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West Virginia to expand Medicaid

CHARLESTON, W.Va. -- Tens of thousands of West Virginians will soon be eligible for Medicaid coverage after Gov. Earl Ray Tomblin announced Thursday the state would expand its program under the federal health care overhaul.

"At the end of the day, we have weighed the options and believe expanding Medicaid is the best choice for West Virginia," Tomblin said to a crowd of more than 200 people gathered outside St. Francis Hospital.

About 91,500 people are expected to seek coverage after the change takes effect, according to a study Tomblin commissioned. The federal government will pick up most of the tab - about $5.2 billion over the next 10 years - but West Virginia will pay about $375 million over that time period as well.

The costs would be greater if the state did nothing, Tomblin said.

"Our tax dollars would pour into other states that do expand, our businesses will be subject to additional taxes and our hospitals would lose significant financial resources," he said. 

See also: Health officials say Medicaid expansion better than nothing

The Patient Protection and Affordable Care Act, often called Obamacare by supporters and opponents alike, greatly expands public health care coverage. That includes providing more federal funds so that states can extend programs to more people.

In June the U.S. Supreme Court ruled Obamacare was legal but mandating states expand Medicaid coverage was not. 

West Virginia was one of the few states that held out on making a decision.

Not everyone who will be eligible under the expanded program is expected to join, said Jeremiah Samples, director of health policy for the West Virginia Offices of the Insurance Commissioner.

Right now, people who earn 35 percent or less of the Federal Poverty Level are eligible for coverage. That's about $8,200 for a family of four. Under the expansion, those earning 138 percent or less of the federal poverty level, or about $38,046 for a family of four, can enroll.

About 350,000 people received health care through Medicaid in West Virginia this year, said Nancy Atkins, commissioner of the state Bureau for Medical Services.

The federal government has pledged to cover the entire cost for the first three years of the program. West Virginia gradually pays for a portion starting in 2017, peeking at 10 percent in 2020 and every year thereafter.

Much of the basic information about Medicaid expansion was known around the time of the Supreme Court's decision. Rob Alsop, Tomblin's chief of staff, acknowledged the decision took time but said the governor wanted more specifics about what that would mean for the state.

West Virginia has allocated up to $860,000 in federal grant funds to pay Maryland-based firm CCRC Actuaries to study health care in the state . The report was due in January, but it took longer than Alsop and others expected to get results concerning the Medicaid expansion. 

"I think we've done it in a way where we pulled the trigger when we felt comfortable. I don't really look at it as a delay," Alsop said, adding he was pushing CCRC to complete its work.

"I can tell you the folks at Medicaid would have liked to have known what we were going to do six months ago, so that they won't be running full-hard through Oct. 1 to make this happen."

On Thursday, CCRC released the Medicaid expansion portion of its report, which cost about $107,000, according to Tomblin spokeswoman Amy Shuler Goodwin. The firm estimates the federal government will pay $5.2 billion for the expansion over the next 10 years, with the state responsible for an additional $375.5 million during the same period.

"With the additional money coming in from the federal government this will be able to make insurance more affordable for those people who are on insurance, and will expand coverage for better health care to all of West Virginia," Tomblin said after his speech.

In the first three years of the program, West Virginia is responsible for $5 million each year, a figure Alsop said is very manageable. By 2020, that share increases to about $65 million, according to the CCRC report.

Tomblin said the state could afford the extra cost.

There are several state-funded health care programs with participants who would be covered by the expansion, Samples said. As those people transition into Medicaid, those state funds can be used to offset the increased cost, Samples said.

A recent report received by the Governor's office that criticizes the state Department of Health and Human Resources also said the state could save more than $50 million by implementing more efficient practices. Samples said that savings could go toward the extra costs.

"West Virginia must protect itself and may be forced to discontinue providing health care benefits to the expansion population," Samples cautioned, reading from another report.

Without the expansion, the report said West Virginia businesses would pay about $6 million a year in fines for failing to provide employees with coverage.

Sen. Jay Rockefeller, D-W.Va., applauded Tomblin's decision. 

"Medicaid is a lifeline for so many West Virginia families. It's affordable and efficient. It creates jobs and wages. Currently a quarter of West Virginians count on it ... West Virginians deserve nothing less," Rockefeller said in a statement. 

Sen. Joe Manchin, D-W.Va., said he would support Tomblin's decision. Secretary of State Natalie Tennant and state Senate President Jeff Kessler also sent out news releases in support of the decision, while other state Democrats attended Tomblin's announcement.

The state Republican Party and Attorney General Patrick Morrisey, a Republican, decried the decision.

GOP Chairman Conrad Lucas called it a sad day and questioned whether the state could afford the change.

Morrisey, a vocal opponent of the federal health care overhaul, did the same.

"While paying for the state's portion of this expansion will be daunting enough today, does anyone really believe that the federal government will maintain its same level of Medicaid funding in the future when it is staring at a $16 trillion debt and desperately needs to reduce spending?" Morrisey said in a press release.

To execute the decision, Tomblin is asking the Department of Health and Human Resources to create a plan for expanding Medicaid eligibility.

The request also requires DHHR to look at creating a co-pay system for Medicaid participants, while moving all aspects of public health care to the four health care providers that compiled the state's managed care system, called Mountain Health Trust.

Acting DHHR secretary Rocco Fucillo said the department has worked for months on hwo to move forward with a Medicaid expansion.

The DHHR's report will be ready by the June 1 deadline and department staff will be ready to take on the extra workload that accompanies expansion, he said.

The newly eligible are able to enroll in Medicaid starting Oct. 1. Coverage begins Jan. 1, 2014. Reporter Dave Boucher can be reached at 304-348-4843 or david.boucher@dailymail.com. Follow him at www.twitter.com/Dave_Boucher1.

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