Overview
Federal policymakers are reportedly considering enacting work reporting requirements for Medicaid in the new Congress. Similar state-level policy led to disastrous consequences in Arkansas in 2018-19 until a federal judge blocked the program. Enacting an Arkansas-style work reporting requirement at the federal level would result in West Virginia’s health care system losing an estimated $270 million annually, 90 percent of which ($243 million) is federal Medicaid dollars, while uncompensated care costs would dramatically increase for providers and the state. Further, an estimated 40,779 residents could be expected to lose their health coverage. Nearly 4,500 job losses in the health care sector and indirectly related industries could be expected.
Medicaid is a Vital Economic and Health Driver in West Virginia
Nearly one in three West Virginians receive health coverage through Medicaid. The program serves many of our state’s families directly and is the largest source of coverage for births, child health care, substance use treatment, and long-term care for West Virginians, benefiting residents across the state. Medicaid is vital to our state’s hospitals and providers, with research showing that Medicaid expansion has resulted in reduced uncompensated care, increases in hospital operating margins, and decreases in closures of hospitals and obstetrics units. Medicaid improves hospital finances by extending coverage to patients who would otherwise be uninsured and require hospital charity or uncompensated care.
According to WorkForce West Virginia, health care is the sector expected to see the most job growth in the state over the coming decade, in large part driven by federal Medicaid investments. A 2018 report from the WVU Bureau for Business and Economic Research estimated that a $29 million reduction in federal Medicaid dollars would cause a loss of 520 jobs annually. Extrapolating from that study, a $243 million annual reduction in federal Medicaid funding could cost West Virginia nearly 4,500 jobs annually.
Most Medicaid Recipients are Already Working, Caring for Family, or Attending School
A large majority of adult Medicaid beneficiaries who can work already do. According to a 2024 analysis, over 80 percent of working-age adults on Medicaid were working, acting as family caregivers, or attending school.
Bureaucratic Barriers to Medicaid, Including Work Reporting Requirements, Result in Pain and Coverage Loss for Eligible People
Proposals that require individuals to regularly document and report hours worked or in school cause eligible people to fall through the cracks. Arkansas, the only state to implement Medicaid work reporting requirements on Medicaid beneficiaries, saw one in four of those subjected to the reporting requirement lose health coverage within six months.
Researchers found that this loss of coverage was generally not because people were unable to comply with the work requirement, but that they found the reporting process itself—the bureaucratic red tape—to be confusing and difficult to comply with, or they were unaware of the requirements altogether.
Of those who lost their health coverage due to the work reporting requirements in Arkansas, half reported serious problems paying medical bills, 56 percent delayed addressing health care needs due to cost, and 64 percent delayed receiving needed medications.
Medicaid Work Reporting Requirements are Ineffective, Burdensome, and Harmful
People Will Fall Through the Cracks
Work Reporting Requirements Do Not Promote Work
County-level Impact Analysis
Below is a chart that estimates the county-level impacts of a federal-level Medicaid work reporting requirement.
Read Kelly’s full fact sheet.
Educators in West Virginia, like their peers across the country, are reporting challenges in fulfilling their mission due to increased student behavior issues.
In response to these growing concerns, lawmakers have considered highly punitive school discipline measures. Their concerns are valid — nearly 90 percent of public schools nationwide have reported negative impacts on students’ socioemotional development following the pandemic. At the same time, increased punitive and exclusionary discipline is not the appropriate response for either the short-term or lifetime well-being of children as young as five and six years old.
Student and child behavior is a highly complex issue that is influenced at multiple levels. Children come to school carrying a lot, particularly in West Virginia where more than 1 in 5 children have experienced at least two significant adverse experiences (including economic hardship, parent death, family violence or living with someone with a substance use disorder). A child’s physical, mental, and emotional health, their connections and interactions with peers, educators and school administrators, school district discipline practices, and state policies on school discipline all interact to produce student behavior. Lawmakers need to recognize the complexity of this issue when making policy decisions.
Recent school discipline policies that have been considered or enacted in our state promoted stricter responses to student misbehavior and increased discretion for teachers in disciplinary decisions. In addition to being harmful to student well-being, research shows that these sorts of policies do not address student misbehavior or improve school safety. Instead, they increase the chances of negative long-term outcomes for all students and contribute to inequities across student groups.
