West Virginia Medicaid HCBS Rate Report Update

West Virginia Bureau for Medical Services (BMS) Commissioner, Cindy Beane, presented to the Legislative Oversight Commission on Health and Human Resources Accountability (LOCHHRA) regarding the Medicaid home and community-based services (HCBS) rate study, which included four programs: Aged and Disabled Waiver (ADW), Personal Care (PC), Traumatic Brain Injury (TBI), & Intellectual/Developmental Disabilities Waiver (IDDW). Click here for a PDF of that report.

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​Report highlights:

• The report recommends increasing ADW and PC hourly rates to $25.42 from $18.92.
• The report does not recommend implementing a geographic rate differential.  For example, rates will be the same for ADW and PC statewide, with no geographic adjustments.
• The TOTAL SPEND to implement these 31% increases (meaning federal + state dollars) is $170,572,366.
• The total STATE spend is $45,105,156.
• The federal match (FMAP) is about 74%, meaning the federal government (CMS) provides about $.74 out of every $1, with the rest provided by the state.
• Broken down by program, the total spend to implement the 31% increases: 
  • ADW $39.2M
  • PC     $25.1M
  • TBI    $508,396
  • IDD   $105.6M

                     (the IDDW rate increases account for $105+M of the $170M+ total spend)
 
Further, BMS Commissioner Cindy Beane presented about the overall Medicaid budget to the Joint Committee on Government & Finance on 12/12/23.

• Medicaid is the largest portion of the DHHR budget and faces a $115M+ shortfall currently.  There are several ways to close that shortfall, all of which will be considered.
• 36% of West Virginia citizens are currently enrolled in Medicaid.
• Since 2020, and during the pandemic, as many as 567,000+ people were enrolled on Medicaid.
• The unwinding process has the Medicaid enrollment number down to 539,250, with hopes of leveling off to 515,000 in 2024.
• The pandemic FMAP enhancement has ended, which resulted in the Medicaid shortfall.

In Summary, initial HCAOA-WV feedback seems pleased with the process and results of the rate study. It was fair, thorough, and considers surrounding state HCBS rates, which are significantly higher than current West Virginia HCBS rates.