Coalition calls for end of redesigned Medicaid program in West Virginia

A coalition of religious, labor and health care activists, on Wednesday said West Virginia should suspend its redesigned Medicaid program because it penalizes low-income children and adults, the Charleston Gazette reports.

The "cornerstone" of the program, called Mountain Health Choices, is a two-tier benefits system, the Gazette reports. The higher tier offers benefits that are better than traditional Medicaid, but beneficiaries must sign a "personal responsibility" agreement to receive the enhanced benefits. The agreement requires beneficiaries to see a physician, show up for appointments and avoid seeking care at emergency departments. Beneficiaries who do not qualify for the higher tier are covered by the lower-tier "basic" plan, which provides benefits that are less than traditional Medicaid.

The Families and Children Educate the State on Medicaid coalition said that 5.5% of adults and 7.5% of children in the state's program are receiving the higher-tier benefits, while the remaining beneficiaries have "bare-bones" coverage. Coalition members also said that many beneficiaries are confused about the program's requirements. Evelyn Dortch, executive director of Direct Action Welfare Group, said that some beneficiaries do not know they are on the basic plan until they are denied a service or prescription drugs. The basic plan allows four prescriptions per month, with the exception of some lifesaving drugs. The coalition said that the state should restore traditional Medicaid or enroll everyone in the higher-tier program. Renate Pore, co-chair of the West Virginia Healthy Kids and Families Coalition, said, "The redesign is about saving money and denying services."

State Health and Human Resources Secretary Martha Walker said that it is too soon to judge the new program, which has been in effect for five months. She said the new program will improve beneficiaries' health and reduce costs. "We're trying to give people an opportunity to make good choices, and when they make good decisions, to reward them," Walker said (Eyre, Charleston Gazette, 6/12).