EYEWITNESS LOCAL NEWSMEDICAID CHANGES
from Eyewitness News Online
Changes Proposed For Some On Medicaid In W.Va.
Reported by: Kallie Cart
Web Producer: Kallie Cart
Reported: May. 14, 2012 6:23 PM EDT
Updated: May. 14, 2012 6:30 PM EDT
Charleston , Kanawha County , West Virginia
Facing a massive budget shortfall, big changes could be coming to Medicaid in West Virginia.
This year the state has enough money to cover Medicaid and actually has a surplus. In 2013, just barely enough. But by 2014 the Department of Health and Human Resources is anticipating more than a $200 million shortfall. So they're trying to come up with ways now to cut costs.
The biggest plan, that is raising some concerns, is to move those receiving Medicaid through Supplemental Security Income or SSI into managed heath care. Managed health care is similar to an HMO. 415,000 West Virginians receive Medicaid, 57,000 of those receive Medicaid through SSI and would qualify for the move to managed health care.
Instead of paying a fee for each service, under the managed health care plan there will be a pre-selected primary care physician and patients must receive approval before obtaining certain tests or procedures.
Health officials say the thought is that it will help those on SSI, generally some of the sickest who are on Medicaid, to have more consistent and preventative care. They believe it will cut down on costly trips to the emergency room and help those patients manage their prescriptions better. The move is anticipated to save $15 million a year.
But there are some real concerns about the plan from patient advocates and lawmakers. Advocates say they are concerned about the quality of care and lawmakers are raising concerns about those patients living in rural areas where there are fewer doctors.
A legislative interim committee heard presentations on the issue Monday. There will be a lot more talk about the plan but there is a quick timeline to make the transition. The plan is to start phasing in counties by the end of this year. The DHHR will start with the more populous counties and say if there isn't a big enough health network in the rural areas, they will adjust the plan.
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