West Virginia Medicaid Reform Plan Likely Illegal, Center On Budget And Policy Priorities Says

Main Category: Medicare / Medicaid / SCHIP
Article Date: 06 Jun 2006 - 7:00 PDT

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West Virginia's new Medicaid law that increases or reduces benefits depending upon beneficiaries' actions is likely illegal, according to a new report by the Center on Budget and Policy Priorities, the Charleston Gazette reports (Finn, Charleston Gazette, 6/1). The Bush administration in May approved West Virginia's Medicaid reform plan, which includes issuing "credits" for health care services to beneficiaries who meet certain treatment goals and restricting access to services for beneficiaries who do not meet the goals. Beneficiaries will be required to choose a "medical home" that will serve as their primary care provider, and they must work with the provider and their managed care plan to develop a "personal responsibility contract." Beneficiaries who do not sign a contract or who do not meet specified goals within one year will have their benefits reduced, including possible reductions in coverage for diabetes treatment, cardiac rehabilitation, mental health care, dental care and substance use treatment. Beneficiaries who do not follow the contract also could face caps on the number of prescriptions that would be covered or other benefits. The new program will apply to about 160,000 children and adults without disabilities, or about half of the state's Medicaid population (Kaiser Daily Health Policy Report, 5/8). Judy Solomon, a senior fellow at CBPP, said the policy violates federal mandates on providing specific services -- like mental health counseling -- to children. (Charleston Gazette, 6/1). She noted that the reform plan calls for cutting Medicaid coverage to children for diseases like diabetes if their parents do not follow the terms of their contracts (AP/Charleston Daily Mail, 6/1). "It wouldn't surprise me if there is litigation because this flies in the face of what federal law requires," Solomon said (Charleston Gazette, 6/1). Cindy Mann, executive director of the Georgetown University Health Policy Institute Center for Children and Families, said it was "troubling ... that this is being done to children who really aren't in the driver's seat." However, John Law, a spokesperson for the West Virginia Department of Health and Human Resources, said CMS ruled that the plan was legal, adding that children will still be screened for diseases like diabetes and receive treatment regardless of benefits reductions (AP/Charleston Daily Mail, 6/1).

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