W.Va. Medicaid commissioner describes big changes from ‘Big, Beautiful Bill’
By Brad McElhinny / October 6, 2025
West Virginia’s Medicaid system faces significant changes through the recently-passed “Big, Beautiful Bill Act,” including implementation of a work requirement structure, a state agency leader told lawmakers.
Cindy Beane, commissioner for the West Virginia Bureau for Medical Services, made her presentation to the Joint Standing Committee on Finance during interim legislative meetings at the state Capitol.
The “Big, Beautiful Bill Act” made big changes to Medicaid, a healthcare program that is jointly funded by the federal government and states.
West Virginia’s Medicaid program costs around $5.5 billion annually, with the federal government covering about eight-tenths of that cost. The overall Medicaid allocation funds a significant portion of the state’s economy and healthcare system.
About 504,000 people are enrolled in Medicaid in West Virginia, Beane said. About 160,000 of those are in the Medicaid expansion population.
The legislation institutes more rigorous requirements for Medicaid that are anticipated to cause millions of people to drop their Medicaid coverage.
One of the new provisions is “community engagement requirements” of at least 80 hours per month of work, education or service for able-bodied adults without dependents.
Delegate Matthew Rohrbach, R-Cabell, asked Beane about the effects of the “Big, Beautiful Bill” and its work requirements on West Virginia’s Medicaid population.
“What is our anticipation of what our effect on our enrollment will be? Should that make the enrollment go down, stay the same, go up?” Rohrbach asked.
Beane responded that West Virginia is still trying to determine the effect of the work requirements.
Delegate Matthew Rohrbach, R-Cabell, asked Beane about the effects of the “Big, Beautiful Bill” and its work requirements on West Virginia’s Medicaid population.
“What is our anticipation of what our effect on our enrollment will be? Should that make the enrollment go down, stay the same, go up?” Rohrbach asked.
Beane responded that West Virginia is still trying to determine the effect of the work requirements.
People would also have to verify their eligibility to be in the program twice a year, rather than just once. And the bill adds a more rigorous income verification for those who enroll in the Affordable Care Act’s health care coverage.
“Commissioner Beane’s testimony makes clear the Big Beautiful Bill will have ‘big’ consequences for state policymakers and people who rely on Medicaid,” Kelly Allen, executive director of the West Virginia Center on Budget & Policy think tank said after the presentation to lawmakers.
“State lawmakers will be forced to absorb hundreds of millions of dollars in new costs over the next several years to implement new bureaucratic hoops for enrollees to jump through and to offset federal cuts to provider payments.”
Allen continued by expressing concern about costs that will be necessary for the state to implement changes.
“The new requirements for enrollees will mean the state will have to make costly new investments in technology and systems upgrades, while all available research tells us more frequent eligibility checks and work reporting requirements mostly result in kicking people off the program who are meeting all the requirements but get tripped up by the confusing new paperwork.
Preparing for the changes will require significant front end work by West Virginia officials, Beane told lawmakers.
“They will be anticipating that you will be ready next January. So we at West Virginia Medicaid have already started work on this,” Beane said.
She elaborated that the state is focused on system requirements and notifications, including making sure “that individuals understand what they are trying to report with regards to their work requirements.”
Beane said West Virginia is participating in a small pilot program with seven other states to explore technology so that Medicaid recipients who are working could report work hours efficiently through a “no touch solution so that people aren’t constantly having to report their work hours.”
Rohrbach asked for more detail about how implementation of work requirements will move forward.
“Are we staffed up for that? Are you going to need more staff? What are the requirements going to be to meet that?” Rohrbach asked.
Beane said that is receiving significant planning up front.
“I think what we’re going to try to do as much as possible with regards to work requirements is to make it as ex parte, as no touch as possible, to see if there are some technologies to employ to where it’s not staff intensive,” she said. “But I do think there will be increased demands.”
Delegate Sean Hornbuckle, D-Cabell, asked about the overall expense of the work requirements: “The community engagement portion of this, with different technologies and systems to be able to take a look at that, do we have a cost for that?”
Beane responded, “We do not currently have a cost, but there will be a cost.”