HANOVER – The Hanover County Board of Supervisors received an update on the local impacts of a recent Medicaid expansion passed by the Virginia General Assembly earlier this year at last week’s August meeting.
The approved legislation means more Virginians will be covered by health insurance, but it also represents a significant increase in the workload of local Social Service agencies.
Sheila Crossen-Powell, director of Hanover’s Social Services, said increases are inevitable due to relaxed eligibility requirements for lower income recipients.
“Before the Medicaid expansion, one million people in the state of Virginia were eligible for Medicaid,” Crossen-Powell said. “We expect an additional 400,000 with the Medicaid expansion.”
Candidates for eligibility must be between the ages of 19 and 64, income must be at or below the 138 percent of the Federal poverty line (for one person, about $16,700 annual income), and the candidate must not be eligible or on any other mandatory coverage group.
Three groups of eligible citizens are now allowed to apply for Medicaid: childless adults who meet income requirements, parents of children who are currently covered and meet income guidelines and disabled citizens. Minimum incomes for parents and childless adults are increased under the expansion.
Hanover County is expecting increases in all three of those eligibility groups once expansion begins on Jan. 1, 2019.
The local impact of the new policies is about 1,600 additional candidates who may qualify for assistance. SNAP (Supplemental Nutrition Assistance Program) and GAP (Governor’s Access Plan) recipients also will be served by local social service agencies as of Jan. 1.
“In addition, we are going to have to assume responsibility for managing the work requirements that are going to accompany Medicaid expansion,” Crossen-Powell said.
In 2017, more than 17,800 Medicaid, GAP and SNAP recipients were served in Hanover County.
“We are requesting -- in order the meet the demands of Medicaid expansion -- two new full-time benefit specialists, one new full-time customer service agent, and we are also requesting that two part-time customer service agents to be taken to full-time in order to support the work of the program specialists,” Crossen-Powell said.
Those positions will be funded with $190,000 in state funds in 2019, but the locality will be required to fund about $40,000 of that amount in future years.
The Community Services Board also will be allowed to bill Medicaid for its 175 qualified recipients for medical services currently receiving care on a sliding fee scale or without compensation.
Cold Harbor supervisor Scott Wyatt expressed his displeasure with the expansion, and pointed to several pieces of failed legislation that could have assisted those without medical care.
Wyatt said one bill strengthened the ability of Virginians to buy short-term medical insurance, while another established low-cost pools.
“I agree that those people who are at the bottom and need help we should help them,” Wyatt said. “There were numerous bills out there that could have given Social Services a little more money and funded more Community Service Boards.”
Wyatt pointed out the expansion increases funding for hospital reimbursements, funds he said could better be used at the local level.
“They voted to give hospitals more reimbursements for these patients they will see when, in my opinion, Social Services could have received a little more money and our CSBs could receive more dollars. That’s a hard pill to swallow,” Wyatt said.
While Ashland supervisor Faye Prichard did agree that unfunded mandates are a nuisance to local government, she endorsed the expansion and the thousands of low-income Virginians who will now have health insurance.
“There will be people in the state of Virginia who will not die this year due to Medicaid expansion,” Prichard said. “If you are currently a fully disabled person in the state of Virginia making more than $7,000 a year, you have no access to medical care except through the emergency room.”
Prichard also responded to Wyatt’s assertion that other proposed bills in this year’s General Assembly could have better addressed the problem.
“This is a moral decision,” Prichard said. “This is not about Hanover County taking care of people across the state. This is about Hanover County participating in a program that helps us take care of people who live in Hanover.”
No amount of access to reduced pools is going to help people who make $6,000 a year.”
Budget director Shelly Wright presented a budget appropriation request to fund the 3.52 full time positions requested by Social Services.
The county received an additional $443,000 from the Commonwealth once the budget was finalized with $190,000 of those funds reserved to fund Medicaid expansion.