40,000 WV Medicaid recipients not meeting work requirements, state estimates

About 40,000 Medicaid recipients in West Virginia are not meeting the new federal work requirements taking effect in January, meaning they could lose their health coverage next year, according to the latest estimate from the state Department of Human Services. 

The new work requirements take effect Jan. 1 under the One Big Beautiful Bill Act, or H.R. 1, which President Donald Trump signed into law last year. 

The new estimate is 7,000 more than an initial estimate from August, and represents the number of West Virginians on expanded Medicaid who have not been identified as meeting the work requirements and or qualifying for an exemption, Angel Hightower, a communications specialist for the Department of Human Services, wrote in an email to West Virginia Watch. 

“The original number of 33,000 was a preliminary estimate made prior to the release of additional federal guidance,” Hightower said. 

She added that the Department of Human Services is reviewing additional data to identify more people who qualify for exemptions, and expects to have updated estimates this month or in early December.

Under the new requirements, beginning Jan. 1, people aged 19 to 64 who are part of expanded Medicaid under the Affordable Care Act will be required to work, volunteer or train at least 80 hours per month in order to keep their healthcare coverage. About 160,000 West Virginians are on expanded Medicaid.

There are exemptions to the work requirements, including households that include someone who gets the Supplemental Nutrition Assistance Program, or SNAP, and already meet the work requirements for that program and those who are “medically frail,” among others.

Court blocks Trump administration’s narrow ‘medical frailty’ definition 

In June, the Trump administration issued an interim final rule that required that those who seek an exemption for medical frailty prove that their condition significantly limits their ability to comply with the work requirements. 

Late last month, a district court ruled that the Centers for Medicare & Medicaid had overstepped its authority with the narrow definition, according to KFF, a nonprofit health policy research, polling, and news organization. 

Based on the court ruling, people will now only need to show they have a condition that falls into one of the five medical frailty categories listed in the law to qualify for an exemption, KFF said. 

The categories include: those who are blind or disabled; people who have a physical, intellectual or developmental disability that limits their ability to perform one or more activities of daily living, those with a substance use disorder or a “disabling” mental disorder; and those with “serious or complex” medical conditions.

Hightower said the department has done an assessment and determined that its current policies are in line with the ruling.

Kelly Allen, director of West Virginia Center on Budget and Policy, said the Trump administration complicated the already difficult process of implementing the work requirements with rules that go beyond H.R. 1, putting more people at risk of losing coverage. 

“Thankfully a court has halted those rules, but that too adds to the chaos and challenges state Medicaid agencies face in implementation and that Medicaid enrollees face in understanding how to comply with new eligibility rules,” Allen said.

“We urge West Virginia to ask CMS for a good faith waiver to delay implementing terminations for work reporting noncompliance while they work to ensure the entire work reporting requirements eligibility apparatus is working properly as a whole,” she said.