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
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 $4,545,328,030 $12,527,356,462 $17,072,684,492
2020-2022 2022 Chapter 1, 2022 Acts of Assembly $4,649,993,559 $14,472,732,262 $19,122,725,821
2022-2024 2023 Chapter 2, 2022 Acts of Assembly, Special Session 1 $5,824,897,704 $14,857,958,805 $20,682,856,509
2022-2024 2023 Base Budget $5,552,084,073 $13,028,216,409 $18,580,300,482
2022-2024 2023 Governor's Amendments $506,586,868 $554,783,124 $1,061,369,992
2022-2024 2023 General Assembly Adjustments ($233,773,237) $1,274,959,272 $1,041,186,035
2022-2024 2024 Chapter 2, 2022 Acts of Assembly, Special Session 1 $6,244,987,584 $14,971,692,667 $21,216,680,251
2022-2024 2024 Base Budget $5,552,084,073 $13,028,216,409 $18,580,300,482
2022-2024 2024 Governor's Amendments $796,210,712 $1,383,309,694 $2,179,520,406
2022-2024 2024 General Assembly Adjustments ($103,307,201) $560,166,564 $456,859,363
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
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 260.02 269.98 530.00
2020-2022 2022 Chapter 1, 2022 Acts of Assembly 263.02 272.98 536.00
2022-2024 2023 Chapter 2, 2022 Acts of Assembly, Special Session 1 266.02 276.98 543.00
2022-2024 2023 Base Budget 263.02 272.98 536.00
2022-2024 2023 Governor's Amendments 3.00 3.00 6.00
2022-2024 2023 General Assembly Adjustments 0.00 1.00 1.00
2022-2024 2024 Chapter 2, 2022 Acts of Assembly, Special Session 1 263.52 274.48 538.00
2022-2024 2024 Base Budget 263.02 272.98 536.00
2022-2024 2024 Governor's Amendments 3.00 3.00 6.00
2022-2024 2024 General Assembly Adjustments (2.50) (1.50) (4.00)
Operating Budget Addenda (in order of greatest impact)
•
Adjust appropriation for centrally funded five percent salary increase for state employees Base Budget Adjustment
  Adjusts appropriation for the five percent salary increase for state employees budgeted in Central Appropriations, Item 477 X. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $1,654,603 $1,654,603
Nongeneral Fund $1,138,042 $1,138,042
•
Adjust appropriation for centrally funded changes to agency information technology costs Base Budget Adjustment
  Adjusts appropriation for changes to information technology and telecommunications usage budgeted in Central Appropriations, Item 478 C. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($418,225) ($418,225)
Nongeneral Fund ($497,718) ($497,718)
•
Adjust appropriation for centrally funded retirement rate changes Base Budget Adjustment
  Adjusts appropriation for changes to contribution rates for state employee retirement plans budgeted in Central Appropriations, Item 477 H. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $248,597 $248,597
Nongeneral Fund $170,983 $170,983
•
Adjust appropriation for centrally funded changes to Performance Budgeting system charges Base Budget Adjustment
  Adjusts appropriation for changes to Performance Budgeting system internal service fund charges budgeted in Central Appropriations, Item 478 H. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($21,394) ($21,394)
Nongeneral Fund $323,782 $323,782
•
Adjust appropriation for centrally funded changes to state health insurance premiums Base Budget Adjustment
  Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 477 G. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $178,126 $178,126
Nongeneral Fund $93,667 $93,667
•
Adjust appropriation for centrally funded changes to Cardinal Human Capital Management System charges Base Budget Adjustment
  Adjusts appropriation for changes to Cardinal Human Capital Management System internal service fund charges budgeted in Central Appropriations, Item 478 G. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $144,383 $144,383
Nongeneral Fund $58,860 $58,860
•
Adjust appropriation for centrally funded workers’ compensation premium changes Base Budget Adjustment
  Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 477 R. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($141,651) ($141,651)
Nongeneral Fund $12,009 $12,009
•
Adjust appropriation for centrally funded changes to Cardinal Financials System charges Base Budget Adjustment
  Adjusts appropriation for changes to Cardinal Financials System internal service fund charges budgeted in Central Appropriations, Item 478 F. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($60,729) ($60,729)
Nongeneral Fund ($30,894) ($30,894)
•
Adjust appropriation for centrally funded general liability premium charges Base Budget Adjustment
  Adjusts appropriation for general liability premiums billed by the Department of the Treasury’s Division of Risk Management budgeted in Central Appropriations, Item 478 J. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $4,344 $4,344
Nongeneral Fund $4,344 $4,344
•
Adjust appropriation for centrally funded state employee other post-employment benefit rate changes Base Budget Adjustment
  Adjusts appropriation for changes to state employee other post-employment benefit rates budgeted in Central Appropriations, Item 477 K. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $2,651 $2,651
Nongeneral Fund $1,819 $1,819
•
Adjust appropriation for centrally funded internal service fund charges for the Personnel Management Information System Base Budget Adjustment
  Adjusts appropriation for Personnel Management Information System internal service fund charges budgeted in Central Appropriations, Item 478 I. of Chapter 552, 2021 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($3,063) ($3,063)
Nongeneral Fund ($1,056) ($1,056)
•
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 $291,278,394 $529,911,804
Nongeneral Fund $320,716,684 $1,068,681,199
•
Increase reimbursement rates for developmental disability waiver services Decision Package
  Increases Medicaid reimbursement rates for those developmental disability waiver services necessary to promote compliance with the settlement agreement.
 
