AN IN-DEPTH LOOK AT ISSUES AFFECTING HEALTH CARE FOCUS

Moving Ahead: Coverage Expansion Next Steps By Christopher S. Bailey and James B. Andrews III

hat’s next? The path to this point effectively began more than eight years ago when the Affordable Care and Patient W For the people and organizations that have spent six years advocating in support of increased Protection Act (ACA) became law in March 2010. A health coverage access in , that is the key fork-in-the-road moment question now that the Commonwealth has arrived six years ago when adopted a budget with Medicaid expansion, the U.S. Supreme Court which Governor Ralph S. Northam signed in a June 2012 ruling into law on June 7. upheld ACA, while making it optional The answer is implementing a plan to for states to cover thousands of Virginians newly expand eligible for coverage that addresses all Medicaid the attendant details, and pursuing eligibility to more necessary federal approvals. low-income, uninsured citizens. In the intervening years, the ACA has withstood repeated attempts in Governor Northam speaks during June 7 Congress to repeal and budget bill signing ceremony replace the law through which an estimated 20 million Americans have gained health coverage.

Counting Virginia, 33 states and Washing- ton, D.C. have Left to right: Senator Emmett Hanger, Delegate Lashrecse expanded Aird, Senator , Senator Jennifer McClellan, Medicaid eligibility Delegate during June 7 State Capitol ceremony to qualified childless

VHHA’S FOCUS — JUNE-JULY 2018 1 adults, among others. Lessons have been learned from posited in a non-reverting fund at the State Treasury, the experiences in those other states. and can only be used to cover the non-federal share of Virginia has adopted a reform-minded plan to extend Medicaid expansion costs. Similar protections are in place for the assessment to fund rate improvement. coverage to as many as 400,000 low-income Virginians by expanding Medicaid eligibility under the ACA. Un- The budget takes a so-called dual-track approach to der the plan, coverage expansion would begin Jan. 1, Medicaid expansion by authorizing an amendment to 2019, pending necessary federal approvals that are the State Plan for Medical Assistance to provide cover- actively being pursued. Many of the new beneficiaries age to newly eligible participants as of Jan. 1, 2019. will be childless adults who previously had been ineli- This is traditional Medicaid expansion. The budget also gible for Medicaid in Virginia regardless of their eco- directs the nomic status. Commonwealth to Expansion of eligibility to people earning up to 138 simultaneously percent of the federal poverty level (FPL) means develop and childless adults making roughly $16,750 in annual submit (within income are eligible for coverage. Medicaid ex- 150 days) pansion in Virginia also means more low- an 1115 income, disabled Demon- individuals and stration working Waiver for parents will approval by the qualify for Centers for cover- Medicare & Medi- age. caid Services (CMS). That paves the way for Two Medicaid reforms to provider promote work, assessments personal on private responsibility, and hospitals in Vir- participation ginia have been standards established to help facilitate among Virgin- coverage expansion. One will help fund state costs ia beneficiaries. associated with coverage expansion. The other will It involves putting fund Medicaid reimbursement rate improvement for in place processes hospitals. Pending CMS approval of necessary state to provide referrals to plan amendments and other authorizations, Oct. 1 is job training, education, the effective date for rate improvement. Both assess- and job placement assis- ments will be administered by Virginia’s Department tance programs for unemployed, able-bodied adults of Medical Assistance Services (DMAS), the agency enrolled in Medicaid. that oversees the Commonwealth’s existing Medicaid program. The budget also specifies that newly eligible people earning 100-138 percent of FPL are to be enrolled in The Virginia Hospital & Healthcare Association (VHHA) Medicaid managed care organizations or employer- is actively working with the Commonwealth and DMAS sponsored insurance through premium assistance, as in planning for implementation of the coverage pro- opposed to enrollment in health insurance gram and the assessments. The adopted budget also marketplace plans. includes statutory language establishing appropriate safeguards on the use of funds generated from the As part of the waiver process, and contingent on provider assessments. Funds generated are to be de- federal approval, standards for monthly coverage

