Medicaid Expansion

WHY WE DID THIS STUDY

Virginia authorized several major changes to its Medicaid program in 2018, including expanding coverage to additional adults living in poverty. Other program reforms include adding a work and community engagement requirement, health and wellness incentives, and employment and housing support for high need populations. These three reforms became known as the COMPASS (Creating Opportunities for Medicaid Participants to Achieve Self-Sufficiency) waiver. The General Assembly directed JLARC to review several aspects of Medicaid expansion implementation:

      • access to health care services for new Medicaid members;
      • accuracy and timeliness of eligibility determinations;
      • Medicaid enrollment and spending following expansion; and
      • state and local readiness to implement the COMPASS waiver.

ABOUT MEDICAID EXPANSION

Medicaid is a joint federal and state program that provides health insurance and long-term care to low-income families, individuals 65 and older, and individuals with disabilities. States have the option to include all adults with low incomes in Medicaid (regardless of whether they are a parent) through the federal Patient Protection and Affordable Care Act. Until recently, Virginia’s Medicaid program did not cover low-income adults who were not parents, but Virginia authorized Medicaid expansion in 2018 to cover this population, with enrollment beginning on January 1, 2019. More than 300,000 individuals enrolled in Medicaid expansion through the first eight months.

WHAT WE FOUND

Access to Services
Managed care organizations (MCOs), which are responsible for developing adequate networks of providers, generally have a sufficient number of the most commonly used providers located across the state. However, it is unclear if Medicaid expansion members are able to get necessary appointments with these providers in a timely manner. The Department of Medical Assistance Services (DMAS) requires managed care organizations to ensure members can get appointments, but does not collect data to measure whether or not it is occurring.

Eligibility Determination
Virginia’s policies and systems are adequate to accurately determine eligibility for the Medicaid expansion population. The strategies deployed to manage the significantly increased eligibility determination workload during the first few months of expansion were effective at enabling most applications and renewals to be completed on time.

Enrollment and Spending
Coming soon: December 2019

COMPASS Readiness
Coming soon: December 2019

 

WHAT WE RECOMMEND

Executive action

  • DMAS should develop and implement a methodology to measure whether Medicaid members are able to schedule appointments in a timely manner.