CHARLESTON -- Two years ago, the state of West Virginia changed the way it delivered Medicaid services to get recipients to play a greater role in their own health care. However, a Georgetown University researcher said the result of that experiment has left thousands of children without the medical benefits they would otherwise receive.

Joan Alker said the punitive nature of the state's reforms have set it apart from other states that enacted their own reforms. While at least one of those efforts failed, it didn't take away from children any medical benefits.

"The (West Virginia) redesign is more of a hatchet rather than a scalpel, and I would suggest looking at the specific behaviors you wanted to improve and then addressing something more targeted," she told the Legislative Oversight Commission on Health and Human Resources Accountability Oct. 14.

Alker is the deputy executive director of the Georgetown Center for Children and Families and the author of an August report highly critical of the Medicaid reforms enacted in the state. Among her findings is that more than nine in 10 West Virginia children with Medicaid have had their benefits restricted since the program began.

However, her conclusions drew sharp criticism from the state Department of Health and Human Resources, which presented lawmakers with a five-page memo outlining what agency personnel said are several errors in Alker's report.

"West Virginia University is currently undertaking an independent, scientific study and evaluation of the program," said DHHR spokeswoman Shelley Baston, emphasizing "scientific" as she read from the memo. She said the department was waiting for those results before it made any substantial changes to the program.

Medicaid Redesign was the name given to the reforms enacted by the state both to cut the cost of providing Medicaid and to promote healthy lifestyle among participants. It basically separated the program into two levels of service.

The "basic" plan was available to everyone. It restricted prescription drugs to four a month and limits the amount of mental health and other medical services participants can receive.

However, Medicaid recipients can also qualify for the "enhanced" package if they sign an agreement to practice healthy living and make healthy choices such as keeping appointments with their physicians. It includes additional benefits such as weight management and nutritional education.

The problem is that children represent 89 percent of those affected by the changes even though they can't take personnel responsibility for their well-being, Alker said. Children and their parents are automatically placed in the basic plan, and children are stuck in it through no fault of their own.

Other states have experimented with Medicaid reform. Alker pointed to Flordia and Idaho. The major difference is those states offer incentives in the form of extra benefits if Medicaid recipients comply with rules set by state officials.

While Florida has proven no more successful with its reforms than West Virginia, the major difference is no children in the Sunshine State have lost benefits they would otherwise receive, she said.

Children with disabilities are excluded from the reforms established in West Virginia, so they still receive the same benefits. However, low-income children are not, and studies have shown that these children suffer from more health problems than children in higher income families, Alker said.

"Moreover, children on Medicaid are more likely than privately insured children to need prescriptions and mental health benefits, and those are two of the key benefits that are limited under the basic plan," she said.

Alker said West Virginia needs a more precise approach to encourage healthy lifestyles and one that doesn't punish children for decisions largely out of their control.

Baston, however, said Alker's report made several claims that are simply not true. For example, the agreement Medicaid recipients sign is not a centerpiece of Medicaid reform, yet one of a spectrum of responsibilities they are asked to take on, such as reading booklets and papers given to them, taking the medicine the doctor prescribes and calling in advance when they need to cancel an appointment.

She noted that the basic plan does restrict patients to four prescriptions a month, but said the population targeted by the reforms regularly use less than one prescription a month. Medicaid also provided unlimited visits to licensed health care providers. The only exception is to rehabilitation services.

Baston said that children continued to be covered under a very comprehensive treatment program under the basic plan. Also, only about 172,000 of the 310,000 West Virginians are eligible for the new program. Eligible Medicaid recipients are poor but have no medical disability.

When time came for questioning, it was Baston and DHHR that received the bulk of lawmakers' skepticism. Delegate Margaret Anne Staggers, D-Fayette, asked those in the room who avoids all junk food, who has kept every doctor's appointment, who gets regular check-ups and who closely monitors their body-mass index. When no one replied, she had made her point.

"When we're talking about behavior modification and we are talking about 'only the welfare people are not doing this right,' when we figure out how to make us do it, maybe we can make them figure out how they can do it," she said.

Other lawmakers questioned DHHR about the forms Medicaid recipients were asked to read and turn in. Sen. Jon Blair Hunter, D-Mongolia, said he looked at them and had a hard time understanding them.

"I couldn't understand it and I spent a good amount of time trying to figure out what this was," he said. "And I have an advanced degree. Most of the people who are working on this do not. So I agree this form is ridiculous."

Committee members generally didn't question Alker over the substance of her report. However, Delegate Barbara Hatfield, D-Kanawha, wondered if the evaluation is coming too soon, because while the reforms were approved in 2006, they've only went into effect statewide in November 2007.

"I think the program needs more than a year to be evaluated," she said. However, she added she thought the program was flawed.

The committee took no action on the report.