Department of Medical Assistance Services [602]
Secretarial Area: Health and Human Resources
Operating Budget Summary
This table shows the Governor's proposed budget for the next two years and the agency's official budget for the previous six years.
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Biennium Fiscal Year Source GF NGF Total
2012-2014 2013 Chapter 1, 2014 Acts of Assembly $3,547,761,312 $4,525,123,550 $8,072,884,862
2012-2014 2014 Chapter 1, 2014 Acts of Assembly $3,669,406,166 $4,829,310,906 $8,498,717,072
2014-2016 2015 Chapter 732, 2016 Acts of Assembly $3,846,847,641 $4,786,951,421 $8,633,799,062
2014-2016 2016 Chapter 732, 2016 Acts of Assembly $4,266,731,052 $5,073,691,875 $9,340,422,927
2016-2018 2017 Chapter 1, 2018 Acts of Assembly $4,450,859,097 $5,472,509,199 $9,923,368,296
2016-2018 2018 Chapter 1, 2018 Acts of Assembly $4,785,782,724 $5,892,680,250 $10,678,462,974
2018-2020 2019 Chapter 854, 2019 Acts of Assembly $5,008,158,914 $7,594,157,772 $12,602,316,686
2018-2020 2019 Previous Legislative Appropriation $4,839,837,209 $7,244,322,901 $12,084,160,110
2018-2020 2019 Governor's Amendments $171,210,598 $349,363,478 $520,574,076
2018-2020 2019 General Assembly Adjustments ($2,888,893) $471,393 ($2,417,500)
2018-2020 2020 Chapter 854, 2019 Acts of Assembly $5,159,981,592 $10,545,577,374 $15,705,558,966
2018-2020 2020 Previous Legislative Appropriation $4,959,670,074 $8,783,161,031 $13,742,831,105
2018-2020 2020 Governor's Amendments $245,641,136 $1,777,688,978 $2,023,330,114
2018-2020 2020 General Assembly Adjustments ($45,329,618) ($15,272,635) ($60,602,253)
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
2012-2014 2013 Chapter 1, 2014 Acts of Assembly 183.82 212.18 396.00
2012-2014 2014 Chapter 1, 2014 Acts of Assembly 198.32 226.68 425.00
2014-2016 2015 Chapter 732, 2016 Acts of Assembly 210.37 216.63 427.00
2014-2016 2016 Chapter 732, 2016 Acts of Assembly 225.02 234.98 460.00
2016-2018 2017 Chapter 1, 2018 Acts of Assembly 232.02 241.98 474.00
2016-2018 2018 Chapter 1, 2018 Acts of Assembly 240.02 249.98 490.00
2018-2020 2019 Chapter 854, 2019 Acts of Assembly 257.52 273.48 531.00
2018-2020 2019 Previous Legislative Appropriation 257.52 259.48 517.00
2018-2020 2019 Governor's Amendments 0.00 14.00 14.00
2018-2020 2019 General Assembly Adjustments 0.00 0.00 0.00
2018-2020 2020 Chapter 854, 2019 Acts of Assembly 259.52 275.48 535.00
2018-2020 2020 Previous Legislative Appropriation 257.52 259.48 517.00
2018-2020 2020 Governor's Amendments 2.00 16.00 18.00
2018-2020 2020 General Assembly Adjustments 0.00 0.00 0.00
Operating Budget Addenda (in order of greatest impact)
•
Fund Medicaid utilization and inflation Decision Package
  Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent expenditure forecast.
 
  FY FY
General Fund $202,221,659 $260,327,089
Nongeneral Fund $270,284,195 $1,750,268,021
•
Adjust Health Care Fund appropriation Decision Package
  Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Tobacco taxes are projected to decrease by $19.2 million in 2019 and $20.4 million in 2020 based on the Department of Taxation's revised forecast. Conversely, Medicaid recoveries are expected to increase by $0.7 million in 2019 and $8.6 million in 2020. The estimates also account for $46.7 million in prior year balances carried over from 2018. Since the fund is used as state match for Medicaid, any change in revenue to the fund impacts general fund support for Medicaid.
 
