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Medicaid Enrollment Reaches 1.5 Million Virginians


Annual year-over-year development of Virginia Medicaid spending and enrollment. Eligibility expanded and supplier reimbursements elevated on the finish of 2018. Supply: Senate Finance Committee presentation.

By Steve Haner

Slightly below two years into Virginia’s Medicaid growth, and fewer than one yr right into a pandemic-sparked financial disaster, enrollment in this system is now about 1.5 million Virginians. Enrollment has grown greater than 25% in lower than two years and spending greater than 30%.

The monetary affect on state taxpayers has been blunted by a COVID-19 associated enhance within the federal share of this system prices, which is anticipated to proceed nicely into 2021. However the federal laws offering the cash additionally prohibited the state from eradicating recipients from this system except they really moved away.

The Senate Finance and Appropriations Committee acquired an update from staff on the Medicaid program at its digital “retreat” on November 19. Extra data is obtainable from the Medicaid growth dashboard nonetheless maintained by the Division of Medical Help Companies (DMAS).

Past its significance as a really costly and the fastest-growing state funds factor, Medicaid will play a task in two different 2021 tales. 

It’s going to probably be a significant situation within the contest for the Republican nomination for Governor, with Senator Amanda Chase of Chesterfield criticizing Republican colleagues who supported the 2018 choice to develop eligibility and supplier funds. These embrace former Home Speaker Kirk Cox of Colonial Heights, who’s working, and Senator Emmett Hanger of Augusta County, who might run.

Additionally, each family on Medicaid within the service territory of one of many two main electrical energy suppliers will probably be eligible for the brand new Percentage of Income Payment Plan. Their precise revenue or electrical energy prices will decide the profit, if any, however being on Medicaid qualifies them for consideration. The electrical energy invoice subsidies might be substantial.

A number of the vital factors from the November 19 briefing presentation:

  • Enrollment has grown greater than 85% in ten years, from about 800,000 in 2011 to 1.5 million, far quicker than the state’s inhabitants.
  • When the 2018 Normal Meeting authorized Medicaid growth, it was projected so as to add 378,000 recipients by now. As an alternative it has added 480,000, maybe accelerated by the pandemic.
  • The upkeep-of-enrollment requirement imposed to obtain the extra COVID funds added about $127 million in prices. What number of recipients would in any other case have misplaced eligibility just isn’t detailed.
  • Finally, the enrollment development might overcome the profit from the COVID-19 enhanced federal share, leaving the state with internet development in prices. And the improved federal profit is about to finish in 2021.
  • If program development continues into the 2022-24 interval at simply 6% per yr (half the current charge), one other $1.1 billion in taxpayer basic funds will probably be required.
  • Legislative choices to extend the state minimal wage and create a brand new Medicaid dental profit for adults will drive up prices in future years as soon as absolutely in drive.

Senate Finance Committee abstract of supplier assessments and the federal matching funds they procure.  Click on to view.

The 2018 Normal Meeting authorized two assessments on personal hospitals, one to fund growth and the opposite to cowl larger funds for service to hospitals and different suppliers. Within the first full yr they have been imposed, Fiscal Yr 2020, they collected $602 million. It’s projected to be slightly below $1 billion by FY 2022, and to exceed $1 billion the next yr.

The cash flows proper again to medical suppliers with matching federal funds hooked up, offering what is anticipated to be internet extra income for them of $1.9 billion this yr and greater than $2.2 billion in FY 2023.

Whether or not these hospital assessments are taxes or charges is debatable, however they’ll proceed to develop quickly and remain missing as an income item on most state funds summaries. At $1 billion-plus per yr they’ll rank among the many 4 or 5 largest state income streams.

As is normally the case, the committee presentation centered primarily on enrollment and {dollars}, with no consideration paid to any enhancements to the well being of the inhabitants served. Even on the DMAS program summary, there’s solely rudimentary data on companies utilized, nonetheless with none well being metrics. It gives some “earlier than and after” knowledge on growth however mentions various things, so just isn’t a comparability (whereas it seems to be like one.).

It mentions that earlier than growth, 25% of Virginians used emergency departments for routine care, 25% spent greater than $500 out of pocket, and 37% reported a well being situation that prevented employment. So, two years into growth with one other half-million folks coated, have these modified? Since growth, 80% of that inhabitants has used not less than one service, and two-thirds have stuffed not less than one prescription. Is there precise proof of higher well being? Wouldn’t that be good to know?

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