Improving Medicaid Coverage Would Mean More Insured Virginians

Virginia's Medicaid system covers certain low-income, disabled, elderly, and young people. Medicaid in Virginia system is one of the stingiest in the United States - 47 states allow people with higher incomes to participate (in Virginia you have to be extremely poor). The cost of Medicaid is shared by the federal and state governments.

The Kaiser Foundation on Medicaid and the Uninsured has released an analysis of the potential effect of federal healthcare reform on the states' Medicaid populations. The report assumes two scenarios: One uses state participation rates assuming moderate levels of participation. The other other assumes enhanced participation by states. Virginia currently has extremely low coverage levels (48th in the United States). What was their conclusion?

The changes to the Medicaid program under the Patient Protection and Affordability Care Act (PPACA) significantly expand Medicaid coverage for adults. There will be large increases in coverage and federal funding in exchange for a small increase in state spending. States with low coverage levels and high uninsured rates will see the largest increases in coverage and federal funding. Higher levels of coverage will allow states to reduce payments they make to support uncompensated care costs.

(Uncompensated care usually refers to care given to people who have no insurance coverage and no way to pay for their care).

The study predicts "state spending could increase by $43 billion while federal spending could increase by $532 billion." This is because the federal government will contribute more for new enrollees than it currently does to present enrollees.

The study also predicts Virginia could see a 50% reduction in the number of uninsured adults at 133% of the federal poverty level or 245,000 more people covered under the "standard" scenario assumptions. The "enhanced" scenario predicts a 75% reduction in uninsured or 365,000 more people covered. Under federal poverty guidelines, a person with an income of $10,830 is considered to be "poor."

Our state presently ranks last in the United States in federal grants due to our limited programs to help low-income people and we ranked 49th in average per capital aid to state and local governments. If you have private insurance, you pay for the uninsured every day so the more people who have health insurance, the better off everyone is.

The bottom line: Given that the federal government will be picking up a large amount of the cost of this, Virginia should be looking very closely at enhancing our Medicaid coverage.

The executive summary is posted below if you would like to read it (it is not light reading material). The full report can be accessed here.

Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below...

Medicaid's Chickens Come Home to Roost

When the General Assembly passed a budget this past session, I voted "No" for a variety of reasons. One of them was because I thought that the Budget was "balanced" using some very risky strategies. You can read my comments here - Harry Byrd Rolls Over.

One of these was counting on about $400 million of federal Medicaid "stimulus" monies that had been approved by the U.S. House and Senate but were stuck in a conference committee waiting for a final compromise and President Obama's signature. Over the last two years, the Federal Government has reimbursed Virginia's Medicaid expenditures at $0.60 on the dollar instead of $0.50 on the dollar to help with state budgets. The idea was to extend that one more year. That was nearly three months ago.

The Virginia Medicaid Program cares for our low-income, elderly, and children. It cares for our most vulnerable citizens and Virginia's Program is the second most restrictive in terms of eligibility in the United States.

Today, I received an email from the House Budget Staff indicating that federal stimulus monies still were not approved yet and that the adopted Budget has restrictions that were triggers to start July 1, 2010 without the federal money. In order to be prepared for the spending reductions, Virginia is going to start announcing these "service changes." They are not going to be pretty.

If this comes true, first you are going to hear about the poor being denied medical care because more doctors and hospitals will stop accepting Medicaid patients. Then you are going to hear about service disruptions to the severely disabled. You are going to hear a loud scream from hospitals like Fairfax INOVA that gives birth to more children paid for by Medicaid than any other facility in Virginia. Finally, you are going to see a nice fat health insurance increase in your paycheck.

However, this is exactly what I warned about when the Budget was adopted. If we had assumed these cuts were going to occur, the State Budget might have been structured very differently because these kinds of program changes would not have been acceptable. Instead, a massive service disruption is about to hit down on our state's sick, elderly, poor and least capable of bearing these expenses - our most vulnerable.

If you want to see what's coming. Read my prior article - Second Class Citizens? - and watch the video embeded in that post.

Visiting The Northern Virginia Training Center

Last month, I visited the Northern Virginia Training Center to learn about the Commonwealth's role in caring for our community's disabled.

The Training Center was started in the early 1970's on a campus of about 85 acres of land about five miles off the Capital Beltway on Braddock Road. The Center cares for about 190 individuals with severe physical and mental disabilities who are not capable of caring for themselves. It is one of five such facilities in the state.

The facility is largely funded through state funds and Medicaid and staffed by a very dedicated team of highly trained staff and volunteers. Our recent round of budget cuts significantly affects these kinds of services.

I spent about two hours walking through the various programs and services that are offered. Aside from the services necessary to care for people and enhance their quality of life, the Center even does bulk mailing, recycling processing, and I even saw a group of residents assembling hard drives. I also had a chance to talk with many community members who were very happy, engaged, and very welcoming to me into their home.

These services are frequently one of the first places we look for budget cuts and they also do not have armies of well-paid lobbyists advocating for their cause. Walking through a facility like this gives you some perspective regarding the importance of state government, our social safety net, and help you to remember why it is important to look out for everyone in the state and not just those who are best at getting your attention.