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
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 1283, 2020 Acts of Assembly $5,008,158,914 $7,594,157,772 $12,602,316,686
2018-2020 2020 Chapter 1283, 2020 Acts of Assembly $4,899,537,379 $10,228,886,509 $15,128,423,888
2020-2022 2021 Chapter 1, 2022 Acts of Assembly, Special Session 1 $4,545,328,030 $12,527,356,462 $17,072,684,492
2020-2022 2021 Previous Legislative Appropriation $4,545,328,030 $12,527,356,462 $17,072,684,492
2020-2022 2021 Governor's Amendments $0 $0 $0
2020-2022 2021 General Assembly Adjustments $0 $0 $0
2020-2022 2022 Chapter 1, 2022 Acts of Assembly, Special Session 1 $4,649,993,559 $14,472,732,262 $19,122,725,821
2020-2022 2022 Previous Legislative Appropriation $5,552,084,073 $13,028,216,409 $18,580,300,482
2020-2022 2022 Governor's Amendments ($785,513,672) $1,219,939,460 $434,425,788
2020-2022 2022 General Assembly Adjustments ($116,576,842) $224,576,393 $107,999,551
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
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 1283, 2020 Acts of Assembly 257.52 273.48 531.00
2018-2020 2020 Chapter 1283, 2020 Acts of Assembly 259.52 275.48 535.00
2020-2022 2021 Chapter 1, 2022 Acts of Assembly, Special Session 1 260.02 269.98 530.00
2020-2022 2021 Previous Legislative Appropriation 260.02 269.98 530.00
2020-2022 2021 Governor's Amendments 0.00 0.00 0.00
2020-2022 2021 General Assembly Adjustments 0.00 0.00 0.00
2020-2022 2022 Chapter 1, 2022 Acts of Assembly, Special Session 1 263.02 272.98 536.00
2020-2022 2022 Previous Legislative Appropriation 263.02 272.98 536.00
2020-2022 2022 Governor's Amendments 0.00 0.00 0.00
2020-2022 2022 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 $0 ($653,688,226)
Nongeneral Fund $0 $1,085,433,112
•
Adjust Health Care Fund appropriation Decision Package
  Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Revenue from the Master Settlement Agreement (MSA) is expected to remain unchanged in FY 2022. Tobacco taxes are projected to increase by $0.8 million in 2022 based on the Department of Taxation's revised forecast which assumes that a decline in cigarette taxes will be offset by other tobacco products revenue. FY 2022 pharmacy rebate estimates are not being adjusted; however, Medicaid recoveries are expected to increase by $39.5 million due to one time deposits. The largest driver of current year revenue growth is a $92.5 million prior year balance in the fund. This revenue was largely attributable to larger than expected MSA payments in FY 2021 and a return of $54.8 million associated with the managed care profit cap. 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 $0 ($132,758,827)
Nongeneral Fund $0 $132,758,827
•
Adjust Medicaid forecast to account for revised Medicare premiums Decision Package
  Accounts for Medicare premium rates that were published after the official Medicaid forecast was completed. During the development of the Medicaid forecast, due November 1, the Department of Medical Assistance Services had to use preliminary assumptions on Medicare premium rates. Since the forecast was finalized, the federal government has released actual Medicare Part A, B and D rates for effective January 1, 2022. The forecast assumed 5% as assumed for Part A, 6.73%for Part B, and 4.86% for Part D; however the actual rates are 5.9%, 14.5%, and 7.31% respectively.
 
  FY FY
General Fund $0 $11,848,650
Nongeneral Fund $0 $8,576,267
•
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 as projected by the Department of Medical Assistance Services.
 
  FY FY
General Fund $0 ($7,730,184)
Nongeneral Fund $0 ($2,804,704)
•
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 (MCHIP) to reflect the latest expenditure forecast as projected by the Department of Medical Assistance Services.
 