  FY FY
General Fund ($38,883,878) $1,675,612
Nongeneral Fund $38,883,878 ($1,675,612)
•
Fund medical assistance services for low-income children utilization and inflation Decision Package
  Adjusts funding for the Commonwealth's Medicaid Children's Health Insurance Program to reflect the latest expenditure forecast. Children between the ages of 6 and 19, with family income from 100 to 133 percent of the federal poverty level, are eligible for this program. The costs are primarily a result of higher than expected managed care rates and, to a lesser extent, increased enrollment.
 
  FY FY
General Fund $2,975,950 $7,233,047
Nongeneral Fund $27,823,633 $34,573,639
•
Address elimination of Medicaid support for Piedmont and Catawba hospitals Decision Package
  Provides general fund in FY 2019 to cover anticipated federal deferrals (immediate reductions) associated with payments to Piedmont Geriatric and Catawba hospitals. Funding is likely to be needed in the current fiscal year to replace federal funds that the Centers for Medicare and Medicaid Services (CMS) has indicated will be deferred dating back to the quarter ending 6/30/2018. Other amendments will provide for the repayment of federal disallowances associated with challenged payments that occurred before 6/30/2018. In addition, FY 2020 state matching funds are transferred to the Virginia Department of Behavioral Health and Developmental Services to offset a portion of on-going operating costs that are funded in a companion amendment.
 
  FY FY
General Fund $18,969,647 ($14,507,846)
Nongeneral Fund $0 ($14,507,846)
•
Make adjustments to administrative appropriation and language to reflect Medicaid expansion implementation Decision Package
  Adjusts appropriations to properly account for the administrative costs associated with Medicaid expansion. While the official Medicaid forecast package makes changes necessary to fund medical costs; this amendment similarly adjusts the administrative appropriations to reflect the latest estimate of the full cost of coverage for Medicaid expansion. In addition, language related to the provider coverage (Section 3-5.15) and provider payment rate (Section 3-5.16) assessments in Part 3 is modified to clarify current policy.
 
  FY FY
General Fund ($14,770,835) ($17,368,267)
Nongeneral Fund $497,458 ($6,817,573)
Positions 14.00 14.00
•
Fund cost of implementing Medicaid 1115 demonstration waiver Decision Package
  Provides funding to cover the estimated cost of administering the Medicaid expansion related 1115 demonstration waiver.
 
  FY FY
General Fund $1,680,143 $10,240,286
Nongeneral Fund $1,680,143 $14,240,286
•
Fund Family Access to Medical Insurance Security (FAMIS) utilization and inflation Decision Package
  Adjusts funding for the FAMIS program to reflect the latest forecast of expenditures. The costs are primarily a result of higher than expected managed care rates and, to a lesser extent, increased enrollment.
 
  FY FY
General Fund $1,275,294 $1,294,221
Nongeneral Fund $12,451,553 $7,446,527
•
Adjust appropriation to reflect transitioned contract costs Decision Package
  Captures the savings associated with the agency no longer directly contracting for the facilitation of attendant payments in managed care. This function will now be handled by managed care organizations (MCO), the cost of which is assumed in the capitated payments made to MCOs.
 
  FY FY
General Fund ($3,691,132) ($7,095,176)
Nongeneral Fund ($3,691,132) ($7,095,176)
•
Increase oversight of Medicaid spending and update forecast projections Decision Package
  Adds language requiring the department to convene a quarterly meeting with executive and legislative branch leadership to explain differences between forecasted and actual Medicaid expenditures. In addition, this amendment modifies projected Medicaid spending by accounting for savings associated with achieving long term care case mix targets in managed care.
 
  FY FY
General Fund $0 ($3,893,868)
Nongeneral Fund $0 ($3,893,868)
•
Provide coverage of preventive services and vaccines for currently eligible adult populations Decision Package
  Provides funding for coverage of preventive services and vaccines for currently eligible adult populations in fee-for-service, Medallion 4.0, and CCC Plus to ensure equity with the expansion population.
 
