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West Virginia and the ACA’s Medicaid expansion

Total Medicaid enrollment is up 64% since 2013

ACA’s Medicaid eligibility expansion in West Virginia

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West Virginia’s leaders opted to expand Medicaid under the Affordable Care Act (ACA) starting on January 1, 2014, providing coverage to low-income adults, most of whom have jobs but no option for employer-sponsored health insurance. The federal government paid the full cost for the expansion population for the first three years, but gradually reduced the funding split until reaching a 90/10 split in 2020, which will remain fixed in future years (but the Build Back Better Act would temporarily boost federal Medicaid expansion funding to 93%, if the version that passed the House is enacted).

Under the expanded eligibility guidelines, adults age 19-64 are eligible for Medicaid with a household income up to 138% of the poverty level. Medicaid expansion initially significantly exceeded the 93,000 people that West Virginia had projected to enroll by 2020 under the expanded eligibility guidelines, but enrollment declined after peaking in 2016. The total number of people enrolled under expanded Medicaid declined slightly by January 2017, to 174,026, and declined further, to 165,917, by March 2018.

But it had grown to 189,640 by 2021, due in large part to the COVID pandemic. Medicaid enrollment has grown nationwide due to the pandemic. Under the Families First Coronavirus Response Act, states are receiving additional federal Medicaid funding, on the condition that they do not disenroll anyone from Medicaid during the COVID public health emergency period. So Medicaid enrollment has generally trended upward since March 2020.

CMS reporting shows that West Virginia’s overall Medicaid population (meaning individuals eligible and enrolled under pre-ACA eligibility requirements plus those eligible and enrolled under the ACA’s expansion criteria) is up 64% between 2013 (pre-ACA) and May 2021. Over 581,000 people were enrolled in Medicaid and CHIP in West Virginia as of May 2021, and nearly a third of that population was enrolled under the ACA’s Medicaid expansion guidelines.

SB564 was signed into law in West Virginia in 2019. The legislation called for CHIP coverage in West Virginia to be expanded to include pregnant women. CHIP eligibility for kids in West Virginia already extended to households with income up to 300% of the poverty level, and that’s the same level that now applies to pregnant women as well. The new CHIP coverage for pregnant women took effect on July 1, 2019 in West Virginia.

Only five other states (Colorado, Missouri, New Jersey, Rhode Island, and Virginia) provide CHIP coverage to pregnant women, but there are numerous states with fairly high income limits for pregnant women to qualify for Medicaid (for example, Medicaid coverage is available to pregnant women in Iowa with household income as high as 375% of the poverty level; in DC, it’s 318%)

West Virginia considered a Medicaid work requirement

As of late 2017, West Virginia’s Department of Health and Human Resources was considering the possibility of seeking a waiver from the federal government in order to implement a work requirement for the state’s Medicaid expansion population. Legislation (HB3136) to create a work requirement was considered in the 2019 legislative session, but it was criticized by consumer advocates and did not advance to a vote.

Although work requirements were a non-starter with the Obama administration, the Trump administration approved them in several states. But the work requirements were either overturned by judges or suspended due to the COVID pandemic, and all of the approved work requirement waivers have been revoked by the Biden administration.

Medicaid expansion helping to combat opioid crisis

The opioid crisis has hit West Virginia particularly hard, and the state has the nation’s highest drug overdose death rate. About 22,000 people covered under expanded Medicaid had received treatment for mental health and substance abuse disorders by early 2017. Without Medicaid expansion, most of those people would have been uninsured and unable to access treatment.

Previous and current governor support Medicaid expansion

West Virginia’s former Governor, Earl Ray Tomblin, was instrumental in West Virginia’s acceptance of Medicaid expansion but was term-limited and could not seek re-election in 2016.

Governor Jim Justice took office in January 2017. He campaigned and was elected as a Democrat, but in the summer of 2017, during his first year in office, he switched to the Republican party. Justice reiterated his support for Medicaid expansion in the weeks leading up to his party switch, stating in late June 2017 that it would be “beyond catastrophic” if the people who had gained coverage under Medicaid expansion were to lose it. But Justice also vetoed a supplemental appropriation for the state’s Medicaid program in 2019, saying that the Medicaid program already had enough funding.

West Virginia has accepted federal Medicaid expansion

  • 581,329 – Number of West Virginians covered by Medicaid/CHIP as of May 2021
  • 226,785 – Increase in the number of West Virginians covered by Medicaid/CHIP fall 2013 to May 2021
  • 54% – Reduction in the uninsured rate from 2010 to 2019
  • 64% – Increase in total Medicaid/CHIP enrollment in West Virginia since Medicaid expansion took effect

Substantial impact on uninsured rate

Expansion of Medicaid has played a primary role in West Virginia’s sharp reduction in the uninsured rate.

West Virginia had the sixth highest drop in uninsured rate during the first half of 2014, due primarily to Medicaid expansion.

According to U.S. Census data, the state’s uninsured rate was 14% in 2013, and had fallen to 5.3% by 2016. But it had increased to 6.7% by 2019, however, mirroring the nationwide trend of increasing uninsured rates under the Trump administration.

