CHARLESTON, W.Va. -- Advocates for Medicaid expansion say Gov. Earl Ray Tomblin is right to carefully consider the option -- but the sooner he decides, the better.

"I think it's good that West Virginia is taking a good long look at expansion and weighing the options," said Ted Boettner, executive director of the West Virginia Center on Budget and Policy. "There's not a thing wrong with that, but I do think we need to move forward.

"As soon as we can make a decision, the better we'll be able to enroll people in the program. It's one of the pitfalls of waiting too long."

Tomblin, who is waiting on an actuarial study about what it would cost the state to expand Medicaid to those making up to 138 percent of the federal poverty rate, is one of a handful of governors who have not indicated whether or not their state will expand Medicaid, according to a report by the research and consulting firm The Advisory Board.

Twenty-four state governors have said they will expand. Four states have indicated they are leaning toward expansion.

Fourteen states have indicated they won't participate in Medicaid expansion and three have indicated they're leaning toward not expanding.

West Virginia is one of five states -- and the only one with a Democratic governor -- where the governor has not indicated at all whether or not the state will participate in expansion.

"It would be the largest investment we would make in low-income families in over four decades," Boettner said of Medicaid expansion.

Providing Medicaid to working adults would not only benefit the parents but their children as well, he said.

Opponents have argued the state cannot afford to expand. Under the Affordable Care Act, the federal government would pay 100 percent of the cost of expansion for the first three years. After that the federal match would gradually drop to 90 percent.

House Minority Leader Tim Armstead, R-Kanawha, said last summer that the state should not expand Medicaid because it couldn't absorb the costs.

Boettner said the money the state and the economic boom the state would get with Medicaid expansion would outweigh the costs to the state.

"I think given the huge federal match, it will create more revenue than it costs," Boettner said. "[There have been] several studies that say the economic impact will create more revenue than it costs to do the matching part of the program."

A study released recently by Families USA and West Virginians for Affordable Health Care estimates that Medicaid expansion would create more than 6,000 jobs in 2016 and generate about $539 million on health care spent in West Virginia.

Opponents have also argued that expanding Medicaid could be risky. The federal government could promise one match rate but fail to follow through due to budget cuts.

Boettner said the government couldn't run out of money, just political will.

"There's not a precedent for the federal government dialing back Medicaid dollars," Boettner said.

Perry Bryant, executive director of West Virginians for Affordable Healthcare, said Tomblin is right to thoughtfully consider expansion, but he is disappointed the study has taken this long.

"The major hold up is the actuary analysis," Bryant said. "I thought doing the analysis was due diligence and understanding the cost and benefits was the correct way to go. We were told early in January, then late January and now late March before it's publicly released.

"The delay has been disappointing," he said.

If Tomblin moves forward with expansion, the state's Medicaid officials need to outline essential health benefits that would be offered to the state's Medicaid population.

That's no easy task, and time is short. Enrollment in Medicaid and the state's health insurance exchange begins in October, Bryant said.

"Any time you deal with benefits it's a tough issue," he said. "There's a conflict between wanting a rich product and rolling down cost. You want meaningful public input."

Opponents have also argued that Medicaid expansion would create too many new patients for the state's doctors to handle and physicians won't accept them all.

But a significant portion of the uninsured that would qualify for Medicaid under the expansion are already being treated at the state's 27 community health centers, said Louise Reese, CEO of the West Virginia Primary Care Association.

In 2011, those centers served 379,702 patients -- 91,000 of which were uninsured, according to the latest data available, Reese said.

Many of them will qualify for Medicaid under the expansion, though the exact number isn't known, she said.

Community health centers receive federal and state money to care for any patient regardless of his or her ability to pay. That money doesn't always cover all of the costs for the uncompensated care, Reese said.

"It's a fine balancing act using other resources to be sure they have the assets to cover the uninsured," Reese said.

While officials wait on word from Tomblin, community centers are identifying their uninsured patients and making sure they have accurate contact information for them, Reese said.

That way, they'll be ready to contact those patients and walk them through the process of finding out what they're eligible for -- be it Medicaid or a plan through the state's health insurance marketplace.

"Health centers will play an important role as the marketplace exchange is implemented and Medicaid expansion," she said.

Other agencies will also be helping the uninsured people find out what they're eligible for, she said.

Health centers want to continue to serve that population if Medicaid is expanded.

"[Health centers are] very adept about providing care coordination and managed care for certain populations," Reese said. "So we understand the Medicaid population well and we know we can do a good job treating them."

Reach Lori Kersey at lori.ker...@wvgazette.com or 304-348-1240.