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Breaking Down Barriers Will Help Virginia Build on Medicaid Expansion Milestone

"New barriers will be erected unless policymakers change course"

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See below for important analysis, by The Commonwealth Institute for Fiscal Analysis, on Virginia Medicaid expansion, as well as on barriers to coverage. The Commonwealth Institute, by the way, is a non-profit organization which “provides fact-based, nonpartisan analyses of fiscal and economic policies and their implications for all Virginians, especially low- and middle-income residents.” Good stuff – and much needed!

Breaking Down Barriers Will Help Virginia Build on Medicaid Expansion Milestone
Over 300,000 newly-eligible adults have enrolled in health coverage through Medicaid, according to just-released data from the state. The Department of Medical Assistance Services (DMAS) automatically enrolling or expediting the enrollment of certain people, such as parents of children already enrolled in Medicaid, are likely part of this success.And partner organizations have strengthened enrollment efforts through outreach. Not only has enrollment been strong, but research has shown that the use of health services by the expansion population is strong as well. So far, 229,100 expansion enrollees have visited a health care provider, filled a prescription, or accessed some other health care service. Strong enrollment and high utilization make it clear: Medicaid expansion is working and meeting the demand for high-quality, comprehensive health coverage for individuals and families across Virginia. 
DMAS has set up an information tool (Medicaid expansion dashboard) that provides a picture of who is benefiting from expansion. But what the tool does not capture is the benefit of expansion for Virginia’s children. Of all new enrollees, nearly 103,000 are parents. Because eligibility requirements are generally more generous for children than adults, if a parent is eligible, their children likely are too. As a result, engaging more parents in health coverage can lead to coverage gains for previously uninsured children.
A new report finds that while children’s enrollment in Medicaid/CHIP has declined overall in the United States since March 2017, Virginia has seen a 8.6% growth in children’s participation in Medicaid/CHIP. Since the start of Medicaid expansion enrollment, child participation in Medicaid/CHIP has increased by 13,000. It’s likely that higher eligibility rates for parents will continue to result in better coverage rates for their children, and potentially better health outcomes. 

Virginia is also seeing significant coverage gains for women due to expansion — 60% of all expansion enrollees have been identified as female as of July 26, 2019. In particular, young women (ages 19 to 34) have accounted for nearly half (46%) of all female-identified new enrollees. This increased access to health care coverage could lead to better maternal and infant health outcomes — not just for young women, but all women who may choose to have a child. This coverage is especially important for Black mothers, who are 3.4 times more likely than white women to die during pregnancy or within one year of pregnancy.There has been an increased focus statewide on maternal mortality, specifically addressing the heightened risk of maternal mortality for Black women. Gov. Northam has ordered an expedited enrollment process for expecting mothers applying for Medicaid, which should result in more people receiving health care earlier in their pregnancy. In addition, with expanded access to Medicaid, women are better able to assess their reproductive health and contraceptive options with a primary care physician.

Expanded access to coverage has also increased the ability to diagnose and manage long-term illnesses. Many new enrollees have chronic illnesses for which they can now access treatment, including 33,000 hypertension diagnoses, 18,800 diabetes diagnoses, 16,100 diagnoses for a substance use disorder, and 3,300 for cancer. There is also new evidence that access to Medicaid, and Medicaid expansion in particular, can improve racial disparities in the care of patients with cancer. Prior to the enactment of the Affordable Care Act, Black patients diagnosed with advanced cancer were 4.8 percentage points less likely to start treatment within 30 days of being diagnosed. But in states that have expanded Medicaid, they are accessing early treatment at nearly the same rate as their white counterparts. The success of Medicaid expansion has clearly led to Virginians’ ability to receive the health care they need.
But there is more work to do in providing health care access for all who call Virginia home. Data on new enrollees is still not broken down by race. Advocates need this data in order to evaluate enrollment and use of services by race, and to assess how well the state and care providers are doing when it comes to providing quality health care to patients of every race and health status. Availability of this data also affords us an opportunity to see what communities are in need of targeted outreach and enrollment efforts. Without expansion data by race, we won’t be able to see how these policies affect communities of color. 
Other barriers to coverage remain, particularly for immigrants in Virginia. Virginia is one of only six states where a lawfully present immigrant must establish a 40 quarter work history, alongside the federal five-year requirement, before reaching eligibility for Medicaid. This is a clear barrier to coverage and prevents agency staff and community partners from making the most out of expansion and covering more people who have chosen to call Virginia home. Two companion budget amendments were introduced last year in the state House and Senate in order to remove this barrier but were ultimately not included in the final budget.
And new barriers will be erected unless policymakers change course. Virginia is currently waiting on federal permission to take health coverage away from people who do not report a certain number of hours worked each month. This, along with increased premiums for some Medicaid enrollees, will lead to tens of thousands of newly covered Virginians losing access to health care. Taking away Medicaid coverage for those who are underemployed or even have trouble reporting hours in order to retain coverage would make it more difficult for families to receive the services they need to stay healthy.
Securing health care coverage for over 300,000 people is a milestone worth celebrating. Unfortunately, there are policies that continue to actively prevent coverage for certain people. Advocates and stakeholders can continue strengthening enrollment with their successful outreach efforts and oppose barriers to coverage in order to make sure that everyone in Virginia has access to health care.
— Kathy Mendes, Research Assistant, and Freddy Mejia, Policy Analyst