Our Policy Goals
Preserve, protect, and improve Medicaid and the Medicaid expansion.
- Maintain current eligibility at 138% of Federal Poverty Level
- Advocate for quality and cost effective managed care
- Support adequate funding for home and community-based services
Medicaid is an important health and long-term care insurance program that serves more than 500,000 West Virginians. It provides services for the elderly, people with disabilities and low-income families and individuals. Medicaid has a variable federal match rate that averages about 73-75 percent with state dollars paying the rest. For the Medicaid expansion, the federal match is 100 percent. The match begins to decrease to 97% beginning in FFY 2017 (October 1, 2015-September 31, 2016). Each following year, the federal match decreases by 1% until it drops to 90% in FFY 2020 and remain there indefinitely. With an annual budget of more than $3 billion, Medicaid has a huge impact on the state’s economy especially in the rural areas of the state. Medicaid has had consistent support from the public, yet it is poorly understood by policy-makers.
Beginning with the SFY 2017 budget process, lawmakers will have to budget additional dollars for Medicaid for the second half of SFY 2017as the federal match begins to decline to 95%.
The loss of 5% in federal dollars will have a large impact on the state budget. WVAHC should begin to prepare legislators for this increase in cost and prepare materials, stories and local support to assure that Medicaid support continues at an appropriate level.
Support and promote appropriate, quality and affordable coverage for children.
- Study the impact of the end of CHIP and alternatives
- Review dental coverage for children in Marketplace and employer plans.
The West Virginia Children’s Health Insurance Program has served almost 200,000 West Virginia children since its start in 1998. The Affordable Care Act did not provide for continuation of CHIP funding beyond 2015 supporting the goal of covering all uninsured children either through Medicaid or Marketplace plans. In March 2015, Congress continued funding for CHIP for two more years through September 30, 2017.
State and national advocates are concerned that Marketplace plans are not ready to provide child health coverage at the level provided by CHIP. Concerns include affordability (CHIP has no deductible), dental care and the needs of children with special health care needs.
Now is the time that state advocates in coordination with national efforts, study the impact of the end of CHIP and devise strategies to assure that children will continue to receive coverage that is affordable and meets the developmental and other special health care needs of children.
Fight for affordable health coverage for all pregnant women.
- Expand Medicaid coverage to pregnant women to 200% of the FPL
- Study the availability of pregnancy coverage of dependent pregnant women.
- Advocate to make pregnancy a qualifying event for Marketplace plans (federal issue).
West Virginia pregnant women are covered by Medicaid up to 150 percent of the Federal Poverty Level (FPL). In addition, the Division of Maternal, Child and Family Health (MCFH) in the DHHR provides funding for prenatal care, labor and delivery services for pregnant women between 150 and 185 percent of the FPL. MCFH coverage is for pregnancy care only. It is not comprehensive health coverage. Many other states (# here) have expanded pregnancy coverage through Medicaid up to 200 percent of the FPL.
It is desirable that West Virginia should also expand coverage to 200 percent of the FPL because:
- Numerous women a year fall through the cracks and do not have Medicaid, MCFH, or access to Marketplace coverage.
- Medicaid has a higher federal match rate than MCFH Title V block grant funds; state dollars could be saved to meet other priorities if Medicaid were expanded to 200 percent.
- Medicaid is a comprehensive covered benefit, which is important to assure that pregnant women have all their health care needs met not just those surrounding the pregnancy.
- Medicaid pays providers more than MCFH for prenatal care and delivery.
Support and promote efficient and consumer-friendly practices in the use of health insurance and health care.
- Conduct outreach and enrollment in Medicaid and Marketplace plans.
- Conduct a public coverage to care education campaign
- Improve the private insurance marketplace.
Making insurance rate setting more transparent and providing consumer input into the process is an important goal. Advocacy groups in several states are taking this on. This is a matter of not just a health care goal but also of good public policy. To address this goal will take a lot of expertise and experience.
Bring a consumer voice to promote quality and value as part of health system improvement
- Participate and support the State Innovation Model (SIM) process
- Expand Choosing Wisely campaign in West Virginia
The American medical care system is considered to be inefficient, uncoordinated with poorer health outcomes than most other developed nations. The Affordable Care Act lays the groundwork for medical system transformation. That transformation is in process now. In West Virginia a $1.9 million federal grant is bringing stakeholders together to plan for primary care system improvement. WVAHC is part of the leadership team (steering committee) for the planning process and will also participate in at least four of the workgroups.
It is estimated that as much as one-third of all tests, drugs and procedures are of questionable value and may even be harmful. One approach to this problem is to identify those tests, drugs and procedures that should only be done after careful consideration by the health care provider and consumer or not at all. More than 60 medical specialty groups have identified more than 270 such tests, drugs and procedures. Consumer Reports has developed educational materials to help providers and consumers understand and make informed choices about such tests, drugs and procedures.
WVAHC is partnering with Consumer Reports to educate providers and consumers about Choosing Wisely, a national initiative of Robert Wood Johnson and the ABIM Foundation. In 2014 – 2015, WVAHC conducted a pilot project in Kanawha County. With additional funding and staff, WVAHC will take the initiative statewide.
Promote and support health equity in West Virginia
The health status of underserved communities in West Virginia is worse than that of others. We have talked for many years about health equity and developed several informative reports documenting the problem. West Virginia has a small African American community (3%), which often feels itself to be invisible. In improving the health outcomes of this community, small may be an advantage in allowing us to have targeted but comprehensive interventions. WVAHC wants to collaborate with the African American community and other minority communities to move this issue forward.
Advocate for Health Impact Assessment in all public policies and projects.
There is an increasing recognition that the environments in which people live, work, learn and play have a tremendous impact on their health. Re-shaping people’s economic, physical, social and service environments can help ensure opportunities for health and support healthy behaviors. But health and public health agencies rarely have the mandate, authority or organizational capacity to make these changes. Responsibility for the social determinants of health falls to many non-traditional health partners, such as housing, transportation, education, air quality, access to clean drinking water, parks, criminal justice, energy and employment agencies. Solutions to our complex and urgent problems will require collative efforts across many sectors and all levels, including government agencies, businesses, and community-based organizations.
An approach of considering health in all policies and services will help leaders and policymakers integrate considerations of health, well-being and equity during the development, implementation and evaluation of policies and services. The Health in All Policies approach is spreading rapidly and dynamically throughout the United States and the rest of the world. WVAHC wants to promote and support this concept in West Virginia.
Advocate for stronger family and medical leave policies.
Several West Virginia groups including the Center on Budget and Policy have done research and provided education on family medical leave. WVAHC believes this is an important health policy goal and will provide support to the Center on Budget and Policy spearheading the family medical leave campaign.
Support a strong, quality public and primary health care system.
- Support improved reimbursement for primary care providers
- Support for adequate reimbursement for all primary care providers
- Support full practice authority for all advanced practice registered nurses (APRNs)
Issue: West Virginia does not have enough primary care practitioners for a transformed health system which emphasizes primary care, medical home, care coordination and wellness. To encourage more primary care practitioners to work in WV, we support increased reimbursement through value-based payment systems. We also support the ability of advanced practice registered nurses (APRNs) to practice autonomously to the full extent of their educational preparation. More than 21 states have modernized their laws to allow their citizen a full choice of health care providers. West Virginia APRN laws have not been update for 30 years to allow