicaid expansion, most of those people would have been uninsured and unable to access treatment.
Behavioral Health Homes In West Virginia
The first WV Health Home started in July of 2014 in southern West Virginia. It is a Behavioral Health Home with a focus on bipolar WV Medicaid beneficiaries who have a high risk of developing Hepatitis B or C. There are now Behavioral Health Homes available all across the state of West Virginia.
The Behavioral Health Home provides individualized, well-managed treatment options. West Virginia Behavioral Health Homes coordinate care by referring you to the best community and social support services , promoting a healthy lifestyle, and providing transitional care for when you are transitioning between providers or moving from a facility back to your home. Health Home services come at no cost to eligible Medicaid beneficiaries.
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Medicaid In West Virginia
- Over 564,000 people in West Virginia are covered by Medicaid , making West Virginia the state with the highest share of its population enrolled in Medicaid.
- Three-fourths of enrollees are children and adults, but nearly two-thirds of the states Medicaid spending is for the elderly and people with disabilities.
- 87,200 of West Virginias Medicare enrollees are also covered by Medicaid, which accounts for over a third of Medicaid spending.
- 53% of all children in West Virginia are covered by Medicaid, including 56% of children with special health care needs.
- 76% of nursing home residents in West Virginia are covered by Medicaid and 41% of Medicaid long-term care spending is for nursing home care. Medicare beneficiaries rely on Medicaid for assistance with services not covered by Medicare, particularly long-term care.
- Nearly half of people in West Virginia live in rural areas. People who live in rural areas are more likely to be dependent on Medicaid.
- West Virginia has the second lowest per capita income in the country and therefore one of the highest federal Medicaid matching assistance percentage at 73%. For every $1 spent by the state, the Federal government matches $2.55. Over three-fourths of all federal funds West Virginia receives are for Medicaid. In Calendar Year 2017, the federal match rate for the Medicaid expansion population is 95%.
Expansion Under The Affordable Care Act
The Affordable Care Act provided for the expansion of Medicaid to cover childless adults whose income is 138 percent of the federal poverty level or below. The provision for expanding Medicaid went into effect nationwide in 2014. As of November 2018, a total of 36 states and Washington, D.C., had expanded or voted to expand Medicaid.
West Virginia expanded Medicaid under the Affordable Care Act in 2014. Former GovernorEarl Ray Tomblin supported Medicaid expansion, but stated that he would “carefully watch federal efforts” for changes in funding and remain “prepared to take action to protect our State.” Governor Jim Justice also expressed support for the expansion in 2017 when he stated, “We cant put the 175,000 West Virginians who benefit from the Medicaid expansion at risk of losing coverage. … The consequences would be beyond catastrophic,” in reference to the 2017 U.S. Senate healthcare bill.
Arguing in support of the expansion of Medicaid eligibility in an April 2013 article, the Center for American Progress states that the expansion helps increase the number of people with health insurance and benefits states economically. The organization argues that by providing health insurance to those who would otherwise be uninsured, Medicaid expansion allows low-income families to spend more money on food and housing:
Who’s Eligible For Medicaid For The Aged Blind And Disabled In West Virginia
Medicare covers a great number services including hospitalization, physician services, and prescription drugs but Original Medicare doesnt cover important services like vision and dental benefits. Some beneficiaries those whose incomes make them eligible for Medicaid can receive coverage for those additional services if theyre enrolled in regular Medicaid benefits for the aged, blind and disabled.
Regular Medicaid for the aged, blind and disabled benefits dont ordinarily cover Long Term Services and Supports , but community-based LTSS services are available to beneficiaries whose medical and financial situation makes them eligible for a Home and Community Based Services waiver.
Medicaid ABD also does not cover routine vision care for adults in West Virginia.
This program is called SSI-Related Medicaid in West Virginia.
Income eligibility: The income limit is $783 a month if single and $1,175 a month if married.
Asset limits: The asset limit is $2,000 if single and $3,000 if married.
