West Virginia needs to carefully balance implementation of work requirements for Medicaid with costs to the state and proceed with caution to be certain that people who are eligible for benefits aren’t knocked off the roles unnecessarily, a state legislative leader said.
About 504,000 people are enrolled in Medicaid in West Virginia. About 160,000 of those are in the Medicaid expansion population.
West Virginia’s Medicaid system faces significant changes through the recently-passed “Big, Beautiful Bill Act,” including implementation of a work requirement structure.
One of the new provisions is “community engagement requirements” of at least 80 hours per month of work, education or service for able-bodied adults without dependents. The requirement calls for twice-a-year verification.
Preparing for the changes will require significant front end work by West Virginia officials, with a system for assessing compliance with the work requirements expected to be in place by Jan. 1, 2027.
Lawmakers on an oversight committee heard an overview of the Medicaid changes during interim meetings this past week.
“Now, one of the real questions that the committee had, and that I certainly had, is, are we going to have enough staff or staff time to comply with that requirement?” said Delegate Matthew Rohrbach, a Republican from Cabell County who is the deputy speaker of the House.
Rohrbach, on MetroNews Talkline, said the State of West Virginia has an obligation to be ready so that people who use Medicaid for their healthcare expenses are able to maintain eligibility.
“If people don’t want to comply, then they’ll get their benefit denied,” he said. “But I certainly don’t think this Legislature wants to see people denied because we don’t have a system in place to timely take their application and verify — so that’s something that we’re going to have to monitor very closely.”
Cindy Beane, commissioner for the West Virginia Bureau for Medical Services, provided an update about how the state is implementing the changes to lawmakers like Rohrbach during interim legislative meetings last week at the state Capitol.
She elaborated that the state is focused on system requirements and notifications, including making sure “that individuals understand what they are trying to report with regards to their work requirements.”
Beane said West Virginia is participating in a small pilot program with seven other states to explore technology so that Medicaid recipients who are working could report work hours efficiently through a “no touch solution so that people aren’t constantly having to report their work hours.”
Overall cost of implementation remains a question for state officials like Rohrbach.
“That’s, I think, what the Bureau of Medicaid Services is trying to get to the bottom of,” he said.
“I think a lot of this is going to be whether it’s personnel driven or how much of it can be computer driven — and what would the cost be for that verification program? So since the ‘Big, Beautiful Bill’ is relatively new — that part, we’re still trying to get a handle on.”
The progressive West Virginia Center on Budget & Policy think tank has estimated the overall financial effect to West Virginia of implementing changes under the “Big, Beautiful Bill” will be up to $659 million in new direct budget costs through fiscal 2030.
Delegate Sean Hornbuckle, D-Cabell, said on MetroNews Midday that he is concerned about that overall cost including implementation of the work requirements.
“Healthcare in West Virginia will be negatively impacted by the big bill that was passed in Congress,” Hornbuckle said.
“There is an estimate, which was confirmed, of 160,000 West Virginia’s that are definitely in peril of potentially losing services, and it’s going to cost the state a lot of money, outside of just the services potentially being eliminated for constituents. It’s a hefty price tag.”
Hornbuckle was skeptical that the state will be able to establish a compliance system that will be efficient for Medicaid recipients without significant cost.
“It’s going to cost the taxpayers a lot of money to be able to do that,” he said.