Health Care Coverage in in West Virginia Sonia D. Chambers, Chair West Virginia Health Care Authorit

1
Health Care Coverage in in West VirginiaSonia
D. Chambers, ChairWest Virginia Health Care
AuthorityMelissa Kolb McCormickJohnna
BeaneWest Virginia University Institute for
Health Policy Research
2
Health Care Coverage By Payor (Public vs.
Private)
WV Healthcare Survey, 2001
3
Health Care Coverage by Payor
WV Healthcare Survey, 2001
4
West Virginians Covered by Public Programs
WV Healthcare Survey, 2001
5
Public HealthInsurance Coverage
6
Numbers of Individuals Covered by Each Public
Program
WV Healthcare Survey, 2001
7
Who has Medicaid?

• 7.5 of working-age (ages 19-64) West Virginians
  
• 26.3 of West Virginia children (ages 0-18)
• 15.1 of older (ages 65 ) West Virginians

WV Healthcare Survey, 2001
8
Medicaid CHIP Eligibility for Children
9
Medicaid Eligibility for Adults
After spend-down to 29 of FPL
10
Medicaid Managed Care

• Covered Lives 47,860
• Companies Writing Policies 2
• Health Plan of the Upper Ohio 64
• Carelink Health Plans Inc. 36

Accidents and Health Lines of Business Survey,
2001
11
Who has Medicare?

• 2.4 of non-elderly (ages 19-64) West Virginians
  
• 0.4 of West Virginia children (ages 0-18)
• 100 of older (ages 65) West Virginians

WV Healthcare Survey, 2001
12
Medicare Eligibility

• Over the age of 65
• Eligible for Supplemental Security Income (SSI)
  or Supplemental Security Disability Income (SSDI)

13
Who has public employer-based coverage?

• 19.9 of working-age (ages 19-64) West
  Virginians
• 53.7 of these adults are between the
• ages of 35 54
• 16.1 of West Virginia children (ages 0-18)

WV Healthcare Survey, 2001
14
Public Employees-Based Coverage

• Federal Employee Health Benefits Program (FEHBP)
• Public Employees Insurance Agency (PEIA)

15
Private Health Care Coverage
16
Who has private employer-based coverage?

• 43.3 of non-elderly (ages 19-64) West
  Virginians
• 56.2 of these adults are between the
• ages of 35 54
• 41.8 of West Virginia children (ages 0-18)

WV Healthcare Survey, 2001
17
Private Insurance by TypeMeasure in Covered Lives
Accidents and Health Lines of Business Survey,
2001
18
Individual Business by TypeMeasure in Covered
Lives
Accidents and Health Lines of Business Survey,
2001
19
Group Business Comprehensive Small
Employers(2-50 employees)

• New Policies Written 29,984
• Renewed Policies 33,526
• New Covered Lives 85,632
• Renewed Covered Lives 93,696
• Companies Writing New Policies 26
• Companies Writing Renewed Policies 31

Accidents and Health Lines of Business Survey,
2001
20
Group Business Comprehensive Small Employers
(2-50 employees)
Accidents and Health Lines of Business Survey,
2001
21
Group Business Comprehensive Large
Employers(51 employees)

• New Policies Written 57,280
• Renewed Policies 58,957
• New Covered Lives 221,348
• Renewed Covered Lives 228,712
• Companies Writing New Policies 31
• Companies Writing Renewed Policies 33

Accidents and Health Lines of Business Survey,
2001
22
Group Business Comprehensive Large Employers
(51 employees)
Accidents and Health Lines of Business Survey,
2001
23
Group Business Comprehensive Associations or
Trusts

• Policies Written 2,323
• Covered Lives 16,517
• Companies Writing Policies 27

Accidents and Health Lines of Business Survey,
2001
24
Group Business Comprehensive Associations or
Trusts
Accidents and Health Lines of Business Survey,
2001
25
Group Business Comprehensive - Discretionary

• Policies Written 245
• Covered Lives 10,168
• Companies Writing Policies 8

Accidents and Health Lines of Business Survey,
2001
26
Group Business Comprehensive - Discretionary
Accidents and Health Lines of Business Survey,
2001
27
Group Business Non-Comprehensive

• Policies Written 2,151
• Covered Lives 7,028
• Companies Writing Policies 29

Accidents and Health Lines of Business Survey,
2001
28
Group Business Non-Comprehensive
Accidents and Health Lines of Business Survey,
2001
29
Who has catastrophic coverage?

• 5.0 of working-age (ages 19-64) West Virginians
• 5.1 of West Virginia children (ages 0-18)
• 16.2 of older (ages 65) West Virginians

WV Healthcare Survey, 2001
30
Group Business Medicare Supplement (Medigap)

• Policies Written 2,173
• Covered Lives 33,773
• Companies Writing Policies 21

Accidents and Health Lines of Business Survey,
2001
31
Group Business Medicare Supplement (Medigap)
Accidents and Health Lines of Business Survey,
2001
32
Individual Comprehensive Policies

• New Policies Written 8,280
• Renewed Policies Written 8,516
• New Covered Lives 12,465
• Renewed Covered Lives 12,813
• Companies Writing New Policies 26
• Companies Writing Renewed Policies 38

Accidents and Health Lines of Business Survey,
2001
33
Individual Comprehensive Policies
Accidents and Health Lines of Business Survey,
2001
34
Individual Non-Comprehensive

• Policies Written 31,274
• Covered Lives 56,456
• Companies Writing Policies 74

Accidents and Health Lines of Business Survey,
2001
35
Individual Non-Comprehensive
Accidents and Health Lines of Business Survey,
2001
36
Individual Medicare Supplement (Medigap)

• Policies Written 37,470
• Covered Lives 38,585
• Companies Writing Policies 64

Accidents and Health Lines of Business Survey,
2001
37
Individual Medicare Supplement (Medigap)
Accidents and Health Lines of Business Survey,
2001
38
West Virginia Insurance Code Mandates for Health
Benefits

• The following minimum benefits must be provided
• in all policies
• Mammography Pap Smear testing
• Colorectal Cancer Examinations
• Following mastectomies, all stages of
  reconstruction must be covered
• All costs of childhood immunizations including
  cost of vaccines and administration

39
Mandates for Health Benefits - Continued

• Must cover diabetes equipment, medication,
  education medically necessary visits as a
  result of a diabetes diagnosis
• Coverage for Emergency Services
• Hospital benefits for Mothers Newborn
• if maternity benefits are offered, a minimum 48
  hr hospital stay is mandated
• No discrimination between Medical-Surgical
  benefits and Mental Health benefits

40
END