As the government shutdown drags on, the focus in Washington is on political gamesmanship. But here in West Virginia, the consequences are dangerously real.
One in 6 West Virginians rely on the Supplemental Nutrition Assistance Program to help put food on the table. That’s more than 270,000 of our friends and neighbors, including nearly 100,000 children, who are now faced with legitimate worry about whether their food assistance will be available next month.
But the path forward is clear: the Trump administration and U.S. Department of Agriculture (the federal agency that oversees SNAP) have the authority, the funding and the responsibility to get SNAP assistance out to families in November even amid the shutdown. All it takes is a choice to do the right thing rather than making families the collateral damage in a political fight.
Historically, administrations from both parties have sustained SNAP without interruption during shutdowns by using contingency funds and carryover appropriations. The USDA has an estimated $5 million to $6 billion in contingency funds right now meant for moments like this one. The Trump administration must follow the law and recent history and commit to releasing SNAP contingency funds for November benefits now. Further, just as they reallocated funds earlier this month to safeguard WIC benefits, they must now take the same approach to ensure SNAP benefits arrive on time. Put simply, the authority and funding to sustain SNAP benefits in November is there — what is missing so far is the political will to prioritize families over politics.
SNAP is essential in a shutdown, just as prior Democratic and Republican administrations have recognized. It is the most effective anti-hunger and anti-poverty program in the United States. In West Virginia, it brings nearly $50 million per month in federal funds into our state, helping households make ends meet and supporting our food, grocery, and farming economies. Our food banks and charitable food networks have already made clear they will not be able to fully fill the $50 million gap if there is an interruption in benefits, and Gov. Patrick Morrisey has said the state cannot or will not do so. The onus is on the USDA and President Donald Trump to do the right thing.
This isn’t an abstract policy debate — it’s a direct threat to food security for children, seniors, veterans and working parents. Withholding dollars for food in a political fight is an affront to the dignity of working families across West Virginia striving to make ends meet. West Virginia’s members of Congress must do their part by calling on Trump and the USDA now to tap the USDA’s contingency reserves and any other funding available to ensure November benefits are available to families without interruption.
Then they must also do the work West Virginians expect them to do as our representatives: end the political gamesmanship, come together with one another to find compromise, and reopen the government.
Read Kelly’s full op-ed.
Check out these articles for more on the government shutdown’s impact on federal employees and SNAP.
Commercial and private health care costs in the United States and West Virginia are rising at a concerning rate. West Virginia outpaces the nation with the highest health care spending of any state, comprising more than one-fourth of the state’s gross domestic product. A groundbreaking RAND Corporation study found that West Virginia residents bear the cost, as the Mountain State has private and commercial health care costs higher than any other state, even those with greater access to health care services and specialization. In 2022, West Virginia spent about $6,000 per capita on hospital care, nearly $2,000 more than the national average, much of which fell on patients to pay.
It is imperative to address high health care costs in West Virginia. These costs have had a pervasive impact on patients, labor and wages, and the state economy. Our new research investigates the role of concentrated provider networks on health care costs and outcomes. While there are many contributing factors, West Virginia has the highest health care costs in the nation and a high rate of consolidated services, with just two networks owning 70 percent of hospitals in the state. Hospitals, as well as the care providers and support staff who work within them, serve communities and protect peoples’ health and safety. However, the concentration of market power—and the lack of policy to mitigate the consequences of this concentration—has had significant repercussions for the state.
Our newest report focuses on hospitals in West Virginia and how provider consolidation trends impact the state and consumers by reallocating market power to just a few hospital networks. This market consolidation is an important area of study for policymakers as well as patients, as it directly impacts their ability to access and afford care and services.
“While West Virginia’s health care system is already quite consolidated and it is infeasible to reverse these trends, our state can and should implement a range of policies to increase transparency and affordability for consumers while limiting future harm,” says Rhonda Rogombé, health and safety net policy analyst and report author. “Policymakers should focus on ways to reduce health care costs, like improving price transparency, limiting facility fees, and more.”
Some evidence also points to hospital consolidation as a factor in the reduction of services, leading to care deserts for critical services in rural and other underserved communities, which the WVCBP will investigate in the future.
