Author Archives: Emily Moore

  1. Moving the Needle on Family Economic Security: 2024 Budget Recap

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    For previous blogs on Economic Security during the 2024 legislative session, click here and here.

    Economic stability is the strongest predictor of a thriving and healthy childhood. But far too many Virginia families are working hard and still struggling to afford nutritious food, comprehensive health care, safe housing, and quality child care. According to the 2024 KIDS COUNT Data Book, Virginia’s national ranking for child economic well-being dropped from 12 to 17. This sadly does not come as a surprise, as Virginia has a 13.6% child food insecurity rate and roughly 35% of families with children live below the ALICE Threshold. ALICE stands for Asset Limited, Income Constrained, Employed and represents the number of households that earn above the federal poverty level but cannot afford the basic cost of living in their locality.  

    Families should not have to make the impossible choice of figuring out what they must forgo to make ends meet for their children. Yet, we hear directly from families that they are still feeling the impacts of rising costs and the elimination of pandemic-era supports such as the expanded federal Child Tax Credit and expanded SNAP benefits. In the most recent Census Household Pulse Survey, Virginia families with children in the household reported:  

    • 78% felt very stressed or moderately stressed by the increase in prices in the last two months  
    • 59% experienced some level of difficulty paying for their usual household expenses in the past week 

    The choice to maintain this status quo is part of a systemic failure to support working families, and young people are collateral damage. This legislative session, lawmakers had a chance to prioritize family economic security and advance tax fairness in our upside-down tax code. The Governor’s veto power proved to be the biggest barrier to enacting pro-family policies like Paid Family & Medical Leave and increasing the minimum wage. 

    2024 Budget Outcomes

    Economic Security Investments:

    • Two Family/Whole Generation Pilot: $1.125 million in FY26 from the TANF Block Grant to continue the Two Family/Whole Generation pilot program, which was removed from the Governor’s proposed budget.  
    • PFML Study: $200,000 in FY25 transferred from Economic Development Incentive Payments to the VEC to update the study they completed in 2021 to include budgetary impacts of PFML for state employees, state-support local employees, and local school divisions. A report of findings and recommendations will be due to the General Assembly by December 1, 2024.  

    Food and Nutrition Access Investments:

    • Summer EBT Program: Retains the Governor’s proposed funding of $5.4 million over the biennium to fund the administration of the Summer EBT program, “SUN Bucks”. Under this program, families whose children qualify for free- and reduced-price lunch will receive a lump sum of $120 to purchase additional food in the summer. 
    • Virginia Commission to End Hunger: $51,296 across the biennium for member payments and reimbursements for their participation in the Virginia Commission to End Hunger (HB 607, Del. Price).  
    • Increased Reimbursements for School Breakfast: $5.075 million over the biennium to increase the state’s share of reimbursement for school breakfast from $0.22 to $0.28.  
      • The governor recommended reducing funding by $2.5 million over the biennium to increase the reimbursement share to $0.25 in his budget amendments, but the funding from the conference budget was retained. 
    • Study of Student Food Insecurity: Directs the State Council of Higher Education (SCHEV) to review the status of programs that address food insecurity at colleges and universities. A report of findings and recommendations will be due to the General Assembly by November 1, 2024.  

    Tax Fairness: 

    • Study of Virginia’s Tax Code: Directs the Joint Subcommittee on Tax Policy to explore efforts to modernize the Commonwealth’s income and sales and use taxes, including evaluating efforts to increase the progressivity of the income tax and long-term revenue growth to maintain core government services. 
      • Unlike other studies and reports, this line item does not specify a date that findings and recommendations would be due to the General Assembly.  
    • Virginia CASH Campaign: $900,000 over the biennium from the TANF Block Grant for the Virginia Community Action Partnership contract to manage the statewide “Virginia CASH Campaign”, the state supported Volunteer Income Tax Assistance program providing outreach, education, and tax preparation services for Virginians who may be eligible for both the federal and new state Earned Income Tax Credit (EITC). This amendment increases the annual funding to $635,725/year.  

    The Path Forward

    Child poverty is a policy choice, and if we learned only one thing from the COVID-19 pandemic, it’s the reality that there are proven solutions that can lift families out of poverty and help them provide for their families—such as having family-focused tax credits and access to paid leave benefits.  

    During the 2025 legislative session, Voices will continue leading the efforts alongside our partners at The Commonwealth Institute to establish a state-level Child Tax Credit (CTC) and expand the refundable state-level Earned Income Tax Credit (EITC) to 20% of the federal credit. We know that when families are given direct cash resources and financial support, it supports them in making ends meet, saving for emergencies, paying off debt, and investing in their child’s future.  

    We will also continue supporting the efforts of the Paid Family & Medical Leave Coalition, convened by our partners at Freedom Virginia, to create a state-administered paid family and medical leave program. A family’s ability to be healthy depends upon their economic stability, and vice versa. Working families need well-paying jobs to afford health care, yet without paid family and medical leave, they risk losing income while trying to seek care for themselves and their families. 

    And lastly, we will continue fighting for healthy school meals at no cost for all students. Virginia has made significant strides in expanding access to no-cost school meals through the Community Eligibility Provision (CEP), but there is still work to be done to ensure that children are not slipping through the cracks in more affluent communities. 

    Investing in the economic stability of families and children should be the number one priority moving forward for Virginia lawmakers and the governor. Family-focused policies impact every aspect of child well–being and by intentionally removing barriers to thriving through social supports and adequate financial resources, we can ensure the healthy development of children and youth. 

  2. The Health of Virginians is a Crucial Investment: 2024 Budget Recap

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    For previous blogs on Health Equity during the 2024 legislative session, click here and here. 

    As we near the end of Medicaid Unwinding, the work to ensure young people have the resources and opportunities they need to be healthy has never been more important. This includes the prioritization of state funding for high-quality, accessible health care services and affordable and stable health insurance coverage. With over 750,000 Virginia children and youth relying on Medicaid/FAMIS for their health insurance coverage, we must ensure that this vital program is easy to navigate and that structural barriers to accessing coverage are removed.  

    Unfortunately, the unwinding has shed light on the inadequacies of our system. As of June 2024, 139,184 children and youth in Virginia have lost their Medicaid coverage during the redetermination process. Of those children and youth, at least 61,208 (44%) have been terminated from coverage due to procedural reasons. Procedural disenrollments happen when enrollees do not respond or are late submitting paperwork during the process to renew their coverage, not due to ineligibility.  

    Families “failure to respond” during this process is often attributed to administrative barriers such as not receiving renewal forms at a new address, widespread mailing delays, inability to get in contact with caseworkers, and language and literacy barriers. When disenrollments are procedural rather than due to ineligibility, it’s likely that many of the young people losing coverage are still eligible for Medicaid/FAMIS. 

    The above number of procedural terminations does not represent the children who had their coverage terminated and then reinstated within the three-month reinstatement period—the Department of Medical Assistance Services (DMAS) is still compiling data on “churn”, and we are awaiting an accurate count of children who experienced this. What we do know is that churn (losing and regaining coverage) still requires families to jump through hoops and re-apply. And even if only for short periods, coverage gaps can be damaging to health outcomes for children whose development requires timely and routine well-child visits, screenings, and immunizations. 

    The final budget makes strides to boost funding to our state agencies that support the health of young people and address the roadblocks to continuity of coverage and care, including efforts to prioritize a workforce that is reflective of Virginians. Unfortunately, the budget does not go as far as it should to ensure all children, regardless of immigration status, have access to health insurance coverage, nor does it invest in creating a pathway to sustainable funding for our dedicated public health professionals, Community Health Workers.  

