Medicaid Expansion Talks May Resume in Virginia, Under One Condition

by | January 31, 2018

By Dave Ress

Virginia House Speaker Kirk Cox says talking about a work requirement for existing Medicaid recipients is a precondition for any expansion of health care coverage for low income Virginians.

Angered by Gov. Ralph Northam's reaction to the idea, and by an administration estimate that doing so would boost Medicaid's administration cost $10 million, Cox said accepting a work requirement for current Medicaid recipients would be a sign of good faith in negotiations over health care access.

"This is a very important component to us," Cox said, speaking after the House Rules Committee voted for legislation directing the state to seek federal permission to impose a work requirement.

Stressing that the bill the committee approved would not expand Medicaid, Cox said he believed as many as 30 percent of Medicaid recipients would be subject to its requirement, unless they are minors, elderly or disabled, or are the primary caregiver for a dependent child or disabled adult.

In a first House of Delegates feeler toward expanding low-income Virginians' access to health care, Speaker Kirk Cox has slated discussion of a work requirement for Medicaid recipients Tuesday.

Some 47 percent of Medicaid beneficiaries are children and 27 percent are aged, blind or disabled. Most of the rest are very low income parents. Currently, in Newport News and Hampton, a single parent with one child earning more than $6,200 a year is not eligible for Medicaid. In much of the state, the cutoff is lower.

The work requirement bill would require adult recipients to work at least 10 hours a week after being on the Medicaid rolls for six months, and at least 20 hours a week after being enrolled for a year.

At the current minimum wage, a Peninsula parent with one child working 20 hours a week would make about $1,300 too much to qualify for Medicaid. A parent with two children in many rural or suburban counties, including the Middle Peninsula as well as York, James City and Isle of Wight counties, working 20 hours a week at the minimum wage would make about $1,100 a year more than the cut off for those localities.

Cox said talk about other reforms to Medicaid or any changes in eligibility would have to come after agreement on a work requirement.

The Northam administration's financial analysis of the bill, a document it is required to produce when legislation could affect the budget, said no current Medicaid recipients would be affected by the work requirement, based on detailed guidance from the Trump Administration about which adults such a requirement would affect and current state welfare regulations.

It said the cost of administering the work requirement would add $10.5 million next year, assuming no current recipients were eligible and that the work requirement applied to any expansion of Medicaid.

But the bill did not provide for any expansion.

"A $10 million administrative expense just doesn't pass the smell test," Cox said, charging that the analysis was intended as a ploy to derail the bill.

In setting the work requirement bill on the Rules Committee agenda Tuesday, Cox complained about Northam's recent comments opposing a work requirement and wanting straightforward Medicaid expansion -- that is, coverage for all Virginians earning less than 138 percent of the federal poverty level, as called for in the federal Affordable Care Act.

He said it was a sign the governor didn't want to engage with Republicans to address their concerns.

"This is just politics," said House Minority Leader David Toscano, D-Charlottesville, a member of the Rules Committee, after voting against the measure.

Senate Majority Leader Thomas K. "Tommy" Norment, Jr., R-James City County, said work requirements for able-bodied adults, as well as finding ways for them to contribute towards their health care costs, are major concerns for his caucus.

But he said it wasn't clear yet how to balance that with an effort to expand access to health care for lower-income Virginians.

"There has to be a middle way between no expansion and full Medicaid expansion," he said. "That's why the legislature and the administration are in continuing talks."

(c)2018 the Daily Press (Newport News, Va.)