Healthcare

in committee · West Virginia · House of Delegates Feb 16, 2026

HB 5483: Relating to financial assistance available for a prescription drug

HB 5483 requires health insurers and pharmacy benefits managers (PBMs) to include all cost-sharing payments (like copays or deductibles) made by patients or others when calculating a patient's total out-of-pocket costs for prescription drugs. It applies annual cost-sharing limits to all health plans sold in West Virginia and prohibits insurers or PBMs from altering coverage terms based on whether a patient has financial assistance for a drug. The bill directly affects patients using prescription drugs, insurers, PBMs, and third-party administrators, ensuring their coverage terms remain unchanged regardless of available drug financial help. Violations carry civil penalties up to $10,000 per incident, with restitution required for affected patients. The law takes effect for new plans on or after January 1, 2027.

Topics ✓ HealthcareSupports HealthcareRequires insurers/PBMs to include all cost-sharing in out-of-pocket calculations, sets annual limits, and prohibits coverage changes for patients with financial assistance - directly improving prescription drug access and protecting patient rights.95% confidence

Sub-Topics Prescription Drugs

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in committee · West Virginia · House of Delegates Feb 9, 2026

HB 5071: Creating the oral health and cancer rights act

HB 5071, the "Oral Health and Cancer Rights Act," requires all health insurance plans in West Virginia (including public employee, medical, and group plans) issued or renewed after January 1, 2026, to cover oral health procedures necessary as side effects of cancer treatments. These procedures include evaluations, medications, dental devices, and rehabilitation services needed to restore functions like eating, swallowing, or speaking affected by cancer therapies such as chemotherapy or radiation. The bill mandates that insurers cover these services as part of cancer treatment, directly affecting cancer patients and their insurance providers. One year after implementation, the Public Employees Insurance Agency and Bureau of Medical Services must report the cost of these coverage changes to the Joint Committee on Government and Finance.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for oral health procedures related to cancer treatment side effects, expanding patient access to necessary care under healthcare coverage requirements.95% confidence

Sub-Topics Insurance

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in committee · West Virginia · House of Delegates Feb 10, 2026

HB 5407: The purpose of this bill is to facilitate the participation of mental health providers in juvenile abuse and neglect cases.

HB 5407 requires West Virginia's child welfare department to share medical, dental, and mental health records of children in abuse/neglect cases with their school counselors within 30 days of placement. This directly affects the department, mental health providers, school counselors, and children involved in juvenile court cases. The key mechanism is a mandatory record-sharing process to improve collaboration among professionals supporting the child's well-being. The bill aims to streamline information flow without changing existing court procedures or standards of care. It is a procedural amendment to existing child welfare law, not a new substantive policy.

Topics ✓ HealthcareSupports HealthcareMandates mental health record-sharing for juvenile abuse cases, improving coordination between providers and school counselors to enhance mental health support access.85% confidence

Sub-Topics Mental Health

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in committee · West Virginia · House of Delegates Feb 3, 2026

HB 5109: Update the regulation of pharmacy benefit managers

HB 5109 updates West Virginia's regulations for pharmacy benefit managers (PBMs) by clarifying key definitions and duties in the Pharmacy Audit Integrity Act. The bill directly affects pharmacies, PBMs, health benefit plans, and patients by standardizing terms like "pharmacy benefits management" (which includes claims processing, network management, and rebate administration) and defining "affiliate" relationships to prevent conflicts of interest. Key mechanisms include requiring clear disclosure of how PBMs determine reimbursement rates (like "maximum allowable cost") and restricting certain ownership ties between PBMs and pharmacies. The changes aim to increase transparency in prescription drug pricing and billing practices without altering coverage rules. This is a definitional update, not a new benefit or funding measure.

Topics ✓ HealthcareSupports HealthcareClarifies PBM regulations to prevent conflicts of interest and standardize terms, enhancing transparency in pharmacy benefit management affecting patient access and insurance coverage.85% confidence

Sub-Topics Prescription Drugs

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in committee · West Virginia · House of Delegates Feb 4, 2026

HB 5184: Prohibiting expanding drug and alcohol treatment facilities and services in certain counties

HB 5184 would prohibit adding new licensed substance abuse treatment beds in any West Virginia county that already has more than 250 such beds. This directly affects counties meeting that bed threshold by restricting the expansion of drug and alcohol treatment facilities. The bill amends existing law to specifically bar new bed additions in these high-capacity counties, while exempting certain approved clinical trials for opioid treatment programs. It does not change rules for counties with fewer than 250 beds or affect existing facilities. The change creates a clear threshold limiting new treatment capacity in areas already serving high demand.