In our state, this was illustrated following implementation of 2023’s House Bill 2890 which provided increased discretion to sixth through 12th grade teachers in their response to student behavioral issues and classroom disruptions.
Data from last school year suggests that minor behavioral incidents increased among students while serious and repeated incidents were not significantly impacted. Several student groups including Black students, students with disabilities, students experiencing homelessness, and students in foster care were disproportionately impacted by discipline decisions. Notably, students with disabilities, while only about one-fifth of the overall student population, accounted for more than double that amount for most disciplinary responses last year including in-school and out-of-school suspensions, alternative education placements, detentions, expulsions and law enforcement involvements.
Rather than excluding students from the classroom or transferring them to alternative education placements, we must improve the capacity of traditional public schools to serve students. Doing so is critical, considering that nearly 90 percent of students in our state are served through the public school system.
While not an immediate solution, building capacity for student support is an approach that can ultimately prevent behavioral issues among students and strengthen our public schools.
Step 1: Increase staffing of student support personnel to meet students’ physical, mental and emotional needs such as nurses, social workers, counselors and psychologists. Many of our school districts are understaffed for these roles while numerous students face challenges including food insecurity, economic strain, homelessness, substance use and poor mental health. In November, lawmakers learned that the statewide ratio of social workers to students is 1:16,000, with entire school districts that lack a single social worker and others that have their professional support staff serving far more than the recommended 1:250 ratio.
Step 2: Increase staffing and retention of teachers, including special education teachers. This step can benefit students and improve experiences and outcomes for educators by addressing staffing shortages and causes of job strain and burnout. Modernizing the school aid formula to ensure districts can hire the appropriate level of professional support staff is a step state lawmakers should take right away to increase support for students and educators alike.
Lawmakers have already demonstrated a willingness to utilize funding to address education in our state through the Hope Scholarship. Rather than further weakening public schools through this program, lawmakers can instead commit these funds to our public school system. For less than half of the estimated cost to make the Hope Scholarship universal, we could achieve sufficient coverage of essential professional support personnel across school districts.
Students and educators alike deserve the opportunity to learn in a safe and supportive environment. The concerns of educators must be addressed to ensure that students and educators can coexist in a public school system that recognizes their value and is committed to their wellbeing and success. By choosing to invest in our public schools, lawmakers can reaffirm their commitment to the students and educators in our state.
Read Tamaya’s full op-ed.
If we want to understand what is happening in West Virginia jails and prisons, we must listen to the people inside them. The Division of Corrections and Rehabilitation (DCR) has taken a step in that direction.
In December 2024, the agency released a new policy that allows people behind bars to submit their grievances electronically. A grievance is a formal, written complaint made to DCR management about unfair treatment or some other wrong experienced behind bars.
Grievances can cover every aspect of a person’s life inside a facility: neglectful medical care; rotten or spoiled food; denial of hygiene supplies or menstrual products; broken toilets and showers; and more. Some grievances may report crimes like physical or sexual assault, or violations of the Americans with Disabilities Act or Prison Rape Elimination Act.
For years, DCR has required people to submit paper grievances directly to jail and prison employees in a complex process that can resemble a game of chutes and ladders. There are time limits, paper limits, and three levels of review before the grievance is considered complete. Along the way, a grievance can be rejected on technicalities because a person folded the form, used more than one staple, wrote on the back of a paper, or submitted a paper with marks or smudges.
The complexity of DCR’s grievance process is likely by design, thanks to a Clinton-era federal law intended to make it harder for incarcerated people to file and to win civil rights cases. The Prison Litigation Reform Act (PLRA) passed with overwhelming support in 1996, during the same period in which policymakers made deliberate decisions to increase the number of people behind bars.
The PLRA created multiple tripwires for incarcerated people attempting to litigate their civil rights in federal court: mandatory filing fees, regardless of poverty; compensation limits to deter lawyers from taking on civil rights cases; curbs on court oversight of jails or prisons; and more.
