Update on WV Medicaid

The WV Medical Services Fund Advisory Council held its regular meeting October 4 in Charleston WVPA Executive Director Richard Stevens represents pharmacy at the Medicaid meetings.

Cindy Beane, Medicaid Commissioner, informed attendees of the expansion of pregnant women included those up to 185% of the Federal Poverty Level. She said the legislature approved the Omnibus Foster Care Bill, which will put the youth into managed care.

She said substance abuse had created a crisis in the child welfare system, and West Virginia leads the nation with children being removed from their homes.

Beane announced one of the managed care organizations had left the market July 1, 2019, leaving Medicaid with three plans in West Virginia.

Deputy Commissioner of Finance Tony Atkins reported West Virginia was receiving 74.34% federal funding, and the federal match will increase because of the Federal Medical Assistance Percentages. He said no other state is receiving this high percentage of funding from the federal government.

Atkins reported there are currently 514,000 persons enrolled in Medicaid. He said this was a decrease from last year, and August 2016 witnessed the highest enrollment. He said enrollment in the adult population was declining with adults who found job opportunities out of state, and adults who remained in the state have found employment from the improved economy.

Deputy Commissioner of Plan Management and Integrity Fred Lewis provided updates on the managed care organizations. He said 390,000 are enrolled in a MCO plan, which is 88.8% of the total Medicaid population. He said 61,200 members will transition from Family Health into one of the three remaining plans. Family Health chose not to review their contract July 1, 2019, leaving three remaining plans.

Lewis reported fraud and abuse recordings will be announced monthly rather than quarterly beginning July 1, 2019. He announced that the Office of Pharmacy Savings Report is now available on the BMS Pharmacy website.

Management Information Services Manage Brandon Lewis reported Asset Verification Solutions goal is to identify and detect fraud, waste and abuse among Medicaid.

Commissioner Cathy Slemp presented information regarding the infectious disease implications epidemic and use of injected drugs. She said this population is at risk for several infectious diseases such as Hepatitis A, and there are 2,749 cases throughout the State. She said the average had been nine a year. She reported Human Immunodeficiency Virus (HIV) cases are increasing in Cabell County.