Opting to opt-In: Policy choice, program expectations and results in West Virginia's medicaid reform initiative

Michael Walsh, L. Christopher Plein, M. Paula Fitzgerald, Tami Gurley-Calvez, Adam Pellillo

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Following the passage of the Federal Deficit Reduction Act in 2005, a few states, including West Virginia, redesigned their Medicaid programs to emphasize personal responsibility and consumer-driven health decisions. The West Virginia program was implemented in 2006 and was subsequently abandoned in 2010 due to changes in Federal laws and continuing criticism by advocacy groups whose expectations for enrollment in a wellness-based plan were not met. Using the results of a survey of the West Virginia members, the authors explore the public policy and implementation factors of this program. We argue that initial policy design relied on existing implementation mechanisms, while it needed specific tactics to address the novelty of the choice members were facing. With the passage of the Patient Protection and Affordable Care Act, the West Virginia results provide valuable insights for future health reform policy implementation, especially as they relate to consumer-directed health decision-making and the role of intermediaries who can play a role in assisting consumers in their choices.

Original languageEnglish (US)
Pages (from-to)1449-1471
Number of pages23
JournalJournal of Health Care for the Poor and Underserved
Issue number3
StatePublished - Aug 2014
Externally publishedYes


  • Consumer decision-making
  • Deficit Reduction Act
  • Health care
  • Medicaid redesign

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Opting to opt-In: Policy choice, program expectations and results in West Virginia's medicaid reform initiative'. Together they form a unique fingerprint.

Cite this