Voices’ Blog

A Comparative Analysis of House and Senate Proposed Budgets for Health Equity: A Closer Look at Key Investments

Posted:  -  By: Emily Moore

As Virginia is still navigating the Medicaid Unwinding process, our legislature and state agencies are approaching Medicaid spending with caution. As Delegate Sickles noted in his budget report for the House Appropriations Subcommittee on Health and Human Resources, we are experiencing growth in our Medicaid program that was not anticipated when the funding forecast was completed in November. As such, many budgetary requests to add services, expand services, or provide further support to Virginians in our Medicaid program were not included.

Despite the cautious approach, the proposed House and Senate budgets include many important investments to increase health care access and address the health needs of Virginia’s young people and their families. However, you will notice that the House and Senate took different paths to funding and addressing these needs.

Investments in both House and Senate budgets:

  1. Medicaid Forecast Reserve
    • Item 288 #4h: The House sets aside $100 million as a reserve against unexpected increases in Medicaid expenditures.
    • Item 471 #6s: The Senate sets aside $150 million as a reserve against unexpected increases in Medicaid expenditures.
  2. Earn to Learn Nursing Education Acceleration Program: The House and Senate budgets retain the Governor’s proposed funding of $8 million across the biennium to establish the Earn to Learn Nursing Education Acceleration Program between high schools, colleges and universities, hospitals, and health providers to increase the number of nursing students receiving clinical training to achieve certification and create employment opportunities for nursing students.
  3. Nurse Scholarship and Loan Repayment Programs: The House and Senate budgets retain the Governor’s proposed funding of $1.87 million across the biennium to fund nursing scholarship and loan repayment programs to recruit and retain nurses and nurse faculty.
  4. Medicaid Eligibility Determination
    • Item 292 #2h: The House invests $3.3 million GF/$19 million NGF across the biennium for the Dept. of Medical Assistance Services (DMAS) to contract with a vendor to implement solutions to assist in timely and accurate Medicaid eligibility determinations and redeterminations.
    • Item 292 #5s: The Senate invests $500,000 GF/$500,000 NGF in FY25 for DMAS to hire a consultant to evaluate the current eligibility determination system. A report of findings and recommendations will be due to the General Assembly by November 1, 2024.
  5. Local DSS Benefits Delivery Systems
    • Item 334 #2h: The House invests $16.8 million GF/$16.5 million NGF across the biennium to replace CommonHelp and VaCMS, the systems used by Virginians to apply for Medicaid, SNAP, TANF, Child Care Subsidy, and Energy Assistance programs.
    • Item 334 #2s: The Senate included a language only amendment directing the Dept. of Social Services (DSS) to develop a plan to improve the CommonHelp portal. The language directs DSS to not proceed with replacing VaCMS until improvements to CommonHelp have been fully implemented. The plan will be due to the General Assembly by September 1, 2024.
  6. Public Health Safety Net—Free and Charitable Clinics and Federally Qualified Health Centers (FQHCs)
    • Item 279 #2h and Item 279 #3s: The House invests $3.96 million across the biennium to support operating costs of Free Clinics, whereas the Senate invests $1.5 million across the biennium.
    • Item 279 #1h and Item 279 #4s: The House invests $3 million across the biennium to support FQHCs, whereas the Senate invests $500,000 across the biennium.
  7. Staffing for the Office of Chief Medical Examiner
    • Item 273 #1h: The House invests $230,000 across the biennium for contractual support in the Office of the CME to assist with expanding the collection and analysis of maternal morbidity data for use by the Maternal Mortality Review Team.
    • Item 273 #1s: The Senate invests $1 million across the biennium for five additional positions in the Office of the CME.
  8. Virginia Health Workforce Development Authority
    • Item 276 #1h: The House invests $2.6 million across the biennium to support efforts to develop and enhance education and training networks within communities, academic institutions, and community-based organizations with the goal of increasing diversity among health professionals, broadening the distribution of the health workforce, enhancing health care quality, and improving health care delivery to rural and underserved areas and populations.
    • Item 276 #1s: The Senate invests $1 million across the biennium for operational costs to support health workforce initiatives across the Commonwealth.

Investments in the House budget:

  1. Community Health Workers in Local Health Districts: Item 278 #1h invests $6.4 million across the biennium to support CHWs in local health departments. The funding should be directed to prioritize CHW positions that serve localities with the highest rates of maternal mortality.
  2. Graduate Medical Residencies for OB/GYNs: Item 288 #12h invests $1 million GF/$1 million NGF across the biennium to add 10 graduate medical education residency slots for obstetric-gynecological medical residents.
  3. Temporary Licensure of Physicians Licensed in a Foreign Country (HB995): Item 285 #3h is a language only amendment to provide one position at the Dept. of Health Professions to support the Board of Medicine in issuing provisional licenses to physicians who are licensed in a foreign country for up to two years. After two years of practice under the license, a physician licensed in a foreign country is eligible to apply for a full, unrestricted license to practice medicine.
  4. Language Access in Virginia State Agencies: Item 331 #3h reallocates $5 million across the biennium to facilitate and improve language access services for individuals with limited English proficiency and individuals with vision and hearing impairments. This funding was removed in the Governor’s introduced budget.

Investments in the Senate budget:

  1. Cover All Kids (SB 231): Item 289 #1s invests $12.4 million in FY26 to create a state-funded comprehensive health care coverage program for young people under age 19 who are ineligible for Medicaid only because of their immigration status.
  2. Community Health Worker Services Medicaid Benefit (SB615): Item 292 #3s invests $125,000 GF/$125,000 NGF in FY25 for DMAS to convene a workgroup to design a Medicaid benefit for Community Health Worker services.
  3. Unconscious Bias and Cultural Competency Training (SB35): Item 285 #1s invests $281,500 across the biennium to provide one position at the Dept. of Health Professions to support the requirement of unconscious bias and cultural competency training for providers licensed by the Board of Medicine.
  4. Violence Prevention Services Medicaid Benefit (SB311): Item 292 #8s is a language only amendment directing DMAS to convene a workgroup to design a Medicaid benefit for violence prevention services. A report on the design of the benefit will be due to the General Assembly by November 1, 2024.
  5. Increase Medicaid Reimbursement Rates for Dental Services: Item 288 #9s invests $11.3 million GF/$21.3 million NGF across the biennium to increase Medicaid reimbursement rates for dental services by three percent.

Investments not included in either budget:

  1. Funding for Administration of Population Health Surveys: Item 283 #4h (Del. Willett) was not included in the House budget. This item would have provided funding support to sustain the increasing costs of administering Population Health Surveys, including the Behavioral Risk Factor Surveillance Survey (BRFSS), Virginia Youth Survey (VYS), and the Pregnancy Risk Assessment Monitoring System (PRAMS).
  2. Increase Medicaid Reimbursement Rates for Physician Services: Item 288 #11h (Del. Carr) / Item 288 #15s (Sen. Deeds) was not included in either budget. This funding would have increased Medicaid reimbursement rates for services provided by primary care physicians, pediatricians, and psychiatrists by five percent.
  3. Virginia Maternal Health Loan Repayment Program: Item 271 #10h (Del. Ballard) / Item 271 #3s (Sen. Hackworth) was included in either budget. This funding would have established the Virginia Maternal Health Loan Repayment Program for practitioners who practice in health professional shortage areas.

Next Steps:

Over the next week, budget conferees will negotiate differences in the House and Senate budgets to develop a final budget proposal that will be sent to Governor Youngkin. You can urge lawmakers to support our priorities through our action alerts.

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