  FY FY
General Fund $0 $3,531,444
Nongeneral Fund $0 $3,556,428
•
Account for change in federal match rate for CHIP administration Decision Package
  Replaces revenue that will be lost due to a reduction in the federal match rate for administering the Children’s Health Insurance Program (CHIP). On October 1, 2019, the federal match rate for CHIP is scheduled to be reduced by 11.5 percentage points. This reduction will increase the general fund share that is necessary to administer the program from 12 percent to 23.5 percent. The additional general fund appropriation will allow the agency to maintain current operations.
 
  FY FY
General Fund $0 $1,745,631
Nongeneral Fund $0 ($1,745,631)
•
Increase funding for managed care enrollment broker services Decision Package
  Funds costs related to new managed care regulations (42 CFR 438.71) that require robust choice counseling, including face-to-face options, be available to all Medicaid recipients enrolled in managed care plans. The additional requirements will increase the cost of the current enrollment broker contract.
 
  FY FY
General Fund $708,750 $896,333
Nongeneral Fund $708,750 $896,333
•
Provide training for consumer-directed attendants Decision Package
  Funds training for consumer-directed attendants who provide personal assistance, respite, and companion services.
 
  FY FY
General Fund $500,000 $500,000
Nongeneral Fund $500,000 $500,000
•
Fund increased cost of the Cover Virginia Call Center Decision Package
  Provides funds to address the increased cost of processing Medicaid and CHIP applications through the Cover Virginia central processing unit. Additional funding will cover higher contract costs associated with an increased number of applications being processed at the Cover Virginia central processing unit and the expanded scope of the contract to provide administrative services.
 
  FY FY
General Fund $0 $440,410
Nongeneral Fund $0 $1,321,230
•
Simplify process for residents of nursing facilities choosing hospice care Decision Package
  Provides funding to simplify the payment process for nursing home residents choosing hospice. Nursing Facilities will submit claims for room and board directly to managed care organizations (MCO) which will in turn pay the nursing facility at 100 percent of the prevailing rate regardless of the resident's election of hospice care.
 
  FY FY
General Fund $0 $447,220
Nongeneral Fund $0 $447,220
•
Enhance federal compliance capabilities Decision Package
  Provides funding to hire an expert contractor(s) in 2019 to aid the agency with federal reporting, cost allocation, and Advanced Planning Documents (APDs). The contractor(s) will focus on improving compliance with federal processes. In addition, resources are provided for the agency to hire four additional positions in 2020. The cost allocation, federal reporting, APD and internal audit units all receive one position.
 
  FY FY
General Fund $225,000 $175,000
Nongeneral Fund $225,000 $175,000
Positions 0.00 4.00
•
Add language to specify medical residencies awards Decision Package
  Adds language to specify which hospitals have been awarded the graduate medical residency slots with funding included in the Appropriation Act.
•
Adjust electronic visit verification (EVV) system implementation date to reflect federal changes Decision Package
  Changes the date for requiring consumer-directed aides providing personal care, respite care and companion services in the Medicaid Commonwealth Coordinated Care (CCC) Plus Waiver and Developmental Disability waiver programs and the Early and Periodic Screening Diagnosis and Treatment (EPSDT) program to utilize an Electronic Visit Verification (EVV) system. The new implementation date will be October 1, 2019, three months ahead of the current federal mandate.
•
Clarify payment rules for new and renovated nursing homes Decision Package
  Adds language requiring the agency to implement prospective fair rental value rates for new and renovated nursing facilities.
•
Medicaid Forecast Adjustment for Suspension of Insurance Tax General Assembly Adjustment
  This amendment reduces $38.9 million from the general fund and a like amount of federal matching funds in the second year to reflect the impact of the federal suspension of a tax on health insurers for calendar year 2019. The continuing resolution (H.R. 195) passed by Congress in January 2018 suspended the tax. The tax on health insurers was created in the Affordable Care Act and the net impact is that the cost of the tax is passed-through to Medicaid managed care companies, which is the reason the tax impacts the state budget.
 
  FY FY
General Fund $0 ($38,900,000)
Nongeneral Fund $0 ($38,900,000)
•
Correct Fund Source for Administrative Appropriation for Medicaid Expansion General Assembly Adjustment
  This amendment corrects the fund source for administrative appropriations for Medicaid expansion from the general fund to nongeneral fund amounts from the Health Care Coverage Assessment Fund.
 