    2024 Budget Outcomes

    Medicaid System Improvements: 

    • Medicaid Forecast Reserve: Sets aside $95 million in FY25 as a reserve against unexpected increases in Medicaid expenditures through program enrollment.  
      • Reduced from $150 million that was set aside in the Conference Budget. 
    • Increase Automation for Medicaid Eligibility Determinations: $3.3 million GF/$19 million NGF over the biennium for DMAS to contract with a vendor to implement solutions to assist in timely and accurate Medicaid eligibility determinations and redeterminations. Enhancements would be provided to Medicaid Management Information System (MMIS) and the Virginia Case Management System (VaCMS).  
      • The governor recommended removing funding in his budget amendments, but the funding from the conference budget was retained. 
    • Centralize Mail Operations for Medicaid Applications & Renewals: $6.2 million GF/$13.7 million NGF over the biennium for the Department of Social Services (DSS) to contract with a vendor to handle all incoming mail currently directed to local DSS agencies, including Medicaid benefit applications and renewal notices. This will allow all returned mail to be processed in one centralized location and will expedite routing of applications to the Cover Virginia Call Center and localities for processing. 
      • The governor recommended removing funding in his budget amendments and creating a study, but the funding from the conference budget was retained. 
    • Evaluation of Medicaid Eligibility Determination: $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 December 15, 2024.  
    • Human-Centered Benefits Delivery CommonHelp Replacement: $3.85 million GF/$3.85 million NGF over the biennium to replace the benefits eligibility system currently used by approximately 2.2 million Virginians to apply for Medicaid, SNAP, TANF, the Child Care Subsidy Program, and Energy Assistance Programs.  

    Workforce Investments: 

    • Earn to Learn Nursing Education Acceleration Program: Retains the Governor’s proposed funding of $8 million over 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.  
    • Nurse Scholarship and Loan Repayment Programs: Retains the Governor’s proposed funding of $1.87 million over the biennium to fund nursing scholarship and loan repayment programs to recruit and retain nurses and nurse faculty.  
    • Virginia Health Workforce Development Authority: $3.2 million over the biennium to support the Area Health Education Centers Program and health workforce responsibilities of the VHWDA. This funding will 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.  
      • The governor recommended reducing funding by $2.6 million over the biennium in his budget amendments, but the funding from the conference budget was retained. 
    • Community Health Workers in Local Health Districts: $6.4 million over 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.   
    • Guidelines for a Collaborative Care Model: Directs DMAS to develop program guidelines for the Collaborative Care Model, in which behavioral health services are delivered in primary care practices. A report on progress developing and implementing the guidelines will be due to the Joint Commission on Health Care and the Chairs of the House Appropriations and Senate Finance and Appropriations Committees by October 1 of each year. 

    Health Care Safety Net Investments: 

    • Free and Charitable Clinics: $3 million over the biennium to support operating costs.  
      • The governor recommended reducing funding by $1 million over the biennium in his budget amendments, but the funding from the conference budget was retained. 
    • Federally Qualified Health Centers (FQHCs): $3 million over the biennium to continue providing comprehensive medical, dental, and mental health services to uninsured Virginians.   
      • The governor recommended reducing funding by $1 million over the biennium in his budget amendments, but the funding from the conference budget was retained. 

    Health Care Accessibility and Inclusivity: 

    • Language Access Funding: $4 million over the biennium for efforts to facilitate and improve language access in state agencies.  
      • The original funding in the FY23/FY24 budget was $5 million—the Governor’s proposed budget removed that funding for the upcoming biennium, and the conference budget put the money back in but decreased funding by $500,000/year.  
      • The governor recommended removing $2 million in FY26 in his budget amendments, but the funding from the conference budget was retained. 
    • School-Based Health Clinics: $30 million over the biennium for the Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Education (DOE) to offer grants through contracts with FQHCs and other healthcare organizations to establish school-based health clinics to offer primary care, mental health services, and other health services in schools.  
      • This funding is a redirection of the school-based mental health integration pilot funding. See our Mental Health budget blog to learn more. 

    The Path Forward

    During the federal public health emergency, the Medicaid continuous coverage provision demonstrated how important it is for young people to have continuity of care and health insurance coverage. Many states across the US are working with their state agencies and the federal Centers for Medicare and Medicaid to extend multi-year periods of continuous Medicaid eligibility for children. During the 2025 legislative session, Voices will work towards passing legislation to allow the Department of Medical Assistance Services to establish multi-year continuous eligibility for young children from birth to 6 years old, following in the footsteps of states like Oregon, Washington, and New Mexico. 

    Voices will continue to fight alongside our partners in the Healthcare for All Virginians Coalition for Cover All Kids, to ensure that the 13,000 children who are barred from Medicaid coverage due to their immigration status have a pathway to access comprehensive, affordable health insurance coverage.  

    Voices will continue supporting the efforts of the PUSH Maternal Health Coalition to increase access to high-quality, comprehensive perinatal health care. We will also continue to work alongside partner organizations, such as Virginia Community Health Workers Association, Virginia Health Catalyst, Virginia Hospital and Healthcare Association (VHHA), and Virginia Interfaith Center for Public Policy, to advocate for sustainable, long-term access to Community Health Workers by creating a process and timeline for Medicaid to reimburse for CHW services. 

    Through these policies, we can work towards a health care system for young people and their families that promotes the improvement of health outcomes through preventative care, provides culturally responsive and gender-affirming care, and prioritizes a workforce that is reflective of our diversity and our needs. 

    Glossary:

    • Conference Budget: Appropriations of state revenue agreed to by the budget conferees from the House and Senate and passed by the General Assembly. The conference budget is sent to the governor for approval. 
    • Governor’s Budget Actions 
      • Veto: Action by which the Governor refuses to sign legislation, including the budget, passed by the General Assembly. A 2/3 vote of each body is required to override a veto. 
      • Amendment: A proposed change that inserts and/or strikes language from the legislation or budget. 
      • Sign: Action by which the Governor signs the legislation, including the budget, and it becomes law. Effective dates are July 1, unless otherwise specified through an emergency clause. 
    • Final Budget: Appropriations of state revenue agreed to by the General Assembly and Governor. 
    • General Fund (GF): The predominant fund for financing state government programs. The primary sources of revenue for the General Fund are the personal income tax, sales tax, and corporation taxes. 
    • Non-General Fund (NGF): All sources of revenue other than the General Fund. For example: federal appropriations, grants, and contracts. 
    • Biennium (FY25-FY26): A two-year period used by the state for financial and budget purposes. It includes two fiscal years, running from July 1 in an even-numbered year to June 30 of the next even-numbered year.  
    • Fiscal Year (FY): A fiscal year is a 12-month accounting period. The fiscal year for Virginia state government begins July 1 and ends June 30. For example, FY25 is from July 1, 2024 – June 30, 2025 and FY26 is from July 1, 2025 – June 30, 2026. 
  3. A Comparative Analysis of House and Senate Proposed Budgets for Economic Security: A Closer Look at Key Investments

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    Families have been hit hard by the impact of inflation, the rising costs of utilities, food, and household necessities, and the loss of pandemic-era supports, such as the expanded federal Child Tax Credit, expanded SNAP benefits, and continuous health coverage through Medicaid. The General Assembly has the opportunity this session to invest in families and address the racial and ethnic disparities that exist in economic stability.

    Both chambers made a critical decision to reject the income tax and sales tax proposals in the Governor’s tax package, which would have done very little for low- and middle-income families and largely benefited the wealthy. But the House and Senate budgets do not go as far as they should to meet the moment and help families make ends meet.

