Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2017 and FY 2018

Introduction
  1. Centers for Medicare and Medicaid Services. National Health Expenditures (Washington, DC: Centers for Medicare and Medicaid Services, December 2015), http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.

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Nevada
  1. Bureau of Economic Analysis, Nevada Per Capita Personal Income 2016 (Bureau of Economic Analysis, September 26, 2017), https://www.bea.gov/regional/bearfacts/pdf.cfm?fips=32000&areatype=STATE&geotype=3.

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  2.   Bureau of Labor Statistics, Databases, Tables, and Calculators by Subject; accessed on October 16, 2017: https://data.bls.gov/timeseries/LASST320000000000003.

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  3. State of Nevada, Executive Budget 2017-2019, (State of Nevada, January 2017), http://budget.nv.gov/uploadedFiles/budgetnvgov/content/StateBudget/2018-2019/FY2017-2019_GovExecBudgetBook-Online.pdf

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  4. Nevada Legislative Counsel Bureau, Legislatively Approved Budget 2017-2019, (Nevada Legislative Council Bureau, July 2017), https://www.leg.state.nv.us/Division/fiscal/FISBU210/BASN210_2017-19/BASN210_2017-19.pdf.

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  5. Kaiser Family Foundation, State Health Facts, Distribution of Total Population by Federal Poverty Level, accessed at: http://www.kff.org/other/state-indicator/distribution-by-fpl/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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  6. Bureau of Economic Analysis, State Personal Income, 2016 (Bureau of Economic Analysis, March 2017), https://www.bea.gov/newsreleases/regional/spi/2017/spi0317.htm.

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  7. Federal Register, November 15, 2016 (Vol 81, No. 220), pp 80078-80080, https://www.gpo.gov/fdsys/pkg/FR-2016-11-15/pdf/2016-27424.pdf.

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  8. Kaiser Family Foundation, State Health Facts, Health Insurance Coverage of the Total Population, accessed at: http://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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  9. Kaiser Family Foundation estimates based on analysis of data from the FFY 2014 Medicaid Statistical Information System (MSIS) and CMS-64 reports. Because FY 2014 data was missing some or all quarters for some states, data were adjusted using secondary data to represent a full fiscal year of enrollment. Available at: http://www.kff.org/medicaid/state-indicator/medicaid-spending-per-full-benefit-enrollee/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  10. Robin Rudowitz, Allison Valentine, Petry Ubri, and Julia Zur, Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States are Most at Risk? (Washington, DC: Kaiser Family Foundation, June 2017), https://www.kff.org/medicaid/issue-brief/proposed-medicaid-section-1115-waivers-in-maine-and-wisconsin/.

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  11. Kaiser Family Foundation, Key Facts about the Uninsured Population (Washington, DC: Kaiser Family Foundation, September 2017), http://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.

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  12. Kaiser Family Foundation, State Health Facts, Population Distribution by Age, accessed at: http://www.kff.org/other/state-indicator/distribution-by-age/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  13. U.S. Census Bureau, Population Division, Interim State Population Projections, 2005, compiled by the US Administration on Aging.

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  14. Kaiser Family Foundation, State Health Facts, Distribution of the Uninsured by Race/Ethnicity, accessed at: https://www.kff.org/uninsured/state-indicator/distribution-by-raceethnicity-2/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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  15. Kaiser Family Foundation, State Health Facts, Estimated Rates (per 100,000) of HIV Diagnoses, Adults and Adolescents, accessed at: http://www.kff.org/hivaids/state-indicator/estimated-rates-per-100000-of-hiv-diagnoses-adults-and-adolescents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  16. Kaiser Family Foundation, State Health Facts, Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted), accessed at: http://www.kff.org/other/state-indicator/opioid-overdose-death-rates/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  17. Kaiser Family Foundation, State Health Facts, Percent of Adults Reporting Fair or Poor Health Status, accessed at:  http://www.kff.org/other/state-indicator/percent-of-adults-reporting-fair-or-poor-health-status/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Adults%20Reporting%20Fair%20or%20Poor%20Health%20Status%22,%22sort%22:%22desc%22%7D