  FY FY
General Fund $0 ($3,619,662)
Nongeneral Fund $0 ($4,877,956)
•
Eliminate remaining Medicaid and FAMIS program co-payments Decision Package
  Eliminates remaining co-payment requirements for children in the Family Access to Medical Insurance Security (FAMIS) managed care program and for adults in fee-for-service (FFS) Medicaid. This action is effective April 1, 2022 or upon expiration of the federal public health emergency related to the Coronavirus Disease 2019 (COVID-19) pandemic, whichever is earlier.
 
  FY FY
General Fund $0 $112,869
Nongeneral Fund $0 $532,206
•
Exclude excess resources accumulated during the public health emergency (PHE) for long-term supports and services (LTSS) recipients Decision Package
  Allows for the exclusion of resources accumulated by individuals receiving LTSS for a period of 12 months after the end of the federal PHE. Federal rules prohibited Virginia from increasing patient pay associated with changes implemented during the PHE. Therefore, some LTSS recipients may have accumulated excess resources and would be at risk for losing Medicaid eligibility at the end of the federal PHE.
 
  FY FY
General Fund $0 $321,708
Nongeneral Fund $0 $321,708
•
Forgo state share of Childrens Hospital of The Kings Daughters disproportionate share hospitals repayments Decision Package
  Allows the Children’s Hospital of The King’s Daughters (CHKD) to retain the state share of any federal disproportionate share hospitals (DSH) repayments for the period of June 2, 2017 through June 30, 2020. This action is limited to refunds required under federal court decisions in connection to calculation of members with dual eligibility or third-party liability.
•
Capture Enhanced Federal Match Savings General Assembly Adjustment
  This amendment captures $104.0 million in general fund savings and reflects additional nongeneral funds as a result of the change in the federal match rate for Medicaid due to the extension of the federal public health emergency (PHE). The Families First Coronavirus Response Act (P.L. 116-127) provides a 6.2 percentage point increase in the state's federal match rate for Medicaid in each quarter under a PHE. The federal Secretary of Health and Human Services announced in January another 90-day extension and this amendment reflects the savings to the Commonwealth for the fourth quarter of fiscal year 2022. Upon enrolling of House Bill 29, the appropriation changes will be reflected in the appropriate items.
 
  FY FY
General Fund $0 ($104,004,934)
Nongeneral Fund $0 $237,148,301
•
Capture FY 2022 Savings from Delayed Waiver Slots General Assembly Adjustment
  This amendment captures savings of $12.6 million from the general fund and $12.6 million from federal Medicaid matching funds in fiscal year 2022 resulting from the delay by the Department of Behavioral Health and Developmental Services (DBHDS) in releasing the authorized DD waiver slots nearly seven months into the fiscal year. This delay resulted in savings in the program.
 
  FY FY
General Fund $0 ($12,571,908)
Nongeneral Fund $0 ($12,571,908)
•
Clarify Authority to Exclude Excess Resources for Medicaid LTC Recipients General Assembly Adjustment
  This amendment clarifies language contained in the introduced budget which provides the Department of Medical Assistance Services the authority to exclude excess resources from increases in patient pay amounts accumulated by certain Medicaid long-term care recipients who must spend down their assets on a monthly basis to pay for a portion of their care in order to quality for Medicaid eligibility for a period of 12 months after the end of the federal public health emergency (PHE). The excess resources have accumulated during the PHE, because states are prohibited from adjusting Medicaid payments based on changes in amounts paid by patients on a monthly or annual basis, termed 'patient pay.'
•
Task Force on Eligibility Redetermination General Assembly Adjustment
  This amendment directs the Secretary of Health and Human Resources to establish a Task Force on Eligibility Redetermination to evaluate the Commonwealth's plan for eligibility redetermination that will result due to the end of the federal Public Health Emergency and the expiration of the maintenance of eligibility requirements in Medicaid pursuant to the Families First Coronavirus Response Act (P.L. 166-127).


p3_bullets - Official Enacted Budget - 06-07-2025 16:14:02