Over 564,000 people in West Virginia are covered by Medicaid (29% of the population), making West Virginia the state with the highest share of its population enrolled in Medicaid.
Three-fourths (74%) of enrollees are children and adults, but nearly two-thirds (61%) of the state’s Medicaid spending is for the elderly and people with disabilities.
87,200 (22%) of West Virginia’s Medicare enrollees are also covered by Medicaid, which accounts for over a third (36%) of Medicaid spending.
53% of all children in West Virginia are covered by Medicaid, including 56% of children with special health care needs.
76% of nursing home residents in West Virginia are covered by Medicaid and 41% of Medicaid long-term care spending is for nursing home care. Medicare beneficiaries rely on Medicaid for assistance with services not covered by Medicare, particularly long-term care.
Nearly half (46%) of people in West Virginia live in rural areas. People who live in rural areas are more likely to be dependent on Medicaid.
West Virginia has the second lowest per capita income in the country and therefore one of the highest federal Medicaid matching assistance percentage (FMAP) at 73%. For every $1 spent by the state, the Federal government matches $2.55. Over three-fourths (79%) of all federal funds West Virginia receives are for Medicaid. In Calendar Year 2017, the federal match rate for the Medicaid expansion population is 95%.
What is at Risk under a Per Capita Cap?
Capping Medicaid funding would reduce the federal assistance for West Virginia to maintain its current Medicaid program.
Under the Better Care Reconciliation Act of 2017 (BCRA), to maintain its current Medicaid program, West Virginia would have to make up $3.4 billion in loss of federal funds between 2020-2029, including $1.5 billion for the phase-out of the enhanced match for the ACA expansion and $1.9 billion for the per enrollee cap on all groups.
If West Virginia dropped the Medicaid expansion in response to the loss of enhanced federal financing, the state would forgo an additional $7.6 billion over the 2020-2029 period, and by 2029, 227,000 West Virginians estimated to be covered in the expansion group would lose Medicaid coverage.
Capping federal Medicaid funding could jeopardize Medicaid programs designed to improve quality of life and access to long-term care for people with disabilities. 20% of West Virginia non-institutionalized population reported a disability, the highest reported percentage compared to a U.S. average of 13%.
West Virginia’s population faces multiple high health needs and limited access to care. Reducing federal funds through a per capita cap or block grant would limit West Virginia’s ability to respond to public health crises such as the opioid epidemic, HIV, or Zika.
West Virginia had the highest opioid death rate in the country in 2015 (36 deaths per 100,000 population). From 2013 to 2015, West Virginia’s opioid death rate grew by 29%. West Virginia also has the highest obesity rate in the country (71.1%).
West Virginia ranks 43 in overall health status. In addition, 30% of people in West Virginia live in a health professional shortage area for primary care and have limited access to the services they need while 14% of adults report not seeing a doctor due to cost.