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  18. Kaiser Family Foundation, State Health Facts, Percent of Adults Reporting Poor Mental Health Status, accessed at:  http://www.kff.org/other/state-indicator/poor-mental-health-among-adults/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  19. Kaiser Family Foundation, State Health Facts, Percent of Adults Who are Overweight or Obese, accessed at : http://www.kff.org/other/state-indicator/adult-overweightobesity-rate/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Adult%20Overweight%2FObesity%20Rate%22,%22sort%22:%22desc%22%7D

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  20. Nevada Department of Health and Human Services, Director’s Office, Medicaid Chart Pack, (Nevada Department of Health and Human Services, September 2017), http://dhhs.nv.gov/uploadedFiles/dhhsnvgov/content/Home/Features/Medicaid%20Chart%20Pack%20(201709).pdf.

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  21. Olivia Pham, Arkansas and Nevada Latest to Eliminate 5-Year Waiting Period for Lawfully Residing Children (Georgetown University Health Policy Institute, Center for Children and Families “Say Ahhh!” blog, August 2017),  https://ccf.georgetown.edu/2017/08/16/arkansas-and-nevada-latest-to-eliminate-5-year-waiting-period-for-lawfully-residing-children/

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  22. Kaiser Family Foundation, State Health Facts, Health Insurance Coverage of the Total Population, https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  23. Los Angeles Times, “Nevada moves closer to a landmark Medicaid-for-all healthcare model”, June 8, 2017, accessed at: http://www.latimes.com/nation/la-na-nevada-health-coverage-20170607-story.html

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  24. Los Angeles Times, “Nevada Governor vetoes Medicaid-for-all bill”, June 17, 2017, accessed at: http://www.latimes.com/nation/la-na-nevada-medicaid-2017-story.html

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  25. Center for Medicare and Medicaid Services, Nevada Comprehensive Care Waiver, accessed at: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/nv/nv-comprehensive-care-waiver-fs.pdf

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  26. Nevada Department of Health and Human Services, Director’s Office, Medicaid Chart Pack, (Nevada Department of Health and Human Services, September 2017), http://dhhs.nv.gov/uploadedFiles/dhhsnvgov/content/Home/Features/Medicaid%20Chart%20Pack%20(201709).pdf.

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  27. Care Management Organization (CMO): Medicaid, presentation accessed at: https://www.medicaid.nv.gov/Downloads/provider/2013_Care_Management.pdf

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  28. Ibid.

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  29. Nevada Division of Health Care Financing and Policy, Health Care Guidance Program, (Nevada Division of Health Care Financing and Policy, 2015),  http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Pgms/IHS/HCGP-ProviderManual.pdf?n=7647

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  30. Nevada Division of Health Care Financing and Policy, Nevada Medicaid Delivery Model Recommendation Report, Draft, (Nevada Division of Health Care Financing and Policy, January 2017), http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Pgms/LTSS/MCE/Draft_Nevada_Delivery_System_Report_010317.pdf

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  31. Nevada Division of Child and Family Services, Nevada System of Care, Implementation Grant Strategic Plan, (Nevada Division of Child and Family Services, June 2016),  http://dcfs.nv.gov/uploadedFiles/dcfsnvgov/content/Tips/Reports/NV-SOC-Implementation_Strategic-Plan_update_6-1-16.pdf

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  32. Nevada Complete Medicaid State Plan as of 09-11-17, accessed at http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Manuals/MSP/Complete%20SPA%2009-11-17.pdf

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  33. Nevada DHHS Press Release on January 03, 2017, accessed at: http://dhhs.nv.gov/Reports/Press_Releases/2016/Nevada_One_of_Eight_States_Selected_for_New_Demonstration/.

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  34. Nevada Division of Health Care Financing and Policy, Nevada Medicaid – Provider’s Dental FAQs, (Nevada Division of Health Care Financing and Policy, June 2017), http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Pgms/CPT/Dental%20-%20Provider%20FAQs%20-%20APPROVED%206.29.17.pdf.