VHHA’S FOCUS — JUNE-JULY 2018 2 Coming Soon: New Health Coverage for Adults Beginning on January 1, 2019, more adults living in Virginia will have access to quality, low-cost health coverage. Get more information at CoverVa.org.

premiums, co-pays, and deductibles will be put in strategies, updating state contracts with insurers place for enrollees earning 100-138 percent of FPL. and providers involved in serving the newly eligible, Other planned enrollment standards include a communication and outreach, education and train- waiting period prior to re-enrollment if premiums ing, testing and readiness, and implementation. aren’t paid for three months, and cost-sharing to All of this important work is happening now — the promote healthy behaviors and appropriate emer- planned start of coverage expansion is six months gency department use. Cost-sharing reductions for away. As preparations continue, more information compliance with healthy behaviors are also put in about who is eligible for coverage, household in- place. There are also standards for the Training En- come levels and other qualifications, and commonly rollment, Education, Employment, and Opportunity asked questions are available at CoverVa.org. Program (TEEOP), including gradually escalating community engagement (employment, job skills training, job search activities, education, volunteer work, and caregiving) participation requirements of at least 80 hours per month for beneficiaries. The budget also directs Virginia’s Secretary of Health and Human Resources to develop a 1332 About the Authors Statewide Innovation Waiver to help stabilize the

individual health insurance marketplace. The Christopher S. Bailey is VHHA’s Executive Vice Secretary is required to report on the waiver plan to President. Prior to joining VHHA, he served 10 the House and Senate Committees on Labor and years with the Illinois Hospital Association. He holds a Bachelors of Science and a Masters in Commerce and the House Appropriations and Sen- Health Services Administration from the ate Finance Committees prior to submitting the University of Michigan. waiver application. That report is to include an anal- ysis of the costs and assumptions used to imple- ment the waiver and details about any mechanism James B. “Jay” Andrews III serves as Vice proposed to fund the non-federal share of costs. President of Financial Policy for VHHA, joining the organization in November 2010. Foundational work on each of these efforts is With VHHA, Jay develops and provides rate analysis on Medicare and Medicaid, and ongoing and VHHA is directly engaged as a partner works on other policy-related budgetary and in the implementation process on behalf of member legislative issues. He is a graduate of Virginia hospitals and the patients they serve. Tech with a degree in Accounting, and he earned his CPA certificate in 1987. Next steps include streamlining enrollment

VHHA’S FOCUS — JUNE-JULY 2018 3 Presorted Standard U.S. Postage PAID Richmond, VA Permit #2367

www.ISupportVirginiaHospitals.com

HosPAC is VHHA’s political action committee. The mission of HosPAC is to provide organized and effective political action, and to support state can- didates who will work to improve quality health care through policies supported by Virginia’s hospital and health systems. As elected officials in Virginia and Washington make critical decisions affecting Virginia’s hospi- tals and health systems, HosPAC supports candidates for office whose actions show consideration for Virginia health care providers and the communities they serve. To learn more about HosPAC or to contribute, visit www.vahospac.com.

Join the VHHA Hospital Grassroots Network. Register to be an advocate for health care in your community. Through our online member mobilization tool, Muster, VHHA will send updates and Action Alerts throughout the year, and periodically ask you to send an e-mail to your state delegate or senator to seek their support on important health care issues. The messages are drafted for you, and taking action can take less than one minute. Action Alerts are sent to Hospital Grassroots Members on the most important legislative issues that our hospitals face. Legislators need to hear from people in their districts to understand the local impact of their votes in Richmond. If you previously received VHHA’s VoterVOICE e-mail alerts, you are already registered for the Hospital Grassroots Network. Your voice is important. Sign up online today at https://app.muster.com/250/supporter-registration/.

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