<strong>By Dan Heyman<\/strong>\r\n<h1>Advocates say changes to Medicaid from the proposed Obamacare repeal could be a hit to the West Virginia state budget - at a time when the state is already in a fiscal crisis.<\/h1>\r\nFor every dollar the state spends on health care for the poor through basic Medicaid, the federal government pays the state about $3. But for the 150,000 West Virginians covered under the Medicaid expansion, that so-called match rate is higher - about 90 percent.\r\n\r\nAccording to Renate Pore, chair of the West Virginia Medicaid Coalition, the proposed Affordable Care Act repeal would lower the expansion rate back to that basic 3-to-1 rate.\r\n\r\n\u201cWhich would cause West Virginia to lose about 160 million federal dollars a year,\u201d Pore said. \u201cGiven our current budget situation, that would be very hard for West Virginia to come up with 160 million new dollars.\u201d\r\n\r\nAdvocates for repeal have argued that the Medicaid budget is unsustainable and has to be cut. Both of West Virginia\u2019s U.S. senators have said they want to defend the Medicaid expansion.\r\n\r\nHouse Speaker Paul Ryan has said he agrees that his proposal would cut Medicaid funds for states. But he said, the states could do more with less because that funding would come in the form of block grants that would allow more flexibility.\r\n\r\nPore said Medicaid is already lean and efficient - the typical state program has an overhead of about 3 percent. She said the real result of the proposal would be a shift in costs from the feds to the state, which would put West Virginia in an especially tough spot.\r\n\r\n\u201cThe governor and the Legislature would have to make some really hard decisions about which people to kick off the program and which you leave on,\u201d she said. \u201cAnd it would be a real food fight to figure out how to structure that program without that $160 million.\u201d\r\n\r\nStandard and Poor\u2019s projects that if the GOP repeal becomes law, 4 million - 6 million Americans would be removed from the Medicaid system. More information on Medicaid in West Virginia is available at wvach.org.