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.
more...
Biennium Fiscal Year Source GF NGF Total
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
2021-2024 2022 Chapter1, 2024 Acts of Assembly $5,824,897,704 $14,857,958,805 $20,682,856,509
2021-2024 2023 Chapter1, 2024 Acts of Assembly $5,876,121,463 $16,797,807,713 $22,673,929,176
2024-2026 2025 Chapter 2, 2024 Acts of Assembly, Special Session 1 $6,880,624,122 $17,693,606,990 $24,574,231,112
2024-2026 2025 Base Budget $6,244,987,584 $14,971,692,667 $21,216,680,251
2024-2026 2025 Governor's Amendments $488,949,737 $2,633,403,331 $3,122,353,068
2024-2026 2025 General Assembly Adjustments $146,686,801 $88,510,992 $235,197,793
2024-2026 2026 Chapter 2, 2024 Acts of Assembly, Special Session 1 $7,270,962,970 $18,948,282,779 $26,219,245,749
2024-2026 2026 Base Budget $6,244,987,584 $14,971,692,667 $21,216,680,251
2024-2026 2026 Governor's Amendments $916,820,927 $3,808,412,816 $4,725,233,743
2024-2026 2026 General Assembly Adjustments $109,154,459 $168,177,296 $277,331,755
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
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
2021-2024 2022 Chapter1, 2024 Acts of Assembly 266.02 276.98 543.00
2021-2024 2023 Chapter1, 2024 Acts of Assembly 263.52 279.48 543.00
2024-2026 2025 Chapter 2, 2024 Acts of Assembly, Special Session 1 274.02 292.98 567.00
2024-2026 2025 Base Budget 263.52 274.48 538.00
2024-2026 2025 Governor's Amendments 5.00 5.00 10.00
2024-2026 2025 General Assembly Adjustments 5.50 13.50 19.00
2024-2026 2026 Chapter 2, 2024 Acts of Assembly, Special Session 1 274.02 292.98 567.00
2024-2026 2026 Base Budget 263.52 274.48 538.00
2024-2026 2026 Governor's Amendments 5.00 5.00 10.00
2024-2026 2026 General Assembly Adjustments 5.50 13.50 19.00
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 483 S. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $2,917,291 $2,917,291
Nongeneral Fund $3,058,307 $3,058,307
•
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 483 G. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $196,489 $196,489
Nongeneral Fund $144,211 $144,211
•
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 484 H. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($136,023) ($136,023)
Nongeneral Fund ($186,779) ($186,779)
•
Adjust appropriation for centrally funded information technology auditors and security officers Base Budget Adjustment
  Adjusts appropriation for information technology auditors and information security officers budgeted in Central Appropriations, Item 484 E. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $48,302 $48,302
Nongeneral Fund $107,897 $107,897
•
Adjust appropriation for centrally funded property insurance premium charges Base Budget Adjustment
  Adjusts appropriation for property insurance premiums billed by the Department of the Treasury’s Division of Risk Management budgeted in Central Appropriations, Item 484 J. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $10,535 $10,535
Nongeneral Fund $88,036 $88,036
•
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 484 G. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $28,036 $28,036
Nongeneral Fund $49,721 $49,721
•
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 484 C. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($74,844) ($74,844)
•
Adjust appropriation for centrally funded workers’ compensation premium changes Base Budget Adjustment
  Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 483 P. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($35,182) ($35,182)
Nongeneral Fund $2,965 $2,965
•
Adjust appropriation for centrally funded changes to agency leased space costs Base Budget Adjustment
  Adjusts appropriation for to increased charges to customer agencies for the Department of General Services to perform lease administration services. budgeted in Central Appropriations, Item 485 K. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $11,607 $11,607
Nongeneral Fund $11,607 $11,607
•
Adjust appropriation for centrally funded minimum wage increases Base Budget Adjustment
  Adjusts appropriation to reflect the increase in the Virginia minimum wage effective January 1, 2023, and budgeted in Central Appropriations, Item 483 R. of Chapter 2, 2022 Acts of Assembly, Special Session I. The amounts provided support the annualized general fund cost of increasing the Virginia minimum wage from $11.00 per hour to $12.00 per hour or the equivalent annual salary of $24,960.
 
  FY FY
General Fund $22,856 $22,856
•
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 484 I. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund ($7,934) ($7,934)
Nongeneral Fund ($3,833) ($3,833)
•
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 484 F. of Chapter 2, 2022 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $2,969 $2,969
Nongeneral Fund $7,383 $7,383
•
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 as projected by the Department of Medical Assistance Services.
 
