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West Virginia health insurance exchange

Average 2015 rate hike 6.7%; Kentucky CO-OP delays entry to WV

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  • By
  • healthinsurance.org contributor
  • November 13, 2014

The ACA’s impact in West Virginia

Although West Virginia opted to let HHS run the exchange, the state chose to expand Medicaid under the ACA, and has been working diligently to enroll as many people as possible in expanded Medicaid.  Their efforts have paid off:  The state had the second-highest increase in Medicaid/CHIP enrollment in the country (Oregon was first).

By June 9, West Virginia had 508,496 residents (about 27% of the state’s population) enrolled in Medicaid or Children’s Health Insurance Program.  And as of mid-September, reports indicated that the state had enrolled virtually all of the people who were eligible for expanded Medicaid.  Medicaid enrollment continues year-round, so any remaining eligible residents can enroll at any time.

In 2013, about 17 percent of the West Virginia population was uninsured.  By July 2014, that number had fallen to 6.6 percent, and the reduction is due almost entirely to the ACA.

How many people have enrolled?

In addition to Medicaid and CHIP enrollments, 25,856 people had completed their private plan Obamacare enrollments by early July, which represented an increase of about 6,000 people since the end of the 2014 open enrollment period (qualifying events trigger special enrollment periods for private plans.)

Another 6,171 people had enrolled directly (outside the exchange) through Highmark Blue Cross Blue Shield – the only carrier offering 2014 plans in the WV exchange – between October 1 and April 15.

Prior to open enrollment, there were an estimated 99,000 West Virginians eligible for private Obamacare plans, so the combined total of on and off-exchange enrollments represents nearly a third of those individuals.  Perry Bryant, Executive Director of West Virginians for Affordable Health Care, called the first year’s enrollment numbers “not as robust as we would have liked” but noted that HealthCare.gov is much more functional that it was a year ago.

Kentucky CO-OP postpones expansion to WV

Highmark Blue Cross Blue Shield is the only carrier offering coverage – a total of eleven different plans – in the West Virginia exchange in 2014.  In late May however, West Virginia announced that the Kentucky Health Cooperative would be joining the WV exchange and its plans would be available alongside the Highmark policies during the 2015 open enrollment that begins November 15.

But in early November, Kentucky Health Cooperative announced that they were postponing their expansion into West Virginia by a year, saying that they needed additional time to make sure that the new West Virginia Health Cooperative would be fully functional before being offered for sale in WV.

Kentucky Health Cooperative is a CO-OP (consumer oriented and operate plan) created under the ACA.  Joseph Smith, the CO-OP’s Chairman, mentioned that in Kentucky, the CO-OP had 2014 enrollment that was double what they had expected.  Because the CO-OP filed rates alongside Highmark for 2015, experts believe that Highmark was forced to be more competitive with their rates, and those will not change even with the news that the CO-OP coverage will not be available in WV in 2015.

The lowest cost bronze plan in the WV exchange in 2014 costs an average of $280/month, higher than the national average of $249.  For 2015, the average rate increase in the individual market in West Virginia is 6.7 percent, although there is variation from one plan and region to another.

Why has West Virginia been so successful?

West Virginia is expanding Medicaid, and is using auto-enrollment directly through the state’s Medicaid program, in addition to Medicaid enrollment through the exchange.  The state has been working to contact residents who receive SNAP and WIC benefits, as well as households where some members were already receiving Medicaid benefits.  By letting these individuals know about the expanded Medicaid program, the outreach program has been wildly successful.

Actuaries had predicted that 63,000 people would enroll in WV’s expanded Medicaid program in 2014, but by September, the number of new Medicaid enrollments in WV had grown to between 132,00 and 145,000 people, out of an estimated total of between 143,000 and 150,000 eligible people.

West Virginians for Affordable Health Care is a group that has been instrumental in pressing for healthcare reform in West Virginia for nearly a decade.  They have been involved in education and outreach about the ACA, and are pushing for better management of chronic illnesses, which account for three quarters of the state’s health care spending.  Their efforts have helped to bolster WV’s exchange enrollment numbers, for both Medicaid and private plans.

West Virginia exchange history

After first developing plans to operate a state-run health insurance exchange, West Virginia submitted a blueprint for a partnership exchange to the U.S. Department of Health and Human Services (HHS). The blueprint for the West Virginia Health Insurance Marketplace was approved in March 2013.

Gov. Earl Ray Tomblin’s administration cited cost, particularly the expense associated with information technology systems, as a key factor in deciding against a state-run exchange. Administration officials also said the partnership gives the state some control over the exchange.

Under the partnership, West Virginia is responsible for regulating the companies that sell health insurance policies on the exchange.

The state also oversees the In-Person Assister (IPA) program. Assisters will be under contract with the state and provide individuals impartial help with the enrollment process.  In November, the state announced that it would be hiring an additional 100 people to help residents enroll in the exchange and the state’s expanded Medicaid program.

No extension of grandmothered plans

West Virginia is not allowing non-grandfathered pre-2014 policies in the individual market to renew again in 2014; they must be replaced with ACA-compliant coverage as of their renewal date in 2014.  And the state has also filed a lawsuit against the Obama Administration because the federal government deferred to the states on the decision about whether or not to renew grandmothered plans.

Contact the exchange

West Virginia residents will enroll through the federally facilitated exchange; 2015 enrollment runs November 15, 2014 through February 15, 2015.


West Virginia health insurance exchange links

West Virginia Health Reform Resources

State Exchange Profile: West Virginia
The Henry J. Kaiser Family Foundation overview of West Virginia’s progress toward creating a state health insurance exchange.