    Investments in both House and Senate budgets:

    1. Summer EBT Program: The House and Senate budgets retain the Governor’s proposed funding of $5.4 million across the biennium to fund the administration of the Summer EBT program.
    2. Two Family/Whole Generation Pilot
      • The House budget mirrors the Governor’s introduced budget, which removes funding for the Two Family/Whole Generation pilot in FY26.
      • Item 331 #1s: The Senate invests $1.1 million NGF in FY26 to continue the Two Family/Whole Generation pilot program.
    3. Paid Family and Medical Leave
      • Item 356 #4h: The House included a language only amendment, directing the Virginia Employment Commission (VEC) to update the study they completed in 2021 to include budgetary impacts of PFML for state employees, state-support local employees, and local school divisions.
      • Item 356 #2s: The Senate included a language only amendment authorizing a treasury loan for the implementation of Paid Family and Medical Leave (SB373) and requires the VEC to establish and administer a PFML program beginning January 1, 2027.
    4. Minimum Wage Increases: The House and Senate Budgets invest $79.5 million across the biennium for the state agency cost of increasing the minimum wage to $15/hour by January 1, 2026.

    Investments in the House budget:

    1. Virginia Commission to End Hunger (HB607): Item 1 #4h invests $51,296 across the biennium for member payments and reimbursements for their participation in the Virginia Commission to End Hunger.
    2. Virginia CASH Campaign: Item 331 #8h invests $1.5 million across the biennium for the Virginia Community Action Partnership contract to manage the statewide “Virginia CASH Campaign,” the state supported Volunteer Income Tax Assistance program providing outreach, education, and tax preparation services for Virginians who may be eligible for both the federal and new state Earned Income Tax Credit (EITC).

    Investments in the Senate budget:

    1. Increased Reimbursements for School Breakfast: Item 125 #18s invests $6.7 million across the biennium to increase the state’s share of reimbursement for school breakfast from $0.22 to $0.30.
    2. Study of Student Food Insecurity: Item 132 #3s is a language only amendment directing the State Council of Higher Education (SCHEV) to review the status of programs that address food insecurity at colleges and universities. A report will be due to the General Assembly by November 1, 2024.
    3. Free Tax Filing Options: Item 260 #1s is a language only amendment directing the Department of Taxation to review free file options for individual taxpayers and develop a plan with costs for implementing a free file system in Virginia. A report will be due to the General Assembly by November 1, 2024.

    Investments not included in either budget:

    1. Medicaid Coverage for Nutritious Food: Item 288 #64h (Del. Rasoul) / Item 288 #22s (Sen. Locke) was not included in either budget. This item would have directed the Dept. of Medical Assistance Services (DMAS) to conduct a feasibility assessment for amending the state’s 1115 waiver and the Commonwealth Coordinated Care Plus 1915(c) waiver to include coverage of food as a benefit for Medicaid members and to recognize nutrition security’s critical role as a Health-Related Social Need.
    2. Child Tax Credit (CTC): Item 258 #13h (Del. Tran) / Item 258 #1s (Sen. Aird) was not included in either budget. This item would have established a state-level Child Tax Credit, which would have provided a $500 tax credit per child under 18 to families making less than $100,000 adjusted gross income (AGI).
    3. Earned Income Tax Credit (EITC): Item 4-14 #1h (Del. Price) / Item 0 #5s (Sen. Rouse) was not included in either budget. This item would have expanded the state-level Earned Income Tax Credit, allowing low-income tax filers to claim a refundable tax credit equal to 20% of the federal EITC.
    4. Healthy School Meals for All: Item 125 #8h (Del. Bennett-Parker) / Item 125 #29s (Sen. Roem) was not included in either budget. This funding would have made school breakfast and lunch free for all public school students in Virginia.
    5. Hunger-Free Campus Grant Program: Item 132 #17h (Del. Simonds) / Item 132 #6s (Sen. Roem) was not included in either budget. This funding would have created a grant program for public colleges and universities to address student food insecurity on their campuses.
    6. Farm to School Program Task Force: Item 120 #3h (Del. Cousins) / Item 117 #6s (Sen. Roem) was not included in either budget. This funding would have directed the Department of Education to expand work related to farm-to-school programming by establishing the Farm to School Program Task Force.
    7. Paid Sick Leave (HB348): Item 349 #3h (Del. Ward) was not included in the House budget. This item would have provided funding to the Department of Labor and Industry (DOLI) to enforce and monitor Paid Sick Leave requirements across the commonwealth.
    8. 5000 Families Program: Item 102 #1h (Del. Coyner) / Item 102 #3s (Sen. Hashmi) was not included in either budget. This funding would have established the 5000 Families Pilot Program, which would have provided monthly rental assistance to low-income families with school-aged children.

    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.

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

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    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.

  5. Virginia Roadmap to End Hunger: 2024 Update

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    According to Hunger Free America’s 2023 Annual Hunger Survey, 11.7% of Virginia children live in food insecure households, putting them at risk for poor health outcomes and academic performance. As our communities continue to face rising food prices and decreased safety net benefits, it is important for advocates to continue to build coalition and solidarity to eradicate hunger and food insecurity statewide.

    The 2024 edition of the Roadmap to End Hunger was written by members of the Virginia Food Access Coalition (VFAC). VFAC is a collaborative of public and private organizations advocating for improved access to nutritious, local foods for all Virginians. Voices is a proud member of VFAC, and Emily Moore, Senior Policy Analyst, contributed to this edition of the Roadmap by co-authoring the Food is Medicine section.  

    Continuing its purpose as a living document, the 2024 update to the Roadmap documents the legislative and budgetary opportunities in food access and nutrition policy available to the Commonwealth to make the most significant impact for families and young people facing hunger. 

    The 2024 Roadmap highlights progress and opportunities across:  

    • School Nutrition and Food Insecurity in Higher Education 
    • Food is Medicine 
    • Federal Nutrition Benefit Programs 
    • The Farm Bill 
    • Community Food Access 

    Roadmap to End Hunger_2024 Update_Final.pdf

    Learn more about VFAC and become a coalition member here.   

  6. Investing in Strong and Stable Families During the 2024 Legislative Session

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    All families in Virginia deserve the opportunity to thrive, and the cornerstone of vibrant youth and adolescence is economic security. Communities should be well-resourced, having access to good schools, affordable housing and transportation, physical and mental health care, and nutritious and culturally relevant food. But centuries of policies—which were created to benefit wealthy and white residents—have perpetuated systemic racism, inequitable educational systems, and discrimination in the labor market, creating stark racial and ethnic disparities in economic stability.  

    As demonstrated by the 2023 KIDS COUNT Data Virginia Profile, Black children and Latino children are more likely to live in poverty than white children. This puts inequitable barriers in the lives of young people and hinders their ability to become the prosperous adults they dream to be. 

    During the 2024 legislative session, Virginia lawmakers must acknowledge that child poverty is a policy choice and take action to improve the lives of Virginia’s families and young people. Below are a few policies that Virginia can adopt and implement to help families make ends meet:  

    • Paid Sick Days and Paid Family Medical Leave  
    • Family-focused tax credits, like the state-level Child Tax Credit and fully refundable state Earned Income Tax Credit 
    • Increased access to healthy and nutritious food through SNAP and WIC, Food is Medicine programs, and free school meals for all 

    Economic Security 

    Virginia families are feeling the impact of inflation, the rising costs of utilities, food, and household necessities, and the loss of pandemic-era supports, such as the expanded federal Child Tax Credit, expanded SNAP benefits, and continuous health care coverage through Medicaid. According to the most recent Census Household Pulse Survey

    • 64% of Virginia families with children indicated that they had some level of difficulty paying for their usual household expenses in the past week. 
    • 23% of Virginia families with children sometimes or often did not have enough food to eat. 
    • 50% of Virginia families with children reported feeling very stressed by the increase in prices in the last two months. 

    Economic stability not only influences the ability to feed and house your family but also determines the level of autonomy families have in their lives. When families are given direct cash resources and financial support, it supports them in making ends meet, saving for emergencies, paying off debt, education and training, and college savings for their children. Giving cash directly to families empowers parents and caregivers to invest in their children as they see fit and avoids the paternalistic nature of some public benefit programs. It demonstrates trust in families and doesn’t require them to prove that they will be “responsible” with their money.  