  FY FY
General Fund $175,061,715 $538,941,216
Nongeneral Fund $2,701,200,980 $3,784,771,616
•
Adjust Health Care Fund appropriation Decision Package
  Modifies appropriation in the Virginia Health Care Fund to reflect the latest revenue estimates. Since the Health Care Fund is used as state match for Medicaid, any increase in revenue offsets general fund support for Medicaid and any decrease requires additional general fund dollars.
 
  FY FY
General Fund $255,509,925 $253,409,925
Nongeneral Fund ($255,509,925) ($253,409,925)
•
Add developmental disability waiver slots Decision Package
  Increases the number of developmental disability waiver slots by 3,440 by adding 1,720 slots in each year of the biennium. Over the biennium, the number of Family and Individual Supports waiver slots will increase by 3,096 and the number of Community Living waiver slots will increase by 344.
 
  FY FY
General Fund $50,045,297 $100,208,162
Nongeneral Fund $52,187,065 $104,256,563
•
Continue Chapter 1 funding changes: Update revenue assumptions for the Virginia Health Care Fund Decision Package
  Provides for the ongoing impact of appropriation changes to the Virginia Health Care Fund included in Chapter 1, 2023 Special Session I.
 
  FY FY
General Fund ($42,648,535) ($42,648,535)
Nongeneral Fund $42,648,535 $42,648,535
•
Fund Family Access to Medical Insurance Security utilization and inflation Decision Package
  Adjusts funding for the Family Access to Medical Insurance Security program to reflect the latest forecast of expenditures as projected by the Department of Medical Assistance Services.
 
  FY FY
General Fund $19,647,848 $27,309,014
Nongeneral Fund $44,659,305 $59,432,008
•
Continue Chapter 1 funding changes: Increase rates for personal care, respite, and companion services Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Increases rates by five percent.
 
  FY FY
General Fund $20,808,161 $20,808,161
Nongeneral Fund $23,597,067 $23,597,067
•
Continue Chapter 1 funding changes: Increase community-based mental health services rates Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Increases Medicaid reimbursement rates for community-based mental health services.
 
  FY FY
General Fund $8,699,568 $8,699,568
Nongeneral Fund $18,486,674 $18,486,674
•
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 ($11,090,611) ($4,591,555)
Nongeneral Fund ($14,654,599) ($2,122,746)
•
Replace fiscal agent services system Decision Package
  Provides funding to replace the fiscal agent services (FAS) system. The current FAS system is over twenty years old and the Centers for Medicare and Medicaid Services has informed the agency that future federal funding is dependent on system replacement.
 
  FY FY
General Fund $1,000,000 $2,200,000
Nongeneral Fund $8,000,000 $19,800,000
•
Continue Chapter 1 funding changes: Add 500 developmental disability waiver slots Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Adds 500 developmental disability waiver slots.
 
  FY FY
General Fund $7,577,559 $7,577,559
Nongeneral Fund $7,911,345 $7,911,345
•
Eliminate Medicaid coverage of drugs for weight loss Decision Package
  Eliminates Medicaid coverage for weight loss medication when prescribed for weight loss except in those instances where an individual has a body mass index greater than 40.
 
  FY FY
General Fund ($4,060,985) ($4,765,823)
Nongeneral Fund ($9,996,258) ($11,644,460)
•
Continue Chapter 1 funding changes: Provide physician supplemental payments for Children’s Hospital of The King’s Daughters Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Makes physician supplemental payments for managed care patients of Children’s Hospital of The King’s Daughters.
 
  FY FY
General Fund $5,153,878 $5,153,878
Nongeneral Fund $5,896,122 $5,896,122
•
Adjust Medicaid appropriation for facilities to reflect anticipated costs Decision Package
  Reduces appropriation to reflect anticipated Medicaid costs. This is a technical amendment as any adjustment will not have an impact on services.
 
  FY FY
General Fund ($2,618,703) ($2,584,681)
Nongeneral Fund ($1,267,155) ($1,301,177)
•
Continue Chapter 1 funding changes: Fund coverage of complex rehabilitative technology for Medicaid nursing facility members Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Provides for the initial purchase or replacement of complex rehabilitative technology manual and power wheelchair bases and related accessories for Medicaid patients residing in nursing facilities.
 
