west-virginia guide to health insurance

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West Virginia health insurance exchange

More than 508,000 WV residents enrolled in Medicaid or CHIP

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Although West Virginia opted to let HHS run the exchange, the state’s leaders have been working diligently to enroll as many people as possible in expanded Medicaid, and 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.

In addition to 154,000 Medicaid and CHIP enrollments (both through the exchange and directly with the state), 19,856 people had completed their private plan Obamacare enrollments by April 19, which was nearly double the number who had done so by March 1.  In addition, 6,171 people had enrolled directly through Highmark Blue Cross Blue Shield (the only carrier offering 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 more than a quarter of those individuals.

Obamacare enrollment has continued to climb in the West Virginia exchange.  Qualifying events trigger special enrollment periods for private plans, and Medicaid/CHIP enrollment continues year-round.  HHS will release updated enrollment numbers in November, which is when the 2015 open enrollment period is scheduled to begin.

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 the end of March, the number of new Medicaid enrollments in WV had grown to 117,522, out of an estimated total of between 133,000 and 143,000 eligible people.  Medicaid enrollment runs year-round, so the total should continue to climb slowly over the next several months.  Between expanded Medicaid and new enrollment in private plans through the exchange, West Virginia’s uninsured population dropped from 13.5% of the overall population to 4.2% in mid-February (and has continued to fall since then), demonstrating the effectiveness of a coordinated and automated Medicaid expansion effort.

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.  Highmark Blue Cross Blue Shield is the only carrier offering coverage – a total of eleven different plans – in the West Virginia exchange.  In late May however, WV 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 in November.  Carelink/Coventry Health had also been approved as a QHP prior to the 2014 open enrollment, but pulled out in September 2013.  The lowest cost bronze plan in the WV exchange costs an average of $280/month, higher than the national average of $249.  After four months of open enrollment, 84% of enrollees in private plans in the West Virginia exchange had received premium subsidies – very close to the national average of 83%.

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.

The West Virginia Offices of the Insurance Commissioner (OIC) estimated that between 40,000 and 60,000 West Virginians would purchase insurance through the exchange, so there are still many tens of thousands of people who can enroll during a special open enrollment following a qualifying event, or during the next general open enrollment.  According to Kaiser’s State Health Facts, 14 percent of West Virginians — about 260,000 people — were uninsured in 2013.  But by February 2014, that number had fallen to 4.2 percent of the population.

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.