Who Will Qualify For Medicaid Under Expansion
With enrollment for the new Health Insurance Marketplace just around the corner and the full implementation of the Affordable Care Act hot on its heels, I wanted to take a moment to consider who will qualify for Medicaid under expansion in West Virginia.
Medicaid is a health program designed to provide comprehensive health and dental insurance for the poor. These are people who otherwise are most likely uninsured and unable to afford to see a doctor. Currently, the requirements to qualify for Medicaid in West Virginia are very stringent . Therefore, most Medicaid enrollees are children, the elderly, and the disabled. A healthy, non-elderly, childless adult cannot qualify for Medicaid in West Virginia under any circumstance, no matter how poor he or she is.
Last month, however, Governor Tomblin announced that West Virginia would be joining at least twenty other states in expanding the Medicaid program to insure more people. Beginning on January 1, 2014, the eligibility standards will change significantly. With the dependent child requirement dropped and increased income limits, virtually any legal resident making less than 138% of the federal poverty level will qualify for Medicaid coverage .
So what exactly does this mean? Put simply, a lot more people will gain health insurance.
Systems Of Care Evaluation
In 2019, the West Virginia Department of Health and Human Resources Bureau for Behavioral Health was awarded a four-year System of Care Expansion and Sustainability grant through the Substance Abuse and Mental Health Services Administration to implement improvements in child mental health services across the state. The focus of this program is to create and implement a comprehensive evaluation of the SOC grant in WV. This work will enable the WV DHHR to assess the implementation of evidence-based approaches to childrens mental health care in WV and improve service access and delivery, ultimately improving outcomes for youth and families, while also reducing costs associated with mental health services.
Important Changes Coming To Wv Medicaid & Chip Eligibility Review/renewal
Adapted from the Centers for Medicare & Medicaid Services
Do you or a family member currently have health coverage through Medicaid or the Childrens Health Insurance Program ? If so, you may soon need to take steps to prove eligibility so that you can continue your coverage. During the COVID-19 pandemic, Medicaid and CHIP eligibility reviews were halted so that recipients did not lose their health insurance coverage. Soon, states will resume their normal eligibility review procedures.
To avoid gaps in coverage, here are some things you can do to prepare:
- Make sure your address is up to date
Make sure the WV DHHD has your current mailing address, phone number, email, or other contact information. This way, theyll be able to contact you about your Medicaid or CHIP coverage. To check your contact information, go to WVpath.org or call WV DHHR Customer Service Center at or email .
- Check your mail
The state will mail you a letter about your Medicaid or CHIP coverage. This letter will also let you know if you need to complete a renewal form to see if you still qualify for Medicaid or CHIP. If you get a renewal form, fill it out and return it to the state right away. This may help you avoid a gap in your coverage.
What if you no longer qualify for Medicaid or CHIP?
- Affordable. 4 out of 5 enrollees can find plans that cost less than $10 a month.
- Comprehensive. Most plans cover things like prescription drugs, doctor visits, urgent care, hospital visits, and more.
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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.
West Virginia Medicaid Expansion
With the Affordable Care Act in 2010 came a major West Virginia Medicaid expansion that resulted in a 21% decline in the amount of uninsured West Virginians. The expansion allowed people living at up to 138% of the Federal Poverty Level to have access to Medicaid . This allows people who are employed and earning too much to qualify for Medicaid but still not making enough to cover healthcare to have coverage.
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Substance Use Disorder Prevention That Promotes Opioid Recovery And Treatment Fore Patients And Communities Grant
SUPPORT is a demonstration grant to increase provider capacity in West Virginia for substance use disorder treatment, particularly for pregnant and post-partum women and their children, youth and transition age , and rural populations. In 2017, WV led the nation in opioid overdoses. Although WV continues to see high rates of opioid use disorder and polysubstance use disorder, great strides have been made in treating the disorders through medication assisted treatment . This work will raise awareness of MAT effectiveness, identify gaps in and barriers to MAT as well as all substance use disorders and behavioral health related services, and develop strategies for reaching more people with higher quality treatment and recovery services.
Contact A Knowledgeable Cabell County Lawyer For Assistance With Medicaid Planning
Herrenkohl Law Office assists West Virginia clients who are seeking to establish and maintain eligibility for Medicaid benefits. Please call 304-948-5860 or contact me online to make an appointment with an experienced attorney serving the Huntington area. My offices are in Barboursville and Beckley.
