CHARLESTON, W.Va. -- Gov. Earl Ray Tomblin cast further doubt Monday on the prospect of West Virginia meeting the federal deadline for expanding its Medicaid program coverage under the Affordable Care Act.
In a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius, Tomblin asked a series of questions he believes are crucial to the state meeting the deadline.
He blamed federal delays for the state's problems with rolling out its new Medicaid system and new insurance exchange.
"It concerns me that incomplete rules and guidelines provided by the federal government, to this point, will not support a successful implementation of the requirements for Medicaid Expansion and the functionality of the insurance exchange," Tomblin said in a news release.
In May, Tomblin announced the state would expand its Medicaid coverage as a part of the federal health care overhaul. The decision would greatly loosen eligibility requirements for Medicaid benefits.
People who make 35 percent of the federal poverty level or less - about $8,200 for a family of four - are eligible for Medicaid right now. The expansion would push that to 138 percent, about $32,500 for a family of four.
The state expects some 91,500 more people to seek coverage once the changes take effect. About 350,000 state residents received Medicaid benefits last year. In theory, West Virginians can enroll in the new program starting Oct. 1 and start to receive the new benefits Jan. 1, 2014.
Officials had hoped to unveil a plan outlining steps for expansion, moving all coverage to a state-run managed care program and developing a co-payment system by June.
The plan still isn't ready, Bureau for Medical Services Commissioner Nancy Atkins said.
In early July, she told the Daily Mail the bureau was still waiting on guidelines from the federal Centers for Medicaid and Medicare Services - commonly known as CMS - concerning state plan amendments. The amendments are tentative plans for how the state aims to accomplish its expansion.
The state anticipates filing 18 state plan amendments, and couldn't do so until CMS issued the guidelines, Atkins said.
CMS sent out the guidelines July 5, as part of a massive release of information. The bureau is now using the guidelines to help craft its amendments, communications director Penney Hall said. The bureau plans to have most plans out for public comment by Aug. 1, Hall said.
The bureau held the second of two planned public meetings Monday afternoon to discuss a different waiver associated with the expansion.
The waiver allows for the early implementation of modified adjusted gross income, or MAGI, when determining eligibility. Hall said it's a less complicated way to figure out who is eligible for coverage.
The new waiver would allow the bureau to start enrolling people Oct. 1 using the new eligibility criteria: Although that was the goal of the program all along, Hall said it would not be possible without this waiver.