2021 Health Agenda

Quality, comprehensive, affordable health care is essential for the economic and social success of all West Virginia families.  Children are our state’s future and we must invest in their physical and mental health so that they succeed in both school and life.

While there is often partisan gridlock at the federal level, there is ample opportunity for bipartisan investments to expand access to affordable health care at the state level.

First and foremost, we must acknowledge that Medicaid is a critical health care safety net for a third of West Virginians.  The COVID-19 crisis has driven home the value of the Medicaid program for our state.  Indeed, with its flexibility to adapt to emergencies and meet new health services demands, it has been the single most critical tool in our state’s response to the pandemic.  If West Virginia reduces spending on Medicaid and forces cuts to essential benefits or eligibility, we will hurt not only families who rely on Medicaid to help them face physical and financial health hurdles, but also our rural hospitals and state economy. 

Medicaid is one of West Virginia’s most effective tools to stimulate West Virginia’s economy as we recover from the negative economic impact of COVID-19.  When we invest state funds in Medicaid, we draw down significant new federal Medicaid matching dollars that would otherwise be left on the table. In response to COVID-19, the federal government increased the federal match level to infuse even more federal dollars to increase our state health response capacity. This injection of new federal dollars creates a multiplier effect generating new jobs and business activity in every sector of West Virginia’s economy.

As such, we oppose any efforts to cut Medicaid spending, limit Medicaid federal dollars available to our state, or cut eligibility and benefits.  To do so would harm both West Virginia’s families and our state economy.  We support adequate reimbursement for all Medicaid providers.

Second, no state benefits more from the federal Affordable Care Act (ACA) than West Virginia. The ACA’s consumer protections from insurance company discrimination and the over $1 billion dollars annual federal investment to help West Virginians afford health care and coverage cannot be replaced at the state level.  Without the ACA, West Virginia would lose federal matching dollars for the Medicaid expansion providing coverage to more than 150,000 West Virginians.  ACA consumer protections against health insurance company discrimination would be eliminated including pre-existing condition protections. Every West Virginian could then be denied private health insurance coverage or pay higher premiums for care/treatment based on their health status – including a history of COVID-19.

Therefore, we ask that our state legislature demand that Attorney General Morrisey withdraw West Virginia as a plaintiff to the ACA repeal lawsuit, Texas v United States, and join our state as a defendant on the other side of the lawsuit to fight to preserve the ACA for West Virginians.

Third, we remain dedicated to addressing racial equity in health.  Our commitment to health justice for all West Virginians regardless of income, race, or other factors guides us as we identify the issues that we prioritize for advocacy.  The COVID-19 crisis has amplified in our health system the long-standing health inequities that manifest along race lines as less access to health care, inferior quality of care, race biases in health research, and ultimately, poorer health outcomes.  Health inequities arise due to structural racism that manifests at multiple levels, including both what a person of color may have experienced before entering the health system, and their experiences within the health system.

Fourth, West Virginia can only move forward as a state when we invest in all families through initiatives that reduce the cost of health coverage, necessary care, and prescription drugs, and enable all our families to remain healthy.  We support continued initiatives to address social determinants of health such as food security and housing assistance in all health care and coverage programs, and to expand the use of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and other Medicaid supports for prevention and early intervention to help children and youth and strengthen families.  In the same way that West Virginia demonstrated how to quickly and proactively respond to the COVID-19 threat, our state now needs to show the country how we can be a “leader state” and create a more affordable, universal health care system for our families.

We call on the Senators and Delegates of the West Virginia Legislature to work together to:

Create a Children’s Health Insurance Choice program to close children’s coverage gaps

All children need access to comprehensive health coverage, but there are still children in West Virginia who are not covered. This program would allow families to choose the CHIP insurance plan who do not have access to affordable private coverage.  It would allow families with incomes in excess of CHIP eligibility to purchase comprehensive insurance for their children with lower out-of-pockets costs (copayments, coinsurance and deductibles) more affordable premiums than currently available in the private market.

Create a New Choice health insurance program to provide adult West Virginians with an additional affordable, quality plan option

A New Choice program would provide adult West Virginians who currently do not have access to affordable health coverage a new, more affordable, quality health insurance plan option.  The plan would cover a comprehensive set of benefits and have low deductibles and copays.  The New Choice program would ensure affordable health coverage for more low-wage workers who are hurt by the Medicaid “cliff effect” – those that earn over Medicaid income eligibility levels but do not have an offer of affordable health insurance through their jobs and cannot afford the premiums and out-of-pocket costs of a private individual plan. Utilizing Medicaid administrative efficiencies and purchasing power, the plan would cost less per person than existing individual market plans.  Lawmakers could explore funding streams for subsidizing the plan to make the premiums even more affordable including pulling down existing federal premium subsidies or considering a state-level funding mechanism.

