Creating the Affordable Medicaid Buy-in Program

HB 5122 creates a new West Virginia Medicaid Buy-In Program to provide affordable health coverage to residents who earn too much for Medicaid but too little for private insurance, specifically those ineligible for both Medicaid and Medicare whose employers haven’t denied their group coverage. The program, administered by the Department of Human Services starting January 2027, offers income-based premiums (with priority for those transitioning from Medicaid) and covers essential services like emergency care, prescriptions, mental health treatment, and pediatric services. It requires reimbursement rates to align with Medicaid standards and mandates efforts to maximize federal funding through existing Medicaid options and waivers. The bill ensures non-discrimination in access and aims to maintain coverage continuity between the new program, Medicaid, and private plans.