  FY FY
General Fund $137,130,639 $157,076,913
Nongeneral Fund $141,424,576 $161,995,423
•
Increase Medicaid reimbursement rates for primary care services Decision Package
  Increases Medicaid and FAMIS rates for physician primary care services, excluding those provided in emergency departments, to 80 percent of the federal FY 2021 Medicare equivalent as calculated by the department.
 
  FY FY
General Fund $9,340,824 $10,699,490
Nongeneral Fund $28,835,866 $33,030,174
•
Fund 1,200 developmental disability waiver slots Decision Package
  Provides support for the creation of 100 Community Living (CL) and 500 Family and Individual Support (FIS) waiver slots in FY 2023. An additional 100 CL and 500 FIS waiver slots are created in FY 2024. The total number of additional slots funded by this package over the 2022-2024 biennium is 1,200.
 
  FY FY
General Fund $13,014,050 $26,028,100
Nongeneral Fund $13,014,050 $26,028,100
•
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 effective January 1, 2022. The forecast assumed 5 percent for Part A, 6.73 percent for Part B, and 4.86 percent for Part D; however the actual rates are 5.9 percent, 14.5 percent, and 7.31 percent respectively.CHAR(13) + CHAR(10)
 
  FY FY
General Fund $22,943,316 $23,928,382
Nongeneral Fund $12,972,058 $13,467,403
•
Fund Family Access to Medical Insurance Security 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 $12,662,470 $17,263,736
Nongeneral Fund $9,124,373 $18,142,452
•
Fund re-entry care coordination and outreach Decision Package
  Provides funding to provide care coordination services to individuals who are Medicaid eligible 30 days prior to release from incarceration.
 
  FY FY
General Fund $1,062,185 $1,385,199
Nongeneral Fund $12,544,924 $17,857,653
•
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 as projected by the Department of Medical Assistance Services.
 
  FY FY
General Fund $8,730,923 $13,795,573
Nongeneral Fund ($3,467,369) $5,938,410
•
Increase reimbursement rates for obstetrics and gynecology services Decision Package
  Increases the Medicaid reimbursement rate for obstetrics and gynecology services by 15 percent.
 
  FY FY
General Fund $3,272,840 $3,272,840
Nongeneral Fund $7,592,983 $7,592,983
•
Increase Medicaid reimbursement rates for dental services Decision Package
  Increases Medicaid reimbursement rates for dental services by five percent effective July 1, 2023.
 
