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State's role in ACA depends on feds, official says

Read Gov. Tomblin's letter here:

 

CHARLESTON, W.Va. -- The state of West Virginia needs questions answered in order to expand its Medicaid program and set up its health insurance exchange on time, Jeremiah Samples, assistant secretary for the state Department of Health and Human Resources, said.

Enrollment in both the expanded Medicaid program and the exchange is planned for Oct. 1, with coverage starting in January.

Much of the state's responsibility in implementing the Affordable Care Act depends on the federal government doing its part, Samples said.

"There are many factors that are driving implementation that are dependent on the federal government meeting critical deadlines," Samples said. ... "So I can't necessarily speak to the federal government's implementation. HHS says they are proceeding and will meet their [deadlines for] components."

Samples said the state is "creating contingency plans" in the instances that the federal government doesn't meet those requirements.

"We want to be able to meet the deadlines where there's state responsibility," Samples said.

Gov. Earl Ray Tomblin announced in May the state would expand its Medicaid program to cover those who earn up to 138 percent of the federal poverty line, or $32,500 for a family of four as a part of the Affordable Care Act. State officials say expanding the program will provide insurance coverage to 91,500 state residents.

Last week Tomblin wrote a letter directing 10 questions to Secretary Kathleen Sebelius, of the U.S. Department of Health and Human Services. Tomblin's questions focused on Medicaid expansion and creating a health insurance marketplace.

"It is imperative that West Virginia be given flexibility to implement the federally mandated [Affordable Care Act] so as to best serve the long-term interests of our state," Tomblin wrote to Sebelius. "Furthermore, it is vital that several remaining unknown issues related to enactment of the (ACA) be resolved as expeditiously as possible."

Among other things, Tomblin asked if there will be any rules that haven't yet been announced that need to be implemented before January 1. He also asked who at the federal DHHS Tomblin's administration should contact with questions and issues and he asked when the federal health exchange will be ready.

The state needs answers to those questions before it can follow through with its role in implementing the ACA, Samples said. As of Thursday, Sebelius had not responded.

West Virginia has not yet submitted a state plan amendment relating to Medicaid expansion. Before state officials can do that, they need further clarification from the federal government, Samples said. 

"We're not alone in this," he said. "There's states across the country asking similar questions as we are. We hope that HHS will be able to respond to the governor's questions in a timely manner."

Samples recently took over as assistant DHHR secretary, moving from his prior position as health policy director for the state office of the insurance commissioner. In that role, he oversaw the development of the state's health insurance exchange. Samples said in his new role he will still be able to offer assistance for the exchange.

"We'll be working at the DHHR with the insurance commission and other state agencies on ACA insurance broadly and on the exchange. I'll be able to provide technical assistance on an as-needed way to support in any way I can."

The state government has not released plans for Medicaid co-payments, though Samples said he believes the agency has what it needs from the federal government to do so.

"At the end of the day this is a federally-mandated program, we just need further guidance and answers to critical questions in order to fulfill our role as it's outlined in the federal law."

Reach Lori Kersey at lori.kersey@wvgazette.com or 304-348-1240.


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