On September 10, legislators who serve on the Joint Subcommittee for Health and Human Resources Oversight received presentations from state agencies charged with improving the administration of the Supplemental Nutrition Assistance Program (SNAP), as well as the care delivered in nursing homes in Virginia. Senate Finance and Appropriations Committee Senior Legislative Fiscal Analyst Mike Tweedy also provided an overview of the new Rural Health Transformation Program, which was funded in the recently-enacted federal reconciliation legislation and is expected to provide at least $500 million to Virginia over the next five years to improve rural health care.
SNAP: Kevin Erskine, Acting Commissioner of the Virginia Department of Social Services, reminded legislators about the key policy changes to SNAP in the reconciliation legislation, which include changes to eligibility criteria and work requirements, as well as a shift of administrative costs to the state and a potential new requirement for the state to contribute a share of benefit costs, which heretofore have been wholly funded by the federal government. The Department is anticipating that the state will need to fund approximately $90 million in additional administrative costs, beginning October 1, 2026. The state contribution to benefit payments will depend on the state’s payment error rate, with a maximum potential share of 15 percent of benefit costs, or approximately $270 million. States with error rates of less than 6 percent are not required to make these payments, and the Governor has directed state agencies to work with local departments to reduce Virginia’s error rate below the 6 percent mark. To date, the Department has provided additional support to local departments with high caseloads, required additional training for local staff, and expanded quality control reviews; with additional resources, the Department could supply certain technology enhancements to support local staff and fund incentives for local departments to sustain best practices. Members encouraged the Acting Commissioner to look to other states that have succeeded in reducing errors in their programs. There was some discussion among members and the Acting Commissioner about the state’s influence over local practices given the structure of Virginia’s state-supervised, locally-administered system for the delivery of social services. The Acting Commissioner’s presentation is available at this link.
Rural Health Transformation Fund: Mike Tweedy outlined the key elements of this new program, which will distribute half of its funding equally among states over the next five years, with the remainder allocated based on state applications to the Centers for Medicare and Medicaid services. Funds may be used for a variety of purposes that advance broad goals of improving rural health outcomes, enhancing access to care, bolstering workforce development, and fostering technological innovation. The Governor has directed the Secretary of Health and Human Resources to develop Virginia’s Rural Health Transformation Plan so that Virginia is positioned to apply for its share of funding when the application is made available; CMS is expected to make awards by the end of the year. Currently, the Administration is conducting stakeholder listening sessions and soliciting public comment via email in order to develop its plan. Staff cautioned that the funding, while substantial, is time-limited, and that legislators should avoid creating ongoing obligations that will require new state funding to sustain.
Nursing Facility Inspections and Value-Based Payments: The Virginia Department of Health (VDH) and the Department of Medical Assistance Services (DMAS) presented updates on their agencies’ efforts to improve care in nursing facilities, through conducting more timely inspections (by VDH) and providing financial incentives for meeting certain performance standards (by DMAS). VDH is implementing several approaches to improving its oversight capacity, including workforce recruitment and retention incentives and implementation of new authority to implement intermediate sanctions on poorly performing nursing facilities and to establish a licensure fee structure that will better support the agency’s costs for conducting inspections. As part of a recent Executive Order, a new Advisory Board for Nursing Home Oversight and Accountability has been established; VACo Past President and King and Queen County Supervisor Sherrin Alsop has been appointed to this Board. Legislators voiced concerns about the quality of care in lower-rated facilities, pointing out that these facilities are largely funded through public dollars, and expressing concerns about poorly-performing facilities qualifying for the DMAS incentive program. DMAS staff stressed that the program was only recently implemented and indicated that there are several areas under consideration for revisions.
VACo Contact: Katie Boyle