Most reporting in Virginia appears accurate that Virginia is not yet ready to accept federal money to expand Medicaid, an assistance program that offers healthcare to low income individuals; however, there are candidates campaigning as if the expansion is already a done deal, which might be adding some confusion to the recent “transportation deal”.
In order to get the transportation bill through the Senate, there was a reported agreement between the governor and the legislature to form the 12-member Medicaid Innovation and Reform Commission (MIRC) – including, five from the House of Delegates and five from the State Senate – to oversee Virginia’s “expansion” of Medicaid. This agreement is largely where the confusion stems from.
Currently, Virginia receives a 50 percent federal funding match to pay for Medicaid – a number based largely on a state’s per capita income. With the proposed Medicaid expansion under ObamaCare, the feds stated that they would pick up the full tab for new enrollees (adults without dependent children, those who are 133% above poverty, etc.), but only until 2016. After 2016, the number is still a respectable 90 percent by 2020, yet the mandate on the state will still cost millions.
The cost to Virginia would begin to rise in 2019 and total about $722 million through 2022 as the state assumes a 10 percent share of the bill under the federal law. The federal share of the cost of expansion in Virginia would exceed $23 billion over nine years — including 100 percent of the bill the first three years.
“It is a significant amount of federal money,” Secretary of Health and Human Resources William A. Hazel Jr. told a Senate Finance subcommittee last [January]. “We do have concerns about whether that federal money will be there.”
And what Secretary Hazel said is what has most lawmakers on the right leery of any expansion until there have been reforms to the program.
Medicaid is one of the fastest growing budget line items, quickly beginning to crowd out things like transportation, education, and public safety – so, the legislature wants assurances before committing the state to the program.
As the law stands now, the governor can expand the state’s participation in Medicaid, but with the new budget passed in February, that onus will shift to the legislature as MIRC examines specific reforms to Medicaid prior to agreeing to put Virginia on the hook for more spending.
Governor McDonnell was very clear last week in a letter he wrote to U.S. Secretary of Health and Human Services Kathleen Sebelius:
“The language of the budget actually places a firewall against expansion consideration, unless real, sustainable cost saving reforms are implemented at the state and federal level. Members of the commission have already been appointed by the House of Delegates, and several have already expressed deep concern about expansion.”
McDonnell goes on to state that any reports that Virginia has expanded Medicaid are simply not true.
Does this mean Virginia will not expand Medicaid? No. But it does mean that the bar for doing so is a lot higher, thanks in large part due to legislative efforts from the House of Delegates.
