Healthcare (Medicaid)

in committee · West Virginia · House of Delegates Feb 23, 2026

HB 5661: Increasing Medicaid dental provider reimbursement rates.

HB 5661 increases Medicaid dental provider reimbursement rates in West Virginia. It expands Medicaid coverage for diagnostic/preventative and restorative dental services (excluding cosmetic procedures) to adults aged 21+ with a $2,000 per two-year spending limit. The bill requires the Department of Human Services to raise dental provider payments by at least 20% by December 1, 2028, and mandates annual reports on dental program costs. This directly affects dental providers who treat Medicaid patients and adult Medicaid beneficiaries seeking dental care.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid dental coverage for adults 21+, increases provider reimbursement rates by 20% by 2028, and mandates annual reporting to improve access to care.95% confidence

Sub-Topics Medicaid

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in committee · West Virginia · House of Delegates Feb 5, 2026

HB 5266: Requiring West Virginia Medicaid managed care organizations to contract with any otherwise qualified provider

HB 5266 requires West Virginia Medicaid managed care organizations to contract with any qualified hospital, doctor, behavioral health provider, or other provider who meets all licensing, Medicaid enrollment, and credentialing requirements. It mandates that these providers must be offered the same reimbursement rates and contract terms as comparable providers already in the network. The bill applies directly to Medicaid managed care organizations and providers seeking to join their networks, ensuring they cannot exclude qualified providers based on arbitrary criteria. This would create a more open system for providers to participate in West Virginia's Medicaid program.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid MCOs to contract with qualified providers, ensuring equal reimbursement and expanding access to healthcare services for Medicaid patients.95% confidence

Sub-Topics Hospitals Medicaid Mental Health

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

HB 5568: Relating to the payment of services rendered in proceedings under Chapter 49

HB 5568 amends West Virginia law to clarify how payments are made for services provided to children in court cases under Chapter 49 (child welfare and family proceedings). It requires courts to order the agency with legal custody of a child to pay for professional services (such as therapy or counseling) at Medicaid rates, or at a higher rate if services aren’t provided within 30 days. The bill also covers "socially necessary services" provided by approved entities, with reimbursement rates set by the Department of Human Services. This ensures state funds are used efficiently by requiring a direct connection between the services and the legal case.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid-rate payments for child therapy/counseling in court cases, ensuring mental health service access and preventing delays in care for vulnerable youth.95% confidence

Sub-Topics Medicaid Tags Children

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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 · Senate Feb 19, 2026

SB 1014: Increasing Medicaid dental provider reimbursement rates

SB 1014 increases Medicaid dental reimbursement rates for providers in West Virginia to address rising costs, as noted in a 2024 state report showing current rates fail to cover service expenses. It expands dental coverage for adults 21+ to include diagnostic, preventative, and restorative services (excluding cosmetic procedures), with a $2,000 annual spending limit per beneficiary. The bill requires the state to implement a dental care system with quality oversight and submit annual cost reports to legislators starting in 2027. A 20% fee increase for dental services must be enacted by December 2028 to align with federal matching requirements.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid dental coverage for adults 21+ to include diagnostic/preventative services, increases reimbursement rates to address cost gaps, and mandates quality oversight, directly advancing access and funding for dental healthcare.95% confidence

Sub-Topics Medicaid

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in committee · West Virginia · Senate Feb 11, 2026

SB 921: Prohibiting Medicaid from being used for abortions or gender reassignment surgery

SB 921 prohibits West Virginia Medicaid from funding abortions (except as allowed under existing law) or gender transition procedures. It disqualifies healthcare providers performing these services from participating in Medicaid and bans Medicaid payments for referrals related to them. The bill defines "public funds" broadly to include state and federal healthcare funds and allows lawsuits by affected individuals or the Attorney General to enforce these restrictions. It directly affects Medicaid recipients seeking these services and healthcare providers who perform them.