    Families should also be able to take time off work to care for a sick loved one, be with a newborn child, or care for their own medical needs without having to worry if they will be able to pay for necessities. But roughly 76% of working Virginians—especially women—are unable to do this, which is why this legislative session lawmakers must invest in programs that provide financial security. Having financial security means families can spend more time with their children and less time away from home working multiple jobs. 

    Budget Amendments 

    • Item 357.10 #1h (Delegate Sewell) | Item 356 #4s (Senator Boysko) | Dept. of Labor, Virginia Employment Commission | Language Only  
      • HB 737 & SB 373 – Requires the Virginia Employment Commission to establish and administer a Paid Family and Medical Leave program with benefits beginning January 1, 2027. Funding for the program is provided through premiums assessed to employers and employees beginning in 2026. 
    • Item 349 #3h (Delegate Ward) | Dept. of Labor and Industry | FY25: $250,000; FY26: $250,000  
      • HB 348 – Provides funding to enforce and monitor a Paid Sick Leave program. 
    • Item 471 #5h (Delegate Ward) | Central Appropriations | FY25: $25 million; FY26: $25 million  
      • HB 1 – Provides funding to raise the minimum wage in Virginia. The provisions of this bill will impact state employees, state-supported local personnel, and health care providers compensated through the state’s Medicaid program. 
    • Item 102 #1h (Delegate Coyner) | Item 102 #3s (Senator Hashmi) | Dept. of Housing and Community Development | FY25: $52 million; FY26: $48 million 
      • Establishes the 5000 Families Program, which will provide monthly rental assistance to low-income families with school-aged children. Eligible households will receive a monthly rental voucher in an amount sufficient to allow the family to pay only 30 percent of their monthly income for housing.  

    Tax Fairness 

    According to ITEP’s Tax Inequality Index, Virginia has the 37th most regressive state and local tax system in the country, with the wealthiest paying the least taxes as a share of their income. The current tax proposal from the Governor to lower Virginia’s income tax brackets and increase the state sales tax does very little for families with low- and middle-incomes, and largely benefits the wealthy.

    The Governor’s tax package also proposes increasing the non-refundable option of the Earned Income Tax Credit from 20% to 25%, but very few households will see any help from this change. Tax credits are most effective for supporting working families when the credits are refundable, allowing families access to the full value of their credit via a cash refund. Refundability is important because it expands eligibility to households with low and moderate incomes who are left behind by non-refundable credits.  

    Few tax policies are conditional on providing for the needs of children or ensuring that refunds and credits are distributed based on the number of children in a home. There are proven solutions that can make an impact today and long-term—specifically, establishing a state-level Child Tax Credit (CTC) and expanding the refundable state Earned Income Tax Credit (EITC) to 20% of the federal credit.  

    With the expanded federal Child Tax Credit, families were able to choose how to use the money to meet their needs. More than half of Virginia families reported using the expanded CTC for food, followed by one-third who used the money to pay bills. Financial hardship creates parental stress, mental health concerns, and family instability, but family-focused policy can help impact every one of those aspects of child wellbeing by expanding tax credits and economic security for families. 

    Governor’s Budget Items 

    • OPPOSE | Reduce Income Tax Rates by 12%

      • Virginia’s tax code is already upside down and this proposal furthers that gap. 
      • This proposal would reduce Tax Revenue by $1.1 billion in FY25 and $2.3 billion in FY26. 
    • OPPOSE | Increase Sales Tax by 0.9% (from 4.3% to 5.2%) 
      • Directly impacts families with lower incomes, who spend a larger portion of their income on essentials. 
    • OPPOSE | Expand non-refundable EITC to 25% of Federal Credit 
      • A nonrefundable credit — the credit amount can only count towards income tax liability and may not exceed it — means that many working low-income families who qualify for the credit will be unable to access the full benefit due to having low- or no-income tax liabilities. 

    Budget Amendments 

    • Item 0 #17s (Senator Aird) | Revenues  
      • A Child Tax Credit that is a refundable $500 credit per child under the age of 18 for Virginia households making up to $100,000 adjusted gross income.  
      • This amendment reduces general fund revenue by $627.0 million for a state Child Tax Credit as a placeholder, pursuant to legislation authorized by the 2024 General Assembly. 
    • Item 258 #1s (Senator Aird) | Dept. of Taxation | FY25: $299,356 | 1 FTE; FY26: $73,331 | 1 FTE 
      • Funding to support implementation of a state Child Tax Credit and to hire one additional FTE to manage administration of the credit. 
    • Item 0 #5s (Senator Rouse) | Revenues  
      • Earned Income Tax Credit allowing eligible low-income taxpayers to claim a refundable income tax credit equal to 20 percent of the federal earned income tax credit. 
      • This amendment reduces the general fund based on a preliminary estimate of $36.5 million the first year and $35.5 million the second year.  
    • Item 331 #2h (Delegate Coyner) | Item 331 #3h (Delegate Carr) | Item 331 #4h (Delegate Hernandez) | DSS | FY25: $750,000; FY26: $750,000  
      • Provides funding for the Virginia Community Action Partnership contract to manage the statewide “Virginia CASH Campaign,” the state supported Volunteer Income Tax Assistance program providing outreach, education, and tax preparation services for Virginians who may be eligible for both the federal and new state Earned Income Tax Credit (EITC).

    Food and Nutrition Access 

    Food security is deeply connected to economic stability and community. Inequities in the food system create disparities in access to fresh, nutritious, and culturally appropriate foods and increase the disproportionate prevalence of diet-related illnesses. Between 2020-2022, 11.7% of children in Virginia experienced food insecurity. In 2023, Virginia food banks reported a 5-10% increase in demand at pantries compared to the end of 2022. 

    In the past several years, Virginia has: Eliminated the reduced-price school meals category; Implemented Broad-Based Categorical Eligibility for SNAP benefits; Created the Virginia Food Access Investment Fund; and allocated state funding for Virginia Fresh Match. This legislative session, Virginia can continue to build on our legislative progress by creating a universal school meals program and making additional budget investments.

    Food security does not exist in a silo. It is dependent upon opportunities for economic security, collaboration with health care systems, robust food and nutrition programs, and a vibrant, affordable, and accessible food system.  

    Governor’s Budget Items  

    • SUPPORT | Fund administration for the summer EBT program
      • VDSS | $5.4 million across the biennium | 1 FTE 

    Budget Amendments 

    • Item 288 #64h (Delegate Rasoul) | Item 288 #22s (Senator Locke) | DMAS  
      • Item 288 #64h – FY25: $419,323 GF / $419,323 NGF | 1 FTE; FY26: $169,323 GF / $169,323 NGF | 1 FTE
      • Item 228 #22s – Language only
      • Directs the Department of Medical Assistance Services to conduct a feasibility assessment for amending its existing §1115 waiver and the Commonwealth Coordinated Care Plus §1915(c) waiver to include coverage of food as a benefit for Medicaid enrollees.
    • Item 125 #8h (Delegate Bennett-Parker) | Item 125 #29s (Senator Roem) | Direct Aid to Public Education | FY25: $173 million; FY26: $173 million 
      • HB 686 & SB 283 – Funding to provide free school breakfast and lunch to children enrolled in public schools.  
    • Item 132 #17h (Delegate Simonds) | Item 132 #6s (Senator Roem) | State Council of Higher Education for Virginia (SCHEV) | FY25: $625,000; FY26: $625,000
      • HB 207 & SB 318 – Funding to establish the Hunger-Free Campus Grant Program to address student food insecurity at public institutions of higher education. 
    • Item 120 #3h (Delegate Cousins) | Item 117 #6s (Senator Roem) | DOE | FY25: $60,000; FY26: $60,000
      • Expands work related to farm-to-school food via the Farm-to-School Program Task Force, particularly in relation to experiential student learning opportunities. 

