Introduction
Traditional Medicaid program in Virginia has been considered as one of the leanest in the American nation. To meet the criteria for eligibility, an individual with a disability could not make more than $9,700 a year. When compared with able-bodied, childless adults, they have not been eligible for coverage, even in instances when income was below the poverty threshold (Norris, 2018). Under the Affordable Care Act of 2010, however, all US states, including Virginia, have been awarded the possibility to open their Medicaid rolls to people whose wage and subsequent income were up to 138% of the federal poverty line (Norris, 2018).
Despite the fact that Virginia supported the program only after most states signed up for ur, approximately one million Virginians are currently receiving health coverage through Medicaid. This means that the citizens have access to both no-cost and low-cost, as well as high-quality health coverage. Despite such a positive step, there are also people who express their concerns that the a high level of enrollment would negatively influence the budget of states, partially due to the dual-eligible enrollees (Norris, 2018). Drawing upon the Medicaid overview and discussions related to this issue, this paper provides a critique of the Medicaid Expansion Program and Dual Eligible Policy in the state of Virginia.
Medicaid Expansion Program
Overview of the Program
Medicaid is a program that supports people with limited assets and incomes and pays for their behavioral health and long-term services and overall healthcare. In the state of Virginia, Medicaid became effective in 1969, which makes Virginia be one of the last states in the country to implement this program (Norris, 2018). Though the traditional state Medicaid program has been considered as one of the least generous in the U.S., Virginians, including those who are single, are currently eligible for coverage if they meet income requirements and do not receive or qualify for Medicare (DMAS, 2019). One may suggest that these new eligibility requirements improve not only the health and overall well-being of the state citizens but also change the face of the Medicaid program as a whole.
Critique of the Program
Clearly, the program expansion is a positive step towards improving the existing healthcare delivery system in the state. The main reason for that is because it allows about one million Virginians to access high-quality healthcare at little or no cost. Second, Virginia hospitals are going to benefit from a decline in the number of patients who do not have insurance but receive charitable care, thus decreasing state expenditures. Third, people who previously were in the coverage gap, meaning they were not eligible for Medicaid or premium subsidies, have been enrolled in this group due to the program expansion.
Finally, the federal government pledged to pay at least 90% of the cost, which means that new eligibility requirements are generating cost savings that benefit the overall state budget (DMAS, 2019; Norris, 2018). Nevertheless, there are certain issues regarding Medicaid expansion that should not be overlooked, even though the points made are encouraging.
Indeed, Medicaid expansion provides health insurance for many eligible Virginians, making the new budget to be a clear win for the state. However, the new program is not a no-strings-attached expansion as non-disabled adults (ages 19-64) are required to work, attend educational establishments, or participate in any other community engagement activities or job training programs to meet eligibility requirements. Also, those enrollees whose income is found to be above the poverty level are obliged to pay modest premiums and cost-sharing. As suggested, these measures are designed to promote the well-being and healthy behaviors and to encourage personal accountability and responsibility related to the utilization of healthcare services (Norris, 2018).
However, such measures are controversial because they can serve as a barrier for the poor to be able to maintain Medicaid coverage and afford necessary healthcare. Given this, one may argue that the program with no strings attached could have been a better option. However, it would not be politically feasible. Hence, one may suggest that Medicaid expansion, despite the inclusion of controversial measures and a work requirement, can be considered as a significant step forward in Virginia where hundreds of thousands of Americans have previously been denied access to one of the primary reforms.
Obviously, Medicaid expansion is generally positive for Virginia citizens, which is supported by the high enrollment numbers (Vozella, 2018). One may only assume that this either proves the fact how desperately such an expansion was needed or is a sign that the coverage could swell beyond popular expectations. In addition, there are those who have expressed concerns that the new Medicaid enrollments might negatively affect the state budget, partially because a majority of Medicaid expenditures go to care for disabled individuals and older adults (Norris, 2018). The reason behind this concern is that this population qualifies for both Medicaid and Medicare, otherwise known as “dual eligibles” or “dual-eligible beneficiaries” (Grabowski, Joyce, McGuire, & Frank, 2017).
However, the federal government can only cover minimum 90% of the cost, which means that the expansion within Medicaid is effective at saving costs for the state of Virginia that amount to approximately $2 billion a year (Norris, 2018). In addition, broader coverage can ensure that more citizens seek non-emergency services rather than visit costly emergency rooms, which reduces uncompensated care. As for the dual eligibles, the state converted their care to an integrated managed-care system, but this is a separate issue that will be further discussed below.
