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November 6, 2015

Spoiler Alert

Virginia’s Medicaid is likely to fare well under yet another state watchdog review. But if the past is any indication, that won’t stop opponents of closing the coverage gap from using the new findings as another excuse to refuse the billions in federal funding to help more Virginians get health insurance.

The study, due to be released Monday by the Joint Legislative Audit and Review Commission, represents a compromise on what topics to tackle. The initial House resolution asked for a wide-ranging review of the Medicaid program even though dozens of audits have been done in recent years including former Governor McDonnell’s top-to-bottom audit. Only after reaching a compromise with the Senate did the final study resolution emerge focusing on the more specific question of how Medicaid verifies eligibility for the long-term care services that consume two-thirds of the state’s Medicaid budget. This is an issue, by the way, completely unrelated to the new services that would be provided if Virginia closed the coverage gap. That’s because the vast majority of the newly eligible are low-income able bodied adults who do not need long-term care services like nursing home care.

Previous audits and reviews of Virginia’s Medicaid, while identifying areas for improvement, have consistently found that the state does a good job in promoting program integrity. In fact, a 2013 audit by the federal government found that Virginia’s Medicaid payment error rate was 0.47 percent, far below the national average of 3.3 percent. And after the audit he ordered, Governor McDonnell – who did not support closing the coverage gap – concluded, “the issues that the audit surfaced are neither numerous nor unmanageable.”

One way Virginia Medicaid has done so well is the increasing partnership with managed care organizations and other contractors that coordinate the network of providers eligible to participate in Medicaid. And if Virginia were to close the coverage gap, the people newly eligible should be enrolled in coverage coordinated by these private managed care organizations.

Without a doubt, JLARC’s report will highlight areas for improvement that should be taken seriously. Virginia should always take every step to minimize waste and prevent fraud. Yet to conclude that the commonwealth shouldn’t close the coverage gap because there’s room for improvement is just a thinly veiled delay tactic. States that have closed their coverage gap under the Affordable Care Act are seeing good results and saving money. Virginians deserve no less.

–Massey Whorley, Senior Policy Analyst

The Commonwealth Institute

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