Evaluating the Early-Stage Implementation of Mountain Health Choices

Case study of the implementation of the West Virginia Healthier Medicaid Members Through Personal Responsibility program

In 2008–2009, researchers at the West Virginia University Institute for Health Policy Research and Princeton, N.J.-based Mathematica Policy Research evaluated the early stage implementation of Mountain Health Choices, a key component of West Virginia's redesigned Medicaid program.

Key Findings: The research team reported findings in an August 2009 report, Evaluation of Mountain Health Choices: Implementation, Challenges, and Recommendations (available online). They include:

  • There was widespread support for the goals of Mountain Health Choices—promoting personal responsibility and strengthening patients' medical home.
  • Most provider and advocacy representatives believed the program as implemented would not succeed in those goals because the state failed to receive federal approval for and implement the Healthy Rewards program, and beneficiaries and providers did not receive continuous education and outreach designed to help beneficiaries make an informed choice of benefit plans.
  • Providers and patient advocates were concerned about beneficiaries defaulting into the basic plan, not by choice but because of a lack of understanding of the enrollment process and the importance of meeting the requirements for participation. There was no consensus among those interviewed about how to address this concern.

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