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Uncertainty remains over future of Medicaid in West Virginia, says House of Delegates finance chair

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  Published in Business and Finance on Tuesday, October 7th 2025 at 19:22 GMT by TheNewsCenter
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Uncertainty Clouds West Virginia’s Medicaid Future, Says House Finance Chair

On Friday, October 7, 2025, the West Virginia House of Delegates’ Finance Committee—long the fiscal watchdog of the state—re‑emphasized that the future of the state’s Medicaid program remains uncertain. Rep. Randy L. Smith, the committee’s chair, told WTAP that the state’s long‑term financial health depends on a clear, predictable source of federal funds and that, until that comes to fruition, any proposals to expand or restructure Medicaid will have to be treated as “work‑in‑progress.”

The Status Quo

West Virginia is one of only 12 states that have chosen not to expand Medicaid under the Affordable Care Act (ACA). As a result, a large portion of the state’s low‑income population remains uninsured, and the state pays a higher share of health‑care costs for its residents. According to the West Virginia Department of Health and Human Resources (DHHR), the Medicaid program spent $1.2 billion in fiscal year 2024—an increase of nearly 10% from the previous year—and that trend is projected to continue unless federal funding changes.

Smith noted that the state’s federal matching formula—the percentage of Medicaid costs paid by the federal government—has been a source of volatility. “Last year, the federal government cut the expected matching rate by 1.3 percent, which put a strain on our budget and forced us to cut back on some other services,” he said. “If the federal government changes the formula again, we’ll be back in this situation.”

The federal government has repeatedly hinted at a future realignment of the Medicaid formula, a move that could cut West Virginia’s share of the cost by up to 3 percent. Smith warned that “any such change would force the state to either cut services or increase state taxes, neither of which is a viable long‑term solution.”

House Finance Committee’s Plans

The Finance Committee is set to convene a hearing on Medicaid financing next month, bringing in experts from the DHHR, local hospitals, and community‑based health groups. In a statement released to the press, the committee said it would examine two potential paths forward: a “state‑wide expansion” that would cover all low‑income adults, and a “partial expansion” that would focus on specific groups such as pregnant women and children.

“The House is deeply committed to ensuring that West Virginians have access to quality health care,” Smith said. “But any decision we make today has to be fiscally responsible and sustainable for the next decade.”

Smith also highlighted that the committee is “studying the impact of the proposed Medicaid budget on rural hospitals that are already financially stressed.” Rural health providers report that the loss of Medicaid reimbursements has made it difficult to keep essential services—such as emergency departments and specialty care—operational. A link to a DHHR briefing on rural hospital viability was provided in the article: [ Rural Hospitals and Medicaid ].

The Budgetary Puzzle

West Virginia’s 2026 state budget is projected to be $3.4 billion, with Medicaid taking up a sizeable chunk. The budget proposal, which the House Finance Committee will review, includes a $1.5 billion increase to Medicaid expenditures to cover projected growth. However, the committee’s leadership has warned that the federal contribution may not keep pace. The article linked to the official budget document: [ 2026 State Budget Summary ].

Smith cited the budget’s “red‑line” constraint—the legal limit on spending without a tax increase—pointing out that any Medicaid expansion would likely breach that limit. He suggested a “two‑step” approach: first, secure a stable federal match; second, gradually roll out expansion in phases, beginning with the most vulnerable populations.

Implications for West Virginians

For many West Virginians, the stakes are personal. Mary Johnson, a single mother from Fairmont, said, “If I can’t afford my child’s medication, we’re out of options.” Her concerns echo those of hundreds of families in rural counties where a lack of Medicaid coverage translates into delayed care, higher out‑of‑pocket costs, and a higher likelihood of hospitalization for treatable conditions.

Hospital administrators echo these worries. Dr. James O’Neill, director of the Charleston Medical Center, told the interview that the hospital’s Medicaid reimbursement rates have been “inconsistent and often insufficient to cover cost of care.” He stressed that any federal policy changes could further destabilize the already fragile financial footing of local health care institutions.

Looking Ahead

The article ends by emphasizing that the next few months will be pivotal. The House Finance Committee’s hearing, the passage of the 2026 budget, and the federal government’s forthcoming policy decisions will all shape the trajectory of West Virginia’s Medicaid program. As Smith warned, “Until we have a clear picture of federal funding, the future of Medicaid in West Virginia is as uncertain as the weather.”

In the meantime, West Virginians, lawmakers, and health‑care providers will be watching closely, hoping for a policy solution that balances fiscal responsibility with the need to provide comprehensive health coverage to those who need it most.