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State still waiting results of Medicaid report

CHALRESTON, W.Va. -- Gov. Earl Ray Tomblin is still waiting for a study he commissioned to help him decide whether to expand the state's massive health care program for the poor.

The actuarial analysis considers the ramifications if Tomblin decides to allow more residents to be eligible for Medicaid benefits.

CCRC Actuaries, a Maryland-based company that has done similar work for the state in the past, planned to present the analysis in January, said Rob Alsop, Tomblin's chief of staff.

Data collection issues delayed the report's completion, but Alsop said the actuaries promised to turn over the final analysis by the end of March.

The governor's office has seen parts of the report, "but the numbers have not solidified," Alsop said.

The administration has no idea when the report will be done but hope it's soon.

"I have not kept up with the actuaries or asked them what is taking them time to do it," Alsop said.

"But when you're talking about looking at six years of projections of the state Medicaid program and you really go down in the weeds, that can take some time to get it right."

The office has asked for the report almost daily, he said.

Alsop was unsure how the state was paying for the report or whether CCRC would receive additional compensation for the extra time spent on the project.

When contacted by the Daily Mail last week, CCRC Managing Partner David Bond said the report was not completed and he could not comment further.

In June, the U.S. Supreme Court determined states could choose whether to participate in the expansion of Medicaid called for under the federal Patient Protection and Affordable Care Act.  

If a state does choose to participate, it must expanding eligibility to residents with income of 138 percent of the federal poverty level. That's about $32,500 for a family of four, according to The Associated Press.

Right now West Virginians are eligible if they have income of less than 35 percent of the federal poverty level. That's about $8,240 for a family of four.

About 420,000 state residents already receive their health care through Medicaid, and an estimated 150,000 more could qualify if Tomblin opts to expand the program.

The federal government would pay for the entire cost of the expansion for the first three years, but by 2020 the state would be responsible for 10 percent of the cost.

Medicaid already consumes much of the state budget, and its growing costs have caused the governor to order cuts in other areas.  

Expansion of eligibility raises questions, Alsop said. House Health and Human Resources Committee Chairman Don Perdue, D-Wayne, agreed.

Expansion of the program also could attract more people who already were eligible, Perdue said.

Alsop made the same point and noted that the state had a $140 million Medicaid shortfall this year.

Estimates of the state's 10 percent share of the expansion cost are "all over the board," Perdue said. That's what makes the actuarial study so important.

"I don't know why it's taking so long," Perdue said Tuesday. "We keep hearing, 'We have a draft of it, but we're not satisfied with it. We've gone back to the contractor and we've asked them to revisit some issues there.' "

"They tell me, they say it over and over again, a decision is eminent," he said.  

Alsop said that while the report is expected soon, the governor's decision is still a ways off.

Once Tomblin receives the final report, Alsop said he anticipates the governor speaking with many people to gauge their opinions of the findings.

The regular legislative session ends April 13. Perdue hopes any decision from the governor comes before the final day.

"I would hope that it's still while we're in session; that way more legislators will be exposed to the actuarial study and have a degree of comfort with what we are doing," Perdue said.

"If you get out of town and have to view it from afar, it's not quite the same."

Alsop and Perdue both said they didn't think expansion of Medicaid would require legislative action. However, both said a decision either way would have financial and logistical ramifications that eventually could require legislative action.

Senate Finance Chairman Roman Prezioso, D-Marion, said the issue is definitely on his radar.

He said he had no doubt the Legislature eventually would have to find additional funding if the program were expanded.

Perdue, an ardent supporter of Medicaid expansion, thinks it actually could save money.

He said not every eligible person is expected to seek benefits in the first few years, and that will bring down costs.

He said costs also could be held down if the expansion works as planned — providing more access to health care, making people healthier and keeping them out of the hospital.

"You have to look at our demographics, at our poverty level, at the number of working poor that it would influence," Perdue said.

"Also, the fact that those people who aren't getting any kind of health care. . .when they get sick, we all pay for that. The cost shift occurs. This would either eliminate it or really slow down that cost shift."

Perdue speculated the decision delay also could stem from the state Department of Health and Human Resources.

Expanding the program would present significant changes for the massive agency, so Perdue thought agency officials might be working on a plan.

Many states already have decided to expand their Medicaid programs, although recent opposition has come in Florida and Texas.

In this state, the left-leaning West Virginia Center on Budget & Policy, the Roman Catholic Church and others have voiced support for expanded Medicaid coverage.

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


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