New Rule Will Harm

Texas Lawsuit Threatens ACA & Medicaid Expansion: But No Changes for Now

This past Friday night Federal District Court Judge Reed O’Connor issued a ruling in the Texas v. Azar lawsuit brought by 20 state attorneys general. Judge O’Connor’s found for the plaintiffs and struck down the entire Affordable Care Act (ACA).

The most important things to know about the ruling are:

First, for now, nothing changes: the ACA remains the law of the land.

  • The Medicaid expansion in West Virginia and other states is still in place.
  • Judge O’Connor did not issue an injunction ordering the Administration to stop enforcing the law, and the White House issued a statement affirming that the ACA remains the law of the land pending appeal.
  • emailed consumers telling them that they should still sign up for coverage on the final day of open enrollment, and there will not be changes to their coverage for 2019.

Second, the ruling will be appealed, and the legal arguments are extraordinarily weak. 

  • Judge O’Connor’s decision hinges on the fact that the 2017 tax law zeroed out the penalty attached to the ACA’s individual mandate. The claim is that in zeroing out the penalty, Congress rendered not only the mandate but the entire ACA unconstitutional, effectively repealing the ACA as a byproduct of the tax bill.
  • Legal experts across the political spectrum, including experts who opposed the ACA and supported previous legal challenges to the law, have called that argument “absurd,” noting that Congress obviously intended to zero out the ACA mandate penalty without changing the rest of the law.
  • Seventeen state attorneys general (led by Xavier Becerra from California) had already intervened in the lawsuit to defend the ACA, and they will be able to continue to defend the law on appeal.
  • However, West Virginia Attorney General Morrisey has joined the lawsuit on the side to strike down the ACA and terminate both the Medicaid Expansion for 175,000 West Virginians and end the premium subsidies in the Marketplace for close to 30,000 West Virginians.


1. Call on President Trump to reverse his position and have his Administration defend the ACA in court.

        Phone Number: 1-202-456-1111 

        TTY: 1-202-456-6213. 1-202-456-2121 (Visitor's Office)

2. Call on Attorney General Morrisey to remove West Virginia from the list of states that are on the side arguing to wipe out the ACA and Medicaid Expansion.


3. Call on West Virginia’s United States Congressional delegation to reject the decision, support an appeal to overturn the ruling and leave the ACA and Medicaid expansion intact, and take action to preserve the ACA.

       Contact information for all West Virginia delegation members HERE.

Chart Book: Benefits of Medicaid Expansion

The Center on Budget and Policy Priorities has released a new chart book called “Chart Book: The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion” that is a great tool for Medicaid advocates and policy-makers.

So far, 32 states (counting the District of Columbia) have expanded Medicaid coverage to low-income adults under the Affordable Care Act (ACA). More states are poised to do so next year. West Virginia can be proud that we were one of the first states to take advantage of this opportunity to provide more people quality, affordable health coverage.

More and more research show that Medicaid expansion has produced significant benefits – for those gaining coverage, their families, and their communities. Those enrolled have improved health care access, health outcomes, and financial security, among other things.

In states that have expanded Medicaid, more people with opioid use and other substance abuse disorders are getting treatment. Hospitals in these states have also seen improved financial health.

Here is our favorite from the new chart book.  


Be a Health Care Voter - With Medicaid in Mind

If you care about Medicaid, vote on November 6th with Medicaid in mind.  Consider how candidates for representatives in the West Virginia statehouse and in the U.S. Congress stand on Medicaid.  Some candidates have pledged to repeal the Affordable Care Act - that means the Medicaid expansion.  Others understand that Medicaid is vital for one-third of West Virginians - as the source of affordable health care, as the key payer for opioid addiction prevention, early intervention, and treatment, and as a generator of jobs in our economy

Do your research. Do your homework. Ask questions. Be informed. Participate in democracy. Voting does matter.

And you are not alone.  

Kaiser Family Foundation Election Tracking Poll, October 18, 2018


New Study Shows Medicaid Expansion Matters

new report by the nonpartisan Government Accountability Office was released yesterday, showing that low-income adults in states that expanded Medicaid report better access to health care. The New York Times reports on key findings:

  • Nearly 20 percent of low-income people in states that did not expand Medicaid said they passed up needed medical care in the past 12 months because they couldn't afford it. That compared to 9.4 percent in states that expanded the program.
  • About 8 percent of those in states that did not expand Medicaid reported they either skipped medication doses to save money or took less medication than prescribed. That compared to about 5 percent in states that expanded. For people with chronic conditions such as high blood pressure, diabetes and asthma, staying on a medication schedule is considered essential.
  • About 22 percent of those in states not expanding Medicaid said they needed but could not afford dental care, as compared to 15 percent of similar low-income adults in expansion states.
  • About 11 percent of those in non-expansion states said they needed to see a specialist but weren't able to afford it, as compared to about 6 percent of those in expansion states.

