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West Virginia to expand Medicaid program

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Gov. Earl Ray Tomblin has decided to expand the state's Medicaid program.

The Affordable Care Act, passed in 2010, originally mandated all states expand their Medicaid programs. However, the Supreme Court last year struck down that required mandate, allowing states to choose if they wanted to expand. But states that did not choose to expand Medicaid would face consequences, said Rob Alsop, Tomblin's chief of staff, noting significant consequences for the state in terms of health insurance coverage for thousands of West Virginians, in addition to a loss of federal funds.

"This is a momentous day in West Virginia in a lot of different ways," Alsop said at a May 2 press briefing.

According to Alsop, Tomblin will direct the Department of Health and Human Resources to file a state plan amendment that will expand Medicaid coverage to include populations up to 138 percent of the federal poverty level. Open enrollment will begin Oct. 1 with coverage beginning Jan. 1, 2014.

Alsop said the expansion is expected to cover an additional 90,000 working West Virginians by 2016, "which is a significant step forward."

According to DHHR, about 350,000 West Virginians currently receive Medicaid benefits, with about 170,000 enrolled in managed care.

Jeremiah Samples, director of health policy for the West Virginia Insurance Commission, said that if West Virginia had chosen to not participate in the expansion, federal tax dollars paid by the state's workers would have paid for health insurance in other states.

"In other words, our taxpayers would not see any tax relief and would subsidize Medicaid in other states," Samples said. "We would pay for it, but not benefit."

In addition, employers would see greater penalties, projected to range from $6 million to $18 million annually, and the state's hospitals would see reduced payments from Medicaid and Medicare, leading to reduced revenue.

Consumers can access the insurance marketplace online, although Samples pointed out steps are being taken to give people without Internet access a place to go and people to help determine eligibility.

Consumers also can complete the process through a federal call center, and the state will offer other community-based resources, such as DHHR officials, counselors, federal navigators and insurance commissioners to help the public understand eligibility

The federal government will cover the cost of expansion for the first thee years at a projected cost of $1.267 billion. The state will spend about $15 million in administrative matching funds. When the match rate is fully applied in 2020, the federal government will pay $9 for every $10 spent on the expanded population for cost of care. The expansion will lead to $5.2 billion in federal funds coming into the state between fiscal years 2014 to 2023.

Tomblin said he may not agree with every provision in the act, but he made what he thought was the best decision for West Virginia, based on the circumstances.

"Fiscal responsibility is something I've worked hard to do since my days as a freshman in the House of Delegates in 1975," Tomblin said.

He said the administration will continue to ask questions throughout the process and obtain information to make sure the right decisions are being made.

Sen. Jay Rockefeller, D-W.Va., who attended the press conference where Tomblin made the announcement, said he applauded the decision.

"Health care is so easy to say, but so hard to do," Rockefeller said at the event. "A lot of politicians are scared of health care; they don't think in terms of how it interlocks."

Rockefeller said Congress is not going to "fold" on the guarantee for 90 percent funding.

"This is a commitment to the American public that makes so much financial sense," Rockefeller said. "Earl Ray Tomblin, Gov. Tomblin, in a classic Tomblin move, simply decided to study it; to think about it; to take a businessman's point of view, and a southern West Virginian's point of view.

"He knows well the beauty of Medicaid."

Rockefeller, who has long been a proponent of Medicaid, said he was present at the event in "total, sheer, absolute happiness about the expansion of Medicaid."

But not everyone is happy. The West Virginia Republican Party issued a news release May 2, saying Medicaid expenses will lead to increased state expenses that will be passed on to taxpayers and employers.

"Tomblin could have fought this odious program, like the fiscally responsible governors of more prosperous southern states," the news release reads. "Instead, after months of prevarication, he's doing pretty much what we predicted."

The Republican candidates have attempted to tie Tomblin to President Barack Obama and implementation of the Affordable Care Act.