UPDATE 5/2/13 @ 6:00 p.m.
CHARLESTON, W.Va. (WSAZ) -- Health insurance coverage is now on the way for as many as 90,000 West Virginians, after Governor Earl Ray Tomblin announced the state's plans to expand Medicaid coverage on Thursday.
The federal government will pay nearly all the costs for the first three years of the expanded coverage, with West Virginia paying only administrative costs, to the tune of $5 million a year.
The new eligibility level is 138 percent of the federal poverty line. For a family of four, that works out to annual income below $32,500. The news comes as a relief to people like Celena Roby. She's a domestic abuse survivor who has ongoing medical bills that require her to be hospitalized for treatment every six months.
"I've had to make the decision whether to get the treatments I need or feed my children," Roby said.
After three years of the federal government covering most of the costs, West Virginia's contribution will increase to more than $70 million a year by the end of the decade in 2023. Over that ten-year window, West Virginia would pay a total of $375 million for this expansion. During that same time, the state is slotted to receive $5.2 billion from the federal government. Had it chosen not to expand its Medicaid program, West Virginia would not have gotten this money.
"We have weighed the options and believe expanding Medicaid is the best choice for West Virginia," Tomblin said Thursday.
If the state chose not to expand, federal taxes would have stayed at current levels regardless. West Virginians would then be paying for Medicaid expansion in states other than their own.
The expansion is welcome news for those who are newly eligible. But how does it affect those with private or employer-provided insurance coverage? Until now, premiums have been higher in the private insurance marketplace because of cost-shifting to compensate for the emergency room, hospital and clinic visits of the uninsured.
Now, the state says, people with private insurance can expect to see their premiums go down by about five percent.
"Hospitals will reduce uncollectibles and reduce the cost shift to commercial insurers, and ultimately businesses, that pay those premiums," Tom Jones, president of West Virginia United Health System, said.
Even with federal funding taking care of many costs, the expansion will still cost West Virginia close to $400 million, leaving some wondering how the state can afford the expansion. One way is to move existing funds around.
"If we expand Medicaid, that's going to help reduce the number of uncompensated care cases," Sen. Jay Rockefeller (D-W.Va.) said.
Some money can also be redirected from children's health insurance programs into Medicaid. The state is also exploring managed care options for some of the eligible population, as well as implementing co-pays on a sliding scale based on income.
Supporters say in this economy, health insurance coverage is crucial.
"Times are difficult for a lot of people, especially working families," Roby said. "Trying to be a single parent and work and also provide health care for myself is very difficult."
The state has cautioned that the program may not continue after the initial three years if the federal government doesn't follow through on the promised funding for West Virginia.
"If the program becomes unsustainable, particularly after three years, or the federal government changes its promised funding allocations, we must be prepared to take action," Tomblin said.
Open enrollment begins October 1, and people can check if they're eligible at that time. Coverage would begin on January 1, 2014.
The expanded coverage also means that employers who aren't offering insurance and would otherwise face penalties will save money. Now, they won't pay a penalty if their workers enroll in Medicaid.
Gov. Earl Ray Tomblin announced the decision Thursday.
It follows a financial analysis that says that more than $5 billion in federal funds will pay for nearly all that additional coverage over the next decade.
But the state's share of the costs would increase by $375 million during that time.
"We anticipate expansion will allow us to provide insurance coverage to approximately 91,500 working West Virginians, significantly reducing the number of uninsured," Gov. Tomblin said. "A decision to expand today, However, does not end our efforts. We must carefully watch federal efforts. If the program becomes unsustainable, particularly after three years, or the federal government changes its promised funding allocations, we must be prepared to take action to protect our State.
The federal law calls on states to extend Medicaid to more low-income adults. Around 166,000 more West Virginians would qualify.
The analysis estimates that 91,500 uninsured residents are likely to enroll.
"One out of every four West Virginians -- not strangers, but the men, women and children we know from the playground, church, or the grocery store -- still do not have health insurance," Sen. Jay Rockefeller said. "Governor Tomblin has been working hard to close that gap because it affects everyone in this state in some way.
West Virginia is joining 22 other states to expand. Fourteen states have decided against expansion.
Tomblin also plans to pursue cost controls through managed care for some Medicaid services and co-payments for others.
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Tomblin is unveiling the state's plans Thursday at St. Francis Hospital in Charleston. U.S. Sen. Jay Rockefeller and hospital executives are scheduled to join him.
The Democratic governor is basing his decision on a financial analysis of the potential benefits and pitfalls of expansion. The state already is struggling with Medicaid costs. But federal funds would cover new enrollees almost entirely.
Both supporters and foes of the federal overhaul believe the governor will expand Medicaid. The federal law calls on states to cover more low-income adults through Medicaid. About 166,000 more West Virginians would qualify.
While 22 states so far plan to expand Medicaid, another 14 have decided against it.
Gov. Earl Ray Tomblin plans to announce his decision Thursday at St. Francis Hospital in Charleston. He will be joined by U.S. Sen. Jay Rockefeller and several hospital chief executives.
The federal health care law calls on states to cover more low-income adults through Medicaid.
About 166,000 more West Virginians would qualify. But the U.S. Supreme Court, in upholding the law, ruled that states can't lose federal funds if they don't go ahead with an expansion.
Fourteen states have rejected expansion, while 22 say they will expand.
The Democratic governor is basing his decision on a financial analysis of the potential benefits and pitfalls of expansion. The state is already struggling with Medicaid costs. But federal funds would mostly cover expansion.