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Medicaid at a Glance



 

VIRGINIA MEDICAID OVERVIEW


The Virginia Department of Medical Assistance Services (DMAS) plays an essential role in the Commonwealth’s health care system by offering lifesaving coverage to one in five Virginians, including more than 500,000 newly eligible adults who gained access to care when the program expanded in 2019.

In 2020, the Commonwealth confronted historic economic and health challenges from the COVID-19 pandemic. Virginia Medicaid responded to COVID-19 with a comprehensive set of policies, including coverage protections for our members. During the COVID-19 pandemic and throughout the recovery, we want our members, our providers, and our Commonwealth to know: We’ve got you covered.


 

MEDICAID EXPANSION

 

More than 500,000 Virginians are enrolled in health coverage thanks to expanded Medicaid eligibility rules that took effect in January 2019. Virginia was the only state in the nation to experience a reduction in the uninsured rate between 2018 and 2019, the first year of the expanded eligibility rules. The overall uninsured rate declined from 12.3% to 11%. The reduction was more dramatic for adults ages 18-64 with incomes below 138% of the federal poverty line. That population segment saw its uninsured rate drop from 28.1% to 23%.


Virginians who enrolled in Medicaid coverage reported a dramatic decrease in unmet medical and other health needs, including a 38 percentage point decline in unmet need for primary care and a 32 percentage point decline in unmet need for prescription medicines.

 

Chart indicating the decrease in unmet medical and other health needs from before medicaid expansion to one year after.  This includes a 38% decline in unmet need for primary care, a 32% decline in unmet needs for prescription medicines, and a 26% decline in unmet need for dental care.

 


 

TELEHEALTH

 

Virginia Medicaid adopted policies to encourage telehealth during the COVID-19 health emergency to preserve access to care for our members. Telehealth is an important option to ensure that our members receive the right care at the right time in the right place. For the duration of the emergency, Medicaid is covering telehealth services:

  • To members in their homes
  • Through video and audio-only phone
  • Via remote patient monitoring for COVID-19

Virginia Medicaid will continue to offer payment parity for services provided through video, audio-only and in-person care during the public health emergency.

Over the past year, the Medicaid agency has gained a greater understanding of telehealth’s possibilities and limitations, which include inadequate broadband access in some regions of the state. We continue to collaborate with our providers and members to develop longer-term policies that improve telehealth delivery.

 


 

SUPPORT ACT


In September 2019, Virginia Medicaid was awarded $4.8 million from the Centers for Medicare and Medicaid Services (CMS) Section 1003 Substance Use Disorder (SUD) Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act Grant.

The grant’s goal is to increase provider capacity for addiction and recovery treatment to support DMAS’s core values, including person-centered, strengthsbased and recovery-oriented care. Grant activities include a needs assessment to determine current SUD treatment needs and provider treatment capacity in the Commonwealth, a ‘Brightspot’ assessment to assess community strengths in SUD treatment, clinician trainings, and pilot programs focusing on expanding SUD treatment access.

Grant activities focus on expanding access to treatment for two priority populations: Medicaid members who are pregnant and parenting, and members who are involved in the justice system. The grant time period is September 2019 through September 2021.

 


 

COVID-19 UPDATE

 

Medicaid expansion continues to be a critical support for Virginians throughout the COVID-19 public health emergency, with an additional 117,268 adults enrolling through the new eligibility rules since the declaration of the state of emergency.

Total Medicaid enrollment grew from 1.53 million to 1.76 million during the state of emergency – an increase of 228,528 members, including 72,286 children.

 

Graphic showing an increase in Medicaid enrollment from 1.5 million to 1.6 million members from the time the state of emergency was declared through December 31, 2020.
Graphic showing the steps Virginia Medicaid has to fight covid-19. This includes no copays for covered services, outreach to higher risk and older members to review critical needs, encouraging the use of telehealth, 90 day supply of many routine prescriptions, and ensuring members do not inadvertently lose coverage due to lapses in paperwork.
Graphic indicating a 1700% increase in telehealth claims from February 2020 to June 2020 with over 212,000 Medicaid members receiving a telehealth service.
Graphic highlighting SUPPORT Act Grant Activities from September 2019 through September 2021. This includes training clinicians via 99 webinars, engaging with over 725 participants at stakeholder meetings, and partnering with VCU to survey over 1,000 ARTS members.

 


The Virginia Department of Medical Assistance Services (DMAS) SUPPORT Act Grant projects are supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $4,836,765 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.