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?