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  35. Nevada Assembly Bill 474, accessed at: https://www.billtrack50.com/BillDetail/864306

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  36. Nevada Governor’s Press Release, “Nevada Awarded $5 million to continue the fight against Opioid abuse”, (Carson City, NV: Nevada Governor’s Office, April 2017), http://gov.nv.gov/News-and-Media/Press/2017/Nevada-Awarded-$5-Million-to-Continue-the-Fight-Against-Opioid-Abuse/

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  37. Olivia Pham, Arkansas and Nevada Latest to Eliminate 5-Year Waiting Period for Lawfully Residing Children (Georgetown University Health Policy Institute, Center for Children and Families “Say Ahhh!” blog, August 2017),  https://ccf.georgetown.edu/2017/08/16/arkansas-and-nevada-latest-to-eliminate-5-year-waiting-period-for-lawfully-residing-children/

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North Carolina
  1. Bureau of Economic Analysis, U.S. Department of Commerce. North Carolina Fact Sheet, at https://www.bea.gov/regional/bearfacts/pdf.cfm?fips=37000&areatype=STATE&geotype=3.

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  2. Labor & Economic Analysis Division, North Carolina Department of Commerce, North Carolina’s Gross Domestic Product (North Carolina Department of Commerce), https://www.nccommerce.com/Portals/47/Documents/Economic%20Snapshots/North-Carolina-GDP-January-2017.pdf.

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  3. Bureau of Labor Statistics, State Employment and Unemployment Summary (Bureau of Labor Statistics, August 2017) https://www.bls.gov/news.release/laus.nr0.htm.

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  4. Bureau of Labor Statistics, Tables & Calculators by Subject: Labor Force Statistics from the Current Population Survey (Bureau of Labor Statistics, October 2017), https://data.bls.gov/timeseries/LNS14000000.

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  5. North Carolina General Assembly Fiscal Research Division Memo, General Fund Revenue Consensus Forecast (North Carolina General Assembly, February 2017), http://www.ncga.state.nc.us/FiscalResearch/generalfund_outlook/Consensus%20Revenue%20Report%20February%202017.pdf.

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  6. Barry Boardman, Quarterly General Fund Revenue Report (North Carolina General Assembly Fiscal Research Division, January 2017), at http://www.ncga.state.nc.us/FiscalResearch/generalfund_outlook/16-17_Outlooks/2017_01_16_January_%20Revenue_%20Outlook.pdf.

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  7. Joe Coletti, A New State Budget Based on Time-Tested Principles: A Review of North Carolina’s FY 2017-19 Budget (John Locke Foundation, July 2017), https://www.johnlocke.org/app/uploads/2017/07/Spotlight-496-North-Carolinas-2017-19-Budget.pdf.

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  8. Mark Barrett, “Have NC tax cuts boosted economy? Not so much, economists say” Citizen-Times (May 27, 2017), http://www.citizen-times.com/story/news/local/2017/05/27/have-nc-tax-cuts-boosted-economy-not-so-much-economists-say/342010001/.

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  9. Colin Campbell, “NC House overrides budget veto, making the spending plan law” News & Observer (June 28, 2017), http://www.newsobserver.com/news/politics-government/state-politics/article158589669.html.

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  10. Colin Campbell, “NC state budget deal includes raises for state employees, teachers” News & Observer (June 19, 2017), http://www.newsobserver.com/news/politics-government/state-politics/article157032254.html.

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  11. Kaiser Family Foundation, State Health Facts, Distribution of Total Population by Federal Poverty Level, accessed at: http://www.kff.org/other/state-indicator/distribution-by-fpl/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Under%20100%25%22,%22sort%22:%22desc%22%7D

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  12. Bureau of Economic Analysis, state personal income accounts, 2014.

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  13. Federal Register, November 15, 2016 (Vol 81, No. 220), pp 80078-80080, https://www.gpo.gov/fdsys/pkg/FR-2016-11-15/pdf/2016-27424.pdf

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  14. Kaiser Family Foundation estimates based on the NASBO’s November 2016 State Expenditure Report (data for Actual FY 2015.)

