H. B. 2128
(By Delegates Fleischauer, Leach, R.M. Thompson,
Warner, Poling and Boggs)
[Introduced January 13, 2003; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to amend chapter nine of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto two new articles, designated articles ten and eleven,
all relating to increasing senior citizens' access to
medicines; establishing medicaid outreach and enrollment
program and expanding medicaid eligibility for prescription
Be it enacted by the Legislature of West Virginia:
That chapter nine of the code of West Virginia, one thousand
nine hundred thirty-one, as amended, be amended by adding thereto
two new articles, designated articles ten and eleven, all to read
ARTICLE 10. MEDICAID OUTREACH AND ENROLLMENT FOR QUALIFYING
MEDICARE BENEFICIARIES PROGRAM.
§9-10-1. Medicaid outreach and enrollment program.
This article shall be known and may be cited as the "Medicaid
Outreach and Enrollment Program."
§9-10-2. Purpose and intent.
(a) The Legislature recognizes that:
(1) About three out of every ten medicare enrollees, or more
than two hundred seventy-four thousand medicare enrollees in West
Virginia have no coverage for pharmaceuticals;
(2) Nearly a quarter of this group lives below the federal
(3) Under the medicaid program, West Virginia provides
pharmaceutical coverage for qualifying individuals; and
(4) There are thousands of medicare beneficiaries in the state
who qualify for medicaid services, but are not enrolled and
(b) The Legislature intends that the medicare enrollees who
are eligible for medicaid services, but are not participating, be
identified by outreach initiatives implemented under a medicaid
outreach and enrollment program.
§9-10-3. Medicaid outreach and enrollment program created.
The West Virginia medicaid outreach and enrollment program is
hereby created to be administered by the secretary of health and
human resources. The secretary shall implement and administer the
program through the development of outreach initiatives to identify
medicaid-eligible medicare beneficiaries who are not participating in the medicaid program and to promote and encourage enrollment of
these eligibles in the medicaid program. Initiatives may include,
but are not limited to, mailings, advertisements, public service
announcements, literature dissemination and community outreach.
§9-10-4. Annual report required.
The secretary shall report annually to the Legislature's joint
committee on government and finance
beginning one year from the
implementation date of the medicaid outreach and enrollment
program. The report shall include:
(1) The baseline number of medicare beneficiaries who were
medicaid eligible at the beginning of the previous year;
(2) The number of medicaid-eligible medicare beneficiaries who
were targeted via the medicaid outreach and enrollment program;
(3) The number of medicaid-eligible medicare beneficiaries who
enrolled in medicaid in a given year and any information of
enrollment via the medicaid outreach and enrollment program;
(4) A description of the outreach initiatives used by the
medicaid outreach and enrollment program; and
(5) A detailed accounting of how funding was used.
ARTICLE 11. MEDICAID RX SENIOR ELIGIBILITY EXPANSION PROGRAM.
§9-11-1. Medicaid RX senior eligibility expansion program created;
how administered; duties and authority.
(a) The medicaid RX senior eligibility expansion program is
hereby created, to be administered by the secretary of health and human resources.
(b) The department of health and human resources shall apply
for a federal medicare 1115 demonstration waiver from the secretary
of the United States department of health and human services to
expand medicaid eligibility for the purposes of prescription drug
coverage to qualified medicare beneficiaries and specified
low-income medicare beneficiaries under the medicaid RX senior
eligibility expansion program.
(c) The department may propose rules for legislative approval
in accordance with the provisions of article three, chapter
twenty-nine-a of this code as are necessary to implement the
provisions in this article.
§9-11-2. Purpose and benefits of the program.
The Legislature recognizes that:
(1) Solutions are needed to improve the access of needy
seniors to prescription medicines;
(2) About three of ten medicare enrollees, or approximately
two hundred seventy-four thousand people in the state, have no
coverage for pharmaceuticals, and that a quarter of this group
lives below the federal poverty level;
(3) Thousands more elderly and disabled medicare enrollees are
under-insured for prescription drugs;
(4) A federal 1115 medicaid waiver to extend prescription drug
coverage to qualified medicare beneficiaries and special low-income medicare beneficiaries would provide meaningful access to
prescription drugs for the state's poor and near-poor senior
(5) A federal 1115 medicaid waiver enables the state to
benefit from the well-established state-federal partnership in
medicaid through access to federal matching funds in addition to
(a) For the purpose of this article:
(1) "Department" means the department of health and human
(2) "Qualified medicare beneficiaries" means medicare
beneficiaries with incomes equal to or below one hundred percent of
the federal poverty level who are eligible for medicaid assistance
for the Part-a or Part-b medicare premiums and for medicare
deductibles and coinsurance requirements as set forth in section
1905(p)(1) of Title XIX of the Social Security Act, codified at 42
U.S.C. 1396 et seq.
(3) "Specified low-income medicare beneficiaries" means
medicare beneficiaries who have incomes greater than one hundred
percent of the federal poverty level and less than or equal to one
hundred twenty percent of the federal poverty level and meet the
requirements set forth in section 1902(a)(10)(E)(iii) of Title XIX
of the Social Security Act.
(a) To be eligible for the program an individual must meet the
(1) Be a United States citizen or a lawfully admitted alien;
(2) Be a state resident;
(3) Be at least sixty-five years of age or an individual
between the ages of nineteen and sixty-four who is otherwise
eligible for benefits under Title II of the Social Security Act,
codified at 42 U.S.C. 401 et seq.;
(4) Meet the definition of a qualified medicare beneficiary or
a specified low-income medicare beneficiary; and
(5) Be ineligible for and/or not receiving a prescription drug
benefit through a medicare supplemental policy or any other third
party payer prescription benefit.
(b) Individuals eligible for the medicaid RX senior
eligibility expansion program shall be entitled to the medicaid
prescription drug coverage as provided to medicaid recipients as
set forth in Title XIX of the Social Security Act.
The purpose of this bill is to increase access to
medicines for needy seniors through programs to be administered by
the secretary of health and human resources to identify
medicaid-eligible medicare beneficiaries and to promote enrollment
of these eligible individuals in the medicaid program, and to
expand medicaid waiver benefits available to poor and near-poor
These articles are new; therefore, strike-throughs and
underscoring have been omitted.