West Virginia officials are watching what could happen if a financial framework for the federal government makes major changes to Medicaid.

The U.S. House of Representatives narrowly passed a budget resolution this past week that could open the door to $880 billion in cuts to spending with Medicaid as a big possibility for those dollars. The U.S. Senate has not yet agreed.

Overall, the resolution mandates $2 trillion in spending cuts over 10 years. Of that, the The House Energy and Commerce Committee has been assigned to find $880 million in savings, and one of the biggest programs under its authority is Medicaid.

Medicaid is a joint federal and state program for health insurance and medical services, traditionally for low-income people but more recently also for the working class.

Medicaid spending in West Virginia changes year to year, depending on factors like the eligible population. But generally Medicaid spending in West Virginia has been more than $5 billion — with about 80 percent of that coming from federal dollars.

As of this month, 503,637 West Virginians were supported by the program, according to a state budget overview for the West Virginia Department of Human Services. That’s just under a third of all West Virginia residents.

“I am very concerned about this,” Senator Shelley Moore Capito, R-W.Va., said during a news briefing in response to a MetroNews question.

“I am very concerned about this. As you, as you mentioned, we do have over 500,000 — a lot of children, a lot of elderly who are in nursing homes. I think it’s six out of nine people in every in a nursing home is a Medicaid patient. And so, you know, this is concerning to families.”

Capito said she would not favor a cut in benefits but generally expressed a desire for Medicaid to run more efficiently.

“I think there are ways that we can ask the state to run a more efficient program, to ask at the federal level to run a more efficient program, and to get rid of redundancies, waste, fraud. Now, does that add up to $2 trillion? Probably not, but I think it’s better for everybody if we have a Medicaid program that works better, more efficiently,” she said.

The senator also expressed support for work requirements for Medicaid recipients.

“I think that if they’re able bodied, people that are on Medicaid can work 20 hours a week. I don’t see anything wrong with that. I mean, we’ve talked about it a lot, and that may be one of the provisions that goes in. And, you know, I would be supportive of that.”

These are all questions at the federal level that could affect the state and its finances.

During a budget review by the House Finance Committee in the West Virginia Legislature, state Human Services Secretary Alex Mayer told delegates that a “budgetary risk is the proposed federal changes that could impact funding.”

Delegate Matthew Rohrbach, R-Cabell, asked for further detail about how West Virginia could be affected by various potential changes to Medicaid.

For example, Rohrbach asked, if federal Medicaid funding were to be changed to a block grant, “Do we know how that would affect our match and how it would affect our expansion population?”

Cindy Beane, commissioner of the state’s Bureau of Medical Services, responded that a lot of different scenarios are possible.

“So depending on what happens, and I realize that’s a futuristic forecast, that could be an adverse event to our Medicaid and Human Services budget,” Rohrbach said.

“Yes, Beane responded, “it would definitely require more state dollars to keep the capacity that we have.”

Delegate Sean Hornbuckle followed up by asking for more discussion of what might happen at the federal level and how it might affect West Virginia. “Can you go a little bit deeper into that?”

Mayer responded, “So when we talk about federal changes, I think largely we’re talking about Medicaid, right?”

“But I think as you look across all federal programs and you know what the federal government is doing, I think it’s easy to presume that there’s going to be further discussion when it comes to other programming and what that might look like.”

He suggested those could affect programs like Temporary Assistance for Needy Families or the Low Income Energy Assistance Program, both managed by U.S. Health and Human Services.

“You know, I think it’s easy to presume that time when they’re moving off Medicaid, because Medicaid is a huge driver within the federal budget, right, we can probably anticipate that they’ll begin looking at other areas of programs within HHS and other departments,” Mayer said.

The budget decisions being made at the federal level are bound to affect West Virginia, and they could be painful, said Kelly Allen, executive director of the West Virginia Center on Budget & Policy think tank.

“State and federal policy decisions are always intertwined, and that is especially true this year as Congress moves ahead a budget resolution that could result in deep cuts to Medicaid, SNAP, and other federally funded programs that support West Virginians,” Allen said.

Even steps like work requirements could have undesirable consequences, she said.

Some members of Congress have tried to argue that policies like Medicaid work reporting requirements are not cuts, but research shows they would reduce Medicaid enrollment, increase uncompensated care to hospitals and providers, and cost jobs in the health care sector and beyond — all without meaningfully increasing the workforce among the targeted Medicaid population,” Allen said.

“This means that, while the federal government could reduce spending, the state would face would face increased health care costs and, likely, fewer jobs overall.”

Under Medicaid’s current structure, the federal government pays a fixed share of states’ Medicaid costs, fluctuating with enrollment changes and giving states the predictability they need to run their programs with a set match.

“Each of the Medicaid proposals that has been discussed to reduce federal spending would shift program costs onto state policymakers to either replace lost federal funding or make difficult decisions about what services or populations would be cut,” Allen said.

“Proposals to enact per capita caps, transition to a block grant, lower the federal matching percentage, or limit states’ ability to fund their match with provider taxes would all result in the state absorbing a larger share of Medicaid — just as West Virginia faces its own budget challenges.”