CHARLESTON, W.Va. — The PEIA Task Force is weighing the challenge of greater flexibility for insured people who live on border counties versus the cost to the state.

A task force subcommittee discussed that longstanding issue at length on Thursday morning, taking no action but indicating desire to reach out to Gov. Jim Justice for his opinion.

Throughout its months of work, the task force has discussed the needs of West Virginia’s many border county residents, particularly those in the growing Eastern Panhandle.

Those residents have indicated they want and need more flexibility to seek healthcare out of state but still near where they live.

As it stands now, they pay more to do so.

Ted Cheatham

Public Employees Insurance Agency Director Ted Cheatham acknowledged the issue but also said dealing with it would present additional cost.

Cheatham said the issue could be addressed in three ways:

  • by shifting approved out-of-state healthcare co-pays to an 80-20 split between the plan and the insured, rather than the 70-30 split that exists now.
  • by removing a maximum facility fee
  • and by removing a $25 co-pay from out-of-state services

Taking all those steps would cost about $22.4 million a year to the state, Cheatham said.

He said that cost could be offset by about $9 million through savings provided by the state’s recent switch to a new third party administrator contract.

PEIA Task Force member Geoff Christian, a senior partner with Assured Partners commercial insurance, concluded the problem the Eastern Panhandle is having is that its growth has outpaced coverage.

That problem might not be easily addressed by the PEIA Task Force, Christian said.

Geoff Christian

“We’ve got such big population growth. The population growth means we have a lack of providers,” Christian said. “We don’t have that problem really anywhere else in West Virginia.

“That, in particular, is a tough one to fix.”

He added, “We can deal with a lot of things in fixing insurance, whether it be prescription drugs, or deductibles or co-pays.

“All those things can be mended, but I don’t have an answer for how do we get a number of providers in that area, other than let economic take forces take care of it. Where there’s a demand should bring opportunity for those providers.”

Task Force member Amy Loring, a human resources officer for Berkeley County Schools, underscored that greater flexibility for those on border counties is a major issue.

“It was made crystal clear in the listening sessions across the state that the out of state coverage is one of the leading concerns our members had, and it’s not just in the Eastern Panhandle. It’s across the state,” Loring said.

She suggested the Task Force should be on the verge of making a recommendation on that issue.

“We’re at a crossroads of ‘This is what the members want, but this is the cost associated with it.'”

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