Voices’ Blog

Working to improve health insurance access in Virginia

Posted:  -  By: Margaret Nimmo Holland

Update 2/23/18:

Yesterday, the House and Senate voted on their versions of the budget, which are actually their changes to the budget introduced by outgoing Gov. Terry McAuliffe in December. The two chambers are very far apart because of their stances on Medicaid expansion: the House included it, and the Senate stripped it out.

By bringing back to Virginia $2.5 billion in federal dollars that Virginians have already paid through taxes, the House plan for Medicaid expansion provided $371 million in savings for the biennial budget. These additional funds allowed the House to provide more funding for health initiatives, as well as for public education and other priorities that are important to child advocates.

In the House’s version, Medicaid expansion would be a two-part process. First, Virginia would amend the Medicaid state plan to allow coverage for individuals up to 138% of the federal poverty level (FPL). Second, and simultaneously, Virginia would start development of a waiver application for its Medicaid program to institute work requirements, cost-sharing, and other changes to the program. You can read more about the details in this Richmond Times-Dispatch article by Michael Martz.

Voices for Virginia’s Children continues to be supportive of Medicaid expansion because research shows that when families have health insurance coverage, it is a net positive for child well-being. We believe that the time has come – given circumstances in Virginia and in Washington, D.C. – for Virginia to bring our tax dollars back to our commonwealth and provide health insurance for the estimated 400,000 low-income parents and childless adults who are now uninsured. We are grateful to the House of Delegates for including Medicaid expansion in its budget, and we are hopeful that the Senate will continue to have discussions about this issue in the remaining weeks of the session.

For child advocates, it’s not over yet! It is a critically important time to call your state senator and let him or her know you are supportive of Medicaid expansion.

Update 2/16/18:

The debate around whether to expand Medicaid in Virginia continues to be a primary focus of the 2018 General Assembly session. As we’ve discussed, one vehicle to expand Medicaid is through the budget process. This Sunday, known as Budget Sunday, the House and Senate will reveal their amendments to Gov. McAullife’s outgoing biennial budget introduced in December. We hope to see both chambers draw down federal dollars to expand health insurance access to an estimated 400,000 individuals in Virginia, thereby saving Virginia over $138 million during the biennium.

Update 1/26/18:

Whether to expand access to health insurance through Medicaid is one of the most talked-about issues of the 2018 session. If the state decides to expand the program, it can be done solely through the budget. In fact, Gov. McAuliffe’s outgoing biennial budget, does just that.

Additionally, several legislators on both sides of the aisle have introduced bills addressing how they would like Virginia to proceed. Yesterday, the Senate Education and Health Committee had a discussion and voted on some of these bills (SB 282 – Barker, SB 158 – Edwards, and SB 572 – Hanger). All the bills were defeated on a straight party line vote; the eight Republicans voted against the measures, and the seven Democrats voted for them. However, as committee chairman Sen. Newman asserted at the outset of the discussion, yesterday was just the beginning of the conversation about Medicaid expansion.

And, legislation outside the budget is not required from the most straight-forward expansion plans, which Voices and its partners in the Healthcare for All Virginians (HAV) Coalition favor. We are encouraged that this year the issue is being discussed openly and that legislators from both parties have ideas about how to help low-income Virginians gain health insurance. Stay tuned!

Original post 1/19/18:

Voices for Virginia’s Children is a member of the Healthcare for All Virginians (HAV) Coalition, advocating for Virginia to expand Medicaid coverage for low-income adults who are currently without options for health insurance. As many as 400,000 adults could be eligible for Medicaid if Virginia chose to expand its program as allowed by the ACA. Roughly one-quarter of those adults are parents of minor children. Families are more financially secure when all members are covered by health insurance, and research shows parents are more likely to insure their children and take them to the doctor regularly if the parents are also insured.

Virginia’s current Medicaid program

Virginia’s current Medicaid program is very lean, ranking 46th in per capita Medicaid spending. In our commonwealth, pregnant women and children are eligible for Medicaid if their income is less than 148 percent of the federal poverty level (FPL). That’s an annual income of $30,420 for a family of three. Parents must have an income below 52 percent FPL, or $10,524 annually for a family of three (income eligibility varies somewhat by region, but that’s the maximum). Residents who are elderly or disabled are only eligible if their income is below 80 percent FPL. Most childless adults are not eligible for Medicaid in Virginia.

Economic reasons to expand — for families and the state

Expansion of Medicaid would allow adults up to 138 percent FPL to have health insurance. Many people at these income levels do not work at jobs that offer employee health insurance (think restaurants, construction, hotels, retail), or the coverage is too expensive. Recent polling shows that Virginians believe these low-income folks should have access to Medicaid. The attached fact sheet shows 83 percent of Virginians are in favor of expanding Medicaid – Virginians from every region of the state and political party.

In addition to the health and financial benefits to individuals who would gain health insurance, the state also stands to gain economically– $2 billion in new funding annually in the state, supporting 15,000 jobs and producing millions in state budget savings. That’s because our existing Medicaid program is made up of a 50/50 mix of federal and state dollars. If we were to expand Medicaid to more individuals, Virginia would be able to draw down no less than 90 percent federal dollars for that coverage, supplying no more than 10 percent of the cost with state general fund dollars.

Benefits for those with behavioral health needs

The impact of expanding Medicaid would be particularly significant for Virginians with mental health and substance use disorders. First, adults – including transition age youth who are 19 and 20 years old, the age when many mental illnesses begin – would benefit greatly by having health insurance to provide access to needed treatment for their mental health needs. Second, in an attempt to address the opioid crisis, Virginia has developed an impressive array of Medicaid benefits (ARTS) to treat those with substance use disorders. However, few adults addicted to substances can access that treatment because so few currently are eligible for Medicaid. Finally, Virginia is in the process of transforming its entire behavioral health system – through the state Department of Behavioral Health and Developmental Services (DBHDS) and the 40 community services boards (CSBs) – to provide a consistent array of high-quality services in all areas of the state through its STEP-VA plan. Without the significant infusion of federal Medicaid dollars through expansion, however, it will take many years to implement STEP-VA. Meanwhile, Virginians – both adults AND children – will continue to lack access to critical behavioral health services because Virginia does not have adequate general fund dollars to build out the necessary array of services.

Former Gov. Terry McAuliffe’s introduced budget includes expanding Medicaid. Additionally, several bills have been introduced to authorize the state to expand the program in the most direct way possible: amending our state plan for Medicaid to increase the income eligibility (HB 348, SB 158, and SB 282).

Voices and its partners in the HAV Coalition will continue to work on this issue throughout the 2018 General Assembly session, and we’ll update you on various aspects of the discussion as they relate to kids and families.

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