Virginia looks to add Medicaid work requirements, premiums

Virginia has become the latest state looking to add a work requirement and premiums to its Medicaid program.

State officials already submitted a state plan amendment to the CMS to expand Medicaid to those with incomes of up to 138% of the federal poverty level. Now, Virginia has posted an 1115 waiver application on its website that would add work requirements, premiums and emergency room co-pays to beneficiaries above the federal poverty level.

Under the waiver proposal, eligible Medicaid enrollees would need 20 hours per month of work-related activities for the first three months that they're eligible for the work program. The required hours would gradually increase, ultimately hitting 80 hours per month.

Children under age 19, students in post-secondary education, seniors 65 and older and those dually enrolled in Medicaid and Medicare would be exempt from the work requirement.

Non-exempt enrollees who fail to comply with their work and community engagement requirements for three consecutive or non-consecutive months would have their coverage suspended.

The state also wants permission to impose a monthly premium for beneficiaries above the federal poverty level, assessed on a sliding income scale. Individuals with incomes at 100% to 125% of the federal poverty level would pay $5 per month. Beneficiaries with incomes at 126% to 138% of the federal poverty level would be charged $10 per month.

Medicaid coverage will only be effective on the first day of the month following receipt of the premium payment. Beneficiaries who are exempt from the work requirement also will be exempt from premium obligations.

Virginia would suspend enrollees' coverage if they fail to pay their premiums after a three-month grace period.

Medicaid enrollees who complete at least one so-called healthy behavior, such as an annual wellness exam, mammogram, pap smear, colon cancer screening, or flu vaccination, will have their premiums reduced by 50% in the next coverage year.

Expansion enrollees will also be required to pay a $5 co-payment for non-emergent or avoidable emergency department use.

The state will accept comments on the proposal through Oct. 20. After reviewing and addressing comments, the state's Medicaid agency will send the application to the CMS.

Virginia's state plan amendment stemmed from legislation passed in May after years of opposition by Republican leadership. As many as 400,000 individuals could gain coverage because of expansion. The state's Medicaid program hopes to start accepting new enrollees starting Jan. 1, 2019.