CHARLESTON, W.Va. -- The West Virginia Department of Health and Human Resources told the Legislature last week that as many as 260,000 West Virginians might be newly insured by Medicaid at a cost of between $25 million to $104 million a year, if Congress passes a health-reform bill.
Those numbers are greatly inflated, health-care reform advocates said Thursday.
The DHHR based its estimates on numbers that include all uninsured West Virginians, not just those eligible for Medicaid, the chief financial officer of the DHHR confirmed Thursday.
"I'm completely floored by these numbers," Rep. Shelley Moore Capito said Wednesday. "I simply don't know how our state can absorb such a massive new liability."
However, the DHHR's 260,000 estimate is impossible by Census data, health-reform advocates say.
"That's more than double the number of new enrollees anybody else estimates," Perry Bryant, director of West Virginians for Affordable Health Care said Wednesday. "I am truly puzzled by their numbers."
The DHHR number is based on "talking points" from the House Committee on Energy and Commerce, DHHR spokesman John Law said Thursday.
Tara Buckner, DHHR chief financial officer, told the Gazette on Thursday that Medicaid officials got their numbers from an item in the "talking points" labeled "provide coverage for uninsured residents."
"We added up the numbers from the three Congressional districts," Buckner said. They assumed all those people were Medicaid-eligible, she said.
"Those numbers are not just Medicaid," Bryant said. "They also include West Virginians who will not get their insurance through Medicaid, all the people who will buy insurance, subsidized or not, through the new insurance exchange."
"They used a number of uninsured that's well above what the Census data shows," said Judy Solomon, Senior Health Care analyst of the Center on Budget and Policy in Washington, D.C. "They also assumed that all eligible people will enroll, but no public program ever comes close to 100 percent participation."
When Census data is used, Bryant said, the number of new enrollees "drops significantly and will be more than counterbalanced by new benefits."
West Virginia stands to receive hundreds of millions of federal dollars for expanded community health services and individual insurance subsidies under the reform bills, Bryant said. "Tens of thousands of people newly insured by Medicaid would no longer leave unpaid hospital and emergency room bills that drive up everyone's cost."
The amount the state would pay in return depends on the number of people to be newly covered by Medicaid. Under the Senate bill, West Virginians who earn up to 133 percent of the federal poverty level could get Medicaid insurance. Under the House bill, the cutoff is 150 percent.
If the 260,000 new people were to enroll in Medicaid as the DHHR predicts, the state would pay an average of $25 million a year under the House bill and an average $104 million a year under the Senate bill between now and 2019. The total could range between $147 and $725 million.
"The amount would be far less than that, when Census figures are used," Bryant said.
The federal government would pay 100 percent of the cost of new enrollees until fiscal year 2018, then would pay 91 to 95 percent for two years. Then the rate might go back to the present 73 percent.
To calculate the 260,000 figure, the DHHR's Law said, the agency started with the talking points numbers. "Then we trended it forward, based on our recent experience at Medicaid."