At its December 3 meeting, the Joint Commission on Health Care acted on recommendations from three staff studies and planned its work for the next year.
Addressing Transportation-Related Barriers to Health Care: Commission staff were directed to examine transportation barriers to health care in Virginia and identify strategies that could be implemented to address these barriers. Members approved a series of recommendations aimed at enhancing transportation options, although several members who also serve on the legislature’s “money committees” abstained from voting on recommendations that would involve additional funding, citing a reluctance to commit to additional spending given the known budget pressures facing the state. Key recommendations approved by the Commission include:
- Improving non-emergency medical transportation provided through Medicaid by aligning performance metrics across the state’s Medicaid program and developing guidance for prior authorization for non-emergency medical trips.
- Dedicating a portion of funding from the Commonwealth Mass Transit Fund for human services transportation programs; staff proposed dedicating 0.0045 percent of the Fund to this purpose, in addition to the existing $1.5 million set-aside, which would increase the amount of funding to approximately $2.4 million in total.
- Improving the state’s ability to use federal funds by providing technical assistance to program grantees. Currently, the state benefits from the Federal Transit Administration’s Section 5310 program, which supports mobility enhancements for older adults and individuals with disabilities; other federal funds may be used to match these dollars, but grantees, particularly smaller nonprofits, have expressed concerns about the difficulty of managing funding from multiple sources.
- Supporting regional resource-sharing in transportation services by establishing a competitive grant program for regional hubs to increase their capacity to provide trips, or for expansion of mobility management services, which assist individual clients with coordinating appropriate transportation options.
- Providing funding for localities to support microtransit services in rural areas; these services provide rides upon request by riders through an optimized route with pickup and drop-off points within a set service area.
The full report is available at this link.
Access to Pharmacy Services: Staff presented preliminary findings to the Commission earlier this year, noting that access to community pharmacies improves health outcomes, but that the number of community pharmacies operating in Virginia has declined since 2019, largely due to financial pressures associated with reimbursement rates.
Key recommendations approved by the Commission (with similar abstentions based on financial constraints) include:
- Taking steps to set a minimum dispensing fee for prescriptions for Medicaid members, which would be developed by the Department of Medical Assistance Services. DMAS would also be required to share the results of a 2024 survey of pharmacists’ costs in dispensing prescriptions for Medicaid members; this survey is conducted every five years and is used to update fees.
- Establishing an incentive program to provide funding for pharmacies serving communities with little or no access to pharmacies.
- Increasing funding to the Virginia Association of Free and Charitable Clinics and the Virginia Community Healthcare Association to expand pharmacy services to unserved localities.
- Developing a methodology for setting drug ingredient cost and minimum dispensing fees to be paid by pharmacy benefit managers (PBMs). These entities are third parties that manage prescription drug programs on behalf of payors (such as employers or commercial health plans) and contract with pharmacies to set reimbursement rates. Staff’s report explains that independent community pharmacies report receiving reimbursement rates from PBMs that do not cover their costs, although chain pharmacies may be able to negotiate more favorable rates or absorb lower reimbursements.
The full report is available at this link.
Legislative Oversight of Medicaid Spending: Staff outlined various ways the legislature has enhanced its oversight of the Medicaid program, including the addition of new reporting requirements and legislative involvement in the Medicaid forecasting process, the establishment of the Joint Subcommittee for Health and Human Resources Oversight (which includes Medicaid within its scope), and the creation of a special unit within JLARC to review health and human services issues. Staff offered several options to provide more comprehensive oversight of the program, including establishing a Medicaid-specific legislative commission or adding staff to JLARC, the Joint Commission on Health Care, or the money committees; after some discussion of budget constraints, the Commission opted to direct the Joint Subcommittee on Health and Human Resources Oversight to conduct ongoing monitoring, oversight, and evaluation of the program.
The full report is available at this link.
2026 workplan: Staff will undertake three studies in 2026, which are planned to be limited in scope, pending action by the legislature to refer additional topics next session. These studies will review the financial condition of rural hospitals; the public health effects of e-cigarette use and regulation of e-cigarette retailers; and the impact of federal policy changes on Medicaid in Virginia.
VACo Contact: Katie Boyle