Fresh off the high of securing expanded Medicaid coverage for thousands of Arlingtonians, advocates and healthcare professionals have a new challenge to confront: how to reach people newly eligible for health insurance, when they might have no idea about the change.
That’s a big part of why state officials and Del. Patrick Hope (D-47th District) convened a meeting of more than 100 people Friday (Oct. 26) at the offices of Arlington’s Department of Human Services, offering strategies for just how they can help ensure that everyone who now qualifies for Medicaid gets covered when enrollment starts Thursday (Nov. 1).
The program’s expansion, the result of a years-long battle in the General Assembly that culminated in a compromise signed by Gov. Ralph Northam this spring, will allow low-income adults without any children to access health coverage through Medicaid for the first time ever in Virginia.
It also bumps up the income caps for families and people with disabilities, meaning that roughly 400,000 people are now eligible for the program across the state. And in Arlington alone, roughly 7,000 people could join the Medicaid rolls, according to Anita Freeman, the county’s director of human services.
“It’s a really gratifying day that we’re at this point, talking about enrolling thousands of people to get healthcare who didn’t have it before,” Hope told the crowd. “It’s a long day in coming.”
The expansion is indeed a development welcomed with jubilation by Democrats, and even some moderate Republicans, but it won’t come without complications. Not only will the process of enrolling more people in Medicaid cost localities a bit more money, but state and local officials alike have to work to make people aware they actually stand to benefit from a program that’s long shut them out.
“We’re undertaking the largest expansion of health coverage in Virginia history,” said Dr. Jennifer Lee, the director of the state’s Department of Medical Assistance Services. “We’re all super excited about it, but there is a lot of change too.”
Over the course of the meeting, Lee outlined a variety of ways that her department, which manages Medicaid in the state, plans to start reaching people about their new eligibility. That includes work with Community Service Boards, organizations in each Virginia locality focused largely on overseeing mental health and substance abuse services, and even local and regional jails.
As Lee points out, many people who are currently incarcerated have their healthcare needs covered by the state, but could be shifted to Medicaid under the new rules. And for people looking to re-enter their communities, particularly after being convicted on drug charges, she wants to connect them to Medicaid to get them the tools they need to confront their substance abuse issues.
“We want to get them in to recovery, so that they aren’t constantly cycling in and out of the system due to their addiction,” Lee said.
State officials will also launch a series of mailers to people receiving other government benefits, like food stamps, who may be able to easily enroll in Medicaid coverage by providing a few more details to officials.
But Lee also implored attendees, many of whom came from nonprofits and other groups working with low-income people around the county, to help become “spokespeople” about the new Medicaid realities in their own neighborhoods. She’s particularly interested in finding people who can reach non-English speakers, as they might have the hardest time understanding the maze of new rules governing the program.
“The best message for folks is that the rules have changed in Virginia Medicaid,” Lee said. “If they’ve applied before, they should try again.”
Complicating matters further for Lee and her fellow healthcare advocates is that the rules surrounding the Medicaid expansion will change sometime in the future. That’s because the program will eventually require enrollees to prove that they’re employed, in school or pursuing a job in order to receive coverage, a stipulation insisted on by some state Republicans initially hesitant to back Medicaid expansion.
Yet Lee explained that the state will need to get federal approval before putting those requirements in place. She said her department will submit an application to kick off the process as soon as this week, but there’s no telling when the state will earn the green light.
“It could be next week, six months or two years,” Lee told ARLnow in an interview after the meeting. “And then there will be some ramp-up time once we get the approval, because these are complicated new rules we’ll have to put in place.”
Some Republicans have grumbled that Northam’s administration is taking too long to implement the new work requirements, and that they’ll likely contain too many “loopholes” to help people avoid working — applicants who can prove they have an illness or condition that prevents them from holding a job will be able to earn exemptions from the requirements.
But Lee believes the state’s work requirements are “right in line” with other recently adopted standards, like those in Kentucky and Indiana. She also vigorously disputes any implication that the state is dragging its feet in setting up the new requirements, noting that it’s pressing for federal approval just as quickly as it can.
“Indiana planned for years to put theirs in place,” Lee said. “When you look at other states, we’re actually pursuing an extremely aggressive timeline here.”
Yet, beyond all the complications and the political squabbling, Lee worked to stress just how valuable the Medicaid expansion will be for vulnerable Virginians.
She once worked as a physician in the emergency room at the Virginia Hospital Center in Arlington, and told a story of encountering a woman who suffered an acute stroke and wasn’t able to walk, but initially declined to be admitted to the hospital because she was uninsured and feared she couldn’t afford treatment.
