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News Release

FOR IMMEDIATE RELEASE
Wednesday, May 3, 2006

Contact: CMS Public Affairs
(202) 690-6145

HHS Approves Innovative Medicaid Reform In West Virginia, May 3, 2006

Medicaid enrollees in West Virginia will be among the first in the country to receive new, enhanced benefits under changes in Medicaid law enacted as part of the Deficit Reduction Act of 2005 (DRA), HHS Secretary Mike Leavitt announced today. Kentucky’s redesign of its Medicaid program under the new DRA flexibility was also approved by Secretary Leavitt today.

West Virginia will offer enrollees a choice of two benefit packages, a basic plan based on the current Medicaid service package and an enhanced package that includes benefits not traditionally offered under Medicaid. To enroll in the new advanced benefit package, enrollees will be asked to sign a member agreement with the state that they will comply with all recommended medical treatment and wellness behaviors. Enrollees who chose not to join the enhanced plan or who decide they do not wish to continue in it will receive the standard Medicaid benefit package.

“This innovative new Medicaid program will encourage people with Medicaid to adopt healthy behaviors,” Secretary Leavitt said. “By entering into a partnership with the state, enrollees will become full members of their medical team. We expect this approach to lead to better, healthier lives for all participants covered under the program.”

The initial target group for the new plans will be healthy children and adults. Those who choose the enhanced package will receive tobacco cessation, nutritional education, diabetes care and chemical dependency/mental health services. In addition, children in the enhanced package will receive skilled nursing care and orthotics/prosthetics. Both the basic and enhanced plans will continue to include the Early, Periodic Screening, Diagnostic and Treatment (EPSDT) benefits for children, a hallmark of the traditional Medicaid program.

In addition to the array of standard benefits, adults in the enhanced package will receive cardiac rehabilitation, chiropractic services, and emergent dental services.

“Medicaid enrollees in West Virginia will now become part of an emerging trend in health care that empowers patients to make educated, consumer-driven decisions related to their own treatment,” said Mark B. McClellan, M.D., Ph.D., administrator of the federal Centers for Medicare & Medicaid Services, the agency that oversees the Medicaid program.

The state will measure both medical outcomes and compliance with the member agreement by tracking four indicators in the first year. The indicators include receiving screenings as directed by the health care provider, adherence to health improvement programs designed for them, attending scheduled appointments, and taking medication as directed. Failure to comply with the agreement could result in the enrollees losing access to the enhanced package of benefits.

“Over time this new design will give the medical community as well as healthcare policy makers a clear picture of the relationship between personal involvement in medical care decisions and compliance and health outcomes,” said Dr. McClellan. “This will aid our efforts to examine whether increased ownership of healthcare decision making leads to healthier patients.”

Initial plans are to introduce the new benefit choices in three counties: Clay, Upshur and Lincoln. Enrollees in those counties will be able to choose in which plan they wish to enroll when they first enroll in Medicaid or when they renew their enrollment.

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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

Last revised: January 12, 2009