  FY FY
General Fund $0 $7,392,748
Nongeneral Fund $0 $13,459,781
•
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 increase by $9.6 million over the biennium based on the Department of Taxation's revised forecast. However, revenue from the Master Settlement Agreement and Medicaid recoveries are expected to remain unchanged. 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 ($2,200,000) ($7,400,000)
Nongeneral Fund $2,200,000 $7,400,000
•
Remove one-time funding Decision Package
  Removes funding and the associated language for one-time tasks that are required to be completed by July 1, 2022. This includes the one-time costs associated with facilitated enrollment efforts as well as an analysis of pregnancy and birth outcomes.
 
  FY FY
General Fund ($968,480) ($968,480)
Nongeneral Fund ($5,996,545) ($5,996,545)
•
Increase reimbursement rates for vision services Decision Package
  Increases the Medicaid reimbursement rate for children's covered vision services by 30 percent.
 
  FY FY
General Fund $3,122,860 $3,122,860
Nongeneral Fund $3,571,356 $3,571,356
•
Provide psychiatric residential treatment facilities with rebasing and annualized inflation Decision Package
  Requires the agency to implement annual inflation and triennial rebasing methodology for psychiatric residential treatment facilities.
 
  FY FY
General Fund $731,393 $2,984,084
Nongeneral Fund $1,358,301 $5,541,870
•
Cover the cost of interoperability and patient access requirements Decision Package
  Supports the administrative cost of federally required interoperability. Chapter 552 provided $5.5 million ($2.4 million general fund) to support the costs associated with managed care organizations; however, the agency administrative portion was not funded due to delays associated with the implementation of the Medicaid Enterprise System. This request provides the administrative portion.
 
  FY FY
General Fund $692,573 $142,076
Nongeneral Fund $6,619,427 $1,357,924
•
Fund direct care salary increases at training centers Decision Package
  Funds the second-year Medicaid costs of the salary increases for direct care staff at Southeastern Virginia Training Center and Hiram Davis Medical Center. This adjustment accounts for an additional statewide salary increase of five percent in the second year.
 
  FY FY
General Fund $0 $3,892,304
Nongeneral Fund $0 $3,892,304
•
Adjust appropriation to reflect agency operations Decision Package
  Moves appropriation and a position between programs to ensure that all administrative services are properly budgeted. In addition, this package removes federal appropriation to reflect the end of federal health services grants and the available general fund support for training centers.
 
  FY FY
Nongeneral Fund ($3,859,464) ($3,859,464)
•
Eliminate remaining Medicaid and FAMIS program copayments Decision Package
  Removes remaining copayment requirements for children in the Family Access to Medical Insurance Security managed care program and for adults in fee-for-service Medicaid. This action is effective April 1, 2022 or upon expiration of the federal public health emergency related to the Coronavirus Disease of 2019 (COVID-19) pandemic, whichever is earlier.
 
  FY FY
General Fund $444,369 $426,391
Nongeneral Fund $2,095,303 $2,010,534
•
Cover preventive services and vaccines for eligible adult populations Decision Package
  Adds coverage of the preventive services provided pursuant to the Patient Protection and Affordable Care Act (ACA) for adult, full Medicaid individuals who are not enrolled pursuant to the ACA.
 
  FY FY
General Fund $1,140,831 $1,199,049
Nongeneral Fund $1,140,831 $1,199,049
•
Exclude excess resources accumulated during the public health emergency for long-term supports and services recipients Decision Package
  Allows for the exclusion of resources accumulated by individuals receiving long-term supports and services (LTSS) for a period of 12 months after the end of the federal public health emergency (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 $1,608,540 $0
Nongeneral Fund $1,608,540 $0
•
Fund consolidation of managed care contracts Decision Package
  Provides funding to cover one-time system costs associated with combining the managed care programs as required by Appropriation Act language.
 
  FY FY
General Fund $421,498 $0
Nongeneral Fund $1,188,142 $0
•
Enhance Medicaid financial oversight Decision Package
  Provides funding to hire five additional full-time positions dedicated to finance divisions that will improve the financial oversight of the Medicaid program. The department is required to address the most critical needs by adding these positions in the areas of budget, fiscal, and provider reimbursement.
 
