Mountain Health Choices Survey Findings

Mountain Health Choices Survey Findings

Survey Results Show Medicaid Recipients Do NOT Understandthe New Medicaid Program  – Mountain Health Choices

In May 2006, West Virginia received approval from the federal government to redesign the state’s Medicaid program.  The new Medicaid program known as Mountain Health Choices was implemented in three counties, Clay, Upshur, and Lincoln in March 2007 and went statewide in November 2007. The new program offers low income families two different plans – Basic and Enhanced. The Basic Plan reduces access to medical services including prescription drugs and mental health services.  The Enhanced Plan does not reduce services and includes additional services such as smoking cessation and nutrition. In order to enroll in the Enhanced Plan, the adult in the household must meet with their medical home and sign a Member Agreement.

According to the latest numbers available from the West Virginia Department of Health and Human Resources, (DHHR) Bureau for Medical Services, 137,959 children and adults are currently enrolled in the Mountain Health Choices Program. This number represents approximately 55 percent of the Medicaid population of children and parents (250,000) that are targeted for enrollment in the Mountain Health Choices Program.  The remaining 112,041 Medicaid recipients will have to choose between the Basic and Enhanced Plan on the anniversary date of their enrollment.  This process is expected to be completed by the end of the year.

The numbers provided by DHHR do not provide information on how many Medicaid recipients made an active choice in deciding upon Basic or Enhanced. Upon their reenrollment date Medicaid recipients are placed in Basic.  If no plan is chosen, the recipient and their children are defaulted into the Basic Plan.  According to DHHR, Medicaid recipients are automatically placed in the Basic Plan and remain there unless they complete the enrollment requirements for the Enhanced Plan within 90 days of their eligibility redetermination date.

Direct Action Welfare Group (DAWG) believes that many Medicaid recipients, of which 79% are children, are simply defaulting into the Basic Plan because they do not fully understand the process to enroll in the Enhanced Plan. We further believe this limits a parent’s ability to truly have a choice with regard to their family’s health care.  Because of these concerns, Direct Action Welfare Group conducted a survey of providers and recipients.  The survey was made available via our website ( and was distributed by DAWG and partnering organizations through mailings, newsletters, and emails.

A total of 367 non-duplicate responses were received between February 1, 2008 and August 15, 2008. Of these responses 354 were from current Medicaid recipients and 13 were from health care providers that provide services to Medicaid recipients.


To find out what we learned download copy of the report.





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