  FY FY
General Fund ($1,680,143) ($10,240,286)
Nongeneral Fund $1,680,143 $10,240,286
•
Increase Certain Physician Rates to 70 Percent of Medicare Rates General Assembly Adjustment
  This amendment provides $4.1 million from the general fund and $11.1 million from federal Medicaid matching funds in the second year to increase Medicaid reimbursement to 70 percent of the equivalent Medicare fee for service and managed care rates to primary care physicians and specialists who are currently reimbursed less than 70 percent of Medicare rates. It is the intent of the General Assembly that in the enrolling of this act, funding included in this item shall be allocated among appropriate items within the Department of Medical Assistance Services.
 
  FY FY
General Fund $0 $4,185,199
Nongeneral Fund $0 $11,060,494
•
Medicaid Mental Health Professional Rates General Assembly Adjustment
  This amendment provides $2.6 million from the general fund and $4.5 million from federal Medicaid matching funds to increase the Medicaid rates for mental health practitioners who bill for psychiatric services. These rates are lower than Medicare and commercial rates, resulting in fewer providers accepting Medicaid patients in need of these services. It is the intent of the General Assembly that in the enrolling of this act, funding included in this item shall be allocated among appropriate items within the Department of Medical Assistance Services.
 
  FY FY
General Fund $0 $2,645,706
Nongeneral Fund $0 $4,560,751
•
Eliminate Expanded Preventative Services Coverage for Adults General Assembly Adjustment
  This amendment eliminates $3.5 million from the general fund and a similar amount of federal Medicaid matching funds included in the introduced budget to expand preventative services for adults. Many of the Medicaid managed care organizations already cover these services.
 
  FY FY
General Fund $0 ($3,531,444)
Nongeneral Fund $0 ($3,556,428)
•
Increase Reimbursement for Critical Access Hospitals General Assembly Adjustment
  This amendment adds $1.6 million from the general fund and $3.1 million from nongeneral funds to increase reimbursement for inpatient, outpatient and capital rates for Critical Access Hospitals to 100 percent of allowable costs. A "Critical Access Hospital" is a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS), so that reimbursement policies could be designed to reduce financial vulnerability of these hospitals and improve access to healthcare by keeping essential services in rural communities. There are currently seven Critical Access Hospitals operating in Virginia. It is the intent of the General Assembly that in the enrolling of this act, funding included in this item shall be allocated among appropriate items within the Department of Medical Assistance Services.
 
  FY FY
General Fund $0 $1,612,235
Nongeneral Fund $0 $3,124,796
•
Reduce New Funding for Enrollment Broker Services General Assembly Adjustment
  This amendment reduces $708,750 from the general fund and a like amount of federal Medicaid matching funds the first year and $396,333 from the general fund and a like amount of federal Medicaid matching funds the second year included in the introduced budget for the costs of managed care enrollment broker services, leaving $500,000 from the general fund the second year for this activity.
 
  FY FY
General Fund ($708,750) ($396,333)
Nongeneral Fund ($708,750) ($396,333)
•
Eliminate Training for Consumer-Directed Attendants General Assembly Adjustment
  This amendment removes funding proposed in the introduced budget for training of consumer directed attendants. The Department of Medical Assistance Services does not typically provide health care professional development services.
 
  FY FY
General Fund ($500,000) ($500,000)
Nongeneral Fund ($500,000) ($500,000)
•
Remove New Funding for Cover Virginia Call Center Contract General Assembly Adjustment
  This amendment eliminates $440,410 from the general fund and $1.3 million from federal Medicaid matching funds the second year included in the introduced budget for higher contract costs of the Cover Virginia Call Center. The Commonwealth now allows the federal marketplace to make Medicaid eligibility determinations, which will reduce the workload of the call center.
 
