CHARLESTON - West Virginia has already boomed past the extra 93,000 people the state expected to enroll by 2020 under a Medicaid expansion plan ushered in by Gov. Earl Ray Tomblin in 2013.

More than 164,400 people are now receiving insurance from the widely used expansion. But that won't necessarily mean the state will be footing more of the bill than it first expected.

More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years. At least seven of the states have increased their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states.

Even though enrollment in West Virginia exceeded projections, actual costs are expected to meet the estimates due to lower per-person costs, said Jeremiah Samples, deputy secretary of the state's Department of Health and Human Resources. An update on anticipated 2017 state costs is still in the works.

Thirty states and the District of Columbia expanded Medicaid to include all non-disabled adults with incomes at or below 138 percent of the federal poverty level, currently $16,243 for an individual. The federal government agreed to pay all costs for the new enrollees through 2016, but it will begin lowering its share in 2017. States will pay 10 percent of the costs by 2020.

Supporters of the expansion downplay any budget concerns, predicting their states will save money in the long run because Medicaid will allow some state-run services to be eliminated and will stimulate the economy through new revenues and job creation.

Here is a look at some details of West Virginia's Medicaid expansion:

Medicaid enrollment

n 78,500: People initially projected to enroll by the 2015 fiscal year under West Virginia's Medicaid expansion.

n 159,000: West Virginians enrolled in Medicaid expansion, 2015 fiscal year.

n 164,461: West Virginians enrolled in Medicaid expansion, as of late June.

n 93,000: Initial projection for enrollment under the expansion by fiscal year 2020.

n Currently recalculating: Updated estimate for Medicaid expansion enrollees for 2020.

n 534,495: West Virginians on Medicaid and CHIP, as of April.

n 179,951: average number of West Virginians on Medicaid and CHIP, July-September 2013.

State impact of expansion

n $18.5 million: Original project cost to state of Medicaid expansion in fiscal year 2017.

n Under revision; but meeting projections: Update on expected amount of state cost in fiscal year 2017.

Changes to expansion

West Virginia has made several changes to Medicaid due to budgeting concerns, including: transitioning to a non-emergency medical transportation capitation model; eliminating those transportation services for the expansion population; health home care management; placing dental, prescription, behavioral health and the expansion population itself into managed care; recalculating payment and medical loss ratio models for managed care; adding copays for traditional and expansion populations; modifying non-medical benefits for the intellectually disabled population; and changing eligibility for the Medicaid Work Incentive Network, and Transitional Medicaid and Breast and Cervical Cancer programs.


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