WEST VIRGINIA CODE
WVC 5 - 16 B- 6 D
§5-16B-6d. Modified benefit plan implementation.
(a) Upon approval by the Centers for Medicare and Medicaid
Services, the board shall implement a benefit plan for uninsured
children of families with income between two hundred and three
hundred percent of the federal poverty level.
(b) The benefit plans offered pursuant to this section shall
include services determined to be appropriate for children, but may
vary from those currently offered by the board.
(c) The board shall structure the benefit plans for this
expansion to include premiums, coinsurance or copays and
deductibles. The board shall develop the cost sharing features in
such a manner as to keep the program fiscally stable without
creating a barrier to enrollment. Such features may include
different cost-sharing features within this group based upon the
percentage of the federal poverty level.
(d) Provider reimbursement schedules shall be no lower than
the reimbursement provided for the same services under the plans
offered in article sixteen of this chapter.
(e) All provisions of this article are applicable to this
expansion unless expressly addressed in this section.
(f) Nothing in this section may be construed to require any
appropriation of State General Revenue Funds for the payment of any
benefit provided pursuant to this section, except for the state
appropriation used to match the federal financial participation
funds. In the event that federal funds are no longer authorized for participation by individuals eligible at income levels above
two hundred percent, the board shall take immediate steps to
terminate the expansion provided for in this section and notify all
enrollees of such termination. In the event federal appropriations
decrease for the programs created pursuant to Title XXI of the
Social Security Act of 1997, the board is directed to make those
decreases in this expansion program before making changes to the
programs created for those children whose family income is less
than two hundred percent of the federal poverty level.
(g) The board is directed to report no less than quarterly to
the Legislative Oversight Commission on Health and Human Resources
Accountability on the development, implementation and progress of
the expansion authorized in this section.
Note: WV Code updated with legislation passed through the 2015 Regular Session
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