FAQs Regarding Medicaid Expansion Health Care Access

This document was created by Virginia Health Care Foundation, VAFCC, and Virginia Community Healthcare Association.

Who Will Be Covered? 

About 400,000 uninsured Virginia citizens with incomes below 138% of the Federal Poverty Level. This is equal to $16,753/year for an individual or $28,676/year for a family of 3. 

Most of the people who would qualify work in low-wage or part-time jobs that do not offer insurance, or offer insurance at unaffordable prices. Many work multiple jobs to try to make ends meet. 

There are about 10,000 Virginia veterans without health insurance who would be eligible as well. 

Most of these uninsured Virginians are caught in a terrible Coverage Gap. They don’t make enough to qualify for subsidized insurance from the new health insurance marketplace, but make too much to qualify for Virginia’s current Medicaid program, which has some of the lowest eligibility in the country.

Parents making more than 30% FPL (about $28,676/year for a family of 3) are ineligible. 

Disabled people with incomes more than 80% of FPL (about $9,721/year) are ineligible as are seriously mentally ill individuals with incomes more than 100% of FPL (about $12,140/year). 

Non-disabled adults without children are ineligible regardless of income. 

The Economic & Budgetary Impact - Won’t It Cost Virginia Too Much to Insure So Many? 

No! To the contrary…

The Affordable Care Act (ACA) currently provides 94% federal funding to support Virginia’s coverage. The federal contribution gradually reduces to 90% by 2020 and remains at that level under federal law. 

This money comes from new taxes under the ACA that Virginians have already been paying. 

Every month that Virginia doesn’t expand Medicaid, it loses $142 million in federal funding. Since 2014, Virginia has forfeited $10 billion in money we have all paid out! 

We shouldn’t pay for other states to expand Medicaid while leaving hundreds of thousands of Virginians uninsured. We should bring our tax dollars back to the Commonwealth to help Virginians. 

Studies estimate that using those revenues to provide insurance will result in 23,000 to 30,000 new jobs in the health industry and throughout Virginia’s economy. Many of these will be in rural areas which desperately need an economic boost. 

In addition, by expanding Medicaid coverage, Virginia will save $138 million in its first two years of implementation by shifting the costs of various services which the state currently underwrites to Medicaid. These savings can be redirected to help pay for mental health and substance abuse disorder services or other critical needs. 

Why Is Health Insurance So Important? 

Medical debt is the leading cause of bankruptcy in this country, with the average debt that triggers bankruptcy equaling about $13,000. Offering health insurance to the working poor will help address this. 

Many uninsured put off treatment for illnesses until they are very sick. Typically, they end up in the Emergency Department at their local hospitals. The care they receive is far more expensive that it would have been at a doctor’s office. The high costs of uncompensated care are shifted to all who are insured, driving up the cost of health care. 

How Do We Know That The Federal Government Will Pay Its Share? 

The revenues generated by the ACA are designed and designated by law to pay the costs of expanding Medicaid coverage for uninsured, low-income Virginians. 

As an extra precaution, the General Assembly can include language in the budget that directs Virginia to withdraw from the expansion, if the federal government reduces the percentage of matching dollars promised. 

What About Imposing Work Requirements or Other Obligations as a Condition for Expanding Medicaid? 

Experience and research have continuously shown that imposing conditions on various benefit programs like SNAP (food stamps) ultimately reduces the number of people who can participate (e.g. Nearly 1/3 of SNAP enrollees who lost benefits for not meeting work requirements were actually exempt from those requirements, but failed to adequately prove it to the agency). 

Medicaid already supports work by enabling sick, uninsured adults to obtain needed medical care to treat their chronic diseases so they can keep working and supporting their families. 

Work supports and incentives such as job readiness assessments and counseling or connecting people with existing educational, training, and employment opportunities could be helpful. This is different than requiring work in return for Medicaid coverage. 

Other Key Points: 

It is important that any expansion be done with an amendment to Virginia’s current Medicaid plan. This is the simplest and fastest way forward (90 days). The waiver approach advocated by some will bog the expansion down in federal reviews (waiver reviews typically take 18-24 months before approval).

Some say Virginia’s Medicaid program is broken and needs to be fixed before it is expanded. Not so. In 2013, the General Assembly ordered a lengthy list of reforms. All have been accomplished and are saving millions of dollars. 

Likewise, Virginia’s payment error rate is less than one half of a percent. This is lower than the national average. Virginia has a good track record of collecting misspent funds. 

Medicaid costs are not out of control. Medicaid costs per covered life are lower than those of private insurance. Also, Virginia ranks 46th nationally in Medicaid spending per capita. 

Answers to Legislators’ Common Comments: 

Comment: I’m sympathetic, but I’m not on the Appropriations or Finance Committee and this will all be determined as part of the budget process. 

Answer: I understand that, but don’t you know legislators who are on those committees, who you can talk to and encourage to expand Medicaid? This is very important. People’s lives are literally at stake. 

Question: I’ll see what I can do, but there are many competing demands. I can’t make any promises. 

Answer: Thank you. I understand that there is a process, but at the end of the day, a budget reflects priorities. I hope that you will make sure that Virginia’s General Assembly and its budget puts health care for the uninsured first. We will be paying close attention to this, and greatly appreciate anything you can do. Thank you for investing your time to help expand Medicaid for so many of your patients and other uninsured Virginians!