Medicaid Expansion Passed – What it Means for Healthcare in Virginia


It’s true! After years of advocacy and a long-delayed budget, the Virginia General Assembly passed a state budget that includes the Medicaid expansion coverage created under the Affordable Care Act, also known as Obamacare. Medicaid expansion in the Commonwealth will improve the quality of life for 400,000 Virginians by enabling them to gain access to much needed health care coverage. (Please note: Medicaid expansion deals with eligibility for the Medicaid health care benefit, not the Medicaid Long-term Care benefit that I normally write about). Virginia now joins 32 other states and the District of Columbia in expanding Medicaid coverage. The expansion measure is expected to take effect Jan. 1.

Virginia’s current Medicaid health care program covers approximately 1 million people, so adding 400,000 represents a 40 percent increase — a huge leap for Virginia!

According to Governor Ralph Northam, “This budget is the culmination of five years of effort to bring our taxpayer dollars home from Washington and expand Medicaid. As a doctor, I’m so proud of the significant step we’ve taken together to help Virginians get quality, affordable care.”

What does Medicaid Expansion mean?

Basically, starting next January, people will be able to apply for Medicaid if they are newly eligible. It’s going to phase in somewhat. Virginia is going to pay their share, and the federal government will pay the majority of this expansion. The federal government pledged to pay at least 90 percent of the cost initially, which in Virginia will amount to about $2 billion a year.

• In all states: People can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.

In states that have expanded Medicaid health coverage: People can qualify based on income alone. If your household income is below 133% of the federal poverty level, you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)

Who will now be eligible for Medicaid health coverage in Virginia?
These people who earn less than 138% of the federal poverty line. That’s about $16,000 a year. Unless you’re disabled or a child, you’re not automatically eligible for current Medicaid health coverage in Virginia, even if you’re poor. Virginia has always been one of the least generous states when it comes to Medicaid eligibility. What this expansion does is to extend Medicaid to people with higher incomes and even to people who are not disabled.

To be eligible under the current Virginia Medicaid system, an individual must be disabled and must earn no more than $9,700 a year. Able-bodied, childless adults have not been eligible for Medicaid health care coverage in Virginia, no matter how poor.

Now, under the Affordable Care Act’s Medicaid expansion provisions, Virginia can raise those income limits to $16,750 a year for a disabled or able-bodied adult, and $28,700 for a family of three.

What Medicaid expansion will mean for health care in Virginia

Virginia has traditionally had one of the least generous Medicaid programs, so there are an enormous amount of people who don’t have insurance. Private insurance now under the Affordable Care Act is getting increasingly expensive, and there was a big concern that so many people not having insurance puts a big strain on the state’s ability to deliver health care, even to people that have insurance. So the idea is that Medicaid expansion is going to be something that’s going to improve health care for everyone in the state.

Does Medicaid Expansion Help Elders?

As mentioned above, Medicaid expansion deals only with eligibility for Medicaid health care benefits, not the Medicaid Long-term Care benefits that I typically write about. Medicaid health care covers doctor’s visit and hospitalization. Medicaid Long-term Care benefits cover nursing home stays as well as nursing level care provided at home and, in some areas of the state, adult day care for elders who need long-term care, which means elders who need assistance with activities of daily living such as bathing, dressing, toileting, transferring, eating, etc. Eligibility requirements for the Medicaid long-term care benefit do not change at all under the Affordable Care Act’s Medicaid expansion provisions. However, some low income elderly individuals may become newly eligible for Medicaid health care coverage under the expansion, which will be especially helpful to elders who for whatever reason are not already eligible for Medicare health coverage.

Long-term Care Medicaid Remains Extremely Complex

As already stated, Medicaid expansion does not change anything in connection with Medicaid long-term care eligibility, so elders and their loved ones still typically need the help of an experienced Elder Law attorney to gain access to Long-term Care Medicaid and to conduct Medicaid Asset Protection Planning for long-term care. Medicaid laws are the most complex laws in existence, with 8 separate bodies of law (4 at the Federal level and 4 at the state level) dealing with Medicaid and Medicaid eligibility. To do proper Medicaid asset protection planning and gain eligibility, families need the help of an experienced elder law attorney, such as myself. If you or your spouse is over 65 or suffering from any sort of serious health condition, the best time to do Medicaid Asset Protection planning is now. Whether you or your spouse is years away from needing nursing home care, is already in a nursing facility, or is somewhere in between, the time to plan is now, not when you are about to run out of money. Please don’t hesitate to call us at any time to make an appointment for a no-cost initial consultation:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797

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