The stated goal of West Virginia’s Medicaid Redesign was to improve the health of beneficiaries by promoting healthy behaviors such as smoking cessation, regular doctor visits, and weight loss. Parents of children who receive health care coverage under Medicaid, even if they aren’t eligible themselves, must sign an agreement or their children will automatically be assigned to the basic plan with reduced benefits. Because so few families have successfully executed the agreement, West Virginia’s changes have resulted in limiting benefits, primarily for children, with no real impact on improving health or promoting healthy behavior.