Health Care Reform and West Virginia Medicaid Nancy V. Atkins, R.N., M.S.N., N.P.-B.C.

Health Care Reform and
West Virginia Medicaid
Nancy V. Atkins, R.N., M.S.N., N.P.-B.C.
WV Medicaid
• Medicaid provided healthcare services
to over 400,000 West Virginians in SFY
• Total program expenditures in SFY 2010
- $2.6 billion
Health Care Reform
• What is Health Care Reform
• Key Areas of Reform
• Purpose of PPACA
• PPACA and the States
• PPACA Provisions for Medicaid
• PPACA Funding Opportunities
What is Health Care Reform?
• This presentation is an overview of the purpose,
provisions and related funding of the Patient
Protection and Affordable Care Act (PPACA, Act) as
well as an overview of how the Act will affect the
West Virginia Department of Health and Human
Resources (DHHR) and Bureau for Medical Services
• The Act is also referred to as the Affordable Care Act
• The Obama Administration has stated that the intent
of the Act is to “put individuals, families, and small
business owners in control of their healthcare.”
Much of the PPACA must be resolved through regulations. Many
of the provisions became effective upon enactment, and
requirements of the Act continue through 2019. Most of the
reform activities will occur between 2010 and 2014.
Health Insurance Reform
Employers Offering Health Insurance to Employees
Public Programs Including Medicaid, the Children’s Health Insurance Program (CHIP),
Medicare, and Public Health
Healthcare Workforce Training
Elimination of Fraud, Waste, and Abuse in Healthcare
Improving the Quality of Healthcare
PPACA creates powerful incentives
so that more health care providers
start delivering the kind of
coordinated, patient-centered care
that has been shown to get best
PPACA and the States
• The critical role of state governments is in
managing and financing the Medicaid and CHIP
Programs. The PPACA creates new requirements
for expanded coverage and accountability
mandates for those programs.
• States must also create, manage and regulate
new insurance exchanges for both individual
residents and businesses.
• The extensive new regulations for the health
insurance plans must be enforced by the states
as well.
PPACA Provisions for Medicaid
Continues Medicaid coverage to any
individual who has been in foster care
under the age of 26.
Develops a core set of health care quality
measures for Medicaid-eligible adults.
PPACA Provisions for Medicaid
Eliminates fraud, abuse and waste in the system
which may require outside vendor procurement
and outside contracting meeting the federal
Provides new options to states to provide
Medicaid long-term care services and supports.
PPACA Funding Opportunities
• The Medical Home State Options offers states
enhanced match of 90 percent FMAP for two years
and small planning grants may be available to
promote the use of medical homes for enrollees with
chronic conditions. West Virginia has been a leader in
developing the medical home concept.
• WV has applied and received a planning grant for this
opportunity. Health Homes for persons with Chronic
• WV has received a Money Follows the Person grant.
Electronic Health Records (EHR)
Health care providers and hospitals are encouraged
to use Electronic Health Records to allow them to
securely share patients’
There are incentive payments
for using EHR.
The result is improved health care.
What is a Health Insurance Exchange?
• Offers consumers a choice of health insurance
• One website will provide information about
premiums and coverage so consumers can
comparison shop.
• Enrollment will also be through the website.
• Reforms the insurance market.
• Health insurance program created in
2004 by WV Legislature.
• For West Virginians who have been
unable to get private health insurance
because of a pre-existing medical
• The individual pays the premiums.
Pre-existing Condition Insurance Plan
• Apply online.
• Apply over the phone.
• 1-866-717-5826
• TTY: 1-866-561-1604
Nancy V. Atkins, RN, MSN, NP-BC
Bureau for Medical Services