Although rural residents are more likely to live in states that rejected Medicaid expansion under Obamacare, West Virginia (the third most rural sate in the nation) bucked the trend. A health-care advocate describes how the Mountain State went about exceeding projections for Medicaid – and describes what remains to be done.
You don’t hear much about West Virginia and the Affordable Care Act (ACA) or “Obamacare.” But since the law passed, West Virginians for Affordable Health Care and other advocates in the state have been educating the public about its provisions.
West Virginians for Affordable Health Care (WVAHC) is a non-partisan, nonprofit organization located in Charleston, West Virginia. Perry Bryant, the executive director, started the organization in 2005 to address the rising cost of health care and health-care insurance. When President Obama signed the bill in March 2010, WVAHC was determined to let citizens know the facts about the new law.
For the next several years, WVAHC’s small staff began an educational campaign, developed brochures and reports and made hundreds of presentations on the law state wide to help consumers understand the provisions of the ACA. WVAHC held town-hall meetings and trained more than 200 people on the provisions of the new law. They brought stakeholders together, built coalitions and traveled the state speaking to health care providers, senior centers, mental health staff, county Chambers of Commerce, state wide conferences and a wide variety of community groups. In April 2012 WVAHC brought many health care advocates together at a large rally to urge the governor to expand Medicaid.
On May 7, 2013, Governor Earl Ray Tomblin approved Medicaid expansion for West Virginia, clearing the way for an estimated 133,500 low-income West Virginians to become eligible for benefits as early as January 1, 2014. As open enrollment approached, WVAHC launched their efforts to train “community assisters.” Those who completed the training would have the capacity to enroll people in Medicaid and make referrals to more highly trained enrollment specialists for those who qualified for private plans in the insurance Marketplace. They also raised money and provided mini-grants to 29 organizations that would otherwise have had no one on staff to help educate and enroll the people they served.
With Medicaid expanding, the next challenge was ensuring that those who were eligible for the program got enrolled. The West Virginia Department of Health and Human Services adopted a program that would “automatically” enroll tens of thousands of people in Medicaid. This is how West Virginia became the national leader in enrollment in the Medicaid expansion program. The Department of Health and Human Resources (DHHR) identified 118,000 West Virginians who were eligible for the Supplemental Nutrition Assistance Program (SNAP), as well as parents of children receiving Medicaid. These families received letters saying, “If you want to be automatically enrolled in the Medicaid expansion program, sign this letter and return it to us.” Most importantly, local DHHR employees made follow-up phone calls to tens of thousands of people. The response was so positive that the DHHR sent a second round of letters and made more follow-up phone calls. An estimated 71,200 individuals responded to these letters and phone calls. And another 11,700 individuals have enrolled through the DHHR web site (www.wvinRoads.org). The 114,000 (and growing) enrollment into Medicaid exceeded projections by the Office of the Insurance Commissioner, who estimated that 68,000 West Virginians would enroll in 2014 and 90,000 by 2016.
This is a significant accomplishment. The real heroes of the initiative are the local DHHR employees who made all the follow-up phone calls. They were aided by contractors (in-person assisters) employed by the Office of Insurance Commissioner and assigned to DHHR offices.
However, the number of people who enrolled in private insurance plans was disappointing. Only about 1,200 people had enrolled by mid-December. Highmark Blue Cross Blue Shield is the only insurance company to participate in West Virginia’s Health Insurance Marketplace this year.
Marketplace enrollment was hurt due to several factors. As was well reported, the healthcare.gov web site was dysfunctional until the first of December. The West Virginia Office of Insurance Commissioner originally planned to hire 270 in-person assisters throughout the state but hired only 200. In-person assisters are trained individuals who provide public education and assist people with the enrollment process, particularly the subsidized private insurance plans.
The loss of 70 in-person assisters is serious, but it is not just the reduced numbers that are a problem. The Offices of the Insurance Commissioner also decided to put in-person assisters in senior centers but not in free clinics or local health departments, and Gov. Tomblin turned down federal funds to do a state-wide marketing campaign. In a rural state like West Virginia, this was a huge blow to the thousands who could have been reached doing such a campaign.
The final obstacle to enrollment is affordability. Even with significant subsidies the cost of premiums, deductibles and copayments remains a significant barrier for many people.
As of July 3rd, 132,556 West Virginians have been enrolled in Medicaid coverage. Using the Urban Institute projections for the total number of West Virginians eligible for the Medicaid expansion (176,000), 75% of all those eligible for the Medicaid expansion were enrolled in a nine-month period. That’s an astonishing accomplishment.
Lisa Diehl is regional coordinator of West Virginians for Affordable Health Care.