  FY FY
General Fund $1,272,060 $1,272,060
Nongeneral Fund $1,335,690 $1,335,690
•
Provide authorization and funding for changes in the managed care contract re-procurement Decision Package
  Authorizes the expected changes to the re-procured Cardinal Care Managed Care contract. In addition, funding is provided to support the cost of anticipated changes and three positions to enhance managed care contract oversight.
 
  FY FY
General Fund $516,602 $676,502
Nongeneral Fund $1,273,398 $1,613,498
Positions 3.00 3.00
•
Provide funding to support graduate medical education residencies Decision Package
  Adds funding to support 20 additional psychiatric residency slots funded through Medicaid beginning in 2025.
 
  FY FY
General Fund $1,000,000 $1,000,000
Nongeneral Fund $1,000,000 $1,000,000
•
Adjust funding for medical services for involuntary mental commitments Decision Package
  Adjusts funding for the estimated cost of hospital and physician services for persons subject to an involuntary mental commitment. The most recent forecast of expenditures projects lower costs than previously estimated.
 
  FY FY
General Fund ($2,366,962) ($780,525)
•
Continue Chapter 1 funding changes: Increase rates for early intervention services Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Provides a 12.5 percent rate increase for early intervention services beginning January 1, 2024.
 
  FY FY
General Fund $558,509 $558,509
Nongeneral Fund $593,974 $593,974
•
Fund the modification of waiver service limits Decision Package
  Supports the fiscal impact of Chapter 701, 2023 Virginia Acts of Assembly, which amends the Family and Individual Supports, Community Living, and Building Independence waivers to: (i) combine the maximum annual allowable amount for assistive technology and electronic home-based support services for an individual receiving waiver services to provide for greater flexibility and to better meet the needs of individuals receiving services; and (ii) provide that a total of $10,000 shall be available to an eligible individual for assistive technology and electronic home-based support services each year, which may be divided among such services in the manner that best meets the needs of the individual.
 
  FY FY
General Fund $549,756 $549,756
Nongeneral Fund $597,222 $597,222
•
Continue Chapter 1 funding changes: Provide for parity of mental health and substance use disorder rates Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Establishes reimbursement parity between substance use disorder (SUD) and mental health (MH) partial hospitalization (PHP) and intensive outpatient programs (IOP) by increasing the MH, PHP, and IOP reimbursement rates to the same reimbursement rate as SUD, PHP, and IOP.
 
  FY FY
General Fund $218,918 $218,918
Nongeneral Fund $679,354 $679,354
•
Continue Chapter 1 funding changes: Fund dental program enhancements Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Provides funding the second year for enhancements to dental services in Medicaid.
 
  FY FY
General Fund $214,136 $214,136
Nongeneral Fund $347,386 $347,386
•
Make technical clarification to coverage of prevention services for adults Decision Package
  Amends existing budget language to clarify the coverage of preventative services for adult, full-benefit Medicaid individuals who are not enrolled pursuant to the Patient Protection and Affordable Care Act. This change would allow Virginia to receive an additional one percent in federal matching dollars for impacted services.
 
  FY FY
General Fund ($251,690) ($258,609)
Nongeneral Fund $251,690 $258,609
•
Ensure Medicaid behavioral health services are evidence-based and trauma-informed Decision Package
  Authorizes the replacement of legacy youth and adult behavioral health services with evidence-based and trauma-informed services. All changes must be budget neutral and be implemented by June 30, 2026. This transition is necessary for Virginia to secure federal support for a comprehensive continuum of behavioral health services through an 1115 serious mental illness waiver.
 
  FY FY
General Fund $500,000 $0
Nongeneral Fund $500,000 $0
•
Continue Chapter 1 funding changes: Provide funding for two percent salary increase Decision Package
  Adjusts appropriation for the two percent salary increase for state and state supported local employees budgeted in Central Appropriations, Paragraphs S, T, U, and V of Item 483, Chapter 1, 2023 Acts of Assembly, Special Session I.
 
  FY FY
General Fund $462,270 $462,270
•
Continue Chapter 1 funding changes: Fund collaborative care management services for substance use treatment Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Provides Medicaid reimbursement for collaborative care services to treat mental health conditions and substance use disorders.
 
  FY FY
General Fund $21,589 $21,589
Nongeneral Fund $191,917 $191,917
•
Continue Chapter 1 funding changes: Increase early periodic screening diagnosis and treatment therapeutic group homes rates Decision Package
  Provides for the ongoing impact of appropriation changes included in Chapter 1, 2023 Special Session I. Increases reimbursement for early periodic screening diagnosis and treatment therapeutic group homes.
 
