RICHMOND — House Republicans are fighting Gov. Terry McAuliffe’s plan to insure some of the state’s most severely mentally ill residents, saying the program does not address the full need and could run out of money.
Last year, Republicans, who control the state’s House and Senate, blocked the Democratic governor’s top priority — expanding Medicaid under the federal Affordable Care Act. In response, McAuliffe announced a series of proposals to insure Virginians. One of them, the Governor’s Access Plan, or GAP, was pitched as a way to cover 20,000 of the commonwealth’s most severely mentally ill individuals.
In a floor speech Tuesday, Del. Christopher P. Stolle (R-Virginia Beach) called the GAP program “poorly designed, rushed, incomplete.”
“These are real people,” Stolle said. “What happens when the program runs out of funding? Do we stop their doctor’s visits? Do we cut their medications in half? We are left holding the bag for this poorly designed program.”
McAuliffe’s secretary of health, William A. Hazel Jr., defended the program and said it was not rushed but developed over six months with advice from medical experts and providers.
“There is no question that there is room for substantive discussion here,” Hazel said in a letter responding to the Republicans’ critique. “The most elegant way to fund health care for these Virginians is to use our federal tax dollars to expand Medicaid. In the event of our continued failure to do so, this program creates real opportunity for Virginians who need it.”
The federal government granted the McAuliffe administration special permission to use federal Medicaid dollars for the program, even though it doesn’t meet the standard criteria.
The approval letter, issued this month, gives McAuliffe the authority to spend $13 million to pay for the pilot program through the end of the fiscal year June 30. But General Assembly approval of $77 million is required to continue the program next year.
House Republicans say they have no intention of providing funding because the benefit package lacks coverage for hospitalization and inpatient care, which they contend is critical for this population.
They also say that it was irresponsible for McAuliffe to launch a program that does not have long-term funding and that they worry the money allotted will not cover the overall need.
“The GAP plan was rushed and appeared to put politics ahead of good public policy,” said Del. S. Chris Jones (R-Suffolk), chairman of the House Appropriations Committee.
In the first eight days of the program, 448 people have applied, McAuliffe spokesman Brian Coy said.
Republicans have suggested that the administration was trying to force them to approve the dollars or risk cutting off services to people after they had started receiving them.
But the administration said it was trying to provide immediate help. “These are not political issues — they are matters of economic opportunity, and too often life and death,” Hazel said in the letter. He presented the program to a House committee during a meeting Monday.
According to the state Department of Medical Assistance Services, which administers Medicaid, the GAP program would provide medical and behavioral services and “serve as a bridge to Closing the Coverage Gap for uninsured Virginians.”
Referrals will come from community mental health and other health-care providers, community organizations, law enforcement, jails, prisons and hospitals.
The program amounts to a benefits package worth up to $8,600 per person. At that level, the administration proposed insuring 20,000 people, even though officials acknowledge that as many as 54,000 Virginians could be eligible. If officials approach the limit, the administration could cap the program by tightening eligibility guidelines and initiating a waiting list.
In the morning, House Republicans said the state could not limit the number of people who entered the program. They later said they had been mistaken.
Republicans have said they would come up with another way to cover those mentally ill individuals with the greatest need, but have offered no specifics.
Starting with McAuliffe’s gubernatorial campaign, Democrats have pushed to expand Medicaid under the Affordable Care Act, saying it would provide health care to needy Virginians and create more than 30,000 jobs. Republicans have opposed the move, arguing that the federal government cannot afford to keep its promise to pick up no less than 90 percent of the cost of Medicaid expansion, estimated at $2 billion a year in Virginia.
When House Republicans dug in against Medicaid expansion, McAuliffe quietly began exploring other options. The biggest stumbling block: a requirement in the state constitution that all spending — even pass-through money from Washington — be appropriated by the General Assembly.