On Thursday State Senator Emmett Hanger, concerned about the looming state budget deadline, proposed a compromise in the Medicaid expansion standoff currently taking place between the state Senate, House, and Governor Terry McAuliffe.
“It is my strong belief it would be totally unacceptable,” Hanger said in Thursday’s press release, “for the legislature to abdicate it’s responsibility to produce a balanced budget in a timely manner.”
House leaders expressed encouragement that a state budget may be reached by the deadline.
Hanger, chairman of the Medicaid Innovation & Reform Commission (MIRC) and chairman of the Senate Finance-Health & Human Resources Subcommittee, prefaced his proposals with a few comments:
Today, as Chairman of the Medicaid Innovation & Reform Commission (MIRC) and as Chairman of the Senate Finance-Health & Human Resources Subcommittee, I am offering a proposal intended to serve as the basis for a compromise between the House, the Senate, and the Administration regarding Medicaid. If agreed to, this proposal will allow us to move quickly to final passage of a budget and preserve Virginia’s record of fiscal responsibility. All involved seem to agree there is a mutual desire to effect needed reforms in the current system and insure affordable access to quality healthcare by all of our citizens. The majority of the House and Senate, along with then-Governor McDonnell agreed last year we would access the available federal dollars Virginians are currently paying to the federal government and use those funds to partially cover the costs of providing healthcare to uninsured low-income Virginians.
The only qualification was that MIRC, the Commission that I now chair, was to monitor progress and the Administration was not to apply for a waiver to cover the expanded population until members of the Commission agreed that a series of reforms had been accomplished. Therein is the dilemma; we have a difference of opinion about whether we have accomplished enough reform to merit our approval.
It is my strong belief it would be totally unacceptable for the legislature to abdicate it’s responsibility to produce a balanced budget in a timely manner, for any reason, and as well, it would be totally unacceptable for the Administration to assume executive powers to operate Virginia’s government without an approved budget or to expand Medicaid without the concurrence of the legislature.
With that in mind, those of us in positions of responsibility need to get busy! The attached proposal can serve as one possible framework for that negotiation. The new MIRC bill being proposed was drafted back in April and, in my opinion, is an even more conservative approach than what Republican Governor Pence in Indiana has just agreed to.
He then offered the proposals:
As Chairman of the Medicaid and Innovation Reform Commission (MIRC) and as Chairman of the Health & Human Resources Subcommittee of the Senate Finance Committee I am offering the following proposal to the Budget Conferees and to the Governor as a means of reaching a compromise and moving quickly to a budget agreement:
The Senate would concede to using the House Bill as amended by the Senate as the vehicle for conference.
The Senate would concede to removing language pertaining to Marketplace Virginia from the budget.
The House would concede to the introduction of a Senate bill that would go into conference at the same time as the budget. This bill would change the voting requirements for the MIRC, to allow a simple majority of the MIRC to prevent (veto) any proposed amendment by the Administration to the State Plan for Medical Assistance intended to expand Medicaid eligibility; unless agreed upon objective metrics had been accomplished and circumstances warranted such expansion.
The Senate and House would further agree in the “MIRC” bill to a series of additional reforms in consultation with stakeholders that relate to (a) screening and processing applicant information, (b) developing and implementing a plan to remove disincentives for enrollees to increase income levels, (c) increasing oversight of nursing homes eligibility determinations and developing crosschecks to prevent inappropriate use of nursing home services, (d) developing innovative continuous audits using new technologies, and (e) developing targeted initiatives for health development, and establishment of a Health Information Exchange.
The enactment clause of the “MIRC” bill would propose the following:
1. That any change to the State Plan for Medical Assistance under Title XIX of the Social Security Act authorized with this act shall be a private option plan and shall include in the waiver design the following elements: (i) increased personal responsibility by establishing a schedule of co-payments that is equal to the maximum currently allowed by the Centers for Medicare and Medicaid Services for individuals under 100% of the poverty level and higher than the current maximum for individuals with income between 100% and 138% of the federal poverty level, and which shall reflect incentives for primary care and appropriate treatment of chronic conditions and discourage nonemergency use of emergency rooms, (ii) services that are more closely aligned to commercial insurance, including the restriction of nonemergency transportation service for individuals with income between 100% and 138% of the poverty level; (iii) incentives for preventive services, an initial primary visit, wellness activities, and healthy behaviors; (iv) incentives to encourage employment for individuals who are unemployed, not attending school as full-time students, not receiving unemployment compensation benefits, and not caring for dependent family members under 12 months of age or disabled family members of any age; (v) provisions for protection of the Commonwealth in the event federal funding is reduced below levels set forth in the Patient Protection and Affordable Care Act; (vi) payments to health plans and health care providers that are conditioned on quality care measures and support patient-centered medical homes; (vii) strengthened efforts to prevent, detect and punish fraud and abuse; and (viii) provisions ensuring that coverage is contingent upon approval and duration of the waiver.
Response from the House of Delegates was positive. In a statement they responded:
“Senator Hanger has made a productive offer that leaves us encouraged about the prospects of reaching an agreement on the state budget. He acknowledges the need to separate Medicaid expansion from budget deliberations in order to facilitate the prompt passage of a state budget, recognizes the need for continued reforms before we consider expansion, and emphasizes that any attempt by the Governor to spend money from the state treasury absent a budget law or to expand Medicaid without the legislature’s approval would be totally unacceptable. We will take a very close look at the proposal and immediately begin talking with Senator Hanger.”
For more on today’s developments, see:
– Key senator proposes compromise on Medicaid expansion by Dave Ress (Daily Press)
– Hanger offers compromise to pass state budget (News Leader)
– Hanger offers new proposal on budget, Medicaid by Olympia Meola (Richmond Times-Dispatch)