Virginia Medicaid panel leader cites progress in overhaul efforts

RICHMOND — Virginia is making progress in an effort to reform — and then possibly expand — its Medicaid program, the leader of a legislative panel overseeing the process said Monday.

“I would say that we’re a little over halfway there,” said Sen. Emmett Hanger, R-Augusta County, chairman of the Medicaid Innovation and Reform Commission, which under the new federal health care law is mulling an expansion of the government health insurance program for the poor and disabled.

Meeting for the second time Monday, the commission received an update on 19 areas of reform identified by the General Assembly, which has mandated that the system must be improved before eligibility requirements are broadened.

The commission will hold a public hearing, likely in late September or October, that could draw heated opposition and ardent support for the proposal, one of the key provisions of the Patient Protection and Affordable Care Act.

“We’ve had battle lines drawn from a political standpoint, but I really do sense the interest” from citizens across the state, Hanger said in explaining the need for a public comment process.

“Our long-term interest is not to say whether Obamacare is good or bad,” but rather to strive for quality and cost-efficient health care, Hanger said. A majority vote of the 10-member commission, including at least three of five senators and three of five delegates, is needed for the expansion to move forward.

If the required improvements are achieved, the commission should vote to approve broadening the state-federal insurance program, Hanger said. “That’s our role in the gatekeeper function.”

However, some members of the commission have made it clear that they do not support a move that would leave Virginia dependent on federal funds that may not be there in the future.

“The federal government is broke. They do not have the money to provide to the states for expansion,” Del. Steve Landes, R-Augusta County, told several hundred people who gathered on the Capitol grounds before the meeting to express their disapproval.

Organized by Americans for Prosperity, the rally included opponents wearing green T-shirts and waving signs with slogans such as “Stop the Assault on our Liberty” and “Obama Goons: IRS, DOJ, EPA, FEC.”

The Affordable Care Act proposes that Medicaid be expanded to include people making up to 138 percent of the federal poverty guideline, or about $16,000 for an individual and $32,000 for a family of four.

However, the U.S. Supreme Court ruled in upholding the act that states cannot be forced to go along.

Expansion in Virginia is both optional and uncertain. Lawmakers allowed for expansion as part of a two-year budget approved in March — but only if the system is made more effective and cost-efficient. The legislative commission, which will hold at least one more meeting this year, was created to monitor whether those reforms are accomplished.

Among the proposed changes: Making the government program work more like a commercial insurance plan, reducing fraud and abuse and launching a managed-care-style pilot program to coordinate care for people receiving both Medicare and Medicaid.

An estimated 400,000 Virginians, many of them among the working poor, could benefit from an expanded Medicaid program, which is just one of many parts of the Affordable Care Act.

Another key part of the law will offer private insurance sold through a government-run system to people better off financially than Medicaid recipients, but who still need assistance to comply with the requirement that nearly all Americans have health insurance. Starting in October, that system will offer subsidized insurance plans to people making up to four times the federal poverty guideline.

Should Virginia decide to expand Medicaid — and join 25 other states that have already done so — the federal government is promising to pay the full share of covering the additional beneficiaries for the first three years, starting in 2014.

After that, the share of federal funding would gradually decrease to 90 percent by 2020. Over the next decade, Virginia is expected to spend $137 million on the program while receiving $23 billion in federal funds. The cost of covering those already insured under the current system would remain a 50-50 split between state and federal dollars.

Virginia has some of the strictest criteria for receiving Medicaid in the country, and ranks 48th in the nation on per-capita spending for the program.

During a presentation of how other states have expanded Medicaid, several members of the commission pressed the speaker on the possibility of the federal government reneging on its promise of funding to the states.

Vernon Smith, the former director of Michigan’s Medicaid system and a principal with Health Management Associates, said he considered that possibility to be “extremely unlikely.”

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