A Medicaid-to-work transition program already exists in West Virginia but only for people who are disabled or who have a chronic health condition:  the Medicaid Work Incentive (M-WIN) program.

Expand Medicaid coverage to one year postpartum for women up to 300 percent of the Federal Poverty Level In 2018, the West Virginia Legislature made huge strides for women and families by passing SB 564, expanding coverage for pregnant women at higher income levels for 60 days postpartum. However, postpartum health needs and conditions can continue long after the first 60 days, and continued Medicaid coverage is vital for parents who are receiving treatment for ongoing health conditions such as diabetes or substance use disorders. For women enrolled in Medicaid during—and based on—pregnancy, the postpartum period can be particularly ominous for their health. Providing 12 months of continuous coverage after the end of pregnancy can improve maternal mortality, enhance long-term family health, and address racial inequities.  Expanding coverage to one year postpartum is estimated to cost less than $1 million per year in state dollars.

The United States is the only industrialized nation with a maternal mortality rate that is on the rise, increasing by 26 percent between 2000 and 2014. And across the nation and in West Virginia, there are the stark racial disparities in maternal mortality: Black women are three to four times more likely to die from a pregnancy-related complication than non-Hispanic white women. Data from the Centers for Disease Control and Prevention confirm that roughly one-third of all pregnancy-related deaths occur one week to one year after a pregnancy ends.

Expand the vision care benefit for Medicaid-enrolled adults 

Vision care is critically important to everyone – to see to fill out a job application, to follow a boss’ written instructions, to help their children do homework, and to follow a prescription drug’s directions, for example. In West Virginia, Medicaid only covers an eye exam if it is part of care for a larger vision health concern, such as diabetes. If an adult enrollee needs corrective lenses, one is covered only if a cataract extraction has taken place within the last 60 days. Expanding this benefit, similar to the expansion of dental care passed by the legislature in 2019, will include routine annual eye exams, glasses or contacts to correct vision, and any other needed vision services would help adult Medicaid enrollees function more safely in their homes, as parents taking on new teaching roles, and in workplaces.

Expand Medicaid coverage of assisted living as a lower-cost alternative to nursing home care

Expanding Medicaid coverage of room and board at an assisted living community facility – for Medicaid enrollees who do not need the higher level of care provided in a nursing home – would save West Virginia money and provide a new residential option for people with disabilities and for seniors who need some help to safely engage in activities of daily living.  For these enrollees, the option provides a more independent and active quality of life.

West Virginia, through its Medicaid Personal Care option, pays for personal care for state residents in their place of residence, be that in their own homes, the homes of other family members, and in some instances, in an assisted living community facility, or in adult family care homes. If the care is provided in an assisted living residence or adult family care home, no funds from this program can be put towards the cost of room and board.  For Medicaid to cover room and board, an enrollee must move to a skilled nursing facility (nursing home).

Assisted living facility charges are much less than the charges for nursing home care. In West Virginia, the cost of a nursing home private room averages $11,000/month, and for a semi-private room $10,300/month. In West Virginia in 2019, the average cost of assisted living is $3,619 month statewide, though the cost ranges anywhere from $3,210 / month on the low end to $4,357 / month on the high end.

Make permanent critical expansions of Medicaid telehealth services

In response to the COVID-19 pandemic, West Virginia and states across the country moved quickly to create more flexibility for telehealth to be used in state Medicaid programs.  Under West Virginia’s 1135 COVID-19 Medicaid Emergency Waiver, telehealth visits can be reimbursed for all services.  Telephone visits are reimbursed at the same rate as telehealth video visits, which is critical for our state given its many areas with poor internet connectivity.

A key goal of telehealth is to improve health equity - both access to and quality of care in rural areas and for lower-income families.  West Virginia should move forward to permanently adopt many COVID-19 emergency Medicaid telehealth policies.  The state should also explore how to adapt the emergency policies so that they best serve the needs of both patients/consumers – including people with disabilities - and providers.  We want to make telehealth as user-friendly, navigable and accessible to as many West Virginians as possible. We do not want to inadvertently disincentivize in-office care when most appropriate.

