'Dangerous': WV advocates fear costly cuts in budget bill as Senate eyes passage

The groups are among many advocates who expect the legislation, dubbed the One Big Beautiful Bill Act, to make an ugly mess of the state’s social safety net through cuts to health care and food assistance on which hundreds of thousands of West Virginians rely.

Crafted by congressional Republicans and backed by President Donald Trump, the bill is designed to extend tax cuts first created under Trump in 2017 that benefit the wealthy, aided by savings expected from proposals poised to sever access to Medicaid and the Supplemental Nutrition Assistance Program.

Signatories of Wednesday’s letter included Prevent Child Abuse West Virginia, a group that advocates for expanded child care affordability and family support program funding, and Wellspring of Greenbrier, Inc., a Greenbrier County-based group that provides food and clothing to disadvantaged southern West Virginians.

Spokespeople for Justice did not respond to a request for comment on the letter or his stance on the bill.

On a call with reporters Thursday, Capito rejected the West Virginia groups’ arguments instead of the bill.

“[T[he only people [who] are going to lose a benefit are the people that don't deserve a benefit to begin with,� Capito said.

A wide array of economic and health analysts say that’s not true.

Either the budget bill under Senate consideration or as passed last month by the House would cut off coverage for at least 69,000 West Virginians and increase the state’s uninsured rate by 70%, according to an analysis released Wednesday by Families USA, a nonpartisan health care consumer advocacy group.

Families USA estimated West Virginia’s health care system would lose $666 million per year in federal funding, making it nearly impossible to maintain current levels of coverage, benefits and payments to providers. The bill would result in at least 5,800 job losses and a decrease of $979 million in economic output in the state, Families USA said, citing a March study by the Commonwealth Fund, an independent health care research group, projecting the impact of broad-based Medicaid and SNAP funding reductions.

In a 12-page letter to Senate leaders last week, the American Medical Association’s CEO and executive vice president, Dr. James Madara, noted the House and Senate proposals would create new administrative requirements for patients to enroll in Medicaid and the Children’s Health Insurance Program, and shift billions of dollars in program costs to states.

“We fear these changes would lead to unintended consequences that could affect patients who are eligible for Medicaid and CHIP benefits, rural and underserved communities, and the providers who serve them,� Madara wrote before warning that cost-sharing requirements in the bill could lead to delays in treatment and subsequent increases in emergency room visits and hospitalizations.

The Senate reconciliation bill is largely in line with the House reconciliation bill approved by Reps. Carol Miller and Riley Moore, both R-W.Va., and the Republican House majority in last month’s mostly party-line vote. The independent, nonpartisan Congressional Budget Office estimated the House bill would result in 3 million fewer people each month having SNAP benefits, slashing spending on SNAP by more than $290 billion over 10 years.

“This legislation isn’t just a bad idea,� United Mine Workers of America International president Cecil Roberts said in a statement Friday, “it’s a dangerous one.�

Errors, fraud lower in W.Va. than national averages 

Echoing other proponents of the GOP reconciliation package, Capito has claimed it’s needed to guard against Medicaid and SNAP fraud.

“This is an incentive — again — to get rid of the waste, the fraud,� Capito said of the legislation’s new cost-sharing formula tied to payment error rates that would shift many SNAP costs to states.

But Capito said she didn’t know the extent of waste, fraud or abuse of the programs targeted by the bill in West Virginia.

“[M]ost of the numbers that I’m looking at are obviously the national numbers,� Capito said. 

Federal data indicate Medicaid and SNAP fraud is rare in West Virginia.

Federally certified and funded Medicaid Fraud Control Units recorded four indictments and five convictions in West Virginia in fiscal year 2024, along with total recoveries of roughly $12.5 million that totaled just 0.2% of total Medicaid expenses in the state that year, according to U.S. Department of Health and Human Services Office of Inspector General data.

West Virginia had 6,465 Medicaid beneficiaries concurrently enrolled in a Medicaid managed care program in another state in August 2020, a month in which those beneficiaries received fixed payments totaling about $1.66 million – roughly $257 per beneficiary, per a 2022 HHS OIG report. Nationwide fixed payments totaled $234.1 million to beneficiaries enrolled in a Medicaid managed care program in two states that month.

Capito decried dual Medicaid enrollment and SNAP payment errors during her call with reporters Thursday.

More than 15% of W.Va.'s population on SNAP 

Nationwide from the second quarter of 2023 through the first quarter of 2025, there were roughly 1.94 million fraudulent SNAP transactions — transactions not authorized by a SNAP household due to card skimming, card cloning or similar fraudulent methods, per U.S. Department of Agriculture data.