    View Voices’ Bill Tracker to keep up with Economic Security bills that we are supporting and monitoring: https://vakids.org/our-news/blog/voices-for-virginias-children-2024-legislative-agenda

  7. Investing in Health Equity During the 2024 Legislative Session

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    As we enter the 2024 legislative session, we are also nearing the end of Medicaid Unwinding, which began in March 2023. Over 81,000 children and youth in Virginia have been terminated from Medicaid coverage during unwinding—many for procedural reasons rather than ineligibility—adding to the roughly 87,000 children in Virginia who are uninsured due to administrative guidelines and barriers, language and literacy barriers, and immigration status requirements.

    Lawmakers have an opportunity this session to prioritize expanding health care coverage and equitable access to health care services in all communities. Young people and their families deserve a health care system that:

    • Promotes the improvement of health outcomes through preventative care;
    • Provides culturally responsive and gender-affirming care; and
    • Prioritizes a workforce that is reflective of Virginians.

    Children’s Health Care Coverage

    In Virginia, about 4.5% of children don’t have health care coverage. And 57.5% of all uninsured Virginia children meet income eligibility requirements for Medicaid and FAMIS, meaning that barriers to access, rather than ineligibility or lack of interest, are preventing them from being insured.

    A deep dive into the data shows the stark inequities in health care coverage depending on a child’s immigration status. While children who are citizens have an uninsured rate of 3.7%, Virginia children with undocumented status are estimated to have an uninsured rate of 48%.

    Undocumented and uninsured children currently navigate a patchwork safety net system to access health care services. These systems are difficult to navigate and are costly to families and the state. Investing in the health of children and youth now means a healthier future.

    Budget Amendments

      • Item 289 #1h (Del. Tran) | Item 289 #1s (Sen. Hashmi) | DMAS | FY25: $7.3 million; FY26: $11.96 million
        • “Cover All Kids” funding would establish a health coverage program, which would mirror Medicaid/FAMIS, available to children from low-income families regardless of immigration status.

    Maternal and Infant Health

    As reported by the Virginia Maternal Mortality Review Team, Virginia’s maternal mortality rate more than doubled between 2018 and 2020 from 37.1 deaths to 86.6 deaths per 100,000 births, and Black women continue to experience higher rates of pregnancy-associated deaths compared to their white counterparts (80.5 vs. 53.9, respectively). Despite Virginia’s progress in supporting policies to address disparities in maternal health care—such as FAMIS Prenatal Coverage, 12 months postpartum continuous Medicaid coverage, and Medicaid benefit for doula services—systemic issues and racial disparities continue to persist, leaving many birthing people without access to the quality maternal health care they deserve.

    And even with increased maternal care coverage, the availability of birth hospitals, clinics, and providers is heavily impacted by geography.

    March of Dimes reported that in Virginia, 30.8% of counties are defined as maternity care deserts and 14.8% of birthing people had no birth hospital within 30 minutes from them. Rural communities suffer most from maternal care deserts, with only 1.8% of maternity care providers practicing in rural counties in Virginia.

    Policies that expand maternal care and birthing options will continue to provide birthing people with autonomy and choice throughout pregnancy and during and after birth. Expanding care options, education, and capacity around pregnancy and birth are essential to reducing maternal mortality rates.

    Budget Amendments

      • Item 283 #4h (Del. Willett) | VDH | FY25: $683,053; FY26: $638,053
        • Funding to sustain the increasing cost of administering Population Health Surveys, specifically the Behavioral Risk Factor Surveillance Survey (BRFSS), Virginia Youth Survey (VYS), and Pregnancy Risk Assessment Monitoring System (PRAMS), and support for the oversampling of priority populations. Funding shall also be used to support the Population Health Survey Unit Lead position.
      • Item 285 #10h (Del. Hayes) | Item 285 #2s (Sen. Locke) | Dept. of Health Professions | FY25: $50,000
        • Requires the Board of Medicine to establish a continuing education mandate of unconscious bias and cultural competency training for all licensed medical professionals service individuals who are pregnant or may become pregnant.
      • Item 271 #10h (Del. Ballard) | Item 271 #3s (Sen. Hackworth) | VDH | FY25: $1 million; FY26: $1 million
        • Establishes the Virginia Maternal Health Loan Repayment Program.
      • Item 273 #2h (Del. Carr) | Item 273 #2s (Sen. Carroll Foy) | VDH
        • Item 273 #2h: FY26: $300,000
        • Item 273 #2s: FY25: $250,000; FY26: $250,000
        • Establishes the Fetal and Infant Mortality Review Team to develop and implement procedures, including collecting and reporting triennial data, to ensure that fetal and infant deaths occurring in the Commonwealth are analyzed in a systematic way.
      • Item 273 #3h (Del. McQuinn) | VDH | FY25: $150,000; FY26: $150,000
        • Reestablishes the Task Force on Maternal Health Data & Quality Measures.
      • Item 273 #5h (Del. Cousins) | Item 273 #3s (Sen. Aird) | VDH | FY25: $116,797 | 1 FTE; FY26: $120,263 | 1 FTE
        • Provides funding for one position in the Office of the Chief Medical Examiner for a Maternal Mortality Workgroup Coordinator.
      • Item 277 #4h (Del. Herring) | Item 277 #3s (Sen. Carroll Foy) | VDH | FY25: $150,000; FY26: $150,000
        • Funding to promote engagement in maternal and child health initiatives in Virginia private acute care hospitals, including implementing Title V block grant initiatives and data analytics programs related to advancing health equity and reducing maternal health disparities.
      • Item 277 #10h | Del. Earley | VDH | FY25: $100,000
        • Virginia Department of Health to study and report on obstetric/gynecological and maternity care access throughout the Commonwealth.
      • Item 288 #38s (Sen. Hashmi) | DMAS | FY25: $50,000; FY26: $50,000
        • SB 250 – directs the Department of Medical Assistance Services to modify the state plan for medical assistance to include a provision allowing for reimbursement under certain conditions for remote ultrasound procedures and remote fetal non-stress tests.

    Workforce

    Virginia is experiencing significant shortages of health care providers across many of our health care settings—from pediatrics, to primary care, to hospital settings. According to a study completed by the Virginia Health Workforce Development Authority, 102 of 133 Virginia counties and equivalents are federally designated primary care Health Professional Shortage Areas (HPSAs), which impacts 29% of Virginians. Workforce challenges lead to inequitable access to health care services and disparities in health outcomes.

    Voices is supporting and advocating for budget amendments this session that will improve reimbursement rates for providers and will address the recruitment and retention of a diverse health care workforce.

    Governor’s Proposed Budget Items:

      • Enhance Nurse Preceptor Incentive Program | VDH | $6 million across the biennium
      • Establishes Earn to Learn Nursing Education Acceleration Program | VDH | $8 million across the biennium
      • Additional support for Nursing Scholarships and Loan Repayment Program | VDH | $1.87 million across the biennium

    Budget Amendments

      • Item 288 #68h (Del. Sickles) | Item 292 #7s (Sen. Pillion) | DMAS | FY25: $250,000 GF/$250,000 NGF
        • Ensures sustainable, long-term access to Community Health Workers by creating a process and timeline for Medicaid to reimburse for CHW services.
      • Item 288 #11h (Del. Carr) | Item 288 #15s (Sen. Deeds) | DMAS
        • Item 288 #11h: FY25: $21.5 million GF / $45 million NGF; FY26: $28.2 million GF / $45 million NGF
        • Item 288 #15s: FY25: $21.5 million GF / $45 million NGF; FY26: $21.5 million GF / $45 million NGF
        • Provides funding to increase Medicaid reimbursement rates for services provided by primary care physicians, pediatricians, and psychiatrists by five percent.
      • Item 278 #3h (Del. Sickles) | Item 278 #3s (Sen. Aird) | VDH | FY25: $3 million; FY26: $3 million
        • Preserves access to 100+ state-employed Community Health Workers at risk of losing their jobs beginning July 1, 2024.
      • Item 285 #13h (Del. Tran) | Dept. of Health Professions | FY25: $50,000 NGF; FY26: $50,000 NGF
        • Permits the Board of Medicine to issue a provisional license to a physician licensed in a foreign country for no more than two years, and a subsequent renewable two-year license if the physician practices in a medically underserved area. After two years of practice, a physician licensed in a foreign country is eligible to apply for a full, unrestricted license to practice medicine.

