Virginia’s Response to Federal Health
Care Changes and Medicaid Reforms
Michael Tweedy
Legislative Fiscal Analyst
Senate Finance Committee
2016 Election
 Election results changed the health care
debate
 One-party control of the Presidency and
Congress
 Repeal of the Affordable Care has been
advocated for seven years
 After the election, questions were raised in
the General Assembly about the potential
impact
2
2017 General Assembly Session Actions
Senate
•
Senator Hanger introduced a member
amendment for a Joint Subcommittee to
review Federal Health Care Changes.
•
Senator Dunnavant introduced a member
amendment for a Joint Subcommittee on
Health and Human Resources (HHR)
Agency Oversight and also one for Federal
Medicaid Changes and Block Grants.
•
The Senate Budget included a Joint
Subcommittee for Health Care Changes and
HHR Oversight.
House
•
The House Budget included a Joint
Subcommittee on Medicaid and Health
Care Reform.
3
New Joint Subcommittee - Final Action
The Conference Committee recommended:
• A Joint Subcommittee for Health and Human Resources Oversight of the House
Appropriations and Senate Finance Committees
• Four members to be appointed from each committee
• A chairman and vice chairman to be elected annually
• The purpose is to monitor, evaluate and respond to federal legislation that repeals,
amends or replaces the Affordable Care Act, Medicaid, the Children’s Health
Insurance Program or any proposals to block grant or change the method by which
these programs are funded
• The Joint Subcommittee shall recommend actions to the General Assembly
4
Other Joint Subcommittee Purposes
 Opportunities to improve Virginia’s Medicaid and other health
insurance programs
 Ongoing oversight of initiatives and operations of the Health and
Human Resources agencies
 Examine progress made in Medicaid managed care, Medicaid
waivers, the Medicaid Enterprise System, eligibility processes in
Medicaid and CHIP, the organizational structure and realignment of
the Department of Medical Assistance Services, improving cost
effective delivery of services through the Comprehensive Services
Act, and other HHR initiatives or programmatic changes.
5
Members of the Joint Subcommittee
Senate Finance
House Appropriations
Senators:
Delegates:
• Emmett Hanger
• Chris Jones
• Janet Howell
• Steve Landes
• George Barker
• John O’Bannon
• Siobhan Dunnavant
• Matthew James
6
Joint
Subcommittee’s
First Meeting is
May 17, 2017
House Room 3
The Capitol
Tentative Agenda Topics:
• Overview of American Health
Care Act
• Update on Medicaid Reforms
• 2018 Transition Issues
What is the Vision for the Joint Subcommittee?
 Ultimately will be set by the members
 To prepare the Commonwealth for
potentially dramatic changes in the way
Medicaid is funded
 Looking for opportunities to increase
flexibility in Medicaid
 Increasing oversight of the HHR agencies
which are undergoing significant change
8
Update on Medicaid Reforms
 Reforms directed by the 2013 General
Assembly
 Phase I – Fully implement previously
authorized reforms
 Phase II – Value-based purchasing reforms
 Phase III – Include all remaining
populations and services in a coordinated
delivery system
9
Status of 2013 Phase 1 Medicaid Reforms
Reform
Status
Dual Eligible Demonstration Pilot
Implemented Commonwealth Coordinated
Care
Enhance Program Integrity
Implemented Recovery Audit Contracting,
Data Mining, etc.
Include Foster Care Children in Managed
Care
Implemented
New Eligibility and Enrollment System
In March 2017, All Remaining Social Service
Programs Moved Over
Improve Access to Veterans Services
Increased Focus on Quality Management
Improve Community Behavioral Health
Services
Strengthened regulations and Hired a
Behavioral Health Administrator.
10
Status of 2013 Phase 2 Medicaid Reforms
Reform
Status
Commercial-Like Benefit Package
Implemented for Medicaid Buy-In Program
Cost Sharing and Wellness
Managed Care Changes in 2013 for Chronic
Care, Maternity and Wellness Programs.
Coordinate Behavioral Health Services
Implemented the Behavioral health Services
Administrator in December 2013
Limited Provider Networks and Medical
Homes
Changes to Medallion in 2013
Quality Payment Incentives
Implemented Quality Withholds in July 2014
Parameters to Test Innovative Pilots
Implemented as part of Commonwealth
Coordinated Care and changes to Medallion
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Status of 2013 Phase 3 Medicaid Reforms
Reform
Status
Developmental Disability Waivers Redesign
Implemented Fall of 2016
Non-Disabled Elderly and Disabled Waiver
Enrollees in Managed Care for Medical
Needs
Implemented in Fall of 2014
All Inclusive Coordinated Care for Long-Term
Care Beneficiaries
Commonwealth Coordinated Care Plus meets
this requirement
Complete Statewide Commonwealth
Coordinated Care
Commonwealth Coordinated Care Plus meets
this requirement
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Thank You
Michael Tweedy
Legislative Fiscal Analyst
Senate Finance Committee
Email: [email protected]