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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.
West Virginia Medicaid Enrollment Numbers
As of mid-July 2014, there were 132,556 new West Virginia Medicaid enrollees who were newly eligible under the expanded guidelines. Although most of the newly-eligible population enrolled during the first year, the number of newly eligible enrollees had grown to 164,400 by June 2015, and to 178,394 by August 2016. Enrollment in expanded Medicaid declined slightly by the beginning of 2017, to 174,026, and declined further, to 153,874 by December 2018. It had stabilized by that point, and stood at 156,775 as of November 2019.
But the COVID pandemic has increased the number of people enrolled in Medicaid nationwide, particularly in states that have expanded Medicaid. As of mid-2021, West Virginias Medicaid expansion covered 189,640 people.
In 2013, the Kaiser Family Foundation estimated that about 143,000 people in West Virginia would be newly-eligible for Medicaid as of 2014. But the states estimate had been much lower, with a projected expansion enrollment of 93,000 by 2020.
Overall, West Virginias Medicaid enrollment was 588,279 as of July 2021. Note that this figure includes CHIP enrollment.
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The Wv Medicaid Formulary And Prescription Drug Coverage
The West Virginia Medicaid program has a comprehensive prescription drug program. The drugs on the preferred drug list will act as your formulary. Youll also find information about prior authorization, meaning that there are certain drugs that you will need to have Medicaid approve before you retrieve your prescription at the Medicaid rate.
Where Can Medicare Beneficiaries Get Help In West Virginia
West Virginia State Health Insurance Assistance Program
Free volunteer Medicare counseling is available by contacting the West Virginia State Health Insurance Assistance Program at 1-877-987-4463.
The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors may also be able to provide referrals for home care agencies or long-term care services. The SHIPs website has more information about the services it offers.
Elder law attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys has a search feature beneficiaries can use to find an elder attorney locally.
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Dedicated Attorney Takes Steps So Seniors Can Qualify For Nursing Home Care
Low-income individuals who believe they will require Medicaid to pay for serious expenses such as in-home care or residence in a nursing facility should take steps to maximize the likelihood of receiving benefits. Many people must shift ownership of some property in order to move below the $2,000 asset limit. This process is sometimes referred to as a spend down. My elder law firm conducts a thorough review of clients financial circumstances and advises on how gifts, trusts and other methods of asset reduction can help them qualify for benefits. I also show clients how using available funds for healthcare-related expenses might also serve their long-term interests.
Community Health Needs Assessments
As a result of the Patient Protection and Affordable Care Act, the Internal Revenue Service requires all non-profit hospitals in the state to conduct Community Health Needs Assessments to determine the public health needs of the communities in which they provide services. Every three years, hospitals gather input from community members and service providers in order to summarize these needs into a formal assessment and create a Community Health Implementation Plan that shows how they can address these issues as a non-profit entity. West Virginia University conducts these needs assessments for several hospitals and hospital systems in West Virginia and the surrounding region.
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Find A $0 Premium Medicare Advantage Plan Today
For California residents, CA-Do Not Sell My Personal Info, .
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.
The purpose of this communication is the solicitation of insurance. Callers will be directed to a licensed insurance agent with TZ Insurance Solutions LLC, TruBridge, Inc. and/or a third-party partner who can provide more information about Medicare Advantage Plans offered by one or several Medicare-contracted carrier. TZ Insurance Solutions LLC, TruBridge, Inc., and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.
The Cost Of West Virginia Medicaid
Some beneficiaries will be charged small co-payments for some services*. Pregnant women, kids under 21, and Native Americans are exempt from co-payments. There are no co-payments required for long-term care, hospice, family planning, breast and cervical cancer treatments, or emergency services. Co-payments will never exceed 5% of your household income. They usually range between $0 and $4 for doctor or specialist services and up to $75 for hospital services.
There are out-of-pocket maximums based on your income and the Federal Poverty Level :
- Tier 1: Up to 50% of the FPL Max $8 out-of-pocket
- Tier 2: 50-100% of the FPL Max $71 out-of-pocket
- Tier 3: At or above 100% of the FPL Max $143 out-of-pocket
*Co-payments for prescription drugs are the same for everybody and will range from $0 to $3.
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Medicaid Income Eligibility Chart For 2022
If you are looking into applying to receive Medicaid, whether it is for the first or hundredth time, your eligibility is decided based on your income. However the income eligibility can change from year to year, depending on the economy and what sort of care you require.
