Expected spikes in health care premiums, cuts to Medicaid funding and tighter eligibility requirements have left Arlington social services scrambling to meet an incoming surge in need.
Northern Virginia officials at the state and federal level say they’re doing what they can to soften the impacts of planned federal rollbacks, many of which aren’t scheduled to take effect for months or years. Despite Democrats’ efforts in Congress, however, one of the first major changes — a lapse in enhanced premium tax credits under the Affordable Care Act — is expected to hit as many as 100,000 Virginians at the end of the year.
At a recent panel discussion, leaders from organizations including the Arlington Free Clinic and the Public Assistance Bureau at the Department of Human Services said they’re looking for ways to streamline operations where they can, while bracing for a rising tide of casework.
“Health care costs don’t go away when we don’t address them,” Arlington Free Clinic CEO Lesley Daigle said at the event hosted by Advance Arlington. “Health care needs don’t go away when they’re unmet. They just get worse.”
State Senate Majority Leader Scott Surovell (D-Fairfax) said Virginia legislators are pursuing ways to use state funding to account for lost federal dollars. Meanwhile, U.S. Rep. Don Beyer (D-Va.) underscored that restoring greater support for both health care and food assistance remains a core priority, especially if Democrats can regain the House or Senate next year.
“I can assure you that cuts to Medicaid and SNAP will be at the top of our agenda to remedy,” Beyer said.
How changes will affect local services
Federal changes are expected to go into effect in phases.
Medicaid eligibility requirements for some classes of immigrants, for instance, are scheduled to constrict on Oct. 1, 2026. By default, states are required to implement more stringent work requirements for Medicaid no later than Dec. 31, 2026, and steeper co-pay requirements go into effect on Oct. 1, 2028.
More immediately, enhanced Affordable Care Act subsidies are on track to expire on Dec. 31, driving up premiums nationwide. But it’s still hard to tell what all of this will mean for Arlington.
“We don’t really know what the impacts are going to be,” Daigle said. ” I think it’s going to require all of us to be vigilant in the months to come, and really be keeping an eye out for what Virginia’s interpretation of the new Medicaid rules will be.”
The Arlington Free Clinic, which provides health care to about 1,600 people every year, is cushioned from some of the more severe cuts because 92% of its funding comes from private donations. All the same, as about 10,000 Arlington residents rely on Medicaid expansion, Daigle said she’s expecting a big increase in Arlington’s uninsured population — with inevitable impacts on safety net programs.
“It’s just going to take resources to attack that problem,” she said.
Some expected changes, like a requirement for many Medicaid recipients to work at least 80 hours a month, come with exceptions for people who can’t work because of major health care needs or other issues. But verifying those exceptions — and verifying that people actually worked enough hours to qualify for benefits — will place even greater burdens on social services.
“There are not enough case managers,” said Cicely Whitfield Johnson, chief program officer at the nonprofit Bridges to Independence. “We do not have enough funding to deal with what that looks like.”
Daigle said she hopes to find more ways of increasing coordination between Arlington’s social programs as cuts go into effect, like streamlining documentation requirements to make it easier to access various services.
“It will force all of us in the nonprofit sector to be smarter about what we do, to be more collaborative, to share resources and not duplicate services,” she said.
What N. Va. lawmakers are doing
All of the federal changes add up to billions of dollars in lost funding for Virginia, creating difficult choices for state lawmakers, Surovell said.
“If we don’t have serious conversations about tax increases or not conforming to federal tax law, we have to start talking about priorities,” he said.
The state senator said he’s considering options for various ways to boost the commonwealth’s spending ability, like a sales tax on services or a millionaire income tax. Still, he called the budget a “complete disaster” and warned that the cost of keeping coverage at current levels would far exceed the budget surplus of about $2.7 billion.
“We’re working on it,” Surovell said. “It’s really going to depend on how much money we have to spend. We’re trying to figure it out.”
Surovell added that he’s hopeful that pressure from constituents and change-ups in Congress might help reverse the current trajectory. It’s a point that Beyer hit home, as well.
“Look, I’m still hopeful,” the congressman said. “I’m elated about [the Nov. 4] elections in Virginia and Pennsylvania and New Jersey. So much of the political vandalism brought on by Trump and his cronies [is] going to be curtailed if we can take back the House.”
In Virginia, Surovell said the search for solutions is “mostly just about more money,” as well as beefing up the safety net in other areas, like free clinics. No matter what, he warned that hard times are ahead for many who rely on federally funded health care.
“It’s going to be difficult,” he said.