  FY FY
General Fund $100,330 $100,330
Nongeneral Fund $109,029 $109,029
•
Transfer resources to fund developmental disability waiver responsibilities Decision Package
  Moves funds and a position from the Department of Behavioral Health and Developmental Services to support agency responsibilities associated with developmental disability waiver services that was transferred effective July 1, 2023. This amendment also includes Appropriation Act language designating the Department of Medical Assistance Services as the agency responsible for all financial analysis, rates, and budget work associated with Virginia’s developmental disability waiver services.
 
  FY FY
General Fund $85,000 $85,000
Nongeneral Fund $85,000 $85,000
Positions 1.00 1.00
•
Align outpatient rehabilitation reimbursement methodology with industry standards Decision Package
  Updates the reimbursement methodology for outpatient rehabilitation services to the Resource Based Relative Value Scale. This change is necessary to align Virginia's reimbursement methodology with Medicare and industry standards. All changes must be budget neutral.
•
Authorize the removal of obsolete supplemental payment language Decision Package
  Allows the department to remove outdated provider supplemental payments that were authorized prior to July 1, 2021 from the Medicaid state plan and regulations. This technical change is necessary to ensure Medicaid governoring documents are up to date. There will be no impact to any potentially active supplemental payments.
•
Implement supplemental disproportionate share hospital pool Decision Package
  Authorizes a supplemental disproportionate share hospital (DSH) redistribution methodology for DSH funds that allows the redistribution of excess DSH payments to other eligible DSH hospitals that have not met their uncompensated care costs.
•
Implement telehealth service delivery options for developmental disability waivers Decision Package
  Provides the authority to implement telehealth service delivery options for developmental disability waiver services currently authorized by the Appropriation Act or Code of Virginia.
•
Improve access to peer recovery support services Decision Package
  Expands the availablity of peer recovery specialists in Medicaid by implementing measures that would reduce administrative barriers that limit access to services.
•
Improve the identification of alternative health care coverage eligibility Decision Package
  Requires agency to improve efforts to determine if individuals applying for and enrolled in Medicaid and Children's Health Insurance Program are eligible for alternative health care coverage.
•
Improve third-party liability recoveries Decision Package
  Adds three positions to increase the amount of third-party liability recoveries. It is expected that these positions will generate sufficient savings in the Medicaid program to offset the new administrative costs.
 
  FY FY
Positions 3.00 3.00
•
Reduce reliance on contractual staff Decision Package
  Replaces contractors in the eligbility and enrollment division with three classified positions No additional resources are required as the cost of the new positions will be offset by operational efficiencies.
 
  FY FY
Positions 3.00 3.00
•
Medicaid Forecast Contingency General Assembly Adjustment
  This amendment provides $150.0 million from the general fund in fiscal year 2025 as a contingency for higher than expected enrollment in the Medicaid program.
 
  FY FY
General Fund $150,000,000 $0
•
2024 Special Session I: Increase Rates for Personal Care Attendants General Assembly Adjustment
  Increases reimbursement rates for Medicaid personal care, respite, and companionship services provided in agency-directed and consumer-directed waiver programs. Rates will increase by two percent in FY 2025 and an additional two percent in FY 2026.
 
  FY FY
General Fund $17,551,660 $38,500,912
Nongeneral Fund $20,558,342 $45,131,276
•
Developmental Disability Waiver Slots and Waiver Rate Increases General Assembly Adjustment
  This amendment adds $3.3 million the first year and $37.9 million the second year from the general fund and $3.4 million the first year and $38.4 million the second year from nongeneral matching Medicaid funds to phase 3,440 Priority 1 Community Living and Family and Individual Support Developmental Disability Waiver slots on a quarterly basis over the 2024-26 biennium and provide a three percent increase in the DD waiver services rates each year of the 2024-26 biennium.
 
  FY FY
General Fund $3,258,863 $37,869,802
Nongeneral Fund $3,390,521 $38,389,741
•
Nursing Facility Value Based Purchasing Program General Assembly Adjustment
  This amendment increases funding for nursing homes through the Nursing Facility Value Based Program by $20.0 million from the general fund and $20.8 million from matching federal Medicaid funds each year over the 2024-26 biennium. The program provides enhanced funding for facilities that meet or exceed performance and/or improvement thresholds such as adequate staffing and avoidance of negative care events. Language is added to clarify that this additional funding satisfies the requirement that VBP funding for nursing facilities be adjusted annually for inflation in order for the Commissioner of Health to impose administrative sanctions on nursing facilities that do not comply with staffing requirements set forth in legislation adopted by the 2023 General Assembly.
 