You can find the report’s key findings and policy recommendation summary below.
Key Findings
Policy Recommendation Summary
There is a range of policies available to help rein in hospital health care costs at different points in the process. These include, but are certainly not limited to, strengthening antitrust and merger review policy on the federal and state levels, improving cost and price transparency, and setting a threshold for how much hospitals must spend in charity care to maintain their nonprofit status. Addressing exorbitant health care prices also necessitates finding mechanisms for lowering the high health care costs unique to the United States.
However West Virginia chooses to address high health care costs driven by hospital consolidations, the state must also collect data around prices and the efficacy of various policies to ensure that each tool is functioning as intended. By putting patients—not profits—at the crux of health care, West Virginia can become a healthier, more affordable place for all who call it home.
Please note: The data and analysis for this report was compiled prior to the passage of HR 1, the “One Big Beautiful Bill,” which will have deeply harmful impacts on West Virginians and the state’s health care system by reducing federal funding for health care, making Medicaid more difficult to access, and shifting significant health care costs onto the state budget and charitable entities including nonprofit hospitals. The findings of this report do not change the imperative of policymakers to reverse harmful funding cuts in order to ensure health care remains accessible in rural areas around the state.
For example, in the report, we cite that the difference between the tax benefits nonprofit hospitals in West Virginia received and the amount of charity, uninsured, and uncompensated care they provided totaled $132 million in a single year, enough to completely cover the medical debts of 77,000 West Virginians or the state’s rural hospital losses 13 times over. That amount is still less than one-sixth of the amount of federal health care funds West Virginia will lose once HR 1 is fully phased in. Policymakers should work to implement the policies outlined in this report as they work to mitigate and reverse the deep, harmful cuts in HR 1.
Read the full report.
With Marketplace open enrollment starting November 1, time is running out for the tens of thousands of West Virginians who rely on expiring enhanced premium tax credits to afford their health coverage.
Congress must act now. If they fail to do so, millions across the country will face unaffordable premiums and coverage loss. You can send a letter to your Senators and Representatives asking them to make the enhanced tax credits permanent, reverse health care cuts, and lower health care costs here.
Check out this video from WVCBP health and saftey net policy analyst, Rhonda Rogombe, to learn more about the current landscape. You can find additional details in her recent publications here and here.
Are you impacted and wondering what this means for you? Use the APTC savings calculator to see how much more you might have to pay if Congress fails to extend these credits. Access the calculator here.
HB 2014, West Virginia’s new data center law, prohibits nearly all authority of counties and municipalities to oversee development of data centers and microgrids, redistributes local resources to the state’s wealthiest households, and undermines state-funded programs.
You can view the fact sheet in the images below or download it here.
WVCBP executive director, Kelly Allen, recently spoke at an event discussing the adverse impact of HB 2014 on Tucker County. A recent article highlights some of her insights. You can access the article here.
The enactment of HR 1 (“One Big Beautiful Bill”) introduces new bureaucratic barriers to access and maintain Medicaid (e.g., work requirements), as well as new costs to the state. A recent article, including insight from WVCBP executive director Kelly Allen, provides further details. Excerpt below:
West Virginia needs to carefully balance implementation of work requirements for Medicaid with costs to the state and proceed with caution to be certain that people who are eligible for benefits aren’t knocked off the roles unnecessarily, a state legislative leader said.
About 504,000 people are enrolled in Medicaid in West Virginia. About 160,000 of those are in the Medicaid expansion population.
West Virginia’s Medicaid system faces significant changes through the recently-passed “Big, Beautiful Bill Act,” including implementation of a work requirement structure.
One of the new provisions is “community engagement requirements” of at least 80 hours per month of work, education or service for able-bodied adults without dependents. The requirement calls for twice-a-year verification.
Preparing for the changes will require significant front end work by West Virginia officials, with a system for assessing compliance with the work requirements expected to be in place by Jan. 1, 2027.
Lawmakers on an oversight committee heard an overview of the Medicaid changes during interim meetings.
“Now, one of the real questions that the committee had, and that I certainly had, is, are we going to have enough staff or staff time to comply with that requirement?” said Delegate Matthew Rohrbach, a Republican from Cabell County who is the deputy speaker of the House.
