State social services workers signed up homeless residents for Medicaid at a resource fair in Richmond in 2018. Enrollment in the program has more than doubled since Medicaid expansion, leading to rising demand for mental health services. (Ned Oliver/ Virginia Mercury)
About 35,000 Virginians are still waiting to find out if they remain eligible for Medicaid, as Virginia’s Department of Medical Services projects it will use its $95 million reserve fund to cover delayed payments for fiscal year 2025, according to a presentation agency leaders made to the state Senate Finance Committee Tuesday.
This also means that until it’s sorted out, the state is paying capitation fees, fixed amounts of money to healthcare providers, in order to cover healthcare for those patients. Medicaid is a state and federal program that provides insurance coverage to low-income people or people with disabilities.
The pending redeterminations are part of ongoing national efforts to sort out who should stay on Medicaid and who is no longer eligible. Typically eligibility determinations are made annually, but they’d been on pause nationwide amid the pandemic due to federal policy.
That’s changed over the past year in what’s colloquially referred to as “Medicaid Unwinding,” as provisions of federal law have expired.
A top reason for unenrolling people from Medicaid is that they no longer meet the financial requirements to be eligible — such as income at or below 80% of federal poverty levels. While the ineligibility data could signal higher incomes, which can be a good thing for people, policy analysts at The Commonwealth Institute cautioned over the summer that this is not always the case when it comes to health insurance coverage.
For example, someone could hold a combination of part time jobs that contribute to their overall income — which wouldn’t entail employer-sponsored insurance. Others might have a temporary spike in income through seasonal work that kicks them off eligibility for Medicaid.
So far, more than 2 million Virginians have been redetermined, according to DMAS director Cheryl Roberts, and over the next year the remaining 35,000 people will be sorted out.
The process is not always swift, said DMAS chief financial officer Chris […]
Va. Dept. of Medical Services to tap reserve fund to cover delayed payments amid Medicaid unwinding