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  15. Julia Foutz, Samantha Artiga, and Rachel Garfield, The Role of Medicaid in Rural America (Washington, DC: Kaiser Family Foundation, April 2017), http://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/

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  16. Kaiser Family Foundation, State Health Facts, Health Insurance Coverage of the Total Population, accessed at: http://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Medicaid%22,%22sort%22:%22desc%22%7D

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  17. Kaiser Family Foundation, State Health Facts, Characteristics of Poor Uninsured Nonelderly Adults in the ACA Coverage Gap, accessed at: https://www.kff.org/health-reform/state-indicator/characteristics-of-poor-uninsured-nonelderly-adults-in-the-aca-coverage-gap/

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  18. Kaiser Family Foundation, State Health Facts, Health Insurance Coverage of the Total Population, accessed at: http://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Medicaid%22,%22sort%22:%22desc%22%7D

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  19. Kaiser Family Foundation, State Health Facts, Percent of Adults Reporting Fair or Poor Health Status, https://www.kff.org/other/state-indicator/percent-of-adults-reporting-fair-or-poor-health-status/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Adults%20Reporting%20Fair%20or%20Poor%20Health%20Status%22,%22sort%22:%22desc%22%7D

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  20. United Health Foundation, America’s Health Rankings: 2016 Annual Report; May 25, 2016, https://www.americashealthrankings.org/learn/reports/2016-annual-report

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  21. Kaiser Family Foundation, State Health Facts, Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted), accessed at: https://www.kff.org/other/state-indicator/opioid-overdose-death-rates/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  22. Kaiser Family Foundation, State Health Facts, Estimated Rates (Per 100,000) of HIV Diagnoses, Adults and Adolescents, accessed at: https://www.kff.org/hivaids/state-indicator/estimated-rates-per-100000-of-hiv-diagnoses-adults-and-adolescents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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  23. Kaiser Family Foundation, State Health Facts, Percent of Adults Reporting Not Seeing a Doctor in the Past 12 Months Because of Cost, accessed at: https://www.kff.org/other/state-indicator/could-not-see-doctor-because-of-cost/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Could%20Not%20See%20Doctor%20Because%20of%20Cost%22,%22sort%22:%22desc%22%7D

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  24. Kaiser Family Foundation, State Health Facts, Adults Reporting Mental Illness in the Past Year, accessed at: https://www.kff.org/other/state-indicator/adults-reporting-any-mental-illness-in-the-past-year/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Adults%20Reporting%20Serious%20Mental%20Illness%20in%20the%20Past%20Year%22,%22sort%22:%22desc%22%7D

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  25. Kaiser Family Foundation, State Health Facts, Status of State Action on the Medicaid Expansion Decision (as of January 1, 2017), accessed at: http://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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  26. David Ranii, “Gov. Roy Cooper wants to Expand Medicaid; Republicans Vow to Fight,” News & Observer (January 4, 2017), http://www.newsobserver.com/news/business/article124491039.html.

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  27. Anne Blythe, “NC Lawmakers File Lawsuit to Stop Cooper’s Medicaid Expansion Plan,” News & Observer, (January 13, 2017), http://www.newsobserver.com/news/politics-government/state-politics/article126477064.html.

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  28. Chris Cioffi, “Gov. Roy Cooper’s Medicaid Expansion Plan Temporarily Blocked” The Charlotte Observer (January 14, 2017),  http://www.charlotteobserver.com/news/politics-government/article126678654.html

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  29. Governor Cooper later called on the General Assembly to implement expansion in his FY 2017-2019 budget proposal, which would add up to 624,000 individuals to the program. The governor argued that expansion would pay for itself, with the non-federal share covered by provider contributions and the influx of federal dollars leading to job creation, healthier hospital finances, and $4.4 billion in new spending in the state.

    NC Office of the Governor, Governor Roy Cooper’s Recommended Budget, 2017-2019: Common Ground Solutions for North Carolina, (Office of the Governor, March 2017), https://files.nc.gov/ncosbm/documents/files/BudgetBook_2017_web.pdf.

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  30. Federal and state Health and Human Services were named as defendants in the lawsuit, not Governor Cooper.

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  31. Anne Blythe, “NC legislators drop lawsuit challenging Cooper’s attempt to expand Medicaid under Obamacare” News & Observer, (July 20, 2017), http://www.newsobserver.com/news/politics-government/state-politics/article162771878.html

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  32. House Bill 662, General Assembly of North Carolina, Session 2017, http://www.ncleg.net/Sessions/2017/Bills/House/PDF/H662v1.pdf.

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  33. C. Annette DuBard. CCNC Data Brief: Savings Impact of Community Care of North Carolina: A Review of the Evidence (Raleigh, NC: Community Care of North Carolina, July 2017), https://www.communitycarenc.org/media/files/data-brief-11-savings-impact-ccnc.pdf.