West Virginia had 766 fraudulent SNAP transactions in the same span — just one-thirteenth of the national per capita average.

Under legislative text released by the Senate Agriculture, Nutrition, and Forestry Committee, on which Justice sits, West Virginia could face a cost shift of up to $84 million in fiscal year 2028 if it has an error rate of 10% or higher — as it did in fiscal year 2023 — according to an analysis by the Center on Budget and Policy Priorities, a progressive think tank.

As crafted by the Agriculture, Nutrition, and Forestry Committee, the Senate budget reconciliation bill would require states to contribute a set percentage of the cost of SNAP benefits starting in fiscal year 2028 if their payment error rate exceeds 6% -- far below West Virginia’s fiscal year 2023 error rate of 10.98% and that year’s national rate of 11.68%.

There were over 273,000 recipients of SNAP benefits in West Virginia in February — more than 15% of the state’s population.

Capito has expressed support for the Agriculture, Nutrition, and Forestry panel’s portion of the bill.

'Devastating to millions of people'

The scope of the Senate reconciliation bill has been narrowed by the Byrd rule, per which the Senate parliamentarian finding many provisions would be subject to a 60-vote threshold out of Republicans’ reach instead of a doable majority vote. Named for longtime former Sen. Robert Byrd, D-W.Va., the rule allows senators to strike measures extraneous to the purpose of reconciliation legislation: budget resolution policy encompassing changes in revenue and spending.

But many provisions expected to set up barriers to health care for limited-income West Virginians remain, including:

• States having to condition Medicaid eligibility for people aged 19-64 applying for coverage or enrolled through the Affordable Care Act expansion group on working or participating in qualifying activities for at least 80 hours every month
• States having to conduct eligibility redeterminations once every six months for individuals enrolled through the Affordable Care Act’s Medicaid expansion, as opposed to every 12 months under current law

In his letter to Senate leaders, the American Medical Association’s Madara predicted the latter provision would double both the administrative burdens expansion enrollees face when reenrolling in Medicaid and the opportunities for an eligible patient to lose coverage because of administrative error.

“As physicians, we prize continuity of care for our patients,� Madara wrote, urging the Senate to reconsider the proposed policy change.

Roberts predicted in a letter addressed Friday to senators in coal-producing regions that the consequences of Medicaid funding cuts would “fall heaviest� on rural hospitals and clinics, with UMWA members and their families dying “needlessly and prematurely.�

“Although the final language of the legislation remains in flux, the overall targets under consideration to pay for these tax cuts will be devastating to millions of people,� Roberts wrote.

Bill could favor wealthy over lower income brackets 

Households most affected by cuts to Medicaid and SNAP — those in the bottom fifth of income brackets, would experience the largest losses under the House-approved reconciliation bill, averaging $28,000 lifetime for the working-age population, according to a Penn Wharton Budget Model analysis published last month. In contrast, working-age households in the top fifth of income brackets would benefit from lower taxes, gaining $30,000 on average, per the analysis.

Of West Virginia’s 55 counties, 48 had higher family poverty rates than the national average of 8.7% from 2019 through 2023, according to federal data. Six West Virginia counties — McDowell, Mingo, Calhoun, Webster, Clay and Wyoming — had rates more than double the national average.

Roughly 29% of all West Virginians were enrolled in Medicaid or the Children’s Health Insurance Program as of January 2025, per federal data.

Another sign of economic vulnerability in West Virginia surfaced Tuesday through the release of U.S. Bureau of Labor Statistics data showing the state had the nation’s highest jobs decline over the past year. West Virginia’s total nonfarm employment fell 1.3% from May 2024 to May 2025, per the data.

“We urge you and your Senate colleagues to reject this reconciliation package and instead put forward legislation that puts working families, state budgets, and an economy that works for everyone ahead of tax benefits for the wealthy and corporations,� the nearly two dozen West Virginia groups said in their letter to Capito and Justice.

'We need everyone shouting from the rooftops'

Despite Byrd rule setbacks in their push to make the budget reconciliation bill law, the Senate is still looking to pass its version by July 4. The Senate and House would have to agree on the bill’s language before it advances to Trump for his signature.

In the meantime, the bill’s opponents are ratcheting up political pressure now so low-income West Virginians don’t feel pressure from blocked food and health care access later.

“We need everyone shouting from the rooftops,� West Virginia Citizen Action Group health care organizer Mindy Holcomb said in an email to supporters rallying opposition to the budget reconciliation package Thursday evening. “They will vote soon.