Address Health Disparities by Creating a Minority Health Advisory Team

Structural and racial inequities in our health system leads to disparate outcomes faced by Black West Virginians and other communities of color. The COVID-19 pandemic has only magnified long standing issues. Statewide, Black residents make up 3.6 percent of the total population but account for 7.2 percent of all COVID-19 cases due to longstanding structural health and economic inequities. Additionally, Black residents are more likely to suffer from diabetes, three to four times more likely to die in childbirth than white residents, and more likely to live in poverty than white residents.

For several years, Black leaders have been working to enact a state Minority Health Advisory Team, which would collect data on health disparities and authorize funds for Community Health Equity Initiative Demonstration Projects. Never has the need been more apparent for the state to take concrete steps to address structural inequities faced by low-income and Black West Virginians in our health system.

Improve how Medicaid addresses non-medical factors that impact the health of Medicaid-enrolled families

Housing, transportation, education, social isolation, and other non-medical factors affect access to care and health care utilization as well as outcomes. Addressing these non-medical needs improves the ability for low-income individuals to comply with medical treatment instructions and lead healthier lives. We recommend that Medicaid consistently screens all enrollees for non-medical needs and that the Medicaid program reimburses Medicaid managed care organizations for linking enrollees to community-based services and provides Medicaid payment for primary care provider-prescribed social service needs.  Doing so could lead to significant savings in lower health care utilization and less severe health problems.

As a first step, the state should create and fund a public-private task force with DHHR staff support to examine how the state can expand and improve how Medicaid addresses needs that clearly impact health conditions and costs.  The Task Force can, for example, consider how managed care contract language and capitation rates can support social services such as helping pay for air-conditioning for children with asthma or supplementing food stamps to help pay for sugar free alternatives for people with diabetes.  These preventive non-medical investments can save long-term Medicaid spending on expensive medical interventions.  For example, today West Virginia Medicaid pays for smoking cessation programs to help reduce the incidence of lung disease.

Refund to consumers the cost of unjustified high prescription drug price increases

Prescription drug expenditures are nearly 20 percent of health care costs and growing faster than any other part of the health care dollar.  Four of the top 10 prescription drugs in the United States have increased in price by more than 100 percent since 2011. Brand name drug prices are increasing more than twice as fast as inflation. Nearly one in three adults in 2018 reported cutting a dose in half or even refraining from taking the medicine they need due to costs.

Certain groups are more likely to report difficulty affording medication, including those who are spending $100 or more a month on their prescriptions (58 percent), those who report being in fair or poor health (49 percent), those who take four or more prescription drugs (35 percent), and those with incomes less than $40,000 annually (35 percent).

West Virginia took a first step in 2020 to address high prescription drug costs for West Virginia families by passing the “Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act,” which requires drug manufacturers and health benefit plan issuers who sell prescription drugs in West Virginia to provide cost information, changes in cost information, and prescription drug statistics to the State Auditor who will publish the data on a public website.  In addition, a bipartisan group of legislators worked together to pass a private insurance insulin copay cap of $100 per month.

The state should now move forward to provide refunds to consumers for unjustified high prescription drug price increases in West Virginia. Unfair high drug prices hurt consumers, including those who rely on the Public Employee Insurance Agency (PEIA) program and on Medicaid.  If a prescription drug manufacturer sells a drug with an unsupported and very high price increase in West Virginia, the state will force the manufacturer to pay a refund to the state and West Virginia consumers.  The state will "clawback" part of the Rx drug sale price.  And the state action will send a message to drug manufacturers to stop future bad faith pricing.  To define an unsupported high prescription drug price increase, the state would be able to use an annual list generated by a nationally recognized independent outside group, the Institute for Clinical and Economic Review (ICER), that has a process that allows manufacturers full opportunity to bring in evidence of justification for the price increase before listing a drug price increase as unsupported.

West Virginia should also move forward to protect consumers from high prices for insulin-related supplies necessary for diabetes patients.

Enact Paid Sick/Medical Leave and Paid Family Leave for West Virginia workers

A critical component to overall health is having paid job-protected time off to deal with illness and care for family members who are seriously ill.  Currently in West Virginia, too many are forced to choose between having or keeping a job and fulfilling family caregiving responsibilities. This leaves many who want to continue to work, outside of the workforce altogether and deprives businesses of quality workers. A statewide paid family and medical leave program would guarantee West Virginia workers the ability to take paid time off to recover from a serious illness or to care for a sick family member or new child, and allow businesses to retain skilled, trained employees.  Eight states and the District of Columbia have enacted paid family and medical leave programs, which are fully self-funded through joint employer and employee contributions, similar to their states’ unemployment insurance program.