The most effective block has been the policy that allows civil rights lawsuits to be dismissed if the incarcerated person did not “exhaust” or complete the grievance process through the last level of review.
Notably, the rules and steps of the grievance process are created by the same jails and prisons that would be the target of any civil rights claims.
DCR gets to build the obstacle course incarcerated people must complete to file a civil rights claim against DCR. The more complicated the grievance process, the more likely people will not meet the PLRA’s exhaustion requirement.
Over the last two years, the WVCBP has had dozens of conversations with people behind bars, their loved ones, former jail staff, and people who provide legal or social services to those incarcerated. When asked about the grievance process, we heard a lot of the same things.
The spouse of a person in prison summed up the biggest barrier: fear of retaliation. “I think sometimes people are afraid to use it, because you get retaliated against. You get moved to another dorm, or you get your stuff searched.”
A person who spent three weeks in a regional jail recalled how a correctional officer threatened another jail resident with a discipline report if they filed a grievance.
Others we spoke to stressed the futility of filing paper grievances. One person told us, “I filed grievances, and nothing ever got done. I don’t think they even read it.” Several people believed paper grievances were simply thrown away by staff.
A recent federal case backed this up.
In October 2023, a federal magistrate issued an opinion in a class-action lawsuit against DCR regarding conditions at Southern Regional Jail. In unusually scathing language, the judge described how DCR had failed to preserve paper grievances made prior to pre-2022 despite internal policies that required preservation.
The state agreed to a $4 million settlement days later.
That case revealed how a vulnerable paper grievance system could obscure conditions in a jail where at least 27 people died over a three-year period.
For a system that controls the lives of roughly 10,000 people on any given day, electronic grievances are the obvious policy. And because every adult and child incarcerated in West Virginia is issued a tablet, it is also the easier policy.
One can expect that electronic grievances will be particularly useful regarding accountability in state jails. (Jails incarcerate people who are presumed innocent and awaiting trial, as well as those sentenced for misdemeanor convictions. By contrast, prisons incarcerate people convicted of felony offenses, which carry sentences longer than one year.)
Because of courts’ expansive use of money bail and pretrial detention, the regional jails house tens of thousands more people every year than the state’s prison system. In the past year, West Virginia’s 10 regional jails processed 35,887 admissions and 33,827 releases. The same year, the state’s 13 prison facilities admitted 2,539 people and released 2,884 people.
Jails and prisons have long been shielded from public view. The one legislative committee dedicated to jail oversight was scheduled to meet in December, but then cancelled its meeting.
You can help change this. If you know someone behind bars who is experiencing mistreatment or harmful conditions, encourage them to use the electronic grievance system. It only works if we work it. Our loved ones inside should file their grievances electronically, make sure to complete the entire process, and do so as soon as possible.
Read Sara’s full op-ed.
Join the WVCBP for our second annual Budget and Bites event!
This convening will be held at the WV School Service Personnel Association Convention Center on Wednesday, February 19, 2025. Tickets include appetizers and drinks, available from 4:00-6:30 pm. Please note, registration is required. You can find event registration here.
The program begins at 5:00 with opening remarks by Kelly Allen, WVCBP’s executive director. Following, senior policy analyst, Sean O’Leary, will give a brief analysis of the Governor’s 2026 budget. You’ll also hear from other members of the WVCBP team and coalition partners about the budget impact on West Virginians.
Stay to mix and mingle, get information about upcoming budget priorities, and learn more about the Center and our team. Come and stay or drop in for short conversation in a laid-back pub atmosphere.
To become an event sponsor, email event coordinator, Krysta Rexrode Wolfe, or fill out the sponsorship form here.
The Black Voter Impact Initiative and Black by God, the founders of West Virginia’s Black Policy Day, are excited to invite you to their webinar series focused on specific aspects of the Black Policy Agenda. This is an excellent opportunity to deepen your knowledge and engage with experts across various issue areas ahead of the 2025 West Virginia legislative session.
You can register for the webinar series here.
You can share what you would like to see prioritized in the Black Policy Agenda by filling out this survey.
Mark your calendars for Black Policy Day 2025, which will take place on March 10, 2025. You can become a Black Policy Day sponsor here. Please see the yellow flyer below for further details.
