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, over 135,000 children and youth in Virginia have lost their Medicaid coverage during the redetermination process. Of those children and youth, at least 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.   

• Graduate Medical Education Residency Slots for OB/GYNs: $1 million GF/$1 million NGF over the biennium for 10 graduate medical education residency slots for obstetric-gynecological medical residents to begin in FY25.   

• Additional Position to DHP for Provisional Physician Licenses: $194,952 NGF | 1 FTE over the biennium to support the Board of Medicine in issuing provisional licenses to a physician licensed in a foreign country in accordance with HB 995.  

• 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. 

• Increase Medicaid Reimbursement Rates for Dental Services: $11.3 million GF/$21.3 NGF over the biennium for a 3% increase to dental rates through Medicaid and FAMIS.  

• Maternal Mortality Review Team Data Collection & Analysis: $230,000 over the biennium for support in the Office of the Chief Medical Examiner to expand the scope of MMRT data analysis to include maternal morbidity data.   

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. 

---