photo by: Steven Allen Adams

Dr. Kate Waldeck said that any changes made by Congress or the West Virginia Legislature to the federal Medicaid expansion program would harm the health care of approximately 170,000 West Virginians and have ripple effects on health care providers and rural hospitals.

CHARLESTON — A bill now on pause in the West Virginia House of Delegates could put the state between a rock and a hard place: deciding on what to do should the Trump administration reduce the state’s match for Medicaid expansion.

On one hand, doing nothing could blow a multi-million-dollar hole in the state’s general revenue budget and cause short-term issues with funding other needs within the Department of Human Services. On the other, passing a bill to end West Virginia’s Medicaid expansion program if the federal government reduces the state match could bump 170,000 people off their health insurance and create ripple effects within the state’s rural health care system.

The House Rules Committee moved House Bill 3518, relating to the Medicaid Waiver expansion program, from its special calendar to its inactive calendar, effectively pausing the bill which was set to be read a first time Monday and up for passage Wednesday by the Crossover Day deadline when House bills must be passed and sent on to the state Senate.

Last Thursday, the House Finance Committee recommended for passage House Bill 3518, relating to the Medicaid Waiver expansion program.

It was on first reading Monday and was on track for second reading/amendment stage Tuesday and passage today by the Crossover Day deadline when House bills must be passed and sent to the state Senate.

The goal of HB 3518 was to address a situation where the federal share of the Affordable Care Act’s expansion of Medicaid eligibility is reduced. The bill mandates that the Department of Human Services (DoHS) must disenroll and eliminate coverage for individuals who gained eligibility through Medicaid expansion if the federal match is reduced.

Speaking after the House Rules Committee meeting prior to the start of Monday’s floor session, House Deputy Speaker Matthew Rohrbach said lawmakers had received assurances from federal negotiators on the congressional budget resolution under consideration on Capitol Hill that the federal match would not be reduced.

“One of the congressional negotiators got a hold of me this weekend and assured me that just recently, the administration has decided to go a different direction because there has been a fire storm,” said Rohrbach, R-Cabell.

The Affordable Care Act, supported by former President Barack Obama and passed by Congress in 2010, allowed states to expand their Medicaid programs to adults under age 65 with income up to 138% of the federal poverty level, or $21,597 annual income. Former governor Earl Ray Tomblin announced in 2013 that West Virginia would participate in the Medicaid expansion program, which went into effect in 2014.

According to the Kaiser Family Foundation, 40 states and Washington, D.C., are in the Medicaid expansion program, with 10 states not participating. Under the program, the federal government provides a 90% match (FMAP), with the state covering the remaining 10%.

According to DoHS, there were 503,637 people enrolled in Medicaid in West Virginia as of January, or 29% of the state’s population – one in every four adults. West Virginia’s Medicaid program for fiscal year 2026 includes more than $4.2 billion in federal funding, with more than $649 million coming from appropriated special revenue, and more than $475 million from the general revenue budget. Total Medicaid funding for the next fiscal year is more than $5.4 billion.

However, Congress is considering cuts to Medicaid spending. The U.S. House of Representatives passed a budget resolution recently that targets up to $880 billion in Medicaid cuts. It has been unclear whether this would affect the Medicaid expansion program.

The Kaiser Family Foundation estimates that eliminating the FMAP for adult Medicaid expansion would reduce Medicaid spending in the U.S. by $1.9 trillion over a decade, or roughly one-fifth of Medicaid spending, with approximately 20 million people losing healthcare coverage under that scenario. In West Virginia, that could mean as many as 170,000 adults would lose their health care coverage.

In a statement sent Sunday, DoHS Communications specialist Angel Hightower said that they are monitoring for any potential changes that could come down from Congress or the U.S. Department of Human Services’ Centers for Medicare and Medicaid Services.

“At this time, there have been no confirmed changes that would impact the Medicaid expansion population,” Hightower said. “The Bureau of Medical Services remains in close communication with our federal partners at the Centers for Medicare & Medicaid Services (CMS), and we continue to monitor any developments closely. Should any changes be proposed or implemented, the agency will carefully assess the impacts and work collaboratively with state and federal stakeholders to determine appropriate next steps.”

Rohrbach said one of the things that was being considered at the federal level was reducing the Medicaid expansion FMAP to states from 90% to the state-level FMAP, which in West Virginia is 73.8%. If that would occur, that would blow a $160 million hole in the DoHS budget, either requiring mid-year budget cuts for DoHS or for the Legislature to come in and appropriate funds to compensate. Rohrbach said HB 3518 was meant to send a message to federal officials.

“The reason that we needed to make a statement to Washington is a deal was made in 2014 with all the states that if we go up from 100% to 138% of the poverty level and do the expanded Medicaid, then they would cover 90% of the costs,” Rohrbach said. “For the federal government to go to our state, it would almost triple our cost.”

Just as the House Rules Committee was preparing to meet Monday morning, opponents of HB 3518 rallied outside the House Chamber urging lawmakers to oppose the bill and urge Congress to not cut Medicaid funding.

“That would be devastating or catastrophic to our health care system in West Virginia, specifically our rural hospitals,” said Rich Sutphin, West Virginia Rural Health Association.

“House Bill 3518 will be devastating for our patients,” said Dr. Nicole Bryce, an obstetrician/gynecologist at the Charleston Area Medical Center. “It is so important that we maintain Medicaid in the state of West Virginia, that we are able to provide this care for these patients.”

“This is health care for hardworking people, and the loss of funding would have severe consequences,” said Dr. Kate Waldeck, the medical director at the Hoops Family Children’s Hospital at Cabell Huntington Hospital. “If we end expansion here in West Virginia, we can expect more deaths, more and longer expensive stays, and hospitals that go bankrupt and close.”

In a press conference Monday afternoon, the House Democratic caucus thanked opponents of the bill for making their voices heard over the weekend and urged the public to remain vigilant should HB 3518 come off the inactive calendar.

“I do want to thank all of you all for holding the line and standing strong to fight back against the atrocious health care roll back that we saw in our state government last week,” said House Minority Leader Sean Hornbuckle, D-Cabell. “It was a measure put forth by the supermajority of Republicans to make sure 166,000-plus West Virginians were kicked off of their health care.”

There are 12 states that have passed similar Medicaid expansion trigger laws: Virginia, New Hampshire, North Carolina, Indiana, Illinois, Iowa, Arkansas, Montana, New Mexico, Idaho, Utah, and Arizona. Rohrbach said this bipartisan effort by states under both Republican and Democratic control were what led to the assurances now being received that the federal government would leave the FMAP alone.

“I think we are all standing up in saying a deal was made in 2014. And part of the deal was that they were going to pay 90% and we were going to pay 10% percent,” Rohrbach said. “That is the unfair situation that the administration has put the state’s in that bind. I think that’s why states are looking at saying, wait a minute, we got to have the opportunity to rethink this whole situation if you guys jump out. But I have been assured this weekend that the message has been sent and the message has been delivered and received.”