WV DoHS’s 2025 Achievements To Increase Quality & Control Costs of Medicaid Services

In a recent press release, the West Virginia Department of Human Services’ (DoHS) Bureau for Medical Services (BMS) announced that it is closing 2025 with significant improvements in its oversight and access to services. Over the past year, BMS expanded managed care enrollment, strengthened program integrity, and implemented strategies that improve service delivery while controlling the costs for Medicaid.

“This progress demonstrates a commitment to providing West Virginians with timely, coordinated, and effective services. By focusing on both availability and accountability, we are improving outcomes while safeguarding public resources,” said Governor Patrick Morrisey.

BMS enhanced service delivery by implementing initiatives such as Day One enrollment into managed care, which provides immediate case management and support. The bureau also added two additional Dual-Eligible Special Needs Plans (D-SNP), which expand comprehensive Medicare and Medicaid coverage for eligible participants.

“Our focus remains on maintaining services while ensuring the highest standards of quality and safety, Federal approvals and strategic partnerships allow us to implement evidence-based approaches that improve outcomes and ensure West Virginians get the support they need, when they need it,” said Alex Mayer, Secretary of the Department of Human Services.

The expanded prepayment review prevents potential over-payments before they occur by:

• Auditing managed care spending and tying payments to performance metrics
• Providing targeted training for new and existing managed care plans
• And by increasing referrals to the Attorney General’s Medicaid Fraud Control Unit

BMS also advanced clinical protections and cost containment by expanding the preferred drug list to secure additional rebates, implementing oversight for high-risk medications, and adding lower-cost biosimilar medications as preferred options to maintain effective and affordable care.

Investments that were made in workforce and quality improvements included operationalizing the 2024–2027 Quality Strategy, integrating vital statistics and laboratory data, and partnering with WVU and other clinical organizations to oversee vulnerable populations.

Through these efforts, BMS strengthened coordination, reduced unnecessary costs, and expanded the reach of services for West Virginians. These improvements bolster the state’s Medicaid and CHIP programs while positioning BMS to continue delivering high-quality care in 2026 and beyond.