  FY FY
General Fund $20,000,000 $20,000,000
Nongeneral Fund $20,807,998 $20,807,998
•
2024 Special Session I: Medicaid Contingency General Assembly Adjustment
  This amendment reduces Medicaid enrollment contingency appropriation by $55.0 million.
 
  FY FY
General Fund ($55,000,000) $0
•
Health Care Fund Adjustment General Assembly Adjustment
  This amendment supplants $11.0 million the first year and $13.2 million the second year from the general fund with offsetting revenue from an increase in the tax on liquid nicotine. The Health Care Fund is used as the state match for Medicaid, so any increase in revenue reduces the general fund needed to support Medicaid and likewise any reduction in revenue to the fund requires a corresponding increase in general fund to fully fund the state share of Medicaid.
 
  FY FY
General Fund ($10,970,000) ($13,160,000)
Nongeneral Fund $10,970,000 $13,160,000
•
Increase Dental Rates General Assembly Adjustment
  This amendment provides funding each year to increase Medicaid and children's health insurance program reimbursed dental services by three percent. Rates for dental services were increased by 30 percent in fiscal year 2023. It is the intent that upon enrolling of the bill the amounts needed in Items 287 and 290 shall be allocated as appropriate to reflect the increase in dental rates for the children's health insurance programs, known as FAMIS and Medicaid CHIP.
 
  FY FY
General Fund $5,787,835 $5,526,584
Nongeneral Fund $10,385,496 $10,956,911
•
Increase Automation for Medicaid Eligibility Determinations General Assembly Adjustment
  This amendment adds $206,889 from the general fund and $2.8 million in nongeneral funds the first year and $3.1 million from the general fund and $16.2 million from nongeneral funds the second year for the Department of Medical Assistance Services to contract with a vendor to implement identified solutions to assist in timely and accurate Medicaid eligibility determinations and redeterminations. Solutions will include additional data checks to verify financial and nonfinancial eligibility, additional data matching capability and a portal to receive and track coverage corrections for enrollment requests between the 120 local Departments of Social Services. Funding would provide enhancements to the Medicaid Management Information System and the Virginia Case Management System.
 
  FY FY
General Fund $206,889 $3,094,795
Nongeneral Fund $2,832,111 $16,216,115
•
Consumer-Directed Service Facilitation Rates General Assembly Adjustment
  This amendment provides $5.0 million from the general fund and $5.9 million from the nongeneral fund each year to increase rates for Medicaid consumer-directed service facilitation training and visits to reflect recommendations contained in the most recent report on rebasing of Medicaid developmental disability Medicaid waiver services. While most of the rates were updated as of July 1, 2022, rates for service facilitation were not updated. A service facilitator is a Medicaid-enrolled provider who is responsible for supporting the individual enrolled in Medicaid waivers and the family/caregiver by ensuring the development and monitoring of the Consumer-Directed Services Individual Service Plan, providing employee management training, and completing ongoing review activities as required by the Department of Medical Assistance Services for consumer-directed companion, personal assistance, and respite services.
 
  FY FY
General Fund $5,031,326 $5,037,493
Nongeneral Fund $5,926,564 $5,920,397
•
Centralize Mail Operations for Medicaid Applications & Renewals General Assembly Adjustment
  This amendment adds $2.1 million from the general fund and $4.6 million in nongeneral funds the first year and $4.1 million from the general fund and $9.1 million in nongeneral funds the second year for the Department of Medical Assistance Services to contract with a vendor to handle all incoming mail currently directed to local Departments of Social Services including Medicaid benefit applications and renewal notices. This will allow all returned mail to be processed in one centralized location and will expedite routing of applications to the Cover Virginia Call Center and localities for processing.
 
  FY FY
General Fund $2,104,607 $4,065,218
Nongeneral Fund $4,611,459 $9,070,391
•
Children's Hospital of The King's Daughters General Assembly Adjustment
  This amendment adds $2.7 million from the general fund and $2.7 million from nongeneral funds each year to increase Medicaid payments to Children s Hospital of The King s Daughters (CHKD) . Language increases the Medicaid supplemental payments provided to CHKD to stabilize funding for CHKD.
 
