Medicaid Reform Contingencies May Influence Budget Outcome

February 14, 2013

In addition to the perpetual legislative controversy on how to fund transportation, the significant issue this year is if and/or how Virginia will accept the option under the PPACA to expand eligibility for Medicaid to 133% of federal poverty.  The Senate version moves ahead with the expansion to take advantage of all of the years of the 100% federal funding, but requires that prior to an expansion of coverage, the Department of Medical Assistance Services must seek assurance that a) the services and benefits provided would be similar to the services and benefits provided by commercial insurers with the exception of non-traditional behavioral health and substance use disorder services, b) reasonable limitations on non-essential benefits such as transportation are implemented, and c) patient responsibility is required including reasonable cost-sharing and active engagement in health and wellness activities to improve health and control costs. The House version requires similar reforms to be developed and implemented, to include adding all remaining Medicaid populations in a coordinated  and managed care system, and additional approval by the General Assembly prior to the expansion. Virginia would not be able to take advantage of all the years of 100% federal funding for the expanded population. The Senate also made the release of the new community ID & DD Waiver slots contngent on the development of a care coordination model for all services including Waiver services.  We have expressed our serious concerns that this model could not be implemented within the time specified, in the manner described, for the small number of inidividuals described; and that it would clearly interfere with the initiatives underway to restructure the Waivers and implement the DOJ settlement agreement.