    View Voices’ Bill Tracker to keep up with Health Equity bills that we are supporting and monitoring: https://vakids.org/our-news/blog/voices-for-virginias-children-2024-legislative-agenda

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  8. 2023 General Assembly Budget Passes with Significant Investments for Youth and Family Well-Being

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    In the world of politics and public policy, budgets play a pivotal role in driving change and progress. They serve as the financial blueprints that determine the extent and influence of services and programs in our communities.  

    The 2023 final budget arrives at a critical juncture, coinciding with a pressing crisis in youth mental health and a period where families are grappling with heightened poverty levels compared to the past three years.  

    In this blog post, we will illuminate key budget areas that have a direct impact on young people and their families. Additionally, you can stay informed by signing up for our policy newsletter, as we’ll be sharing insights into Governor Youngkin’s signature budget proposal in December. 

    Notable investments in the final budget compromise 

    For a full overview of bills we supported, monitored, and opposed, visit our 2023 Legislative Agenda and Outcomes page. 

    Early Care and Education

    Promoting accessible and affordable early education and child care helps families work and helps children learn.

    No additional money was included in the budget for Child Care Subsidy, Virginia Preschool Initiative (VPI), or Mixed Delivery – the package reflects funding levels in the biennial budget.  

    • The budget did include authorization of waivers for altering staff-to-child ratios in licensed child day centers and child day centers that participate in the Child Care Subsidy Program. To read the full details, click here. 

    Mental Health 

    We will not accept a mental health system that treats children and youth as “phase two” — our system should prioritize children and youth to foster a lifetime of mental health and wellness. 

    The 2023 budget creates a strong foundation for building and supporting a comprehensive continuum of mental health services that span from prevention to crisis. Many of the investments reflect components of Governor Youngkin’s signature behavioral health proposal, “Right Help, Right Now.” We are pleased to see a priority on youth mental health and an effort to transform the system to offer services and support whenever and wherever young people need them. 

    • $58 million to expand and modernize the comprehensive crisis services system (additional Crisis Receiving Centers, Crisis Stabilization Units, and enhancements to existing sites)  
    • $10 million in one-time funding for mobile crisis units in underserved areas  
      • There are currently 32 mobile crisis teams across the Commonwealth 
    • $4.2 million in additional funding for children’s behavioral health services, bringing total funding to $12.6 million (first increase since 2017) 
      • The compromise does not include the updated language suggestions, which would have supported flexible use of the funds 
    • $10 million for up to 3 comprehensive psychiatric emergency programs in emergency departments, including public-private partnerships  
    • $5 million in additional funding for school-based mental health integration grants through public or private provider partnerships, bringing total funding to $7.5 million 
      • The compromise does not remove the word “pilot” from the language, as the Governor’s budget proposed 
    • 10% rate increase for Medicaid-funded community-based services ($8.7 million):  
      • Intensive In-Home, Mental Health Skill Building, Psychosocial Rehabilitation, Therapeutic Day Treatment, Outpatient Psychotherapy, Peer Recovery Support Services — Mental Health 
      • Comprehensive Crisis Services (23-hour Crisis Stabilization, Community Stabilization, Crisis Intervention, Mobile Crisis Response, and Residential Crisis Stabilization), Assertive Community Treatment, Mental Health – Intensive Outpatient, Mental Health – Partial Hospitalization, Family Functional Therapy and Multisystemic Therapy 
    • $4.4 million inflation adjustment for the first three STEP-VA services: Same Day Access, Primary Care Screening, and Outpatient Services
    • $4 million in additional funding for Virginia Mental Health Access Program (VMAP) to expand to early childhood mental health and perinatal mental health, bringing total funding to $10.8 million  
    • $1.5 million for the Behavioral Health Loan Repayment Program for psychiatrists, licensed clinical psychologists, licensed clinical social workers, licensed professional counselors, child and adolescent psychiatrists, psychiatric physician assistants, psychiatric pharmacists, and psychiatric nurse practitioners
    • $18 million for a 5% salary increase for Community Services Board (CSB) staff, effective January 1, 2024
      • This increase is in addition to the 2% increase for state supported local agencies

    Child Welfare 

    The child welfare system was created to address family disruptions and to protect children and youth; the future of the system focuses on preventing disruptions and giving youth the tools to succeed. 

    We are glad to see the investments to support kinship caregivers—it is past time that we provide similar levels of support to relatives and kinship caregivers that we provide to foster parents. Unfortunately, funding was not included for the Driver’s License Program for foster youth that we have been working towards since the funding was unallotted during the COVID pandemic. We are also disappointed to see that funding was not included for the Parent Legal Representation Pilot. Both of these issues were identified during the Foster Care Caucus meeting in February as priorities for supporting children and families involved in the child welfare system. 

    • Salary increases for local child welfare workers – $30 million 
    • Training and QA for Local DSS – $10.5 million  
    • Continue of the Enhanced Treatment Foster Care Pilot – $1.1 million 
    • The Dept. of Social Services (DSS) shall develop a plan to provide access statewide to a Kinship Navigator Program which will provide services to kinship caregivers who are having trouble finding assistance for their unique needs and to help these caregivers navigate their locality’s service system, as well as federal and state benefits (language only) 
    • Support for Safe and Sound Taskforce – $3 million 
    • Implement pilot programs that increase the number of foster care children adopted – $3 million 
    • Foster care agencies to cover the costs of coordination, recruitment, and additional training – $200,000 
    • The DSS shall create an emergency approval process for kinship caregivers and develop foster home certification standards for kinship caregivers  
    • Development of collaborative partnerships between local departments of social services to increase capacity to approve kinship caregivers and recruit, train, and develop locally approved foster parents – $600,000 
    • Implement Office of the State Inspector General (OSIG) child protective services recommendations – $8.2 million 
    • Convene a workgroup to examine inclusion of residential treatment services in managed care (language only) 

    Health Care Access 

    All children in Virginia must have accessible health care regardless of income, race, ethnicity or geography. 

    While there are investments to address workforce needs and reimbursement rates, the budget did not go as far as it could have to ensure all children have access to health care coverage and high-quality care. The budget did not include funding for Cover All Kids or the Medicaid benefit study for Community Health Workers, both of which would have contributed to young people having uninterrupted access to culturally-responsive health care, particularly non-citizen children with undocumented status. 

    • $38 million NGF to support Dept. of Medical Assistance Services (DMAS) and local Dept. of Social Services (DSS) agencies during the 14-month Medicaid unwinding period  
      • This funding was allocated in the “skinny” (stopgap) budget passed by the General Assembly and Governor in April 2023 while full budget negotiations were still taking place 
    • $3 million in additional funding for the Nursing Preceptor Incentive Program, bringing the total funding to $3.5 million  
      • Adds Licensed Practical Nurse and Registered Nurse to the list of providers who are eligible for the program 
    • DMAS has authority to begin the reprocurement process for managed care services 
      • The RFP was released August 31, 2023 and DMAS is preparing for a summer 2024 implementation 
      • The procurement reflects DMAS’ goals to improve services, delivery and access in Right Help Right Now Behavioral health focus, maternal and child health, member engagement, single specialty plan for foster care, innovation, new technology, performance and quality improvement incentives, new payment models and increased accountability 
      • Cannot include any new services in the contract unless authorized by General Assembly 
      • Cannot create any future funding commitments unless authorized by General Assembly 

    Family Economic Security 

    Experiencing economic hardship impacts every aspect of a child’s life; a child cannot be healthy or ready to learn unless their family budget can provide for their day-to-day needs. 