Rohrbach, on MetroNews Talkline, said the State of West Virginia has an obligation to be ready so that people who use Medicaid for their healthcare expenses are able to maintain eligibility.
“If people don’t want to comply, then they’ll get their benefit denied,” he said. “But I certainly don’t think this Legislature wants to see people denied because we don’t have a system in place to timely take their application and verify — so that’s something that we’re going to have to monitor very closely.”
Cindy Beane, commissioner for the West Virginia Bureau for Medical Services, provided an update about how the state is implementing the changes to lawmakers like Rohrbach during interim legislative meetings last week at the state Capitol.
She elaborated that the state is focused on system requirements and notifications, including making sure “that individuals understand what they are trying to report with regards to their work requirements.”
Beane said West Virginia is participating in a small pilot program with seven other states to explore technology so that Medicaid recipients who are working could report work hours efficiently through a “no touch solution so that people aren’t constantly having to report their work hours.”
Overall cost of implementation remains a question for state officials like Rohrbach.
“That’s, I think, what the Bureau of Medicaid Services is trying to get to the bottom of,” he said.
“I think a lot of this is going to be whether it’s personnel driven or how much of it can be computer driven — and what would the cost be for that verification program? So since the ‘Big, Beautiful Bill’ is relatively new — that part, we’re still trying to get a handle on.”
The progressive West Virginia Center on Budget & Policy think tank has estimated the overall financial effect to West Virginia of implementing changes under the “Big, Beautiful Bill” will be up to $659 million in new direct budget costs through fiscal 2030.
Delegate Sean Hornbuckle, D-Cabell, said on MetroNews Midday that he is concerned about that overall cost including implementation of the work requirements.
“Healthcare in West Virginia will be negatively impacted by the big bill that was passed in Congress,” Hornbuckle said.
“There is an estimate, which was confirmed, of 160,000 West Virginia’s that are definitely in peril of potentially losing services, and it’s going to cost the state a lot of money, outside of just the services potentially being eliminated for constituents. It’s a hefty price tag.”
Hornbuckle was skeptical that the state will be able to establish a compliance system that will be efficient for Medicaid recipients without significant cost.
“It’s going to cost the taxpayers a lot of money to be able to do that,” he said.
Read the full article.
Learn more about how these new Medicaid work requirements could negatively impact West Virginians in this recent article, featuring insight from Rhonda and Seth.
The enactment of HR 1 (“One Big Beautiful Bill”) cements the largest cuts to Medicaid in history, putting rural hospitals at risk of closure. A provision was included in the legislation to help address this concern, but the funds allotted are inadequate to make up for the Medicaid funding losses. A recent article, including insight from WVCBP executive director Kelly Allen, provides further details. Excerpt below:
West Virginia may receive at least $100 million a year from a five-year federal program aimed at “transforming the health care delivery ecosystem,” but that money won’t make up for the Medicaid funding state hospitals stand to lose when the One Big Beautiful Bill Act is fully implemented.
When the Republican megabill is fully in effect, West Virginia hospitals will lose more than $1 billion per year, Jim Kaufman, president and CEO of the West Virginia Hospital Association, told West Virginia Watch.
“That will have an impact, and hospitals will have to figure out what they do to ensure access with fewer resources,” Kaufman said. “And that may radically change what they can offer in certain communities.”
The Rural Health Transformation Program is a provision of the One Big Beautiful Bill Act, or HR 1. Congress included the $50 billion rural health fund in the bill in response to the threat of rural hospitals closing because of historic Medicaid cuts in the bill.
The legislation cuts states’ directed payment programs for Medicaid. West Virginia currently levies a 6% provider tax — the maximum allowable — on hospitals that care for Medicaid recipients. The money collected goes toward Medicaid and the state draws a 3-to-1 federal match for that money. The money is distributed to state hospitals based on the number of Medicaid beneficiaries it serves, Kaufman said.
Beginning in 2028, the law requires states to lower their provider taxes to a maximum of 3.5%. The legislation also lowers the Medicaid payment rates to those of Medicare, which don’t cover the full costs of services, he said.
