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W. Va.'s Medicaid expansion aided by key Obama administration adviser

West Virginia Gov. Earl Ray Tomblin's decision to open Medicaid to more low-income West Virginians was reached neither quickly nor easily, administration officials say.

"When we found out we had a choice, we started studying it," Tomblin Chief of Staff Rob Alsop said Friday.

The governor at first sought wiggle room. He quizzed HHS Secretary Kathleen Sebelius in July about whether West Virginia could expand Medicaid more gradually or only partly and still count on the hefty federal funding promised by the health care law. After a September follow-up inquiry by the governor, Sebelius shot down that option for West Virginia and other states in December.But by then, the Tomblin administration had already begun crunching the numbers surrounding the expansion question. The state Insurance Commission had hired CCRC Actuaries over the summer as it faced a series of complicated provisions and looming deadlines arising from the federal overhaul. The administration enlisted CCRC to study what West Virginia should expect — both for Medicaid and the state's health coverage landscape generally —if it expanded the program or rejected that call.

The analysis process proved lengthy and complex, Alsop said. The actuaries, for instance, needed detailed figures from the Department of Health and Human Resources, which runs Medicaid, to estimate the price tag for overseeing the expansion. While the overhaul pledges federal funds for the actual health care costs — the analysis concluded that West Virginia can expect $5 billion over the next 10 years — it would pay for only half of the administrative expenses.

In the months leading up to Tomblin's decision, Alsop fielded weekly inquiries and appeals from advocacy groups and organizations representing health care providers on the topic. These representatives appeared uniformly in favor of expansion, Alsop recalled. He said the West Virginia Hospital Association was particularly helpful by providing data. Several hospital executives appeared with Tomblin and U.S. Sen. Jay Rockefeller, D-W.Va., on Thursday to herald the Medicaid announcement.

"The issue of how close we were tied to the Obama administration was a huge issue in the election," Alsop said.

"There are certainly concerns about the cost and how we go about this," Alsop said. "Some of the points conservatives have raised need to be considered. On the flip side, the fact that several Republican governors have said that the scales tip in favor of expansion show that it's not a partisan political decision... We carefully weighed the pros and cons."
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