Medicaid is the state’s largest health insurance program. At the beginning of 2023, the program provided services for then 650,000 including children, pregnant women, people with disabilities, low-income working adults, and seniors. Medicaid played a major role in protecting the state’s population from the spread of the deadly and contagious COVID virus. At a projected federal/state budget of more than about $5.2 billion, Medicaid supports not only West Virginia residents but also the health care infrastructure through more than $4 billion in federal matching dollars. Today, 516,000 West Virginia residents are on Medicaid. 87,000 West Virginia residents enrolled in Medicare are also covered by Medicaid. Over 50% of West Virginia residents live in rural areas; rural residents are much more likely to depend upon Medicaid than those living in urban areas. WVAHC supports a strong, accountable, and fully funded Medicaid program.

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Experience has shown that continuous eligibility works–many states already had this policy prior to the new national one year requirement, and their child disenrollment rates were about half of the rate of the states without continuous eligibility. Unwinding highlights how arduous and ineffective the current renewal process is for families, and the success of continuous eligibility policies highlights the benefits of keeping kids enrolled. Keeping kids covered is a cost saver for both families and states. On average, states lose $400-$600 in administrative costs for each child that rotates in and out of Medicaid coverage, a process called “churn.” Research also shows that Medicaid enrollment significantly reduces families’ medical debt. This stability helps support a family’s overall financial health, making them less likely to carry non-medical debt as well. Both of these factors allow parents to purchase other necessities for their children such as food, clothing, and housing. While 12 months of continuous eligibility is a great start, it’s not enough to keep our kids covered. KFF reports that after the 12-month window passes, child churn more than doubles. Children need consistent access to health care coverage to receive the routine and emergency medical care that they need during their earliest years. The American Academy of Pediatrics recommends that children visit their physicians at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months to ensure that they are developing properly. Most churn gaps last 3-9 months, meaning that young children could miss nearly half of these critical appointments. This means that doctors may not detect emerging conditions or developmental delays in a timely manner, delaying diagnosis and treatment. To keep kids covered WVAHC advocates for six-year continuous eligibility, which keeps kids covered during the most important years for their development. Continuous eligibility eliminates churn in early childhood, ensuring that children can receive all their vaccines, screenings, and routine checkups at an affordable cost to their parents. With five-year continuous eligibility, children, regardless of their socioeconomic background, can receive the care they need to be successful as they begin school. This simple extension also reduces administrative burdens for both families and state governments by reducing the frequency of the redetermination processes. As of January 1, 2024, all states are required to provide 12 months of continuous health coverage for children in Medicaid and the Children's Health Insurance Program (CHIP). This reduces the risk of eligible children losing coverage due to administrative barriers or temporary fluctuations in family income. WVAHC supports continuous enrollment from children ages 0 – 6 yrs.

West Virginia has a lower health status rate than most other states. Studies have shown that social determinants of health such as income, housing, environmental exposure, education, and race all have an impact on the health status of a population. One key social driver of health is the affordability and availability of dental care. Dental health is linked to better overall health and wellness. Poor oral health leads to several serious diseases that might have been prevented or minimized with affordable, quality oral health care. West Virginia can draw down its three to one federal match by providing increased dental health as an optional service. Another service that would decrease the C-Section rate and promote better birth outcomes is providing reimbursement through Medicaid through a trained birth assister or doula. Research supports that doula care can improve birth outcomes including death and morbidity. WVAHC supports increased access to oral health care including increasing Medicaid payments to oral health providers and developing a payment methodology for doula care. We also support the use of Medicaid 1115 waiver to improve coverage for substance use treatment. We support the funding and hiring of more application assisters, connectors, and community health workers.

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