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At Henrico forum, McAuliffe and Cuccinelli differ on Medicaid expansion

Cuccinelli, McAuliffe speak at mental health forum in Henrico

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Republican gubernatorial nominee Ken Cuccinelli plans “very, very significant” changes for the state agency that administers Virginia’s Medicaid program, while Democrat Terry McAuliffe said expanding the program as prescribed by the Affordable Care Act is critical to funding the unmet needs of the commonwealth’s mentally ill.

Whether to cut and reallocate the Medicaid program’s current funding or accept more federal dollars and expand it framed the greatest difference in the candidates’ responses to a series of questions during a forum on mental health issues Monday evening at the Collegiate School in western Henrico County.

Speaking separately and responding to the same half dozen questions, which they were given in advance, McAuliffe and Cuccinelli told the audience of nearly 500 people — many of them health professionals — that increased funding for mental health services would be a priority if elected.

As a lawyer, Cuccinelli handled hundreds of involuntary-commitment cases early in his career. He said he supports preschool vouchers for low-income children, incentives for more people to become trained as mental health providers, and a streamlining of the licensing process so qualified providers from other states can work in Virginia without bureaucratic delays.

McAuliffe said funding is necessary to increase services at crisis stabilization centers, and improve the training of staffs in jails and in agencies providing services to veterans. He also made a pitch for increased teacher pay and training to help educators identify and address mental health issues among students.

But they had radically different ideas on how to pay for their priorities.

Cuccinelli, Virginia’s attorney general, opposes the expansion under the Affordable Care Act of Medicaid, the jointly funded federal and state program that provides medical care to the poor, elderly and disabled.

He questioned the promise of the federal government to fund the expansion and said that without significant reforms, it would cost the state hundreds of millions that it cannot afford.

“There are services provided right now in Medicaid that are not strictly medical services, and by shifting some of those dollars … we can pay for more actual medical services in the form of mental health services,” Cuccinelli told reporters after addressing the forum.

“This is a multibillion-dollar budget, and what we’re talking is in the order of tens of millions of dollars to move over, and I’m confident that is entirely achievable.”

McAuliffe, a McLean businessman and former Democratic National Committee chairman, endorses opting to expand the program, saying it will provide medical care to an additional 400,000 Virginians, create 33,000 jobs and free up $500 million in the budget that could be used to help increase mental health services.

“If we don’t take the expansion, our hospitals will incur $190 million in expenses down the road,” said McAuliffe, noting that 29 states, including those run by Republican governors, have already signed on to the expansion of the program.

He called the expansion “a great investment. If we don’t take this Medicaid expansion money … you’re going to see your resources cut.”

McAuliffe told reporters after the forum: “It is fiscally irresponsible, not to mention socially irresponsible, not to take that Medicaid money for those 400,000 Virginians who would get access to quality, life-saving care that today they don’t get care.”

Both candidates had trouble with numbers associated with Medicaid expansion. Cuccinelli insisted that expansion would cost the state $200 million a year, or $2 billion over 10 years, while McAuliffe estimated Virginia would save $500 million on mental health services.

The state’s 40 community services boards estimate that more than 80,000 Virginians with mental illness could qualify for Medicaid if it is expanded for people making up to 138 percent of the federal poverty level, as required to receive federal support under the Affordable Care Act.

The administration of Gov. Bob McDonnell has estimated that expansion would cost the state $137.5 million over 10 years — and up to $1 billion if all eligible Virginians enroll in the program immediately.

The net costs assume substantial savings in the first five years, almost $300 million in state money now spent directly on mental health care. The administration also estimates hundreds of millions in savings on health care for prison inmates, most of whom are not eligible for matching federal Medicaid funds now.

The forum was sponsored by a mental health coalition led by Voices for Virginia’s children and NAMI-Virginia, part of the National Alliance on Mental Illness.

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Twitter: @RTDNolan

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