For a spreadsheet of 2025 investments in Health Equity budget priorities across each step of the budget process, click here. 

Medicaid is a lifeline for nearly 2 million Virginians’ health coverage – including over 750,000 young people. Yet, the rates of uninsured children have increased, and 4.6% of Virginia children are left without health insurance coverage. Even more concerning, 6% of children in households below 200% poverty threshold, who would be income eligible for Medicaid/FAMIS, were uninsured in 2023.  

We know that young people and their families face obstacles as they seek care, including administrative burdens, language barriers, and literacy barriers. Additionally, there are stark inequities in health coverage depending on a child’s immigration status, leaving 13,000 children without access to health coverage.  

Legislators on Virginia’s House Appropriations Committee and Senate Finance & Appropriations Committee released their respective budgets over the weekend, colloquially known as “Budget Sunday.” It is clear that our lawmakers had a lot to consider as they worked to craft an amended budget for fiscal years 2025 and 2026—Virginia is facing a $630 million Medicaid budget shortfall over the next two years, as well as grave uncertainty regarding what will take place with proposed cuts to Medicaid at the federal level. Unfortunately, that meant not being able to make critical, substantive investments in initiatives that would ensure young people stay enrolled as long as they remain eligible and to prevent more young people from losing health coverage. 

Voices’ children’s health coverage budget priorities were not included in either
the house or senate budget

• Continuous Medicaid Eligibility for Children aged 0-6 (Item 288 #50h Del. Rasoul | Item 288 #3s, Sens. Boysko & Srinivasan) 
  • Would ensure that young children maintain their health care coverage without frequent re-enrollment or eligibility reassessments and regardless of changes in family circumstances. This policy is designed to promote early childhood health by ensuring uninterrupted access to affordable medical care during critical developmental years. 

• Cover All Kids (Item 289 #2h, Del. Tran | Item 289 #1s, Sen. Hashmi) 
  • Would establish a health coverage program in Virginia that would cover children from low-income families regardless of their immigration status. 

• Increase Upper Income Eligibility for Children’s Health Insurance Program (Item 287 #1s, Sen. Srinivasan) 
  • Would increase the eligibility threshold for FAMIS from 205% FPL to 255% FPL. Virginia has the second-lowest income eligibility in the nation, with Idaho (190% FPL) having the lowest income eligibility. Meanwhile, the median CHIP income eligibility is 255% FPL across the United States.  

Investments in Maternal Health

Despite the legislature making the decision to not make further investments in children’s health coverage at this time, they did invest substantially in maternal health initiatives. Addressing Virginia’s worsening maternal health crisis will require structural changes in a broad range of areas. While Medicaid is a critical payer for maternal health, there are also many programs outside of Medicaid that build upon efforts to grow and diversify the perinatal workforce, increase access to quality perinatal care, and build a more robust infrastructure. Many of the policies funded in the budget were featured in the Momnibus Package. 

• Remote Patient Monitoring for Pregnant and Postpartum Patients | Included in House Budget 

• Midwife Parity in Medicaid Reimbursement | Included in House and Senate Budgets 

• Increase Medicaid Benefit for Postpartum Doula Visits from 4 to 6 | Included in House Budget 

• Medicaid/FAMIS Presumptive Eligibility for Pregnant Individuals | Included in House Budget 

• Comprehensive Dental Services for Pregnant Individuals | Included in House Budget 

• Perinatal Health Hub Pilot Program | Included in Governor’s budget, and retained in the House Budget 
  • Senate budget removes Dept. of Health and replaces with Virginia Neonatal Perinatal Collaborative 

• Maternal Mobile Health Clinics | Included in House and Senate Budgets 

• Postpartum Depression Public Awareness & Education Campaign | Included in House and Senate Budgets 

• Pregnancy Mobile Application for Medicaid Members | Included in House and Senate Budgets 

• Community Grants for Maternal Mental Health Care Programs | Included in House Budget 

• Billing Hub for Doulas Administered by Birth in Color | Included in House Budget 

Investments in Medicaid System Improvements 

As a result of Virginia’s Medicaid budget shortfall and a recent study that revealed that Virginia’s eligibility and renewal systems are not functioning adequately to meet public demand, the Senate Finance & Appropriations Committee took additional steps to invest in funding and direct language to ensure stricter and more thorough oversight of Virginia’s Medicaid program and financing.

• Oversight of Medicaid Program | Included in the Senate Budget  

• Improving Timely and Accurate Medicaid Eligibility Processing | Included in Senate Budget 

• Cost Estimates for Medicaid Eligibility System Fixes and Establish Joint Medicaid Steering Committee | Included in Senate Budget 

• Medicaid Financial Oversight Council | Included in Senate Budget 

• Office of Medicaid Financial Oversight (SB 1164) | Included in Senate Budget 

Addressing Virginia’s Medicaid Expansion Trigger Language 

Additionally, Virginia’s Senate members doubled down on their commitment to ensuring that we do not disenroll over 630,000 adults covered by Medicaid Expansion if proposed cuts happen at the Federal level. Senators Deeds and Hashmi brought forth language that was included in the Senate budget to require the Joint Subcommittee for Health and Human Resources Oversight to meet and begin immediate consideration of the financial impact to the commonwealth from the loss of federal assistance for the Medicaid Expansion population prior to disenrolling those individuals from coverage.  

Next Steps 

As advocates often say, a budget is a statement of values. The House and Senate budgets each provide critical investments in health equity, despite the challenges and uncertainty we are facing. But we know that there is still much more that Virginia can do to uphold our commitment to young people—addressing the multifaceted challenges facing Virginia’s children requires a concerted effort to implement policies that promote their health and well-being.  

Virginia’s budget conferees must spend ample time speaking with advocates and community-based providers as they craft the conference budget, which will be released at the end of February, to understand exactly which investments will make the most impact on communities’ ability to easily enroll in health coverage and access the health services they need. 

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