The Affordable Care Act and Medicaid expansion in West Virginia

Pocahontas Memorial Hospital is pleased to welcome a new AmeriCorps VISTA Volunteer to the county.  Claire Groth is a graduate from the University of California at Berkeley with a Bachelor’s Degree in Biology.  Her future plans include attending medical school.  Originally from Portland, Oregon, Claire will live in West Virginia for the next year and work with the Rural Health Clinic at PMH to qualify as a “Patient Centered Medical Home.”  She will focus on enhancing the patient experience for those who seek healthcare at the Rural Health Clinic.  As part of that work, she recently attended a meeting highlighting the upcoming changes with the implementation of the Affordable Care Act and the possible Medicaid expansion in West Virginia.

Organized by the group “West Virginians for Affordable Health Care” (WVAHC), the Town Hall style meeting in Lewisburg specifically focused on changes that will affect women and children. After a presentation by the WVAHC, an expert panel including Dr. Coy Flowers of Greenbrier Physicians, Inc. and WVSOM professor Arnold Hassen, answered questions from meeting attendees.

A large focus of the meeting was Governor Earl Ray Tomblin’s approaching decision on whether to expand Medicaid in West Virginia. Under the ACA, each state has the option of adopting Medicaid expansion before it will automatically go into effect in January 2014. As of March 1, 24 states have opted in, 14 have declined, and the remaining 12 (including West Virginia) are undecided. If Governor Tomblin votes to approve Medicaid expansion now, the following will go into effect immediately:

1) Those with incomes at or below 133% of the Federal Poverty Level ($15,000/year for individuals; $31,000/year for a family of four) will be eligible for Medicaid.

2) Those making between 100 and 400% of the FPL (400% of the FPL equates to $46,000/year for an individual and $94,000 for a family of four) will be eligible to receive private health insurance subsidies. For example, if you are a 40 year-old single adult with an annual income of about $22,000 (which would make you ineligible for Medicaid), you could receive a government tax credit that would cover around 65% of your annual premium (go to http://healthreform.kff.org/subsidycalculator.aspx to calculate the amount of subsidy you could receive).

Another important piece of the ACA discussed in the meeting was the requirement that new health insurance plans cover preventive care measures at no charge. Plans that were already in existence on March 23, 2010 (when the ACA was signed into law), referred to as “grandfathered” plans, are exempt from providing this extensive preventive care coverage so long as they do not make major changes in the costs paid by employees or the services they cover. PEIA, for example, has lost its “grandfathered” status because of the large changes it made in employee costs. Therefore, PEIA must cover the preventive measures required under the ACA. Here are a few of the covered preventive measures:

-Type 2 Diabetes screening for adults with high blood pressure

-Diet counseling for adults at higher risk for chronic disease

-Tobacco Use screening for all adults and cessation interventions for tobacco users

-Depression screening for adults and adolescents

To see a complete list,go to www.healthcare.gov/news/factsheets/2010/07/preventive-ser vices-list.html.