  FY FY
General Fund $300,000 $300,000
Nongeneral Fund $300,000 $300,000
Positions 5.00 5.00
•
Increase funding for external quality review organization activities Decision Package
  Funds the higher than expected cost of federally required external quality review organization activities.
 
  FY FY
General Fund $80,001 $80,001
Nongeneral Fund $335,250 $335,250
•
Hire position to support provider reimbursement Decision Package
  Funds a full-time position with the actuarial and accounting experience necessary to provide ongoing expertise on nursing facility reimbursement and rate methodology issues.
 
  FY FY
General Fund $90,000 $90,000
Nongeneral Fund $90,000 $90,000
Positions 1.00 1.00
•
Fund study of human milk bank donation for babies Decision Package
  Requires a study of the cost and efficacy of donated human milk.
 
  FY FY
General Fund $100,000 $0
Nongeneral Fund $100,000 $0
•
Allow the blending of third party liability rates Decision Package
  Provides the authority to create a blended rate model to merge capitation rates for those with third-party liability and those with no third party liability. The rate model shall be developed in an actuarially sound manner during the annual capitation calculation process.
•
Clarify continuous eligibility for pregnant women Decision Package
  Clarifies current budget language to ensure that Virginia meets federal requirements to provide continuous coverage to enrollees for the duration of pregnancy through 12 months postpartum.
•
Forgo state share of Children’s Hospital of The King’s 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 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.
•
Review emergency room utilization program Decision Package
  Requires a review of the Medicaid emergency room (ER) utilization program to determine the program’s impact on member care, ER utilization, and treatment costs.
•
Capture Savings from Federal Match Rate Change General Assembly Adjustment
  This amendment captures savings of $242.5 million the first year and $146.9 million the second year from the general fund and reflects additional nongeneral funds as a result of the change in the federal match rate for Medicaid. The federal public health emergency was extended until July 2022, which results in the temporary 6.2 percentage point increase in the federal match rate continued until September 30, 2022. In addition, the regular match rate will increase from 50% on October 1, 2022, to 50.65% and to 51.28% (based on preliminary estimates) on October 1, 2023. The federal match rate for Medicaid is updated every year and is based on a state's personal per capita income as compared to the national average. The floor is 50%, which Virginia had received since 2004.
 
  FY FY
General Fund ($242,539,277) ($146,889,634)
Nongeneral Fund $905,626,216 $156,523,850
•
Adjust Health Care Fund Appropriation for Managed Care Repayments General Assembly Adjustment
  This amendment reflects additional revenue to the Virginia Health Care Fund of $127.3 million the first year and $149.6 million the second year from managed care organization (MCO) repayments resulting from not meeting the medical loss ratio (MLR) requirement or for exceeding the profit caps that apply to Medicaid MCOs. The impact of the COVID-19 pandemic on health care utilization has resulted in increased profits and difficulty in meeting the MLR requirement for MCOs and therefore results in repayments to the Commonwealth. These repayments are deposited in the Health Care Fund, which is used as state match for Medicaid. Therefore, the increase in revenue results in a corresponding reduction in general fund appropriation for Medicaid.
 
  FY FY
General Fund ($127,301,202) ($149,559,890)
Nongeneral Fund $127,301,202 $149,559,890
•
Increase in Medicaid Dental Rates General Assembly Adjustment
  This amendment provides $40.5 million from the general fund and $76.5 million from nongeneral funds the first year and $37.0 million from the general fund and $67.3 million from nongeneral funds the second year to increase the five percent dental rate increase included in the introduced budget to 30 percent. This amendment accelerates the dental rate increase to July 1, 2022.
 
  FY FY
General Fund $40,490,550 $36,963,744
Nongeneral Fund $76,476,181 $67,298,906
•
Personal Care Rates General Assembly Adjustment
  This amendment provides $43.4 million the first year and $42.5 million the second year from the general fund and $47.2 million the first year and $46.6 million the second year in federal Medicaid matching funds to increase on July 1, 2022, the Medicaid reimbursement rates for personal care, respite and companion services by 7.5% for consumer-directed and agency-directed attendants.
 
