Virginia Senate expands Medicaid

Bill to mandate Affordable Care Act requirements; Republican sponsor requests program expenditure reduction waivers

The south portico of the Virginia State Capitol, in Richmond, VA, with the Senate, left, and House of Delegates (right) chambers. Photo taken Monday, April 23, 2007. Bob Brown and Bob Brown | Cavalier Daily

The Virginia State Senate adopted an amendment to the 2013 budget Thursday that would conditionally expand Medicaid under provisions of the Affordable Care Act. The budget, along with this modification, passed by a vote of 36-4.

The amendment, which was introduced by Sen. Walter Stosch, R–Glen Allen, would create the infrastructure required for Medicaid expansion so long as Virginia can obtain necessary federal waivers to give the state control over reducing program expenditures. It would require state Medicaid benefits to offer payouts similarly to those given by private insurance plans and place “reasonable limitations” on certain benefits, including transportation costs.

Senate Democratic Caucus Spokesperson Joshua Karp said all Democrats supported the Medicaid expansion measure because it offered the opportunity to cover more Virginians and lower state costs.

“This is going to give healthcare to almost 400,000 people without it,” Karp said. “For every cent that we put into that program, the federal government will give us $1.70” over the next 10 years.

Stosch’s office did not return requests for comment.

Karp said the Senate measure, unlike similar measures in the House of Delegates’ budget, was a legitimate attempt at compromise and sought to responsibly expand Medicaid. He believes Virginia can obtain the waivers required to effect the amendment.

“That’s a contrast to the House budget, which has provisions in it [that are] very onerous… which amount to not including Medicaid [expansion] in the House budget,” Karp said.

The Center for Medicare and Medicaid Services did not comment on the likelihood of approving the requested waivers, but listings on its website indicated Virginia has not yet filed the necessary waivers.

In a December 10, 2012 memo, CMS said the federal government was willing to offer states some flexibility in implementation of the ACA through the use of “global waivers,” but offered few specifics.

The state budget will now be reviewed by conference committee, where House and Senate members will attempt to finalize a version to submit to Gov. Bob McDonnell. Karp said the ongoing negotiations make it impossible to determine whether Medicaid expansion will make it into the final budget.

“It’s been traditional for the conferees from both Houses to stick to the positions of their [respective chambers],” Karp said. “We don’t possibly know what the final results will look like.”

McDonnell spokesperson Jeff Caldwell said in an email the governor wants “real and meaningful Medicaid reforms” from the federal government before considering Medicaid expansion. The governor has taken no position on the Senate’s expansion amendment.

In an email to The Cavalier Daily earlier this month, University Medical Center spokesperson Eric Swensen said his organization supports Medicaid expansion in Virginia, particularly because seven out of every 100 patients treated at the Medical Center are uninsured.

“As shown by Virginia Health Information, we provide more care to uninsured and underinsured patients than any other hospital in the Commonwealth of Virginia, with the exception of VCU,” Swensen said.

Karp said Senate Democrats had not yet decided whether they would support a final budget if it did not include Medicaid expansion.

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