WV HB5459

Replaces the existing tiered member-month tax structure for health maintenance organizations (HMOs) with a flat 2.5% tax on gross premiums written in West Virginia, effective July 1, 2026

Exempts Medicare Advantage plans, West Virginia Public Employees Insurance Agency plans, and Federal Employees Health Benefits Act plans from the tax

Removes complex five-tier rate structure that previously taxed Medicaid member months at rates ranging from $1.036 to $36.26 and non-Medicaid member months at 10.36 to 25.9 cents

Requires federal approval from the Centers for Medicare and Medicaid Services confirming the new tax structure qualifies as a permissible health care-related tax eligible for federal financial participation

Tax automatically becomes void if CMS determines it no longer qualifies for federal financial participation