  FY FY
General Fund $43,431,625 $42,476,217
Nongeneral Fund $47,203,255 $46,568,674
•
Rebase Medicaid DD Waiver Rates General Assembly Adjustment
  This amendment adds $38.7 million the first year and $44.1 million the second year from the general fund and $40.6 million the first year and $46.5 million the second year from matching federal Medicaid and other nongeneral funds to rebase the Medicaid rates for DD waiver services that were not included in the House Bill 30, as introduced, including services provided in Group Homes serving 5 to 12 persons, Group Day Support, Group Supported Employment, Workplace Assistance, Community Guide, DD Case Management and Benefits Planning. The amendment also adds language setting out the appropriation for the Developmental Disability (DD) waiver rebasing totaling $377.0 million from the general fund (GF) and $390.6 million from federal Medicaid matching funds and other nongeneral funds over the biennium. Language also provides the Department of Medical Assistance Services (DMAS) with the authority to update the rates based on recent rebasing estimates after a review of the model assumptions is conducted and reported, no later than July 1, 2022. Language further clarifies that the rates shall be reflective of Tiered payments contained in the rebasing model. 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 $38,662,406 $44,120,435
Nongeneral Fund $40,635,919 $46,544,002
•
Continue 12.5 Percent Rate Increase for Certain Home and Community Based Services General Assembly Adjustment
  This amendment adds funding and language to continue the temporary fiscal year 2021 rate increase that was provided to most Medicaid home and community based providers with exceptions for developmental disability waiver services and personal care, respite, and companion care services. In the first year, the state share will be funded from American Rescue Plan Act (ARPA) funds. A companion amendment in Item 486 appropriates $38.1 million in ARPA funds for this purpose.
 
  FY FY
General Fund $0 $43,489,163
Nongeneral Fund $56,640,476 $64,983,275
•
Add Funding for Medicaid Value Based Purchasing Program for Nursing Homes General Assembly Adjustment
  This amendment adds $12.5 million the first year and $25.0 million the second year from the general fund and $12.6 million the first year and $25.7 million the second year from federal Medicaid matching funds for Medicaid's Value-based Purchasing (VBP) program for nursing homes. This amendment also adds language to specify that the non-metric portion of the VBP program funding be provided as a Medicaid payment add-on to the rate instead of a lump sum payment. Under the federally-required structure of a VBP program, paying the non-metric based portion under VBP would delay payment until December for the relevant non-metric based payments. This will create a significant cash flow issue for five months beginning July 1, 2022 when rates would fully revert to having no add-on despite significant ongoing expenses. By excluding the non-metric based amount from federal approval of the VBP program and instead paying that portion as a Medicaid payment add-on to the rate (like the current $15 per day), the delay would be avoided. In addition to the cash flow issue due to the timing of the lump-sum approach delaying the non-metric based portion until December is contrary to the purpose of the funding, which was intended to help facilities get ready to meet the metrics and improve.
 
  FY FY
General Fund $12,500,000 $25,000,000
Nongeneral Fund $12,622,500 $25,658,561
•
Delay Developmental Disability Waiver Slots General Assembly Adjustment
  This amendment reflects a delay in adding developmental disability waiver slots. The introduced budget includes 600 new slots each year. This amendment reflects maintaining 600 slots in the second year. The COVID-19 pandemic and resulting labor shortages have resulted in significant provider disruption. A companion amendment in this item provides rate increases to stabilize the provider network. After the provider network is stabilized and capacity exists to absorb additional slots, the General Assembly may consider adding the additional slots in the 2023 Session.
 
  FY FY
General Fund ($13,014,050) ($13,014,050)
Nongeneral Fund ($13,014,050) ($13,014,050)
•
Modify Reentry Care Coordination and Outreach Initiative General Assembly Adjustment
  This amendment removes funding in the introduced budget to provide managed care coordination services to incarcerated individuals that enroll in Medicaid managed care 30 days prior to release. The amendment requires Medicaid managed care organizations to conduct a video or telephone conference to establish a transition plan during that same period with the individual.
 
