MEDICAID in WV

Basic Facts

Here are some basic facts about Medicaid and the Children’s Health Insurance Program (CHIP)in West Virginia

• 37% of non-elderly West Virginia residents have pre-existing conditions.1   

-- This is the highest in the entire nation.

-- While many people in the state need health care to manage these pre-existing conditions, not everyone can afford the cost of insurance.

-- In fact, with a pre-existing condition, most people cannot afford the cost of health insurance on the open market. 

• 507,000 West Virginians are covered by the combination of Medicaid and CHIP.2 

-- This is 29% of all West Virginians.3

-- WV leads the nation in having the highest share of its population enrolled in Medicaid/CHIP.  

• The 507,000 number includes half (52%) of all children and three-quarters of all nursing home residents in the state.

• 7.5% of Medicaid recipients in WV receive care for opioid addiction, the highest percentage in the nation. 4 

• The 507,000 number includes 166,000 individuals on ACA Medicaid Expansion.  Coverage for these individuals was threatened in this year’s WV legislative session by a trigger bill that would have canceled all 166,000 if the federal government backed down on their 90% share of the cost.  Fortunately, that bill was withdrawn after considerable push from Medicaid Expansion recipients, care givers, clinic leaders, and community organizations.

• Cancellation of any part of Medicaid in WV will have horrible consequences

-- There will be many more uninsured patients who will have worse health outcomes.

-- Clinics, hospitals, and nursing homes will suffer loss of revenue and be pushed towards closure. Rural areas, which is most of WV, will suffer the worst impact.

-- We will move further away from the goal of healthy adults who are ready to work and healthy children who are ready to learn.

Potential impact on Medicaid/CHIP recipients in WV if work requirements are implemented.

The Big Bill passed by the House of Representatives in May 2025 is structured so that people who are eligible for Medicaid will lose their coverage because of failure to comply with intentionally burdensome paperwork rules associated with new work requirements. This was done to generate more money to fund tax cuts that disproportionately benefit the rich.  

If the Senate passes the bill with the same provisions, the anticipated impact in West Virginia would be the following: 5

• 41,000 adults and 4,000 children in West Virginia would lose their Medicaid healthcare coverage.  Nearly all would lose coverage because they were unable to keep up with the burdensome paperwork rules that are part of the work requirements .  

• 130 additional preventable deaths would occur each year in West Virginia, which means a total of 650 additional preventable deaths over 5 years.  This would happen because people without healthcare insurance are more likely to become sick and die.

• 2,550 jobs would be lost in West Virginia because of the reduction in healthcare expenditures.  These losses would have an especially severe impact on rural hospitals and clinics that are already struggling to stay open.

BOTTOM LINE for Medicaid in West Virginia : 

• Hands Off WV Medicaid!

• All West Virginians Deserve Healthcare Insurance!

Footnotes

1 https://www.kff.org/affordable-care-act/issue-brief/pre-existing-condition-prevalence-for-individuals-and-families/#

2 https://www.kff.org/statedata/custom-state-report/?i=123149%7C27e9eff9~110530%7C27e9eff9&g=wv&view=3 Numbers are for November 2024

3 https://www.census.gov/quickfacts/fact/table/WV/AGE295223 

4 https://www.brookings.edu/articles/the-role-of-medicaid-in-addressing-the-opioid-epidemic/#:~:text=The%20five%20states%20with%20the,%2C%20and%20Maryland%20(6.2%25)

5 https://www.americanprogress.org/article/the-collateral-damage-of-medicaid-work-requirements/