  FY FY
General Fund $0 ($440,410)
Nongeneral Fund $0 ($1,321,230)
•
Medicaid Funding for All Payer Claims Database General Assembly Adjustment
  This amendment provides $87,500 from the general fund and $262,500 from federal Medicaid matching funds to support the All Payer Claims Database (APCD). House Bill 2798 and Senate Bill 1216 make participation in the APCD mandatory. This amendment allows the Department of Medical Assistance Services (DMAS) to access enhanced federal funding to support its use of the APCD. Medicaid can use enhanced federal funding at a 75 percent federal matching rate to support the maintenance and operations of the APCD. At least seven other states (Oregon, Florida, New York, Colorado, Rhode Island, Utah and New Hampshire) currently pay for a portion of the maintenance and operations of their APCD using Medicaid enhanced federal funding. Furthermore, the Centers for Medicare and Medicaid Services (CMS) has confirmed that this type of funding can be available to Virginia's APCD if DMAS submits and CMS approves an Operational Advanced Planning Document (O-APD) for the project and payments. This amount is proportional to the volume of APCD claims that are associated with Virginia Medicaid members.
 
  FY FY
General Fund $0 $87,500
Nongeneral Fund $0 $262,500
•
Alternative Medicaid Pharmacy Benefit Delivery Models General Assembly Adjustment
  This amendment provides $125,000 from the general fund and $125,000 in matching federal Medicaid funds for the Department of Medical Assistance Services (DMAS) to contract with their actuary to determine the best pharmacy benefit delivery model for the Medicaid and Children's Health Insurance Programs in terms of cost effectiveness and other considerations. DMAS is required to report findings from the review of pharmacy benefit management realignment in the Medicaid and Children's Health Insurance Programs to the Chairmen of House Appropriations and Senate Finance Committees by December 1, 2019. The language requires the contracted actuary of DMAS to determine potential cost savings. Upon approval of the 2020 General Assembly, the department may make programmatic changes to align the payments for prescribed drugs and dispensing fees with the most beneficial financial solution for the Commonwealth. Language also authorizes the agency to contract with a Virginia university for administration of a common formulary across its programs for pharmacy benefits.
 
  FY FY
General Fund $0 $125,000
Nongeneral Fund $0 $125,000
•
Medicaid Telehealth Site Facility Fee General Assembly Adjustment
  This amendment provides $23,215 from the general fund and $27,529 from federal Medicaid matching funds to increase the Medicaid telehealth originating site facility fee to 100 percent of the Medicare rate, including annual Medicare fee increases. This a recommendation of the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century.
 
