A new law allows states more flexibility in structuring their Medicaid programs. Two states, Kentucky and West Virginia, so far have taken advantage of the new policy.

Kentucky plans to establish separate Medicaid coverage plans with different benefits for the general population, the elderly, children, and the developmentally disabled. The state also intends to limit Medicaid prescription drug coverage and limit physical therapy and speech therapy visits to 15 annually per beneficiary. The revisions could save Kentucky an estimated $200 million over two years.

West Virginia, meanwhile, plans to allow its 160,000 Medicaid beneficiaries to sign a contract under which they agree not to miss physician appointments and visit the emergency department only for emergencies. More states are considering revisions to their Medicaid programs, according to a spokesperson from the Department of Health and Human Services.