Photo by Getty Images/iStockphoto
While some questions surrounding Obamacare remain unresolved heading into 2019, more Virginians will be eligible for health care coverage courtesy of the state’s Medicaid expansion, and the ACA marketplace will have a new provider, Virginia Premier, available to metro Richmond residents.
The most profound impact will come from Medicaid expansion, which was passed by the General Assembly and signed by Gov. Ralph Northam in June. It goes into effect on Jan. 1 and will make Medicaid coverage available for 300,000 to 400,000 more people.
Under current guidelines, Medicaid coverage is unavailable in Virginia to adults without children, nor to people with disabilities with income of more than $9,700. Coverage for 2019 will be open to adults with no children in the household and who have an income of no higher than $16,754 (that’s about 138 percent of the poverty level). It also expands coverage to people with disabilities who have an income of no more than $16,754. Income-level restrictions are adjusted by household size.
The Medicaid expansion will also provide coverage to Virginians who went without health insurance because they made too little (below the poverty level) to be eligible to purchase coverage through the ACA marketplace.
There will be work training and education requirements, but those have yet to be announced. You can check on whether you would be eligible for coverage and find additional information at coverva.org.
Peter Cunningham, a Virginia Commonwealth University professor of health and behavior policy, says it would be hard to imagine another piece of legislation that would have as significant an impact on health care. “What it means is we are going to see several hundred thousand people who currently don’t have health insurance to be enrolled in Medicaid,” he says.
Funding for the expansion is 90 percent federal dollars with a 10 percent state match. Hospitals with acute care facilities will be taxed to provide the match, with exemptions for VCU and for the University of Virginia’s hospital. Hospitals are expected to roughly break even as the expansion is expected to result in fewer uninsured people and more paying patients at their facilities.
Cunningham says the expansion could lead to a 30 percent increase in Medicaid enrollment in Virginia over the next couple of years, which could lead to more demand for services of primary and behavioral health care, but there may not be enough providers available in some portions of the state, such as southwest Virginia, says Cunningham.
Free and low-cost clinics are trying to determine the impact of the Medicaid expansion on their service populations.
Health Brigade (the former Fan Free Clinic) estimates about half to 60 percent of the people seeking medical care at its facilities (it reported 5,722 medical visits in 2016-17) may qualify for coverage through the expansion, according to Karen A. Legato, the nonprofit's executive director. She notes in an email that the remainder can’t afford to buy insurance on their own and don’t have the resources to pay for services “outside of a charitable clinic.”
“We will continue to serve those who do not qualify for Medicaid and evaluate the best way for Health Brigade to serve in the future once Medicaid is fully rolled out in Virginia,” she says.
The nonprofit health care center Daily Planet estimates that approximately 37 percent of its patients, about 2,700 people, would qualify for Medicaid coverage under the expansion, according to Maureen Neal, COO for advancement. About 13 percent of those seeking care last year were covered by Medicaid. That number would rise to 50 percent counting the patients who would qualify under the expansion.
That scenario has multiple implications: More financial reimbursement for services, more people seeking additional services, and the need to find additional staffing and the ability to provide the services, she notes. It may be harder to find enough providers to work with the population, and also, Neal notes, the patients have had limited experience with health insurance and may need additional help from the social services staff in explaining benefits and procedures.
There are also changes in store for Virginia residents seeking Obamacare coverage in 2019.
Nationally, Republicans failed to repeal and replace the Affordable Care Act, but tax reforms approved earlier in the year have affected ACA by ending cost-sharing payments to insurers and by eliminating the mandate that individuals must have health coverage or pay a penalty.
Those changes may exacerbate problems that are already occurring, with rising premiums and fewer providers from which to choose.
“I think there’s a lot of concern about the viability of the marketplaces going forward,” says Cunningham.
In much of metro Richmond, Cigna is the only provider offering ACA marketplace coverage in 2018. Virginia Premier has filed paperwork to enter the marketplace for 2019, marking its first entry into the individual plan market.
For 2019, Virginia Premier is partnering with VCU Health and Bon Secours Health System, and will offer a network that includes providers and facilities from both. It has filed plans to offer care to residents of the city and the counties of Amelia, Caroline, Chesterfield, Goochland, Hanover, Henrico, New Kent and Powhatan. It will include one gold plan, two silver plans and one bronze plan. Virginia Premier is owned by VCU and currently offers Medicare and Medicaid plans.
“We really wanted to create more access,” says Linda Hines, CEO of Virginia Premier. The provider has taken a methodical approach to entering the market and will be starting small and assessing as they go. Hines says they didn’t want to make a big initial splash only to have to scale back coverage later. They may eventually expand their individual policy offerings, she says.
Potential providers must have their plans approved by the federal Centers for Medicare & Medicaid Services and by the Virginia Bureau of Insurance. Healthinsurance.org takes a deeper dive into the state of Virginia’s ACA marketplace.
