CHARLESTON, W.Va. -- Gov. Earl Ray Tomblin's decision to open Medicaid to more low-income West Virginians was reached neither quickly nor easily, administration officials say.
The path to last week's announcement began in June, when the U.S. Supreme Court upheld the federal health care law. The ruling struck down language that threatened existing federal Medicaid funding for states that didn't expand their programs as called for by the sweeping overhaul.
"When we found out we had a choice, we started studying it," Tomblin Chief of Staff Rob Alsop said Friday.
The governor at first sought wiggle room. He quizzed U.S. Health and Human Services Secretary Kathleen Sebelius in July about whether West Virginia could expand Medicaid more gradually or only partly and still count on the hefty federal funding promised by the health care law. After a September follow-up inquiry by the governor, Sebelius shot down that option for West Virginia and other states in December.
But by then, the Tomblin administration had already begun crunching the numbers surrounding the expansion question. The state Insurance Commission had hired CCRC Actuaries over the summer as it faced a series of complicated provisions and looming deadlines arising from the federal overhaul. The administration enlisted CCRC to study what West Virginia should expect -- both for Medicaid and the state's health coverage landscape generally -- if it expanded the program or rejected that call.
Aiding that financial analysis was Jonathan Gruber, an economist at the Massachusetts Institute of Technology. Gruber advised officials in that state when it adopted its health coverage mandate under then-Gov. Mitt Romney. Gruber also consulted the Obama administration as it developed the federal overhaul.
The analysis process proved lengthy and complex, Alsop said. The actuaries, for instance, needed detailed figures from the Department of Health and Human Resources, which runs Medicaid, to estimate the price tag for overseeing the expansion. While the overhaul pledges federal funds for the actual health care costs -- the analysis concluded that West Virginia can expect $5 billion over the next 10 years -- it would pay for only half of the administrative expenses.