2020 Session

Budget Amendments - SB30 (Member Request)

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Chief Patron: Locke
Modify Locality Groupings for Medicaid Eligibility

Item 313 #43s

Item 313 #43s

First Year - FY2021 Second Year - FY2022
Health and Human Resources
Department of Medical Assistance Services FY2021 $196,727 FY2022 $196,727 GF
FY2021 ($196,727) FY2022 ($196,727) NGF


Page 321, after line 18, insert:

"GGGG. The Department of Medical Assistance Services shall adjust the "Groupings of Localities" used for cerain categories of Medicaid eligibility to be consistent with that used in the Temporary Assistance to Needy Families (TANF) program.  Any future changes to the Groupings for purposes of TANF or Medicaid shall be implemented uniformly in both programs."


(This amendment adds $196,727 from the general fund each year and reduces $197,727 in nongeneral funds and language requiring the department to adjust how localities are grouped for purposes of determining certain categories of Medicaid eligibility and to ensure that any changes to these groupings are implemented consistently between the Medicaid and TANF programs. This action would move individuals who are currently eligible for Medicaid under expansion into the base Medicaid program, thus requiring the addition of general funds and reducing nongeneral funds which cover the cost of the expanded Medicaid population. The "Groupings of Localities" originated in Virginia's Aid to Families with Dependent Children program (now TANF) to provide three different levels of cash assistance benefits, depending on where the family resided. The three groups of counties and cities were roughly divided into rural (Group I), urban (Group II), and Northern Virginia areas (Group III), originally reflecting differences in the cost of shelter. Medicaid adopted the same groupings to determine eligibility for certain Medicaid categories, such as the medically needy program (spenddown) and for low-income parents. Over time, the Groupings have been revised differently in both programs, and currently there are major inconsistencies that lack any justification and create major inequities and complexities in application processing and eligibility for benefits. For example, the following counties are in the lowest Grouping for Medicaid, but the highest Grouping for TANF: Caroline County, Fauquier County, James City County, King George County, Spotsylvania County, Stafford County and York County. The inequities are significant. For example, to meet a 6-month spenddown, an elderly person in these counties would need to incur $979 more in medical expenses before qualifying for Medicaid than.a similarly situated person in the highest Group. Another four counties/cities are in the middle Grouping for Medicaid, but the highest grouping for TANF: Augusta County, Newport News, Poquoson, and Staunton.)