RICHMOND, Va. -- On the steps of the south portico at Virginia's State Capitol on Thursday, Governor Ralph Northam signed off on a two-year state budget that includes expansion of the state's Medicaid program to an estimated 300,000 low-income Virginians. Virginia becomes the 33rd state and the District of Columbia to expand Medicaid coverage under the Affordable Care Act (ACA), after years of debate.
During remarks to a crowd of voters, advocates, and state budget workers, Northam praised the budget deal, which funds state government for fiscal years 2019 and 2020, for providing a raise to teachers and state employees, despositing nearly $1 billion into the state's reserve fund, and investing in behavioral health services. The loudest appalls, however, were for Medicaid expansion.
"As Thomas Jefferson said, 'Without health, there is no happiness,'" Northam said. “As a doctor and a public servant, I believe making sure all Virginians have the access to the care they need to be healthy and productive is both a moral and economic imperative.”
The budget bill included a work requirement for able-bodied adults who will receive Medicaid coverage in Virginia , and includes a tax on hospital revenues to help generate funding for Virginia's share of expanding the federal health care coverage program. Under the ACA, federal tax dollars pay for the majority of the cost of expanding Medicaid to people who who make up to 138% of the federal poverty level. States are responsible for around 10 percent of the cost of expansion, lawmakers said.
Although several Republicans in both the House of Delegates and Senate voted with Democrats to pass the budget bill and expand Medicaid, a majority of statehouse GOP members voted against the measure.
Virginia Republicans have long opposed expanding Medicaid, arguing that doing so will drive up health care costs for every Virginian and wreck the financial future of the Commonwealth if federal funding ended. Senator Amanda Chase (R-Chesterfield) said other state services would see funding cut if that ever happened.
“This budget marks a stark departure, both from the conservative fiscal policies observed by the Commonwealth for generations and in the manner in which it was approved by the General Assembly," said Senate Majority Leader Tommy Norment (R-James City) after the Senate adopted the budget bill last week.
Northam said Virginia would immediately begin filling out paperwork with the federal government to begin the process of Medicaid expansion. The federal government must approve several waivers, including the work requirement, before new recipients can begin enrolling in Virginia. Northam had previously estimated new enrollment would begin in January 2019.
Lauralyn Clark, a home health care worker from Richmond who does not have health insurance, said she was grateful for the years of work it took to expand Medicaid to people like herself. Clark said she has not been to a doctor in years, and she said Medicaid coverage would allow her to begin seeking preventative care.
"Arthritis, I got high blood pressure. It's a struggle day to day, just to maintain," Clark said. "Today means the world to me."
Speaker of the House Kirk Cox (R-Colonial Heights) supported Medicaid expansion that included reforms.
"I am glad to see Governor Northam signed the budget bills as passed by the House and Senate without amendments. When we started the budget discussions, I said reforms to the current Medicaid system were vital to any potential agreement. Back in February, I laid out six principles for reform, including strong work requirements and a taxpayer safety switch. I am pleased those were included in the final budget bill," Cox said in a statement Thursday.
Virginia political observers believe the "blue wave" election of 2017, when Democrats gained more than a dozen seats in the House of Delegates, opened the door to Medicaid expansion this year. Governor Northam had also promised to push for expansion during his gubernatorial campaign.
The two year budget deal includes the following, according to the Governor's office.
- Increases deposits to the Rainy Day Fund and the new Revenue Reserve Fund, bringing the total deposits to nearly $1.0 billion by the end of the biennium.
- Adds $189 million in new general fund resources for behavioral health and developmental services, including $84.1 million for community mental health services and $67 million to expand services for people with developmental disabilities.
- Includes more than $530 million in general funds for K-12 education, and $131 million for a three percent pay raise for state-supported teachers and support staff, effective July 1, 2019.
- Includes $87 million for a two percent pay raise for state and state-supported local employees, and another $38 million for a two percent merit raise for state workers with at least three years of service. The budget also provides $49 million for targeted pay raises for direct care staff at our state behavioral health facilities; corrections officers at our Department of Corrections and Juvenile Justice facilities; and marine police and deputy sheriffs.
- Adds $350 million to advance planning and engineering requirements and to fund capital projects to widen and dredge the Norfolk Harbor Channel and Elizabeth River.