  FY FY
General Fund $2,700,000 $2,700,000
Nongeneral Fund $2,700,000 $2,700,000
•
Reimbursement Rate for Durable Medical Equipment General Assembly Adjustment
  This amendment provides $2.4 million from the general fund each year and $3.0 million in federal matching funds each year to increase the reimbursement rate to 100 percent of the Medicare rural rates or 100 percent of non-rural rates if a rural rate does not exist for specific Durable Medical Equipment products, including enteral products and supplies and those listed in the following categories in the DMAS fee schedule as Feeding Kits and Tubes and Nutrition Kits/Feeding Tubes.
 
  FY FY
General Fund $2,422,941 $2,425,910
Nongeneral Fund $2,956,023 $2,953,054
•
Increase Medicaid Rates for Therapeutic Group Homes General Assembly Adjustment
  This amendment authorizes the Department of Medical Assistance Services to rebase rates for therapeutic group home providers accepting children requiring early and periodic screening, diagnosis, and treatment (EPSDT) services. There is only one such provider in the Commonwealth serving approximately 70 Virginia-Medicaid children. This population of children have both a mental health or psychiatric diagnosis and an intellectual or developmental disability and require staffing and services not provided elsewhere.
 
  FY FY
General Fund $866,840 $867,905
Nongeneral Fund $1,017,065 $1,016,000
•
Locally-owned Nursing Facilities Unreimbursed Costs General Assembly Adjustment
  This amendment adds $1.9 million from the general fund each year to allow five local government-owned nursing facilities to receive supplemental payments to cover unreimbursed Medicaid costs not to exceed the upper payment limit for each nursing facility.
 
  FY FY
General Fund $1,850,000 $1,850,000
•
Medicaid Third Party Liability Activities General Assembly Adjustment
  This amendment provides $367,340 from the general fund and $1.3 million from nongeneral funds each year for 14 additional positions within the Department of Medical Assistance Services to enhance third party liability functions to implement the provisions of House Bill 315 and address the current backlog of cases. Language is modified to reflect the increases in funding and positions.
 
  FY FY
General Fund $367,340 $367,340
Nongeneral Fund $1,346,913 $1,346,913
Positions 14.00 14.00
•
Graduate Medical Education Residency Slots for OB/GYNs General Assembly Adjustment
  This amendment provides $500,000 the first year and $500,000 the second year from the general fund and $500,000 the first year and $500,000 the second year from nongeneral funds to add 10 graduate medical education residency slots for obstetric-gynecological medical residents, funded through the Medicaid program to begin in fiscal year 2025.
 
  FY FY
General Fund $500,000 $500,000
Nongeneral Fund $500,000 $500,000
•
Evaluation of Medicaid Eligibility Determination General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to hire a consultant to assess the current eligibility determination system for Virginia's Medicaid program.
 
  FY FY
General Fund $500,000 $0
Nongeneral Fund $500,000 $0
•
Medical Services for Involuntary Mental Commitments General Assembly Adjustment
  This amendment adjusts funding for the estimated cost of hospital and physicians services for persons subject to an involuntary mental commitment to align spending with current estimates.
 
  FY FY
General Fund ($500,000) ($500,000)
•
Peer Mentoring Services Rate Increase General Assembly Adjustment
  This amendment provides $8,500 from the general fund and $8,500 from nongeneral funds each year to increase the rate for Peer Mentoring services in fiscal year 2025, in accordance with the 2021 Burns and Associates rate report.
 