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  34. North Carolina Office of the State Auditor, Community Care of North Carolina Financial Related Audit (Raleigh, NC: North Carolina Office of the State Auditor, August 2015), http://www.ncauditor.net/EPSWeb/Reports/FiscalControl/FCA-2014-4445.pdf.

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  35. Section Law 2015-245, General Assembly of North Carolina, Session 2015, http://www.ncleg.net/Sessions/2015/Bills/House/PDF/H372v8.pdf.

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  36. North Carolina Department of Health and Human Services, North Carolina’s Proposed Program Design for Medicaid Managed Care (Raleigh, NC: North Carolina Department of Health and Human Services, August 2017), https://files.nc.gov/ncdhhs/documents/files/MedicaidManagedCare_ProposedProgramDesign_REVFINAL_20170808.pdf.

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  37. Beneficiaries dually eligible for Medicaid and Medicare, PACE beneficiaries, medically needy beneficiaries, beneficiaries only eligible for emergency services, presumptive eligible enrollees (during presumptive eligibility period), and Health Insurance Premium Payment (HIPP) beneficiaries, family planning beneficiaries, and prison inmates. All excluded populations would continue to receive health benefits on a fee-for-service basis. Members of federally recognized tribes will have a choice between FFS and capitated managed care plans.

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  38. The state envisions phasing tailored plans in. At program launch, beneficiaries with more serious behavioral health or I/DD needs would continue to receive care via FFS and LME-MCO.

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  39. Enhanced care management through behavioral health and I/DD health homes is also under consideration.

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  40. In contrast to the original waiver application, DHHS no longer plans to pursue a Delivery System Reform Incentive Payment (DSRIP) initiative.

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  41. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. “Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted)” accessed September 19, 2017, http://www.kff.org/other/state-indicator/opioid-overdose-death-rates.

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  42. North Carolina Prescription Drug Abuse Advisory Committee (PDAAC), North Carolina Opioid Action Plan (2017-2021) Fact Sheet (Raleigh, NC: North Carolina Department of Health and Human Services, 2017), https://files.nc.gov/ncdhhs/Opioid%20Plan%20Fact%20Sheet_FINAL_6_27_17B.pdf.

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  43. North Carolina Department of Health and Human Services. North Carolina’s Opioid Action Plan 2017-2021, https://www.ncdhhs.gov/opioids.

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  44. House Bill 243, General Assembly of North Carolina, Session 2017, http://www.ncleg.net/Sessions/2017/Bills/House/PDF/H243v6.pdf.

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  45. North Carolina Department of Health and Human Services, North Carolina’s Proposed Program Design for Medicaid Managed Care (Raleigh, NC: North Carolina Department of Health and Human Services, August 2017), https://files.nc.gov/ncdhhs/documents/files/MedicaidManagedCare_ProposedProgramDesign_REVFINAL_20170808.pdf.

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West Virginia
  1. West Virginia FY 2018 Executive Budget, Volume I Budget Report, p. 118; accessed at http://www.budget.wv.gov/executivebudget/Documents/VI2018.pdf.

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  2. U.S. Bureau of Economic Analysis, Gross Domestic Product by State: Fourth Quarter and Annual 2016, May 11, 2017, accessed at https://www.bea.gov/newsreleases/regional/gdp_state/2017/pdf/qgsp0517.pdf.

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  3. U.S. Bureau of Economic Analysis, Quarterly Gross Domestic Product by State: Statistics for the First Quarter of 2017, August 2017, accessed at https://www.bea.gov/scb/pdf/2017/08-August/0817-gdp-by-state.pdf.

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  4. West Virginia University College of Business and Economics, Mountain State Business Index: West Virginia economy to see solid growth through end of 2017, September 6, 2017, accessed at http://wvutoday.wvu.edu/stories/2017/09/06/mountain-state-business-index-west-virginia-economy-to-see-solid-growth-through-end-of-2017.

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  5. The unemployment rate represents the total number of unemployed individuals divided by the size of the labor force. A decreasing labor force can lead to decreases in unemployment rates even if the number of unemployed individuals remains the same or even increases since the denominator (size of the labor force) shrinks.

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  6. U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics, accessed at https://data.bls.gov/timeseries/LASST540000000000004?amp%253bdata_tool=XGtable&output_view=data&include_graphs=true.

