Expanding Medicaid in W.Va. has already cost money

West Virginia finally decided last Thursday that it will expand its Medicaid program under the federal Affordable Care Act. Gov. Earl Ray Tomblin made the announcement during a news conference in Charleston as West Virginia became the final state in the nation to make its decision.

Twenty states and the District of Columbia had already indicated they will expand coverage and four more states are expected to take that position as well, according to Avalere Health LLC. Ten states will likely opt out of the program and 15 states have already said they will not participate.

The study to determine what West Virginia should ultimately decide about the continuation of its Medicaid program has already cost the state more than $860,000. At the request of legislators, the state hired Maryland-based CCRC Actuaries to study the available options.

The governor said in February that West Virginia would enter into a partnership with the federal government for its exchange instead of running its own program or leaving it entirely in the hands of the federal government. Last Thursday, he confirmed that West Virginia will open the Medicaid program to more lower-income residents.

The new federal law requires states to offer the Medicaid program to additional lower-income residents with unadjusted annual household incomes of up to 138 percent of the federal poverty level. This higher-income level — about $31,800 for a family of four — means another 91,500 more people in West Virginia will get Medicaid coverage.

The United States Supreme Court, even though it upheld the federal Medicaid overhaul last year, did strike down the federal threat to withhold a state’s existing federal Medicaid funding to any state that refuses to expand the number of residents who can receive coverage via the Medicaid program.

During the last year, about 415,000 residents of West Virginia received health care services from Medicaid. In fact, this state has the 12th largest Medicaid program in the country as measured as a percentage of its population.

The federal government will cover the costs of expanding Medicaid for three years but the individual states must cough up 10 percent of the costs by the year 2020. And Medicaid already takes a big bite out of this state’s budget. So the governor has already cut spending in some other areas to allow for the rising costs.

Health policy director for the state insurance commissioner Jeremiah Samples said the original contract with CCRC Actuaries did not include a completion date. He also said the goals have changed since it was awarded but that CCRC had expected to finish its report by the end of January. However, private insurers were reluctant to share information, which caused the delay.

Meanwhile, it would be appropriate to say that new Attorney General Patrick Morrisey has “hit the ground running” in his new role as the state’s “premier warrior,” a description that can be traced back to an earlier ruling by the state Supreme Court

Less than four months into his swearing in, Morrisey has already embarked on several new goals for the office including a statewide “Jobs Summit” tour. He has also made it clear he plans to challenge the U. S. Environmental Protection Agency in instances that he considers “federal overreach.” Some critics wonder whether he has the authority to tackle these topics.

Certainly his predecessor Darrell V. McGraw sought and relished the limelight during his 20 years in the same position when he made consumer protection among his primary efforts. Morrisey surprised many political observers by defeating McGraw in the 2012 general election last November.

Morrisey’s high-profile behavior so far is based on claims that he has wide-reaching authority from both the state constitution and state laws. West Virginia University law professor Bob Bastress said the state constitution is “quite vague” on what the state attorney general can and can’t do.

Finally, the president of the West Virginia Citizens Defense League — a group dedicated to private gun ownership — has issued a challenge to U. S. Sen. Joe Manchin, who plans to reintroduce his bill in Congress to require enhanced background checks on gun purchases.

CDL President Keith Morgan last week told a Beckley newspaper that Manchin’s proposal is “de facto registration” and could lead to confiscation of firearms. He said it would do nothing to prevent the illegal use of guns but rather will outlaw face-to-face gun transactions at shows.

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