Virginia prepares for Medicaid expansion

Monique Calello | The News Leader

STAUNTON – The new state budget directs the Dept. of Medical Assistance Services to change Virginia’s eligibility rules for Medicaid. Essentially, provide access to coverage for over 400,000 more Virginians.

“These are low income adults, as we found through focus groups, who are very interested in having health coverage but haven’t been able to afford it in the past," says Jennifer Lee, agency director for the Dept. of Medical Assistance Services. “Most of them are working, but they’re working in sectors such as retail, food service or landscaping or other industries where the wages aren’t very high, or they just don’t have access to affordable coverage.”

“We are very excited about having the opportunity to provide them with a pathway to coverage, so they can get the coverage that they need and get healthier, so they can pursue opportunities that they deserve for themselves and their families."

According to Lee, DMAS has been singularly focused on following all of the directives in the state budget in terms of timeline.

“Changing the rules so we can accept the 400,000 Virginians into the program, and get them coverage starting on January 1, 2019," says Lee.

There are multiple pathways of work to get prepared for expansion.

“It’s extraordinarily complex because it does touch on every aspect of the program that we run today. Right now, we already cover over 1.3 million Virginians through the Medicaid program, and it is a 10 billion dollar program.”

Some of the changes underway include seeking federal approval for the policy and giving authority to DMAS to modify the state plan.

“And update the eligibility rules for the new population to be able to offer services to them to claim the higher federal match," says Lee, "which is what results in savings to the state budget, so working closely with our managed care plans."

According to Lee, DMAS currently contracts with six private plans to provide health coverage to current enrollees. Over 90% of enrollees are in managed care, and the new population would also be covered through managed care through private plans, such as Anthem, Aetna and United Healthcare.

“In order to do that, it means there’s a lot of back office changes and system updates that need to be made to our information systems to our contracts to our budgets to a lot of the processes that we use to enroll people into Medicaid coverage to assign them to the right health plan to ensure they get the benefits and services that they need at the quality that they deserve.”

DMAS is working closely with partners in order to accomplish this, says Lee. The dept. is working with local social service agencies and the Virginia Dept. of Social Services to train enrollment workers on the new rules, update information systems that screen people for eligibility determination and make the changes that need to be made to current processes. This includes partnering with behavioral health departments, community service boards, local health departments and community-based organizations to prepare for changes to the program.

“That means we need a coordinated communications strategy, and we’re working hard to have a plan, and we’re working hard to implement that over the next few months," says Lee. "We are working to hire additional staff. Fortunately, we were provided additional staffing in the budget in order to implement these significant changes. We are recruiting while we are working hard to make the changes.”

DMAS will begin accepting applications for Medicaid coverage on Nov. 1, and while the number of individuals who will apply in November is uncertain, the dept. is working with the estimate of 400,000 planning to enroll under the new rules.

“We are working to update our estimates to get as accurate an adjustment as we can," says Lee. "There is some uncertainty, because frankly there are quite a few uninsured individuals who are just unknown to the system right now.”

Lee expects there will be a rapid rise early on but then a slower increase as people continue to come into the program.

“I wouldn’t expect everyone to come into the program right in those first two months. We’d expect a significant number. We don’t know exactly how many, but we would expect it also be spread out over the course of the year as people learn about the new rules and apply.”

The federal standard for processing Medicaid applications is 45 days.

“We would, of course, shoot to have anyone who applies for the program to be processed under that time, but as quickly as possible and as smoothly as possible for them," Lee says. "And we’re working closely with our social service agencies to achieve that."

"It is a big lift, I will say that," says Lee. "It’s a lot of changes to the program. There will be a lot of training that needs to happen, a lot of questions to be answered, but we’re very pleased with the partnership we’ve had to date.”

For more information on Virginia health plans, including Medicaid and FAMIS programs for children, pregnant women and adults, visit Cover Virginia.

Reporter Monique Calello can be reached at mcalello@newsleader.com.