The bill also includes work requirements and more frequent redeterminations for Medicaid, which are also expected to decrease the number of recipients.
And while hospitals will feel the brunt of the Medicaid cuts, Rich Sutphin, executive director of the West Virginia Rural Health Association, said that very little of the Rural Health Transformation Program money is slated to go directly to hospitals.
“You can’t do capital expenditures beyond minor alterations to a facility,” Sutphin said. “You can’t use it to replace any provider revenue that is already being paid for. So you can’t add enhanced reimbursement for certain services.”
The money also can’t be used to replace Medicaid funding, Sutphin said.
“[The Centers for Medicare and Medicaid Services’] guidance has made clear that the Rural Health Transformation Program is not meant to backfill deep Medicaid cuts or otherwise shore up the rural health hospitals and providers that will be most impacted by them,” said Kelly Allen, director of the West Virginia Center on Budget and Policy. “In their notice of funding, they specify that no more than 15% of the funding can go to provider payments that would help fill in the gaps of the deepest cuts to Medicaid in our nation’s history.”
If hospitals have to cut services, that will affect entire communities, not just Medicaid recipients, Kaufman said.
“I’ve actually had somebody say to me, ‘Well, I’m not on Medicaid, I don’t care about those cuts,’” Kaufman said. “Hospitals do not recruit a provider or run a service only for Medicaid. They provide that service for a community. So when you talk about those cuts, that is resources going out of a community.”
Program aims to ‘transform’ health care delivery
According to the federal Centers for Medicare and Medicaid Services (CMS), the Rural Health Transformation Program aims to “strengthen rural communities across America by improving health care access, quality and outcomes by transforming the health care delivery ecosystem.”
The $50 billion fund will be distributed to approved states over the next five years, with $10 billion will be distributed each year starting in fiscal year 2026.
Half of the money will be distributed evenly to states with approved applications. The other half will be distributed based on states’ individual metrics and applications that “reflect the greatest potential for and scale of impact on the health of rural communities.
The program has five strategic goals: Make rural America healthy again, sustainable access, workforce development, innovative care and tech innovation, according to CMS.
Read the full article.
As part of the “One Big Beautiful Bill” (HR 1) Congress enacted historically significant changes to the Supplemental Nutrition Assistance Program (SNAP) that will have impacts on enrollees, state policymakers, and the broader food system. One of these changes is an expansion of the SNAP work requirement. A recent article, including comment from WVCBP senior policy outreach director Seth DiStefano, provides further details. Excerpt below:
The passage of President Trump’s One Big Beautiful Bill act set the stage for greater obstacles to SNAP access. New guidelines will reportedly require those receiving assistance to provide extensive documentation of their efforts to find employment. Senior Policy Outreach Director, Seth DiStefano told 59News the impacts of this red tape will be felt throughout the southern portion of the state.
“You don’t have to receive SNAP benefits or rely on them in order for this to impact you, and I worry that this is going to be especially pronounced in southern West Virginia,” he said.
These changes could stand to impact local businesses as well. With a potential drop in access to SNAP funds, he said many locally owned shops and grocers could eventually be forced to close their doors.
Read the full article.
Our recent fact sheet documents upcoming SNAP changes and when they will go into effect. View the fact sheet in the images below or download it here.
Following 10 years of Summer Policy Institute, we’re excited to announce our inaugural Fall Policy Institute!
Join us for “Lunch and Learn” workshops happening between now and December and an in-person advocacy day at the State Capitol on December 7.
Workshop topics include:
You can register for any or all of the free virtual events here.
Randolph, Fayette, Jackson, and Calhoun counties! Do you have questions about how federal funding changes will impact health care in your community?
Join the WVCBP for a community conversation where you can:
You can find details about date, time, and location for the respective community conversations in the flyers below. At each event, a presentation will be provided by WVCBP staff.
You can RSVP for the Randolph County event here, the Fayette County event here, the Jackson County event here, and the Calhoun County event here.
For more info, please email our community engagement coordinator, Alex.
Do you have questions about how recent federal funding changes will impact health care access and your community?
The WVCBP is here to help. We are offering to host community conversations for concerned community members to:
If you are interested, please fill out this form and we will be in contact with you about scheduling a community meeting near you!
