Healthcare (Insurance)

in committee · West Virginia · Senate Feb 20, 2026

SB 1019: Requiring coverage for medically necessary treatment for cleft lip and cleft palate

Senate Bill 1019 requires health insurance plans in West Virginia to cover medically necessary treatment for cleft lip and cleft palate. This applies directly to individuals with these congenital conditions, particularly children, who rely on insurance for surgical and medical care. The bill mandates coverage for all necessary treatments without excluding specific procedures, ensuring plans cover the full range of care deemed medically appropriate by a physician. It sets eligibility and defines coverage terms but does not specify cost-sharing details or financial limits.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for medically necessary cleft lip/palate treatment, expanding access and removing exclusions for a specific health condition.95% confidence

Sub-Topics Insurance

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in committee · West Virginia · House of Delegates Feb 3, 2026

HB 5122: 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.

Topics ✓ HealthcareSupports HealthcareCreates Medicaid Buy-In program to expand health coverage for income-eligible residents excluded from current Medicaid/private insurance, directly advancing healthcare access.95% confidence

Sub-Topics Insurance Medicaid Mental Health

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

HB 5433: Require all state‑regulated health insurance plans to provide meaningful coverage for hearing aids and to cover at least one annual audiological evaluation.

HB 5433 requires all state-regulated health insurance plans to cover hearing aids and annual audiological evaluations for insured individuals with hearing impairment. The bill mandates coverage for initial and replacement hearing aids (every 36 months), necessary adjustments, and at least one yearly hearing evaluation. It limits coverage to $1,400 per hearing-impaired ear every 36 months for standard hearing aids, while allowing individuals to pay extra for more expensive options without penalties. The law applies to policies issued or renewed after January 1, 2026, and excludes batteries and cords from coverage.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for hearing aids and annual evaluations, expanding access to essential hearing healthcare services for insured individuals.95% confidence

Sub-Topics Insurance

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

HB 5242: State Living Donor Protection Act

HB 5242, the State Living Donor Protection Act, prohibits West Virginia insurers from denying or limiting life insurance, major medical coverage, disability insurance, or long-term care insurance based solely on a person's status as a living organ donor. It directly affects living organ donors who might otherwise face coverage denials, premium increases, or policy cancellations due to their donation status. The bill bans insurers from refusing coverage, requiring donors to forgo organ donation as a condition of coverage, or discriminating in policy terms solely because of donation status. These protections apply to all insurers offering such policies in West Virginia, ensuring donors are not penalized for their life-saving actions.

Topics ✓ HealthcareSupports HealthcareProhibits insurers from denying/limiting coverage based on living donation status, directly protecting donor access to health insurance and aligning with patient rights protection in healthcare.95% confidence

Sub-Topics Insurance Long-Term Care

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

HB 5238: Screening for adverse childhood experiences

House Bill 5238 requires all health insurance plans in West Virginia (both public and private) to cover screening for adverse childhood experiences during routine preventative child wellness visits. For children without health insurance, the State Department of Education must create school-based screening programs through local schools. The bill defines adverse childhood experiences as traumatic events in childhood that increase the risk of chronic health conditions like obesity, heart disease, and respiratory illness. This law directly affects health insurance providers and school systems by mandating accessible screenings to address early childhood trauma.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for ACE screening and creates school-based programs for uninsured children, expanding preventive healthcare access and addressing chronic health risks linked to childhood trauma.95% confidence

Sub-Topics Insurance Tags Children

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in committee · West Virginia · House of Delegates Feb 3, 2026

HB 5153: To provide for the coordination of programs to prevent and treat obesity

This bill requires health insurance plans in West Virginia to cover GLP-1 class medications when a patient has a valid prescription. It directly affects patients prescribed these medications (used for conditions like obesity and type 2 diabetes) and insurance companies providing coverage. The key provision mandates that insurers must cover these medications without additional restrictions beyond a valid prescription. This policy change aims to improve access to a specific medication class by guaranteeing insurance coverage.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for GLP-1 medications without restrictions, improving patient access to obesity/diabetes treatment per bill summary.95% confidence

Sub-Topics Insurance

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

HB 5241: Relating to insurance coverage for breast cancer screening

HB 5241 requires health insurers in West Virginia to cover specific breast cancer screenings starting January 1, 2026. It mandates annual mammograms for women aged 40+ and baseline mammograms for women 30-39, with additional annual screenings for those under 40 who have family history or risk factors. The bill also requires insurers to cover comprehensive ultrasound screenings when mammograms show dense breast tissue (per American College of Radiology guidelines) or for high-risk patients. Additionally, it mandates that mammography facilities notify patients about breast density and associated risks, providing educational materials without creating new legal obligations for providers.

Topics ✓ HealthcareSupports HealthcareMandates insurers to cover specific breast cancer screenings, including high-risk cases and dense breast tissue ultrasounds, expanding preventive care access per medical guidelines.95% confidence

Sub-Topics Insurance

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in committee · West Virginia · House of Delegates Feb 13, 2026

HB 5379: To require payment by insurers directly to the out-of-network emergency medical services agency and the prompt payment of clean claims.

HB 5379 requires health insurers in West Virginia to pay out-of-network emergency medical services agencies (like ambulances) directly for covered ground ambulance services, rather than reimbursing patients. Insurers must pay "clean claims" (properly submitted claims without errors) within 30 days of receipt, with exceptions for fraud, coordination with other insurers, or prior payment. The bill also mandates that insurers provide written notice within 30 days if denying a claim, specifying the reason or needed additional information. This directly affects ambulance providers who previously relied on patient reimbursement and insurers who must adjust payment processes. The law aims to streamline payment for emergency services while reducing patient financial burden.

Topics ✓ HealthcareSupports HealthcareRequires insurers to pay emergency providers directly and within 30 days, reducing patient financial burden and improving access to emergency care.95% confidence

Sub-Topics Insurance

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in committee · West Virginia · House of Delegates Feb 9, 2026

HB 5071: Creating the oral health and cancer rights act

HB 5071, the "Oral Health and Cancer Rights Act," requires all health insurance plans in West Virginia (including public employee, medical, and group plans) issued or renewed after January 1, 2026, to cover oral health procedures necessary as side effects of cancer treatments. These procedures include evaluations, medications, dental devices, and rehabilitation services needed to restore functions like eating, swallowing, or speaking affected by cancer therapies such as chemotherapy or radiation. The bill mandates that insurers cover these services as part of cancer treatment, directly affecting cancer patients and their insurance providers. One year after implementation, the Public Employees Insurance Agency and Bureau of Medical Services must report the cost of these coverage changes to the Joint Committee on Government and Finance.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for oral health procedures related to cancer treatment side effects, expanding patient access to necessary care under healthcare coverage requirements.95% confidence

Sub-Topics Insurance

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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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