As Medicaid eligibility requirements return, thousands of West Virginians come off rolls

Thousands of West Virginians are coming off government health insurance programs as states snap back to Medicaid eligibility requirements that were in place before the covid-19 pandemic.

More than half were ruled ineligible not because they wouldn’t qualify, but instead because they haven’t completed their paperwork.

Jim McKay

“Losing coverage presents a huge challenge for families and their children,” said Jim McKay, state coordinator of Prevent Child Abuse, West Virginia, a program of TEAM for West Virginia Children.

“We know that access to Medicaid helps families access healthcare, substance use disorder treatment and postpartum services. It’s important for healthy births too.”

Medicaid is the joint federal and state program for some low-income people, families and children, pregnant people, the elderly and people with disabilities.

During the pandemic there was a requirement that Medicaid programs keep people “continuously enrolled.” Now the regular enrollment requirements are returning back into effect in states across the country, a process described as “unwinding.” Estimates indicate 8 million to 24 million will be removed from the rolls across the country.

Since the start of the pandemic, West Virginia Medicaid increased by 160,250 enrollees. The numbers rose from 504,760 in March 2020 to 665,010 in March 2023 because of the sustained enrollment provision during the pandemic.

That continuous enrollment condition came to an end on March 31. States started resuming normal operations, including restarting full eligibility renewals for Medicaid and the Children’s Health Insurance Program and terminations of coverage for people who are no longer eligible.

Since the start of April, 145,937 Medicaid enrollees in West Virginia have completed the renewal process, according to officials with the state Department of health and Human Resources.

Among those, 61,813 members have been determined to no longer be eligible for Medicaid coverage, according to state officials. Many of those are ineligible because of income — they make too much money for the  program.

But more than half of that number — 36,505 — were not eligible due to procedural reasons, which include members moving out of state, aging into Medicare, or having employer-sponsored coverage and no longer needing the program.

Rhonda Rogombe

“A lot of those folks might still be eligible for the program but did not return the paperwork. So these are just losses that eligible folks are facing,” said Rhonda Rogombé, health and safety net policy analyst at the West Virginia Center on Budget and Policy.

“A lot of people moved during the pandemic and didn’t update their contact information. I think a l0t of people are confused by the paperwork or assume adverse action will be taken if they fill things out since there hasn’t ben any action taken since the pandemic, about three years now. People get busy and forget. There are lots of reasons a person might not be willing or able to fill out their paperwork.”

Renewals can be submitted online through the WV PATH portal (wvpath.wv.gov), by mail, in-person at local DHHR offices, and by phone at 1-877-716-1212.

After their coverage closes, Medicaid members have three months to complete their renewal, and partway through last week about 6,000 members had regained Medicaid coverage.

West Virginia Medicaid does not track the ages of those who are determined ineligible.

Those without coverage might now be making difficult choices about their healthcare, Rogombe said.

“It’s important to be insured because it means you are connected to services that can help you lead a healthy life. Medicaid covers a broad range of services including things like preventive care, care for pregnant folks, recovery services, mental health services. There’s just so much Medicaid gives access to folks for and can help ensure they are living the healthiest version of their life.

“On a broader scale, the health of our communities speaks to the health of our society overall. The healthier a person is, the more engaged people can be in their own lives, including being able to work, being able to provide for their families, be involved with their communities, living the healthiest lives possible.”

For more than a year, DHHR’s Bureau for Medical Services has been communicating to providers and the public about the need for  Medicaid and CHIP enrollees to contact the state to ensure contact information such as mailing address, phone number, and email address is up-to-date, watch their mail for a renewal letter, and complete the renewal form as quickly as possible.

West Virginia Medicaid is assuring each member receives two calls and an email in addition to the renewal notice the month before it is due. In addition, 10 days prior to Medicaid coverage closure, another notice and phone call occur before any action is taken, according to state officials.

Jim Kaufman

Medical providers also have been working to communicate about the renewal requirements, through efforts like signage or quick chats during check-in or check-out for healthcare visits, said Jim Kaufman, president and chief executive of the West Virginia Hospital Association.

Kaufman praised state government’s outreach to people subject to renewal, noting that it’s hard to reach everyone. But he said healthcare providers have been concerned about the possible number of uninsured.

“When a Medicaid beneficiary shows up, we can try to flag that for them to try to reduce the number of people who lose access in the future,” Kaufman said.

Options for people who are deemed ineligible because of income requirements include the federal health insurance Marketplace, which can be relatively low-cost. WV Navigator can help with federal Marketplace plans for West Virginians without healthcare coverage: 304-356-5834 (toll-free: 1-844-WV-CARES).

“The optimal outcome while people may lose Medicaid is we get them covered through the exchanges or other commercial insurance,” Kaufman said. “While we may see Medicaid enrollment decline, we want to make sure across the board that people maintain their access to care and their health insurance.”

Kaufman said access to insurance is a key aspect of personal health and a major factor in overall healthcare costs.

“What we saw prior to the public health emergency, when people didn’t have health insurance, they didn’t get care so therefore things were treated at a much later stage that’s more expensive, so it drives up healthcare costs overall,” he said.

“And also because they weren’t insured they may, instead of going to a primary care physician’s office, they’re more likely to show up at an emergency room where they do get care but it’s not the best setting. So that’s why we really want to work with as many people as possible to make sure these individuals don’t lose their Medicaid coverage so they can access healthcare at the most appropriate setting.”





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