Medicaid, exchange answers elude W.Va. lawmakers

Published on NewsOK Modified: February 11, 2013 at 6:58 pm •  Published: February 11, 2013

But while upholding the overhaul last year, the U.S. Supreme Court struck down its threat to withhold a state's existing federal Medicaid dollars if a state refuses to expand its rolls. Around 415,000 West Virginians received health care services through Medicaid during the past budget year. West Virginia has the 12th-largest Medicaid program when measured as a percentage of a state's population.

Samples, meanwhile, said he expects officials will work right up until the Friday deadline for a blueprint for its health care exchange. The overhaul requires each state to set up a marketplace within which individuals and small businesses can pool their buying power and seek coverage from private insurers. Samples' office has estimated that 37,000 to 60,000 West Virginians would seek insurance through the exchange once it opens.

West Virginia has decided to partner with the federal government for its exchange, instead of running one on its own or leaving it entirely to the U.S. government to operate. While exchange details remain elusive, Samples told lawmakers that he could help resolve some confusion about the exchange concept. Samples said the exchange will not offer its own health coverage plan, process claims, set premiums or tell insurers how much they can pay providers. Insurance agents will continue to sell coverage plans, and negotiate with insurance companies for their commissions, Samples said.