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  7. Work Force West Virginia, Labor Market Information, accessed at http://lmi.workforcewv.org/.

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  8. West Virginia FY 2018 Executive Budget, Volume I Budget Report, p. 118; accessed at http://www.budget.wv.gov/executivebudget/Documents/VI2018.pdf.

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  9. West Virginia Executive Budget, Fiscal Year 2018, Volume I Budget Report, p. 4, accessed at http://www.budget.wv.gov/executivebudget/Documents/VI2018.pdf.

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  10.   Since 2007, the state has phased out both the grocery tax on food and the business franchise tax, lowered the corporate net income tax rate, and created other tax credits for business and low-income families. Ted Boettner and Sean O’Leary, Confronting the Fiscal Gap: The Governor’s Amended 2016 Budget and Proposed 2017 Budget, West Virginia Center on Budget & Policy, Policy Brief February 16, 2016, accessed at http://www.wvpolicy.org/wp-content/uploads/2016/02/PDF-FY17-Gov-Budget-Brief-2.16.16-FINAL.pdf.

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  11. West Virginia State Budget Office, FY 2017 Revenue Collections, July 3, 2017, accessed at http://www.budget.wv.gov/reportsandcharts/revenuereports/Documents/June%202017%20GRF.pdf.

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  12. Office of Governor Jim Justice, Justice was Right, Revenue Collections are $18.7 million Below Estimate, July 12, 2017 Press Release, accessed at http://www.governor.wv.gov/News/press-releases/2017/Pages/Justice-Was-Right,-Revenue-Collections-Way-Off-Mark.aspx.

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  13. West Virginia State Budget Office, General Revenue Fund Monthly Revenue Estimates FY 2018, June 2017, accessed at http://www.budget.wv.gov/reportsandcharts/revenueestimates/Documents/FY%202018%20monthly%20General%20Revenue%20Estimates.pdf.

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  14. West Virginia Executive Budget, Fiscal Year 2018, Volume I Budget Report, p. 1., accessed at  http://www.budget.wv.gov/executivebudget/Documents/Volume%20I%20-%20Budget%20Report%202018.pdf.

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  15. Office of Governor Jim Justice, Justice was Right, Revenue Collections are $18.7 million Below Estimate, July 12, 2017 Press Release, accessed at http://www.governor.wv.gov/News/press-releases/2017/Pages/Justice-Was-Right,-Revenue-Collections-Way-Off-Mark.aspx.

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  16. Phil Kabler, WV begins fiscal year $11M in hole after revenue collections fall short, Charleston Gazette-Mail, July 12, 2017, accessed at http://www.wvgazettemail.com/news-politics/20170712/wv-begins-fiscal-year-11m-in-hole-after-revenue-collections-fall-short.

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  17. West Virginia Executive Budget, Fiscal Year 2018, Volume I Budget Report, p. 1., accessed at  http://www.budget.wv.gov/executivebudget/Documents/Volume%20I%20-%20Budget%20Report%202018.pdf.

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  18. Jeff Jenkins, Justice vetoes budget by unveiling bull manure, WV Metro News, April 13, 2017, accessed at http://wvmetronews.com/2017/04/13/justice-vetoes-budget-by-unveiling-bull-manure/.

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  19. West Virginia Governor Won’t Sign Budget Amid Tax Impasse, Associated Press, June 21, 2017, accessed at https://www.usnews.com/news/best-states/west-virginia/articles/2017-06-21/west-virginia-governor-wont-sign-budget-amid-tax-impasse.

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  20. Sean O’Leary, West Virginia Center on Budget and Policy Blog, June 22, 2017 post, accessed at http://www.wvpolicy.org/2017/06/.

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  21. Ted Boettner, Yes, State Government and Taxes Are Shrinking, West Virginia Center on Budget and Policy Blog, July 5, 2017 post, accessed at http://www.wvpolicy.org/yes-state-government-and-taxes-are-shrinking/.

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  22. Jake Zuckerman, WV governor blames House Democrats for party switch, Charleston Gazette-Mail, August 5, 2017; accessed at http://wvpress.org/breaking-news/wv-governor-blames-house-democrats-party-switch/.

