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Friday, July 13, 2018

Thousands of Fairfax County residents will get health coverage under Medicaid expansion

The Virginia General Assembly (Virginia-Pilot)
Beginning in January 2019, approximately 28,000 uninsured individuals in Fairfax County could be eligible for healthcare coverage, thanks to the efforts of the General Assembly to finally approve a Medicaid expansion measure as part of the state budget.

The measure ensures the most vulnerable people, including the elderly, disabled, children, and people with low-paying jobs, have access to medical care. Nearly 40,000 people will benefit from the new program across the state.

The program is open to adults ages 19-64 who meet certain income limits but earn too much to be eligible for Medicaid. To qualify, an individual must have an income of no more than 138 percent of the federal poverty line. That means a single adult can earn no more than $16,753 and the parent in a family of four can earn no more than $34,638.

These services will be covered:
  • Doctor, hospital, and emergency services, including primary and specialty care 
  • Prescription drugs 
  • Laboratory and X-ray services 
  • Maternity and newborn care 
  • Home health services 
  • Behavioral health services, including addiction and recovery treatment 
  • Rehabilitative services, including physical, occupational, and speech therapies 
  • Family planning 
  • Medical equipment and supplies 
  • Preventive and wellness services, including annual wellness exams, immunizations, smoking cessation, and nutritional counseling.
Those eligible for benefits under this new program will be covered for pre-existing conditions.

Virginia is in the process of developing additional requirements for coverage – including work force training and education – which will be announced before the program takes effect.

With some limited exceptions, those covered will be asked to choose a health insurance plan that will coordinate care and reimburse doctors and other providers for services received. People who want to keep their doctors should check with their healthcare providers to find out whether they participate in one of the health insurance plans in the program.

Once the program begins early next year, people who enroll will be mailed a card they will be submit when accessing healthcare.

Medicaid expansion is a huge victory for Gov. Ralph Northam, a pediatrician, who has made expanded healthcare a top priority since his election last November.

Democratic members of the Senate and House of Delegates had worked for passage of Medicaid expansion for the past five years, while Republicans blocked any attempt to consider the issue, mainly because the Medicaid expansion is part of the Affordable Care Act. That not only left hundreds of thousands without healthcare but kept billions of federal tax dollars out of Virginia.

“Health care is not a privilege: It is a right,” said Sen. Minority Leader Dick Saslaw, who represents the 35th District, which covers parts of Bailey’s Crossroads, Lincolnia, Falls Church, and  Springfield, and led the effort to expand Medicaid.

“A lot of us here have had a lot of breaks in our lives, but there are many others out there who do not get these breaks,” Saslaw said. “They work hard, but for one reason or another things don’t turn out right for them. These people need our help, and we have done that.”

Senators Janet Howell (D-32nd District) and George Barker (D-39th District) were also instrumental in ensuring passage of the Medicaid expansion measure.

Virginia now joins 32 other states and the District of Columbia that have already expanded Medicaid.

Under the state budget passed in May, Virginia will be obligated to cover 10 percent of the cost of Medicaid expansion. Those costs will be shared with hospitals in the form of a provider assessment, which then will free up revenue for other spending priorities.

The federal government will pay at least 90 percent of the cost, which is estimated to be about $2 billion a year.

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