U of KS Study: Medicaid Expansion Increases Employment Among People with a Disability

Individuals with disabilities are significantly more likely to be employed in states that have expanded Medicaid coverage as part of the Affordable Care Act, new research from the University of Kansas has found. Similarly, individuals who report not working because of a disability have significantly declined in expansion states, while neither trend happened in states that chose not to expand Medicaid.  West Virginia - one of the first states to expand Medicaid under the Affordable Care Act - was included in the states studied. 

The trends have broad policy implications as many states are considering work requirements for Medicaid eligibility, and they also have the potential to show similar employment benefits for individuals without disabilities. "In effect, Medicaid expansion is acting as an employment incentive for people with disabilities," the researchers wrote.

The study, authored by Jean Hall, professor of applied behavioral science and director of KU's Institute for Health and Disability Policy Studies; Adele Shartzer of the Urban Institute; Noelle Kurth, senior research assistant in KU's Institute for Health and Disability Policy Studies; and Kathleen Thomas of the University of North Carolina, was published in the American Journal of Public Health.


New Ohio Evaluation of Medicaid Expansion: Helps Enrollees Work

From one of West Virginia Together for Medicaid's national partners, Community Catalyst

2018 Ohio Medicaid Group VIII (Medicaid Expansion Population) Assessment – This August 2018 report (executive summary here) from the Ohio Department of Medicaid highlights how Medicaid expansion has positively impacted enrollees (sometimes referred to as “Group VIII”). The findings show that Medicaid helps people to get and stay healthy, and provides family stability, employment opportunity, and financial security.

Of particular note are the 290,000 people who received Medicaid benefits post-expansion that have since left the rolls because they were started working or began earning more. Most of the recipients told the state that having insurance helped them find or keep their job. Some additional findings:

  • Family Stability- More than three-fourths (75.7%) of the continuously enrolled expansion population studied who are family caregivers reported that Medicaid made it easier for them to care for their family member(s), as did more than four-fifths of parents (81.6%).
  • Employment Opportunity- A large majority of employed Medicaid expansion enrollees (83.5%) reported that Medicaid made it easier to work; most unemployed enrollees (60.0%) reported that Medicaid made it easier to look for work. Many Group VIII enrollees reported that Medicaid made it easier to work because they were able to obtain care for previously untreated health conditions. In the words of one enrollee: “[Medicaid] allows me to get surgery which has allowed me to return to work.”
  • Physical Health- When asked what Medicaid meant to them, 35.7% of survey respondents specifically mentioned either their health or access to care. In the words of one respondent: “If it wasn’t for Medicaid, I would not have been able to pay for surgery that was needed for a heart condition I was born with.”
  • Health Risk Behaviors- More than one third (37.0%) of Medicaid expansion enrollees who quit smoking in the last two years said that Medicaid helped them to quit.  This translates to approximately 26,000 Ohioans.

Medicaid Keeps People Working and Healthy

Ohio state officials released a report on Tuesday showing Medicaid expansion has reduced the uninsured rate, and has made it possible for people to continue working or seek jobs. Like West Virginia, Ohio  expanded Medicaid in 2014.

Dr. Akram Boutros, a fellow of the American College of Healthcare Executives, is president and CEO of The MetroHealth System in Cleveland.  His commentary in the Cleveland Plain Dealer is worth a read.

CLEVELAND -- You might know Mary. Maybe you shop at the same grocery store, belong to the same church or have the same favorite Indians player.

Mary takes medication to control her diabetes. A few years back, she lost her job and could no longer afford her medicine or her regular visits to the doctor.

When her symptoms got bad, she got scared and went to the emergency room. It happened more than once.

Then, in 2014, Ohio expanded Medicaid, the government program that provides health coverage to low-income adults, children, pregnant women, the elderly and the disabled.

Mary qualified for the expansion and was able to find a primary care doctor at MetroHealth. She got back on her medication and regained her health. Then she found a new job.

We learned this past week that her story is not unusual. There are at least 290,000 people just like Mary in Ohio - folks who got coverage through Medicaid expansion and then unenrolled when they found a new job or saw their income rise.

