VA the ACA and Medicaid Expansion

In March of 2010, President Obama signed the Patient Protection and Affordable Health Care Act (ACA). One of the ACA’s major provisions is Medicaid expansion. Under the law, states can broaden the Medicaid financial eligibility criteria to families and individuals making up to 133% of the federal poverty level ($15,400 per individual or $32,000 per family of four).This could provide access to more of Grafton’s lower income clients and many others across the state, but unfortunately at this time, the Virginia General Assembly has chosen not to expand this important program.

Prior to any expansion, the General Assembly would like to see Medicaid reform. There are many worthy Medicaid reform goals, particularly the desire for improved service delivery, administration, and beneficiary engagement. Like many of our elected officials, I believe Virginia’s system should be consumer driven with multiple benefit options and that any reform should include predictable growth in future Medicaid expenditures. However, the need for reform should not serve as an excuse for failing to take advantage of this opportunity.

Critics of expansion will point to the Medicaid expense forecasted fear that the federal government will not live up to the proposed funding model. According to (add here), Virginia’s Medicaid expenses predicted to double between 2014 and 2022. The funding model, however, looks like a good deal for the state. Medicaid expansion is fully financed by the federal government from 2014 to 2016, 95% financed in 2017, 94% financed in 2018, 93% funded in 2019 and 90% financed in 2020. In 2020, Virginia would be required to pay $1 for every $10 in Medicaid care financed by the federal government. Virginia also would have an “opt out” clause if the federal government failed to deliver on the promised funding.

While Medicaid reform is needed and the General Assembly’s fiscal concerns are understandable, Medicaid expansion will be a lifeline for thousands of Virginia citizens. The state’s current income limit is around $11,500 per individual or $23,500 for a family of four. When compared to other states, Virginia is currently 48th in Medicaid spending per capita and 24th in spending per Medicaid recipient. If Virginia expanded Medicaid to include up to 133% of the federal poverty level, it is estimated that 270,000 Virginians would qualify for Medicaid. These individuals include kids, veterans, and low wage workers. I believe it is wise to invest into a program that serves this broad a population and provides a better than 900% return on our investment.

The expansion of Medicaid also includes an increase in primary care Medicaid reimbursements rates for the first two years. Currently, many physicians do not accept or are opting out of Medicaid due to low reimbursements rates. If Virginia agrees to expand Medicaid, this could increase the number of primary care physicians willing to treat Medicaid clients and would offer Grafton clients (and many others) better access to quality healthcare. Our lawmakers would then need to look at making these rate changes permanent to ensure more primary healthcare providers continue to accept Medicaid clients, once the ACA regulations back off.

Medicaid expansion could also enable more Grafton clients to maintain meaningful employment. Often, our clients are reluctant to maintain full time employment as it would put them above the financial eligibility threshold for Medicaid, but still not provide enough income to pay for the private healthcare coverage needed for their level of disability. The expansion of Medicaid would help bridge this gap for our “low wage” earners with disabilities.
Medicaid expansion is right for Grafton’s clients. It is right for nearly 300,000 low income Virginians, and it is a cost-effective way to expand needed health care coverage throughout the state. As other states across the country benefit from the ACA’s Medicaid provisions, Virginia should too.