West Virginia Code 9-4D-8 – Analytical criteria and reporting requirements
(a) The secretary shall establish criteria to determine the effectiveness of the Medicaid buy-in program and continued Medicaid coverage through Section 1619 of the federal Social Security Act (42 U.S.C. § 1382h). The criteria shall include an analysis of the following:
Terms Used In West Virginia Code 9-4D-8
- Assistance: means the three classes of assistance, namely: Federal-state assistance, federal assistance and state assistance. See West Virginia Code 9-1-2
- Department: means the Department of Health and Human Resources. See West Virginia Code 9-4D-2
- Dependent: A person dependent for support upon another.
- Disability: means a medically determinable physical or mental condition that:
(A) Can be expected to result in death or has lasted, or can be expected to last, for a continuous period of not less than twelve months. See West Virginia Code 9-4D-2
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
- Income: means money earned from employment wages or self-employment earnings and unearned money received from any other source. See West Virginia Code 9-4D-2
- Secretary: means the secretary of the Department of Health and Human Resources: Provided, That beginning January 1, 2024, "secretary" means the secretary of the Department of Human Services. See West Virginia Code 9-1-2
- Services: means nursing facility services, home and community-based services, and related hospital and prescription drug services for which an individual received Medicaid medical assistance. See West Virginia Code 9-1-2
- State: when applied to a part of the United States and not restricted by the context, includes the District of Columbia and the several territories, and the words "United States" also include the said district and territories. See West Virginia Code 2-2-10
(1) The number of individuals with disabilities who are:
(A) Enrolled in the buy-in program; or
(B) Receiving Medicaid through Section 1619 of the federal Social Security Act (42 U.S.C. § 1382h);
(2) The amount of state revenues resulting from premiums paid by participants in the buy-in program; and
(3) The amount of state costs incurred as a result of implementing the buy-in program, including administrative costs and costs of providing services.
(b) In addition to the criteria required under subsection (b) of this section, the secretary may establish criteria to determine the following:
(1) Comparative costs of Medicaid funded services for participants in the buy-in program and work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. § 1382h) before and after employment;
(2) The number of supplemental security income and social security disability insurance recipients in West Virginia who are no longer dependent on, or who have reduced dependence on, public assistance or health care entitlement services, other than Medicaid or the Children's Health Insurance Program, due to participation in the buy-in program or work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. § 1382h);
(3) The number of individuals with severe disabilities who are no longer dependent on, or who have reduced dependence on, public benefits or services, other than Medicaid or the Children's Health Insurance Program, due to income or support services received through participation in the buy-in program or work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. § 1382h); and
(4) The change in the number of buy-in program participants or participants in work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. § 1382h) who have health care needs and related services covered through employer based benefit programs.
(c) In evaluating the effectiveness of the state's work incentives initiatives for individuals with disabilities, the secretary:
(1) Shall collaborate with other state agencies on data collection; and
(2) May consult with an independent contractor to collect data on the criteria required by this section.
(d) The department secretary shall provide an annual report of its evaluation of the Medicaid buy-in program performed pursuant to the requirements of this section to the Legislature no later than the last day of December of each year, beginning in two thousand four.