West Virginia has long faced significant health-related challenges, many of which could have been meaningfully addressed by bills introduced during the 2023 legislative session. Maternal and infant mortality rates continue to rise nationally, and the most recent pre-pandemic state data indicated that infant mortality in West Virginia outpaces the national rate.[1] Opioid overdose deaths continue to take the lives of vulnerable people. And the number of kids in the West Virginia foster care system exceeds the national average. While a couple of positive health-focused bills were passed by the legislature this year, lawmakers focused much of their attention on health-related policies based on fear—not facts.
Two bills that aim to improve health outcomes in the state passed this legislative session, but one has yet to be signed into law. SB 577, which awaits the Governor’s signature, addresses insulin costs for West Virginians with private insurance, lowering copay caps for a 30-day supply from $100 to $35. This reduced cost would be particularly relevant in West Virginia, which leads the nation in diabetes prevalence. Rising costs for insulin have made treating diabetes financially unfeasible for many West Virginians, and this provision would make treatment more accessible.
Meanwhile, the Governor has already signed SB 89 into law. This bill sets higher treatment standards for victims of sexual assault in hospitals. It requires hospitals to have a qualified sexual assault nurse examiner on staff. A transfer agreement with another hospital is needed if they do not have this staff. It also codifies time frames for submitting test kits to local law enforcement and storage protocol. As a whole, the legislation addresses barriers that negatively impact crucial care for people who have experienced sexual assault and is a positive step forward.
Several additional bills sought to improve health outcomes in the Mountain State, but did not pass. HB 3274 would have addressed the Medicaid benefits cliff by enacting a Basic Health Plan to allow West Virginians just over the Medicaid income limit to maintain coverage with an income-based premium. The plan would have been entirely federally funded, empowering folks to stay healthy while working. While the bill passed the House overwhelmingly, it stalled in the Senate following industry opposition.
SB 269 would have doubled the annual dental benefit limit for adults enrolled in Medicaid from $1,000 to $2,000. Expansion of the limit would have improved dental benefits for low-income folks, many of whom have not had dental benefits in their adult life.
Bills that would have increased access to doula care and menstruation products in public schools and correctional facilities also did not pass.
SB 268 significantly changed PEIA benefits to address the program’s rising costs. A positive provision raises inpatient hospital reimbursement to 110 percent of Medicare rates to keep the provider network intact. Through this legislation, lawmakers also sought to address PEIA solvency by shifting costs further onto employees via two main provisions—enacting a firm 80/20 employer-employee benefit split, which will increase employee premiums by an estimated 26 percent in July, and raising insurance costs for employees’ spouses who have another offer of health coverage. While lawmakers paired these health coverage cost increases with a public employee pay raise, some workers will still experience negative financial impacts overall. It remains to be seen how these benefit changes will exacerbate public agency vacancies across the state.
Unfortunately, several harmful bills were passed this year. The most egregious of these bills is HB 2007, limiting gender-affirming care for transgender youth. West Virginia is home to more transgender youth per capita than any other state. Many need health care that aligns their body with their gender, which studies have shown improves their mental health and life outcomes. This health care includes hormone replacement therapy and medication that pauses puberty, the latter being reversible. Despite wide support from medical and transgender communities to protect these therapies, the state passed a law banning access to them, except for those at risk of self-harm or suicide. These risk factors can develop because of untreated gender dysphoria. The bill also prohibits gender-affirming surgery for minors. Notably, there is no evidence that West Virginia children undergo—or have ever undergone—these surgeries. HB 2007 creates unnecessary barriers to critical care and disparages the state’s queer community. This bill was one of several targeting transgender and queer West Virginians, following concerning national trends.
HB 2006 split the Department of Health and Human Resources (DHHR) into three separate agencies. Lawmakers did so without outlining associated costs, fully addressing how the move may impact interactions between bureaus within the agency, and showing how the action would address the core issues DHHR faces. The timing is particularly concerning: the end of the Medicaid continuous coverage provision related to the public health emergency is coming this spring, and the staff-strapped agency will have to re-evaluate hundreds of thousands of West Virginians’ eligibility for Medicaid and other programs. Undertaking the agency split amid this additional work could disrupt communication between bureaus that must work together to return the agency to pre-pandemic regulations smoothly.
Overall, the session heavily focused on health-related issues. Still, except for a couple of positive pieces of legislation, it is unclear how the health priorities of lawmakers will actually improve health outcomes in the Mountain State.
[1] WVCBP presentation: “Infant and Maternal Mortality: National and West Virginia Landscape,” Spring 2021.
