West Virginia’s Medicaid reform

The following editorial appeared in The Exponent Telegram on Feb. 16:

One element of the Affordable Care Act, commonly known as Obamacare, that we have supported is the expansion of state-sponsored Medicaid to residents who earn up to 150 percent of the federal poverty level. We’ve also supported extension of the West Virginia Children’s Health Insurance Plan to cover youth under the age of 18 who live in households earning up to 200 percent of the federal poverty level.

Gov. Earl Ray Tomblin opted to expand Medicaid under the Affordable Care Act as of Jan. 1, 2014. The state is utilizing federal funds to provide Medicaid for the newly eligible population of low-income adults, most of whom have jobs but no option for employer-sponsored health insurance.

However, like everything else in life, there’s no such thing as a free lunch. Starting in 2017, the state will gradually begin to pay a percentage of the cost of expanded Medicaid coverage, though it will never exceed 10 percent.

Under the new eligibility guidelines under Obamacare, West Virginia’s Medicaid enrollment grew by nearly 193,000 between the fall of 2013 and October 2015, representing an increase of 54 percent.

That includes residents who were already eligible (but not yet enrolled) prior to 2014. But even if we only consider the Medicaid expansion population, enrollment had grown by 164,400 people as of the end of June 2015. That’s significantly more than the 93,000 people that West Virginia had projected to enroll by 2020.

Elected officials anticipated savings from a 2007 state Medicaid overhaul that was intended to generate more than enough in cost reductions to cover the state’s increased share of Medicaid costs due to the expansion. That was a very important financial consideration, considering the mess the state’s budget is in.

But a study released in January by the Health Research and Educational Trust, which examined West Virginia’s 2007 Medicaid program overhaul, has found that the state’s “nudging” plan to decrease emergency room visits backfired — an outcome that could affect how states approach lowering the cost of health care under the Affordable Care Act.

According the an article in the Charleston Gazette Mail, the study looked at the impact of the Mountain Health Choices program, which replaced traditional Medicaid plans with two types of plans: Basic plans, which offered less coverage than prior Medicaid plans, and advanced plans, which offered more coverage and required participants to agree to rules that were designed to improve health behaviors.

Consumers who opted for advanced plans were asked to sign a member agreement and follow a personalized health plan, while those with basic plans received far less extensive coverage, including a cap on prescriptions and no coverage for substance abuse services and inpatient mental health services.

Unfortunately, only 12 percent of participants have chosen an advanced plan through the Mountain Health Choices program. Also, the program saw an increase in emergency room visits among those who chose or were automatically enrolled in basic plans, as well as an increase in the average number of non-emergency ER visits for Medicaid recipients overall, despite a decrease among those who opted for an advanced plan.

Which simply proves that old habits are hard to break. We have trained generations of West Virginia Medicaid recipients to simply go to the hospital emergency room — the most expensive form of health care — when they need medical attention.

West Virginia’s Mountain Health Choices program was one of the most controversial, as it imposed coverage limits based on member behavior.

But assessing the impacts of such efforts is important as states continue to grapple with the goal of reducing costs without causing negative health impacts.

Everyone must take responsibility for his or her own health care choices. The key is that everyone must have some skin in the game. From those of us on private insurance to PEIA — we are all forced to make smart health care and lifestyle choices.

West Virginia Medicaid recipients must be held to similar standards.

Online: http://www.theet.com

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