That statistic is part of a new Ohio Department of Medicaid report measuring the impact of the 2014 expansion. The findings reveal lots of good news: Expanding the program has slashed the uninsured rate; it's improved the health of enrollees;  and it's eased financial worries for Ohio families.

But the most significant news from the report is that Medicaid expansion hasn't done many of the things opponents predicted it would:

It hasn't become a lifelong entitlement. As Mary and the hundreds of thousands of people just like her show, coverage through expansion is often a temporary benefit. Since 2014, almost 1.2 million Ohioans have received coverage. Almost 500,000 of them are no longer on Medicaid.

It hasn't diminished recipients' motivation to work. In fact, it's increased it. Fifty percent of recipients are now employed, compared to 43 percent in 2016. Significant majorities of enrollees say coverage has either made it easier to work or easier to look for work.

It hasn't blown up the budget. During a presentation of the report's findings on Wednesday in Cleveland, Ohio Budget Director Tim Keen revealed that each recipient of Medicaid expansion costs the state less than $21 a month. "Medicaid expansion is manageable and affordable," he said, "now and into the future."

MetroHealth saw how well expansion could work before almost anyone. In 2013, a year before the state expanded coverage, the federal government gave us permission to see how it might work in practice. The program, called CarePlus, offered health coverage to about 30,000 uninsured Cuyahoga County residents. The results were better than we expected: Enrollees saw significant improvements in care and outcomes, and the cost of caring for them came in about 30 percent below the government's estimate.

Last week's report is more proof of what we at MetroHealth have seen firsthand.  Medicaid expansion has proven to be a lot like a lifeguard: When members of the community start to splash and sink because of a lost job, a sick relative or a sudden crisis, expanded coverage is there to help them, to pull them onto solid footing, allow them to catch their breath - and then dive back into work and life.

We should all feel a bit more comfortable knowing that Medicaid expansion is protecting our community pool.

Lots of people deserve credit for the success of Ohio's Medicaid expansion. Two of the most deserving are Gov. John Kasich and Department of Medicaid Director Barbara Sears. Both went against the wishes of many of their fellow Republicans and saw the true conservative benefits - controlled costs, personal responsibility, moral imperatives - of Medicaid expansion. Because of their courage and determination, life is better for hundreds of thousands of Ohio families. That's quite a legacy.

I'll speak for those families, for Mary and for those of us fortunate enough to have not needed Medicaid expansion: Thank you.

Let's all work to make sure the next resident of the governor's mansion knows the importance and success of this program - and that he keeps the lifeguard on duty.

EPSDT: Medicaid's Guarantee that Children Get All the Health Care They Need When They Need It

Any caregiver or guardian for a child or adolescent on Medicaid should know about EPSDT-  the Early and Periodic Screening, Diagnostic and Treatment benefit.  EPSDT provides comprehensive health preventive and treatment services for all children under age 21 who are enrolled in Medicaid.  It is a guarantee that children and adolescents receive all of the physical and mental health care that they need when they need it. 

In West Virginia, the Medicaid EPSDT program is called “HealthCheck.” More information about HealthCheck is online here.

Here is what that hard-to-remember benefit stand for:

Early – EPSDT benefit covers a range of testing to identify any health problems early. 

Periodic – The benefit provides a systematic approach to check the child’s overall health at periodic, age-appropriate intervals. 

Screening – EPSDT provides physical, mental, developmental, dental, hearing, vision, and other screening tests to detect any potential health-related problems.  Screening services include:

  • Comprehensive health and developmental history
  • Comprehensive unclothed physical exam
  • Appropriate immunizations
  • Laboratory tests
  • Health education (guidance including child development, healthy lifestyles, and accident and disease prevention)
  • Vision services
  • Dental services
  • Hearing services

Diagnosis – Based on screening findings, EPSDT covers diagnostic tests to follow up whenever a health risk is identified.  When a screening examination indicates the need for further evaluation of a child’s health, then  diagnostic services must be provided.  Necessary referrals are expected to be made without delay and there should be follow-up to ensure the enrollee receives a complete diagnostic evaluation.

Treatment – When a screening examination indicates the need for further evaluation of a child’s health, then diagnostic services must be provided. The Medicaid program must cover services necessary to control, correct or reduce any health problems found in children and youth in the screening and diagnostic process, by financing a very broad range of appropriate and necessary pediatric services.

