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Health Care Reform in the Commonwealth of Virginia
Hunter W. JamersonMacaulay & Burtch, P.C.
Richmond, VA
Indoctrination into Virginia living Medicaid program fundamentals Breakdown of Virginia’s Medicaid Program Virginia’s health reform initiative Medicaid eligibility expansion debate A review of other exemplar states The path forward in Virginia What should family physicians think?
Overview of Presentation
Red? Blue? Purple? Gerrymandered? Outgoing governor, election on Tuesday Very strong Hospital Association, Health Plan
Association, and medical societies Heavy presence of Tea Party organizations
and Americans For Prosperity
Welcome to the Commonwealth
Budget stalemate over transportation and health care reform
Enactment of 3-phase health care reform process
Creation of the Medicaid Innovation and Reform Commission (“MIRC”) 6 House Members, 6 Senate members, 2 Cabinet
Secretaries Majority of the members from each chamber must
vote to support eligibility expansion
2013 Legislative Session
Medicaid is a state program in the form of a state-federal partnership
States operate Medicaid programs under federal law and regulations that define the terms and conditions for a state to receive federal matching funds
States are entitled to federal Medicaid matching funds on all qualifying expenditures, as defined in:
- Medicaid state plan, including - Any federally-approved waivers that
allow expenditures that otherwise would not qualify
Medicaid Program Fundamentals
State Medicaid programs are designed and administered by state policy makers, within federal rules Each state Medicaid program is unique State programs vary based on state decisions on:
Eligibility, provider payment levels, benefits and limits on benefits, cost sharing, delivery systems, use and types of managed care, quality requirements, special initiatives and innovations
Decisions reflect state priorities, fiscal realities, health care systems, traditions and values
State Decisions but Federal Permission
Frugality through cost controls, public-private partnership, and innovation
Initiatives to improve care and control costs through Virginia Medicaid; a few recent examples: Statewide managed care Development of a demonstration plan to integrate and
coordinate care for dual Medicaid – Medicare eligible population
Development of initiative to coordinate behavioral health services
Working toward managed long term services and supports
Virginia’s Medicaid Program
700,000 Medicaid members 80% in managed care, 20% in traditional FFS Seven managed care plans (including 4
provider sponsored plans) All managed care plans are full-risk Existing Medicaid program = 21% of Virginia’s
annual budget Cost drivers: FFS, LTC, ABD, Foster Care and
Behavioral Health
Virginia’s Medicaid Program Today
Concern that federal government might not live up to its commitment for ongoing funding, due to its focus on federal debt
Concern about local political backlash Concern about access and lack of providers
to serve more Medicaid patients Concern that current Medicaid program can
be improved and should be reformed first.
The Medicaid Expansion Debate
Amendment to the 2013 Appropriations Bill handed down by the Governor during Veto Session
Three-phase approach to reforming the existing Medicaid Program
Many reforms will require CMS approval Reforms must either be completed or have a
plan in place for completion prior to Virginia Medicaid requesting permission to expand
Virginia’s Health Care Reform Initiative
Ohio – Governor Kasich has proposed program expansion driven by cost sharing for adults 100-133% of FPL
Michigan – Governor Snyder has proposed full expansion through mandatory managed care enrollment and creation of a Health Savings Fund
Indiana – Governor Pence has proposed an expansion of the Healthy Indiana Plan to encompass the newly eligible potential Medicaid population; driven by an HSA model
Expansion Proposals in Other States
Arizona – Mandatory managed care for entire population; expansion tied to an 80% federal match sunset clause
Iowa – Wellness Plan (ACO/PCMH model within Medicaid) and Marketplace Choice Plan (Exchange premium assistance)
Arkansas – Premium assistance through commercial plans, cost sharing, HSAs
Expansion Proposals in Other States
A Virginia Expansion Solution?
How much of your practice is Medicaid? What impedes you from taking more
Medicaid patients? Does the existing program need overhaul
before new patients are added? Is Medicaid Expansion a priority for you?
What Should Family Physicians Think?
http://mirc.virginia.gov http://hac.virginia.gov/MIRC/10-21-13/
102113_No5_Jones_MIRC.pdf http://mirc.virginia.gov/documents/10-21-13/
102113_No7_Hazel_MIRC.pdf http://mirc.virginia.gov/documents/08-19-13/
Health_Mgmt_Assoc.pdf http://mirc.virginia.gov/documents/08-19-13/
Costs_of_Medicaid_Expansion.pdf
Sources
Questions?