  FY FY
General Fund $0 $23,215
Nongeneral Fund $0 $27,529
•
Carryforward Limitation in Medicaid General Assembly Adjustment
  This amendment reverts any general fund year-end balance in the Medicaid program each year. The appropriation for the Medicaid program is based on an annual forecast, which adjusts the appropriation as needed as part of the normal budget process and therefore any remaining balance in the program should revert at the end of the fiscal year.
•
Fiscal Impact Review of Medicaid Program Changes General Assembly Adjustment
  This amendment modifies the fiscal impact review process for changes to the Medicaid program to include the potential fiscal impact on Medicaid managed care capitation rates resulting from contract changes, and clarifies that any change that may result in a general fund impact, which has not been funded, will be delayed until the General Assembly specifically authorizes such action.
•
Improve Medicaid Eligibility Screening Services General Assembly Adjustment
  This amendment provides authority for the Department of Medical Assistance Services, in collaboration with the Department of Social Services, to consider and review proofs of concept with vendors for a pilot program to improve screening services for income and assets as part of the Medicaid eligibility determination process for both initial applications and renewals. The pilot program may include new methods to increase automation of various financial accounts to improve the verification process for eligibility. The pilot may also include methods to monitor compliance with the provisions of the Training, Education, Employment, and Opportunity Program. The Department of Medical Assistance Services will notify the Chairmen of the House Appropriations and Senate Finance Committees of any viable proposals.
•
Managed Care Notification and Training Requirements for Certain Providers General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to require the Medicaid managed care organizations to provide written notification and training to agency-directed personal care providers at least 60 days prior to the implementation of all changes to Quality Management Review and prior authorization policies and processes.
•
Medicaid Behavioral Health Services Realignment General Assembly Adjustment
  This amendment adds language authorizing the realignment of behavioral health services to ensure the system supports evidence-based, trauma-informed, prevention-focused and cost-effective services for individuals served across the lifespan. Language requires a plan on the changes in provider rates, new services and other programmatic or cost changes to the Chairmen of House Appropriations and Senate Finance Committees by December 1, 2019. Agency authority to implement the changes is contingent on approval of the 2020 General Assembly and the federal Centers for Medicare and Medicaid Services.
•
Modify DSH Methodology for TDO Utilization General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to develop a new methodology for the allocation of Disproportionate Share Hospital (DSH) payments to increase reimbursement to hospitals that are serving more individuals who are subject to temporary detention orders and likewise to reduce reimbursement to hospitals whose utilization of such TDO services declines. This program is intended to assist in reducing census pressure on the state mental health hospitals.
•
Notification Requirement of Federal Deferrals and Disallowances General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to notify the Department of Planning and Budget and the Chairmen of the House Appropriations and Senate Finance Committees of any federal deferral of grant funds, release of a deferral, or disallowance.
•
Oversight of Medicaid Forecast and Expenditures General Assembly Adjustment
  This amendment modifies the quarterly meeting created to increase oversight of Medicaid expenditures as compared to the official Medicaid forecast. The language eliminates the Secretary of Administration and the Joint Commission for Health Care in order to limit the meeting to the parties with the most interest in tracking the program. In addition, the Department of Medical Assistance Services is directed at each quarterly meeting to include any information on changes to managed care programs that may have an impact on the overall fiscal impact of the programs. The department is also required to report on the Discrete Incentive Transition Program and overall trends in managed care trends.
•
Partial Reversion FY 2018 Carryforward Balances General Assembly Adjustment
  This amendment partially reverts the carryforward balance from fiscal year 2018 for the Department of Medical Assistance Services' administrative budget that was approved by the Governor. The agency's administrative program had a remaining balance at the end of fiscal year 2018 of $12.8 million general fund and the Governor reappropriated $7.8 million of that balance in fiscal year 2019. Based on the current funding level for the agency, this appropriation is not necessary.
•
Reimbursement Model for Rural Hospital in Southwest Virginia General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to pursue alternatives for cost based reimbursement for a rural hospital in Southwest Virginia that has closed in the last five years.
•
Report on Use of ERs for Adult Dental Issues in Medicaid General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to report data on the use of hospital emergency rooms for dental-related issues by Medicaid beneficiaries. The report will be submitted to the Chairmen of the House Appropriations and Senate Finance Committees by November 1, 2019.
•
Reporting on Agency Organization General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services to annually report on the agency's organization and operations and any changes that occurred during the year. The agency will make this report available on its website by August 15 of each year. This information will assist in providing information regarding the transition of the agency from managing a fee-for-service system to oversight of a managed care delivery system.
•
Reporting on Medicaid Pharmacy Claims by Managed Care Organizations General Assembly Adjustment
  This amendment modifies language that directs the Department of Medical Assistance Services to include language in all its managed care contracts requiring quarterly reports on details related to pharmacy claims. It eliminates language that provides a time limit on the quarterly reporting of data through June 30, 2019. It also adds language to require an annual report using aggregated data to the Chairmen of the House Appropriations and Senate Finance Committees by October 1 of each year.
•
Requirement to Provide Renewal Data to Managed Care Organizations General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services, in collaboration with the Department of Social Services, to submit renewal data for managed care plan members in Medicaid and FAMIS to assist the managed care organizations in reducing the number of enrollees who have lapsed coverage during the year due to disenrollment that occurs as part of the annual eligibility renewal process in Medicaid or FAMIS.
•
Staff Competency Requirements for Waiver Providers General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services and the Department of Behavioral Health and Developmental Services to recognize certain certifications in lieu of competency requirements for supported employment staff in the three Medicaid developmental disability waiver programs and allow certain providers that hold national accreditation for services they provide in the developmental disability waivers to be deemed qualified to meet employment staff competency requirements.


p3_bullets - Official Enacted Budget - 01-24-2026 17:28:57