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West Virginia House Health Committee considers Medicaid buy-in program

CHARLESTON — Lawmakers discussed a bill Thursday that would help poor families who make just enough to not qualify for Medicaid gain access to affordable health insurance.

The House Health and Human Resources Committee recommended for passage Thursday a strike-and-insert amendment to House Bill 3274, creating the Affordable Medicaid Buy-in Program. The bill heads next to the House Judiciary Committee.

HB 3274 would create a new state option for a high-quality, low-cost health insurance plan for low-income West Virginians who earn just enough to not qualify for Medicaid. The buy-in plan allows residents to pay a low monthly premium based on a sliding scale for individuals who earn under 200% of the federal poverty level, prioritizing families who have been bumped off of Medicaid.

Beginning Jan. 1, 2024, the state Department of Health and Human Resources would establish a state-administered healthcare coverage plan that leverages Medicaid coverage. The program would be limited to residents who are ineligible for Medicaid and Medicare, and whose employer has not disenrolled or denied the resident enrollment in employer-sponsored health coverage because they would otherwise qualify for the buy-in program.

Covered benefits in the buy-in program would include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, and pediatric services.

The bill allows DHHR to pursue any available federal financial participation, and to coordinate the plans enrollment and eligibility to maximize the continuity of coverage between the plan, Medicaid and private health plans. Health care provider reimbursement rates would be based on the Medicaid fee schedule, though DHHR would be allowed to increase reimbursement rates contingent on available fund as long as the increases do not jeopardize the sustainability of Medicaid or the buy-in plan.

According to West Virginians for Affordable Health Care, a Medicaid buy-in program would benefit individuals and families who earn more than the current Medicaid income eligibility cap of 138% of the federal poverty level and 200% of the federal poverty level; or between $1,677 per month and $2,430 per month for an individual and $2,859 per month and $4,143 per month for a family of three.

Cindy Beane, commissioner of DHHR’s Bureau for Medical Services, told committee members her office deals with individuals and families who end up making $100 more than the cap and asking to remain in Medicaid, but the rules require them to be bumped.

“They’re seeing the workers not even want to work the full amount of time any longer because they are afraid of losing their benefits,” Beane said.

Sometimes called the “cliff effect,” individuals who were in Medicaid and start work at a job that bumps up their salary just beyond Medicaid eligibility often face high costs for health insurance coverage, often leaving them as poor as they were before taking the new job. Dr. Jessica Ice, executive director for West Virginians for Affordable Health Care, said this issue often causes someone to quit a job and remain on Medicaid.

“West Virginia workers are rational,” Ice said. “They may say ‘no thanks’ to more work hours, a promotion or even a raise if making more money will push them off Medicaid, increase their health insurance costs and leave them worse off than before. We need to eliminate this financial barrier for workers who want to move up the economic ladder.”

According to the West Virginia Center for Budget and Policy, a left-of-center public policy advocacy organization, Medicaid buy-in programs help ease people leaving Medicaid into the workforce until they can earn enough to afford other health insurance plans.

“As it currently stands, transitions in and out of Medicaid eligibility based on small income changes can be disruptive to impacted workers and families, creating challenges to accessing providers, obtaining needed medications, and seeking care,” wrote Kelly Allen and Rhonda Rogombe. “Under a Medicaid buy-in, rather than losing eligibility altogether with a change in income, a worker or household would have the option to move into a plan very similar to the one they are currently enrolled in, by beginning to pay a monthly premium that is affordable based on a sliding scale.”

HB 3274 would not cost the state additional dollars, with tax premiums credits from the payments to managed care companies being used to pay the cap, though there could be some costs for additional administration services down the road.

“The tax premium credits are high enough that the money that would come over would pay for all of that cap, so there would be no cost for services,” Beane said.

A similar bill was introduced last year but was never taken up. This year, the bill was approved by the committee in a unanimous voice vote and received bipartisan praise.

“I believe this is a wonderful piece of legislation,” said Del. John Hardy, R-Berkeley.

“It’s not going to cost us anything, but overall it’s going to have a very positive economic impact,” said House Health Committee Minority Chairman Mike Pushkin, D-Kanawha. “It’s actually a very conservative idea. It encourages work and encourages people to work harder, get raises, and then buy in — not get anything — and keep the same kind of healthcare they were used to.”

Steven Allen Adams can be reached at sadams@newsandsentinel.com

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