Highmark West Virginia tells lawmakers its Medicaid option and individual-market growth could hinge on federal subsidies

Parkersburg, W.Va. — At a meeting of the Joint Committee on Government Finance in Parkersburg, James Fawcett, president of Highmark West Virginia, and Jason Landers, a Highmark representative, briefed lawmakers on the insurer's statewide operations, recent growth in individual coverage and the rollout of a Blue Cross Blue Shield'branded Medicaid option.

Fawcett described Highmark West Virginia as "the only insurance carrier in the state of West Virginia that can serve West Virginians and all 55 counties," and said the company provides Medicaid, ACA individual plans, small- and large-group coverage, and Medicare products. He told the committee the state's payer mix is heavily weighted toward government coverage; citing the insurance commissioner's report, he said about 1.7 million people live in the state and roughly "74% of all West Virginians are covered by a plan or have no insurance that end up reimbursing our health system providers."

The presentation emphasized how that payer mix affects market dynamics. "When mandates come in ... our commercial policy holders bear a lot of that weight," Fawcett said, noting that many large employers are self-funded and often outside state regulatory reach. He also highlighted individual-market growth, saying enrollment in exchange products rose from about 20,000 to roughly 51,000 people in recent years and that more than half of individual-market enrollees receive large advanced premium tax credits (APTC). Fawcett warned that the current APTC framework "will sunset on 12 31 of 25," a reference to Dec. 31, 2025, and said that outcome will be driven by federal policy.

Landers described the company's Medicaid offering, Highmark Health Options, which began Aug. 1 and "went from 860 members the 1st month to a couple of 1,000 the next month," calling it rapid growth. He said Highmark selected multi-state operational platforms (Health Rules Payer and HealthEdge) and emphasized a "West Virginia first" hiring approach: "we hired all of our key staff ... they are all now in place ... they live here in West Virginia." Landers framed the Medicaid work as "going beyond care," pointing to efforts such as remote cardiac rehab, workforce reentry supports and reentry work with formerly incarcerated members.

Fawcett also presented Highmark's 2023 premium-dollar breakdown from its state filing: about 49 cents of the premium dollar goes to facility reimbursements, 13% to physician reimbursement, 28% to prescription and specialty drugs, and about 10% to administration (with a reported margin of 1.8%). He described a charitable fund that in recent years has granted roughly $6 million to nonprofits across the state and highlighted a roughly $2.5 million commitment over three years to WVU Medicine's Food for Mountaineers and similar healthy-neighborhood programs, which provide clinician-issued debit cards for nutritious food and supportive services.

Committee members asked several questions. One member (Speaker 4) observed that the committee had an updated Medicaid-enrollment figure of about 518,000 and asked whether people removed during redetermination would become uninsured or move into other plans; Fawcett and Landers said redetermination and marketplace transitions are factors to monitor. Another lawmaker (Speaker 5) asked whether raising inpatient rates to 110% of Medicare had reduced private premiums; Fawcett replied, "Not a single health system came back and offered to lower the reimbursement rates for us." A question about Allegheny Health Network prompted Fawcett to say he did not expect that system to enter the West Virginia market and reiterated that Highmark West Virginia's earnings remain in-state.

The committee had no further business and adjourned. The transcript does not specify the meeting date; that detail was not provided in the materials presented to the committee.