Bill > HB4821

This bill establishes the Affordable Medicaid Buy-In Program, a new state-administered health insurance plan designed to offer West Virginia residents a high-quality, low-cost option by leveraging federal funds and the existing Medicaid structure. The program, to be developed and managed by the Department of Human Services, will provide comprehensive benefits including ambulatory services, emergency care, hospitalization, maternity care, mental health services, prescription drugs, and more, with coverage available to residents ineligible for Medicaid or Medicare, and who are not denied employer-sponsored coverage because of potential eligibility for this new plan. Premiums and cost-sharing, such as copayments (a fixed amount paid for a service) and deductibles (an amount paid before insurance coverage begins), will be determined by a sliding scale based on household income, with a focus on affordability for those below 200% of the federal poverty level, and provider reimbursement rates will generally align with Medicaid fee schedules. The bill also creates a Health Care Affordability and Access Improvement Fund, establishes an advisory council to guide the program's implementation and operation, and prohibits employers from dropping coverage for employees who might qualify for the Affordable Medicaid Buy-In Plan.

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=4821&year=2026&sessiontype=RS&btype=bill