The Bush administration this summer approved the revisions, which will take effect in a pilot phase in three rural counties over the next few months, as part of an effort to encourage states to test approaches using more "personal responsibility" in Medicaid programs, according to the Times. Under the revisions, West Virginia will ask Medicaid beneficiaries to sign a contract, under which they agree "to do my best to stay healthy," attend "health improvement programs as directed," seek routine medical checkups and screenings, attend all scheduled physician appointments, take medications as prescribed and visit emergency departments only for medical emergencies. Medicaid beneficiaries who adhere to the contract will receive "enhanced benefits," such as coverage for mental health counseling, anti-smoking and anti-obesity programs, cardiac rehabilitation, diabetes management assistance, certain prescription drugs and home health visits. In future years, Medicaid beneficiaries who continue to adhere to the contract will receive additional enhanced benefits, possibly including coverage for orthodontic or other dental care. Medicaid beneficiaries who do not sign or adhere to the contract will receive the minimum benefits required by federal law.

Comments Nancy Atkins, state commissioner of medical services, said, "We want to reach people before they get chronic and debilitating diseases that will keep them on Medicaid for the rest of their lives." She said that West Virginia has some of the highest rates of diabetes, heart disease, obesity and smoking in the U.S. However, some physicians and health care advocates have said the new program might limit access to care for Medicaid beneficiaries. Judith Solomon of the Center on Budget and Policy Priorities said that the revisions are unlikely to improve the health of Medicaid beneficiaries or reduce costs. Gene Bishop, a physician at Pennsylvania Hospital and co-author of an August New England Journal of Medicine editorial that criticized the revisions, said, "What if everyone at a major corporation were told they would lose benefits if they didn't lose weight or drink less?" (Eckholm, New York Times, 12/1).

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