WHEELING, W.Va. (WTRF) – As of July 1, state employees may no longer have their medical care covered at WVU Medicine Wheeling Hospital. 

Jim Kaufman, President and CEO of the West Virginia Hospitals Association, made that announcement on MetroNews TalkLine on Thursday.

It comes after years of issues funding West Virginia Public Employees Insurance (PEIA). 

WVU Health System said WVU Medicine Wheeling Hospital is not being properly reimbursed for treating patients with PEIA. 

Wheeling Hospital will no longer accept West Virginia Public Employees Insurance after a certain date

With the state’s legislative session only days away, the question is, how can West Virginia properly fund PEIA so more hospitals don’t drop the coverage?

Nothing has changed with PEIA.

State Senator Ryan Weld, (R) Majority Whip

That seems to be causing the problem. 

Our budget hasn’t kept pace with inflation. We haven’t spent money over what we’ve spent five, six years ago and that’s led to a lot of crises across the state.

Kelly Allen, Executive Director, West Virginia Center on Budget and Policy

While this issue will most likely be a major topic as part of the upcoming legislative session, State Senator Ryan Weld said it’s not up to the legislature to just give the money to fund PEIA. 

We do not have control over this health insurance program, nor do I think the legislature should be controlling a health insurance program.

State Senator Ryan Weld, (R) Majority Whip

Weld explained that the PEIA Finance Board works with the Governor’s office to determine how much money they request within the state’s budget. 

That budget then goes to the legislature. 

Weld said what PEIA has requested has been approved in past years and that if they want more money, it needs to go in the budget. 

They’re the ones that determine the rates that they pay. They’re the ones that determine what amount needs to be appropriated by the legislature.

We can’t just give more money without an actual request being made, so we have always followed what the PEIA Finance Board has put together.

State Senator Ryan Weld, (R) Majority Whip

This isn’t a new problem in West Virginia. 

Several years ago the Governor established a PEIA Rainy Day Fund to cover the costs until there was a permanent solution to the funding problem, but there’s still no answers to issues like reimbursement rates. 

No permanent solution has been presented. The Governor put I think about $105 million dollars into a fund for a one-time band aid that’s allowed them to keep PEIA sustainable, but there’s not permanent fix. So, we’re coming up to this permanent cliff in the next four of five years where PEIA needs about another $376 million per year to be sustainable. 

Kelly Allen, Executive Director, West Virginia Center on Budget and Policy

Those reimbursement rates are the issue here. 

WVU Medicine WVU Health System said in a statement that PEIA pays more to out of state hospitals than those in the Mountain State. It was 475% more in 2021.

During a recent public session, PEIA reported that in 2020, it paid $47.8 million to out-of-state hospitals for just 1,903 inpatient visits while paying West Virginia hospitals $42 million for 11,576 visits. The following year, PEIA paid out-of-state hospitals $57.6 million for 2,195 inpatient visits and West Virginia hospitals $56.3 million for 12,313 visits. PEIA’s average payment for inpatient services to out-of-state hospitals in 2020 was nearly 600% higher than what PEIA paid to West Virginia hospitals. In 2021, the average was nearly 475% higher.

WVU Medicine Spokesperson

With WVU Medicine Wheeling Hospital losing $56 million over the past three years, cutting PEIA patients helps financially.

However, PEIA patients will still be accepted at WVU Medicine Wheeling Hospitals for emergency room visits.

All these changes are effective on July 1.

No one should be surprised because we are a hospital in this area that has hospitals in other states very close by. So, when people can go to those hospitals as well and those hospitals can receive a higher reimbursement rate from PEIA than hospitals in our very own state due to decisions that have been created by PEIA, I don’t think anybody should be surprised by that unfortunately.

State Senator Ryan Weld, (R) Majority Whip

WVU Health System also said in the same statement that this isn’t a new issue. They took their concerns to PEIA before making a final decision. 

While we had outlined our concerns to PEIA on this topic several months ago, no changes have been made. Nonetheless, we remain committed to working with PEIA to change how it reimburses West Virginia’s hospitals. The WVU Health System is making big investments in Wheeling to expand access and services, but Wheeling Hospital must be financially viable to achieve what we want to do there.

WVU Medicine Spokesperson

As for what happens now., Weld said changes will have to be made so state employees have healthcare coverage. 

This has historically been a problem for the legislature that is of the creation of others. So, it’s ‘hey you better give us more money right now or our inability to make tough decisions or our inability to manage this program is going to result in people not receiving healthcare’.

State Senator Ryan Weld, (R) Majority Whip

The other looming question is could PEIA not be accepted at other hospitals in the future?

Kaufman said on TalkLine that WVU Medicine Wheeling Hospital is the first, but other hospitals have discussed it as well. No decisions have been made.