  FY FY
General Fund ($1,062,185) ($1,385,199)
Nongeneral Fund ($12,544,924) ($17,857,653)
•
Supplemental Payments for Chesapeake Regional and Lake Taylor Hospitals General Assembly Adjustment
  This amendment adds $11.1 million each year from matching federal Medicaid funds, and modifies language in the introduced budget directing the agency to implement supplemental payments for Chesapeake Regional and Lake Tayler Hospitals that is consistent with the methodology used for private acute care providers.
 
  FY FY
Nongeneral Fund $11,125,683 $11,125,683
•
Indirect Medical Education Funding for Children's Hospital of The King's Daughters General Assembly Adjustment
  This amendment adds funding and language directing the Department of Medical Assistance Services to adjust the formula used to calculate indirect medical education (IME) reimbursement for managed care discharges at Children's Hospital of the King's Daughters (CHKD). This change would restore CHKD's case mix index factor to the fiscal year 2019 level, which had been reduced in fiscal year 2020. The change is intended to stabilize CHKD s IME funding levels so the hospital is not subject to fluctuations in future Medicaid payments that occur with rebasing and changes in federal policy. Using fiscal year 2019 as a more typical year for CHKD (pre-COVID), the general fund impact would be an estimated $8.1 million, with a nongeneral fund impact of $8.3 million over the biennium.
 
  FY FY
General Fund $4,039,123 $4,106,384
Nongeneral Fund $4,118,661 $4,214,556
•
Provide Inflation for Psychiatric Residential Treatment Facilities General Assembly Adjustment
  This amendment adds funding and language to provide an inflation adjustment in the first year to reflect the change in costs for psychiatric residential treatment facilities since 2018. In fiscal year 2022, the rates for these facilities were increased based on certified 2018 cost reports, however the rates did not recognize any inflation in those costs since 2018. This amendment also combines two separate paragraphs related to reimbursement for these facilities into one paragraph.
 
  FY FY
General Fund $3,991,691 $3,991,691
Nongeneral Fund $4,239,723 $4,239,723
•
Medicaid Reimbursement for Virginia Home Nursing Facility General Assembly Adjustment
  This amendment adds $3.6 million from the general fund and $4.0 million from Medicaid matching funds the first year and $3.7 million from the general fund and $4.1 million from Medicaid matching funds the second year to create a new peer group with criteria only met by The Virginia Home, a unique nursing facility that cares for individuals suffering from quadriplegia, traumatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy, over 90% of whom are Medicaid recipients. The population it serves maintain higher acuity scores and require significantly more staffing. Because of the patient population, The Virginia Home must operate private rooms and have more equipment such as mechanical lifts, electric chairs, etc. for its residents.
 
  FY FY
General Fund $3,598,845 $3,687,567
Nongeneral Fund $3,972,952 $4,096,151
•
Medicaid Traumatic Brain Injury Targeted Case Management Services (HB 680) General Assembly Adjustment
  This amendment adds funding for the fiscal impact of House Bill 680, 2022 Special Session I, which directs the Department of Medical Assistance Services to update the State Plan for Medical Assistance to include a provision for the payment of Medicaid targeted case management services for individuals with severe traumatic brain injury. 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 $1,718,823 $1,747,506
Nongeneral Fund $4,066,196 $4,153,214
•
Nursing Home Quality Improvement Program General Assembly Adjustment
  This amendment adds $3.5 million from nongeneral funds and one position each year for a quality improvement program addressing nursing home capacity building. It adds language directing the Department of Medical Assistance Services to seek federal approval to design the quality improvement program. Funding for the program will come from civil monetary penalties received from nursing facilities that can be used to reinvest in nursing facility improvement projects. This is a recommendation of the Joint Commission on Health Care.
 
