Medicaid is one of the most important health care programs in West Virginia. During the COVID-19 public health emergency (PHE), it served up to 655,000 people—or one in three West Virginians. It helped folks across the state stay afloat and connected to their health care during an unprecedented time. Between April 2023 and April 2024, the state embarked on reviewing every single case, a process referred to as the Medicaid unwinding. The program returned to pre-pandemic enrollment levels after the unwind and covers 508,000 West Virginians as of November 2024.
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Throughout the pandemic and the subsequent unwinding, the WVCBP has worked in partnership with West Virginians for Affordable Health Care (WVAHC) on a series of listening projects to better understand how folks navigated their health care via Medicaid during an unprecedented period for the program. Through these conversations, we hoped to highlight the value of the program to enrollees and to identify opportunities to enhance the user experience. This year, we focused on hearing from populations we repeatedly received feedback from and about via external partners: families with children and folks who were in recovery from a substance use disorder (SUD). Members within these groups had unique experiences that helped us determine specific strengths and gaps in the Medicaid user experience.
Key Themes:
We aimed to understand how West Virginians accessed and utilized Medicaid during and after the COVID-19 PHE. In addition to quantitative data, the majority of the information that shaped this project came from conversations with direct service providers, advocates, and people with lived experiences.
The WVCBP hosted biweekly stakeholders’ meetings throughout and after the PHE. These meetings provided clarity about federal and state rule changes, as well as connected advocates’ efforts to help folks stay updated and connected to their health care. Importantly, it was during these meetings that the WVCBP and WVAHC began to hear anecdotes from providers about how enrollees were accessing (or not accessing) health care during this unprecedented period. Significantly, different populations had unique experiences, with some navigating changes more easily than others.
There is a misconception that the PHE created a host of problems within Medicaid programs across the United States, including funding and budgetary issues. While this period introduced challenges, including disconnection from health care during the lockdown period, our findings indicate that, while the PHE exacerbated some patterns, it primarily uncovered longstanding issues that participants had experienced prior to the pandemic. Furthermore, the federal government sent states additional funds in exchange for keeping folks enrolled in the program, temporarily delaying an impending budget crisis in the Mountain State. In other words, the pandemic provided an opportunity for advocates to closely examine barriers facing Medicaid programs across the country, while flexibilities at the federal level created a roadmap to mitigating these difficulties until states could address them permanently.
