Amid a public health emergency, the 2021 state legislative session presented a unique opportunity to improve health and wellness outcomes across West Virginia. This year, delegates and senators introduced several bills related to health care and the social safety net that will impact families across the state, especially those with lower incomes. While some bills had the potential to positively affect West Virginians, like a Medicaid buy-in program, others turned into laws that will harm vulnerable populations, like the new restrictions on harm reduction programs. Here is a recap of social and health policies that legislators discussed during the 2021 session.
Drug Screening for Temporary Public Assistance (SB 387): SB 387 extends the drug screening pilot program for recipients of Temporary Assistance for Needy Families (TANF), also known as WV WORKS. This week, the Governor signed this bill into law, which extends the screening program through 2026 despite overwhelming evidence of its ineffectiveness regarding reduced substance use among enrollees or improved outcomes. Additionally, the fiscal note attached to the original bill estimates that this program will cost the state $22,000 annually, in addition to the initial $50,000 cost.
Restrictions on Harm Reduction Programs (SB 334): SB 334 implements several new requirements for harm reduction services and was swiftly signed into law by Governor Justice. Restrictions include adding barcodes to syringes, following a strict one-to-one needle exchange, and mandating that participants have West Virginia identification. According to syringe services providers, this bill essentially constitutes a ban on harm reduction. It will force existing programs to close, despite their critical role in stopping the spread of bloodborne illnesses and their ability to link people facing addiction with wraparound services. The U.S. Centers for Disease Control finds that “Syringe Services Programs [SSPs] are associated with an estimated 50 percent reduction in HIV and hepatitis C virus incidence… SSPs serve as a bridge to other services.”
In 2020, Kanawha County alone had one of the highest rates of new hepatitis C and HIV cases in the country, the latter surpassing New York City despite a population size 50 times smaller. Public health officials predict that this policy will further exacerbate this trend.
Restructuring Local Health Departments (SB 12): SB 12, which goes into effect this summer, will give elected officials more control over local health departments (LHDs). This law generally requires that changes LHDs make receive approval from a county commissioner or municipalities. This change is occurring as LHDs face over a decade of decreasing funding. Health experts anticipate that this law will further hamper their ability to provide services and implement regulations that positively impact community health outcomes.
Especially during a global pandemic and an opioid epidemic in which West Virginia finds itself at the center, these bills are poor public health policies. They decrease the state’s capacity to respond to crises and help those struggling across the state, particularly low-income people and those living with substance use disorders.
Extending Postpartum Medicaid Coverage to 12 Months (HB 2266): HB 2266 extends postpartum Medicaid coverage from 60 days to one year. What’s more, the legislature increased the income threshold for this population from 138 percent of the federal poverty level (FPL) to 185 percent FPL. A 2017 study found that 51 percent of maternal deaths occur postpartum – and that racial disparities compound these effects. By providing coverage to more mothers for more prolonged periods of time, West Virginia has taken a critical step in prioritizing maternal and infant health.
Establishing Paternity for DHHR Benefits (SB 35): SB 35 could have required that families establish paternity before receiving benefits from the Department of Health and Human Services (DHHR). These benefits include Medicaid, the Supplemental Nutrition Assistance Program (SNAP), TANF, and more. By establishing paternity, the state aimed to secure more child support payments. The bill’s language mandates that these payments count toward income, reducing the amount of aid available to the primary caregiver and children. Furthermore, such programs may disregard family dynamics, nonmonetary aid, and valid reasons for not establishing paternity – including domestic violence.
Requiring Child Support Compliance for Public Benefits (HB 2911): HB 2911 would make public benefits contingent on child support compliance. Under this bill, families could not receive public assistance if they did not cooperate with child support enforcement. Like SB 35, HB 2911 aims to ensure that more parents pay child support. And like the Senate bill, it ignores pertinent and nuanced explanations for noncompliance.
Both bills punish families based on class and race stereotypes that do not consider several crucial factors. West Virginia must focus on implementing legislation that expands family wellness rather than creating barriers as prerequisites to benefits to which families are otherwise entitled.
Reducing the Cost of Prescription Drugs (HB 2166): HB 2166 would make prescription drugs more affordable for consumers. The bill included two potential means of achieving this goal: first, by essentially subsidizing drug costs to reduce out-of-pocket payments by patients, or second, by reducing the cost to the carrier. Both a direct and indirect means of reaching consumers would meaningfully reduce the cost of prescription drugs for those who need them.
Medicaid Buy-In Program (HB 3001): The bipartisan HB 3001 would have allowed West Virginians to pay to enroll in a Medicaid-like program. Anyone in the state could enroll in the program, but individuals under 200 percent FPL would be eligible to receive subsidized insurance. By tapping into an existing network, such a program would be cost-effective, making health care accessible to more people. Under the proposed model, an additional 26,000 West Virginians could receive health coverage.
Prohibiting Short-Term Health Insurance Plans (SB 257): SB 257 would have restored an Obama-era regulation prohibiting insurance companies from offering short-term, limited-duration (STLD) health insurance policies. STLDs are plans that last less than a calendar year and tend to have low premiums and high deductibles. The structure makes them very affordable, but enrollees may end up paying astronomical out-of-pocket payments for a medical event – even for interventions that the plans cover. Further, in 2018, only about one-third of STLDs in West Virginia covered substance use recovery and none covered maternity care – two provisions that regular insurance plans must include as per Affordable Care Act guidelines.
Permitting Interstate Telemedicine (HB 2004): HB 2004 could allow licensed out-of-state health care practitioners to offer virtual appointments to West Virginia residents. This bill would increase the number of practitioners permitted to see West Virginia patients. Amid the COVID-19 pandemic, telemedicine has become increasingly crucial for reducing wait and travel time. By increasing the number of health care providers in the state, this bill could allow more individuals to access care from their homes.
These bills can improve health outcomes in West Virginia, and legislators should revisit these bills next session.
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