2024 Session

Budget Amendments - HB30 (Conference Report)

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Evaluation of Medicaid Eligibility Determination

Item 292 #7c

Item 292 #7c

First Year - FY2025 Second Year - FY2026
Health and Human Resources
Department of Medical Assistance Services FY2025 $500,000 FY2026 $0 GF
FY2025 $500,000 FY2026 $0 NGF

Page 349, line 32, strike "$304,695,832" and insert "$305,695,832".

Page 355, after line 51, insert:

"GG. Out of this appropriation, $500,000 from the general fund and $500,000 from nongeneral funds the first year shall be provided to the Department of Medical Assistance Services (DMAS) to hire a consultant, with Medicaid-specific knowledge related to eligibility determination, process-design and information technology, to evaluate Medicaid eligibility determination in the Commonwealth.  The consultant shall conduct a systematic review and evaluate all aspects of Medicaid eligibility determination as performed by DMAS and local departments of social services (LDSS).  This review shall include, but not be limited to, the following: (i) evaluate the current information technology systems; (ii) measure the accuracy, processing times and efficiency of current eligibility determination processes; (iii) determine how well the current structure and systems handle high volumes; (iv) assess the current level of automation and determine processes that could be streamlined; (v) analyze the overall cost-effectiveness of how eligibility is conducted, considering staffing costs and ongoing operational expenses; (vi) examine best practices in other states; and (vii) develop cost-effective options for enhancing eligibility determination in the Commonwealth including alternative delivery models.  DMAS, the Department of Social Services, and LDSS shall provide full cooperation with the consultant and provide the necessary assistance to conduct the required evaluation. The consultant shall be required to report their findings and recommendations directly to the Governor, Department of Planning and Budget, and Chairs of the House Appropriations and Senate Finance and Appropriations Committees by December 15, 2024. The Director, Department of Planning and Budget, shall unallot this appropriation until the Department of Medical Assistance Services provides documentation of the contract's cost, and shall only allot the amount needed for the contract.""


(This amendment directs the Department of Medical Assistance Services to hire a consultant to assess the current eligibility determination system for Virginia's Medicaid program.)