Affordable Care Act Archives - Read. Think. Act.

Enrolling Virginians in Medicaid with Deepak Madala

(Nov. 12, 2018) Catherine Read sits down with Deepak Madala, Director of Enroll Virginia, to discuss the process of enrolling Virginians in Medicaid. Enroll Virginia was created by the Virginia Poverty Law Center, and is a non-partisan community based effort to educate all Virginians about the new health insurance marketplace and provide free, unbiased assistance with the application and enrollment process.

When the Virginia General Assembly passed Medicaid expansion this year, Virginia became the 33^rd state to expand Medicaid through the Affordable Care Act (ACA). Approximately 400,000 Virginians became eligible for benefits. Deepak explains how Enroll Virginia is working hard to reach eligible participants, and get them signed up for health insurance. Madala notes that Virginia has the benefit of learning best practices, and pitfalls, from the states that have already gone through this process.

Medicaid is sometimes confused with Medicare. Both Medicaid and Medicare are public health insurance programs but Medicare is administered solely by the federal government and provides coverage for seniors aged 65+, people with disabilities, and those with end stage renal disease. Medicaid (the subject of this show) is a partnership between the federal government and the state governments, designed to provide health insurance coverage for those in poverty. When the ACA passed in 2010, it afforded the states the option of expanding Medicaid with federal dollars for adults aged 19-64 who are considered the “working poor”. Applicants can make up to 400% of the poverty level and still qualify for this program. The state administers and sets guidelines for this program, however it is funded through federal tax dollars.

Enroll Virginia is working hard to reach everyone who is eligible for this coverage. They are leveraging partners in the social services arena to spread the word and educate the public. “Train the Trainer” workshops are being scheduled throughout the commonwealth. This is helping to educate social workers and case managers, so they can better understand and communicate eligibility and benefits. Organizations can contact the Virginia Health Care Foundation to register for a SignUpNow workshop. There are no restrictions of who can receive this training; it can be a non-profit, a religious organization or even a business. The rules have changed for the better here in Virginia, and their mission to ensure that the word gets out.

For those who are interested in finding out if they are eligible, they can simply call the 1-800 number to speak with a trained representative, go online to do the application or they can mail in a paper copy. The applicants will need to provide information about income, and after that is verified they will know what benefits they are eligible for. If the applicant calls in, and their income can be verified on the spot, then they may not even have a waiting period to know how to proceed.

Enrollment for Medicaid is rolling, so there is no deadline to get signed up (as there is in traditional insurance plans). However, the deadline for securing insurance with the ACA State Marketplace is December 15^th. So, if an applicant is not sure of whether or not they are eligible for Medicaid Expansion they should contact the office as soon as possible, because if they do not qualify for Medicaid then they have adequate time to secure private insurance by the December 15^th deadline.

There are six different plan options available to all Virginians, which are different health insurance networks. Coverage is not limited, and there are no premiums, co-pays or deductibles. There is also a specific emphasis on preventative care, things like immunizations and well visits. When choosing a plan, applicants will want to review the various networks to find their current doctors, in order to ensure that they are finding a plan that best meets their needs. Many of the free clinics, where these patients currently seek care, will have counselors on hand to help patients navigate getting signed up for Medicaid and best understand all of the different options.

For people who are already receiving certain benefits from the state, such as FAMIS, Virginia’s health insurance program for children, or Supplemental Nutrition Assistance Program (SNAP) benefits, the state has technology in place to assess eligibility for other family members. Recipients should expect to receive a YELLOW envelope in the mail, where they will need to complete a few more pieces of information in order to finalize the application. The goal of the program is to enroll as many eligible participants as possible. If people do not receive this envelope, they should visit the CoverVA website, call 1-855-242-8282, email [email protected], or fill out a paper application at their local social services office to determine eligibility.

by Rachel Simon

Del. Patrick Hope – Medicaid Expansion in Virginia

(June 4, 2018) Catherine Read interviews Delegate Patrick Hope (D-47) of Arlington to discuss the recent passage of the Medicaid Expansion in the Virginia General Assembly, as part of the biennial budget signed by Gov. Ralph Northam. Del. Hope currently sits on the the General Laws, Courts of Justice and Health and Welfare Committees in the House of Delegates, where he is able to lend his professional expertise from his career as a healthcare attorney. Del. Hope also serves on the Joint Commission on Healthcare and the Deeds Commission, which has been tasked with studying and making recommendations on improvements to Virginia’s mental health care delivery system.

