Blog Posts > Smoothing the Transition: A Medicaid Buy-in Could Reduce Churn and Expand Health Insurance Coverage to Thousands of West Virginians
October 20, 2020

Smoothing the Transition: A Medicaid Buy-in Could Reduce Churn and Expand Health Insurance Coverage to Thousands of West Virginians


Despite major gains under the Affordable Care Act (ACA), too many low- and middle- income West Virginians still lack consistent affordable health care coverage options. West Virginia saw the largest drop in the uninsured rate in the country after implementation of the ACA and Medicaid expansion, going from 13.5 percent of the population uninsured in 2013 to 4.9 percent in 2016. Among non-elderly adults under 65, the uninsured rate went from 20.5 percent in 2013 to 7.5 percent in 2016. After a record low in 2016, the state’s uninsured rate has begun to climb back upward to 6.7 percent overall and 9.4 percent for non-elderly adults in 2019 and has likely increased due to the COVID-19 health and economic crisis. Read the full policy brief.

Progress toward the goal of ensuring that all West Virginians have health coverage has stalled for several reasons, including rising costs and lack of choice in the individual insurance market, as well as fluctuating incomes for residents causing them to experience cliff effects and churn with public benefits programs like Medicaid. Because of these challenges, several states are considering alternative coverage options for residents who are unable to access quality affordable health coverage. A worthwhile option for West Virginia policymakers to consider to address these challenges is a Medicaid buy-in program, which could address many of the barriers to coverage that uninsured people report facing.

A Medicaid buy-in is a state-initiated health insurance coverage product that allows people above current Medicaid eligibility levels to pay a monthly premium, possibly with state or federal subsidies to help cover the cost of the premiums, to receive health care coverage through Medicaid or a Medicaid-like plan built atop the state’s existing Medicaid infrastructure.

As states explore opportunities to control health costs, stabilize their insurance markets, and provide consumers with more robust health insurance options, a Medicaid buy-in is emerging as a potential solution in states across the country. Moreover, the 2020 pandemic has only made the need for a Medicaid buy-in more clear. Amid a widespread health and economic crisis stemming from COVID-19, ensuring that residents have health care is more important than ever. And as unemployment is expected to remain high while it takes years for the economy to recover, health coverage options not tied to one’s job become increasingly critical.

West Virginians and policymakers have an economic interest in seeing as many West Virginians as possible insured, as uninsured residents receive less preventive care and have poorer health outcomes, creating a fiscal burden both for families and for the health care system. Fortunately, our state can build upon the successes of the ACA’s public insurance supports and enact a Medicaid buy-in to move West Virginia forward on health coverage progress, improving health and well-being across our state.

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