RICHMOND — A House committee voted Tuesday to impose work requirements on Medicaid recipients, something Republicans are seeking as a precondition to expanding the health-care program to more low-income, uninsured Virginians.
It was not clear how many of the state's 1 million Medicaid recipients would be affected if the bill becomes law because the majority are children, the elderly, pregnant women and people with disabilities, all of whom would be exempt under the plan because they are considered to face some barrier to work.
But one category of able-bodied adults — single parents with young children — would be required to find employment.
House Speaker M. Kirkland Cox (R-Colonial Heights) said Tuesday that he thinks the work requirement would apply to about a third of current Medicaid recipients.
Whatever the number, the proposal has stimulated a conversation about Medicaid expansion between Cox and Gov. Ralph Northam (D) after years of fierce GOP opposition. In a letter to Northam on Monday, Cox suggested a willingness to consider expansion if work requirements or other reforms are part of the deal.
"Work brings dignity," Cox said Tuesday prior to the House Rules Committee vote. "I think work is a good thing. Not only that, I think it really helps people with self-sufficiency. And we have got to be about helping people, not just being concerned about how many people we can put on the Medicaid rolls."
Earlier this month, the Trump administration invited states to apply for a waiver that would clear the way for work requirements for Medicaid recipients. Kentucky is the first state to win a waiver; eight other states have requests pending.
Northam has said that he does not favor work requirements but could support a "work search" program. The distinction might be a mostly semantic one. Under the bill approved Tuesday, Medicaid recipients would be required to spend at least 20 hours per week working — or seeking employment. Participation in job-training, educational programs or public service would also count.
The bill passed on a 14-to-3 vote, with three Democrats voting for it and three against. The measure now heads to the House Appropriations Committee.
Expansion of the federal-state health-care program was one of Northam's marquee campaign promises in last year's election. He is seeking to expand access to Medicaid under the Affordable Care Act to an additional 400,000 low-income Virginians.
Republicans in the state legislature fought expansion for the past four years under Northam's Democratic predecessor, Terry McAuliffe, questioning whether Washington could afford to keep its promise to pick up most of the $2 billion-a-year tab.
But opposition has softened a bit as Washington has failed to repeal the ACA under a Republican-controlled White House and Congress. Add to that the Democrats' stronger-than-expected showing in Virginia elections in November, in which pro-expansion Democrats swept three statewide offices and picked up 15 seats in the House.
Cox, whose party has a paper-thin majority (51 to 49) in the chamber, warned in his letter to Northam that expansion could hinge on the Medicaid work-requirements bill. Northam greeted the letter as good news, even though Cox framed the letter as an ultimatum.
Cox voiced more concerns Tuesday ahead of the committee vote because of the price tag — $10.5 million in the first year — that Northam's Department of Planning and Budget had put on administering the work requirement. He said the "ridiculous" estimate, released Monday night, had been inflated to derail GOP reforms.
Because the department concluded that no current enrollees would be required to work, it based the estimate on the additional 400,000 who would be added under expansion.
"I will tell you the fiscal impact statement — that late, that ridiculous — gives me pause about whether we can get anything done or not," Cox said. "Ten million dollars' worth of administrative costs — that just does not pass the smell test."
Hours later, Northam spokeswoman Ofirah Yheskel issued a statement acknowledging that the cost estimate "was unintentionally based on incomplete information. We have communicated that to the speaker's office and will submit a revised fiscal impact statement in response to changes that have been made to the legislation."
It was not clear if the revised estimate was expected to go up or down. Yheskel declined to elaborate.
"We appreciate the administration admitting the initial fiscal impact statement was completely wrong," said Cox spokesman Parker Slaybaugh. "We would like to see a commitment to basic reforms such as requiring able-bodied people to work before receiving Medicaid benefits."