Del. Hope was elected to office in 2009, one year before the Affordable Care Act, otherwise known as Obamacare, was passed into law. Under the ACA, Washington allows states to open their rolls to people with income up to 138% of the federal poverty level, which is $16,750 for an individual and $28,700 for a family of three. The federal government agrees to pay 90% of the cost of expanding the rolls, totaling approximately $2 billion a year. These are dollars that Virginians have been paying with their federal taxes that will now be returning home. Baked into this year’s proposed budget is a tax on hospitals in Virginia, which is designed to cover the 10% cost that the state will be responsible for.

Since the adoption of the ACA in 2010, Hope has advocated for expanding Medicaid, and bringing these federal tax dollars back to the commonwealth for individuals who fall in the “gap”. This gap exists because as the program works today, Medicaid in Virginia has a very low-income threshold for eligibility – $6900 for a family of three, $9700 for a disabled individual, and able-bodied childless adults are not eligible at all, no matter how poor they are. Therefore, insurance on the ACA marketplace was not accessible to the 300,00+ working poor citizens of Virginia.

Effective January 1, 2019 this will all change. The influx of federal dollars to provide healthcare to those in need will free up money in the biennial state budget to invest in other important initiatives. Teachers will receive a 3% pay raise, all judgeships will be fully funded (and 30 judgeships will be added to cover increase caseloads), and state employees will get a 2% pay raise. Money will also be allocated to improve mental health services, as well as addiction and substance abuse programs throughout the state. Del. Hope points out that these are important investments in our safety net and our future.

The adoption of Medicaid expansion will also be a big boost to the state’s economy. By bringing 300,000+ residents onto the healthcare rolls, we will need to find healthcare “homes” for all of the new patients. More doctors, nurses, support and administrative staff will be needed to accommodate the increase in patients. These will be new, well paying and sustainable jobs that will help drive the economy forward.

In order to bring Republicans on board with adopting Medicaid expansion, there are several provisions that were incorporated into the new law. Work requirements will be imposed on all able-bodied adults age 18-55, to ensure that nobody is getting a benefit without putting effort into finding or training for work. The program is called the Training, Education, Employment and Opportunity Program (TEEOP), and will have to seek approval by the Trump Administration before it can be implemented. Del. Hope praised the bipartisan work in the House of Delegates, who included Medicaid expansion in their original proposed budget, along with the hard work and brave efforts of Sens. Emmett Hangar (Hanover), Frank Wagner (Virginia Beach ) , Jill Holtzman Vogel (Faquier) and A. Benton Chafin, Jr. (Russell) who propelled the Senate to move the budget forward with Medicaid expansion included. There will be much work to be done to get the program off the ground, but passage of the budget was the first step of the process.

by Rachel Simon

Healthcare in Virginia – Senator George Barker

(Dec. 4, 2017) Catherine Read interviews State Senator George Barker (D-39) to discuss Healthcare in Virginia. Sen. Barker represents the 39^th District, which includes southern Fairfax County and parts of Prince William County and the City of Alexandria. His academic credentials include an undergraduate honors degree in Economics and Public Health, along with a Masters degree in Public Health Policy and Management, both from Harvard University. For 30 years, Sen. Barker has worked for Northern Virginia’s regional health planning agency, the Health Systems Agency of Northern Virginia. He has worked hard to contain skyrocketing health care costs, promote quality of care and ensure access to medical care for all Northern Virginians. He spoke today about the current state of healthcare and how we can best move forward to serve all Virginians, along with the importance of expanding Medicaid in Virginia.

Sen. Barker first gives an overview of how healthcare is delivered to the most needy in our community. In the 1980’s, Fairfax County was visionary in how it established Community Health Care Network to deliver care to the uninsured (although the centers do take insurance and Medicaid payments if patients have coverage). Officials recognized the importance of treating people for day-to-day illnesses and preventative care, so that trips to the Emergency Rooms could be minimized and costs could be kept down.

