Most of WV Medicaid recipients aren’t aware that work requirements are coming, survey finds

Beginning next year, work requirements will be a condition of eligibility for more than 161,000 Medicaid recipients in West Virginia, and most state enrollees are not aware, a new survey found.

About 55% of West Virginia recipients surveyed were not aware of the new Medicaid work requirements. The same percent of Medicaid recipients nationally did not know about the work requirements. 

The Health Management Academy, a health system research organization based in Arlington, Virginia, did the survey of 1,974 Medicaid enrollees in April. Of the respondents, 38 were from West Virginia. 

Beginning Jan. 1, 2027, people aged 19 through 64 who are part of the Medicaid expansion population will have to work or train for 80 hours a month in order to qualify for the program. Expanded Medicaid includes those who qualify for the program because they make up to 138% of the federal poverty line, or about $45,540 for a family of four. 

Exceptions will be made for pregnant people, Native Americans, caregivers of children under 14 or disabled adults, and others.

The changes are part of the One Big Beautiful Bill Act, which President Donald Trump signed into law last summer. The federal legislation makes historic cuts to healthcare and food assistance. All four members of the state’s congressional delegation, all Republicans, voted in support of the bill. 

Sen. Shelley Moore Capito, R-West Virginia, has said the changes coming to Medicaid and to federal food assistance in the bill are necessary to eliminate “waste, fraud and abuse,” and to preserve the programs for those who deserve them. 

State officials have said they expect the state’s Medicaid enrollment to decline when the requirements are in place, but they have not said by how much. The state enlisted West Virginia University Health Affairs to help with project management and systems requirements for the work requirements, officials said. 

As of earlier this year, West Virginia’s Medicaid expansion population included 161,184 people. 

The poll also found that nationally, another 27% of respondents said they had heard something about the work requirements, but were unsure of the details. About 85% of those polled did not know that Medicaid eligibility determinations will be done twice a year beginning next year, the survey found. 

A study earlier this year found that in West Virginia, between 40,000 and 75,000 people will lose their healthcare because of the work requirements and more frequent eligibility checks. The actual number of those who lose coverage will depend on policies the state of West Virginia put in place, the study said. 

States are required to start outreach to Medicaid recipients to let them know of the program changes by June 30. 

A spokeswoman for the West Virginia Department of Human Services did not respond to questions for this story. 

Rhonda Rogombe, health and safety policy safety net analyst at the West Virginia Center on Budget and Policy, said she was not surprised but disappointed to hear that most West Virginia Medicaid recipients were not aware of the forthcoming work requirements. 

She said the state learned during Medicaid unwinding — when people were removed from the program as it returned to pre-pandemic eligibility requirements — that people can be difficult to reach. During that time, 75% of those people who lost coverage did so not because they were not eligible but because they didn’t complete necessary paperwork, she said. 

“That just goes to show that there’s a lot more that we, as advocates and others, can do to ensure that people stay connected to their coverage and understand what’s going on,” Rogombe said. 

Rogombe noted that the state has a new website that explains the changes that are coming to Medicaid. She said the state has also started sending postcards to affected families and will follow-up with detailed notices, as is required by federal law.

She said the Department of Human Services has been working with West Virginia University and with advocates on its plans for implementing the Medicaid changes. 

“All of these things have been, I think, really good for getting this off the ground,” Rogombe said. “But it’s only as good as its ability to reach the people it’s meant for. So, I think that that is like the next biggest challenge.”

Michele Goldman, executive director of the West Virginia Association of Free Clinics, said with the changes coming to Medicaid, member organizations have been gearing up to take on patients who no longer have health insurance. 

Goldman, a nurse who formerly ran a free clinic, said she’s most disturbed that people will deal with losing their healthcare coverage by rationing medications. People don’t understand that skipping dosages of blood thinners can lead to strokes and heart attacks, she said. 

“Our concern is hospitals are going to be overrun with patients, because that’s one where they’re going to go get care if there’s no place else (to go),” she said. “And two, because they’re going to be so sick, they’re going to need more specialty care. West Virginia — another issue we have, is there’s so many healthcare deserts because of just the geography of the state.”

The association represents four of the seven free and charitable clinics in the state of West Virginia. 

Goldman said free clinics in the state are considering expanding telehealth or opening satellite offices to fill in some of the gaps where there aren’t other healthcare providers.

Telehealth is one aspect of Gov. Patrick Morrisey’s plan for the Rural Health Transformation Program, a five-year federal program that has allocated $199 million to West Virginia for fiscal year 2026. 

“I think everybody’s going to try to do their best with what they can do with funding. It’s pretty competitive to get (Rural Health Transformation Program) funding,” she said. “I’m not sure that the free clinics will be able to get as much as we would like, so we’re actually looking at other ways of getting some funding to do telehealth too.”

“I think across the country it’s going to be difficult for people, especially because I don’t think people are really paying attention to what’s going on, and I think they’re going to be surprised when all of a sudden they don’t have their Medicaid coverage,” Goldman said.