Bill > HB5459

This bill modifies the existing tax on managed care organizations (MCOs), which are entities like health maintenance organizations (HMOs) that provide healthcare services in West Virginia. The primary change is to transition the tax structure from a tiered system based on the number of Medicaid and non-Medicaid member months to a flat rate of two and one-half percent of each certified HMO's gross premiums written in the state, effective July 1, 2026, and contingent on federal approval. Gross premiums are defined as the total amount received for providing or arranging healthcare services. This new tax structure will apply uniformly to all certified HMOs, regardless of their membership mix, and will not apply to Medicare Advantage plans, plans from the West Virginia Public Employees Insurance Agency, or plans under the Federal Employees Health Benefits Act to the extent federal law preempts such taxation. The bill also updates the definition of an MCO to simply mean a certified HMO operating in West Virginia, removing previous distinctions related to Medicaid contracts. The effective date of this new tax structure is dependent on receiving approval from the federal Centers for Medicare and Medicaid Services (CMS) that the tax is a permissible healthcare-related tax eligible for federal financial participation.

Budget and Finance

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=5459&year=2026&sessiontype=RS&btype=bill