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Joint Commission on Health Care Plans 2023 Work, Discusses Medicaid “Unwinding”

The Joint Commission on Health Care held its first meeting of the year on May 17.  In addition to mapping out its work for the remainder of 2023, Commission members received a briefing from the Department of Medical Assistance Services and the Department of Social Services on the required “unwinding” of the continuous Medicaid coverage that was in place during the pandemic as a condition of Virginia’s receipt of an enhanced federal match rate for the program.

The Commission will move forward with three previously-planned studies and also address two additional issues as part of its workplan.  The following studies are planned for the 2023 interim:

  • Obesity and eating disorders: This study was directed by legislation in 2022 and will examine the prevalence of obesity and eating disorders; identify evidence-based strategies for prevention, early identification, and treatment; determine the extent to which Medicaid and state-regulated health plans cover these services; and identify barriers for patients and families seeking treatment.
  • Vertically-integrated carriers and providers: This study is intended to evaluate the scope of vertically-integrated carriers and providers in Virginia and nationwide and determine the effect of vertical integration on access to services, health care costs, and quality of care.  The study will focus on vertical integration (a joint ownership interest) between payers and acute care hospitals.
  • Team-based care: This study directs staff to review evidence-based models of team-based care (the provision of health services by at least two professionals who work collaboratively with patients and caregivers to accomplish shared goals) and their effectiveness at improving outcomes; determine the extent to which team-based care is being used in Virginia and any obstacles to its implementation; and consider policy options for the state to promote effective models of team-based care.

Additionally, in response to Commission discussions in past years regarding health care workforce pressures, members requested that workforce issues be an area of ongoing focus.  Staff will begin by cataloging existing efforts, to include consultation with the Virginia Health Workforce Development Authority, and will recommend next steps for the Commission.  Staff will also respond to members’ request for information on issues regarding prescription drug affordability by arranging a briefing on the potential impact of federal legislation, as well as federal court rulings on the issue.

Sarah Hatton, Deputy Director for Administration at the Department of Medical Assistance Services, and Carl Ayers, Deputy Commissioner for Human Services at the Department of Social Services, briefed the Commission on the status of Medicaid “unwinding” — the end of the continuous coverage requirement that was implemented at the beginning of the pandemic and the return to normal enrollment procedures.  In accordance with the December 2022 Consolidated Appropriations Act, the continuous coverage requirement ended March 31, 2023, and the enhanced federal match that had accompanied this requirement will phase out by December 31.  While the continuous coverage requirement was in place, Virginia experienced an increase of more than 630,000 Medicaid enrollees (a 41 percent increase in enrollment growth), with Medicaid rolls now approaching 2.2 million members; with the end of the continuous coverage requirement, all Medicaid members will need to have their eligibility redetermined over the next 12 months.  This task will be particularly challenging given the volume of redeterminations that must be conducted by local departments of social services that in many cases are already experiencing staff shortages.  The state has contracted for support through the Cover Virginia program, which is planned to process approximately one-third of cases, and funding was recently approved in the “skinny budget” to assist local departments with their workload.  DMAS and VDSS have also conducted training for local departments, and worked with the managed care plans serving Medicaid members to assist with outreach to members and with the transition of individuals who no longer qualify for Medicaid to the state health insurance exchange.  The DMAS and VDSS briefing may be found at this link.

VACo Contact:  Katie Boyle

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