Medicaid spend-down for regular Medicaid for the aged, blind and disabled benefits in West Virginia
Individuals with incomes too high to qualify for Medicaid benefits for the aged, blind and disabled can enroll in the Medicaid spend-down in West Virginia.
Medicaid Expansion States See Better Health Outcomes Study Finds
Newly published research makes the case that a smaller share of low-income adults in Southern states that expanded Medicaid under the Affordable Care Act experienced declines in their physical and mental health than did their counterparts in Southern states that did not expand.
Health care policy experts and physicians have suspected this for a while, but with our study, we now have the actual evidence showing that non-expanding Southern states could materially improve population health if they accept expansion funds, said John Graves, lead author of the study and an associate professor in health policy at Vanderbilt University School of Medicine, to WKNO radio near Memphis, Tennessee. The study was published in this months issue of the journal Health Affairs.
For several years, researchers have tried to determine what impact expanding Medicaid, a central feature of the ACA, was having on health outcomes. While studies have consistently demonstrated that expansion had improved access to health care and reduced financial strain on low-income populations, data on the health impact was less clear. While some published studies found some improvements, the majority detected none.
The new study, which Graves conducted with researchers at Harvard Medical School, may be the most comprehensive while addressing the limitations of previous work.
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Apply For Obamacare: Health Plans And How Much You Will Pay
When shopping in the West Virginia Obamacare Marketplace, you will find four primary health plans to can choose from: Bronze, Silver, Gold, and Platinum. These plans each have a different percentage of healthcare costs they will pay for over the course of a coverage year the remaining percentage is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. Think about it this way: If the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay the remaining 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount of healthcare services each plan pays for:
- Bronze Plan 60%
Need West Virginia Obamacare Insurance? Get a quote.
What Is At Risk Under A Per Capita Cap
- Capping Medicaid funding would reduce the federal assistance for West Virginia to maintain its current Medicaid program.
- Under the Better Care Reconciliation Act of 2017 , to maintain its current Medicaid program, West Virginia would have to make up $3.4 billion in loss of federal funds between 2020-2029, including $1.5 billion for the phase-out of the enhanced match for the ACA expansion and $1.9 billion for the per enrollee cap on all groups.
- If West Virginia dropped the Medicaid expansion in response to the loss of enhanced federal financing, the state would forgo an additional $7.6 billion over the 2020-2029 period, and by 2029, 227,000 West Virginians estimated to be covered in the expansion group would lose Medicaid coverage.
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West Virginia Is A Medicaid Leader State
Hoping Senator Manchin Continues the Tradition of Caring About Our Families
There has been a lot of hand-wringing across the country about our Senator Manchin and the Build Back Better legislative package in Congress. There is no question that Senator Manchin has the future of Build Back Better in his hands. Will he vote for this package of family supports? Only Joe knows.
I have been on national conference calls ad nauseum calling on West Virginians to influence our Senator. And I can document that West Virginians have sent thousands of calls to his office expressing support for Build Back Better. We have shared the stories of West Virginia families who will benefit from Build Back Better at media events. We have written opinion editorials and letters to the editor. West Virginians even took their kayaks to Washington to encircle the Senators yacht.
So you can imagine how my hackles rose when a colleague from another state asked me, What is wrong with West Virginia?
Even as Senator Manchin holds the fate of Build Back Better in his hands, I want to point out that West Virginia has some bragging rights when it comes to caring about our families and children.
Guess what. West Virginia already passed a law last year to get special permission from the feds to extend postpartum Medicaid coverage. It had bipartisan support in our legislature.
You guessed right. West Virginia already has this policy in place.
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Where Can I Apply For Medicaid In West Virginia
An in-person interview is always required when applying for long-term care benefits, and some states also require one for Medicaid ABD. However, interviews are not required for applicants who are only seeking an MSP.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive.