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  23. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation estimates based on the Census Bureau's March Current Population Survey (CPS: Annual Social and Economic Supplements), 2017, “Distribution of Total Population by Federal Poverty Level,” http://www.kff.org/other/state-indicator/distribution-by-fpl/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Under%20100%25%22,%22sort%22:%22desc%22%7D.

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  24. Bureau of Economic Analysis, state personal income accounts, 2014.

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  25. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation estimates based on the Census Bureau's March Current Population Survey (CPS: Annual Social and Economic Supplements), 2014-2017, “Health Insurance Coverage of the Total Population,  http://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Medicaid%22,%22sort%22:%22desc%22%7D

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  26. Federal Register, November 15, 2016 (Vol 81, No. 220), pp 80078-80080, https://www.gpo.gov/fdsys/pkg/FR-2016-11-15/pdf/2016-27424.pdf.

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  27. Kaiser Family Foundation analysis of National Association of State Budget Officers (NASBO), State Expenditure Report: Fiscal 2014-2016, November 17, 2016, http://www.nasbo.org/reports-data/state-expenditure-report.

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  28. Julia Foutz, Samantha Artiga, and Rachel Garfield, The Role of Medicaid in Rural America (Washington, DC: Kaiser Family Foundation, April 2017), http://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/.

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  29. United Health Foundation, America’s Health Rankings: 2016 Annual Report (Minnetonka, MN: United Health Foundation, May 2016), https://www.americashealthrankings.org/learn/reports/2016-annual-report.

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  30. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of the Center for Disease Control and Prevention (CDC)'s Behavioral Risk Factor Surveillance System (BRFSS) 2013-2016 Survey Results, “Percent of Adults Reporting Fair or Poor Health Status,https://www.kff.org/other/state-indicator/percent-of-adults-reporting-fair-or-poor-health-status/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Adults%20Reporting%20Fair%20or%20Poor%20Health%20Status%22,%22sort%22:%22desc%22%7D.

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  31. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of the Centers for Disease Control and Prevention (CDC)'s Behavioral Risk Factor Surveillance System (BRFSS) 2013-2016 Survey Results, “Percent of Adults Who are Overweight or Obese,” https://www.kff.org/other/state-indicator/adult-overweightobesity-rate/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Adult%20Overweight%2FObesity%20Rate%22,%22sort%22:%22desc%22%7D.

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  32. Erickson, W., Lee, C., von Schrader, S. (2017). Disability Statistics from the 2014 American Community Survey (ACS). Ithaca, NY: Cornell University Employment and Disability Institute (EDI). Retrieved June 7, 2017 from www.disabilitystatistics.org.

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  33. Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of December 31, 2016 and U.S. Census Bureau, State Population Totals Datasets: 2010-2016.

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  34. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of the Center for Disease Control and Prevention (CDC)'s Behavioral Risk Factor Surveillance System (BRFSS) 2013-2016 Survey Results, “Percent of Adults Reporting Not Seeing a Doctor in the Past 12 Months Because of Cost,” https://www.kff.org/other/state-indicator/could-not-see-doctor-because-of-cost/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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  35. Robin Rudowitz, Allison Valentine, Petry Ubri, and Julia Zur, Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk? (Washington, DC: Kaiser Family Foundation, June 2017), https://www.kff.org/report-section/factors-affecting-states-ability-to-respond-to-federal-medicaid-cuts-and-caps-which-states-are-most-at-risk-issue-brief/.

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  36. Lisa Diehl, W.V. in Top Tier of Medicaid Expansion, The Daily Yonder, August 12, 2014, accessed at http://www.dailyyonder.com/wv-top-tier-medicaid-expansion/2014/08/12/7491/.

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  37. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of Medicaid enrollment data collected from the Centers for Medicare and Medicaid Services (CMS) Medicaid Budget and Expenditure System (MBES), “Medicaid Expansion Enrollment,” http://www.kff.org/health-reform/state-indicator/medicaid-expansion-enrollment.

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  38. Kaiser Family Foundation, Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion, (Washington, DC: Kaiser Family Foundation, November 2013), https://www.kff.org/medicaid/issue-brief/fast-track-to-coverage-facilitating-enrollment-of-eligible-people-into-the-medicaid-expansion/view/print/.

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  39. CMS, June 2017 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report, accessed at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.

