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

• Support Comprehensive Health Care Coverage for All Children by sending this action alert to your lawmakers
  
• Support Funding for Crucial Population Health Survey Data Collection by sending this action alert to your lawmakers
• Support Unconscious Bias and Cultural Competency Training for Health Professionals by sending this action alert to your lawmakers
• Support Sustainable, Long-term Access to Community Health Workers by sending this action alert to your lawmakers

 

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