The Medicaid Income Eligibility chart is a tool for determining if your income falls under the limit, depending on if you need regular medicaid or Medicaid for long-term nursing care. All you need to do is find the listings for your state, line that up with the care you need, and then you will see the income limit for both single and married applicants.
If you are looking for an overview of the Medicaid Income Eligibility Chart regarding your situation, this is the article you need to read. Here, I will be providing all of the information for each state, type of care, and marital status for those who are trying to learn the facts. Read on to get more information about the benefits that are available to you!
West Virginia Medicaid Benefits
Services include but are not limited to inpatient and outpatient hospital care, nursing home care, physician services, laboratory and x-rays, immunizations and other early and periodic screening, diagnostic, and treatment services for children, family planning, health centers and rural health clinics.
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Medicare Premium Assistance Programs
- https://dhhr.wv.gov/bcf/Services/familyassistance/Pages/Medicare-Premium-Assistance-Programs.aspx
- Eligiblity: Income Limit. â¢100% of the Federal Poverty Level. Asset Limit. â¢$6,680 Individual. â¢$10,020 Couple. Specified Low-Income Medicare Beneficiary Medicaid coverage is limited to payment of the Medicare, Part B, premium. The SLIMB applicant/recipient may be a recipient of other Medicaid coverage.
How To Qualify For Medicaid
Almost every state has multiple Medicaid programs. But, as a good rule of thumb, if you make less than 100% to 200% of the federal poverty level and are pregnant, elderly, disabled, a parent/caretaker or a child, theres likely a program for you. And if you make less than 133% of the FPL**, theres possibly a program for you, depending on whether your state expanded Medicaid under Obamacare. In 2021, the federal poverty levels range from $12,880 to $44,660 .
In 2021, the federal poverty level in Alaska ranges from $ $16,090 to $55,850 . The federal poverty level in Hawaii ranges from $14,820 to $51,360 .
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Substance Use Disorder Waiver Evaluation
The Centers for Medicare and Medicaid Services granted the West Virginia Department of Health and Human Resources Bureau for Medical Services a 1115 Waiver for the states Medicaid program that has enabled new types of substance use disorder treatment. To ensure compliance with CMS federal guidelines, the Office of Health Affairs is developing an evaluation plan that focuses on examining measures of SUD-related morbidity and mortality before and after waiver implementation. The team is using a differences-in-differences design with data from a control state that will provide both real-time and long-term feedback for the project and measure processes and outcomes.
West Virginia Has Accepted Federal Medicaid Expansion
- 588,279 Number of West Virginians covered by Medicaid/CHIP as of July 2021
- 233,735 Increase in the number of West Virginians covered by Medicaid/CHIP fall 2013 to May 2021
- 54% Reduction in the uninsured rate from 2010 to 2019
- 66% Increase in total Medicaid/CHIP enrollment in West Virginia since Medicaid expansion took effect
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How Does West Virginia Regulate Long
Medicare beneficiaries increasingly rely on long-term services and supports or long-term care which is mostly not covered by Medicare. Twenty percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015, and the portion of beneficiaries who will need these services will continue increasing as the population ages.
Medicaid fills this gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. Whats more eligibility rules vary significantly from state to state.
Medicaid nursing home coverage in West Virginia
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married .
When only one spouse needs Medicaid, the income limit for single applicants is used and only the applicants income is counted.
However, this income limit doesnt mean an applicant can keep all of their income up to the limit. Nursing home enrollees must pay nearly their entire income toward their care, other than a small personal needs allowance and money to pay for health insurance premiums .
Assets limits: The asset limit is $2,000 per applicant. If only one spouse needs Medicaid, spousal impoverishment rules allow the other spouse to keep up to $126,800.
Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car. Applicants are also not allowed to have more than $595,000 in home equity.
Uncompensated Care Costs Decline Sharply
According to data compiled by West Virginians for Affordable Health Care, hospitals in West Virginia saw a 40% decline in uncompensated care costs from 2013 to 2014, thanks in large part to Medicaid expansion that resulted in far fewer uninsured residents in the state.
But although the hospitals acknowledge that their uncompensated care and charity care costs have declined significantly, some also note that Medicaid reimbursements are less than the cost of providing care, and that their losses on Medicaid volume are offsetting the improvements theyve seen in uncompensated care.
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