The budget passed by the Virginia General Assembly last night does not included dental benefits for the approximately 15,000 pregnant women enrolled in Medicaid, nor does it include expansion of Medicaid benefits to nearly 400,000 uninsured Virginians, all of whom would gain access to an emergency dental benefit had Medicaid eligibility expanded.
As a reminder, funding to provide dental benefits for pregnant women enrolled in Medicaid and language that would have authorized the development of an alternative plan for traditional Medicaid expansion, Marketplace Virginia, was included in the Senate's proposed budget when the legislature adjourned in March (the House proposed budget did not include either measure). The budget that passed today looks vastly different than the budgets either chamber adopted in March.
Since March, Virginia has seen tremendous revenue shortfalls – now projected to be $1.55 billion over the next two years. The revised budget includes significant cuts – almost $850 million – to offset an existing and future revenue shortfall that has become apparent over the past several weeks. Dipping in to the state's rainy day fund will help off-set these shortfalls, but the Commonwealth cannot do so until after the budget is certified by the state Comptroller. The budget now goes to Governor McAuliffe, who has the option to veto.
The result of this shortfall is significant and includes losses to health care, education and virtually every segment of the government.
After many hours of discussion, an amendment was offered by all 20 members of the Senate Republican Caucus that was included to ensure the Governor no longer has the ability to expand Medicaid through an Executive Order. The amendment, below, passed on party lines. The language requires the majority of both the House of Delegates and the Senate to approve an appropriation for any expenditures related to implementing coverage for newly eligible individuals in an appropriation bill (budget) after July 2014. An appropriation could practically not even be considered until the 2015 Session. With a strong Republican majority in the House of Delegates, it will be extremely difficult, if not impossible, for an appropriation for Medicaid expansion to be approved.
Senate Republican Caucus Amendment:
That notwithstanding any other provision of this act, or any other law, no general or nongeneral funds shall be appropriated or expended for such costs as may be incurred to implement coverage for newly eligible individuals pursuant to 42 U.S.C. § 1396d(y)(1) of the Patient Protection and Affordable Care Act, unless included in an appropriation bill adopted by the General Assembly on or after July 1, 2014.
In addition, Sen. Hanger introduced a bill that would change the process for advancing the Marketplace Virginia plan, a private option for Medicaid expansion through the Medicaid Innovation and Reform Commission. That bill failed to pass the Senate – though three Republicans voted for the bill, three Democrats voted against the bill. A reconsideration of the bill was allowed, but the bill was passed by for the day, which means the bill was defeated. The existing budget language which authorized the creation of the Medicaid Innovation and Reform Commission (MIRC) expires June 30, thus eliminating MIRC.
The budget was approved by the House of Delegates by a party line vote of 69 – 31 and is now before the Governor for his approval or veto. His action on the bill is expected to occur in the next seven days.
The Coalition will continue to follow this process and provide updates on the impact to oral health access.