  FY FY
Nongeneral Fund $3,500,000 $3,500,000
Positions 1.00 1.00
•
Expand Remote Patient Monitoring General Assembly Adjustment
  This amendment provides funding to expand remote patient monitoring under Medicaid pursuant to Chapter 269, 2022 Acts of Assembly, provided via telemedicine, for: (i) patients who have experienced an acute health condition and the use of remote patient monitoring may prevent readmission to a hospital or emergency department; (ii) patient-initiated asynchronous consultations in the context of an existing provider-patient relationship; and (viii) provider-to-provider consultations.
 
  FY FY
General Fund $733,009 $1,309,667
Nongeneral Fund $820,357 $1,470,587
•
Medicaid Peer and Family Support Rate Increase General Assembly Adjustment
  This amendment adds funding and language each year to require the Department of Medical Assistance Services to increase Medicaid reimbursement rates for certified peer recovery and family support services. Research demonstrates that these services provide successful interventions for individuals in crises and overcoming addiction.
 
  FY FY
General Fund $354,404 $383,110
Nongeneral Fund $767,695 $784,878
•
Add 10 Psychiatric Residency Slots General Assembly Adjustment
  This amendment adds $500,000 from the general fund and $500,000 in nongeneral funds each year to fund 10 new psychiatric residency slots using Medicaid supplemental payments.
 
  FY FY
General Fund $500,000 $500,000
Nongeneral Fund $500,000 $500,000
•
Medicaid Coverage of Anesthesia for Children's Dental Procedures General Assembly Adjustment
  This amendment adds funding and language to require the Department of Medical Assistance Services to cover necessary general anesthesia and hospitalization, or facility charges, for Medicaid eligible children under age ten receiving dental services who require such services.
 
  FY FY
General Fund $244,499 $266,088
Nongeneral Fund $289,372 $316,317
•
Capture Administrative Savings from Merger of Managed Care Programs General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services and the Department of Planning and Budget to evaluate the impact of merging the Commonwealth Care Coordinated Plus and Medallion 4.0 managed care programs to identify administrative cost savings and efficiencies and to develop a plan for saving at least $1.0 million a year from combining the two programs and contracts.
 
  FY FY
General Fund $0 ($500,000)
Nongeneral Fund $0 ($500,000)
Positions 0.00 (5.00)
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Adjust Administrative Appropriation General Assembly Adjustment
  This amendment eliminates $421,498 from the general fund and $1.2 million in federal Medicaid matching funds provided in the introduced budget for costs related to the merger of the Commonwealth Coordinated Care Plus and Medallion 4.0 managed care programs and provides $1.5 million from the Medicaid expansion coverage assessment appropriation to reflect higher contractual costs. The first action was funded in the 2021 Appropriation Act, which provided $1.0 million from the general fund and $1.5 million from federal Medicaid funds for the merger-related costs of the two programs in fiscal year 2022. Additional funding is unnecessary since this funding would be provided after the merger of the two programs, which will actually result in administrative cost savings for the Commonwealth. The second action provides $1.5 million in coverage assessment appropriation to reflect higher contractual costs in fiscal year 2023 due to the increase in the Medicaid Expansion population resulting from the federal Public Health Emergency. Upon enrolling of House Bill 30, the appropriations will be allocated to the appropriate programs.
 
  FY FY
General Fund ($421,498) $0
Nongeneral Fund $311,858 $0
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Traumatic Brain Injury Waiver Plan General Assembly Adjustment
  This amendment provides $250,000 from the general fund the first year for the Department of Medical Assistance Services, in conjunction with relevant stakeholders, to convene a workgroup to develop a plan for a neurobehavioral science unit and a waiver program for individuals with brain injury and neuro-cognitive disorders.
 
  FY FY
General Fund $250,000 $0
Nongeneral Fund $250,000 $0
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Plan to Allow Direct Purchase of OTC Medications (HB 1046) General Assembly Adjustment
  This amendment adds $150,000 from the general fund and $150,000 from matching federal Medicaid funds the first year for the fiscal impact of House Bill 1046, 2022 Special Session I, which directs the Department of Medical Assistance Services to study options for and develop a plan to implement a process that provides Medicaid recipients with payments that can be used to purchase over-the-counter medications and medical supplies. Currently, certain over-the-counter medications can be purchased more cheaply by a recipient than the amount charged to the Medicaid program.
 