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  40. The Kaiser Family Foundation State Health Facts. Data Source: Data compiled through review of Marketplace documents and communication between the states and CCIIO by the Kaiser Family Foundation, “State Decisions for Creating Health Insurance Marketplaces,” https://www.kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-marketplaces/.

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  41. West Virginia Legislature, 2017 Regular Session, House Bill 2119, http://www.legis.state.wv.us/Bill_Status/bills_text.cfm?billdoc=hb2119%20ENR.htm&yr=2017&sesstype=RS&i=2119.

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  42. “West Virginia health insurance marketplace: history and news of the state’s exchange,” https://www.healthinsurance.org/west-virginia-state-health-insurance-exchange/.

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  43. CMS, 2017 Marketplace Open Enrollment Period Public Use Files, accessed at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/Plan_Selection_ZIP.html.

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  44. West Virginia Department of Health and Human Resources, Bureau for Medical Services, Your 2017 Guide to Medicaid,” accessed at http://www.dhhr.wv.gov/bms/BMSPUB/Documents/Guide%20to%20Medicaid%20%202017%20%20July%201%2c%202017%20approved.pdf.

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  45. West Virginia Department of Health and Human Resources, Bureau for Medical Services, Managed Care Monthly Report 2017 accessed at http://www.dhhr.wv.gov/bms/Members/Managed%20Care/MCOreports/Documents/Copy%20of%20Copy%20of%20MCO%20Monthly%20Enrollment%20September%202017.pdf.

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  46. Holly Hedegaard, M.D., Margaret Warner, Ph.D., and Arialdi M. Miniño, M.P.H. Drug Overdose Deaths in the United States, 1999-2015, Centers for Disease Control and Prevention, National Center for Health Statistics, NCHS Data Brief, No. 273, February 2017; accessed at https://www.cdc.gov/nchs/data/databriefs/db273.pdf.

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  47. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016, “Opioid Overdose Deaths and Opioid Overdose Deaths as a Percent of All Drug Overdose Deaths,” http://www.kff.org/other/state-indicator/opioid-overdose-deaths.

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  48. West Virginia Department of Health and Human Resources, Bureau for Medical Services, Provider Newsletter, Quarter 4, 2016, accessed at  http://www.dhhr.wv.gov/bms/BMSPUB/Documents/4QTRProvidernewsletter2016-rev.pdf.

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  49. Ibid.

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  50. West Virginia Department of Health and Human Resources, Bureau for Children and Families, Monthly Legislative Foster Care Reports, accessed at http://www.dhhr.wv.gov/bcf/Reports/Pages/Legislative-Foster-Care-Reports.aspx; West Virginia Department of Health and Human Resources, Bureau for Medical Services,  Provider Newsletter, Quarter 4, 2016, accessed at  http://www.dhhr.wv.gov/bms/BMSPUB/Documents/4QTRProvidernewsletter2016-rev.pdf.

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  51. West Virginia Department of Health and Human Resources, Bureau for Medical Services,  Provider Newsletter, Quarter 4, 2016, accessed at  http://www.dhhr.wv.gov/bms/BMSPUB/Documents/4QTRProvidernewsletter2016-rev.pdf.

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  52. When an opioid prescription is submitted for a member in the fee-for-service delivery system, the member’s medication profile is evaluated to determine the patient’s average MME dose for the past 90 days. An average does that equals or exceeds 50 MME will trigger further review through the prior authorization process and the patient will be locked into one pharmacy of their choice for prescriptions for controlled substances so their therapy can be more carefully managed. Ibid.

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  53. West Virginia response to the 2017 Medicaid Budget Survey for State Fiscal Years 2017 and 2018, Kaiser Commission on Medicaid and the Uninsured.

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  54. CMS, West Virginia “Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorders” Section 1115 Waiver Demonstration Approval, accessed at https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/wv/wv-creating-continuum-care-medicaid-enrollees-substance-ca.pdf.

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  55. West Virginia Department of Health and Human Resources, Bureau for Medical Services, Provider Newsletter, Quarter 1, 2017, accessed at  http://www.dhhr.wv.gov/bms/BMSPUB/Documents/1Quarter2017FinalApproved.pdf.

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  56. West Virginia response to the 2017 Medicaid Budget Survey for State Fiscal Years 2017 and 2018, Kaiser Family Foundation.

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