“She told us, ‘I can’t be admitted because I have to go to work tomorrow,” Lee said. “So don’t forget, this is real. This is for our friends, our family, who desperately need access to care, and can’t get it.”
Arlington officials expect as many as 3,000 more people will be able to earn health insurance through the Medicaid expansion passed by state lawmakers this year — and now the county needs new staffers to sort through the paperwork.
The County Board could soon accept just over $277,000 in state funds to hire six new workers to process Medicaid eligibility applications, anticipating that Arlington will see up to 7,000 requests for coverage through the program when changes officially take effect next year.
The General Assembly approved the expansion this spring, after Democrats’ sweeping gains in the legislature set the stage for a compromise on an issue that had long roiled state politics. Now, Arlington and other localities around the state are preparing for an influx of applications from low-income and disabled workers looking to earn healthcare coverage under the program for the first time.
Starting Jan. 1, 2019, Medicaid benefits will be available for childless, able-bodied adults for the first time, so long as they earn no more than $16,754 a year. The income cap will be raised to the same level for adults with disabilities, up from $9,700 a year, while income limits will also be bumped up for families with anywhere from three to eight children.
Under those new standards, county officials project at least 2,904 additional people in Arlington will be eligible for the program, and staff fully expects that evaluating the incoming flow of applications will overwhelm county workers.
While income is one measure Medicaid officials will examine in determining if someone is eligible for benefits, the program will also require many recipients to hold down a job — Republicans insisted on including the work requirements as a condition for approving the plan, though it will likely entail complex reporting requirements.
Accordingly, hiring six new staffers would help the county better distribute work among its employees and “contribute to reducing the error rate and processing time for application and recertification processing,” staff wrote in a report prepared for the Board.
In all, the county expects to spend about $527,000 annually to afford those staffers moving forward, with the state covering just over half that amount. Staff are hoping to pay for the remaining $249,000 or so with its own money, then evaluate in future budget years if the county needs to maintain those positions.
The Board is set to sign off on the new hires at its meeting Saturday (Sept. 22).
Photo via Arlington County
Sen. Tim Kaine (D-Va.) is calling the bipartisan budget deal, which passed early Friday morning after a five-hour government shutdown, “good for the country and good for Virginia.”
The deal, which adds billions of dollars in federal spending for military, disaster relief, and domestic programs, comes weeks after a historic package of tax cuts championed by President Trump and the GOP was signed into law.
Kaine is touting several portions of the spending bill as Virginian victories, such as the $3 billion for 2018 and 2019, respectively, that the budget sets aside to tackle the national substance abuse epidemic. The Children’s Health Insurance Program (CHIP) has been funded for an additional four years, which a press release from the Senator’s office states will benefit 66,000 Virginian children.
A two year funding extension of federally-qualified community healthy centers was included in the spending bill. The Senator’s press release states that “approximately 300,000 Virginians receive health care at more than 100 community health center locations in underserved communities” across the state.
“I am proud to have worked with a bipartisan group of my colleagues last month on negotiations to reopen the government that led us toward this deal, but our work isn’t done. We now must build on this bipartisan progress and immediately proceed to debate and pass legislation that permanently protects Dreamers,” stated a press release quoting Kaine.
The bill ends military sequestration, which Kaine says has been “painful” to Virginia’s military community. It also increases national security and military spending by $80 billion in 2018 and $85 billion in 2019. Domestic spending will be increased by $63 billion in 2018 and $68 billion in 2019, which will fund education, health, and non-defense national security programs.
Other Virginia “wins” cited by Kaine, via press release, include:
- Veterans – $2 billion for FY 18 and $2 billion for FY 19 to reduce the VA health care maintenance backlog
- Child Care – $2.9 billion for FY 18 and $2.9 billion for FY 19 for child care, including for the Child Care Development Block Grant program;
- Higher Education – $2 billion for FY 18 and $2 billion for FY 19 for programs that aid college completion and affordability, including those that help police officers, teachers, and firefighters;
Drug Addiction and Mental Health – $3 billion for FY18 and $3 billion for FY19 to combat the substance abuse epidemic;
- Infrastructure: Transportation, Clean Water and Broadband – $10 billion for FY 18 and $10 billion for FY 19 to invest in infrastructure, including programs related to rural water and wastewater, clean and safe drinking water, rural broadband, roads, rail and bridges;
Photo via Sen. Tim Kaine’s office