Across West Virginia, it’s already hard for many people to access health care. And unless state lawmakers change the budget they passed last month, it’s about to get even more difficult, especially for people who live in the most rural areas and those considered lower income.
Starting in July, at the start of the next fiscal year, West Virginia officials will be forced to dramatically cut the state’s Medicaid budget. Roughly one-third of the state’s population relies on the government health insurance program.
Despite testimony from state officials that the program needed more funding because of increased health care costs and the end of COVID relief funding, lawmakers gave the program about $150 million less than what was needed. They also didn’t pass a proposal for a bill recommended by health officials to fund some of the increase by increasing the tax on managed care organizations.
And because the state will also lose three federal matching dollars for each fewer dollar that West Virginia spends on the program, the cuts could be severe.
West Virginians covered by Medicaid include single adults who make about $20,000 a year up to families of four earning around $40,000 annually. Along with low-income adults, the insurance covers nearly half of the children in West Virginia as well as people whose conditions prevent them from working.
Under federal law, the insurance has to cover some services, such as inpatient and outpatient hospital visits and some doctor visits. But facing funding problems, state health officials could cut services such as hospice care, dental care, physical therapy, speech therapy, in-home care for people with disabilities and prescription drugs.
They could also pay providers who accept Medicaid patients less money for seeing those patients — which could mean more medical professionals around the state could decide not to accept Medicaid patients at all. This would severely impact the most rural areas of the state, which already suffer from a lack of health care providers.
State health officials at the Department of Human Services didn’t respond to emailed questions about how they might reduce services.
But Akeiisa Coleman, senior program officer for Medicaid at the Commonwealth Fund, a health care advocacy and research group, said the easiest and most likely way for state health officials to reduce Medicaid costs would be cutting payments to providers.
“They may reduce the number of Medicaid patients that they accept or stop taking new Medicaid patients,” she said.
Sen. Eric Tarr, R- Putnam and chair of the Finance Committee, which writes the budget, denied an interview request through a spokesperson.
In a committee meeting, he indicated that he wants to reduce Medicaid costs, asking health officials questions about whether Medicaid dollars are resulting in improved health and if people who use Medicaid are receiving better benefits than those using private insurance.
Among his committee members, there’s some interest in revisiting the issue.
Sen. Mike Oliverio, R-Monongalia, said in an interview that he hopes lawmakers allocate more funding to Medicaid later, possibly during a special session. He said lawmakers passed a tight budget in part because they weren’t sure if the federal government was going to require the state to return funds, after the state failed to meet certain education spending requirements.
But another member of the finance committee, Sen. Rupie Phillips, R-Logan, said lawmakers want to see more people working and fewer people on programs like Medicaid.
“If you need help, I want you to have help,” he said. “People just — they just gotta quit mooching off the government and go to work.”
For advocates like Rich Sutphin, executive director of the West Virginia Rural Health Association, the cuts are counterproductive, and could be permanent even if more money is added back into the budget later.
He said that some rural hospitals and health clinics would likely have to permanently close if provider reimbursements are cut. Especially amid layoffs at large employers like Allegheny Wood Products and Cleveland-Cliffs, people need the health care they receive through programs like Medicaid to be well enough to find work.
“Medicaid serves as a safety net,” he said. “It just takes something like that for folks to fall on hard times and need that safety net program to make sure that their kids are healthy, make sure that families still get the care they need and make sure that their chronic conditions are managed.”
Kelly Allen, executive director of the West Virginia Center on Budget and Policy, said that recovering from diseases like substance use disorder can take multiple attempts at treatment.
“We have a long history of negative health outcomes in West Virginia,” she said. “Recovery takes a long time.”
She blamed the current shortfall on lawmakers’ failure to fund Medicaid on pace with inflation, and for taking a chunk out of state revenues with moves like the 2023 personal income tax cut.
“If we want to study the effectiveness of Medicaid, I’m all for that,” she said. “But I don’t think cutting it right now and just seeing what happens is an effective way of studying that.”