Virginia Medicaid History and Facts

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Initial Medicaid Implementation: Virginia initially implemented their Medicaid program in July of 1969. The decision to establish a Medicaid program was pushed by physician groups who also advocated for payment rates that were at least equal to the payment rates in Medicare. The governor of Virginia in early years made an appeal to physicians to use restraint for utilization of all services because of the cost of providing these services. 

Key Medicaid Political Issues: Virginia implemented a primary case management program in 1991 that gave people who had Medicaid managed primary care services. The program was implemented in five counties and then later expanded to the whole state. The program, named Medallion and Medallion 2, provided more extensive managed care services in later years of the program’s development. The state also implemented a premium assistance program for families who would qualify for CHIP coverage. Before the state implemented Medicaid expansion the state took advantage of a provision of the Affordable Care Act that allowed states to enroll people in prison in Medicaid coverage if they were eligible.

Medicaid Expansion Implementation: Virginia expanded Medicaid through their legislature in May of 2018 a few months following the 2017 election which brought the state a Democratic governor and a majority in the House and a near tie in the Senate. While the state had a Democratic governor from 2014-2018, the legislature blocked all attempts to expand coverage. The bill that included a Medicaid expansion also called for the state to request implementation of a work requirement as a condition of the Medicaid expansion. The state was allowed to implement the Medicaid expansion while the work requirement waiver was being processed by the state and federal government. It was anticipated that 400,000 people would be eligible for Medicaid expansion.

General facts about Virginia Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Family Access to Medical Insurance Security (FAMIS)

Separate or combined CHIP:  Combination

Medicaid Enrollment: 1.039 million (2018 estimate)

Total Medicaid Spending: $9.04 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 12%

Share of Children covered by Medicaid: 25% (estimate)

Share of Medicaid that is Children and Adults: 72%

Share of Spending on Elderly and people with disabilities: 66%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 233,000 (as of February 2019)

Work Requirement: Under Review

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