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Mountain Health Trust And The West Virginia Health Bridge Alternative Benefit Plan
Mountain Health Trust and the West Virginia Health Bridge Alternative Benefit Plan are the managed care organizations for the West Virginia Medicaid program. Once accepted into the program, you will receive a packet in the mail which will tell you which MCO program you are in. The main differences between the two programs are a few coverage limits. For example, the Health Bridge program does not include nursing home coverage and has a limit of 24 chiropractic treatments per year. On the other hand, the Health Bridge program allows for 30 physical and occupational therapy visits per year instead of the traditional 20, and 100 home health visits instead of 60. Whichever program you qualify for, you will receive detailed information about your coverage limits in the mail upon your acceptance.
West Virginia And The Aca
As federal government officials have been progressively working to undo and/or replace ACA legislation, many states have been doing what they can to cling on to ACA regulation. They have done so by passing new state laws that bolster what other lawmakers have changed or removed.
However, West Virginia has done little to maintain the policies of the ACA for its citizens. In fact, state officials have been actively working against it. Lawmakers of several states, including West Virginia, have done this by filing a series of lawsuits under the thesis that the ACA is unconstitutional. At the same time, the West Virginia government has been trying to create its own healthcare plan, called the West Virginia Healthcare Continuity Act, to prepare in case the ACA is repealed at some point. Progress of these lawsuits and this new legislation are ongoing and will be worth keeping track of.
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West Virginia Medicaid Income Limit Charts
The West Virginia Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in West Virginia who qualify for Medicaid.
West Virginia Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
|West Virginia Medicaid Income Limit Children
|Children Medicaid Ages 0-1
How to Read the West Virginia Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 185% of the Federal Poverty Level which for a family of two is $32,227 as shown in the chart above.
Substantial Impact On Uninsured Rate
Expansion of Medicaid has played a primary role in West Virginias sharp reduction in the uninsured rate.
West Virginia had the sixth highest drop in uninsured rate during the first half of 2014, due primarily to Medicaid expansion.
According to U.S. Census data, the states uninsured rate was 14% in 2013, and had fallen to 5.3% by 2016. But it had increased to 6.7% by 2019, however, mirroring the nationwide trend of increasing uninsured rates under the Trump administration.
West Virginias uninsured rate had been similar to the U.S. average in 2013, but the states uninsured rate in 2019 was well below that national average at that point, which was 9.2%. West Virginias better-than-average performance in reducing the uninsured rate was due in large part to the expansion of Medicaid.
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When Hospitals Close Communities Lose Jobs
In many circumstances, hospital closures result in lost access to critical care for local communities. The consequences of closures or reductions in services can be a matter of life or death for people who live nearby.
But closures can also result in mass-unemployment and accelerated financial decline.
A 2019 review of employment figures found that hospitals or health care adjacent companies were the top employers in 17 states, including West Virginia, and a 2017 study by the West Virginia Center for Budget and Policy estimated the elimination of the ACA would result in the loss of at least 16,000 jobs in West Virginia.
Big sweeping changes to hospital finances have spillover effects that have broader economic impacts, Sommers said.
West Virginians have already felt those impacts.
The closure of a hospital in Wheeling in 2019 resulted in the third largest layoff by a single employer in the last 10 years, according to data from layoff notices submitted to the state. More than 700 people lost their jobs.
Earlier this year, a Marion County hospital closed, and more than 500 jobs were lost. Local officials worried that the absence of medical care would cause further economic instability and hurt attempts to attract new residents.
You cant have a county without a hospital and expect people to move in, said Delegate Michael Angelucci, a Marion County Democrat, when the hospital closed in March.
She said were the ACA to be repealed, the number of uninsured would compound.
Previous And Current Governor Support Medicaid Expansion
West Virginias former Governor, Earl Ray Tomblin, was instrumental in West Virginias acceptance of Medicaid expansion but was term-limited and could not seek re-election in 2016.
Governor Jim Justice took office in January 2017. He campaigned and was elected as a Democrat, but in the summer of 2017, during his first year in office, he switched to the Republican party. Justice reiterated his support for Medicaid expansion in the weeks leading up to his party switch, stating in late June 2017 that it would be beyond catastrophic if the people who had gained coverage under Medicaid expansion were to lose it. But Justice also vetoed a supplemental appropriation for the states Medicaid program in 2019, saying that the Medicaid program already had enough funding.
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