West Virginia’s uninsured rate had been similar to the U.S. average (14.5%) in 2013, but the state’s uninsured rate in 2019 was well below that national average at that point, which was 9.2%. West Virginia’s better-than-average performance in reducing the uninsured rate was due in large part to the expansion of Medicaid.

Who is eligible for Medicaid in West Virginia?

West Virginia Medicaid is available for these legally present residents, in addition to the aged, blind, and disabled.

  • Infants aged 0 to 1 in households with income up to 158 percent of the federal poverty level (FPL)
  • Children aged 1-5 in households with income up to 141 percent of FPL
  • Children aged 6-18 in households with income up to 133 percent of FPL
  • Pregnant women with income up to 185 percent of poverty
  • Adults with incomes up to 133 percent of poverty

Pregnant women and children in households with up to 300 percent of FPL qualify for CHIP in West Virginia.

How does Medicaid provide financial help to Medicare beneficiaries in West Virginia?

Many Medicare beneficiaries receive assistance from Medicaid with Medicare premiums, prescription drug costs, and expenses not covered by Medicare – including long-term care.

Our guide to financial assistance for Medicare enrollees in West Virginia includes overviews of these benefits, including Medicaid long-term care coverage, Medicare Savings Programs, and eligibility guidelines for assistance.

How do I enroll in Medicaid in West Virginia?

You can apply for West Virginia Medicaid through the federally-run exchange by visiting HealthCare.gov or calling 1-800-318-2596 24 hours a day.

Or you can apply through the state at www.wvinroads.org and that site can also provide SNAP and cash assistance programs for eligible residents.

Medicaid enrollment is year-round: There is no specific time frame during which applications must be completed.

West Virginia Medicaid enrollment numbers

As of mid-July 2014, there were 132,556 new West Virginia Medicaid enrollees who were newly eligible under the expanded guidelines. Although most of the newly-eligible population enrolled during the first year, the number of newly eligible enrollees had grown to 164,400 by June 2015, and to 178,394 by August 2016. Enrollment in expanded Medicaid declined slightly by the beginning of 2017, to 174,026, and declined further, to 153,874 by December 2018. It had stabilized by that point, and stood at 156,775 as of November 2019.

But the COVID pandemic has increased the number of people enrolled in Medicaid nationwide, particularly in states that have expanded Medicaid. As of mid-2021, West Virginia’s Medicaid expansion covered 189,640 people.

In 2013, the Kaiser Family Foundation estimated that about 143,000 people in West Virginia would be newly-eligible for Medicaid as of 2014. But the state’s estimate had been much lower, with a projected expansion enrollment of 93,000 by 2020.

Opponents of Medicaid expansion predicted that states with a surge in Medicaid enrollment would find that Medicaid patients were unable to get appointments for primary care, but West Virginia doctors weren’t indicating that was a problem when enrollment initially spiked. Instead, some of their challenges include a significant population of newly-insured people who are requesting pain medication at office visits, and patients who have previously been on free drug samples and need to be switched to another drug that’s covered by Medicaid. Despite the unexpectedly large enrollment in Medicaid expansion — combined with the fact that the state began paying a portion of the Medicaid expansion costs starting in 2017 — West Virginia’s Medicaid budget had a surplus as of early 2019.

Overall, West Virginia’s Medicaid enrollment (including both individuals eligible and enrolled under pre-ACA eligibility requirements plus those eligible and enrolled under the ACA’s expansion criteria) was 581,329 as of May 2021. Note that this figure includes CHIP enrollment.

Uncompensated care costs decline sharply

According to data compiled by West Virginians for Affordable Health Care, hospitals in West Virginia saw a 40% decline in uncompensated care costs from 2013 to 2014, thanks in large part to Medicaid expansion that resulted in far fewer uninsured residents in the state.

But although the hospitals acknowledge that their uncompensated care and charity care costs have declined significantly, some also note that Medicaid reimbursements are less than the cost of providing care, and that their losses on Medicaid volume are offsetting the improvements they’ve seen in uncompensated care.

West Virginia’s Medicaid expansion history

West Virginia had initially considered setting up a state-run exchange, but later opted for a partnership exchange, citing cost as one of the reasons for avoiding a fully state-run exchange.

State leaders have said that given the choice between a state-run exchange and Medicaid expansion, the latter seemed like it would provide more bang for the buck (and judging by the state’s extremely successful Medicaid enrollment in 2014, it would appear they were correct).

In May 2013, then-Governor Earl Ray Tomblin announced that West Virginia would proceed with Medicaid expansion. Enrollment for newly-eligible residents began on October 1, 2013, with coverage effective January 1, 2014.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in West Virginia

Apply through HealthCare.gov or by calling 1-800-318-2596 (24 hours a day).

Eligibility: The aged, blind, and disabled.  Also, adults with incomes up to 138% of FPL; children with household incomes up to 300% of FPL are eligible CHIP; pregnant women with incomes up to 158% of FPL.

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