RICHMOND — Virginia is gearing up to expand Medicaid eligibility to as many as 400,000 residents in January, but requirements that recipients work and pay premiums could lag two years behind, officials said this week.
The gap has infuriated Republican state senators who opposed the expansion effort and viewed work requirements as making it slightly less objectionable.
But the state’s director of medical services, Jennifer Lee, told lawmakers this week that the timetable is largely up to authorities in Washington who have to grant Virginia a waiver to impose restrictions on the federally funded Medicaid program.
“There is no defined time frame for [federal officials] to approve a waiver application,” Christina Nuckols, spokeswoman for the state Department of Medical Assistance Services, said Friday.
The state unveiled details of the Medicaid expansion plan last week. Virginia Medicaid recipients would have to work or participate in a list of “community engagement” activities for 20 hours a month in the first three months of enrollment. The hours requirement would increase in stages, reaching a maximum of 80 hours per month after a year of enrollment.
Participants also would have to pay premiums of up to $10 a month, based on income.
The plan will undergo a 30-day public comment period, with explanatory hearings held around the state, before being finalized and submitted in early November. Federal authorities have taken a year or more to review and approve such plans in other states, and Virginia officials said it could take up to a year after approval to put the mechanisms in place.
“While I don’t support Medicaid expansion, I do believe if we’re going to have it, it needs to have the work requirement, and it needs to be in there as soon as possible,” said state Sen. Richard Stuart (R-Stafford), a member of the Senate Finance Committee who got a briefing from the state Department of Medical Assistance Services on Thursday.
Fellow committee member Sen. Ryan McDougle (R-Hanover) said he is frustrated that the administration of Gov. Ralph Northam (D) can’t give a more specific timetable for the work requirement.
“I have no confidence, based on what I heard yesterday, that the work requirement will be put into effect in a timely way or that it will have any significant enforcement,” McDougle said Friday.
Stuart and McDougle were not among the four Republicans in the state Senate who voted with Democrats to authorize Medicaid expansion in May, breaking an impasse that had left the General Assembly unable to adjourn as scheduled in March.
Republicans had resisted for four years, but public support for Medicaid expansion has steadily grown. A poll released last week by the University of Mary Washington found that 76 percent of Virginians favor expanding Medicaid.
The General Assembly’s plan calls for expansion to go into effect Jan. 1 as the state works separately to seek the federal waiver for work requirements.
As the program rolls ahead, Virginia won federal approval to tax hospitals to raise nearly $300 million to cover the state’s portion of the program’s cost. The federal government will cover 90 percent of Medicaid expansion under the Affordable Care Act.
Before expansion, Virginia made Medicaid available only to pregnant women or children under age 18 in families making less than twice the federal poverty level, which is $42,599 annually for a family of three; people with disabilities making less than 80 percent of the poverty level, or $9,712; and parents making less than 33 percent of the federal poverty level, or $6,924 for a family of three.
Beginning next year, the federal health insurance will be available to disabled people and families making up to 138 percent of the poverty level. That’s annual income of $16,750 for disabled individuals or $28,700 for a family of three.
Childless adults will be eligible for the first time if they make less than $16,750 per year.
The work requirements, once they kick in, would include a broad range of activities under the proposal unveiled this week: Job skills training, education, community volunteering and job search activities would all meet the definition.
Anyone who failed to meet the requirement for three months out of a year of eligibility would be booted from the program.
There would be a host of exemptions from the work requirement, including for recipients who are pregnant; primary caregivers for children or elderly people; and people who have serious medical conditions.
The state also proposes creating programs to help find work and training for people who are eligible for Medicaid, as well as setting up services to help them find or maintain housing.
Taxes on private, acute-care hospitals will cover the state’s expenses, as well as provide extra funds to allow the state to increase its Medicaid reimbursement rates.
The hospital industry has supported this approach, saying that extending insurance coverage to more people will create more revenue and cut down on expensive emergency room visits. The taxes are capped at 6 percent of net patient revenue, and public, psychiatric and children’s hospitals are excluded from them.
Because Medicaid will take over some functions now paid for by the state government, Virginia expects to save $355 million over the next two years through the expansion program.
State officials will hold four public hearings over the coming weeks to explain the proposals, including Sept. 25 in Richmond; Oct. 3 in Roanoke; Oct. 9 in Great Falls; and Oct. 11 in Virginia Beach.