Study criticizes West Virginia Medicaid program

Researchers studying the effectiveness of a new Medicaid program in West Virginia have concluded that the program reduces Medicaid services for at least 90 percent of the population that receives them.

The Mountain Health Choices program grants enrollees additional services if they make certain commitments, such as showing up at all medical appointments and staying out of the hospital emergency room except for authentic emergencies.

Enrollees who choose not to sign the contract, or who fail to adhere to it, receive reduced Medicaid services.

Researchers at West Virginia University’s Institute for Health Policy Research found that scaled-back benefits might result in people covered by Medicaid making fewer trips to the doctor and doing without medicines and mental health services.

“Since most Mountain Health Choices members are children, the impact on their lives can be huge if their parents either don’t grasp the program or don’t adhere to the rules,” said Michael Hendryx, the project’s lead investigator and associate professor in the WVU Department of Community Medicine. “Children might end up being punished for their parents’ lack of understanding or lack of compliance."

"On the plus side, we found widespread support for the concept of people taking personal responsibility for their behaviors and choices regarding their health,” he added.

Hendryx’s review is the first since statewide implementation of Mountain Health Choices began in late 2007. The research was supported by a $100,000 Robert Wood Johnson Foundation grant.

The WVU research team interviewed four stakeholder groups: state Medicaid representatives, patient advocacy organizations, professional association representatives and healthcare providers and their staffs.

Hendryx said they discovered that the program is too complex for many participants to understand, resulting in a lack of service for some target populations, such as people with severe mental health problems.

The research team also noted that the state moved ahead with implementation before the rewards component of the program was ready, so no means existed to reinforce people who signed the contract or improved their behaviors.

WVU researchers’ greatest concern was that 90 percent of Medicaid recipients fell into the “basic benefit” version of the program. The basic plan offers a scaled-back version of traditional Medicaid benefits. It restricts, for example, the number of prescription medicines allowed and coverage for mental health services.

“A recurrent theme of the criticism is that not enough outreach took place to keep Medicaid recipients informed,” Hendryx said. “This is a highly transient population, and many have a low level of literacy. Most of those interviewed believe that a large proportion did not understand the informational mailings that were sent out, especially the initial mailings.”