Topics ✗ HealthcareOpposes HealthcareRestricts new substance abuse treatment beds in high-capacity counties, limiting access to mental health services per bill's prohibition on expansion.95% confidence

Sub-Topics Mental Health Substance Abuse

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in committee · West Virginia · House of Delegates Feb 3, 2026

HJR 36: Relating to Reproductive Healthcare Freedom

HJR 36 is a constitutional amendment proposal (not a regular bill) that would add a new section to West Virginia's Constitution guaranteeing reproductive rights. It states that every individual has the right to make decisions about contraception, fertility treatment, pregnancy, miscarriage care, and abortion, with the state prohibited from interfering unless using the least restrictive means for health. The amendment allows abortion restrictions after fetal viability (when a fetus can survive outside the womb with medical care) only if a physician determines it's necessary to protect the patient's life or health. This proposal requires voter approval in the 2026 general election to become part of the state constitution.

Topics ✓ HealthcareSupports HealthcareGuarantees reproductive rights including abortion access, protecting patient autonomy in healthcare decisions per constitutional amendment.95% confidence

Sub-Topics Women's Health

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in committee · West Virginia · House of Delegates Feb 2, 2026

HB 5054: Relating to requiring the counties particpating in the QMHP Pilot Program to have at least one qualified mental health professional in each public school in that county.

HB 5054 requires counties participating in West Virginia's QMHP Pilot Program to ensure every public school in the county has at least one qualified mental health professional (QMHP). A QMHP is defined as a registered mental health professional (including school counselors, who are automatically classified as QMHPs under the bill) who collaborates with schools but does not practice independently. This mandate applies only to schools in counties that join the pilot program, aiming to guarantee student access to mental health support. The bill does not alter existing school counselor duties but formalizes their role in meeting the QMHP requirement.

Topics ✓ EducationSupports EducationMandates mental health staffing in public schools to enhance student support services, aligning with educational access and student program enhancement indicators.92% confidence ✓ HealthcareSupports HealthcareMandates mental health professionals in public schools for QMHP Pilot Program, directly advancing mental health services under healthcare policy.95% confidence

Sub-Topics Student Health Healthcare Workforce Mental Health

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in committee · West Virginia · House of Delegates Feb 16, 2026

HB 5573: Rural Medical Residency Program concentrating on obstetrics and gynecology for rural hospitals, can be funded from the Rural Health Inititive or other sources funded by the legislature.

HB 5573 creates a new Rural Medical Residency Program focused specifically on obstetrics and gynecology (OB/GYN) for rural hospitals in West Virginia. The bill directs the Rural Health Initiative to fund this program using existing Rural Health Initiative resources or other legislative appropriations. It prioritizes OB/GYN care - a critical need in rural "health care deserts" where access is limited - as part of the state’s strategy to address shortages of primary care physicians. The program will operate within rural hospitals and align with the Rural Health Initiative Act’s goals to improve health care accessibility in underserved areas.

Topics ✓ HealthcareSupports HealthcareCreates funded OB/GYN residency program for rural hospitals, directly improving access in healthcare deserts with limited services.95% confidence

Sub-Topics Primary Care Women's Health

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in committee · West Virginia · Senate Feb 3, 2026

SB 729: Setting forth mandatory Medicaid program requirements

This bill establishes mandatory Medicaid program requirements for West Virginia, directly affecting Medicaid enrollees including adults, children, and individuals receiving coverage under the Children’s Health Insurance Program. Key provisions include implementing a work requirement by January 1, 2027; prohibiting Medicaid use by undocumented residents starting October 1, 2026; requiring biannual eligibility verification; ending multi-state enrollment; removing deceased members quarterly; reducing error rates to 3% by 2028; and limiting retroactive eligibility to 30-60 days. The bill aligns West Virginia’s Medicaid program with federal requirements under the One Big Beautiful Bill Act (OBBBA), mandating the Bureau for Medical Services to seek necessary federal authority to implement these changes. It also requires Medicaid waivers to be budget neutral and amends specific taxes related to managed care and providers.

Topics ✗ HealthcareOpposes HealthcareImposes work requirements, bans undocumented residents from Medicaid, and restricts eligibility - clearly limits coverage access and reduces program participation.95% confidence ✗ ImmigrationOpposes ImmigrationProhibits Medicaid access for undocumented residents starting Oct 2026, directly restricting immigrant access to state health services.95% confidence

Sub-Topics Insurance Medicaid

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in committee · West Virginia · House of Delegates Feb 16, 2026

HB 5547: To Protect Newborn Genetic Privacy Rights

HB 5547 requires healthcare providers to obtain specific written consent from parents before conducting newborn genetic screening, which cannot be fulfilled by general consent forms signed at hospital admission. It limits blood collection to only what's necessary for screening and mandates destruction of blood samples after three weeks unless parents give additional written consent for retention. The bill also prohibits using newborn blood samples for research, law enforcement, or other purposes without separate consent from parents or the adult who was a minor when the sample was taken. Healthcare facilities must provide written information about screening options and the right to opt out during pregnancy.

Topics ✓ HealthcareSupports HealthcareRequires specific parental consent for genetic screening, prohibits sample misuse, and protects patient privacy rights in newborn healthcare services.95% confidence ✓ TechnologySupports TechnologyRequires parental consent for genetic data use, mandates sample destruction, prohibits non-consensual research - directly protects genetic data privacy under technology policy framework.95% confidence

Sub-Topics Hospitals

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