Gov. Ralph Northam has directed Virginia’s Medicaid program to “pause” negotiations with the federal government on approval of a work requirement that was central to a political deal that allowed the state to expand eligibility for the program’s health care benefits to hundreds of thousands of uninsured Virginians.
Northam cited the Democratic takeover of both chambers of the General Assembly in legislative elections last month. He also referred to litigation that has faced other states that have tried to link Medicaid health benefits to requirements that program participants seek work, training, education or other forms of civic engagement.
“Virginians made clear they want more access to health care, not less,” he said in a statement on Wednesday. “Given the changed makeup of the General Assembly and based on conversations with new leadership, it is unlikely Virginia will move forward with funding a program that could cause tens of thousands of Virginians to lose health care coverage.”
Northam’s reversal drew a swift rebuke from House Speaker Kirk Cox, R-Colonial Heights, who had worked closely with the Democratic governor on a compromise that would allow Republicans to drop opposition to expanding Medicaid under the Affordable Care Act after a bitter, five-year political battle.
“I’m disappointed to say the least,” Cox said in a statement. “The governor and I made personal commitments to each other on this long-term public policy agreement.”
“There wasn’t an asterisk that said ‘unless my party wins the next election,’ “ he said. “It’s a sad reflection on the value of integrity in modern politics.”
Northam’s statement accompanied a letter that Virginia Medicaid Director Karen Kimsey sent to the Centers for Medicare and Medicaid Services on Tuesday. It formally asks for a delay in ongoing negotiations between the state and federal government over a proposed waiver that would have included a work requirement and help for participants to comply.
Kimsey cited “dynamic policy conversations” about the demonstration waiver proposal after the legislative elections. “Virginia’s request to pause finalizing these provisions at this time also stems from our concern regarding the substantial effort and cost of implementation in the face of ongoing uncertainty, as experienced in several states, which may delay or imperil these aspects of our demonstration,” she wrote federal Medicaid officials.
Jill Hanken, health attorney at the Virginia Poverty Law Center, said the governor made a good choice about a proposal she said would undermine the Medicaid program’s commitment to providing health care to people who otherwise could not afford it.
Hanken urged the new General Assembly to require the state to withdraw its proposals for a Medicaid work requirement and sharing of monthly premium payments by some program participants.
“Those changes would be very complex and threaten health coverage for thousands of low-income Virginians,” Hanken said. “Implementing the restrictions would also cost tens of millions of state dollars, which could be put to much better use.”
The Northam administration had begun backing away from the work requirement commitment before the elections, citing federal refusal to pay the substantial costs of carrying out the Training, Education, Employment Opportunity Program.
Virginia has added more than 342,000 people to its Medicaid program under expanded eligibility guidelines in the Affordable Care Act, which commits the federal government to paying 90% of the cost.
Secretary of Health and Human Resources Dan Carey estimated this fall that the proposed work requirement would apply to more than 65,000 people in the program, and about 14,000 would lose their health coverage without adequate state support to comply with the proposal.
Republican leaders protested in September after Carey told federal Medicaid officials that the state “would be unable to commit to move forward” with the program without full federal funding of the supporting services to prevent thousands of low-income recipients from losing health coverage.
“This is breaking the deal on what we had agreed to do,” House Appropriations Chairman Chris Jones, R-Suffolk, said in September. “It was never predicated that we have federal funding for that to happen.”
Jones, the main architect of the Medicaid budget agreement, was defeated for re-election in November, when Democrats took an apparent 55-45 majority in the House, pending a recount in one close race in Virginia Beach.
Democrats also took a 21-19 majority in the Senate, giving them full control of the legislature for the first time in more than 20 years.