According to Bryant, nearly 85,000 low-income residents have been enrolled in Medicaid since Oct. 1. An actuarial study commissioned by Tomblin's office in early 2013 predicted 91,500 residents would be enrolled in Medicaid under the expansion by 2018.
"Before, there were some national standards, particularly for pregnant women and children, but for adults, states were pretty much free to set their own standards, and that's where you see the major enrollment shift," Bryant said. "Previously, if you were a childless adult, you wouldn't qualify. We had, and continue to have, some of the best percentages, as far as the federal government covering our Medicaid, but we had some of the lowest eligibility."
Samples said actuaries for the DHHR determined that 130,000 West Virginians are eligible for the Medicaid expansion, and the agency predicts that some of those eligible will go uninsured. Because Medicaid is a "point in time" service, the open enrollment period does not apply to those eligible for Medicaid, Samples said, and many of those eligible for Medicaid do not pay federal income taxes or make enough income to be penalized by a fine.
"We want folks to get engaged and get enrolled, but even by 2016, actuaries have predicted there will be a population eligible for the expansion but won't enroll because they simply don't need the service," Samples said. "You're always going to have a pocket of uninsured population."
Although some might not sign up, Samples said he believes the Medicaid expansion might serve as a "bridge" for people who are struggling financially to become more stable.
"Currently, in traditional Medicaid, that population was eligible because of health conditions, and those who were eligible for it because of income were the poorest of the poor," he said. "The expansion really does allow for a ladder out of poverty and into the middle class for some."
According to Samples, the primary concern with Medicaid expansion is a shortage of health-care providers across the state and around the country, and something that needs to be addressed once a larger segment of the population is covered by health insurance.
"It's a true issue that needs to be addressed in the state, especially with respect to specialized providers," Samples said. "In terms of primary care, however, while we don't have quite what we want, we are better positioned than most states simply because we have a great network of primary-care providers that have satellites throughout the entire state, and that primary-care infrastructure is really critical."
Actuarial studies conducted by the DHHR predicted the state's uninsured population would drop from 246,000 to 76,000 by 2016. The state's costs for Medicaid expansion will be about $375.5 million between fiscal years 2014 and 2023, and will mean an additional $5.2 billion in federal funding during the same period.
Reach Lydia Nuzum at lydia.nu...@wvgazette.com or 304-348-5189.