  FY FY
General Fund $8,500 $8,500
Nongeneral Fund $8,500 $8,500
•
2024 Special Session I: Conform Legally Responsible Individual Lang. in Item 288 KKKK. to HB 909 General Assembly Adjustment
  Adjusts language to eliminate a requirement that, in order for legally responsible individuals to receive reimbursement for personal care services, no one else be available to provide services to the member. This change is necessary to conform Act language to legislation passed by the 2024 General Assembly.
•
2024 Special Session I: Modify conjunction in Item 288 TTTT. Weight Loss Drug Policy General Assembly Adjustment
  This amendment modifies budget language to clarify the Commonwealth's coverage of weight loss medications in the Medicaid program.
•
2024 Special Session I: Modify language in Item 288 BBBBB. to reflect change in Medicaid contingency funding General Assembly Adjustment
  This amendment modifies budget language to reflect the reduction of $55.0 million to Medicaid enrollment contingency funds.
•
Disproportionate Share Hospital Workgroup General Assembly Adjustment
  This amendment directs the Department of Medical Assistance to convene a workgroup to evaluate the criteria for hospitals to qualify for disproportionate share hospital (DSH) payments. to ensure that those hospitals with the largest uncompensated care costs are receiving appropriate DSH payments.
•
Ensure Oversight of Managed Care Reprocurement Implementation General Assembly Adjustment
  This amendment modifies the requirements of Medicaid managed care reprocurement.
•
Fiscal Agent Services System General Assembly Adjustment
  This amendment directs the Department of Planning and Budget to unallot the funding for replacement of the fiscal agent services system until the actual costs are known and the funding is needed to meet expenditures.
•
Guidelines for Collaborative Care Model General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to develop program guidelines for the Collaborative Care Model, in which behavioral health services are delivered in primary care practices. This amendment is a recommendation of the Joint Commission on Health Care (JCHC) and supported by findings from a 2023 JCHC report including that Virginia primary care practices need for integrating behavioral health services is growing, but practices are struggling to meet the demand without additional resources. Health care professionals consistently indicated that limited insurance coverage for integrated primary care was a significant barrier to increase these services for patients in their practices, and, in 2023, Virginia was one of 26 states that had not yet implemented Medicaid coverage of the Collaborative Care Model.
•
Inflation Adjustment for Psychiatric Residential Treatment Facilities General Assembly Adjustment
  This amendment adds language to clarify the Department of Medical Assistance Services' reimbursement methodology for Medicaid payments to Psychiatric Residential Treatment Facilities (PRTFs). The PRTF reimbursement methodology was changed recently; however, the application of an annual inflation increase beginning in fiscal year 2025 was not specified in the Appropriation Act to allow for agency regulations to reflect this change.
•
Limit Weight Loss Medications in Medicaid General Assembly Adjustment
  This amendment modifies language related to limits on Medicaid payments for covered weight loss medications in the introduced budget. Language requires the agency to require service authorization on weight loss medications to ensure appropriate utilization and clinical criteria. Language also adds criteria for the newer weight loss medications to allow coverage after meeting certain criteria.
•
Medicaid Reimbursement for FQHC Changes in Scope of Services General Assembly Adjustment
  This amendment adds language directing the agency to implement a change in scope process on January 1, 2025 by which FQHCs may request a reimbursement change to reflect the scope for services that have been added or changed. This amendment authorizes DMAS to reimburse an FQHC for unreimbursed costs, as allowed by federal law. This will allow the FQHCs to cover their costs of patient care during this period through receipt of the full federal match for these reimbursements.
•
Modify External Financial Review Committee Requirements General Assembly Adjustment
  This amendment modifies the External Financial Review Committee requirements to reduce the number of meetings from four to three each year and adds reporting on enrollment at each meeting to better monitor enrollment trends and potential impacts on program costs.
•
Modify Supplemental Payment Program for Private Acute Care Hospitals General Assembly Adjustment
  This amendment adds language defining public entities that are able to transfer funds to the Department of Medical Assistance Services to cover the non-federal share to match federal Medicaid funding for physician supplemental payments to private acute care hospitals with which they have affiliation agreements. Language also clarifies the purposes for which hospitals may receive supplemental payments such as increasing and enhancing access to outpatient care for Medicaid patients, supporting critical healthcare workforce needs and advancing Medicaid's health and quality improvement goals. The amendment directs the department to periodically assess the quality measures that are submitted to the Centers for Medicare and Medicaid Services for supplemental payments to ensure that appropriate quality measures are being used for each supplemental payment. Language requires reporting and makes payments contingent on progress towards goal attainment. It also provides five positions at the agency for administration of the supplemental payment program.
 
  FY FY
Positions 5.00 5.00
•
Requirements for Medicaid Consumer-Directed Facilitators General Assembly Adjustment
  This amendment adds language directing the agency to eliminate the requirement that Consumer-Directed Services Facilitators hold an Associate's or Bachelor's Degree in order to provide services.
•
Update nongeneral fund revenue for Department of Social Services related amendments General Assembly Adjustment
  Updates nongeneral fund revenue for Department of Social Services related amendments included by the 2024 General Assembly.


p3_bullets - Official Enacted Budget - 06-07-2025 07:47:07