Bush Administration Approves West Virginia Plan for Medicaid 'Personal Responsibility Contracts'

The Bush administration on Wednesday approved a Medicaid proposal by West Virginia that will issue "credits" for health care services to beneficiaries who meet certain treatment goals and will restrict access to services for beneficiaries who do not meet the goals, the Charleston Gazette reports. Under the plan, beneficiaries will be required to choose a "medical home" that will serve as their primary care provider, and they must work with the provider and their managed care plan to develop a "personal responsibility contract." The contract will include steps a beneficiary will take to improve his or her health, such as taking prescribed medications, attending physician appointments or exercising. Beneficiaries will have to sign the contract, with parents or guardians signing for dependent children. Those who follow the contract will receive credits in a "healthy rewards account," which they can use toward optional health care services. Beneficiaries who do not sign a contract or do not meet its goals within one year will have their benefits reduced, including possible reductions in coverage for diabetes treatment, cardiac rehabilitation, mental health care, dental care and substance use treatment, according to the Gazette. Beneficiaries who do not follow the contract also could face caps on the number of prescriptions that would be covered or other benefits. The new program will apply to about 160,000 children and adults without disabilities, or about half of the state's Medicaid population. Shannon Riley, spokesperson for the state Bureau of Medical Services, said, "We will follow the federal law and children will receive the services to which they are entitled." Riley said only children who meet the terms of their contracts will be eligible for the credits program. Gov. Joe Manchin (D) said, "I'm asking people to partner with us, take care of themselves, and we'll reward them if they do." He added, "We need desperately to get this program under control and better utilize our limited dollars" (Finn, Charleston Gazette, 5/5).

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