Topics ✗ HealthcareOpposes HealthcareRestricts Medicaid coverage for abortions and gender transition procedures, limiting access to healthcare services under public health programs.95% confidence

Sub-Topics Medicaid

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signed · West Virginia · House of Delegates Jun 29, 2026

HB 5459: Relating to a tax on managed care organizations

HB 5459 imposes an annual tax on certified health maintenance organizations (HMOs) operating in West Virginia that provide Medicaid services. It establishes tiered tax rates based on Medicaid member months (with higher rates for larger volumes) and non-Medicaid member months, adjusting annually using West Virginia's Medicaid capitation rate changes. Starting July 1, 2027, the tax shifts to a flat 2.5% of each HMO's gross premiums in the state, applying uniformly regardless of membership type. The bill exempts Medicare Advantage plans and certain government health plans as specified in federal law.

Topics ✓ Budget & TaxesSupports Budget & TaxesImposes tax on HMOs to generate state revenue for Medicaid programs, directly increasing government funding under Budget & Taxes.95% confidence ✓ HealthcareSupports HealthcareTax on Medicaid-providing HMOs generates revenue tied to Medicaid capitation rates, potentially funding public health programs per bill's structure.90% confidence

Sub-Topics Medicaid Medicare

in committee · West Virginia · Senate Feb 19, 2026

SB 994: Relating to Medicaid reimbursement rates for certain mental health procedures

SB 994 requires West Virginia Medicaid to set reimbursement rates for outpatient mental health services at the same level as Medicare Part B rates. It directly affects mental health providers in licensed behavioral health centers who offer services like psychotherapy, medication management, and psychiatric evaluations for adults, children, and families. The bill mandates a state board to develop a proposal for these rate increases by July 1, 2026, ensuring Medicaid rates never fall below Medicare rates for identical services. This change aims to improve payment equity for mental health care providers participating in Medicaid.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid reimbursement rates for mental health services to match Medicare Part B rates, increasing provider payments and improving access to care.95% confidence

Sub-Topics Medicaid Medicare Mental Health

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signed · West Virginia · Senate Jun 25, 2026

SB 828: Supplemental Appropriation to Department of Human Services, fund 5090

SB 828 is a procedural bill that allocates unspent funds from the Department of Human Services' Medicaid State Share Fund (Fund 5090) for fiscal year 2026. It directs $174,483,090 already designated for "Medical Services" to cover ongoing Medicaid provider payments, using money remaining unappropriated after the fiscal year began. This bill does not create new policy or change eligibility - it simply ensures existing unspent Medicaid funds are used for medical services as intended. It directly affects Medicaid providers in West Virginia by securing payment for covered services.

Topics ✓ HealthcareSupports HealthcareDirects unspent Medicaid funds to cover ongoing medical provider payments, maintaining current healthcare funding without defunding services.92% confidence

Sub-Topics Medicaid

in committee · West Virginia · House of Delegates Mar 11, 2026

HB 5301: Supplemental Appropriation to the Department of Human Services- CHIP from the Unappropriated Balance.

HB 5301 increases funding for West Virginia's Children's Health Insurance Program (CHIP) by $871,991 using unused state funds. It specifically adds $422,562 for CHIP administrative costs and $449,429 for CHIP services under the Department of Human Services. This supplemental appropriation draws from the unappropriated balance in the State Fund, General Revenue, to cover existing program expenses during fiscal year 2026. The bill does not change CHIP eligibility or benefits but ensures current funding levels for administration and services.

Topics ✓ Budget & TaxesSupports Budget & TaxesIncreases CHIP funding via unappropriated balance, supporting public health program without tax changes or eligibility changes.95% confidence ✓ HealthcareSupports HealthcareIncreases CHIP funding by $871,991 for administrative and service costs, ensuring continued health coverage for children without eligibility changes.95% confidence

Sub-Topics Appropriations Revenue Children's Health Insurance Medicaid

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