Editorial: Medicaid Reforms Necessary In W.Va.

The Intelligencer, May 2, 2005

West Virginians helped pay the health care bills for one person who visited hospital emergency rooms more than 300 times in two years, according to state officials. That's outrageous. Stop it - now.

State Medicaid officials would like to do that, in addition to making several other common-sense changes in the health care program for low-income and some elderly people. Unfortunately, it appears that they need federal approval to impose such reforms.

About 373,000 West Virginians are helped by the Medicaid program. Slightly less than one-fourth of the cost is paid with state funds; federal money covers the rest.

Like many other states, West Virginia is having trouble paying for Medicaid. State officials said this spring that they probably would have to find ways to cut about $115 million in Medicaid spending for the coming year.

Among measures proposed by state officials is eliminating unnecessary use of health care services by Medicaid clients. Frequent emergency room visitors are one target. Those such as the patient who visited emergency rooms an average of three times a week for two years prompted that recommendation. The need for such limits is obvious because of current rules whereby Medicaid clients are eligible for "the full array of services, regardless of your health status or your health care need," as one official noted.

Other proposed reforms involve requiring that Medicaid patients actually show up for appointments with health care providers and encouraging those served by the program to avoid unhealthy lifestyles. Healthy eating habits and steps to curb use of tobacco would be among initiatives in that regard.

Because of federal Medicaid rules, West Virginia needs approval to undertake the reforms. State officials are seeking a waiver to allow them to make the changes. It should be granted without delay.