Redesigned West Virginia Medicaid plan restricting benefits for more than 90% of child beneficiaries, report states

West Virginia's redesigned Medicaid program is restricting benefits for more than 90% of child beneficiaries because of insufficient efforts by the state to enroll children in an expanded plan, according to a report released Thursday, the Charleston Gazette reports.

The Medicaid changes took effect two years ago with the creation of Mountain Health Choices. The program covers more than 230,000, or 30%, of West Virginia children and offers expanded benefits for children whose parents sign "personal responsibility" agreements to improve their children's health. The agreement requires that beneficiaries see a physician, keep appointments and avoid seeking care at emergency departments. Eight percent of parents with children enrolled in Medicaid have signed the agreement.

Children of parents who do not sign the agreement receive "basic" coverage that provides fewer benefits than traditional Medicaid. This format is intended to encourage parents to take a greater interest in their children's health, but the redesigned plan is "seriously flawed" and is "not working as currently structured," the report states. The report, authored by Georgetown University Center for Children and Families Deputy Executive Director Joan Alker, states that beneficiaries receive a mailing notifying them that they must sign up for the expanded benefit package within 90 days after they become eligible to renew coverage. However, the date is not indicated in the mailing and parents are not warned that benefits could be reduced, according to the report. The study also states that the program has had "no real impact" on improving health or promoting healthy behavior.

The report found that children comprise 85% of state residents affected by the Medicaid changes. Alker said, "Children are losing their benefits under this punitive policy change," adding, "Clearly, the children who are most negatively impacted are children who have the most serious health care needs." She said, "Improving health and promoting healthy behaviors are laudable goals, but restricting health care coverage for infants and children is not the way to achieve them."

State officials defended the plan as offering "very good" health coverage. Shannon Landrum, a spokesperson for the West Virginia Bureau for Medical Services, said, "No children have lost coverage," and the state is "monitoring our enrollment data to gauge the long-term success of implementation." Landrum added that the date was included in a separate mailing to beneficiaries (Eyre, Charleston Gazette, 8/8). Landrum said that her department sees the report as "an oversimplification of what's happening with the Medicaid program and we truly wish they would have called to ask us about it" (Parnass, CQ HealthBeat, 8/8). Medicaid officials said all children in the program receive comprehensive care including regular screenings (AP/Wheeling News Register, 8/8).

The report is available online.