West Virginia

In 2007 the West Virginia Bureau for Medical Services was awarded several CMS grants through the Medicaid Transformation Program. Work from these projects led to the creation of the West Virginia Health Improvement Institute. Since its incorporation as a nonprofit organization in 2009, the Institute has led several pilot programs on primary care transformation to medical homes and use of health information technology to facilitate health care improvement. The Institute is currently working with the State to develop a Section 2703 Health Homes Program, leading the Tri-state Children's Health Improvement Consortium (T-CHIC) and acting as the West Virginia Regional Health Information Technology Extension Center (WVRHITEC).

Legislated in April 2013, the West Virginia Public Employees Insurance Act called for the evaluation and administration of programs to improve quality, improve health status of members, develop innovative payment methodologies, manage health care delivery costs, evaluate effective benefit designs, evaluate cost sharing and benefit based programs, and adopt effective industry programs that can manage the long-term effectiveness and costs for the programs at the Public Employees Insurance Agency to include implementation and evaluation of medical homes. 

Primary Care Innovations and PCMH Activity

Dual Eligible 2703 SPA CPC CPC+ PCMH QHP PCMH Legislation Private Payer

Private Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Highmark Blue Cross Blue Shield West Virginia Commercial Statewide
Humana medical home program - Huntington Internal Medicine Commercial Huntington Humana Medical Home Program

State Legislation

Legislation Status Year
SB 641 Primary Care Support Program

This bill creates the Primary Care Support Program within the Bureau of Public Health within the Department of Health and Human Resources. The program will provide technical and organizational assistance to community-based primary care services. It will also create and administer a Primary Care Grant Fund to grant money to federally qualified health centers and federally qualified health center look-alikes, and secure federal medical assistance percentage funding. Federally qualified health center look-alikes already receiving grant funding at the time this program is created will continue to receive grant funding annually. Upon approval by the secretary of the department, federally qualified health centers in need of immediate financial assistance may be granted funding annually. All funds designated to federally qualified health centers may be transferred to Medicaid for the purpose of securing federal medical assistance percentage funding. Additionally, the secretary may use certain portions of funds within this account for activities in support of rural and primary care.


This bill also creates a special revenue fund in the State Treasury to be known as the Primary Care Support Fund into which all appropriations, payments, and interest to the fund created herein shall be deposited, to be held and disbursed according to law.

The Primary Care Support Program will conduct and make available upon request an annual primary care report which shall consist of total West Virginia Medicaid primary care expenditures as a percentage of total West Virginia Medicaid expenditures. 

Enacted 2019
West Virginia Public Employees Insurance Act

The Act called for the evaluation and administration of programs to improve quality, improve health status of members, develop innovative payment methodologies, manage health care delivery costs, evaluate effective benefit designs, evaluate cost sharing and benefit based programs, and adopt effective industry programs that can manage the long-term effectiveness and costs for the programs at the Public Employees Insurance Agency to include implementation and evaluation of medical homes.

Enacted 2013

State Facts:

Population:
1,832,500
Uninsured Population:
13%
Total Medicaid Spending FY 2013: 
$3.0 Billion 
Overweight/Obese Adults:
68.8%
Poor Mental Health among Adults: 
32.0%
Medicaid Expansion: 
Yes

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