West Virginia revisions to Medicaid programs examined

Aug 24 2006

NPR's "Morning Edition" on Tuesday examined revisions to the Medicaid programs in Kentucky and West Virginia, which are the first two states to revise their programs under a new federal law that allows states increased flexibility in determining benefits and out-of-pocket costs (Rovner, "Morning Edition," NPR, 8/22).

Kentucky plans to establish separate Medicaid coverage plans with different benefits for the general population, children, the elderly and the developmentally disabled.

In addition, the state plans to limit Medicaid prescription drug coverage and limit physical therapy and speech therapy visits to 15 annually per beneficiary.

The revisions are thought to save Kentucky an estimated $200 million over two years (Kaiser Daily Health Policy Report, 5/24).

According to NPR, Kentucky's program gives rewards to beneficiaries for certain actions that "hold down costs," such as selecting generic rather than brand-name medications or participating in disease management programs for chronic conditions ("Morning Edition," NPR, 8/22).

West Virginia

West Virginia plans to allow 160,000 Medicaid beneficiaries -- many of whom are parents of children enrolled in the program -- to sign a "personal responsibility contract," under which they agree not to miss physician appointments and visit the emergency department only for emergencies.

Medicaid beneficiaries who adhere to the contract every three months will receive credits that they can use to purchase additional benefits.

The state will place Medicaid beneficiaries who fail to adhere to or decline to sign the contract in a basic coverage plan with limited benefits (Kaiser Daily Health Policy Report, 5/24).

Under the state's plan, physicians become "in effect, the compliance officer for the state," NPR reports.

Doctors must decide whether to provide care for or report beneficiaries who fail to adhere to the contract and to participate in the administrative appeals processes for beneficiaries who may lose benefits, NPR reports.

The NPR segment includes comments from Nancy Atkins, commissioner of West Virginia's Bureau for Medical Services; Kentucky Gov. Ernie Fletcher (R); Cindy Mann, director of the Center for Children and Family at Georgetown University's Health Policy Institute; and Joan Phillips, president of the West Virginia Chapter of the American Academy of Pediatrics ("Morning Edition," NPR, 8/22).