2013 Session

Budget Amendments - SB800 (Member Request)

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Chief Patron: Favola
Co-Patron(s): Alexander, Barker, Colgan, Ebbin, Herring, Howell, Locke, Lucas, McEachin, Miller, Northam, Petersen, Puckett, Puller, Saslaw
Expand Medicaid Eligibility up to 133 percent of poverty (language only)

Item 307 #6s

Item 307 #6s

Health And Human Resources
Medical Assistance Services, Department of

Page 280, after line 14, insert:  
"JJJJ.  The Department of Medical Assistance Services shall have authority to amend the State Plans for Medical Assistance under Titles XIX and XXI of the Social Security Act, and any waivers thereof, to implement requirements of the federal Patient Protection and Affordable Care Act (PPACA) as it pertains to the expansion of Medicaid eligibility up to 133 percent of federal poverty guidelines.  The department shall have authority to implement such standards and practices upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change.
KKKK.  1.  It is the intent of the General Assembly that the Department of Medical Assistance Services shall implement a Medicaid expansion program that embraces targeted reforms and enhances state flexibility, wherever possible.  The new population to be covered shall be served through the current practice of managed care delivery models.  The department shall share with Medicaid providers best practices for improving health outcomes within a cost efficient framework.  
2.  The department shall ensure that the Medicaid Expansion program includes, among other covered services, primary care, prevention, wellness and mental health care services as outlined in the Patient Protection and Affordable Care Act.  The department shall also build in incentives for healthy behaviors.  Patient engagement is an important component in any effort to get well and stay well, therefore, the department shall develop a “patient engagement” requirement for this program.  The department shall establish a reasonable co-pay structure and eliminate non-emergency transportation as a covered Medicaid service unless approved on a case-by-case basis.
3.  The department shall implement reform strategies for current Medicaid recipients and those enrolled in the expanded Medicaid program.  Specifically, the department shall implement or seek waivers, if necessary, by September 1, 2013 to:
a)  Improve the coordination and management of care for those dually eligible for Medicaid and Medicare, building on lessons learned in other states as well as the state’s own experience with the Program for All-Inclusive Care for the Elderly (PACE).
b)  Enhance management of care for the highest cost Medicaid recipients, including those who use emergency rooms frequently and patients with 10 or more active prescriptions.
c)  Enhance the coordination of care for all populations covered by Medicaid or FAMIS, drawing on lessons from “Best Practice” states and the Commonwealth’s Medicaid managed care network.
d)  Improve the quality of prenatal care and post-partum education provided to pregnant women covered by Medicaid to improve birth outcomes and reduce infant mortality.
e)  Improve the effectiveness of community mental health services and reduce, in a manner consistent with public health and safety, the incidence of incarceration of mentally ill adults and children.
f)  Strengthen chronic disease prevention among children, focusing on preventing childhood obesity and related co-morbidities such as diabetes.
4.  Participation in the Medicaid Expansion program is contingent upon the Federal government funding 100% of the additional costs for for newly eligible individuals from 2014 through 2016.
5.  The Department shall establish an evaluation mechanism, including the collection of key data, to assess whether the services available to the expanded Medicaid population result in good health outcomes and health cost savings.  
6.  Copies of waiver submissions, as well as a summary of any expenditure of Federal funds in implementing this item, shall be provided to the chairs of the Senate Education and Health and Finance Committees; as well as the House Appropriations and Health, Welfare, and Institutions Committees; and the Joint Commission on Health Care within ten days of submission."

(This amendment authorizes the Department of Medical Assistance Services to adopt the expanded Medicaid coverage provided in the Patient Protection and Affordable Care Act of 2010 (PPACA), effective January 1, 2014. This expansion raises income eligibility up to 133 percent of the federal poverty line and provides 100 percent federal funding from FFY 2014 -2016. Coverage is estimated to reach up to 400,000 low-income, uninsured Virginians. According to several studies, the federal funding will support approximately 30,000 jobs and other economic activity that will generate additional general fund revenue. Language is also added stating the General Assembly's intent that the department implement a Medicaid expansion program that embraces targeted reforms and enhances State flexibility, wherever possible including modifying the benefit structure, imposing reasonable co-pay requirements and patient engagement. Similar reforms shall be implemented for the existing Medicaid population. Other initiatives such as integration of care for "dual eligibles", enhanced care of high-cost patients, and better attention to chronic diseases are also included as well as an evaluation component.)