    The Governor’s proposed budget included nearly $1 billion in permanent, costly, and untargeted tax cuts that disproportionately benefited wealthy individuals and corporations. The compromise provides $96.2 million in permanent tax cuts, preserving funds in future budgets to be invested in critical and underfunded services, such as education and health care. 

    • During tax year 2024, there will be a modest increase for the state standard deduction ($8,500 for single filers and $17k for joint filers): budget impact = $48.1 million 
    • This fall, taxpayers will receive one-time rebates of $200 for single filers and $400 for joint filers: budget impact = $906.8 million  
      • These are nonrefundable, which will leave out some of our lower-income community members.  
      • These rebates also do not take into consideration family size. 
    • Lawmakers unfortunately failed to advance legislation to continue strengthening Virginia’s Earned Income Tax Credit (EITC) or establish a state Child Tax Credit (CTC). 
    • The budget does not include the 10% increase in Temporary Assistance to Needy Families (TANF) eligibility and assistance that the Senate proposed 
    • The budget does not include the proposed increase in funding for the “Virginia CASH Campaign” to support tax filing preparation at community action agencies 

    Student Belonging and Connection 

    Positive school climates are necessary for students to feel safe, accepted, and connected to their school environments. 

    While the budget invests over $600 million in our public school system, the one-time nature of this funding limits our ability to address the long-term implications of workforce shortages and the immediate need for wraparound student supports. 

    • $152.3 million to get Virginia closer to lifting the cap placed on school support staff.  
    • $418 million in flexible one-time support for the implementation of the Virginia Literacy Act, learning loss recovery, and additional operating and infrastructure support 
    • $54.6 million for the state share of an additional 2% salary increase for school personnel 
      • A 5% increase was already budgeted, bringing the total salary increase to 7% 
    • By not increasing funding for the Virginia Tiered Systems of Support, the budget fails to invest in a positive behavioral interventions and supports program and professional development for educators focused on trauma-informed care 

    Additional Investments for Young People 

    Young people deserve a world where their potential is not predictable by race, gender identity, socioeconomic status, or geography. But as we know, there are barriers present that prevent young people and their families from thriving. The budget includes measures to address some of those barriers, such as funding to facilitate language access at state agencies and funding to support holistic, community-based strategies to address community violence and gun violence. 

    • $2.5 million for state agencies to facilitate and improve language access
      • Virginia Dept. of Social Services (VDSS) and Secretary of Health and Human Resources (HHR) to develop a process for receiving requests and administering the grants to state agencies 
    • $10 million for the Safer Communities Program 
      • Supports strategies that address the root causes and conditions of community violence, such as after school programs and mentorships, connections to education and economic opportunities, and trauma-informed mental health care 
      • Establishes the Office of Safer Communities under the Dept. of Criminal Justice Services (DCJS) 
    • $5 million in additional funding for the Firearm Violence Intervention and Prevention Fund to support community engagement and youth programs 
    • Dept. of Juvenile Justice (DJJ) required to provide report to General Assembly money committees by December 1, 2023 on the impact of the Length of Stay Guidelines that were adopted by the Board of Juvenile Justice in November 2022 
  9. Child Poverty is a Policy Choice

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    On September 12, the U.S. Census Bureau released the findings of three reports estimating income, poverty, and health insurance coverage in the United States. According to the Supplemental Poverty Measure (SPM), the overall rate of poverty increased from 7.8 percent in 2021 to 12.4 percent in 2022. The most dramatic change, however, was the sharp increase in child poverty.  

    Child poverty increased from a record low of 5.2 percent in 2021 to 12.4 percent in 2022, largely due to expiration of the expanded child tax credit. 

    The Supplemental Poverty Measure (SPM) indicates that poverty rates increased for all groups of children, but Black and Hispanic children continued to experience disproportionately high rates of poverty. 17.8 percent of Black children and 19.5 percent of Hispanic children experienced poverty in 2022, compared to 7.2 percent of non-Hispanic white children.  

     
    U.S. Census Bureau, Poverty in the United States: 2022

    Understanding the Child Tax Credit

    In 2021, as part of the American Rescue Plan, the expanded Child Tax Credit (CTC) was implemented to provide advanced monthly payments at an increased amount to families to help them put food on their tables and pay for their day-to-day needs.  

    The CTC was fully refundable, which means it was available to families who had no reported earnings or federal income tax liability. And the expanded CTC worked—it kept 2.9 million children of out poverty, cutting the child poverty rate almost in half to a record low, and reduced the poverty rate of Black children and Hispanic children by 6.3 percentage points each. 


    Center for Law and Social Policy (CLASP), How to End Child Poverty for Good 

    Unfortunately, the expanded CTC expired at the end of 2021, leaving over 350,000 children in Virginia ineligible for the full Child Tax Credit because their families’ earnings are too low or because there are no adults in the workforce.  

    At a time when inflation has made it even more difficult to afford necessities like housing, food, and utilities, the end of pandemic-era benefits has made it increasingly difficult for families to support the health and wellbeing of their children.  

    As monthly child tax credit payments ended and families’ incomes decreased, the child poverty rate increased, and families experienced more financial strain and higher levels of food insecurity. 

    When parents and caregivers cannot provide the necessities to keep their families well, they feel stressed, and their children are impacted by this stress and lack of resources. For families to achieve economic stability, we must intentionally remove barriers to thriving. 

    Poverty is often a result of policy decisions made by lawmakers rather than choices made by individual families and communities. Our federal and state lawmakers witnessed the benefits of policies like the expanded CTC, continuous Medicaid coverage, and SNAP emergency allotments, and still decided not to extend the support or make them permanent programs.  

    Virginia made progress in 2022, when the General Assembly approved a state refund for a portion of the Earned Income Tax Credit (EITC) available to low-income working families. Additionally, the 2023 state budget, passed in September 2023, will provide one-time tax rebates of $200/$400 this fall to individuals or couples with taxable income. Unlike the EITC, these rebates are nonrefundable, and family size will not be factored into the payment—only marital status. Nonrefundable rebates benefit households with an income tax liability, whereas refundable rebates benefit all households. A rebate program should be well targeted and family-friendly by making rebate checks refundable and by accounting for dependents—then a wealthy individual making $300,000 a year does not receive the same amount as a working mother of 2 children making $60,000 a year. Clearly there is more that must be done to support families and address this sharp increase in child poverty.  

    As we near the 2024 legislative session, when our General Assembly members will be making decisions for our next biennial budget, developing a state-level Child Tax Credit and expanding the state-level EITC will be imperative to supporting families’ economic stability.

    Establishing a State-level Child Tax Credit

    Establishing a state-level CTC would benefit more than 1 million children in Virginia. As detailed in the 2023 legislation introduced by former Senator Jennifer McClellan and Delegate Kathy Tran, the state-level CTC would create a refundable $500 child tax credit per child under 18 in households earning less than $100,000 each year 

    The temporary expansion of the federal CTC demonstrated that direct cash support to families is one of the best ways to help them meet their needs and research on the federal child tax credit found that families used the additional funds to pay for food, utilities, and clothing.


    The Commonwealth Institute for Fiscal Analysis (TCI), January 2023

    Voices, alongside our partners at The Commonwealth Institute for Fiscal Analysis (TCI) and the Tax Fairness Coalition, will be pursuing state-level CTC legislation during the 2024 General Assembly session. Sign up for our Policy newsletter, Voices from the Capitol, to stay up to date on how you can advocate for a state-level CTC during the 2024 General Assembly session. 