  FY FY
General Fund $150,000 $0
Nongeneral Fund $150,000 $0
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Eliminate Study of Human Donated Breast Milk General Assembly Adjustment
  This amendment eliminates funding included in the introduced budget for a study of the cost and efficacy of donated human milk.
 
  FY FY
General Fund ($100,000) $0
Nongeneral Fund ($100,000) $0
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Acquisition Policy for Type One Hospitals General Assembly Adjustment
  This amendment clarifies the Commonwealth s policy on Type One (state teaching hospitals) status designation for Medicaid reimbursement of acquired hospitals. A Type Two hospital is a private hospital. Historically, private hospitals purchased by VCU Health or UVA Health (the only Type One hospitals) have been conveyed Type One status. Due to the Commonwealth's enhanced reimbursement polices for Type One hospitals, the extension of that designation to purchased private hospitals results in a general fund impact on the Medicaid program. Such budgetary decisions are the responsibility of the General Assembly. In addition, those private hospitals are removed from the pool of acute care hospitals that contribute to the coverage assessment that pays the state share of the costs of Medicaid Expansion. Recent acquisitions by UVA Health include Culpeper Medical Center, Haymarket Medical Center, and Prince William Medical Center. VCU Health recently purchased Riverside Tappahannock Hospital.
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Allow Medicaid Payments for Parents to be Caregivers of Eligible Minor Children General Assembly Adjustment
  This amendment adds language to extend the provision of Medicaid reimbursement of parents or spouses of Medicaid eligible minor children to provide personal care/personal assistance services that have been available during the pandemic through a Medicaid Appendix K waiver and approved by the federal government. Language also provides authority to the agency to promulgate emergency regulations to continue parents/spouses as personal care/personal assistance providers.
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Eliminate Medicaid Spending Target General Assembly Adjustment
  This amendment eliminates language in the introduced budget that establishes a Medicaid state spending target.
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Medicaid Mobile Vision Services General Assembly Adjustment
  This amendment adds language requiring the Department of Medical Assistance Services (DMAS) to revise its contracts with Medicaid and FAMIS managed care organizations to include MCO provider agreements to provide access to mobile vision services in localities where local school divisions or schools have written agreements with mobile vision providers as an alternative service delivery model to increase access to vision services for children. Eye exams and glasses provided at  bricks and mortar optometry practices are currently covered by Medicaid and FAMIS. Language allows for the comprehensive vision exam to include the use of alternative technology that bypasses the need for dilation of the eye. Language requires the department to require MCOs to expedite enrollment and credentialing of mobile vision providers and to work with the managed care organizations to offer a variety of lens and frame options for children in any setting.
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Rates for Specialized Care Facilities General Assembly Adjustment
  This amendment adds language to inflate specialized care facilities rates participating in the Medicaid program for one additional year in lieu of the normal annual rebasing. The Department of Medical Assistance Services has determined that they remain unable to rebase these rates as cost and days data contained in the specialized care database were not reliable due to the transition from fee-for-service to managed care. The language also fixes a terminology preference related to the rebasing for fiscal year 2024 to properly indicate that methodology is prospective, not cost-based.
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Remove Emergency Room Utilization Program Study General Assembly Adjustment
  This amendment eliminates language included in the introduced budget directing the Department of Medical Assistance Services to review the Medicaid emergency room utilization program. This program was recently studied by a stakeholder workgroup over a two-year period and is the subject of a Joint Commission on Health Care study in 2022.
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Supplemental Payments to Private Hospitals General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services develop an amendment to the State Plan for Medical Assistance and a plan to make supplemental payments to private hospitals and related health systems who would execute affiliation agreements with public entities that are capable of transferring funds to the department for purposes of covering the non-federal share of the authorized payments.


p3_bullets - Official Enacted Budget - 07-18-2025 15:10:51