The New York Times on Friday examined new revisions to the West Virginia Medicaid program that will "reward 'responsible' patients with significant extra benefits or -- as critics describe it -- punish those who do not join weight-loss or anti-smoking programs, or who miss too many appointments, by denying important services" to help reduce costs.
The Bush administration this summer approved the revisions, which will take effect in a pilot phase in three rural counties over the next few months, as part of an effort to encourage states to test approaches using more "personal responsibility" in Medicaid programs, according to the Times. Under the revisions, West Virginia will ask Medicaid beneficiaries to sign a contract, under which they agree "to do my best to stay healthy," attend "health improvement programs as directed," seek routine medical checkups and screenings, attend all scheduled physician appointments, take medications as prescribed and visit emergency departments only for medical emergencies. Medicaid beneficiaries who adhere to the contract will receive "enhanced benefits," such as coverage for mental health counseling, anti-smoking and anti-obesity programs, cardiac rehabilitation, diabetes management assistance, certain prescription drugs and home health visits. In future years, Medicaid beneficiaries who continue to adhere to the contract will receive additional enhanced benefits, possibly including coverage for orthodontic or other dental care. Medicaid beneficiaries who do not sign or adhere to the contract will receive the minimum benefits required by federal law.