During George W. Bush’s administration, there was bipartisan support for a similar federal model to be employed. When a new system was established, Fairfax County was able to take advantage of federal dollars to support their ever-growing operations. Fairfax County now contracts with INOVA and has three centers located in South County, Merrifield and Reston designed to serve people who make up to 200% of the poverty limit. Alexandria, Arlington and Prince William also have also employed a similar free clinic model. One of the challenges faced by patients is that the clinics can be located far away from their homes, and the trip could be difficult or expensive. Additionally, many people do not even know that these centers exist to serve them. If the General Assembly were to expand Medicaid, these centers would not be so over-burdened, as many would opt for covered care closer to home.

The Children’s Health Insurance Plan (CHIP) has dominated the news cycle for many weeks now. The program is set to expire, and Congress will have to fund it in order for the program to be sustained. Developed by Orrin Hatch and Ted Kennedy back in the mid-1990’s, CHIP was designed to specifically serve children and pregnant women whose families incomes fell in the 133%-200% of the poverty limit (in today’s dollars, for a family of four that range would be $27,000-$40,000). These are the working poor, who are making enough money to make ends meet, but cannot afford private insurance. Sen. Barker shared that in Virginia this program is called FAMIS (Family Access to Medical Insurance Services). There are approximately 68,000 children and about 1,000 pregnant women throughout the commonwealth enrolled in this program. Recent statistics show that approximately 1/3 of the births in Virginia are to women who are covered in this program. (Since the air date, Congress did in fact fund this program)

When pressed about how Virginia stacks up to other states, Sen. Barker said that Virginia is consistently ranked as of the best and most efficient Medicaid programs in the country. They have been inventive, creative and out front in supporting programs that create incentives for people to do the right thing. He notes that the state is, however, quite frugal. The reimbursement rates lag behind others, as Virginia does not reimburse doctors at competitive rates. This is challenging because fewer doctors are then opting to accept Medicaid payments.

In the final segment of the show Catherine discusses the Affordable Care Act with Sen. Barker. Looking back to 2010, President Obama used a very Republican framework for creating the ACA. It was modeled after the Massachusetts healthcare system implemented by then Governor Mitt Romney. The main goal was to target the uninsured and to address rising costs. At the time the US was spending 20% of its GDP on healthcare. No other advanced western nation spends more than 13% of their GDP. Although vehemently opposed by the GOP controlled Congress, Sen. Barker shared that the result has been that more people are insured, it has helped decrease the deficit, expenditures have been less than projected and the revenues that support the expenditures have been higher than expected.

In order for the ACA to work properly, the idea is that everyone needs to be insured so that there is a large, divese “pool” of people paying into the system. This spreads out the risk amongst all people, and allows insurance companies to take on the risk of covering all patients, even those with illness and preexisting conditions. Unfortunately, the recent tax bill passed by Congress has taken away the penalty for the individual mandate. This basically tells young, healthy people that you do not have to seek coverage – just wait until you are older and need insurance. Sen. Barker’s estimate is that 13 million people will lose their coverage under this scheme.

Looking ahead to 2018, Sen. Barker is encouraged by the prospect of expanding Medicaid in Virginia. Back in 2014, when states became eligible to participate in the federally subsidized program, the Virginia General Assembly opted to not take the federal dollars to expand the program. Hundreds of thousands of Virginians continue to go uninsured because they make too much money to qualify for Medicaid, but do not make enough money to afford insurance on the exchange. In past years, both the Governor and the Senate have favored opting into the federal program, but the House has flat out rejected it. With the new makeup of the House of Delegates this year (Democrats picked up 15 new seats in this past election) Sen. Barker indicates that there is real hope of getting this passed.

Although Medicaid has failed over the past 4 sessions, Sen. Barker did want to point out that there have been some advances and new initiatives in covered services. As far as mental health and behavioral health is concerned, people who previously did not qualify for benefits can now access them, and don’t necessarily need to wait to qualify. This helps to get people what they need when they need it, before it become a crisis situation where they can harm themselves or others. Additionally, the ARTS (Addiction Rehabilitation Treatment Services) was established. This progam is targeted to those suffering from substance abuse, so that treatment is more readily available and less expensive. The success of these programs, according to Sen. Barker, justifies moving ahead with Medicaid expansion.

Since this interview aired, the General Assembly has proposed the biennial budget for 2018-2020. The House budget did include Medicaid expansion, however the Senate budget did not include the program. The budget conferees are currently negotiating the status. The GA session ends on March 10, and they hope to have things resolved so the budget can be passed and sent on to the Governor.