Health care is one of the most important issues for West Virginia voters. A majority of voters support expanding affordable health coverage and care options, and initiatives that will lower health care prices. While there is 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, West Virginia Medicaid is a critical health care safety net for a third of West Virginians. Our families cannot withstand the physical and financial health challenges if our state reduces spending on Medicaid and forces cuts to essential benefits or eligibility.
Second, West Virginia can move forward to improve Medicaid by using “Medicaid surplus funds” as well as additional state funds to drawn down significant new federal matching dollars waiting on the table to pay for coverage and care for West Virginia families.
Third, West Virginia can move forward to 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 initiatives to address social determinates of health such as food security and housing assistance in all health care and coverage programs, and to expand the use of EPSDT and other Medicaid supports for prevention and early intervention to help children and youth and strengthen families.
Expand Medicaid coverage to one year postpartum for women up to 300 percent of the Federal Poverty Level
In 2018, the WV Legislature made huge strides for women and families by passing SB564, expanding coverage for pregnant women at higher income levels for 60 days postpartum. However, postpartum conditions can continue long after the first 60 days, and continued Medicaid coverage is vital for parents who have substance use disorders. Expanding coverage to one year postpartum is estimated to cost less than $1 million per year in state dollars.
Increase funding in the 2021 Budget to clear the Medicaid I/DD waiting list
West Virginia’s Home and Community-Based Services Waiver program for individuals with intellectual and other developmental disabilities (I/DD) was implemented in 1984 and assists states in complying with a requirement to provide supports to residents in the most integrated settings. All who qualify are legally required to be served, but the current wait list for waivers in West Virginia has over 1,000 individuals and would take over 9 years for the newest person on the list to receive services at the current rate. Increased state funding can “clear” the list and give all qualified individuals these vital services.
Provide expanded dental care for Medicaid-enrolled adults
Low-income adults are nearly 40 percent less likely to have had a dental exam over the previous year than those with higher incomes. Poor oral health elevates risk for chronic conditions including diabetes and heart disease. It also reduces employability and results in lost workdays.
Investing in oral care now improves employability and saves money on acute medical care down the road.
Create a workforce promotion program for Medicaid enrollees.
West Virginia can create a voluntary workforce promotion program for adult Medicaid enrollees. Like Montana’s successful HELP-Link program it would not condition coverage on participation. The program helps enrollees who are looking for work or better jobs (48 percent of adult Medicaid enrollees already work), linking them with services such as career counseling, on-the-job training, and educational opportunities. The goal of the program is to improve the long-term employability of the client, thus reducing their reliance on Medicaid. Labor force participation rates among low-income households has increased 6 to 9%. Among those receiving HELP-Link funds for training, 71% of participants have increased wage earnings after completion of their training. The average wage increase was $8,712 annually
Address the high cost of prescription drugs for all West Virginia families
West Virginia can take a first step to help West Virginia families afford prescription drugs by capping the maximum copays for insulin at $50 per month for any insured patient regardless of their source of insurance or the type of insulin they require. Further, the state can create a Prescription Drug Affordability Board to provide consumers with information about how other prescription drugs are priced and how price increases are set. The Affordability Board would include the authority to establish a mechanism to regulate high drug prices.
One in four Americans reported that they or another family member did not fill a prescription drug in the past year because of cost. Prescription drug expenditures are nearly 20 percent of health care costs and growing faster than any other part of the health care dollar. In the U.S, the increase in the list price of brand prescription drugs averaged 10% between 2012 and 2016. Four of the top 10 prescription drugs in the United States have increased in price by more than 100 percent since 2011. Type 1 diabetics paid an average of $5,705 for insulin in 2016, nearly double what they paid in 2012.
Create a Medicaid Buy-in Program to increase choice and improve affordable health coverage options for West Virginians transitioning to a job without affordable health insurance
West Virginia can allow all adult Medicaid enrollees transitioning to work to use their ACA subsidy or tax credit (paid for by all federal dollars) to buy into the Medicaid plan. A Medicaid-to-work transition already exists in WV for people who are disabled or who have a chronic health condition: the Medicaid Work Incentive (M-WIN) program. A similar program for non-disabled adults would expand choice and ensure affordable health coverage for low-income and transitioning workers who often do not get health insurance through their jobs.
Create a Children’s Health Insurance Program (CHIP) buy-in to close children’s coverage gaps
All children need access to comprehensive health coverage, but there are still WV children who are not covered. A CHIP buy-in can address child health coverage gaps among moderate-income families who do not have access to affordable private coverage. A CHIP buy-in allows families with incomes in excess of CHIP eligibility to purchase insurance for their children through the public plan.
Use settlements from Pharma Opioid lawsuits to support children in West Virginia’s foster care system
Use of prescription opioids has created a crisis in families of children in West Virginia and greatly expanded the number of children who end up in an underfunded foster care system. To support these children and help them grow into productive adults, West Virginia can take advantage of the Opioid settlement money.
Create a Minority Health Advisory Team to advise the Commissioner of Public Health on addressing health disparities
Racial health disparities exist at an alarming rate within our public health data. African Americans are 72% more likely to be diabetic, 44% more likely to die of stroke, 20% more likely to have asthma, and 3 times as likely to die from it, women are 3-4 times more likely to die in childbirth, 52% more likely to die of cervical cancer and 40% more likely to die of breast cancer than their white counterparts. These shocking inequities can be addressed utilizing existing state and local resources to promote community health and well-being by authorizing the Commissioner of the Bureau of Public Health to establish a Minority Health Advisory team, collect data, and authorize funds for a Community Health Equity Initiative demonstration Project.
Enact Paid Family and Medical Leave for West Virginia Workers
In West Virginia, too many are forced to choose between having or keeping a job and fulfilling family caregiving responsibilities. A paid family and medical leave law would guarantee WV 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 it would allow businesses to retain skilled, trained employees.
Protect West Virginians from pre-existing condition exclusions in case of reversal of the Affordable Care Act (ACA)
Prior to the ACA, it was common practice for insurers to deny coverage or charge more for people with pre-existing conditions. The ACA ended that discriminatory practice, and to lose that protection in the state with the highest percentage of adults with pre-existing conditions would be unthinkable. The state legislature can commit to protecting West Virginians in case of an ACA reversal.
Pass legislation to end surprise medical bills
“Surprise” medical bills occur when a patient visits an in-network hospital or doctor’s office but unknowingly receives care from an out-of-network provider (such as an anesthesiologist or radiologist), and an insurer refuses to cover the bill. For the past several years, a bill has been introduced to take consumers out of the middle of billing disputes between providers and insurance companies when these costs were incurred at no fault of their own. Legislation is pending at the federal level but many states have already passed their own legislation. West Virginia can do the same if Congress does not act.