    Expanded State-level Earned Income Tax Credit

    Over 600,000 families in Virginia currently receive the federal EITC. As of 2022, Virginia gives tax-filers an option: claim a state-level EITC up to 20 percent of a family’s federal EITC that does not exceed any income tax owed or claim a state EITC at 15 percent of the federal EITC and receive a refund of the amount that exceeds what was owed in income taxes. Making Virginia’s version of the credit refundable means that instead of just reducing how much a low-income tax filer owes without giving money back, the refundable EITC can now lead to a bigger refund or provide a refund that otherwise wouldn’t exist. The exact size of the credit depends on a tax filer’s income, marital status, and how many children they have. Check out this blog from The Commonwealth Institute (TCI) on the impact of Virginia’s EITC options.  

    Continuing to strengthen Virginia’s EITC to make the credit refundable at 20% of the federal credit would go even further to benefit families and provide economic relief to those who need it most. Delegate Cia Price championed a bill during the 2023 legislative session to expand the EITC to 20 percent of the federal credit, but it unfortunately did not pass. Lawmakers should prioritize bringing this bill back during the 2024 legislative session. 

     

    By targeting tax credits to low-income families, these refunds benefit Black and Brown families who have been disproportionately impacted by low wages and policies that created racial inequities in access to wealth.  

    As indicated in the 2023 KIDS COUNT Data Book, Black children in Virginia are more likely to live in poverty and have a parent who lacks full-time, year-round employment. Choices to expand the EITC and to target a state-level Child Tax Credit can provide more financial resources to the families who have often been left behind. 

    When we prioritize children and families in our policy choices, we can strengthen our future. It’s time to deepen our commitment to ensuring that families have the resources needed to thrive by offering targeted tax relief to families.

  10. Health, Healing, and Hope for Children: Voices’ trip to the Children’s Hospital of the King’s Daughters

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    Pictured above, from left to right: Jack Warburton, VP of Mental Health Service Line at CHKD; Stephanie Osler, Director of Mental Health Service Line at CHKD; Allison Gilbreath, Sr. Director of Policy and Programs at Voices; Rachael Deane, CEO at Voices; Emily Moore, Policy Analyst and Voices; and Bryant Thomas, VP of Advancement at CHKD 

    Take a moment to think about the way you would describe an inpatient psychiatric care facility. Do words like “sterile” and “institutional,” and maybe even “uninviting,” come to mind? I think many of us imagine white walls, speckled tile floors, and no natural light. The Voices team was lucky to see a new approach and a different reality last week when we visited the Children’s Pavilion at Children’s Hospital of the King’s Daughters (CHKD) in Norfolk.  

    The Children’s Pavilion is a holistic wellness checkpoint for young people, offering general pediatrics and sports medicine in addition to inpatient and outpatient mental health services. Housing all these services under one roof supports the integration of mental and physical health care, reducing stigma and ensuring young people get the full breadth of care they need to thrive. Of course, we as professionals were thrilled to see these services available, but the real question was, “How do you make this a place that young people and their families feel comfortable coming to for support?” The answers became abundantly clear as Jack, Stephanie, and Bryant (pictured above) gave us a tour.  

    From the moment you exit the parking garage, you are met with vibrant colors, comfortable seating options, and an abundance of natural light. As we have noted in a previous blog post, designing physical facilities with young people’s needs in mind is just as critical as the design and implementation of services. So, while we were there to learn about their mental health services, we quickly became interested in the physical, built space and the “why” behind their design choices.

    Artwork from Massachusetts artist Joseph Wardell in the garage lobby with CHKD’s mission statement, “Health, Healing and Hope for All Children” 

     

    Some highlights of how CHKD’s built environment is trauma-informed, healing-focused, and family friendly are:  

    • Vibrant artwork in a variety of mediums, from blown glass to kinetic sand art to repurposed old vinyl records: CHKD has a webpage dedicated to showcasing the use of art to create a healing environment.   
    • Space for play: The top floor of the Pavilion towers 14 stories over the Hampton Roads area, with incredible views of downtown Norfolk, the Elizabeth River, and the naval ships nearby. But that’s not even the best part—the top floor is dedicated to recreation, featuring a basketball court, a grassy turf area, and horticultural benches for gardening.  
    • Creative expression: The 13th floor integrates inpatient beds with opportunities to be creative, through an indoor exercise studio, a music therapy and recording studio, and an art therapy room.  
    • Keeping patients safe: The inpatient rooms were designed with both comfort and safety in mind. They have textured walls for soothing sensory input, color changing lights above the bed, and large windows with a view of the naval ships and water. But the elements that are less obvious and extremely important are the safety features like the specially designed door handles, impact-resistant glass and drywall, and concealed sprinklers. 
    • Family lounge: A space for family members to grab a snack, take a breather, catch up on work, and connect with other parents who are navigating a similar journey.

     

    CHKD’s Art Therapy Room

    CHKD’s Indoor Recreation Center

    When planning for the Children Pavilion’s design and programming, the focus on integrating family members into their child’s care was at the forefront. Stephanie shared with us that visiting hours for family members are very liberal—families don’t have to adhere to the typical 8 am to 8 pm visiting hours that you would see at most hospitals. Instead, the inpatient rooms are private rooms equipped with two beds so that a parent or caregiver can spend the night. We know the importance of engaging families as partners in the mental health treatment of their children, as a young person’s mental health needs do not exist in a silo outside of their family and environment.

    We were blown away at the intentionality and care put into providing support to young people at the Children’s Pavilion. And we were also curious about what happened when a young person left the facility and went back home and into their community. What does the follow through and continuum of care look like at a time when mental health services for young people are scarce and providers have long waiting lists? Jack shared that in addition to community partnerships and referrals, CHKD has five locations in surrounding communities to provide outpatient therapy, intensive outpatient care, and partial hospitalization services. Continuity of care is deeply important, so CHKD clinicians and social workers ensure that there is a discharge plan in place and do their best to connect children to community-based support as needed.  

    But as we are seeing across the Commonwealth, there are still barriers to ensuring all children have access to mental health care in their communities. CHKD is not immune from the challenges we are seeing across the mental health field, including struggling to fill enough positions to have a robust workforce that meets the immense need and navigating reimbursement rates that do not accurately reflect how much it costs to provide care.  

    As the Virginia Health Care Foundation points out in their Assessment of the Capacity of Virginia’s Licensed Behavioral Health Workforce, we suffer from a severe shortage of child and adolescent psychiatrists and 3.2 million Virginians live in a federally-designated Mental Health Professional Shortage Area. CHKD is fortunate to have been able to hire 17 child and adolescent psychiatrists for the Children’s Pavilion, but they still face barriers with insurance credentialing and reimbursement rates. They acknowledged how restrictive the regulations have been regarding who can provide care and who can get paid for providing the care—for example, there are complicated billing processes for residency and counseling students who are working towards licensure. Voices was proud to share that there was legislation passed during the 2023 General Assembly session (HB 2262) to streamline insurance credentialing and remove administrative barriers to new clinicians getting paid in a timely manner through managed care insurance organizations (MCOs). 

    Takeaways and Hopes for the Future 

    Voices’ CEO Rachael shared that this visit was inspiring to her as a professional, but even more so as a parent. At a time when Virginia ranks 48th in the nation for youth mental health, we find hope in the collective efforts to transform the way Virginia provides mental health care to young people. We also know that there is a long road ahead until we have a truly comprehensive continuum of mental health care across the state. This path forward is one that requires investment from our state lawmakers and our localities, and one that allows us to look beyond the current system to reimagine what is possible and create a world where children and youth can thrive. 

    We have a roadmap to transform our behavioral health system through expanding school-based mental health services, investing in more youth-serving community crisis supports, and supporting the workforce in our Community Services Boards and private providers. We also have a commitment from our Governor and bipartisan support from state lawmakers to invest a historic amount of funding into transforming this system. We are hopeful that we will soon see a final budget that acknowledges the importance of these investments and puts young people’s mental health needs at the forefront. When the investments are made, we look forward to seeing many of these healing elements that we saw firsthand at CHKD be incorporated into the implementation of new and expanded services across the Commonwealth.