The new Republican leader of the House of Delegates has opened the door to a “dialogue” with Democratic Gov. Ralph Northam on expanding Virginia’s Medicaid program, but only if the new governor is willing to accept conditions that would require able-bodied recipients of health benefits to work or actively seek employment.
Speaker of the House Kirk Cox, R-Colonial Heights, challenged Northam in a letter Monday over the governor’s comments to the Richmond Times-Dispatch last week that he would aid Medicaid recipients in seeking work and training, but not require them to work as a condition of receiving health benefits in a program expanded to cover childless adults.
“The House is willing to begin a dialogue on health care that includes significant reforms and strong taxpayer safeguards, but I want to be clear that the 51-member House Republican Caucus has taken a binding caucus position against ‘straightforward’ Medicaid expansion,” Cox wrote Northam in a letter the House leadership distributed publicly.
People are also reading…
“If your position is to pass straightforward Medicaid expansion without work requirements or other reforms, then you will be responsible for the failure to provide health care coverage to more Virginians,” the speaker added.
The letter marks a turning point for House Republicans, who blocked expanding Medicaid for hundreds of thousands of uninsured Virginians for more than four years under then-Speaker Bill Howell, R-Stafford, and Cox as majority leader.
“Governor Northam is encouraged that House Republicans are willing to begin the discussion about coverage expansion, though he believes the dialogue should begin with connecting more Virginians with quality health care, not less,” spokeswoman Ofirah Yheskel said in a statement for the governor. “He looks forward to working with the General Assembly on a plan that works for all Virginians.”
The Northam administration was not happy with the line Cox drew on Medicaid expansion by warning the governor that if he does not support pending bills to impose work requirements on existing recipients — most of whom are pregnant women, children and people with disabilities — “I fear the window on health care reform will narrow.”
However, Yheskel said the administration would withhold comment until it sees what bills the House approves.
Two bills will come before the House Rules Committee, which Cox chairs with an 11-6 Republican majority, on Tuesday morning that would impose a work requirement on “all able-bodied adult recipients” of Medicaid benefits. The bills, proposed by Dels. Jason Myares, R-Virginia Beach, and Charles Poindexter, R-Franklin County, would require recipients to work at least 20 hours a week, or “if he is unable to do so, demonstrate that he is seeking and continues to actively seek such employment” or participate in job training.
The bills also would require periodic checks of the recipients’ household income, as required for other social welfare benefits, and include exemptions for adults who are attending college, acting as sole caregivers for children under 6, receiving long-term disability benefits or otherwise proved to be “physically or mentally unable to work.”
“The response to this legislation will provide a good indicator of whether there is a path forward for further conversations on health care as part of the budget discussions,” Cox told the governor.
Currently, Virginia’s Medicaid program doesn’t include a work requirement because it doesn’t cover childless adults, no matter how low their income. The program also sets stringent eligibility income thresholds for parents, depending on where in the state they live.
The Republican legislation would require the state to seek federal approval of a Medicaid waiver to impose the work requirements, as Kentucky has done in expanding its Medicaid program under the Affordable Care Act.
Northam supports expanding the program to cover all Virginians earning less than 138 percent of the federal poverty level — $16,753 for a single person and $34,638 for a family of four — but he has stepped gingerly around the issue of whether to include a work requirement as a condition for receiving benefits.
In an interview with The Washington Post in December, the then-governor-elect set off a firestorm with his supporters over comments that seemingly suggested a willingness to include work requirements as part of a deal with Republicans to expand Medicaid eligibility for hundreds of thousands of uninsured Virginians.
Last week, Northam told The Times-Dispatch that he favors expanding the program “in the most straightforward way we can” and said he opposed a work requirement as a condition.
“I’d be glad to do anything I can to help train people for the workforce and enter the workforce, but I would not be in favor of a work requirement,” he said Jan. 24.
The reality for both Northam and Cox is that the $115 billion budget then-Gov. Terry McAuliffe proposed last month is built on $421.7 million in assumed savings from expanding Medicaid and requiring hospitals to cover the state’s share of the costs with a provider tax in net inpatient revenues. The state cannot afford to wait for federal approval of a waiver if it wants to include $3.2 billion in federal money to pay for expanding the program on Oct. 1.
The only way Virginia could hope to include that money in the budget would be to propose an amendment to the state’s Medicaid plan, which defines services and program requirements. Senate Finance Co-Chairman Emmett Hanger, R-Augusta, had proposed to expand the program in a two-pronged fashion — including a waiver with a work requirement — in legislation that Republicans killed in a Senate committee last week.
The showdown between Cox and Northam comes less than three weeks before each chamber has to approve a budget for the other to consider in the second half of the General Assembly session. That job would be harder without expanding Medicaid and approving a provider assessment to pay the state’s share of the costs. For example, the budget proposes to use federal funds instead of state money to pay $44 million in prison inmate health care, as well as uncompensated hospital care for uninsured patients and community treatment of mental health or substance use disorders.
House Democrats said they were encouraged by the speaker’s willingness to talk about expanding Medicaid coverage for as many as 400,000 uninsured Virginians, but not his conditions for the discussion.
“However, we are disheartened that Republicans want to begin the conversation by reducing, rather than expanding, access to affordable health care,” House Minority Leader David Toscano, D-Charlottesville, and Democratic Caucus Chair Charniele Herring, D-Alexandria, said in a joint statement Monday.
“This is a critical issue. We’re ready to sit down and make this work for Virginia.”