Overview of the Program
As mentioned above, Medicaid supports people with limited incomes and pays for their healthcare services. In turn, Medicare provides insurance for people older than age 65, disabled individuals, and those with amyotrophic lateral sclerosis and end-stage renal disease (Grabowski et al., 2017). Due to the fact that such individuals predominantly have low income, they qualify for both Medicaid and Medicare programs. Though this group only represents around 15% of the population of beneficiaries, they are responsible for approximately a third of all Medicaid costs (Grabowski et al., 2017). Given this, one may suggest that Medicaid expansion has generated a need for an integrated delivery model that would address the challenges associated with Medicare-Medicaid enrollees.
Critique of the Program
The state of Virginia has long recognized the need for a comprehensive managed-care system for its Medicare-Medicaid members. Typically, dual-eligible beneficiaries receive their Medicaid and Medicare benefits through each program separately. However, capped Medicaid funding arrangements could increase Medicare spending and adversely impact this population that is particularly vulnerable and high-cost.
In this connection, a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) was designed to address fragmentation in financing and lack of coordination in the delivery of both programs’ services to integrate benefits for beneficiaries through a single managed-care organization, and to prevent inefficiency and poorer health outcomes. The result of that plan was increased care coordination and decreased incentives for cost-shifting, which, in turn, improved care for dual-eligible beneficiaries and savings for Medicaid and Medicare.
However, there is still a lack of good contact information for some members, which continues to contribute to low enrollment in Virginia. In addition, some members do not see the positive side of changing their regular coverage to FIDE-SNP as they believe that the uncertainty and risks of enrolling into a new program outweigh the potential benefits of improved care coordination (Grabowski et al., 2017). One may suggest that current conditions require certain flexibility in approaching this particular population to improve access and increase enrollment.
Critical Analysis and Recommendations
The analysis of the Medicaid Expansion Program and Dual Eligible Policy revealed that both could be considered as significant steps towards improving the existing healthcare delivery system in Virginia. Having had one of the leanest programs in the country, it currently provides high-quality services to approximately one million people and benefits the overall state budget. As regards FIDE-SNP, one may assume that the goal of this program was to develop person-centered care delivery system that would integrate the full range of healthcare services, as well as address challenges associated with the lack of care coordination. Though viewed as predominantly successful, it, however, requires some flexibility to better address dual-eligible beneficiaries’ needs and equip them to live independently in their communities.
As one of the core values of Saint Leo University’s states, healthcare providers should “foster a spirit of belonging, unity, and interdependence based on mutual trust and respect” (Saint Leo University, 2019). Therefore, Virginia should aim to improve the entire state population care experience through the principles of wellness promotion, cultural competence, and independent living in order “to create socially responsible environments that challenge to listen, to learn, to change, and to serve” (Saint Leo University, 2019). This means that healthcare providers must be more attentive to the unique demands of their patients given their diverse needs.
Conclusion
Under the Affordable Care Act, however, all states, including Virginia, have been given the opportunity to open their Medicaid rolls to individuals whose incomes were up to 138% of the federal poverty line. Currently, approximately one million Virginians are receiving health coverage through Medicaid, making the new budget to be a win for the state. Though there are certain issues that should not be overlooked, such as the inclusion of work requirement, Medicaid premiums, and cost-sharing are significant steps forward in Virginia where hundreds of thousands of Americans have previously been denied access to one of the primary reforms.
As regards FIDE-SNP, this program has proved to increase care coordination and decrease incentives for cost-shifting, which, in turn, has improved care for dual-eligible beneficiaries and savings for Medicaid and Medicare. However, there are still issues related to a lack of good contact information that contributes to low enrollment. This suggests that the current situation should be met with a unique approach to the population of eligible patients. Therefore, Virginia should aim to improve the entire state population care experience through the principles of wellness promotion, cultural competence, and independent living to better address their needs and equip them to live independently in their communities.
References
DMAS (Department of Medical Assistance Services of the State of Virginia). (2019). Medicaid at a glance. Web.
Grabowski, D.C., Joyce, N.R., McGuire, T.G., & Frank, R.G. (2017). Passive enrollment of dual-eligible beneficiaries into Medicare and Medicaid managed care has not met expectations. Health Affairs (Milwood), 36(5), 846-854.
Norris, L. (2018). Virginia and the ACA’s Medicaid Expansion. Health Insurance. Web.
Saint Leo University. (2019). History, values, & Catholic roots. Web.
Vozella, L. (2018). Enrollment in Virginia’s expanded Medicaid program is beating projections. The Washington Post. Web.