Virginia Medicaid Expansion Q&A by Virginia Department of Medical Assistance Services

September 20, 2018

Who will be covered under the new eligibility rules for Virginia Medicaid? Beginning January 1, 2019, Virginia adults are eligible for coverage if they are between the ages of 19 to 64, meet income requirements and are not eligible for Medicare. Under the new guidelines, a single adult making at or below $16,750 annually may be eligible. A parent in a family of three with a household income at or below $28,700 may also qualify. For more information about income requirements, visit coverva.org and check out the Eligibility Screening Tool to see if you or someone you know might meet the income requirement.

How many people will benefit from the new eligibility rules for Medicaid? New Medicaid eligibility rules will give up to 400,000 Virginia adults access to health coverage.

What services are included in the coverage? Hospital stays, primary care doctors, specialists, prescriptions, mental health services, addiction treatment and many more.

When does the new coverage begin? Coverage begins January 1, 2019.

How can people apply for coverage? We hope to begin accepting applications for the new coverage before January 1, 2019. Information on when adults can begin applying for the new coverage will be available soon on coverva.org. Individuals can also sign up on coverva.org to receive the latest updates by text or email, including updates on when adults can begin applying for the new coverage.

You can review all of the ways to apply for Medicaid by phone, online, or in person, by visiting our website at coverva.org.

1. By phone: Cover Virginia call center at 1.855.242.8282 (TDD: 1.888.221.1590)
2. Online: Visit commonhelp.virginia.gov OR healthcare.gov
3. In Person: Visit your local department of social services agency in your community. You can search for the agency location in your community by visiting coverva.org.

How is DMAS working with local departments of social services to improve the eligibility and enrollment process? DMAS eligibility and enrollment leaders recently collaborated with Department of Social Services officials on detailed informational sessions for 300 local department of social services staff, and DMAS is continuing that collaboration for a series of similar meetings across the state this fall.

How is DMAS working with our local community services boards (CSBs) to ensure that they are able to provide behavioral health services and receive reimbursements promptly? The CSBs are well positioned to continue to be one of our most important partners in serving Medicaid members. Most CSBs in Virginia are in-network providers in all six of the health plans that will serve our new adult members as well as existing members. CSBs will not need to obtain new contracts to serve the new adult enrollees. The processes that the CSBs use today for current Medicaid members will be the same for the new adults. The primary impact of this change for CSBs will be an increase in the number of individuals covered by Medicaid and a decrease in the number of individuals who pay out-of-pocket for care. We know from other states that have already expanded adult Medicaid eligibility that public mental health providers are able to generate new revenues, as a larger percentage of their clients have coverage.

CSBs are an important partner in our work to provide coverage to Virginians, and we see that partnership growing stronger. We are planning a series of town halls this fall specifically for our CSB partners so that we can share information and support CSBs as they train staff to assist with enrollment. We are committed to working closely with the CSBs so they can help their eligible patients enroll in Medicaid and gain coverage.  We want to give CSBs the support they need to enroll all of their eligible clients and be ready to bill Medicaid for services for the newly eligible adults on January 1, 2019.

How will local jails be affected by the new coverage? Jails have historically been able to bill Medicaid for incarcerated individuals who require hospitalization and who are eligible for coverage. Now, a larger percentage of the incarcerated population will be eligible for coverage of hospitalizations. We also are working with state, regional and local officials to streamline the process for accepting and processing applications for individuals as part of the pre-release process.

What is the status of Virginia’s § 1115 Waiver request and when will that take effect? We remain focused on the work necessary to ensure that new health coverage for Virginia adults is available beginning on January 1, 2019. Developing a waiver is a separate, ongoing process, as described in the state budget, and the development of the waiver proposal remains on schedule for submission this fall. The state budget clearly envisions that new coverage for adults will begin on January 1, 2019, when the waiver is still under development, and that sequence of events remains unchanged.

What is the cost of Medicaid expansion in Virginia? Expanding coverage in the Commonwealth will result in state budget savings. The state budget anticipates a net savings to the state of $355 million for fiscal years 2019-20, and Virginia will benefit from an additional $2.4 billion in new federal funds that will go directly to health care providers for the care they give to the newly covered adults. Now, Virginia can obtain new federal funds for behavioral health services and other health-related costs that were previously paid through state tax dollars. Virginians are expected to see savings in areas including temporary detention orders, services for some pregnant women, coverage for inpatient hospital care and behavioral health services at CSBs, and indigent care payments.

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