West Virginia needs to send a message to the federal government about the possibility of cuts to Medicaid expansion coverage, the deputy speaker of the House of Delegates said.
If federal officials cut the amount West Virginia is reimbursed for the healthcare expenses of its Medicaid expansion population below the current 90% level, delegates are preparing a refusal in state law to assure the state would not fill the gap.
“This is kind of a preemptive thing to send a message to Washington that hopefully they’ll hear loud and clear that we don’t want this to go below the 90% and if it does, we will have to take steps to deal with it,” Delegate Matthew Rohrbach, R-Cabell, said on MetroNews “Talkline.”
On the line for the state is about $160 million in West Virginia dollars that represent the funding in that gap.
The executive director of the West Virginia Rural Health Association has a different message.
Rich Sutphin says rural health providers would be endangered if both the federal government and state cut their financial support for the Medicaid expansion population.
On the line from this point of view is health insurance for about 165,000 West Virginians.
And more broadly, what’s on the line is crucial financial support for the rural healthcare system.
“We know that strong rural health in West Virginia creates a stronger economy for West Virginia. If the provisions in this bill are implemented, you’re going to weaken the safety net in rural communities, and potentially you’re going to have a lot more rural hospitals closing,” Sutphin said last week before the House Finance Committee.
“So we want to continue to Protect Rural Health in West Virginia, and protect our hospitals from closing.”
West Virginia trigger possibility
The public policy conflict is over the possibility that the federal government would scale back its current 90% reimbursement rate for adults under age 65 who earn up to 138% of the federal poverty level.
Those are the people who make up the Medicaid expansion population.
Reacting to the possibility of that kind of federal cut, the House Finance Committee last week rolled out a bill with a trigger:
If the federal assistance for that expansion program is reduced, the West Virginia bill would disenroll and eliminate state coverage for Medicaid expansion.
That started a rumble now primed to reverberate through the final days of the regular legislative session and possibly into the weeks beyond.
‘Killing Rural Hospitals Act’
At 10:30 a.m. Monday, organizations now pushing against the change plan to gather for a press conference on what they’re terming the “Killing Rural Hospitals Act of 2025.”
Scheduled participants include Sutphin of the Rural Health Association; Dr. Nicole Bryce, a resident at Charleston Area Medical Center in obstetrics/gynecology; Dan Hager of Ebenezer Medical Outreach; Sherri McKinney of the Service Employees International Union 1199 and Rev. James Patterson of Partnership for African American Churches.
“We all know someone who is covered through or qualifies for Medicaid expansion. It would also put rural hospitals, which already operate on thin margins and rely on Medicaid for at least 20 percent of their revenue, at risk of closing their doors and laying off staff,” the participants said in the announcement of the press conference.
Medicaid is the backbone of rural hospitals and a lifeline for the 165,000 residents who are covered through the expansion, said Kelly Allen, executive director of the West Virginia Center on Budget & Policy, who also testified before the House Finance Committee.
“If state lawmakers want to send a message to Congress,” Allen said, “they should stand shoulder to shoulder with Medicaid participants, hospitals, and health experts in encouraging our federal delegation to keep current federal Medicaid funding levels, rather than making painful decisions for them.”
90% match; preparation to respond
Medicaid is a joint federal and state program for health insurance and medical services, traditionally for low-income people but more recently also for the working class.
The 2010 Affordable Care Act encouraged states to expand Medicaid to cover more low-income Americans lacking employer-provided insurance. Forty states participated, insuring about 21 million people since 2014 and reducing the national uninsured rate.
The federal government covers 90% of the expansion cost, significantly more than the average reimbursement rate for other Medicaid beneficiaries.
West Virginia needs to get into position to respond to potential federal cuts, Rohrbach said.
He said the federal government enticed states into accepting those terms years ago because many perceived the deal as too good to pass up.
Now, if states are stuck with the whole bill for that population, he said, “I think you see an awful lot of states saying, ‘No, it’s not going to work that way.’ We can’t get stuck with this bill.”
Potential federal cuts
The U.S. House of Representatives narrowly passed a budget resolution that could open the door to $880 billion in cuts to spending with Medicaid as a big possibility for those dollars.
Overall, the resolution mandates $2 trillion in spending cuts over 10 years. The Republican majorities in Congress are looking for the big budget savings to meet their goal of fully extending President Donald Trump’s 2017 tax cuts.
The budget plan assigns the U.S. House Energy and Commerce Committee to find $880 million in savings, and one of the biggest programs under its authority is Medicaid.
“So if they lowered this down, then we’d have to make cuts the whole Medicaid program that would affect not only the people in the expansion population, but the people in the traditional population. And that’s just not palatable with this legislature,” Rohrbach said.
“So we’re trying to get out ahead of this and get some statements made, so hopefully the Senate and House in Washington can say, ‘No, we just can’t back out of the contract that we made with these states, all states, when we did the expansion.'”
Some other states already have such a trigger law: Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia.
Rohrbach characterized such a policy as both a message and a precaution
“I hope and pray that this bill never gets enacted,” he said. “I don’t want this trigger bill to get into effect.”
‘These are the working poor’
The state’s top Medicaid official testified last week before delegates that the downside of a trigger law would be that it doesn’t allow for flexibility.
“None of us know what the federal government might do,” said Cindy Beane, commissioner for the West Virginia Bureau for Medical Services
“Is it going to go down to our regular match? Is it going to go down at all? Are we going to go down maybe 2% or 5%? So those different things create different numbers and so as written it would eliminate the expansion population.”
Thousands of West Virginians could be affected, Beane said.
“These are the working poor,” she said. “A person working a minimum wage job would qualify for Medicaid expansion. These are also parents of young children.”
Beane told delegates the expanded coverage “provides their health care. It is their health insurance to go to the doctor, go to the dentist, keep ’em healthy, keep ’em working.”
As the bill is written, she said, if the federal funding were cut then the department would be directed to immediately begin to disenroll people who qualify under Medicaid expansion.
Furthermore, she said the financial effects could flow to hospitals.
“Those funds don’t go to the enrollees. They go to our doctors, our hospitals, our providers,” Beane said. “It would definitely have an impact on hospitals.”