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With Virginia making progress on reforms, lawmakers should keep the door open to Medicaid expansion.
Thursday, June 20, 2013
In the final, frantic hours of the 2013 General Assembly session, state lawmakers stitched together a compromise that kept open the possibility of using federal dollars to expand Medicaid coverage in Virginia.
The legislature authorized a 10-member, bicameral commission to serve as a gatekeeper that could allow Medicaid expansion to proceed if the state gets federal approval for program reforms that reduce costs and improve service delivery.
By the time the Medicaid Innovation and Reform Commission wrapped up its first meeting on Monday, members had more reason to support an expansion that could cover as many as 400,000 Virginians, protect hospitals from financial penalties and also boost the state’s economy.
State Secretary of Health and Human Resources Bill Hazel told the commission Monday that Virginia has a “unique opportunity” to expand Medicaid eligibility and get the Obama administration’s approval for more flexibility to administer the program. Under Hazel’s leadership, the state already has received federal approval for a pilot program to coordinate long-term care and other services for more than 78,000 Virginians — about 13,000 in Western Virginia — who are enrolled in both the Medicaid and Medicare programs.
State officials also are negotiating with a federal agency led by someone who knows Virginia’s health care programs well. Marilyn Tavenner, the recently confirmed administrator of the Centers for Medicare and Medicaid Services, served as former Gov. Tim Kaine’s secretary of health and human resources.
State lawmakers already had the benefit of an economic impact study commissioned by the Virginia Hospital and Healthcare Association, which concluded that Medicaid expansion would provide a $3.9 billion boost to the state’s economy and support more than 30,000 jobs. Carilion Clinic has estimated that it could lose up to $15 million a year if Virginia opts out of Medicaid expansion, largely due to reductions in funding for hospitals that treat disproportionately large numbers of Medicare and Medicaid patients. Those cuts will occur whether or not the state expands Medicaid.
Gov. Bob McDonnell and Republican legislative leaders have argued that Virginia should not expand Medicaid without reforms and assurances that the federal government won’t stick the state with a big chunk of the bill. The federal government will cover 100 percent of the expansion’s cost through 2017 before gradually reducing its share to 90 percent.
The governor and the General Assembly can take steps to protect state taxpayers if the federal government fails to live up to its funding commitment. Just this week, Arizona Gov. Jan Brewer signed a Medicaid expansion plan into law that includes a provision to halt expansion if federal reimbursements decrease.
Virginia lawmakers should seize the opportunity to lead the way in reforming Medicaid and making it work for more Virginians.
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