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W.Va. health coverage plan not ready

CHARLESTON, W.Va. - There's been little progress by the state in creating a plan to expand Medicaid coverage in West Virginia since Gov. Earl Ray Tomblin announced the move in May.

That could change following the release of rules by a federal health care agency Friday, but officials say it will still be a challenge to have a plan in place by the Oct. 1 deadline.

Tomblin announced May 1 the state would expand Medicaid in connection with the massive changes to health care under the federal Affordable Care Act.

Right now only people who make 38 percent of the federal poverty level or less - about $8,200 for a family of four - are eligible for Medicaid. Tomblin's decision expands that to 138 percent, or about $32,500 for a family of four.

The state expects more than 90,000 people to seek coverage once the changes take effect. About 350,000 people received benefits through Medicaid last year in West Virginia.  

In his announcement, Tomblin called on the Bureau for Medical Service - an agency within the state Department of Health and Human Resources - to create a report about how it will extend coverage.

The report is also supposed to outline how the state can create a co-pay system and move all aspects of public health care under the state's current managed care system, called Mountain Health Trust.

Tomblin said he expected the report in June, and then-DHHR head Rocco Fucillo pledged it would be completed sooner.

It's still not done, DHHR and governor's office officials said.

Nancy Atkins, commissioner of the Bureau for Medical Services, blamed the federal government, saying officials had failed to provide final guidelines the state should follow in crafting a plan.

"I think everybody is kind of waiting with bated breath for that final guidance so we can kind of move everything forward," Atkins said last week.

In May, Fucillo said the department had been working for months on moving forward with Medicaid expansion in case Tomblin opted to open the program. Last week Atkins said they initially expected to be done in May. They've worked since then on aspects of the plan, but Atkins said they're at a standstill without the final guidance from the federal government.

The bureau must prepare state plan amendments: Atkins described them as the documents the state needs to submit to the federal Centers for Medicare and Medicaid Services - commonly known as CMS - in order to proceed with the state's plan for implementation.

Atkins said the state anticipates filing 18 different state plan amendments. She said they can't finalize those documents until CMS creates a "template" for those documents.

CMS released a more than 600-page document Friday outlining how states should proceed with expansion. It addresses eligibility requirements, adds "flexibility regarding benefits and cost sharing for state Medicaid programs," provides guidance for states in implementing health insurance exchanges and much more.

Atkins wasn't immediately available for comment, and a message left with the governor's office wasn't returned.

Earlier in the week Atkins said the release of the rule doesn't mean the state will be able to quickly complete it's own report.

"Even when they publish those final rules, we certainly have to go through them with a fine-tooth comb," Atkins said.

The massive report is "pretty far down in the weeds" at some points but very important, said Perry Bryant, executive director of West Virginians for Affordable Health Care. The nonprofit is comprised of health care professionals and supports implementation of the Affordable Care Act.

The state will go through the final rules and create a plan, which will then be available for public comment, Atkins said.

Once they receive comment, they must submit them to CMS for final approval before they can be implemented, Atkins said.

Perry said the state doesn't actually have to ask for public approval, only present the plans to the Medicaid Services Fund Advisory Council.

The council, which meets quarterly, has its next meeting this Friday. Atkins is scheduled to provide a health care reform update.

"It's not like we have a choice whether to (implement it), it's the law of the land," Bryant said, referring to the Affordable Care Act. "The only question is whether we do it well or we do it poorly."

Atkins said the bureau was preparing for the rules to be released so it could finish the plans as soon as possible. The newly eligible may begin enrolling Oct. 1, with services available beginning Jan. 1.

Bryant said it's unknown whether the state can get everything done in time.

The federal government already announced it would delay the Affordable Care Act mandate that larger employers provide insurance to workers. In the report released Friday, CMS hints other aspects might be delayed as well.

"Finally, this final rule provides notice that we are considering, for purposes of the initial open enrollment period . . . whether various provisions of the Medicaid and CHIP regulations should be effective October 1, 2013, or whether a later effective date is appropriate," the report states.

A summary and the full report are available at

Contact writer Dave Boucher at 304-348-4843 or Follow him at

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