There are few limits to the EPSDT benefit.  Services need to be deemed “medically necessary” by a qualified health practitioner. The concept of medical necessity in EPSDT is intentionally expansive, consistent with promoting children’s healthy development and maximizing their health and function.  Service limits that state Medicaid programs may impose on adults, such as a limit on therapy sessions, or a maximum number of prescriptions per month, cannot be applied to children. 

If requested, states must also offer the enrolled youth or family assistance with scheduling appointments, or with transportation, to access the services to which the child is entitled.  Furthermore -- for very young children, for example -- services may be provided directly to the parent or caregiver, on behalf of the enrolled child, to address the identified healthcare need of that child, without regard to the Medicaid eligibility status of that parent or caregiver.

The EPSDT provisions in the Medicaid program require West Virginia to: 

  • Inform all Medicaid-eligible individuals under age 21 that EPSDT services are available;
  • Inform them of the need for age-appropriate immunizations;
  • Provide or arrange for the provision of screening services for all children;
  • Arrange (directly or through referral) for corrective treatment as determined by child health screenings; and
  • Report EPSDT performance information to CMS annually.

Assistance Finding a Doctor or Other Provider.  The West Virginia Medicaid programs must provide Medicaid enrolled children or their parents/guardian with referral assistance for any treatment services their providers might not cover, that are found to be needed because of conditions identified or disclosed during the screening and diagnostic processes.  Specifically, such referral assistance must include giving the family or recipient the names, addresses, and telephone numbers of providers who will furnish services at little or no expense to the family. 

EPSDT rules also require West Virginia to make available a variety of individual and group providers qualified and willing to provide EPSDT services in all areas of the state. West Virginia must also make appropriate use of state health, vocational rehabilitation and maternal and child health programs, as well as other public health, mental health, and education programs and related programs, such as Head Start, Title XX (Social Services) programs, and the Special Supplemental Food Program for Women, Infants and Children (WIC), to provide an effective and comprehensive child health program.


Story-Telling Night & Picnic Barbour County Sept 6

West Virginia & Kavanaugh Confirmation: Arkansas Lawsuit Raises Stakes

A new lawsuit argues that imposing work requirements in Medicaid is “threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country.”

One of West Virginian Together for Medicaid’s national allies, The National Health Law Program, filed the lawsuit against the Trump administration this week for approving work requirements in Arkansas. The lawsuit asserts that Medicaid work requirements are not within the Trump administration’s authority under the Medicaid statute without action from Congress. In June, a federal judge blocked similar Medicaid work requirements in Kentucky, the first court test for the Trump administration’s initiative.

It is likely that this issue will end up before the U.S. Supreme Court.  The Court will have to decide about the future of the Medicaid program and whether the President and the Executive branch alone – without action by Congress – can undermine the statutory purpose of Medicaid and add new eligibility restrictions to Medicaid.

If Brett Kavanaugh is confirmed as a new U.S. Supreme Court Justice, many consumer protections for Medicaid enrollees could be lost.  (See more about Judge Kavanaugh and the critical vote of Senator Manchin here and here.)

We worry that if our state moved in this direction, West Virginia Medicaid enrollees could be harmed by a work requirement.  Not for failing to work if they are deemed capable, but by simply failing to meet reporting requirements.

"However, since one in three Medicaid adults never use a computer or the internet and four in ten do not use email, many enrollees would face barriers in complying with work reporting requirements to maintain coverage," according to a new Kaiser Family Foundation brief

According to the West Virginia Department of Health and Human Resources (DHHR), 66% of adult and child Medicaid enrollees in WV are in families with a worker. They are servers in restaurants, home care workers, retail workers, child-care workers and others. Some enrolled in the Medicaid expansion don’t work for wages but take care of elderly parents or children.  Others are in school or looking for work or they are in-between jobs.  Still others have chronic health problems, a mental illness or substance abuse disorder that makes it difficult to work. Many of these workers have seasonal jobs or other types of employment with fluctuating hours and/or temporary lay-offs.

New data released by the state of Arkansas this week show Medicaid enrollees who are subject to the work requirement struggle to comply. The data show that those who must tell the state what they're doing to meet the requirement are overwhelmingly failing to do so. 

In July — the second month in which the work requirements were in effect — 12,722 people either failed to report their activities to the state or didn't meet the 80-hour-a-month requirement. 

The vast majority of those people — about 12,587 — didn't log on to the state's Medicaid website and report their activities. The remaining 135 people did report their activities but failed to meet the 80-hour threshold. 

West Virginians Together for Medicaid